29 CFR 18.705 - Disclosure of facts or data underlying expert opinion.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Disclosure of facts or data underlying expert opinion. 18... Testimony § 18.705 Disclosure of facts or data underlying expert opinion. The expert may testify in terms of opinion or inference and give reasons therefor without prior disclosure of the underlying facts or data...

29 CFR 18.705 - Disclosure of facts or data underlying expert opinion.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true Disclosure of facts or data underlying expert opinion. 18... Testimony § 18.705 Disclosure of facts or data underlying expert opinion. The expert may testify in terms of opinion or inference and give reasons therefor without prior disclosure of the underlying facts or data...

29 CFR 18.705 - Disclosure of facts or data underlying expert opinion.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Disclosure of facts or data underlying expert opinion. 18... Testimony § 18.705 Disclosure of facts or data underlying expert opinion. The expert may testify in terms of opinion or inference and give reasons therefor without prior disclosure of the underlying facts or data...

29 CFR 18.705 - Disclosure of facts or data underlying expert opinion.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Disclosure of facts or data underlying expert opinion. 18... Testimony § 18.705 Disclosure of facts or data underlying expert opinion. The expert may testify in terms of opinion or inference and give reasons therefor without prior disclosure of the underlying facts or data...

49 CFR 1503.645 - Expert or opinion witnesses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROCEDURES Rules of Practice in TSA Civil Penalty Actions § 1503.645 Expert or opinion witnesses. An employee of the agency may not be called as an expert or opinion witness, for any party other than TSA, in any... an expert or opinion witness for TSA in any proceeding governed by this subpart to which the...

A Step-Wise Approach to Elicit Triangular Distributions

NASA Technical Reports Server (NTRS)

Greenberg, Marc W.

2013-01-01

Adapt/combine known methods to demonstrate an expert judgment elicitation process that: 1.Models expert's inputs as a triangular distribution, 2.Incorporates techniques to account for expert bias and 3.Is structured in a way to help justify expert's inputs. This paper will show one way of "extracting" expert opinion for estimating purposes. Nevertheless, as with most subjective methods, there are many ways to do this.

Determining e-Portfolio Elements in Learning Process Using Fuzzy Delphi Analysis

ERIC Educational Resources Information Center

Mohamad, Syamsul Nor Azlan; Embi, Mohamad Amin; Nordin, Norazah

2015-01-01

The present article introduces the Fuzzy Delphi method results obtained in the study on determining e-Portfolio elements in learning process for art and design context. This method bases on qualified experts that assure the validity of the collected information. In particular, the confirmation of elements is based on experts' opinion and…

Expert opinion vs. empirical evidence

PubMed Central

Herman, Rod A; Raybould, Alan

2014-01-01

Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops. PMID:24637724

Expert opinion vs. empirical evidence: the precautionary principle applied to GM crops.

PubMed

Herman, Rod A; Raybould, Alan

2014-01-01

Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops.

Using expert opinion to evaluate a habitat effectiveness model for elk in western Oregon and Washington.

Treesearch

Richard S. Holthausen; Michael J. Wisdom; John Pierce; Daniel K. Edwards; Mary M. Rowland

1994-01-01

We used expert opinion to evaluate the predictive reliability of a habitat effectiveness model for elk in western Oregon and Washington. Twenty-five experts in elk ecology were asked to rate habitat quality for 16 example landscapes. Rankings and ratings of 21 experts were significantly correlated with model output. Expert opinion and model predictions differed for 4...

Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.

PubMed

Pittet, Anne-Laure; Saraga, Michael; Stiefel, Friedrich

2015-01-01

The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland. Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies. Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events. Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests.

Defining Sustainable Universities Following Public Opinion Formation Process

ERIC Educational Resources Information Center

Zaptcioglu Celikdemir, Deniz; Gunay, Gonca; Katrinli, Alev; Penbek Alpbaz, Sebnem

2017-01-01

Purpose: The purpose of this paper is to define the sustainable university in Turkey, by considering perspectives of various stakeholders such as experts, intellectual, public, political parties and media using public opinion formation analysis. The paper aims to re-define the "sustainable university" with all dimensions including…

Application of fuzzy fault tree analysis based on modified fuzzy AHP and fuzzy TOPSIS for fire and explosion in the process industry.

PubMed

Yazdi, Mohammad; Korhan, Orhan; Daneshvar, Sahand

2018-05-09

This study aimed at establishing fault tree analysis (FTA) using expert opinion to compute the probability of an event. To find the probability of the top event (TE), all probabilities of the basic events (BEs) should be available when the FTA is drawn. In this case, employing expert judgment can be used as an alternative to failure data in an awkward situation. The fuzzy analytical hierarchy process as a standard technique is used to give a specific weight to each expert, and fuzzy set theory is engaged for aggregating expert opinion. In this regard, the probability of BEs will be computed and, consequently, the probability of the TE obtained using Boolean algebra. Additionally, to reduce the probability of the TE in terms of three parameters (safety consequences, cost and benefit), the importance measurement technique and modified TOPSIS was employed. The effectiveness of the proposed approach is demonstrated with a real-life case study.

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…

Mainstream medicine versus complementary and alternative medicine in the witness box: resolving the clash of ideologies.

PubMed

Kune, Randall; Kune, Gabriel

2007-02-01

Mainstream medical philosophy and practice differ in many respects from those of complementary and alternative medicine (CAM), differences which are explored in this article. Because of a resurgence of CAM therapies, courts and tribunals will scrutinise CAM in more and more contexts in the future. Such court cases may require the resolution of conflicts between opinions of CAM and medical experts. This article considers how courts evaluate such opinions where experts hold conflicting ideologies or philosophical approaches, and addresses the following questions: Do the opinions of CAM practitioners qualify as "expert" opinions in court? How do the courts examine the basis of such opinions? Are they systematically given less weight than the opinions of mainstream medical practitioners? Will recent procedural reforms for hearing expert evidence make it easier for courts to resolve these issues?

Structuring expert input for a knowledge-based approach to watershed condition assessment for the Northwest Forest Plan, USA

Treesearch

Sean N. Gordon; Gallo Kirsten

2011-01-01

Assessments of watershed condition for aquatic and riparian species often have to rely on expert opinion because of the complexity of establishing statistical relationships among the many factors involved. Such expert-based assessments can be difficult to document and apply consistently over time and space. We describe and reflect on the process of developing a...

[Giving medico-legal opinions in cases with suspicion of medical mistake.part 1. between medicine and justice.

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

2017-01-01

Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.

The majority of bold statements expressed during grand rounds lack scientific merit.

PubMed

Linthorst, Gabor E; Daniels, Johannes M A; van Westerloo, David J

2007-10-01

Frequently, during grand rounds and other medical conferences, bold statements are made regarding 'exotic medical facts'. Such exotic expert opinions are frequently voiced with great conviction and are usually subsequently assimilated by junior staff as medical fact. The level of scientific evidence for each exotic expert opinion expressed during daily grand rounds over a 4-month period was evaluated. If, following a short discussion of the statement, any doubt as to the merits of the claim persisted, the person who made the statement was asked to perform a search in the medical literature on the subject. In total, 25 cases of exotic expert opinion were identified during the study period. Of these, 22 statements were made by senior staff and 3 by residents. Careful review of the literature showed only 8 of the statements were actually evidence-based. In 17 cases the available literature actually contradicted the statement (n = 13) or no literature on the subject could be located (n = 4). Although opinions were most often expressed by staff members, the reviews of their merits were more often performed by residents. The vast majority of exotic expert opinions expressed by senior staff members during grand rounds are not evidence-based. Thus, great care must be taken to ensure that exotic expert opinion is not accepted as factual without careful review. Furthermore, this study shows that although seniority is (as expected) associated with a higher incidence of voicing exotic expert opinion, it is negatively associated with reviewing the merits of such opinion.

THE GHOST IN THE MACHINE? THE VALUE OF EXPERT ADVICE IN THE PRODUCTION OF EVIDENCE-BASED GUIDANCE: A MIXED METHODS STUDY OF THE NICE INTERVENTIONAL PROCEDURES PROGRAMME.

PubMed

Oyebode, Oyinlola; Patrick, Hannah; Walker, Alexander; Campbell, Bruce; Powell, John

2016-01-01

The aim of this study was to determine the aspects of expert advice that decision makers find most useful in the development of evidence-based guidance and to identify the characteristics of experts providing the most useful advice. First, semi-structured interviews were conducted with seventeen members of the Interventional Procedures Advisory Committee of the UK's National Institute of Health and Care Excellence. Interviews examined the usefulness of expert advice during guidance development. Transcripts were analyzed inductively to identify themes. Second, data were extracted from 211 experts' questionnaires for forty-one consecutive procedures. Usefulness of advice was scored using an index developed through the qualitative work. Associations between usefulness score and characteristics of the expert advisor were investigated using univariate and multivariate analyses. Expert opinion was seen as a valued complement to empirical evidence, providing context and tacit knowledge unavailable in published literature, but helpful for interpreting it. Interviewees also valued advice on the training and experience required to perform a procedure, on patient selection criteria and the place of a procedure within a clinical management pathway. Limitations of bias in expert opinion were widely acknowledged and skepticism expressed regarding the anecdotal nature of advice on safety or efficacy outcomes. Quantitative analysis demonstrated that the most useful advice was given by clinical experts with direct personal experience of the procedure, particularly research experience. Evidence-based guidance production is often characterized as a rational, pipeline process. This ignores the valuable role that expert opinion plays in guidance development, complementing and supporting the interpretation of empirical data.

The Viewpoints of Students and Evaluation Experts About Performance Processes of Faculty Member Evaluation at Mazandaran University of Medical Sciences, 2014.

PubMed

Ghahrani, Nassim; Balaghafari, Azita; Aligolbandi, Kobra; Vahedi, Mohammad; Siamian, Hasan

2015-06-01

One of the most common ways used in most of the countries and Iran to determine the status of teacher training is the evaluation by students. The most common method of evaluation is the survey questionnaire, the content of a number of questions about educational activities provided to the students. The researchers plan to evaluate the students' and experts' performances at Mazandaran University of Medical Sciences on the process of evaluating the performance of teachers, they examined in 2014. This study surveys the students and experts in the evaluation of faculty members' performance process. The study subjects were 3904 students and 37 evaluation expert of Mazandaran University of Medical Sciences. Using Cochran sampling formula of 350 students through proportional stratified random sampling were selected. The experts' viewpoint, method was used. Data collection tools consisted of 14 questions with answers Yes, or, I don't know. Descriptive Statistical analysis of the data and chi-square test was performed. From total of 350 students, 346 and the entire 37 evaluations expert participated in this study. Most of the students, 80 (23.12%) and the largest number of experts, 8 (21.62%) were from Sari Allied Medical Sciences Faculty. Most of the demographic information about gender were, 255 female students (74.56%) and 29 female experts (78.37%). In most age groups of students, 188 (55.62 percent) were in the category of 18 to 20 years, and the experts, 19 (51.35%) were in the category of 22 and 31 years. Most students, 232 of them (70.95%) were in semester 2 and 4. Most experts, 20 (54.05 percent) were under 10 years of work experience. The comparison between the views of students and experts in the evaluation process between the schools of Mazandaran University of Medical Sciences, Sari School of Nursing and Midwifery, there was difference between the opinions of experts and students (p-value=0.01. It showed 86.7% student and 33.3% of experts is satisfied with the evaluation process. on comparison of students and experts viewpoints on the implementation of the evaluation process, it is noteworthy that among students of different opinions on how the evaluation process. It worth to mention that there is insignificant difference between their viewpoints and majority of students and evaluation experts with the evaluation the process. In addition, the experts evaluated at different schools, most of them are satisfied the process.

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…

Cost estimation: An expert-opinion approach. [cost analysis of research projects using the Delphi method (forecasting)

NASA Technical Reports Server (NTRS)

Buffalano, C.; Fogleman, S.; Gielecki, M.

1976-01-01

A methodology is outlined which can be used to estimate the costs of research and development projects. The approach uses the Delphi technique a method developed by the Rand Corporation for systematically eliciting and evaluating group judgments in an objective manner. The use of the Delphi allows for the integration of expert opinion into the cost-estimating process in a consistent and rigorous fashion. This approach can also signal potential cost-problem areas. This result can be a useful tool in planning additional cost analysis or in estimating contingency funds. A Monte Carlo approach is also examined.

A Delphi Investigation into Future Trends in E-Learning in Israel

ERIC Educational Resources Information Center

Aharony, Noa; Bronstein, Jenny

2014-01-01

The purpose of this study is to investigate the views and opinions of e-learning experts regarding future trends in the e-learning arena. The Delphi technique was chosen as a method of study. This technique is an efficient and effective group communication process designed to systematically elicit judgments from experts in their selected area of…

The Viewpoints of Students and Evaluation Experts About Performance Processes of Faculty Member Evaluation at Mazandaran University of Medical Sciences, 2014

PubMed Central

Ghahrani, Nassim; Balaghafari, Azita; Aligolbandi, Kobra; Vahedi, Mohammad; Siamian, Hasan

2015-01-01

Background and purpose: One of the most common ways used in most of the countries and Iran to determine the status of teacher training is the evaluation by students. The most common method of evaluation is the survey questionnaire, the content of a number of questions about educational activities provided to the students. The researchers plan to evaluate the students’ and experts’ performances at Mazandaran University of Medical Sciences on the process of evaluating the performance of teachers, they examined in 2014. Materials and methods: This study surveys the students and experts in the evaluation of faculty members’ performance process. The study subjects were 3904 students and 37 evaluation expert of Mazandaran University of Medical Sciences. Using Cochran sampling formula of 350 students through proportional stratified random sampling were selected. The experts’ viewpoint, method was used. Data collection tools consisted of 14 questions with answers Yes, or, I don’t know. Descriptive Statistical analysis of the data and chi-square test was performed. Results: From total of 350 students, 346 and the entire 37 evaluations expert participated in this study. Most of the students, 80 (23.12%) and the largest number of experts, 8 (21.62%) were from Sari Allied Medical Sciences Faculty. Most of the demographic information about gender were, 255 female students (74.56%) and 29 female experts (78.37%). In most age groups of students, 188 (55.62 percent) were in the category of 18 to 20 years, and the experts, 19 (51.35%) were in the category of 22 and 31 years. Most students, 232 of them (70.95%) were in semester 2 and 4. Most experts, 20 (54.05 percent) were under 10 years of work experience. The comparison between the views of students and experts in the evaluation process between the schools of Mazandaran University of Medical Sciences, Sari School of Nursing and Midwifery, there was difference between the opinions of experts and students (p-value=0.01. It showed 86.7% student and 33.3% of experts is satisfied with the evaluation process. Conclusion: on comparison of students and experts viewpoints on the implementation of the evaluation process, it is noteworthy that among students of different opinions on how the evaluation process. It worth to mention that there is insignificant difference between their viewpoints and majority of students and evaluation experts with the evaluation the process. In addition, the experts evaluated at different schools, most of them are satisfied the process. PMID:26236169

[Deontology of the medical expert].

PubMed

Raszeja, S

1995-09-01

The authority of prosecuting organ to choose the expert, set his task and verify the following opinion is defined. The qualities of the medical expert and his duties are described, referring to: -his expertise; -his morality; -his ability to issue an independent (objective) opinion. Detailed rules, which can be ascribed to a specific medical expert's deontological code, are listed and explained.

Modeling Expert Opinion: Likelihoods under Incomplete Probabilistic Specification

DTIC Science & Technology

1992-12-09

regarding points per game for participants in the 1991 NBA championship basketball series. 2 1. Introduction Expert opinion is often sought with regard to...for the participants in the 1991 NBA championship basketball series. We present a synthesis of this opinion. The key features of our approach are...applied to opinion collected regarding points per game for participants in the 1991 NBA championship basketball series.

Expert opinion on landslide susceptibility elicted by probabilistic inversion from scenario rankings

NASA Astrophysics Data System (ADS)

Lee, Katy; Dashwood, Claire; Lark, Murray

2016-04-01

For many natural hazards the opinion of experts, with experience in assessing susceptibility under different circumstances, is a valuable source of information on which to base risk assessments. This is particularly important where incomplete process understanding, and limited data, limit the scope to predict susceptibility by mechanistic or statistical modelling. The expert has a tacit model of a system, based on their understanding of processes and their field experience. This model may vary in quality, depending on the experience of the expert. There is considerable interest in how one may elicit expert understanding by a process which is transparent and robust, to provide a basis for decision support. One approach is to provide experts with a set of scenarios, and then to ask them to rank small overlapping subsets of these with respect to susceptibility. Methods of probabilistic inversion have been used to compute susceptibility scores for each scenario, implicit in the expert ranking. It is also possible to model these scores as functions of measurable properties of the scenarios. This approach has been used to assess susceptibility of animal populations to invasive diseases, to assess risk to vulnerable marine environments and to assess the risk in hypothetical novel technologies for food production. We will present the results of a study in which a group of geologists with varying degrees of expertise in assessing landslide hazards were asked to rank sets of hypothetical simplified scenarios with respect to land slide susceptibility. We examine the consistency of their rankings and the importance of different properties of the scenarios in the tacit susceptibility model that their rankings implied. Our results suggest that this is a promising approach to the problem of how experts can communicate their tacit model of uncertain systems to those who want to make use of their expertise.

Regulatory decision-making under uncertainty: are costs proportionate to benefits when restricting dangerous chemicals on European markets?

PubMed

Brouwer, Roy; Cauchi, Jonathan; Verhoeven, Julia

2014-04-01

Since 2007 regulation 1907/2006/EC concerning the Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) is in force in Europe to reduce the adverse effects of hazardous chemical substances on human health and the environment. Implementation of the regulation by the European Chemicals Agency (ECHA) is supported by a Socio-Economic Analysis (SEA) Committee, consisting of European experts who help prepare ECHA's opinion on proposals for either restricting or authorizing dangerous substances. This paper presents the outcomes of the SEA underlying the first restriction proposals. Member states proposing a restriction have to show that it will reduce the risks to an acceptable level at a cost which is proportionate to the avoided risk. What is considered proportionate is not clearly defined in REACH. The opinion making process is characterized by many uncertainties: the expert group had no previous experiences to fall back on and limited information about the expected costs and benefits of the proposed restrictions. The study provides insight into expert opinions on environmental and health risks under uncertainty in the specific context of REACH. Particular attention is paid to the confidence experts place on the estimated socio-economic benefits of the avoided risks compared to the estimated compliance costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Paediatric expert witness.

PubMed

Johnson, Sandra L J

2013-08-01

Paediatricians may be asked to provide expert opinion in paediatric cases that come under legal consideration. This article provides suggestions to assist paediatricians in this role and emphasises their duty to the court when giving expert opinion. © 2013 The Author. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Survey of Expert Opinion on Intelligence: Causes of International Differences in Cognitive Ability Tests

PubMed Central

Rindermann, Heiner; Becker, David; Coyle, Thomas R.

2016-01-01

Following Snyderman and Rothman (1987, 1988), we surveyed expert opinions on the current state of intelligence research. This report examines expert opinions on causes of international differences in student assessment and psychometric IQ test results. Experts were surveyed about the importance of culture, genes, education (quantity and quality), wealth, health, geography, climate, politics, modernization, sampling error, test knowledge, discrimination, test bias, and migration. The importance of these factors was evaluated for diverse countries, regions, and groups including Finland, East Asia, sub-Saharan Africa, Southern Europe, the Arabian-Muslim world, Latin America, Israel, Jews in the West, Roma (gypsies), and Muslim immigrants. Education was rated by N = 71 experts as the most important cause of international ability differences. Genes were rated as the second most relevant factor but also had the highest variability in ratings. Culture, health, wealth, modernization, and politics were the next most important factors, whereas other factors such as geography, climate, test bias, and sampling error were less important. The paper concludes with a discussion of limitations of the survey (e.g., response rates and validity of expert opinions). PMID:27047425

Defining landscape resistance values in least-cost connectivity models for the invasive grey squirrel: a comparison of approaches using expert-opinion and habitat suitability modelling.

PubMed

Stevenson-Holt, Claire D; Watts, Kevin; Bellamy, Chloe C; Nevin, Owen T; Ramsey, Andrew D

2014-01-01

Least-cost models are widely used to study the functional connectivity of habitat within a varied landscape matrix. A critical step in the process is identifying resistance values for each land cover based upon the facilitating or impeding impact on species movement. Ideally resistance values would be parameterised with empirical data, but due to a shortage of such information, expert-opinion is often used. However, the use of expert-opinion is seen as subjective, human-centric and unreliable. This study derived resistance values from grey squirrel habitat suitability models (HSM) in order to compare the utility and validity of this approach with more traditional, expert-led methods. Models were built and tested with MaxEnt, using squirrel presence records and a categorical land cover map for Cumbria, UK. Predictions on the likelihood of squirrel occurrence within each land cover type were inverted, providing resistance values which were used to parameterise a least-cost model. The resulting habitat networks were measured and compared to those derived from a least-cost model built with previously collated information from experts. The expert-derived and HSM-inferred least-cost networks differ in precision. The HSM-informed networks were smaller and more fragmented because of the higher resistance values attributed to most habitats. These results are discussed in relation to the applicability of both approaches for conservation and management objectives, providing guidance to researchers and practitioners attempting to apply and interpret a least-cost approach to mapping ecological networks.

Drive Innovation Faster.

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

Lemon, Douglas K.

2005-08-01

Authored article by Doug Lemon. An expert opinion/thought piece on how PNNL approaches R&D projects, incorporating IP protection earlier in the process of innovation to shorten the development timeline. Article cites example of SMART program to illustrate point.

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.

Heterodoxy, iconoclasm and spuriousness: the limits of novel expert evidence.

PubMed

Freckelton, Ian

2007-12-01

A difficult issue arises for courts' decision-making at common law and under statutory evidentiary regimes when expert opinions are significantly unorthodox, iconoclastic or methodologically flawed. This editorial analyses the relevant evidentiary principles and the Australian jurisprudence on the subject, giving particular attention to the decisions of the South Australian Supreme Court in R v Parenzee [2007] SASC 143 and R v Parenzee [2007] SASC 316 in which expert opinions about the existence, identifiability and transmissibility of HIV and its relationship to AIDS adduced on behalf of the defence in a criminal trial were found to be seriously wanting. A variety of factors indicative of low probative value in expert opinions are distilled.

A Strategic Planning Process Model for Distance Education

ERIC Educational Resources Information Center

Pisel, Kenneth P.

2008-01-01

As more institutions seek to implement or expand distance learning programs, it becomes critical to integrate distance learning programs into broader strategic visions and plans. Using the informed opinion from a panel of peer-nominated experts via iterative Delphi questionnaires, a 10-phased strategic planning process model for distance education…

A Fifteen-Year Forecast of Information-Processing Technology. Final Report.

ERIC Educational Resources Information Center

Bernstein, George B.

This study developed a variation of the DELPHI approach, a polling technique for systematically soliciting opinions from experts, to produce a technological forecast of developments in the information-processing industry. SEER (System for Event Evaluation and Review) combines the more desirable elements of existing techniques: (1) intuitive…

A new approach to the identification of Landscape Quality Objectives (LQOs) as a set of indicators.

PubMed

Sowińska-Świerkosz, Barbara Natalia; Chmielewski, Tadeusz J

2016-12-15

The objective of the paper is threefold: (1) to introduce Landscape Quality Objectives (LQOs) as a set of indicators; (2) to present a method of linking social and expert opinion in the process of the formulation of landscape indicators; and (3) to present a methodological framework for the identification of LQOs. The implementation of these goals adopted a six-stage procedure based on the use of landscape units: (1) GIS analysis; (2) classification; (3) social survey; (4) expert value judgement; (5) quality assessment; and (6) guidelines formulation. The essence of the research was the presentation of features that determine landscape quality according to public opinion as a set of indicators. The results showed that 80 such indicators were identified, of both a qualitative (49) and a quantitative character (31). Among the analysed units, 60% (18 objects) featured socially expected (and confirmed by experts) levels of landscape quality, and 20% (6 objects) required overall quality improvement in terms of both public and expert opinion. The adopted procedure provides a new tool for integrating social responsibility into environmental management. The advantage of the presented method is the possibility of its application in the territories of various European countries. It is flexible enough to be based on cartographic studies, landscape research methods, and environmental quality standards existing in a given country. Copyright © 2016 Elsevier Ltd. All rights reserved.

Selecting Research Areas and Research Design Approaches in Distance Education: Process Issues

ERIC Educational Resources Information Center

Passi, B. K.; Mishra, Sudarshan

2004-01-01

The purpose of this paper is to study the process used for selecting research areas and methodological approaches in distance education in India. Experts from the field of distance education in India were interviewed at length, with the aim of collecting qualitative data on opinions on process-issues for selecting areas for research, research…

Common problems in the elicitation and analysis of expert opinion affecting probabilistic safety assessments

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

Meyer, M.A.; Booker, J.M.

1990-01-01

Expert opinion is frequently used in probabilistic safety assessment (PSA), particularly in estimating low probability events. In this paper, we discuss some of the common problems encountered in eliciting and analyzing expert opinion data and offer solutions or recommendations. The problems are: that experts are not naturally Bayesian. People fail to update their existing information to account for new information as it becomes available, as would be predicted by the Bayesian philosophy; that experts cannot be fully calibrated. To calibrate experts, the feedback from the known quantities must be immediate, frequent, and specific to the task; that experts are limitedmore » in the number of things that they can mentally juggle at a time to 7 {plus minus} 2; that data gatherers and analysts can introduce bias by unintentionally causing an altering of the expert's thinking or answers; that the level of detail the data, or granularity, can affect the analyses; and the conditioning effect poses difficulties in gathering and analyzing of the expert data. The data that the expert gives can be conditioned on a variety of factors that can affect the analysis and the interpretation of the results. 31 refs.« less

43 CFR 45.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2013 CFR

2013-10-01

..., conclusions, opinions, or legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are...

43 CFR 45.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2011 CFR

2011-10-01

..., conclusions, opinions, or legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are...

43 CFR 45.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2012 CFR

2012-10-01

..., conclusions, opinions, or legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are...

43 CFR 45.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2014 CFR

2014-10-01

..., conclusions, opinions, or legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are...

Short-term Forecasting of the Prevalence of Trachoma: Expert Opinion, Statistical Regression, versus Transmission Models.

PubMed

Liu, Fengchen; Porco, Travis C; Amza, Abdou; Kadri, Boubacar; Nassirou, Baido; West, Sheila K; Bailey, Robin L; Keenan, Jeremy D; Solomon, Anthony W; Emerson, Paul M; Gambhir, Manoj; Lietman, Thomas M

2015-08-01

Trachoma programs rely on guidelines made in large part using expert opinion of what will happen with and without intervention. Large community-randomized trials offer an opportunity to actually compare forecasting methods in a masked fashion. The Program for the Rapid Elimination of Trachoma trials estimated longitudinal prevalence of ocular chlamydial infection from 24 communities treated annually with mass azithromycin. Given antibiotic coverage and biannual assessments from baseline through 30 months, forecasts of the prevalence of infection in each of the 24 communities at 36 months were made by three methods: the sum of 15 experts' opinion, statistical regression of the square-root-transformed prevalence, and a stochastic hidden Markov model of infection transmission (Susceptible-Infectious-Susceptible, or SIS model). All forecasters were masked to the 36-month results and to the other forecasts. Forecasts of the 24 communities were scored by the likelihood of the observed results and compared using Wilcoxon's signed-rank statistic. Regression and SIS hidden Markov models had significantly better likelihood than community expert opinion (p = 0.004 and p = 0.01, respectively). All forecasts scored better when perturbed to decrease Fisher's information. Each individual expert's forecast was poorer than the sum of experts. Regression and SIS models performed significantly better than expert opinion, although all forecasts were overly confident. Further model refinements may score better, although would need to be tested and compared in new masked studies. Construction of guidelines that rely on forecasting future prevalence could consider use of mathematical and statistical models. Clinicaltrials.gov NCT00792922.

[Unnecessary use of security measures and psychiatric hospitalisation].

PubMed

Hajdukiewicz, Danuta; Heitzman, Janusz

2006-01-01

The authors of this paper formulated an expertise opinion in answering the court on the former opinion of expert psychiatrists which concerned the psychic state and legibility, as well as the necessity of using security measures in the case of a woman who was considered non legible due to a delusional disorder, when she damaged the tyres in a car. The faults in the opinion stimulated the authors to present the results of the analysis formulated, with the idea that other experts will take more care when forming their expertise opinions.

Optimizing an Immersion ESL Curriculum Using Analytic Hierarchy Process

ERIC Educational Resources Information Center

Tang, Hui-Wen Vivian

2011-01-01

The main purpose of this study is to fill a substantial knowledge gap regarding reaching a uniform group decision in English curriculum design and planning. A comprehensive content-based course criterion model extracted from existing literature and expert opinions was developed. Analytical hierarchy process (AHP) was used to identify the relative…

False confessions, expert testimony, and admissibility.

PubMed

Watson, Clarence; Weiss, Kenneth J; Pouncey, Claire

2010-01-01

The confession of a criminal defendant serves as a prosecutor's most compelling piece of evidence during trial. Courts must preserve a defendant's constitutional right to a fair trial while upholding the judicial interests of presenting competent and reliable evidence to the jury. When a defendant seeks to challenge the validity of that confession through expert testimony, the prosecution often contests the admissibility of the expert's opinion. Depending on the content and methodology of the expert's opinion, testimony addressing the phenomenon of false confessions may or may not be admissible. This article outlines the scientific and epistemological bases of expert testimony on false confession, notes the obstacles facing its admissibility, and provides guidance to the expert in formulating opinions that will reach the judge or jury. We review the 2006 New Jersey Superior Court decision in State of New Jersey v. George King to illustrate what is involved in the admissibility of false-confession testimony and use the case as a starting point in developing a best-practice approach to working in this area.

Opinions of Inservice Experts.

ERIC Educational Resources Information Center

King, Vera R.; Hahn, Margaret

Two hundred and twenty-five inservice experts (administrators, counselors, teachers, and curriculum specialists) from 15 school districts were surveyed, and their opinions used in planning an improved mathematics education teacher preparation program at a Texas university. Results of the survey indicate that although most of the parties felt…

Science In The Courtroom: The Impact Of Recent US Supreme Court Decisions

NASA Astrophysics Data System (ADS)

Poulter, Susan

2000-03-01

Most physicists' work is far removed from the courtroom, but the principles of physics are important to a number of legal controversies. Several recent lawsuits have claimed that cellular phones cause brain cancer. And litigation over claims that electromagnetic fields cause other cancers has even more important implications for society. The problem of how to distinguish good science from bad in the courtroom has vexed lawyers and scientists alike for many years, and finally drew the attention of the United States Supreme Court in 1993. The Court has now issued three opinions on the standards for screening expert testimony, which require trial judges to evaluate scientific expert witnesses to determine if their testimony is reliable. How well are the new standards working? Is the judicial system doing any better at screening out junk science? This session will discuss how the Supreme Court's opinions are being applied and suggest several strategies, including the use of court appointed experts, that are being implemented to improve the process further.

Assessing uncertainty in sighting records: an example of the Barbary lion.

PubMed

Lee, Tamsin E; Black, Simon A; Fellous, Amina; Yamaguchi, Nobuyuki; Angelici, Francesco M; Al Hikmani, Hadi; Reed, J Michael; Elphick, Chris S; Roberts, David L

2015-01-01

As species become rare and approach extinction, purported sightings can be controversial, especially when scarce management resources are at stake. We consider the probability that each individual sighting of a series is valid. Obtaining these probabilities requires a strict framework to ensure that they are as accurately representative as possible. We used a process, which has proven to provide accurate estimates from a group of experts, to obtain probabilities for the validation of 32 sightings of the Barbary lion. We consider the scenario where experts are simply asked whether a sighting was valid, as well as asking them to score the sighting based on distinguishablity, observer competence, and verifiability. We find that asking experts to provide scores for these three aspects resulted in each sighting being considered more individually, meaning that this new questioning method provides very different estimated probabilities that a sighting is valid, which greatly affects the outcome from an extinction model. We consider linear opinion pooling and logarithm opinion pooling to combine the three scores, and also to combine opinions on each sighting. We find the two methods produce similar outcomes, allowing the user to focus on chosen features of each method, such as satisfying the marginalisation property or being externally Bayesian.

[Giving medico-legal opinions in cases with suspicion of medical mistake. part 2. Expert evidence in cases with suspicion of medical mistake - expectations, possibilities, threats…].

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.

[Assessment on the criminal responsibility of drug-induced mental disorders: a questionnaire survey].

PubMed

Zhang, Sheng-yu; Zhao, Hai; Tang, Tao; Guan, Wei

2014-12-01

To understand the assessment on the criminal responsibility of drug-induced mental disorders and judicial experts' opinions. The judicial experts from institutes of forensic psychiatry in Shanghai were selected. They were asked to finish a self-made questionnaire of assessment on the criminal responsibility of drug-induced mental disorders by letters and visits. Most of experts knew the special regulation, "not suitable for evaluation" towards the criminal responsibility of drug-induced mental disorders of the guideline promulgated by Ministry of Justice. Before and after the guideline was issued, no expert made a no-responsibility opinion in such cases. After the guideline was issued, some experts made a full-responsibility or limited-responsibility opinion in such cases. There was a little disagreement among the experts in the case that the crime was unrelated with mental symptoms or the criminals used drugs even though he knew it could induced insanity. But there were still many obvious disagreements among experts in the case that crime was related to such symptoms and person was no ability to debate. Most experts agreed to settle the disagreements with improved legislative perfection. Most experts are not strictly complying with the assessment guidelines during their practice, and there is still an obvious disagreement towards the criminal responsibility of drug-induced mental disorders.

[A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years].

PubMed

Uhlenbrock, Judith; Hinrichs, Jens; Heuft, Gereon

2017-09-01

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

Development of a practical approach to expert elicitation for randomised controlled trials with missing health outcomes: Application to the IMPROVE trial.

PubMed

Mason, Alexina J; Gomes, Manuel; Grieve, Richard; Ulug, Pinar; Powell, Janet T; Carpenter, James

2017-08-01

The analyses of randomised controlled trials with missing data typically assume that, after conditioning on the observed data, the probability of missing data does not depend on the patient's outcome, and so the data are 'missing at random' . This assumption is usually implausible, for example, because patients in relatively poor health may be more likely to drop out. Methodological guidelines recommend that trials require sensitivity analysis, which is best informed by elicited expert opinion, to assess whether conclusions are robust to alternative assumptions about the missing data. A major barrier to implementing these methods in practice is the lack of relevant practical tools for eliciting expert opinion. We develop a new practical tool for eliciting expert opinion and demonstrate its use for randomised controlled trials with missing data. We develop and illustrate our approach for eliciting expert opinion with the IMPROVE trial (ISRCTN 48334791), an ongoing multi-centre randomised controlled trial which compares an emergency endovascular strategy versus open repair for patients with ruptured abdominal aortic aneurysm. In the IMPROVE trial at 3 months post-randomisation, 21% of surviving patients did not complete health-related quality of life questionnaires (assessed by EQ-5D-3L). We address this problem by developing a web-based tool that provides a practical approach for eliciting expert opinion about quality of life differences between patients with missing versus complete data. We show how this expert opinion can define informative priors within a fully Bayesian framework to perform sensitivity analyses that allow the missing data to depend upon unobserved patient characteristics. A total of 26 experts, of 46 asked to participate, completed the elicitation exercise. The elicited quality of life scores were lower on average for the patients with missing versus complete data, but there was considerable uncertainty in these elicited values. The missing at random analysis found that patients randomised to the emergency endovascular strategy versus open repair had higher average (95% credible interval) quality of life scores of 0.062 (-0.005 to 0.130). Our sensitivity analysis that used the elicited expert information as pooled priors found that the gain in average quality of life for the emergency endovascular strategy versus open repair was 0.076 (-0.054 to 0.198). We provide and exemplify a practical tool for eliciting the expert opinion required by recommended approaches to the sensitivity analyses of randomised controlled trials. We show how this approach allows the trial analysis to fully recognise the uncertainty that arises from making alternative, plausible assumptions about the reasons for missing data. This tool can be widely used in the design, analysis and interpretation of future trials, and to facilitate this, materials are available for download.

Interictal epileptiform discharge characteristics underlying expert interrater agreement.

PubMed

Bagheri, Elham; Dauwels, Justin; Dean, Brian C; Waters, Chad G; Westover, M Brandon; Halford, Jonathan J

2017-10-01

The presence of interictal epileptiform discharges (IED) in the electroencephalogram (EEG) is a key finding in the medical workup of a patient with suspected epilepsy. However, inter-rater agreement (IRA) regarding the presence of IED is imperfect, leading to incorrect and delayed diagnoses. An improved understanding of which IED attributes mediate expert IRA might help in developing automatic methods for IED detection able to emulate the abilities of experts. Therefore, using a set of IED scored by a large number of experts, we set out to determine which attributes of IED predict expert agreement regarding the presence of IED. IED were annotated on a 5-point scale by 18 clinical neurophysiologists within 200 30-s EEG segments from recordings of 200 patients. 5538 signal analysis features were extracted from the waveforms, including wavelet coefficients, morphological features, signal energy, nonlinear energy operator response, electrode location, and spectrogram features. Feature selection was performed by applying elastic net regression and support vector regression (SVR) was applied to predict expert opinion, with and without the feature selection procedure and with and without several types of signal normalization. Multiple types of features were useful for predicting expert annotations, but particular types of wavelet features performed best. Local EEG normalization also enhanced best model performance. As the size of the group of EEGers used to train the models was increased, the performance of the models leveled off at a group size of around 11. The features that best predict inter-rater agreement among experts regarding the presence of IED are wavelet features, using locally standardized EEG. Our models for predicting expert opinion based on EEGer's scores perform best with a large group of EEGers (more than 10). By examining a large group of EEG signal analysis features we found that wavelet features with certain wavelet basis functions performed best to identify IEDs. Local normalization also improves predictability, suggesting the importance of IED morphology over amplitude-based features. Although most IED detection studies in the past have used opinion from three or fewer experts, our study suggests a "wisdom of the crowd" effect, such that pooling over a larger number of expert opinions produces a better correlation between expert opinion and objectively quantifiable features of the EEG. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis.

PubMed

Kjeken, Ingvild

2011-12-01

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

6 CFR 5.49 - Prohibition on providing expert or opinion testimony.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Prohibition on providing expert or opinion testimony. 5.49 Section 5.49 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY DISCLOSURE OF RECORDS AND INFORMATION Disclosure of Information in Litigation § 5.49 Prohibition on providing...

Classification of Word Levels with Usage Frequency, Expert Opinions and Machine Learning

ERIC Educational Resources Information Center

Sohsah, Gihad N.; Ünal, Muhammed Esad; Güzey, Onur

2015-01-01

Educational applications for language teaching can utilize the language levels of words to target proficiency levels of students. This paper and the accompanying data provide a methodology for making educational standard-aligned language-level predictions for all English words. The methodology involves expert opinions on language levels and…

Reliability of Causality Assessment for Drug, Herbal and Dietary Supplement Hepatoxicity in the Drug-Induced Liver Injury Network (DILIN)

PubMed Central

Hayashi, Paul H.; Barnhart, Huiman X.; Fontana, Robert J.; Chalasani, Naga; Davern, Timothy J.; Talwalkar, Jayant A.; Reddy, K. Rajender; Stolz, Andrew A.; Hoofnagle, Jay H.; Rockey, Don C.

2014-01-01

Background Due to the lack of objective tests to diagnose drug induced liver injury (DILI), causality assessment is a matter of debate. Expert opinion is often used in research and industry but its test-retest reliability is unknown. Aims To determine the test-retest reliability of the expert opinion process used by the Drug-Induced Liver Injury Network (DILIN) Methods Three DILIN hepatologists adjudicate suspected hepatotoxicity cases to 1 of 5 categories representing levels of likelihood of DILI. Adjudication is based on retrospective assessment of gathered case data that includes prospective follow-up information. One hundred randomly selected DILIN cases were re-assessed using the same processes for initial assessment but by 3 different reviewers in 92% of cases. Results The median time between assessments was 938 days (range: 140–2352). Thirty-one cases involved >1 agent. Weighted kappa statistics for overall case and individual agent category agreement were 0.60 (95% CI: 0.50–0.71) and 0.60 (0.52–0.68), respectively. Overall case adjudications were within one category of each other 93% of the time, while 5% differed by 2 categories and 2% differed by 3 categories. Fourteen-percent crossed the 50% threshold of likelihood due to competing diagnoses or atypical timing between drug exposure and injury. Conclusions The DILIN expert opinion causality assessment method has moderate inter-observer reliability but very good agreement within 1 category. A small but important proportion of cases could not be reliably diagnosed as ≥ 50% likely to be DILI. PMID:24661785

[Professionalization of Legal Dental Experts in Germany: Results of Studies on Structured Focus Groups].

PubMed

Brauer, H U; Walther, W; Dick, M

2018-04-01

Legal expert opinions are a crucial instrument of professional self-control in medicine. To give impulses for further development, focus groups were initiated to reflect upon the perspective of legal dental experts. 5 focus group discussions on the topic "Professionalization of legal dental experts" were conducted. A total of 32 experienced legal dental experts participated in the discussions. The results were evaluated by qualitative content analysis. A catalogue of 68 ideas was generated for improvement and divided into 15 categories. Among these were periodic quality circles, interprofessional exchange, supervision of novices and periodic feedback for legal dental experts and dentists. Self-reflection can be included as an instrument for quality improvement of legal dental expert opinions. © Georg Thieme Verlag KG Stuttgart · New York.

32 CFR 516.52 - Expert witnesses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... States Has An Interest § 516.52 Expert witnesses. Requests for present or former DA personnel as expert... SJA or legal adviser. In no event, may present or former DA personnel furnish expert or opinion...

Medicine authentication technology as a counterfeit medicine-detection tool: a Delphi method study to establish expert opinion on manual medicine authentication technology in secondary care

PubMed Central

Naughton, Bernard; Roberts, Lindsey; Dopson, Sue; Brindley, David; Chapman, Stephen

2017-01-01

Objectives This study aims to establish expert opinion and potential improvements for the Falsified Medicines Directive mandated medicines authentication technology. Design and intervention A two-round Delphi method study using an online questionnaire. Setting Large National Health Service (NHS) foundation trust teaching hospital. Participants Secondary care pharmacists and accredited checking technicians. Primary outcome measures Seven-point rating scale answers which reached a consensus of 70–80% with a standard deviation (SD) of <1.0. Likert scale questions which reached a consensus of 70–80%, a SD of <1.0 and classified as important according to study criteria. Results Consensus expert opinion has described database cross-checking technology as quick and user friendly and suggested the inclusion of an audio signal to further support the detection of counterfeit medicines in secondary care (70% consensus, 0.9 SD); other important consensus with a SD of <1.0 included reviewing the colour and information in warning pop up screens to ensure they were not mistaken for the ‘already dispensed here’ pop up, encouraging the dispenser/checker to act on the warnings and making it mandatory to complete an ‘action taken’ documentation process to improve the quarantine of potentially counterfeit, expired or recalled medicines. Conclusions This paper informs key opinion leaders and decision makers as to the positives and negatives of medicines authentication technology from an operator's perspective and suggests the adjustments which may be required to improve operator compliance and the detection of counterfeit medicines in the secondary care sector. PMID:28478398

Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations.

PubMed

Luauté, Jacques; Plantier, David; Wiart, Laurent; Tell, Laurence

2016-02-01

The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Sexual offences--selected cases].

PubMed

Łabecka, Marzena; Jarzabek-Bielecka, Grazyna; Lorkiewicz-Muszyńska, Dorota

2013-04-01

Expert testimony on violence victims also includes victims of sexual assault. The role of an expert is to classify the injuries by their severity as defined in art. 157 156 or 217 of the Criminal Code pertaining to crimes against health and life. Also, the role of an expert opinion is to determine whether the injuries identified during the exam occurred at the time and under the circumstances stated in medical history. The examination of sexual assault victims is conducted by two experts: a gynecologist and a forensic physician. Most examinations are performed at different times and various medical centers. The conclusions are presented in an official report. Regardless of victim age, all sexual crimes are investigated ex officio by the Police Department and the Prosecutor's Office. Further legal classification of criminal offenses is the task of an appropriate legal body and the offenses are codified in accordance with the provisions of chapter XXV of the Criminal Code, articles 197 - 205. In controversial cases, i.e. when two different expert opinions appear on the same case, or if, according to the law enforcement, a medical opinion is insufficient for some reason, an appropriate expert or team of experts is appointed to resolve the problem. To present selected cases of sexual violence victims treated at the Department of Gynecology and assessed at the Department of Forensic Medicine with reference to the challenges regarding qualification of the sustained injuries and clinical diagnoses. Research material included selected forensic opinions developed for law enforcement offices that involved victims of sexual violence. The expert opinions were prepared either on the basis of submitted evidence, or both, submitted evidence and examination of the victim at the Department of Forensic Medicine. Moreover the article presents a case of a patient examined and treated at the Department of Gynecology in Poznan. Based on the selected cases, the authors conclude that a medico-legal expert cannot uncritically accept previous diagnoses. Moreover every expert is given the right and obligation to verify them. The need for complete, rapid and almost simultaneous colaboration between physicians in charge of the case, forensic doctors, police officers and prosecutors was demonstrated. Lack of cooperation may give rise to different opinions, leading to unnecessary elongation of the medico-legal procedures. It was observed that time plays a crucial role if qualification of an injury is required. The obligation of medical staff to inform the law enforcement about all cases of child abuse was also emphasized.

Setting the Scope of Concept Inventories for Introductory Computing Subjects

ERIC Educational Resources Information Center

Goldman, Ken; Gross, Paul; Heeren, Cinda; Herman, Geoffrey L.; Kaczmarczyk, Lisa; Loui, Michael C.; Zilles, Craig

2010-01-01

A concept inventory is a standardized assessment tool intended to evaluate a student's understanding of the core concepts of a topic. In order to create a concept inventory it is necessary to accurately identify these core concepts. A Delphi process is a structured multi-step process that uses a group of experts to achieve a consensus opinion. We…

Subjective Prior Distributions for Modeling Longitudinal Continuous Outcomes with Non-Ignorable Dropout

PubMed Central

Paddock, Susan M.; Ebener, Patricia

2010-01-01

Substance abuse treatment research is complicated by the pervasive problem of non-ignorable missing data – i.e., the occurrence of the missing data is related to the unobserved outcomes. Missing data frequently arise due to early client departure from treatment. Pattern-mixture models (PMMs) are often employed in such situations to jointly model the outcome and the missing data mechanism. PMMs require non-testable assumptions to identify model parameters. Several approaches to parameter identification have therefore been explored for longitudinal modeling of continuous outcomes, and informative priors have been developed in other contexts. In this paper, we describe an expert interview conducted with five substance abuse treatment clinical experts who have familiarity with the Therapeutic Community modality of substance abuse treatment and with treatment process scores collected using the Dimensions of Change Instrument. The goal of the interviews was to obtain expert opinion about the rate of change in continuous client-level treatment process scores for clients who leave before completing two assessments and whose rate of change (slope) in treatment process scores is unidentified by the data. We find that the experts’ opinions differed dramatically from widely-utilized assumptions used to identify parameters in the PMM. Further, subjective prior assessment allows one to properly address the uncertainty inherent in the subjective decisions required to identify parameters in the PMM and to measure their effect on conclusions drawn from the analysis. PMID:19012279

Towards a Fuzzy Expert System on Toxicological Data Quality Assessment.

PubMed

Yang, Longzhi; Neagu, Daniel; Cronin, Mark T D; Hewitt, Mark; Enoch, Steven J; Madden, Judith C; Przybylak, Katarzyna

2013-01-01

Quality assessment (QA) requires high levels of domain-specific experience and knowledge. QA tasks for toxicological data are usually performed by human experts manually, although a number of quality evaluation schemes have been proposed in the literature. For instance, the most widely utilised Klimisch scheme1 defines four data quality categories in order to tag data instances with respect to their qualities; ToxRTool2 is an extension of the Klimisch approach aiming to increase the transparency and harmonisation of the approach. Note that the processes of QA in many other areas have been automatised by employing expert systems. Briefly, an expert system is a computer program that uses a knowledge base built upon human expertise, and an inference engine that mimics the reasoning processes of human experts to infer new statements from incoming data. In particular, expert systems have been extended to deal with the uncertainty of information by representing uncertain information (such as linguistic terms) as fuzzy sets under the framework of fuzzy set theory and performing inferences upon fuzzy sets according to fuzzy arithmetic. This paper presents an experimental fuzzy expert system for toxicological data QA which is developed on the basis of the Klimisch approach and the ToxRTool in an effort to illustrate the power of expert systems to toxicologists, and to examine if fuzzy expert systems are a viable solution for QA of toxicological data. Such direction still faces great difficulties due to the well-known common challenge of toxicological data QA that "five toxicologists may have six opinions". In the meantime, this challenge may offer an opportunity for expert systems because the construction and refinement of the knowledge base could be a converging process of different opinions which is of significant importance for regulatory policy making under the regulation of REACH, though a consensus may never be reached. Also, in order to facilitate the implementation of Weight of Evidence approaches and in silico modelling proposed by REACH, there is a higher appeal of numerical quality values than nominal (categorical) ones, where the proposed fuzzy expert system could help. Most importantly, the deriving processes of quality values generated in this way are fully transparent, and thus comprehensible, for final users, which is another vital point for policy making specified in REACH. Case studies have been conducted and this report not only shows the promise of the approach, but also demonstrates the difficulties of the approach and thus indicates areas for future development. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Assessing the risk of Nipah virus establishment in Australian flying-foxes.

PubMed

Roche, S E; Costard, S; Meers, J; Field, H E; Breed, A C

2015-07-01

Nipah virus (NiV) is a recently emerged zoonotic virus that causes severe disease in humans. The reservoir hosts for NiV, bats of the genus Pteropus (known as flying-foxes) are found across the Asia-Pacific including Australia. While NiV has not been detected in Australia, evidence for NiV infection has been found in flying-foxes in some of Australia's closest neighbours. A qualitative risk assessment was undertaken to assess the risk of NiV establishing in Australian flying-foxes through flying-fox movements from nearby regions. Events surrounding the emergence of new diseases are typically uncertain and in this study an expert opinion workshop was used to address gaps in knowledge. Given the difficulties in combining expert opinion, five different combination methods were analysed to assess their influence on the risk outcome. Under the baseline scenario where the median was used to combine opinions, the risk was estimated to be very low. However, this risk increased when the mean and linear opinion pooling combination methods were used. This assessment highlights the effects that different methods for combining expert opinion have on final risk estimates and the caution needed when interpreting these outcomes given the high degree of uncertainty in expert opinion. This work has provided a flexible model framework for assessing the risk of NiV establishment in Australian flying-foxes through bat movements which can be updated when new data become available.

Climate Change to the Year 2000: A Survey of Expert Opinion.

ERIC Educational Resources Information Center

Institute for the Future, Menlo Park, CA.

This survey of expert opinion was conducted by the National Defense University, Washington, D.C. to quantify the likelihood of significant changes in climate and their practical consequences. The major objectives of the study are embodied in four tasks. This publication presents the results of the first task only: the definition and estimation of…

75 FR 34769 - The University of Wisconsin; Facility Operating License No. R-74; Notice of Acceptance for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-18

... specific statement of the issue of law or fact to be raised or controverted. In addition, the petitioner... alleged facts or expert opinion which support the contention and on which the petitioner intends to rely... to establish those facts or expert opinion. The petition must include sufficient information to show...

Evaluation of current state of agricultural land using problem-oriented fuzzy indicators in GIS environment

USDA-ARS?s Scientific Manuscript database

Current state of agricultural lands is defined under influence of processes in soil, plants and atmosphere and is described by observation data, complicated models and subjective opinion of experts. Problem-oriented indicators summarize this information in useful form for decision of the same specif...

Criterion III: Maintenance of rangeland productive capacity [Chapter 4

Treesearch

G. R. Evans; R. A. Washmgton-Allen; R. D. Child; J. E. Mitchell; B. R. Bobowskl; R. V. Loper; B. H. Allen-Diaz; D. W. Thompson; G. R. Welling; T. B. Reuwsaat

2010-01-01

Maintenance of rangeland productive capacity is one of five criteria established by the Sustainable Rangelands Roundtable (SRR) to monitor and assess rangeland sustainable management. Within this criterion, six indicators were developed through the Delphi Process and the expert opinions of academicians, rangeland scientists, rangeland management agency personnel, non-...

Chapter 10: Management recommendations

Treesearch

Deborah M. Finch; Janie Agyagos; Tracy McCarthey; Robert M. Marshall; Scott H. Stoleson; Mary J. Whitfield

2000-01-01

This chapter was developed over a series of meetings using a group-consensus process. Our recommendations are based on published results, on information compiled in the previous chapters, on expert opinion, and on unpublished data of conservation team members. This chapter is available as temporary guidance until the Recovery Plan for the southwestern willow flycatcher...

Incorporating historical ecosystem diversity into conservation planning efforts in grass and shrub ecosystems

Treesearch

Amy C. Ganguli; Johathan B. Haufler; Carolyn A. Mehl; Jimmie D. Chew

2011-01-01

Understanding historical ecosystem diversity and wildlife habitat quality can provide a useful reference for managing and restoring rangeland ecosystems. We characterized historical ecosystem diversity using available empirical data, expert opinion, and the spatially explicit vegetation dynamics model SIMPPLLE (SIMulating Vegetative Patterns and Processes at Landscape...

The application of the heuristic-systematic processing model to treatment decision making about prostate cancer.

PubMed

Steginga, Suzanne K; Occhipinti, Stefano

2004-01-01

The study investigated the utility of the Heuristic-Systematic Processing Model as a framework for the investigation of patient decision making. A total of 111 men recently diagnosed with localized prostate cancer were assessed using Verbal Protocol Analysis and self-report measures. Study variables included men's use of nonsystematic and systematic information processing, desire for involvement in decision making, and the individual differences of health locus of control, tolerance of ambiguity, and decision-related uncertainty. Most men (68%) preferred that decision making be shared equally between them and their doctor. Men's use of the expert opinion heuristic was related to men's verbal reports of decisional uncertainty and having a positive orientation to their doctor and medical care; a desire for greater involvement in decision making was predicted by a high internal locus of health control. Trends were observed for systematic information processing to increase when the heuristic strategy used was negatively affect laden and when men were uncertain about the probabilities for cure and side effects. There was a trend for decreased systematic processing when the expert opinion heuristic was used. Findings were consistent with the Heuristic-Systematic Processing Model and suggest that this model has utility for future research in applied decision making about health.

Personalised, predictive and preventive medication process in hospitals—still rather missing: professional opinion survey on medication safety in Czech hospitals (based on professional opinions of recognised Czech health care experts)

PubMed Central

2014-01-01

The survey had the following aims: (1) to rationalise the hypothesis that risks and losses relating to medication process' errors in Czech hospitals are at least comparable with the other developed countries and EU countries especially, (2) to get a valid professional opinion/estimate on the rate of adverse drug events happening in Czech hospitals, (3) to point out that medication errors represent real and serious risks and (4) to induce the hospital management readiness to execute fundamental changes and improvements to medication processes. We read through a lot of studies inquiring into hospitals' medication safety. Then, we selected the studies which brought reliable findings and formulated credible conclusions. Finally, we addressed reputable Czech experts in health care and asked them structured questions whether the studies' findings and conclusions corresponded with our respondents' own experience in the Czech hospital clinical practice and what their own estimates of adverse drug events' consequences were like. Based on the reputable Czech health care expert opinions/estimates, the rate of a false drug administration may exceed 5%, and over 7% of those cause serious health complications to Czech hospital inpatients. Measured by an average length of stay (ALOS), the Czech inpatients, harmed by a false drug administration, stay in hospital for more than 2.6 days longer than necessary. Any positive changes to a currently used, traditional, ways of drug dispensing and administration, along with computerisation, automation, electronic traceability, validation, or verification, must well pay off. Referring to the above results, it seems to be wise to follow the EU priorities in health and health care improvements. Thus, a right usage of the financial means provided by the EC—in terms of its new health programmes for the period 2014–2020 (e.g. Horizon 2020)—has a good chance of a good result in doing the right things right, at the right time and in the right way. All citizens of the EU may benefit using the best practice. PMID:24834138

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

[Medical data security in medico-legal opinioning].

PubMed

Susło, Robert; Swiatek, Barbara

2005-01-01

Medical data security can be approached in medico-legal opinioning in three main situations: security of medical data, on which the opinion should be based, opinioning itself and whether the medical data security was properly ensured and ensuring medical data security during medico-legal opinion giving. The importance of medical data security, during collecting, processing and storing, as well in medical as in legal institutions, is of major importance for the possibility of providing a proper medico-legal opinion. Theoretically speeking, it is possible to give a proper medico-legal opinion using incorrect data, but the possibility is low. When the expert is given improper, unreadable, incomplete or even bogus in part or in the whole medical data it is extremely possible, that he fails in giving his opinion. The term "medical data" was defined and subsequently there was a brief review of medical data storing methods made and specific threats bound with them, based on modern literature. The authors also pointed out possible methods of preventing the threats. They listed Polish as well as international regulations and laws concerning the problem, accenting the importance of preserving medical data for the purposes of medico-legal opinioning.

Bayesian assessment of overtriage and undertriage at a level I trauma centre.

PubMed

DiDomenico, Paul B; Pietzsch, Jan B; Paté-Cornell, M Elisabeth

2008-07-13

We analysed the trauma triage system at a specific level I trauma centre to assess rates of over- and undertriage and to support recommendations for system improvements. The triage process is designed to estimate the severity of patient injury and allocate resources accordingly, with potential errors of overestimation (overtriage) consuming excess resources and underestimation (undertriage) potentially leading to medical errors.We first modelled the overall trauma system using risk analysis methods to understand interdependencies among the actions of the participants. We interviewed six experienced trauma surgeons to obtain their expert opinion of the over- and undertriage rates occurring in the trauma centre. We then assessed actual over- and undertriage rates in a random sample of 86 trauma cases collected over a six-week period at the same centre. We employed Bayesian analysis to quantitatively combine the data with the prior probabilities derived from expert opinion in order to obtain posterior distributions. The results were estimates of overtriage and undertriage in 16.1 and 4.9% of patients, respectively. This Bayesian approach, which provides a quantitative assessment of the error rates using both case data and expert opinion, provides a rational means of obtaining a best estimate of the system's performance. The overall approach that we describe in this paper can be employed more widely to analyse complex health care delivery systems, with the objective of reduced errors, patient risk and excess costs.

Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.

PubMed

Ferdosi, Masoud; Ziyari, Farhad Bahman; Ollahi, Mehran Nemat; Salmani, Amaneh Rahim; Niknam, Noureddin

2016-01-01

In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance. In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions. This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software. According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors. Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Development of a practical approach to expert elicitation for randomised controlled trials with missing health outcomes: Application to the IMPROVE trial

PubMed Central

Mason, Alexina J; Gomes, Manuel; Grieve, Richard; Ulug, Pinar; Powell, Janet T; Carpenter, James

2017-01-01

Background/aims: The analyses of randomised controlled trials with missing data typically assume that, after conditioning on the observed data, the probability of missing data does not depend on the patient’s outcome, and so the data are ‘missing at random’ . This assumption is usually implausible, for example, because patients in relatively poor health may be more likely to drop out. Methodological guidelines recommend that trials require sensitivity analysis, which is best informed by elicited expert opinion, to assess whether conclusions are robust to alternative assumptions about the missing data. A major barrier to implementing these methods in practice is the lack of relevant practical tools for eliciting expert opinion. We develop a new practical tool for eliciting expert opinion and demonstrate its use for randomised controlled trials with missing data. Methods: We develop and illustrate our approach for eliciting expert opinion with the IMPROVE trial (ISRCTN 48334791), an ongoing multi-centre randomised controlled trial which compares an emergency endovascular strategy versus open repair for patients with ruptured abdominal aortic aneurysm. In the IMPROVE trial at 3 months post-randomisation, 21% of surviving patients did not complete health-related quality of life questionnaires (assessed by EQ-5D-3L). We address this problem by developing a web-based tool that provides a practical approach for eliciting expert opinion about quality of life differences between patients with missing versus complete data. We show how this expert opinion can define informative priors within a fully Bayesian framework to perform sensitivity analyses that allow the missing data to depend upon unobserved patient characteristics. Results: A total of 26 experts, of 46 asked to participate, completed the elicitation exercise. The elicited quality of life scores were lower on average for the patients with missing versus complete data, but there was considerable uncertainty in these elicited values. The missing at random analysis found that patients randomised to the emergency endovascular strategy versus open repair had higher average (95% credible interval) quality of life scores of 0.062 (−0.005 to 0.130). Our sensitivity analysis that used the elicited expert information as pooled priors found that the gain in average quality of life for the emergency endovascular strategy versus open repair was 0.076 (−0.054 to 0.198). Conclusion: We provide and exemplify a practical tool for eliciting the expert opinion required by recommended approaches to the sensitivity analyses of randomised controlled trials. We show how this approach allows the trial analysis to fully recognise the uncertainty that arises from making alternative, plausible assumptions about the reasons for missing data. This tool can be widely used in the design, analysis and interpretation of future trials, and to facilitate this, materials are available for download. PMID:28675302

Short-term Forecasting of the Prevalence of Trachoma: Expert Opinion, Statistical Regression, versus Transmission Models

PubMed Central

Liu, Fengchen; Porco, Travis C.; Amza, Abdou; Kadri, Boubacar; Nassirou, Baido; West, Sheila K.; Bailey, Robin L.; Keenan, Jeremy D.; Solomon, Anthony W.; Emerson, Paul M.; Gambhir, Manoj; Lietman, Thomas M.

2015-01-01

Background Trachoma programs rely on guidelines made in large part using expert opinion of what will happen with and without intervention. Large community-randomized trials offer an opportunity to actually compare forecasting methods in a masked fashion. Methods The Program for the Rapid Elimination of Trachoma trials estimated longitudinal prevalence of ocular chlamydial infection from 24 communities treated annually with mass azithromycin. Given antibiotic coverage and biannual assessments from baseline through 30 months, forecasts of the prevalence of infection in each of the 24 communities at 36 months were made by three methods: the sum of 15 experts’ opinion, statistical regression of the square-root-transformed prevalence, and a stochastic hidden Markov model of infection transmission (Susceptible-Infectious-Susceptible, or SIS model). All forecasters were masked to the 36-month results and to the other forecasts. Forecasts of the 24 communities were scored by the likelihood of the observed results and compared using Wilcoxon’s signed-rank statistic. Findings Regression and SIS hidden Markov models had significantly better likelihood than community expert opinion (p = 0.004 and p = 0.01, respectively). All forecasts scored better when perturbed to decrease Fisher’s information. Each individual expert’s forecast was poorer than the sum of experts. Interpretation Regression and SIS models performed significantly better than expert opinion, although all forecasts were overly confident. Further model refinements may score better, although would need to be tested and compared in new masked studies. Construction of guidelines that rely on forecasting future prevalence could consider use of mathematical and statistical models. PMID:26302380

75 FR 36705 - Regents of the University of California; Notice of Acceptance for Docketing and Opportunity for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... of a specific statement of the issue of law or fact to be raised or controverted. In addition, the... statement of the alleged facts or expert opinion which support the contention and on which the petitioner... intends to rely to establish those facts or expert opinion. The petition must include sufficient...

Biology Teacher and Expert Opinions about Computer Assisted Biology Instruction Materials: A Software Entitled Nucleic Acids and Protein Synthesis

ERIC Educational Resources Information Center

Hasenekoglu, Ismet; Timucin, Melih

2007-01-01

The aim of this study is to collect and evaluate opinions of CAI experts and biology teachers about a high school level Computer Assisted Biology Instruction Material presenting computer-made modelling and simulations. It is a case study. A material covering "Nucleic Acids and Protein Synthesis" topic was developed as the…

[Legal quality criteria of expert opinions in liability for medical malpractice].

PubMed

Neu, Johann

2017-09-01

In litigation regarding to liability for medical malpractice the court itself for lack of medical expert knowledge cannot judge a claimed error in treatment. That applies too for the question if there is causation between the error in treatment and claimed damage to patient's health. In this respect, the court is dependent on a medical expert and is bound to his assessment, unless there is no quality deficit in respect of medical and/or legal criteria. The more the medical expert knows the legal background of physician's liability for medical malpractice, the less is the risk of legal quality deficits in his expert opinion and thereby also of judicial errors by court. Georg Thieme Verlag KG Stuttgart · New York.

Medicine authentication technology as a counterfeit medicine-detection tool: a Delphi method study to establish expert opinion on manual medicine authentication technology in secondary care.

PubMed

Naughton, Bernard; Roberts, Lindsey; Dopson, Sue; Brindley, David; Chapman, Stephen

2017-05-06

This study aims to establish expert opinion and potential improvements for the Falsified Medicines Directive mandated medicines authentication technology. A two-round Delphi method study using an online questionnaire. Large National Health Service (NHS) foundation trust teaching hospital. Secondary care pharmacists and accredited checking technicians. Seven-point rating scale answers which reached a consensus of 70-80% with a standard deviation (SD) of <1.0. Likert scale questions which reached a consensus of 70-80%, a SD of <1.0 and classified as important according to study criteria. Consensus expert opinion has described database cross-checking technology as quick and user friendly and suggested the inclusion of an audio signal to further support the detection of counterfeit medicines in secondary care (70% consensus, 0.9 SD); other important consensus with a SD of <1.0 included reviewing the colour and information in warning pop up screens to ensure they were not mistaken for the 'already dispensed here' pop up, encouraging the dispenser/checker to act on the warnings and making it mandatory to complete an 'action taken' documentation process to improve the quarantine of potentially counterfeit, expired or recalled medicines. This paper informs key opinion leaders and decision makers as to the positives and negatives of medicines authentication technology from an operator's perspective and suggests the adjustments which may be required to improve operator compliance and the detection of counterfeit medicines in the secondary care sector. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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.

A case of bipolar psychosis and transsexualism.

PubMed

Habermeyer, Elmar; Kamps, Ingrid; Kawohl, Wolfram

2003-01-01

A case of bipolar disorder and transsexualism is reported and discussed. The case report shows the problematic nature of the distinction between transsexualism and psychosis-induced transsexual desires. If there is a true comorbidity of these disorders, a subtly differentiated process to guide medical expert opinion and therapy is necessary. Copyright 2003 S. Karger AG, Basel

Parametric Cost Modeling of Space Missions Using the Develop New Projects (DMP) Implementation Process

NASA Technical Reports Server (NTRS)

Rosenberg, Leigh; Hihn, Jairus; Roust, Kevin; Warfield, Keith

2000-01-01

This paper presents an overview of a parametric cost model that has been built at JPL to estimate costs of future, deep space, robotic science missions. Due to the recent dramatic changes in JPL business practices brought about by an internal reengineering effort known as develop new products (DNP), high-level historic cost data is no longer considered analogous to future missions. Therefore, the historic data is of little value in forecasting costs for projects developed using the DNP process. This has lead to the development of an approach for obtaining expert opinion and also for combining actual data with expert opinion to provide a cost database for future missions. In addition, the DNP cost model has a maximum of objective cost drivers which reduces the likelihood of model input error. Version 2 is now under development which expands the model capabilities, links it more tightly with key design technical parameters, and is grounded in more rigorous statistical techniques. The challenges faced in building this model will be discussed, as well as it's background, development approach, status, validation, and future plans.

39 CFR 230.23 - May an Office of Inspector General employee testify as an expert or opinion witness?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false May an Office of Inspector General employee testify as an expert or opinion witness? 230.23 Section 230.23 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL Rules Governing Compliance With Subpoenas, Summonses, and Court Orders by Postal...

Lay Evaluation of Financial Experts: The Action Advice Effect and Confirmation Bias.

PubMed

Zaleskiewicz, Tomasz; Gasiorowska, Agata; Stasiuk, Katarzyna; Maksymiuk, Renata; Bar-Tal, Yoram

2016-01-01

The goal of this experimental project was to investigate lay peoples' perceptions of epistemic authority (EA) in the field of finance. EA is defined as the extent to which a source of information is treated as evidence for judgments independently of its objective expertise and based on subjective beliefs. Previous research suggested that EA evaluations are biased and that lay people tend to ascribe higher EA to experts who advise action (in the case of medical experts) or confirm clients' expectations (in the case of politicians). However, there has been no research into biases in lay evaluations of financial experts and this project is aimed to fill this gap. Experiment 1 showed that lay people tended to ascribe greater authority to financial consultants who gave more active advice to clients considering taking out a mortgage. Experiment 2 confirmed the action advice effect found in Experiment 1. However, the outcomes of Experiments 2 and - particularly - 3 suggested that this bias might also be due to clients' desire to confirm their own opinions. Experiment 2 showed that the action advice effect was moderated by clients' own opinions on taking loans. Lay people ascribed the greatest EA to the advisor in the scenario in which he advised taking action and where this coincided with the client's positive opinion on the advisability of taking out a loan. In Experiment 3 only participants with a positive opinion on the financial product ascribed greater authority to experts who recommended it; participants whose opinion was negative tended to rate consultants who advised rejecting the product more highly. To conclude, these three experiments revealed that lay people ascribe higher EA to financial consultants who advise action rather than maintenance of the status quo , but this effect is limited by confirmation bias: when the client's a priori opinion is salient, greater authority is ascribed to experts whose advice confirms it. In this sense, results presented in the present paper suggest that the action advice effect might be also interpreted as a specific manifestation of confirmation bias.

Lay Evaluation of Financial Experts: The Action Advice Effect and Confirmation Bias

PubMed Central

Zaleskiewicz, Tomasz; Gasiorowska, Agata; Stasiuk, Katarzyna; Maksymiuk, Renata; Bar-Tal, Yoram

2016-01-01

The goal of this experimental project was to investigate lay peoples’ perceptions of epistemic authority (EA) in the field of finance. EA is defined as the extent to which a source of information is treated as evidence for judgments independently of its objective expertise and based on subjective beliefs. Previous research suggested that EA evaluations are biased and that lay people tend to ascribe higher EA to experts who advise action (in the case of medical experts) or confirm clients’ expectations (in the case of politicians). However, there has been no research into biases in lay evaluations of financial experts and this project is aimed to fill this gap. Experiment 1 showed that lay people tended to ascribe greater authority to financial consultants who gave more active advice to clients considering taking out a mortgage. Experiment 2 confirmed the action advice effect found in Experiment 1. However, the outcomes of Experiments 2 and – particularly – 3 suggested that this bias might also be due to clients’ desire to confirm their own opinions. Experiment 2 showed that the action advice effect was moderated by clients’ own opinions on taking loans. Lay people ascribed the greatest EA to the advisor in the scenario in which he advised taking action and where this coincided with the client’s positive opinion on the advisability of taking out a loan. In Experiment 3 only participants with a positive opinion on the financial product ascribed greater authority to experts who recommended it; participants whose opinion was negative tended to rate consultants who advised rejecting the product more highly. To conclude, these three experiments revealed that lay people ascribe higher EA to financial consultants who advise action rather than maintenance of the status quo, but this effect is limited by confirmation bias: when the client’s a priori opinion is salient, greater authority is ascribed to experts whose advice confirms it. In this sense, results presented in the present paper suggest that the action advice effect might be also interpreted as a specific manifestation of confirmation bias. PMID:27729892

Standard operating procedures in the disorders of orgasm and ejaculation.

PubMed

McMahon, Chris G; Jannini, Emmanuele; Waldinger, Marcel; Rowland, David

2013-01-01

Ejaculatory/orgasmic disorders are common male sexual dysfunctions and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. To provide recommendations and guidelines of the current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men as standard operating procedures (SOPs) for the treating health care professional. The International Society of Sexual Medicine Standards Committee assembled over 30 multidisciplinary experts to establish SOPs for various male and female sexual medicine topics. The SOP for the management of disorders of orgasm and ejaculation represents the opinion of four experts from four countries developed in a process over a 2-year period. Expert opinion was based on grading of evidence-based medical literature, limited expert opinion, widespread internal committee discussion, public presentation, and debate. PE management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin reuptake inhibitors and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. All men seeking treatment for PE should receive basic psychosexual education. Graded behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic etiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. Retrograde ejaculation is managed by education, patient reassurance, and pharmacotherapy. Additional research is required to further the understanding of the disorders of ejaculation and orgasm. © 2012 International Society for Sexual Medicine.

Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study.

PubMed

Golder, Vera; Huq, Molla; Franklyn, Kate; Calderone, Alicia; Lateef, Aisha; Lau, Chak Sing; Lee, Alfred Lok Hang; Navarra, Sandra Teresa V; Godfrey, Timothy; Oon, Shereen; Hoi, Alberta Yik Bun; Morand, Eric Francis; Nikpour, Mandana

2017-06-01

To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state. Copyright © 2017 Elsevier Inc. All rights reserved.

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).

The effect of case-based discussion of topics with experts on learners' opinions: implications for spinal education and training.

PubMed

Berjano, Pedro; Villafañe, Jorge Hugo; Vanacker, Gerard; Cecchinato, Riccardo; Ismael, Maryem; Gunzburg, Robert; Marruzzo, Daniele; Lamartina, Claudio

2018-02-01

This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience's opinions on the treatment of patients during a continuing medical education event for spine surgeons. We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant's opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance. Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment. On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners' opinions.

The effect of case-based discussion of topics with experts on learners' opinions: implications for spinal education and training.

PubMed

Berjano, Pedro; Villafañe, Jorge Hugo; Vanacker, Gerard; Cecchinato, Riccardo; Ismael, Maryem; Gunzburg, Robert; Marruzzo, Daniele; Lamartina, Claudio

2017-10-01

This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience's opinions on the treatment of patients during a continuing medical education event for spine surgeons. We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant's opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance. Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment. On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners' opinions.

Assessing the probability of introduction and spread of avian influenza (AI) virus in commercial Australian poultry operations using an expert opinion elicitation.

PubMed

Singh, Mini; Toribio, Jenny-Ann; Scott, Angela Bullanday; Groves, Peter; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Black, Amanda; Hernandez-Jover, Marta

2018-01-01

The objective of this study was to elicit experts' opinions and gather estimates on the perceived probability of introduction and spread of avian influenza (AI) virus in the Australian broiler and layer industry. Using a modified Delphi method and a 4-step elicitation process, 11 experts were asked to give initial individual estimates for the various pathways and practices in the presented scenarios using a questionnaire. Following this, a workshop was conducted to present group averages of estimates and discussion was facilitated to obtain final individual estimates. For each question, estimates for all experts were combined using a discrete distribution, with weights allocated representing the level of expertise. Indirect contact with wild birds either via a contaminated water source or fomites was considered the most likely pathway of introduction of low pathogenic avian influenza (LPAI) on poultry farms. Presence of a water body near the poultry farm was considered a potential pathway for introduction only when the operation type was free range and the water body was within 500m distance from the shed. The probability that LPAI will mutate to highly pathogenic avian influenza (HPAI) was considered to be higher in layer farms. Shared personnel, equipment and aerosol dispersion were the most likely pathways of shed to shed spread of the virus. For LPAI and HPAI spread from farm to farm, shared pick-up trucks for broiler and shared egg trays and egg pallets for layer farms were considered the most likely pathways. Findings from this study provide an insight on most influential practices on the introduction and spread of AI virus among commercial poultry farms in Australia, as elicited from opinions of experts. These findings will be used to support parameterization of a modelling study assessing the risk of AI introduction and spread among commercial poultry farms in Australia.

Expert opinion paper on atrial fibrillation detection after ischemic stroke.

PubMed

Haeusler, Karl Georg; Gröschel, Klaus; Köhrmann, Martin; Anker, Stefan D; Brachmann, Johannes; Böhm, Michael; Diener, Hans-Christoph; Doehner, Wolfram; Endres, Matthias; Gerloff, Christian; Huttner, Hagen B; Kaps, Manfred; Kirchhof, Paulus; Nabavi, Darius Günther; Nolte, Christian H; Pfeilschifter, Waltraud; Pieske, Burkert; Poli, Sven; Schäbitz, Wolf Rüdiger; Thomalla, Götz; Veltkamp, Roland; Steiner, Thorsten; Laufs, Ulrich; Röther, Joachim; Wachter, Rolf; Schnabel, Renate

2018-04-27

This expert opinion paper on atrial fibrillation detection after ischemic stroke includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. This paper was endorsed by the Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork. In patients with ischemic stroke, detection of atrial fibrillation should usually lead to a change in secondary stroke prevention, since oral anticoagulation is superior to antiplatelet drugs. The detection of previously undiagnosed atrial fibrillation can be improved in patients with ischemic stroke to optimize stroke prevention. This paper summarizes the present knowledge on atrial fibrillation detection after ischemic stroke. We propose an interdisciplinary standard for a "structured analysis of ECG monitoring" on the stroke unit as well as a staged diagnostic scheme for the detection of atrial fibrillation. Since the optimal duration and mode of ECG monitoring has not yet been finally established, this paper is intended to give advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on the expert opinion, reported case series and clinical experience. Therefore, this paper is not intended as a guideline.

Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique.

PubMed

Lin, Yen-Ko; Chen, Chao-Wen; Lee, Wei-Che; Lin, Tsung-Ying; Kuo, Liang-Chi; Lin, Chia-Ju; Shi, Leiyu; Tien, Yin-Chun; Cheng, Yuan-Chia

2017-11-29

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients' knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department (ED) were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts' opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480 . The date of registration was April 18, 2011 (retrospectively registered).

[Health insurance companies and medical genetics, what do they want to know? Expert opinions concerning medical genetic services].

PubMed

Nippert, Reinhart Peter; Schmidtke, J

2012-03-01

Based on the compilation of medical opinions delivered by a medical genetic expert between 2002 and 2010, solicited by private health insurance companies in Germany, an analysis of the main issues raised was made to identify the information needs of company employees with respect to human and medical genetics. The findings are discussed and recommendations for improvement and further training are suggested.

Communicating Risks and Benefits in Informed Consent for Research: A Qualitative Study

PubMed Central

Nusbaum, Lika; Douglas, Brenda; Damus, Karla; Paasche-Orlow, Michael; Estrella-Luna, Neenah

2017-01-01

Multiple studies have documented major limitations in the informed consent process for the recruitment of clinical research participants. One challenging aspect of this process is successful communication of risks and benefits to potential research participants. This study explored the opinions and attitudes of informed consent experts about conveying risks and benefits to inform the development of a survey about the perspectives of research nurses who are responsible for obtaining informed consent for clinical trials. The major themes identified were strategies for risks and benefits communication, ensuring comprehension, and preparation for the role of the consent administrator. From the experts’ perspective, inadequate education and training of the research staff responsible for informed consent process contribute to deficiencies in the informed consent process and risks and benefits communication. Inconsistencies in experts’ opinions and critique of certain widely used communication practices require further consideration and additional research. PMID:28975139

Expert assessment of the current state of the energy management system in the company

NASA Astrophysics Data System (ADS)

Minnullina, Anna; Abdrazakov, Rais

2017-10-01

The authors’ expert assessment of the current state of the energy management system in the company is proposed in the article. The experts are invited to assess the status of the energy management system in the following categories: energy policy, organizational structure, training, motivation, control, communication, investment, and energy consumption culture. For the purposes of interpretation of the results of the expert evaluation obtained, a gradation based on a possible range of values is proposed. The expert evaluation allows representing the status of the energy management system in general and at each of its individual levels, which makes it possible to identify the problem areas more accurately. To confirm the applied nature of the proposed methodology, the authors assessed the opinions of 8 experts, employed by the road construction company of the Tyumen Region and related in one way or another to the process of energy consumption in the company due to the nature of their activities.

Development and Cross-cultural Validation of the Korean Version of SMArtphone's uSability Heuristics (SMASH).

PubMed

Jeong, Yeo Won; Kim, Jung A

2017-10-01

The purpose of this study was to develop and cross-culturally validate the Korean version of SMArtphone's uSability Heuristics (K-SMASH). In the study, it was used the adaptation process consisted of five stages, namely, translation, synthesis, back translation, expert committee review, and pretesting. In the pretesting stage, a mobile application, using the prefinal K-SMASH, was evaluated for the severity of usability problems by three experts in computer science and informatics. Each participant completed the evaluation and was interviewed about their understanding, interpretation, and opinion of the cultural relevance of the prefinal K-SMASH. Next, we reviewed the differences in the experts' opinions and the questionnaire results. Twelve SMASH items, words and sentences, were translated, back translated, and revised, considering the conceptual meaning in the context of the Korean culture, by experts in various fields, including a Korean linguist and a bilingual translator, through the first stage to the fourth stage. In the pretesting stage, the results showed no major differences among the severity ratings of participants. Furthermore, all participants answered that there were no critical discrepancies or inconsistencies with the cultural relevance of the prefinal K-SMASH. The results of the study provide preliminary evidence that the modified K-SMASH can be used for heuristic evaluation, one of the usability tests, when developing applications in Korea.

Evaluation of infectious diseases and clinical microbiology specialists' preferences for hand hygiene: analysis using the multi-attribute utility theory and the analytic hierarchy process methods.

PubMed

Suner, Aslı; Oruc, Ozlem Ege; Buke, Cagri; Ozkaya, Hacer Deniz; Kitapcioglu, Gul

2017-08-31

Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another. Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP). A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices. In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.

Expert Opinion on Three Phage Therapy Related Topics: Bacterial Phage Resistance, Phage Training and Prophages in Bacterial Production Strains.

PubMed

Rohde, Christine; Resch, Grégory; Pirnay, Jean-Paul; Blasdel, Bob G; Debarbieux, Laurent; Gelman, Daniel; Górski, Andrzej; Hazan, Ronen; Huys, Isabelle; Kakabadze, Elene; Łobocka, Małgorzata; Maestri, Alice; Almeida, Gabriel Magno de Freitas; Makalatia, Khatuna; Malik, Danish J; Mašlaňová, Ivana; Merabishvili, Maia; Pantucek, Roman; Rose, Thomas; Štveráková, Dana; Van Raemdonck, Hilde; Verbeken, Gilbert; Chanishvili, Nina

2018-04-05

Phage therapy is increasingly put forward as a "new" potential tool in the fight against antibiotic resistant infections. During the "Centennial Celebration of Bacteriophage Research" conference in Tbilisi, Georgia on 26-29 June 2017, an international group of phage researchers committed to elaborate an expert opinion on three contentious phage therapy related issues that are hampering clinical progress in the field of phage therapy. This paper explores and discusses bacterial phage resistance, phage training and the presence of prophages in bacterial production strains while reviewing relevant research findings and experiences. Our purpose is to inform phage therapy stakeholders such as policy makers, officials of the competent authorities for medicines, phage researchers and phage producers, and members of the pharmaceutical industry. This brief also points out potential avenues for future phage therapy research and development as it specifically addresses those overarching questions that currently call for attention whenever phages go into purification processes for application.

Expert Opinion on Three Phage Therapy Related Topics: Bacterial Phage Resistance, Phage Training and Prophages in Bacterial Production Strains

PubMed Central

Rohde, Christine; Resch, Grégory; Blasdel, Bob G.; Gelman, Daniel; Górski, Andrzej; Hazan, Ronen; Huys, Isabelle; Kakabadze, Elene; Łobocka, Małgorzata; Maestri, Alice; Makalatia, Khatuna; Malik, Danish J.; Mašlaňová, Ivana; Merabishvili, Maia; Rose, Thomas; Štveráková, Dana; Van Raemdonck, Hilde; Verbeken, Gilbert; Chanishvili, Nina

2018-01-01

Phage therapy is increasingly put forward as a “new” potential tool in the fight against antibiotic resistant infections. During the “Centennial Celebration of Bacteriophage Research” conference in Tbilisi, Georgia on 26–29 June 2017, an international group of phage researchers committed to elaborate an expert opinion on three contentious phage therapy related issues that are hampering clinical progress in the field of phage therapy. This paper explores and discusses bacterial phage resistance, phage training and the presence of prophages in bacterial production strains while reviewing relevant research findings and experiences. Our purpose is to inform phage therapy stakeholders such as policy makers, officials of the competent authorities for medicines, phage researchers and phage producers, and members of the pharmaceutical industry. This brief also points out potential avenues for future phage therapy research and development as it specifically addresses those overarching questions that currently call for attention whenever phages go into purification processes for application. PMID:29621199

Graphic Novels in Libraries: An Expert's Opinion

ERIC Educational Resources Information Center

Foster, Katy

2004-01-01

Barbara Gordon a librarian and computer expert from Gotham city is a genius level intellect and photographic memory expert at research and analysis. According to her, graphic novels and comics are wildly appealing to readers of all ages and intensely popular with adolescents.

[Expert assessment of hearing loss within the scope of the social compensation law and the law regarding severely handicapped patients].

PubMed

Plath, P

1992-10-01

Special problems are described concerning expert opinions on hearing disability and hearing loss with regard to the German Social Rights for Compensation and the laws for handicapped persons. In some aspects there are similarities to the rights of accident insurance, but disability programs question only the degree of handicap present and not the source of the hearing loss. The expert opinion on the subject's ability to work in his or any other profession must only determine the patient's ability to hear and the tasks needed to fulfill the profession. Special attention is given to the problems arising from tinnitus.

38 CFR 3.328 - lndependent medical opinions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... would be harmful to the physical or mental health of the claimant, disclosure shall be subject to the... experts who are not employees of VA. Opinions shall be obtained from recognized medical schools...

Using expert opinion surveys to rank threats to endangered species: a case study with sea turtles.

PubMed

Donlan, C Josh; Wingfield, Dana K; Crowder, Larry B; Wilcox, Chris

2010-12-01

Little is known about how specific anthropogenic hazards affect the biology of organisms. Quantifying the effect of regional hazards is particularly challenging for species such as sea turtles because they are migratory, difficult to study, long lived, and face multiple anthropogenic threats. Expert elicitation, a technique used to synthesize opinions of experts while assessing uncertainty around those views, has been in use for several decades in the social science and risk assessment sectors. We conducted an internet-based survey to quantify expert opinion on the relative magnitude of anthropogenic hazards to sea turtle populations at the regional level. Fisheries bycatch and coastal development were most often ranked as the top hazards to sea turtle species in a geographic region. Nest predation and direct take followed as the second and third greatest threats, respectively. Survey results suggest most experts believe sea turtles are threatened by multiple factors, including substantial at-sea threats such as fisheries bycatch. Resources invested by the sea turtle community, however, appear biased toward terrestrial-based impacts. Results from the survey are useful for conservation planning because they provide estimates of relative impacts of hazards on sea turtles and a measure of consensus on the magnitude of those impacts among researchers and practitioners. Our survey results also revealed patterns of expert bias, which we controlled for in our analysis. Respondents with no experience with respect to a sea turtle species tended to rank hazards affecting that sea turtle species higher than respondents with experience. A more-striking pattern was with hazard-based expertise: the more experience a respondent had with a specific hazard, the higher the respondent scored the impact of that hazard on sea turtle populations. Bias-controlled expert opinion surveys focused on threatened species and their hazards can help guide and expedite species recovery plans. © 2010 Society for Conservation Biology.

29 CFR 18.701 - Opinion testimony by lay witnesses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Opinion testimony by lay witnesses. 18.701 Section 18.701 Labor Office of the Secretary of Labor RULES OF PRACTICE AND PROCEDURE FOR ADMINISTRATIVE HEARINGS... Opinion testimony by lay witnesses. If the witness is not testifying as an expert, the witness' testimony...

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 reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and "evidence-informed deliberative processes" where the trade-offs along the 3 dimensions of UHC-extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures-can be discussed in a transparent and contextualized setting. © Paul et al.

Psychological and interpersonal dimensions of sexual function and dysfunction.

PubMed

Althof, Stanley E; Leiblum, Sandra R; Chevret-Measson, Marie; Hartmann, Uwe; Levine, Stephen B; McCabe, Marita; Plaut, Michael; Rodrigues, Oswaldo; Wylie, Kevan

2005-11-01

There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms. To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research. An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countries. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides a compelling reason for skepticism that any single intervention (i.e., a phosphodiesterase type 5 inhibitor, supraphysiological doses of a hormone, processing of childhood victimization, marital therapy, pharmacotherapy of depression, etc.) will be sufficient for most patients or couples experiencing sexual dysfunction. There is need for collaboration between healthcare practitioners from different disciplines in evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. Assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG).

PubMed

2018-04-01

Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.

a New Method for Fmeca Based on Fuzzy Theory and Expert System

NASA Astrophysics Data System (ADS)

Byeon, Yoong-Tae; Kim, Dong-Jin; Kim, Jin-O.

2008-10-01

Failure Mode Effects and Criticality Analysis (FMECA) is one of most widely used methods in modern engineering system to investigate potential failure modes and its severity upon the system. FMECA evaluates criticality and severity of each failure mode and visualize the risk level matrix putting those indices to column and row variable respectively. Generally, those indices are determined subjectively by experts and operators. However, this process has no choice but to include uncertainty. In this paper, a method for eliciting expert opinions considering its uncertainty is proposed to evaluate the criticality and severity. In addition, a fuzzy expert system is constructed in order to determine the crisp value of risk level for each failure mode. Finally, an illustrative example system is analyzed in the case study. The results are worth considering in deciding the proper policies for each component of the system.

The Use of Expert Opinion to Assess the Risk of Emergence or Re-Emergence of Infectious Diseases in Canada Associated with Climate Change

PubMed Central

Cox, Ruth; Revie, Crawford W.; Sanchez, Javier

2012-01-01

Global climate change is predicted to lead to an increase in infectious disease outbreaks. Reliable surveillance for diseases that are most likely to emerge is required, and given limited resources, policy decision makers need rational methods with which to prioritise pathogen threats. Here expert opinion was collected to determine what criteria could be used to prioritise diseases according to the likelihood of emergence in response to climate change and according to their impact. We identified a total of 40 criteria that might be used for this purpose in the Canadian context. The opinion of 64 experts from academic, government and independent backgrounds was collected to determine the importance of the criteria. A weight was calculated for each criterion based on the expert opinion. The five that were considered most influential on disease emergence or impact were: potential economic impact, severity of disease in the general human population, human case fatality rate, the type of climate that the pathogen can tolerate and the current climatic conditions in Canada. There was effective consensus about the influence of some criteria among participants, while for others there was considerable variation. The specific climate criteria that were most likely to influence disease emergence were: an annual increase in temperature, an increase in summer temperature, an increase in summer precipitation and to a lesser extent an increase in winter temperature. These climate variables were considered to be most influential on vector-borne diseases and on food and water-borne diseases. Opinion about the influence of climate on air-borne diseases and diseases spread by direct/indirect contact were more variable. The impact of emerging diseases on the human population was deemed more important than the impact on animal populations. PMID:22848536

Evaluation of soil erosion risk using Analytic Network Process and GIS: a case study from Spanish mountain olive plantations.

PubMed

Nekhay, Olexandr; Arriaza, Manuel; Boerboom, Luc

2009-07-01

The study presents an approach that combined objective information such as sampling or experimental data with subjective information such as expert opinions. This combined approach was based on the Analytic Network Process method. It was applied to evaluate soil erosion risk and overcomes one of the drawbacks of USLE/RUSLE soil erosion models, namely that they do not consider interactions among soil erosion factors. Another advantage of this method is that it can be used if there are insufficient experimental data. The lack of experimental data can be compensated for through the use of expert evaluations. As an example of the proposed approach, the risk of soil erosion was evaluated in olive groves in Southern Spain, showing the potential of the ANP method for modelling a complex physical process like soil erosion.

Combining analytical hierarchy process and agglomerative hierarchical clustering in search of expert consensus in green corridors development management.

PubMed

Shapira, Aviad; Shoshany, Maxim; Nir-Goldenberg, Sigal

2013-07-01

Environmental management and planning are instrumental in resolving conflicts arising between societal needs for economic development on the one hand and for open green landscapes on the other hand. Allocating green corridors between fragmented core green areas may provide a partial solution to these conflicts. Decisions regarding green corridor development require the assessment of alternative allocations based on multiple criteria evaluations. Analytical Hierarchy Process provides a methodology for both a structured and consistent extraction of such evaluations and for the search for consensus among experts regarding weights assigned to the different criteria. Implementing this methodology using 15 Israeli experts-landscape architects, regional planners, and geographers-revealed inherent differences in expert opinions in this field beyond professional divisions. The use of Agglomerative Hierarchical Clustering allowed to identify clusters representing common decisions regarding criterion weights. Aggregating the evaluations of these clusters revealed an important dichotomy between a pragmatist approach that emphasizes the weight of statutory criteria and an ecological approach that emphasizes the role of the natural conditions in allocating green landscape corridors.

Survey of Opinions on the Primacy of "g" and Social Consequences of Ability Testing: A Comparison of Expert and Non-Expert Views

ERIC Educational Resources Information Center

Reeve, Charlie L.; Charles, Jennifer E.

2008-01-01

The current study examines the views of experts in the science of mental abilities about the primacy and uniqueness of "g" and the social implications of ability testing, and compares their responses to the views of a group of non-expert psychologists. Results indicate expert consensus that "g" is an important, non-trivial determinant (or at least…

Factors Influencing Continuing Professional Development: A Delphi Study among Nursing Experts

ERIC Educational Resources Information Center

Brekelmans, Gerard; Poell, Rob F.; van Wijk, Kees

2013-01-01

Purpose: The aim of this paper is to present an inventory of expert opinions on the factors that influence the participation of registered nurses in continuing professional development (CPD) activities. Design/methodology/approach: A Delphi study was conducted among 38 Dutch experts (nursing employers, managers, education institutions, and…

Somatic diseases in child survivors of the Holocaust with posttraumatic stress disorder: a comparative study.

PubMed

Sperling, Wolfgang; Kreil, Sebastian; Biermann, Teresa

2012-05-01

The incidence of mental and somatic sequelae has been shown to be very high in people who survived the Holocaust. In the current study, 80 Holocaust survivors with posttraumatic stress disorder were examined based on evaluation of their complete record (medical reports, clinical history, medical statements, and handwritten declarations of patients under oath). These survivors were compared with subjects with posttraumatic stress disorder caused by traumata other than the Holocaust. The data were analyzed for the presence of cardiovascular, gastrointestinal, and orthopedic diseases that developed in the time between the earliest medical report (expert opinion) and the latest expert opinion. Analysis revealed an increase in myocardial infarction, chronic degenerative diseases, and cancerous changes in the second expert opinion. No differences between the groups were seen with regard to sex, age at traumatization, or age at examination. Several implications of the data are discussed, including the implication that the survivors examined in this study may comprise a highly resilient group, inasmuch as they had reached an advanced age.

Parameterization of the InVEST Crop Pollination Model to spatially predict abundance of wild blueberry (Vaccinium angustifolium Aiton) native bee pollinators in Maine, USA

USGS Publications Warehouse

Groff, Shannon C.; Loftin, Cynthia S.; Drummond, Frank; Bushmann, Sara; McGill, Brian J.

2016-01-01

Non-native honeybees historically have been managed for crop pollination, however, recent population declines draw attention to pollination services provided by native bees. We applied the InVEST Crop Pollination model, developed to predict native bee abundance from habitat resources, in Maine's wild blueberry crop landscape. We evaluated model performance with parameters informed by four approaches: 1) expert opinion; 2) sensitivity analysis; 3) sensitivity analysis informed model optimization; and, 4) simulated annealing (uninformed) model optimization. Uninformed optimization improved model performance by 29% compared to expert opinion-informed model, while sensitivity-analysis informed optimization improved model performance by 54%. This suggests that expert opinion may not result in the best parameter values for the InVEST model. The proportion of deciduous/mixed forest within 2000 m of a blueberry field also reliably predicted native bee abundance in blueberry fields, however, the InVEST model provides an efficient tool to estimate bee abundance beyond the field perimeter.

Advance care planning in dementia: recommendations for healthcare professionals.

PubMed

Piers, Ruth; Albers, Gwenda; Gilissen, Joni; De Lepeleire, Jan; Steyaert, Jan; Van Mechelen, Wouter; Steeman, Els; Dillen, Let; Vanden Berghe, Paul; Van den Block, Lieve

2018-06-21

Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual's preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Following the Belgian Centre for Evidence-Based Medicine's procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.

School Construction Management: Expert Administrators Speak.

ERIC Educational Resources Information Center

Fickes, Michael

2001-01-01

Presents expert opinion on school construction management communication concerning educational needs, obtaining consensus among diverse groups, and envisioning what schools must offer in the future. Why furniture issues are also important is highlighted. (GR)

The effectiveness of psychological first aid as a disaster intervention tool: research analysis of peer-reviewed literature from 1990-2010.

PubMed

Fox, Jeffrey H; Burkle, Frederick M; Bass, Judith; Pia, Francesco A; Epstein, Jonathan L; Markenson, David

2012-10-01

The Advisory Council of the American Red Cross Disaster Services requested that an independent study determine whether first-aid providers without professional mental health training, when confronted with people who have experienced a traumatic event, offer a "safe, effective and feasible intervention." Standard databases were searched by an expert panel from 1990 to September 2010 using the keyword phrase "psychological first aid." Documents were included if the process was referred to as care provided to victims, first responders, or volunteers and excluded if it was not associated with a disaster or mass casualty event, or was used after individual nondisaster traumas such as rape and murder. This search yielded 58 citations. It was determined that adequate scientific evidence for psychological first aid is lacking but widely supported by expert opinion and rational conjecture. No controlled studies were found. There is insufficient evidence supporting a treatment standard or a treatment guideline. Sufficient evidence for psychological first aid is widely supported by available objective observations and expert opinion and best fits the category of "evidence informed" but without proof of effectiveness. An intervention provided by volunteers without professional mental health training for people who have experienced a traumatic event offers an acceptable option. Further outcome research is recommended.

Promoting ethical and objective practice in the medicolegal arena of disability evaluation.

PubMed

Martelli, M F; Zasler, N D; Johnson-Greene, D

2001-08-01

As providers of medical information and testimony, clinicians have ultimate responsibility for ethical conduct as it relates to this information. The authors offer the following recommendations for enhancing ethical relationships between expert clinicians and the courts. 1. Avoid or resist attorney efforts at enticement into joining the attorney-client team. Such compromises of scientific boundaries and ethical principles exist on a continuum ranging from standard attorney-client advocacy at the beginning of the expert consultation phase (e.g., promotional information at the forefront of retaining an expert, with either provision of selective or incomplete records or less than enthusiastic efforts to produce all records) and extending to completion of evaluation, when requests for changes in reports and documentation might be made. 2. Respect role boundaries and do not mix conflicting roles. Remember that the treating doctor possesses a bond with the patient but does not as a rule obtain complete preinjury and postinjury information in the context of assessing causality and apportionment. In contrast, the expert witness must conduct a thorough and multifaceted case analysis sans the physician-patient relationship in order to facilitate objectivity and allow optimum diagnostic formulations. Finally, the trial consultant's function in this adversarial process is to assist with critically scrutinizing and attacking positions of experts for the opposing side. These roles all represent inherently different interests, and mixing them can only reduce objectivity. 3. Insist on adequate time for thorough record review, evaluation, and report generation. Also insist on sufficient time and preparation for deposition and court appearances. 4. Work at building a reputation for general objectivity, reliance on multiple data sources, reaching opinions only after reviewing complete information from both sides, and completing the evaluation. 5. Spend a good amount of time actually treating the patient population being examined or being offered testimony about. This treatment should be current and should be of a similar frequency to treating practitioner specialists. Be able to discuss relevant research and scientific methodology issues competently and without notes. 6. Arrive at opinions only after reviewing all of the evidence from both sides of the adversarial fence, employing multiple data sources, completing the evaluation, and interpreting data within the full context of comprehensive historical, behavioral observation, and contextual information. Being otherwise favorable to retaining attorney interests suggests endorsement of "opinion prostitute," "scientific perjurer," or "hired gun" status. The only way a practitioner can reduce the likelihood of facing an "opinion prostitute" on the opposing side in future cases is to insist on establishing and maintaining a reputation for scientific objectivity. 7. Balance cases from plaintiff and defense attorneys. Predilection for one side or the other suggests bias and sets up predisposition to nonobjectivity. For example, a preponderance of plaintiff work suggests an overdiagnosis or uncritical sympathy bias, whereas a ratio that favors hiring by the defense suggests an underdiagnosis or skepticism bias. Perhaps Brodsky's suggested cut-off ratio of .8 for favorability findings would represent an initial cutoff for defense versus plaintiff ratio. That is, experts should do at least 20% work for the opposite side of the current case being represented. Further, it might be a reasonable expectation that data on these ratios be collected as an important method for ensuring objective opinions. 8. Ensure against excessive favorability to the side of the retaining attorney or firm. Objectivity demands that scientific opinions not be influenced by the position of the legal advocate. Importantly, Brodsky recommends using a ratio of .8 as a cut-off for detecting excessive bias. That is, practitioners should possess prerequisite objectivity to disagree with the referring attorney at least 20% of the time. We suggest that a more useful cut-off would be .75, where experts are expected to generate findings that do not support the referring attorney's position at least 25% of the time. 9. Never arrive at opinions that are inconsistent with plaintiff records, examination data, test data, behavioral presentation, and so forth, especially when such opinions are favorable to the side of the retaining attorney firm. Instead, use the following recommendations. (ABSTRACT TRUNCATED)

BAYESIAN META-ANALYSIS ON MEDICAL DEVICES: APPLICATION TO IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

PubMed Central

Youn, Ji-Hee; Lord, Joanne; Hemming, Karla; Girling, Alan; Buxton, Martin

2012-01-01

Objectives: The aim of this study is to describe and illustrate a method to obtain early estimates of the effectiveness of a new version of a medical device. Methods: In the absence of empirical data, expert opinion may be elicited on the expected difference between the conventional and modified devices. Bayesian Mixed Treatment Comparison (MTC) meta-analysis can then be used to combine this expert opinion with existing trial data on earlier versions of the device. We illustrate this approach for a new four-pole implantable cardioverter defibrillator (ICD) compared with conventional ICDs, Class III anti-arrhythmic drugs, and conventional drug therapy for the prevention of sudden cardiac death in high risk patients. Existing RCTs were identified from a published systematic review, and we elicited opinion on the difference between four-pole and conventional ICDs from experts recruited at a cardiology conference. Results: Twelve randomized controlled trials were identified. Seven experts provided valid probability distributions for the new ICDs compared with current devices. The MTC model resulted in estimated relative risks of mortality of 0.74 (0.60–0.89) (predictive relative risk [RR] = 0.77 [0.41–1.26]) and 0.83 (0.70–0.97) (predictive RR = 0.84 [0.55–1.22]) with the new ICD therapy compared to Class III anti-arrhythmic drug therapy and conventional drug therapy, respectively. These results showed negligible differences from the preliminary results for the existing ICDs. Conclusions: The proposed method incorporating expert opinion to adjust for a modification made to an existing device may play a useful role in assisting decision makers to make early informed judgments on the effectiveness of frequently modified healthcare technologies. PMID:22559753

Using expert opinion to quantify unmeasured confounding bias parameters.

PubMed

Navadeh, Soodabeh; Mirzazadeh, Ali; McFarland, Willi; Woolf-King, Sarah; Mansournia, Mohammad Ali

2016-06-27

To develop and apply a method to quantify bias parameters in the case example of the association between alcohol use and HIV-serodiscordant condomless anal sex with potential confounding by sensation seeking among men who have sex with men (MSM), using expert opinion as an external data source. Through an online survey, we sought the input of 41 epidemiologist and behavioural scientists to quantify six parameters in the population of MSM: the proportion of high sensation seeking among heavy-drinking MSM, the proportion of sensation seeking among low-level drinking MSM, and the risk ratio (RR) of the association between sensation seeking and condomless anal sex, for HIV-positive and HIV-negative MSM. Eleven experts responded. For HIV-positive heavy drinkers, the proportion of high sensation seeking was 53.6% (beta distribution [α=5.50, β=4.78]), and 41.1% (beta distribution [α=3.10, β=4.46]) in HIV-negative heavy drinkers. In HIV-positive low-level alcohol drinkers, high sensation seeking was 26.9% (beta distribution [α=1.81, β=4.92]), similar to high sensation seeking among HIV-negative low-level alcohol drinkers (25.3%) (beta distribution [α=2.00, β=5.89]). The lnRR for the association between sensation seeking and condomless anal sex was ln(2.4) (normal distribution [μ=0.889, σ=0.438]) in HIV-positive and ln(1.5) (normal distribution [μ=0.625, σ=0.391]) in HIV-negative MSM. Expert opinion can be a simple and efficient method for deriving bias parameters to quantify and adjust for hypothesized confounding. In this test case, expert opinion confirmed sensation seeking as a confounder for the effect of alcohol on condomless anal sex and provided the parameters necessary for probabilistic bias analysis.

Assessing the probability of introduction and spread of avian influenza (AI) virus in commercial Australian poultry operations using an expert opinion elicitation

PubMed Central

Toribio, Jenny-Ann; Scott, Angela Bullanday; Groves, Peter; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Black, Amanda; Hernandez-Jover, Marta

2018-01-01

The objective of this study was to elicit experts’ opinions and gather estimates on the perceived probability of introduction and spread of avian influenza (AI) virus in the Australian broiler and layer industry. Using a modified Delphi method and a 4-step elicitation process, 11 experts were asked to give initial individual estimates for the various pathways and practices in the presented scenarios using a questionnaire. Following this, a workshop was conducted to present group averages of estimates and discussion was facilitated to obtain final individual estimates. For each question, estimates for all experts were combined using a discrete distribution, with weights allocated representing the level of expertise. Indirect contact with wild birds either via a contaminated water source or fomites was considered the most likely pathway of introduction of low pathogenic avian influenza (LPAI) on poultry farms. Presence of a water body near the poultry farm was considered a potential pathway for introduction only when the operation type was free range and the water body was within 500m distance from the shed. The probability that LPAI will mutate to highly pathogenic avian influenza (HPAI) was considered to be higher in layer farms. Shared personnel, equipment and aerosol dispersion were the most likely pathways of shed to shed spread of the virus. For LPAI and HPAI spread from farm to farm, shared pick-up trucks for broiler and shared egg trays and egg pallets for layer farms were considered the most likely pathways. Findings from this study provide an insight on most influential practices on the introduction and spread of AI virus among commercial poultry farms in Australia, as elicited from opinions of experts. These findings will be used to support parameterization of a modelling study assessing the risk of AI introduction and spread among commercial poultry farms in Australia. PMID:29494696

A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

PubMed Central

Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-01-01

Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope®; Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations. PMID:25347226

A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

PubMed

Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-03-01

Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.

Numerical Algorithms for the Analysis of Expert Opinions Elicited in Text Format

DTIC Science & Technology

2013-04-01

generative process just described actually means. No “real” intelligible document will ever be gen- erated from such a process, rather, a bag of words...Linguistics, 1992, pp. 977–981. Bra89. N. Bratchell, Cluster analysis, Chememeotrics and Intelligent Laboratory Sys- tems 6 (1989), 105–125. Bre99. P...with graphical models, Journal of Arti- ficial Intelligence Research 2 96 (1994), 159–225. UNCLASSIFIED 39 DSTO–TR–2797 UNCLASSIFIED Bun02. Wray L

Knowledge acquisition for medical diagnosis using collective intelligence.

PubMed

Hernández-Chan, G; Rodríguez-González, A; Alor-Hernández, G; Gómez-Berbís, J M; Mayer-Pujadas, M A; Posada-Gómez, R

2012-11-01

The wisdom of the crowds (WOC) is the process of taking into account the collective opinion of a group of individuals rather than a single expert to answer a question. Based on this assumption, the use of processes based on WOC techniques to collect new biomedical knowledge represents a challenging and cutting-edge trend on biomedical knowledge acquisition. The work presented in this paper shows a new schema to collect diagnosis information in Diagnosis Decision Support Systems (DDSS) based on collective intelligence and consensus methods.

Validation of a published case definition for tuberculosis-associated immune reconstitution inflammatory syndrome.

PubMed

Haddow, Lewis J; Moosa, Mahomed-Yunus S; Easterbrook, Philippa J

2010-01-02

To evaluate the International Network for the Study of HIV-associated IRIS (INSHI) case definitions for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRIS) in a South African cohort. Prospective cohort of 498 adult HIV-infected patients initiating antiretroviral therapy. Patients were followed up for 24 weeks and all clinical events were recorded. Events with TB-IRIS as possible cause were assessed by consensus expert opinion and INSHI case definition. Positive, negative, and chance-corrected agreement (kappa) were calculated, and reasons for disagreement were assessed. One hundred and two (20%) patients were receiving TB therapy at antiretroviral therapy initiation. Three hundred and thirty-three events were evaluated (74 potential paradoxical IRIS, 259 potential unmasking IRIS). Based on expert opinion, there were 18 cases of paradoxical IRIS associated with TB and/or other opportunistic disease. The INSHI criteria for TB-IRIS agreed in 13 paradoxical cases, giving positive agreement of 72.2%, negative agreement in 52/56 non-TB-IRIS events (92.9%), and kappa of 0.66. There were 19 unmasking TB-IRIS cases based on expert opinion, of which 12 were considered IRIS using the INSHI definition (positive agreement 63.2%). There was agreement in all 240 non-TB-IRIS events (negative agreement 100%) and kappa was 0.76. There was good agreement between the INSHI case definition for both paradoxical and unmasking TB-IRIS and consensus expert opinion. These results support the use of this definition in clinical and research practice, with minor caveats in its application.

Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting.

PubMed

Donaldson, Ian A; Alonzi, Roberto; Barratt, Dean; Barret, Eric; Berge, Viktor; Bott, Simon; Bottomley, David; Eggener, Scott; Ehdaie, Behfar; Emberton, Mark; Hindley, Richard; Leslie, Tom; Miners, Alec; McCartan, Neil; Moore, Caroline M; Pinto, Peter; Polascik, Thomas J; Simmons, Lucy; van der Meulen, Jan; Villers, Arnauld; Willis, Sarah; Ahmed, Hashim U

2015-04-01

Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field. To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design. Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health. Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level. Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging-targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3+3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus. The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy. In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Focal Therapy: Patients, Interventions, and Outcomes—A Report from a Consensus Meeting

PubMed Central

Donaldson, Ian A.; Alonzi, Roberto; Barratt, Dean; Barret, Eric; Berge, Viktor; Bott, Simon; Bottomley, David; Eggener, Scott; Ehdaie, Behfar; Emberton, Mark; Hindley, Richard; Leslie, Tom; Miners, Alec; McCartan, Neil; Moore, Caroline M.; Pinto, Peter; Polascik, Thomas J.; Simmons, Lucy; van der Meulen, Jan; Villers, Arnauld; Willis, Sarah; Ahmed, Hashim U.

2015-01-01

Background Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field. Objective To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design. Design, setting, and participants Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health. Outcome measurements and statistical analysis Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level. Results and limitations Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging–targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5 mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3 + 3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus. Conclusions The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy. Patient summary In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer. PMID:25281389

Cancer Battles and the Sleep of Reason policy and science need not be related.

PubMed

Bennett, David

2003-01-01

Cancer Battles and the Sleep of Reason is an inquiry into the role of scientific experts in environmental health policy-making. The article first establishes two propositions: that there is no necessary relationship between science and environmental health policy; and that risk assessment is not the only science of environmental health. It then asks the question: why should policy-makers consult the scientific experts? If experts are to be consulted, there will have to be some way of grading experts as to the quality of their advice and their usefulness to policy-makers. A mode of grading experts is provided in Environmental Cancer--A Political Disease? by S. Robert Lichter and Stanley Rothman. But the arguments in this book are shown to be worthless; the book fails to address the underlying issue of why the experts should be consulted at all. The article concludes that experts are to be consulted whenever policy-makers consider their advice to be essential or useful. There is nothing in the scientific disciplines that entrenches them in the policymaking process; the opinions of scientific experts have no special place in environmental health policy.

Utilizing Expert Knowledge in Estimating Future STS Costs

NASA Technical Reports Server (NTRS)

Fortner, David B.; Ruiz-Torres, Alex J.

2004-01-01

A method of estimating the costs of future space transportation systems (STSs) involves classical activity-based cost (ABC) modeling combined with systematic utilization of the knowledge and opinions of experts to extend the process-flow knowledge of existing systems to systems that involve new materials and/or new architectures. The expert knowledge is particularly helpful in filling gaps that arise in computational models of processes because of inconsistencies in historical cost data. Heretofore, the costs of planned STSs have been estimated following a "top-down" approach that tends to force the architectures of new systems to incorporate process flows like those of the space shuttles. In this ABC-based method, one makes assumptions about the processes, but otherwise follows a "bottoms up" approach that does not force the new system architecture to incorporate a space-shuttle-like process flow. Prototype software has been developed to implement this method. Through further development of software, it should be possible to extend the method beyond the space program to almost any setting in which there is a need to estimate the costs of a new system and to extend the applicable knowledge base in order to make the estimate.

A comparison of two methods for expert elicitation in health technology assessments.

PubMed

Grigore, Bogdan; Peters, Jaime; Hyde, Christopher; Stein, Ken

2016-07-26

When data needed to inform parameters in decision models are lacking, formal elicitation of expert judgement can be used to characterise parameter uncertainty. Although numerous methods for eliciting expert opinion as probability distributions exist, there is little research to suggest whether one method is more useful than any other method. This study had three objectives: (i) to obtain subjective probability distributions characterising parameter uncertainty in the context of a health technology assessment; (ii) to compare two elicitation methods by eliciting the same parameters in different ways; (iii) to collect subjective preferences of the experts for the different elicitation methods used. Twenty-seven clinical experts were invited to participate in an elicitation exercise to inform a published model-based cost-effectiveness analysis of alternative treatments for prostate cancer. Participants were individually asked to express their judgements as probability distributions using two different methods - the histogram and hybrid elicitation methods - presented in a random order. Individual distributions were mathematically aggregated across experts with and without weighting. The resulting combined distributions were used in the probabilistic analysis of the decision model and mean incremental cost-effectiveness ratios and the expected values of perfect information (EVPI) were calculated for each method, and compared with the original cost-effectiveness analysis. Scores on the ease of use of the two methods and the extent to which the probability distributions obtained from each method accurately reflected the expert's opinion were also recorded. Six experts completed the task. Mean ICERs from the probabilistic analysis ranged between £162,600-£175,500 per quality-adjusted life year (QALY) depending on the elicitation and weighting methods used. Compared to having no information, use of expert opinion decreased decision uncertainty: the EVPI value at the £30,000 per QALY threshold decreased by 74-86 % from the original cost-effectiveness analysis. Experts indicated that the histogram method was easier to use, but attributed a perception of more accuracy to the hybrid method. Inclusion of expert elicitation can decrease decision uncertainty. Here, choice of method did not affect the overall cost-effectiveness conclusions, but researchers intending to use expert elicitation need to be aware of the impact different methods could have.

Engagement and Education

PubMed Central

Tosh, Pritish K.; Hick, John L.; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M.; Shah, Umair A.; Fagbuyi, Daniel B.; Skippen, Peter; Dichter, Jeffrey R.; Kissoon, Niranjan; Christian, Michael D.; Upperman, Jeffrey S.; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

2014-01-01

BACKGROUND: Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS: The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians. PMID:25144161

[Medico-legal opinion in establishing "exposure to direct danger of death or grave detriment to health"].

PubMed

Jurek, Tomasz; Maksymowicz, Krzysztof

2005-01-01

This paper deals with the problem of competence of the forensic expert opinions on the exposure to "direct danger of death or grave detriment to health". According to the analysis of judicial verdicts and the comments of lawyers "direct danger" depends closely on the probability, time and number of occurrences between the behavior of the perpetrator and the threatening act. The competence of the forensic expert does not allow for the legal qualification of the act but for the assessment of from the medicolegal point of view, defining the threat and possible outcomes in a descriptive fashion. The assessment of "direct danger" should be the result of close cooperation between the judicial representative and forensic expert.

[Recommendations for terminating child custody--reasons and grounds in 30 expert decisions].

PubMed

Klosinski, G; Karle, M

1996-11-01

In a retrospective analysis 30 expert opinions on the right of visitation, which recommend the exclusion of this right for the non-custodial parent, are evaluated. These cases represent 23% of the expert opinions concerning the right of visitation that have been given by the department of Child and Adolescent Psychiatry of the University of Tübingen between 1991 and 1994. Focusing on the decisive argument for the expert to exclude the right of visitation, it became apparent that in 40% of the cases the will of the child was the determining factor, followed by sustained tension between the parents in 33% of the cases. Emotional neglect, (continuous) abuse and maltreatment (12%) as well as offences against the clause of good behaviour (Wohlverhaltensklausel) were of significant smaller influence on the decision. And although 61% of the children have been classified as psychological disturbed, only in 5% of the cases this diagnosis was of importance.

On the "general acceptance" of eyewitness testimony research. A new survey of the experts.

PubMed

Kassin, S M; Tubb, V A; Hosch, H M; Memon, A

2001-05-01

In light of recent advances, this study updated a prior survey of eyewitness experts (S. M. Kassin, P. C. Ellsworth, & V. L. Smith, 1989). Sixty-four psychologists were asked about their courtroom experiences and opinions on 30 eyewitness phenomena. By an agreement rate of at least 80%, there was a strong consensus that the following phenomena are sufficiently reliable to present in court: the wording of questions, lineup instructions, confidence malleability, mug-shot-induced bias, postevent information, child witness suggestibility, attitudes and expectations, hypnotic suggestibility, alcoholic intoxication, the crossrace bias, weapon focus, the accuracy-confidence correlation, the forgetting curve, exposure time, presentation format, and unconscious transference. Results also indicate that these experts set high standards before agreeing to testify. Despite limitations, these results should help to shape expert testimony so that it more accurately represents opinions in the scientific community.

Experts' Views Regarding the Conceptualization of Narcissism.

PubMed

Ackerman, Robert A; Hands, Aaron J; Donnellan, M Brent; Hopwood, Christopher J; Witt, Edward A

2017-06-01

There is debate over the definition of narcissism across social/personality and clinical psychology. The current article aims to quantify the level of disagreement by measuring experts' opinions concerning the attributes most central to narcissism. Accordingly, we developed a comprehensive list of attributes associated with narcissism and had 49 self-identified experts (among them 17 women, 23 psychologists from clinical psychology and 22 from social/personality psychology) rate these characteristics and provide their opinions on several issues related to the conceptualization of narcissism. Experts generally believe that the grandiose features of narcissism are more central than the vulnerable features. However, differences between clinical and social/personality psychologists were evident, especially regarding the relevance of self-esteem. Given the results, we suggest that researchers specify the kind of narcissism being assessed in a given study and consider using assessments of the full range of narcissistic features in future research to provide a more comprehensive perspective on the construct.

[The criteria for appointing experts in forensic medicine].

PubMed

Vojtíšek, Tomáš

In the Czech Republic, forensic medicine is an independent medical field, in which physicians with the appropriate attestation perform expert activities, especially in criminal proceedings, after being formally appointed by a regional court. In order to improve the quality of the activities provided by these experts, the Ministry of Justice is endeavouring to tighten up the general conditions for the appointment of new forensic experts. The individual criteria do not, however, take into account the special nature of forensic medicine as a medical field, the very essence of which involves the specialist qualifications which are necessary for the provision of expert opinions, most frequently to the police. In particular, the introduction of a strict requirement for ten-years of work experience after leaving medical school has hindered and stalled the entrance of young physicians with completed post-graduate studies into the area of forensic medicine. An inquiry sent to the regional courts has discovered that the average length of work experience for newly appointed experts in the period from 2004 to 2013 was 8.2 years, that half of them had work experience of seven years or less and that 75 percent of the newly appointed experts did not meet any set requirements for the length of their work experience at the time of their appointment. The new conditions may have a negative impact on attracting qualified graduates to forensic medicine after the completion of their medical studies and in the long term it may endanger the ability of the field of forensic medicine to provide expert opinions in criminal proceedings. In conclusion, it is the authors opinion that the appointment conditions should be set in cooperation with the professional medical associations and that they should take into account the specific characteristics of the individual medical fields, especially if they are to be set directly by means of a legal regulation within the framework of the recodification of the standing of forensic experts in the Czech Republic. forensic medicine - expertises - criminal procedure.

Dramatically Polarized Opinion on the Role of Brachytherapy Boost in Management of High-risk Prostate Cancer: A Survey of North American Genitourinary Expert Radiation Oncologists.

PubMed

McClelland, Shearwood; Sandler, Kiri A; Degnin, Catherine; Chen, Yiyi; Mitin, Timur

2018-06-01

Three randomized clinical trials have established brachytherapy (BT) boost in combination with external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT) as superior to definitive EBRT and ADT alone in terms of biochemical control (but not overall survival) at the expense of increased toxicity in men with high-risk (HR) prostate cancer (PCa). The current view regarding these 2 treatment algorithms among North American genitourinary (GU) experts is not known. A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to opinions regarding BT as monotherapy for low-risk PCa and BT boost for HR PCa. Responders were asked to self-identify as BT experts versus non-experts. Treatment recommendations were correlated with practice patterns using the Fisher exact test. Forty-two radiation oncologists completed the survey, of whom 23 (55%) recommend EBRT and ADT alone and 19 (45%) recommend addition of BT boost. Twenty-five participants (60%) identified themselves as BT experts. Nearly 90% of those recommending BT boost were BT experts versus approximately 10% of non-BT experts (P < .001). Responders who recommended BT monotherapy as first-choice treatment for low-risk PCa were more likely to recommend BT boost for HR PCa (P < .0001). There is a dramatic polarization in opinions regarding incorporation of BT boost into EBRT + ADT therapy for patients with HR PCa among North American GU radiation oncology experts, who serve on decision-making committees and influence the national treatment guidelines and future clinical trials. Those who identify themselves as BT experts are significantly more likely to recommend BT boost. These findings are likely to influence the national guidelines and implementation of BT boost in current and future North American PCa clinical studies. Copyright © 2018 Elsevier Inc. All rights reserved.

Expert scientific judgment and cancer risk assessment: a pilot study of pharmacokinetic data.

PubMed

Hawkins, N C; Graham, J D

1988-12-01

When high-dose tumor data are extrapolated to low doses, it is typically assumed that the dose of a carcinogen delivered to target cells is proportional to the dose administered to test animals, even at exposure levels below the experimental range. Since pharmacokinetic data are becoming available that in some cases question the validity of this assumption, risk assessors must decide whether to maintain the standard assumption. A pilot study of formaldehyde is reported that was undertaken to demonstrate how expert scientific judgment can help guide a controversial risk assessment where pharmacokinetic data are considered inconclusive. Eight experts on pharmacokinetic data were selected by a formal procedure, and each was interviewed personally using a structured interview protocol. The results suggest that expert scientific opinion is polarized in this case, a situation that risk assessors can respond to with a range of risk characterizations considered biologically plausible by the experts. Convergence of expert opinion is likely in this case of several specific research strategies ar executed in a competent fashion. Elicitation of expert scientific judgment is a promising vehicle for evaluating the quality of pharmacokinetic data, expressing uncertainty in risk assessment, and fashioning a research agenda that offers possible forging of scientific consensus.

40 CFR 159.153 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., aquatic plants (including macrophyte, floating, and submerged plants), and terrestrial (all non-aquatic... has relevant expert credentials, e.g., a medical doctor giving a medical opinion, a plant pathologist giving an opinion on plant pathology, etc. Registrant includes any person who holds, or ever held, a...

I.S.Mu.L.T. first-time patellar dislocation guidelines

PubMed Central

Vetrano, Mario; Oliva, Francesco; Bisicchia, Salvatore; Bossa, Michela; De Carli, Angelo; Di Lorenzo, Luigi; Erroi, Davide; Forte, Alfonso; Foti, Calogero; Frizziero, Antonio; Gasparre, Giuseppe; Via, Alessio Giai; Innocenti, Bernardo; Longo, Umile Giuseppe; Mahmoud, Asmaa; Masiero, Stefano; Mazza, Daniele; Natali, Simone; Notarangelo, Christian; Osti, Leonardo; Padulo, Johnny; Pellicciari, Leonardo; Perroni, Fabrizio; Piccirilli, Eleonora; Ramponi, Carlo; Salvatore, Giuseppe; Panni, Alfredo Schiavone; Suarez, Tania; Tarantino, Umberto; Vittadini, Filippo; Vulpiani, Maria Chiara; Ferretti, Andrea; Maffulli, Nicola

2017-01-01

Summary Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. Level of evidence: Ia. PMID:28717605

Human Resource Slack as an Antecedent to Instilling the Entrepreneurial Mindset within Department of Defense Organizations

DTIC Science & Technology

2003-03-01

complete the findings. 23 Through the available literature and the opinions of entrepreneurship /innovation experts within the academic community, a...the following criteria: (1) the formally expressed desire by the firm to pursue entrepreneurship and innovation in the firm’s processes and...would most closely resemble DoD organizations. Firm’s Desire to Pursue Entrepreneurship and Innovation Firms desiring innovation must be willing

Precision in Setting Cancer Prevention Priorities: Synthesis of Data, Literature, and Expert Opinion.

PubMed

Girschik, Jennifer; Miller, Laura Jean; Addiscott, Tony; Daube, Mike; Katris, Paul; Ransom, David; Slevin, Terry; Threlfall, Tim; Weeramanthri, Tarun Stephen

2017-01-01

Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30-40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention.

Precision in Setting Cancer Prevention Priorities: Synthesis of Data, Literature, and Expert Opinion

PubMed Central

Girschik, Jennifer; Miller, Laura Jean; Addiscott, Tony; Daube, Mike; Katris, Paul; Ransom, David; Slevin, Terry; Threlfall, Tim; Weeramanthri, Tarun Stephen

2017-01-01

Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30–40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention. PMID:28634579

Key attributes of expert NRL referees.

PubMed

Morris, Gavin; O'Connor, Donna

2017-05-01

Experiential knowledge of elite National Rugby League (NRL) referees was investigated to determine the key attributes contributing to expert officiating performance. Fourteen current first-grade NRL referees were asked to identify the key attributes they believed contributed to their expert refereeing performance. The modified Delphi method involved a 3-round process of an initial semi-structured interview followed by 2 questionnaires to reach consensus of opinion. The data revealed 25 attributes that were rated as most important that underpin expert NRL refereeing performance. Results illustrate the significance of the cognitive category, with the top 6 ranked attributes all cognitive skills. Of these, the referees ranked decision-making accuracy as the most important attribute, followed by reading the game, communication, game understanding, game management and knowledge of the rules. Player rapport, positioning and teamwork were the top ranked game skill attributes underpinning performance excellence. Expert referees also highlighted a number of psychological attributes (e.g., concentration, composure and mental toughness) that were significant to performance. There were only 2 physiological attributes (fitness, aerobic endurance) that were identified as significant to elite officiating performance. In summary, expert consensus was attained which successfully provided a hierarchy of the most significant attributes of expert NRL refereeing performance.

Paradigms of forensic science and legal process: a critical diagnosis

PubMed Central

Roberts, Paul

2015-01-01

This article reconsiders the relationship between criminal adjudication and forensic expertise in the light of ‘new paradigms' of forensic practice and recent law reform. It briefly summarizes conventional wisdom on the typical shortcomings of forensic science and other expert evidence, as a springboard for a more searching critical diagnosis of longstanding maladies. The fundamentally jurisdictional nature of law is emphasized, and some implications for expert testimony noted. English law's traditionally adversarial model of criminal procedure is then reassessed, taking account of a proper understanding of its normative structure and modern development, and drawing on comparative legal research and theorizing to obtain a more rounded second opinion. In conclusion, some avenues for intelligent prescription are canvassed, highlighting the importance of promoting and facilitating effective communication between experts, lawyers and courts, and prioritizing modest practical remedies over radical surgery. PMID:26101282

Eminence-based medicine versus evidence-based medicine: level V evidence in sports medicine.

PubMed

Tjoumakaris, Fotios P; Ganley, Theodore J; Kapur, Rahul; Kelly, John; Sennett, Brian J; Bernstein, Joseph

2011-11-01

Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: "It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters"; "Resistance training ('weight lifting') should be avoided until physeal closure"; "Jogging during pregnancy is to be avoided"; "At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present"; "Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently"; "The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history"; "Femoroacetabular impingement is a myth-the designation of anatomic variation as disease"; "An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail"; "Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle"; "Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice." One statement was accepted as true: "Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated." In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.

Comparative effectiveness research: what to do when experts disagree about risks.

PubMed

Lie, Reidar K; Chan, Francis K L; Grady, Christine; Ng, Vincent H; Wendler, David

2017-06-19

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees (ERCs) should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when "nothing is known" about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative(s). We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation.

Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.

PubMed

Djalali, Ahmadreza; Ingrassia, Pier Luigi; Corte, Francesco Della; Foletti, Marco; Gallardo, Alba Ripoll; Ragazzoni, Luca; Kaptan, Kubilay; Lupescu, Olivera; Arculeo, Chris; von Arnim, Gotz; Friedl, Tom; Ashkenazi, Michael; Heselmann, Deike; Hreckovski, Boris; Khorram-Manesh, Amir; Khorrram-Manesh, Amir; Komadina, Radko; Lechner, Kostanze; Patru, Cristina; Burkle, Frederick M; Fisher, Philipp

2014-08-01

Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training. This qualitative study was performed in 2013. A questionnaire-based evaluation of experts' opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data. This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters. The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services. Failures in leadership and in coordination among teams are also a problem. All deficiencies need to be applied to competency-based curricula.

Expertise, Domains, and the Consensual Assessment Technique

ERIC Educational Resources Information Center

Kaufman, James C.; Baer, John; Cole, Jason C.

2009-01-01

The Consensual Assessment Technique (CAT) argues that the most valid judgments of the creativity are those of the combined opinions of experts in the field. Yet who exactly qualifies as an expert to evaluate a creative product such as a short story? This study examines both novice and expert judgments of student short fiction. Results indicate a…

Idea Generation and Exploration: Benefits and Limitations of the Policy Delphi Research Method

ERIC Educational Resources Information Center

Franklin, Kathy K.; Hart, Jan K.

2007-01-01

Researchers use the policy Delphi method to explore a complex topic with little historical context that requires expert opinion to fully understand underlying issues. The benefit of this research technique is the use of experts who have more timely information than can be gleamed from extant literature. Additionally, those experts place…

Adaptation and validation of the REGEN expert system for the Central Appalachians

Treesearch

Lance A. Vickers; Thomas R. Fox; David L. Loftis; David A. Boucugnani

2011-01-01

REGEN is an expert system that predicts future species composition at the onset of stem exclusion using preharvest stand conditions. To extend coverage into hardwood stands of the Central Appalachians, we developed REGEN knowledge bases for four site qualities (xeric, subxeric, submesic, mesic) based on relevant literature and expert opinion. Data were collected from...

Reliability of clinical guideline development using mail-only versus in-person expert panels.

PubMed

Washington, Donna L; Bernstein, Steven J; Kahan, James P; Leape, Lucian L; Kamberg, Caren J; Shekelle, Paul G

2003-12-01

Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion. We tested whether a less expensive, mail-only process could substitute for the standard in-person process normally used. We performed a 4-way replication of the appropriateness panel process for coronary revascularization and hysterectomy, conducting 3 panels using the conventional in-person method and 1 panel entirely by mail. All indications were classified as inappropriate or not (to evaluate overuse), and coronary revascularization indications were classified as necessary or not (to evaluate underuse). Kappa statistics were calculated for the comparison in ratings from the 2 methods. Agreement beyond chance between the 2 panel methods ranged from moderate to substantial. The kappa statistic to detect overuse was 0.57 for coronary revascularization and 0.70 for hysterectomy. The kappa statistic to detect coronary revascularization underuse was 0.76. There were no cases in which coronary revascularization was considered inappropriate by 1 method, but necessary or appropriate by the other. Three of 636 (0.5%) hysterectomy cases were categorized as inappropriate by 1 method but appropriate by the other. The reproducibility of the overuse and underuse assessments from the mail-only compared with the conventional in-person conduct of expert panels in this application was similar to the underlying reproducibility of the process. This suggests a potential role for updating guidelines using an expert judgment process conducted entirely through the mail.

Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion.

PubMed

Barton, C J; Bonanno, D R; Carr, J; Neal, B S; Malliaras, P; Franklyn-Miller, A; Menz, H B

2016-05-01

Running-related injuries are highly prevalent. Synthesise published evidence with international expert opinion on the use of running retraining when treating lower limb injuries. Mixed methods. A systematic review of clinical and biomechanical findings related to running retraining interventions were synthesised and combined with semistructured interviews with 16 international experts covering clinical reasoning related to the implementation of running retraining. Limited evidence supports the effectiveness of transition from rearfoot to forefoot or midfoot strike and increase step rate or altering proximal mechanics in individuals with anterior exertional lower leg pain; and visual and verbal feedback to reduce hip adduction in females with patellofemoral pain. Despite the paucity of clinical evidence, experts recommended running retraining for: iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome. Tailoring approaches to each injury and individual was recommended to optimise outcomes. Substantial evidence exists for the immediate biomechanical effects of running retraining interventions (46 studies), including evaluation of step rate and strike pattern manipulation, strategies to alter proximal kinematics and cues to reduce impact loading variables. Our synthesis of published evidence related to clinical outcomes and biomechanical effects with expert opinion indicates running retraining warrants consideration in the treatment of lower limb injuries in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A methodology for uncertainty quantification in quantitative technology valuation based on expert elicitation

NASA Astrophysics Data System (ADS)

Akram, Muhammad Farooq Bin

The management of technology portfolios is an important element of aerospace system design. New technologies are often applied to new product designs to ensure their competitiveness at the time they are introduced to market. The future performance of yet-to- be designed components is inherently uncertain, necessitating subject matter expert knowledge, statistical methods and financial forecasting. Estimates of the appropriate parameter settings often come from disciplinary experts, who may disagree with each other because of varying experience and background. Due to inherent uncertain nature of expert elicitation in technology valuation process, appropriate uncertainty quantification and propagation is very critical. The uncertainty in defining the impact of an input on performance parameters of a system makes it difficult to use traditional probability theory. Often the available information is not enough to assign the appropriate probability distributions to uncertain inputs. Another problem faced during technology elicitation pertains to technology interactions in a portfolio. When multiple technologies are applied simultaneously on a system, often their cumulative impact is non-linear. Current methods assume that technologies are either incompatible or linearly independent. It is observed that in case of lack of knowledge about the problem, epistemic uncertainty is the most suitable representation of the process. It reduces the number of assumptions during the elicitation process, when experts are forced to assign probability distributions to their opinions without sufficient knowledge. Epistemic uncertainty can be quantified by many techniques. In present research it is proposed that interval analysis and Dempster-Shafer theory of evidence are better suited for quantification of epistemic uncertainty in technology valuation process. Proposed technique seeks to offset some of the problems faced by using deterministic or traditional probabilistic approaches for uncertainty propagation. Non-linear behavior in technology interactions is captured through expert elicitation based technology synergy matrices (TSM). Proposed TSMs increase the fidelity of current technology forecasting methods by including higher order technology interactions. A test case for quantification of epistemic uncertainty on a large scale problem of combined cycle power generation system was selected. A detailed multidisciplinary modeling and simulation environment was adopted for this problem. Results have shown that evidence theory based technique provides more insight on the uncertainties arising from incomplete information or lack of knowledge as compared to deterministic or probability theory methods. Margin analysis was also carried out for both the techniques. A detailed description of TSMs and their usage in conjunction with technology impact matrices and technology compatibility matrices is discussed. Various combination methods are also proposed for higher order interactions, which can be applied according to the expert opinion or historical data. The introduction of technology synergy matrix enabled capturing the higher order technology interactions, and improvement in predicted system performance.

50 CFR 221.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2012 CFR

2012-10-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

7 CFR 1.641 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2011 CFR

2011-01-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

7 CFR 1.641 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2012 CFR

2012-01-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

7 CFR 1.641 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2013 CFR

2013-01-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

50 CFR 221.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2014 CFR

2014-10-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

7 CFR 1.641 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2014 CFR

2014-01-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

50 CFR 221.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2011 CFR

2011-10-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

50 CFR 221.41 - How may parties obtain discovery of information needed for the case?

Code of Federal Regulations, 2013 CFR

2013-10-01

... legal theories of an attorney. (g) Experts. Unless restricted by the ALJ, a party may discover any facts known or opinions held by an expert concerning any relevant matters that are not privileged. Such...

Agile IT: Thinking in User-Centric Models

NASA Astrophysics Data System (ADS)

Margaria, Tiziana; Steffen, Bernhard

We advocate a new teaching direction for modern CS curricula: extreme model-driven development (XMDD), a new development paradigm designed to continuously involve the customer/application expert throughout the whole systems' life cycle. Based on the `One-Thing Approach', which works by successively enriching and refining one single artifact, system development becomes in essence a user-centric orchestration of intuitive service functionality. XMDD differs radically from classical software development, which, in our opinion is no longer adequate for the bulk of application programming - in particular when it comes to heterogeneous, cross organizational systems which must adapt to rapidly changing market requirements. Thus there is a need for new curricula addressing this model-driven, lightweight, and cooperative development paradigm that puts the user process in the center of the development and the application expert in control of the process evolution.

Ask the experts: the challenges and benefits of flow chemistry to optimize drug development.

PubMed

Anderson, Neal; Gernaey, Krist V; Jamison, Timothy F; Kircher, Manfred; Wiles, Charlotte; Leadbeater, Nicholas E; Sandford, Graham; Richardson, Paul

2012-09-01

Against a backdrop of a struggling economic and regulatory climate, pharmaceutical companies have recently been forced to develop new ways to provide more efficient technology to meet the demands of a competitive drug industry. This issue, coupled with an increase in patent legislation and a rising generics market, makes these themes common issues in the growth of drug development. As a consequence, the importance of process chemistry and scale-up has never been more under the spotlight. Future Medicinal Chemistry wishes to share the thoughts and opinions of a variety of experts from this field, discussing issues concerning the use of flow chemistry to optimize drug development, the potential regulatory and environmental challenges faced with this, and whether the academic and industrial sectors could benefit from a more harmonized system relevant to process chemistry.

Learning from Fiction: Applications in Emerging Technologies

ERIC Educational Resources Information Center

Gordon, Ruthanna

2009-01-01

Understanding the development of public opinion about emerging technologies, when the scope of that emergence is still speculative, poses particular challenges. Opinions and beliefs may be drawn from conflicting experts in multiple fields, media portrayals with varying biases, and fictional narratives that portray diverse possible futures. This…

Development and Cross-cultural Validation of the Korean Version of SMArtphone’s uSability Heuristics (SMASH)

PubMed Central

Jeong, Yeo Won

2017-01-01

Objectives The purpose of this study was to develop and cross-culturally validate the Korean version of SMArtphone's uSability Heuristics (K-SMASH). Methods In the study, it was used the adaptation process consisted of five stages, namely, translation, synthesis, back translation, expert committee review, and pretesting. In the pretesting stage, a mobile application, using the prefinal K-SMASH, was evaluated for the severity of usability problems by three experts in computer science and informatics. Each participant completed the evaluation and was interviewed about their understanding, interpretation, and opinion of the cultural relevance of the prefinal K-SMASH. Next, we reviewed the differences in the experts’ opinions and the questionnaire results. Results Twelve SMASH items, words and sentences, were translated, back translated, and revised, considering the conceptual meaning in the context of the Korean culture, by experts in various fields, including a Korean linguist and a bilingual translator, through the first stage to the fourth stage. In the pretesting stage, the results showed no major differences among the severity ratings of participants. Furthermore, all participants answered that there were no critical discrepancies or inconsistencies with the cultural relevance of the prefinal K-SMASH. Conclusions The results of the study provide preliminary evidence that the modified K-SMASH can be used for heuristic evaluation, one of the usability tests, when developing applications in Korea. PMID:29181243

Tocilizumab: therapy and safety management.

PubMed

Pham, Thao; Claudepierre, Pascal; Constantin, Arnaud; de Bandt, Michel; Fautrel, Bruno; Gossec, Laure; Gottenberg, Jacques-Eric; Goupille, Philippe; Guillaume, Séverine; Hachulla, Eric; Masson, Charles; Morel, Jacques; Puéchal, Xavier; Saraux, Alain; Schaeverbeke, Thierry; Wendling, Daniel; Bruckert, Eric; Pol, Stanislas; Mariette, Xavier; Sibilia, Jean

2010-06-01

To develop fact sheets about tocilizumab, in order to assist physicians in the management of patients with inflammatory joint disease. 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable; 2. identification and review of publications relevant to each topic; 3. development of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The 20 experts were rheumatologists and invited specialists in other fields, and they had extensive experience with the management of RA. They were members of the CRI (Club Rhumatismes et Inflammation), a section of the Société Francaise de Rhumatologie. Each fact sheet was revised by several. experts and the overall process was coordinated by three experts. Several topics of major interest were selected: contraindications of tocilizumab; the management of adverse effects and concomitant diseases that may develop during tocilizumab therapy; and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: Several topics of major interest were selected: contraindications of tocilizumab; the management of adverse effects and concomitant diseases that may develop during tocilizumab therapy; and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA, initiation and monitoring of tocilizumab therapy, management of patients with specific past histories, and specific clinical situations such as pregnancy; 2. diseases other than RA, such as juvenile idiopathic arthritis; 3. models of letters for informing the rheumatologist and general practitioner; 4. and patient information. These tocilizumab fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on tocilizumab therapy. They will be available continuously at www.cri-net.com and updated at appropriate intervals. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

Validation of a systems-actuarial computer process for multidimensional classification of child psychopathology.

PubMed

McDermott, P A; Hale, R L

1982-07-01

Tested diagnostic classifications of child psychopathology produced by a computerized technique known as multidimensional actuarial classification (MAC) against the criterion of expert psychological opinion. The MAC program applies series of statistical decision rules to assess the importance of and relationships among several dimensions of classification, i.e., intellectual functioning, academic achievement, adaptive behavior, and social and behavioral adjustment, to perform differential diagnosis of children's mental retardation, specific learning disabilities, behavioral and emotional disturbance, possible communication or perceptual-motor impairment, and academic under- and overachievement in reading and mathematics. Classifications rendered by MAC are compared to those offered by two expert child psychologists for cases of 73 children referred for psychological services. Experts' agreement with MAC was significant for all classification areas, as was MAC's agreement with the experts held as a conjoint reference standard. Whereas the experts' agreement with MAC averaged 86.0% above chance, their agreement with one another averaged 76.5% above chance. Implications of the findings are explored and potential advantages of the systems-actuarial approach are discussed.

Disorders of orgasm and ejaculation in men.

PubMed

McMahon, Chris G; Abdo, Carmita; Incrocci, Luca; Perelman, Michael; Rowland, David; Waldinger, Marcel; Xin, Zhong Cheng

2004-07-01

Ejaculatory/orgasmic disorders, common male sexual dysfunctions, include premature ejaculation, inhibited ejaculation, anejaculation, retrograde ejaculation and anorgasmia. To provide recommendations/guidelines concerning state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Ejaculation/Orgasm in Men Committee, there were nine experts from six countries. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Premature ejaculation management is dependent upon etiology. When secondary to ED, etiology-specific treatment is employed. When lifelong, initial pharmacotherapy (SSRI, topical anesthesia, PDE5 inhibitors) is appropriate. When associated with psychogenic/relationship factors, behavioral therapy is indicated. When acquired, pharmacotherapy and/or behavioral therapies are preferred. Retrograde ejaculation, diagnosed with spermatozoa and fructose in centrifuged post-ejaculatory voided urine, is managed by education, patient reassurance, pharmacotherapy or bladder neck reconstruction. Men with anejaculation or anorgasmia have a biologic failure of emission and/or psychogenic inhibited ejaculation. Men with age-related penile hypoanesthesia should be educated, reassured and be instructed in revised sexual techniques which maximize arousal. More research is needed in understanding management of men with ejaculation/orgasmic dysfunction.

[A mistake in forensic psychiatric evaluation or abuse of psychiatry for non-medical purposes - a case report].

PubMed

Florkowski, Antoni; Zboralski, Krzysztof; Macander, Marian; Flinik-Jankowska, Magdalena; Wierzbiński, Piotr

2015-11-01

In this study we attempted to visualize certain irregularities that took place in the evaluation of a patient with personality disorders performed by psychiatrist expert witness, which resulted in an incorrect diagnosis, leading to wrong ruling of the court and a referral of the patient to clinical therapy lasting six years. The psychiatric and psychological expert opinions submitted to the court and first-hand psychiatric and psychological examination of the patient were analyzed. Efforts were made to show that the failure to comply with the diagnostic criteria in the process of diagnosis and not taking into account the previously issued five forensic psychiatric opinions issued by independent and experienced teams of psychiatrist expert witnesses, as well as not taking into account the nature of the offense committed have led to a number of irregularities in the assessment of the mental state of the patient. Above mentioned shortcomings have caused unjustified legal classification of the offense and six years long detention of the patient in closed psychiatric institutions, in our regard unnecessary. The described case could be regarded as an abuse of psychiatry for the non-medical purposes and thus should have be punish. Based on the presented case it has been demonstrated that insufficient experience in forensic psychiatry and failure to comply with diagnostic criteria of psychiatrists and psychologists expert witnesses had led to a series of blatant offense of civil rights and liberties, and thus unnecessary detention of the patient for six years. © 2015 MEDPRESS.

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion.

PubMed

Chiumello, Davide; Brochard, Laurent; Marini, John J; Slutsky, Arthur S; Mancebo, Jordi; Ranieri, V Marco; Thompson, B Taylor; Papazian, Laurent; Schultz, Marcus J; Amato, Marcelo; Gattinoni, Luciano; Mercat, Alain; Pesenti, Antonio; Talmor, Daniel; Vincent, Jean-Louis

2017-09-12

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30-45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS.

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 high levels of participation observed in this study, by involving experts and stakeholders and ascertaining their views, underpinned the added value of using a transparent Web-Delphi process to promote agreement on what indicators are relevant to appraise population health.

Quantifying catchment water balances and their uncertainties by expert elicitation

NASA Astrophysics Data System (ADS)

Sebok, Eva; Refsgaard, Jens Christian; Warmink, Jord J.; Stisen, Simon; Høgh Jensen, Karsten

2017-04-01

The increasing demand on water resources necessitates a more responsible and sustainable water management requiring a thorough understanding of hydrological processes both on small scale and on catchment scale. On catchment scale, the characterization of hydrological processes is often carried out by calculating a water balance based on the principle of mass conservation in hydrological fluxes. Assuming a perfect water balance closure and estimating one of these fluxes as a residual of the water balance is a common practice although this estimate will contain uncertainties related to uncertainties in the other components. Water balance closure on the catchment scale is also an issue in Denmark, thus, it was one of the research objectives of the HOBE hydrological observatory, that has been collecting data in the Skjern river catchment since 2008. Water balance components in the 1050 km2 Ahlergaarde catchment and the nested 120 km2 Holtum catchment, located in the glacial outwash plan of the Skjern catchment, were estimated using a multitude of methods. As the collected data enables the complex assessment of uncertainty of both the individual water balance components and catchment-scale water balances, the expert elicitation approach was chosen to integrate the results of the hydrological observatory. This approach relies on the subjective opinion of experts whose available knowledge and experience about the subject allows to integrate complex information from multiple sources. In this study 35 experts were involved in a multi-step elicitation process with the aim of (1) eliciting average annual values of water balance components for two nested catchments and quantifying the contribution of different sources of uncertainties to the total uncertainty in these average annual estimates; (2) calculating water balances for two catchments by reaching consensus among experts interacting in form of group discussions. To address the complex problem of water balance closure, the water balance was separated into five components: precipitation, evapotranspiration, surface runoff, recharge and subsurface outflow. During the study, experts first participated in individual interviews where they gave their opinion on the probability distribution of their water balance component of interest. The average annual values and uncertainty of water balance components and catchment-scale water balances were obtained at a later stage by reaching consensus during group discussions. The obtained water balance errors for the Ahlergaarde catchment and the Holtum catchment were -5 and -62 mm/yr, respectively, with an uncertainty of 66 and 86 mm/yr, respectively. As an advantage of the expert elicitation, drawing on the intuitive experience and capabilities of experts to assess complex, site-specific problems, not only the uncertainty of the water balance error was quantified, but the uncertainty of individual water balance components as well.

Communicating Chemical Risks for Social Learning: Findings from an Expert Opinion Survey

ERIC Educational Resources Information Center

Lyytimaki, Jari; Assmuth, Timo; Hilden, Mikael

2009-01-01

Environmental and health risks caused by chemical substances have been intensively debated in various arenas of science and policy, and in news media. The impacts of risk debates on the public have been widely studied, while less attention has been paid to expert views. We present results from a cross-national survey charting expert views on the…

Weighing In: The Taste-Engineering Frame in Obesity Expert Discourse

PubMed Central

Zimmerman, Frederick J.; Gilliam, Franklin D.

2015-01-01

Objectives. We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames—personal responsibility and the environment—and examined alternative frames for understanding and addressing obesity. Methods. We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate’s essence. Results. Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame—the taste-engineering frame—identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient. Conclusions. Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed. PMID:25602888

Weighing in: the taste-engineering frame in obesity expert discourse.

PubMed

Ortiz, Selena E; Zimmerman, Frederick J; Gilliam, Franklin D

2015-03-01

We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity. We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence. Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient. Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed.

Expert Opinions on Nutrition Issues in Clinical Dentistry.

ERIC Educational Resources Information Center

Palmer, Carole A.; And Others

1990-01-01

A survey of 79 experts in dental nutrition sought consensus on the appropriate scope of nutrition in clinical dentistry. Results support the need for greater attention to nutrition issues in dental schools and better models for nutrition interventions in dental practice. (Author/MSE)

Legal Decisions and Opinions in Pollution Cases

ERIC Educational Resources Information Center

Hills, John P.

1976-01-01

When dealing with the "frontier of scientific knowledge" and questions of public health, United States courts are waiving traditional burdens of proof, giving increased weight to expert opinions and/or lowering their standard of necessary proof. Recent cases involving asbestos, pesticides, lead in gasoline, and vinyl chlorides are discussed. (BT)

Estimating distribution and connectivity of recolonizing American marten in the northeastern United States using expert elicitation techniques

USGS Publications Warehouse

Aylward, C.M.; Murdoch, J.D.; Donovan, Therese M.; Kilpatrick, C.W.; Bernier, C.; Katz, J.

2018-01-01

The American marten Martes americana is a species of conservation concern in the northeastern United States due to widespread declines from over‐harvesting and habitat loss. Little information exists on current marten distribution and how landscape characteristics shape patterns of occupancy across the region, which could help develop effective recovery strategies. The rarity of marten and lack of historical distribution records are also problematic for region‐wide conservation planning. Expert opinion can provide a source of information for estimating species–landscape relationships and is especially useful when empirical data are sparse. We created a survey to elicit expert opinion and build a model that describes marten occupancy in the northeastern United States as a function of landscape conditions. We elicited opinions from 18 marten experts that included wildlife managers, trappers and researchers. Each expert estimated occupancy probability at 30 sites in their geographic region of expertise. We, then, fit the response data with a set of 58 models that incorporated the effects of covariates related to forest characteristics, climate, anthropogenic impacts and competition at two spatial scales (1.5 and 5 km radii), and used model selection techniques to determine the best model in the set. Three top models had strong empirical support, which we model averaged based on AIC weights. The final model included effects of five covariates at the 5‐km scale: percent canopy cover (positive), percent spruce‐fir land cover (positive), winter temperature (negative), elevation (positive) and road density (negative). A receiver operating characteristic curve indicated that the model performed well based on recent occurrence records. We mapped distribution across the region and used circuit theory to estimate movement corridors between isolated core populations. The results demonstrate the effectiveness of expert‐opinion data at modeling occupancy for rare species and provide tools for planning marten recovery in the northeastern United States.

Drug exposure in register-based research—An expert-opinion based evaluation of methods

PubMed Central

Taipale, Heidi; Koponen, Marjaana; Tolppanen, Anna-Maija; Hartikainen, Sirpa; Ahonen, Riitta; Tiihonen, Jari

2017-01-01

Background In register-based pharmacoepidemiological studies, construction of drug exposure periods from drug purchases is a major methodological challenge. Various methods have been applied but their validity is rarely evaluated. Our objective was to conduct an expert-opinion based evaluation of the correctness of drug use periods produced by different methods. Methods Drug use periods were calculated with three fixed methods: time windows, assumption of one Defined Daily Dose (DDD) per day and one tablet per day, and with PRE2DUP that is based on modelling of individual drug purchasing behavior. Expert-opinion based evaluation was conducted with 200 randomly selected purchase histories of warfarin, bisoprolol, simvastatin, risperidone and mirtazapine in the MEDALZ-2005 cohort (28,093 persons with Alzheimer’s disease). Two experts reviewed purchase histories and judged which methods had joined correct purchases and gave correct duration for each of 1000 drug exposure periods. Results The evaluated correctness of drug use periods was 70–94% for PRE2DUP, and depending on grace periods and time window lengths 0–73% for tablet methods, 0–41% for DDD methods and 0–11% for time window methods. The highest rate of evaluated correct solutions for each method class were observed for 1 tablet per day with 180 days grace period (TAB_1_180, 43–73%), and 1 DDD per day with 180 days grace period (1–41%). Time window methods produced at maximum only 11% correct solutions. The best performing fixed method TAB_1_180 reached highest correctness for simvastatin 73% (95% CI 65–81%) whereas 89% (95% CI 84–94%) of PRE2DUP periods were judged as correct. Conclusions This study shows inaccuracy of fixed methods and the urgent need for new data-driven methods. In the expert-opinion based evaluation, the lowest error rates were observed with data-driven method PRE2DUP. PMID:28886089

[Relevance of a driving simulator in the assessment of handicapped individuals].

PubMed

Carroz, A; Comte, P-A; Nicolo, D; Dériaz, O; Vuadens, P

2008-06-01

To evaluate the value of our driving simulator in deciding whether or not to allow patients with physical and/or cognitive deficits to resuming driving and to analyze whether or not the medical expert's final decision is based more on the results of the driving simulator than those of the neuropsychological examination. One hundred and twenty-three patients were evaluated with the driving simulator. Thirty-five of those with cognitive deficits also underwent a neuropsychological examination prior to the medical expert's decision on driving aptitude. In cases of uncertainty or disagreement, a driving assessment in real conditions was performed by a driving instructor. In cases of physical handicap, the medical expert's decision concurred with that of the occupational therapist. For brain-injured patients, there was a significant correlation between the neuropsychologist's opinion and that of the occupational therapist (kappa=0.33; P=0.01). However, the sensibility and specificity were only 55 and 80%, respectively. The correlation between an occupational therapy decision based on the driving simulator and that of the medical expert was very significant (kappa=0.81; P<0.0001) and the sensibility and specificity were 84 and 100%, respectively. In contrast, these values were lower (63 and 71%, respectively) for the correlation between the neuropsychologist's opinion and that of the medical expert. Our driving simulator enables the danger-free evaluation of driving aptitude. The results mirror an in situ assessment and are more sensitive than neuropsychological examination. In fact, the neuropsychologist's opinion often is more negative or uncertain with respect to the patient's real driving aptitude. When taking a decision on a patient's driving aptitude, the medical expert is more inclined to trust the results of the driving simulator.

Paradigms of forensic science and legal process: a critical diagnosis.

PubMed

Roberts, Paul

2015-08-05

This article reconsiders the relationship between criminal adjudication and forensic expertise in the light of 'new paradigms' of forensic practice and recent law reform. It briefly summarizes conventional wisdom on the typical shortcomings of forensic science and other expert evidence, as a springboard for a more searching critical diagnosis of longstanding maladies. The fundamentally jurisdictional nature of law is emphasized, and some implications for expert testimony noted. English law's traditionally adversarial model of criminal procedure is then reassessed, taking account of a proper understanding of its normative structure and modern development, and drawing on comparative legal research and theorizing to obtain a more rounded second opinion. In conclusion, some avenues for intelligent prescription are canvassed, highlighting the importance of promoting and facilitating effective communication between experts, lawyers and courts, and prioritizing modest practical remedies over radical surgery. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Ask the experts how to treat individuals with spatial neglect: a survey study.

PubMed

Chen, Peii; Pitteri, Marco; Gillen, Glen; Ayyala, Harsha

2017-07-11

Spatial neglect (SN) impedes rehabilitation success and leaves long-term consequences. We asked experts to provide their opinions in addressing SN by scenario (ideal vs. reality) and by recovery phase (earliest, acute, subacute, and chronic). Experts were individuals who have assessed or treated patients with SN clinically. This study was conducted using an anonymous survey on the Internet with 189 responders over 3 months. Located in 23 different countries, 127 experts of seven disciplines were included (occupational therapy, physical therapy, nursing, speech and language pathology or therapy, neurology, physical medicine and rehabilitation, and psychology or neuropsychology). Comparing the two scenarios, more treatments were selected in the ideal than in the reality scenario for all recovery phases except for the chronic phase. In both scenarios, (1) more treatments were selected in acute and subacute phases than in earliest or chronic phases, (2) less experienced experts selected diverse treatment options more often, and (3) highly experienced experts were more likely to provide their reasons of treatment selection, suggestions of treatment delivery methods, and other insights. Finally, 83.7% reported obstacles in treating SN. Experts' treatment selections are consistent with current evidence and practice guidelines. Recognizing the limitation of evidence, their opinions may help generate ideas in various topics (e.g., dosing, integrative intervention, and treatment implementation) to be examined in future studies. Implications for Rehabilitation Clinicians with experience in treating people with spatial neglect (i.e., experts as defined in the present study) recognized the limitation of evidence but nonetheless suggested specific treatments by recovery phase. In both the reality and ideal scenarios, experts included visual scanning, active limb activation, and sustained attention training in the top-five selections. Prism adaptation was in the top-five selections in the ideal scenario, while in the reality scenario, it was in the top-five in all phases except for the earliest phase where it was the sixth most selected. They also shared their valuable opinions in when to use which treatment to address spatial neglect and how to deliver certain interventions, which may help to generate ideas in various topics (e.g., dosing, integrative intervention, knowledge dissemination, and treatment implementation) that can be examined in future studies. We suggest that (1) clinicians consider collective expert opinions reported here to enhance their clinical judgment and practices, (2) researchers develop studies focused on treatments with limited evidence but selected here by experts, and (3) funding agencies provide the means to research and implementation projects that will generate rich information for improving practice guidelines and rehabilitation outcomes for patients with spatial neglect. The majority of the experts reported some obstacles in providing treatment for spatial neglect, and time and equipment shortages were the most common barriers, which should be addressed at the system level to determine whether removing those barriers have long-term beneficial impacts on both patients and healthcare systems.

Public authority control strategy for opinion evolution in social networks

NASA Astrophysics Data System (ADS)

Chen, Xi; Xiong, Xi; Zhang, Minghong; Li, Wei

2016-08-01

This paper addresses the need to deal with and control public opinion and rumors. Existing strategies to control public opinion include degree, random, and adaptive bridge control strategies. In this paper, we use the HK model to present a public opinion control strategy based on public authority (PA). This means utilizing the influence of expert or high authority individuals whose opinions we control to obtain the optimum effect in the shortest time possible and thus reach a consensus of public opinion. Public authority (PA) is only influenced by individuals' attributes (age, economic status, and education level) and not their degree distribution; hence, in this paper, we assume that PA complies with two types of public authority distribution (normal and power-law). According to the proposed control strategy, our experiment is based on random, degree, and public authority control strategies in three different social networks (small-world, scale-free, and random) and we compare and analyze the strategies in terms of convergence time (T), final number of controlled agents (C), and comprehensive efficiency (E). We find that different network topologies and the distribution of the PA in the network can influence the final controlling effect. While the effect of PA strategy differs in different network topology structures, all structures achieve comprehensive efficiency with any kind of public authority distribution in any network. Our findings are consistent with several current sociological phenomena and show that in the process of public opinion/rumor control, considerable attention should be paid to high authority individuals.

Public authority control strategy for opinion evolution in social networks.

PubMed

Chen, Xi; Xiong, Xi; Zhang, Minghong; Li, Wei

2016-08-01

This paper addresses the need to deal with and control public opinion and rumors. Existing strategies to control public opinion include degree, random, and adaptive bridge control strategies. In this paper, we use the HK model to present a public opinion control strategy based on public authority (PA). This means utilizing the influence of expert or high authority individuals whose opinions we control to obtain the optimum effect in the shortest time possible and thus reach a consensus of public opinion. Public authority (PA) is only influenced by individuals' attributes (age, economic status, and education level) and not their degree distribution; hence, in this paper, we assume that PA complies with two types of public authority distribution (normal and power-law). According to the proposed control strategy, our experiment is based on random, degree, and public authority control strategies in three different social networks (small-world, scale-free, and random) and we compare and analyze the strategies in terms of convergence time (T), final number of controlled agents (C), and comprehensive efficiency (E). We find that different network topologies and the distribution of the PA in the network can influence the final controlling effect. While the effect of PA strategy differs in different network topology structures, all structures achieve comprehensive efficiency with any kind of public authority distribution in any network. Our findings are consistent with several current sociological phenomena and show that in the process of public opinion/rumor control, considerable attention should be paid to high authority individuals.

Survey of Expert Opinion on Intelligence and Aptitude Testing.

ERIC Educational Resources Information Center

Snyderman, Mark; Rothman, Stanley

1987-01-01

Psychologists and educational specialists with expertise in areas related to intelligence testing responded to a questionnaire dealing with possible racial and socioeconomic bias of IQ tests. Overall, experts hold positive attitudes about the validity and usefulness of intelligence and aptitude tests. (Author/LHW)

Is Weight Training Safe during Pregnancy?

ERIC Educational Resources Information Center

Work, Janis A.

1989-01-01

Examines the opinions of several experts on the safety of weight training during pregnancy, noting that no definitive research on weight training alone has been done. Experts agree that low-intensity weight training probably poses no harm for mother or fetus; exercise programs should be individualized. (SM)

Challenges in Biomarker Discovery: Combining Expert Insights with Statistical Analysis of Complex Omics Data

PubMed Central

McDermott, Jason E.; Wang, Jing; Mitchell, Hugh; Webb-Robertson, Bobbie-Jo; Hafen, Ryan; Ramey, John; Rodland, Karin D.

2012-01-01

Introduction The advent of high throughput technologies capable of comprehensive analysis of genes, transcripts, proteins and other significant biological molecules has provided an unprecedented opportunity for the identification of molecular markers of disease processes. However, it has simultaneously complicated the problem of extracting meaningful molecular signatures of biological processes from these complex datasets. The process of biomarker discovery and characterization provides opportunities for more sophisticated approaches to integrating purely statistical and expert knowledge-based approaches. Areas covered In this review we will present examples of current practices for biomarker discovery from complex omic datasets and the challenges that have been encountered in deriving valid and useful signatures of disease. We will then present a high-level review of data-driven (statistical) and knowledge-based methods applied to biomarker discovery, highlighting some current efforts to combine the two distinct approaches. Expert opinion Effective, reproducible and objective tools for combining data-driven and knowledge-based approaches to identify predictive signatures of disease are key to future success in the biomarker field. We will describe our recommendations for possible approaches to this problem including metrics for the evaluation of biomarkers. PMID:23335946

Challenges in Biomarker Discovery: Combining Expert Insights with Statistical Analysis of Complex Omics Data

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

McDermott, Jason E.; Wang, Jing; Mitchell, Hugh D.

2013-01-01

The advent of high throughput technologies capable of comprehensive analysis of genes, transcripts, proteins and other significant biological molecules has provided an unprecedented opportunity for the identification of molecular markers of disease processes. However, it has simultaneously complicated the problem of extracting meaningful signatures of biological processes from these complex datasets. The process of biomarker discovery and characterization provides opportunities both for purely statistical and expert knowledge-based approaches and would benefit from improved integration of the two. Areas covered In this review we will present examples of current practices for biomarker discovery from complex omic datasets and the challenges thatmore » have been encountered. We will then present a high-level review of data-driven (statistical) and knowledge-based methods applied to biomarker discovery, highlighting some current efforts to combine the two distinct approaches. Expert opinion Effective, reproducible and objective tools for combining data-driven and knowledge-based approaches to biomarker discovery and characterization are key to future success in the biomarker field. We will describe our recommendations of possible approaches to this problem including metrics for the evaluation of biomarkers.« less

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…

EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice.

PubMed

Colebatch-Bourn, A N; Edwards, C J; Collado, P; D'Agostino, M-A; Hemke, R; Jousse-Joulin, S; Maas, M; Martini, A; Naredo, E; Østergaard, M; Rooney, M; Tzaribachev, N; van Rossum, M A; Vojinovic, J; Conaghan, P G; Malattia, C

2015-11-01

To develop evidence based points to consider the use of imaging in the diagnosis and management of juvenile idiopathic arthritis (JIA) in clinical practice. The task force comprised a group of paediatric rheumatologists, rheumatologists experienced in imaging, radiologists, methodologists and patients from nine countries. Eleven questions on imaging in JIA were generated using a process of discussion and consensus. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, scintigraphy and positron emission tomography. The experts used the evidence obtained from the relevant studies to develop a set of points to consider. The level of agreement with each point to consider was assessed using a numerical rating scale. A total of 13 277 references were identified from the search process, from which 204 studies were included in the systematic review. Nine points to consider were produced, taking into account the heterogeneity of JIA, the lack of normative data and consequent difficulty identifying pathology. These encompassed the role of imaging in making a diagnosis of JIA, detecting and monitoring inflammation and damage, predicting outcome and response to treatment, use of guided therapies, progression and remission. Level of agreement for each proposition varied according to the research evidence and expert opinion. Nine points to consider and a related research agenda for the role of imaging in the management of JIA were developed using published evidence and expert opinion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Fitness and exercise as correlates of sleep complaints: is it all in our minds?

PubMed

Gerber, Markus; Brand, Serge; Holsboer-Trachsler, Edith; Pühse, Uwe

2010-05-01

Restoring sleep is associated with psychological well-being. In contrast, poor sleep leads to impaired daily cognitive, emotional, and social functioning. Both commonplace and expert opinion hold that exercise has a favorable impact on preventing poor sleep and improving its quality. However, the scientific basis for this opinion remains limited, and results are mixed. The aim of the present study, therefore, was to explore the impact of perceived physical fitness, exercise, and a perceived lack of activity on sleep in early adulthood. Gender-related patterns were also examined. A total of 862 participants (639 females and 223 males; mean +/- SD = 24.67 +/- 5.91 yr) took part in the study. Respondents completed a series of self-report questionnaires assessing perceived physical fitness, exercise, perceived lack of physical activity, insomnia (Insomnia Severity Index), dysfunctional sleep-related thoughts (Fragebogen zur Erfassung allgemeiner Persönlichkeitsmerkmale Schlafgestörter), and quality of sleep (Pittsburgh Sleep Quality Index). High perceived physical fitness, but not exercise, was associated with favorable scores for various sleep indicators. A perceived lack of physical activity was associated with poor sleep. Perceived physical fitness and exercise were moderately correlated. Compared with males, females reported more sleep difficulties and also more dysfunctional sleep-related thoughts. For early adulthood, findings did not support commonplace or expert opinion that exercise behavior has a favorable influence on sleep. Rather, the findings lend support to the importance of cognitive processes in the onset and maintenance of sleep complaints.

Combining Analytical Hierarchy Process and Agglomerative Hierarchical Clustering in Search of Expert Consensus in Green Corridors Development Management

NASA Astrophysics Data System (ADS)

Shapira, Aviad; Shoshany, Maxim; Nir-Goldenberg, Sigal

2013-07-01

Environmental management and planning are instrumental in resolving conflicts arising between societal needs for economic development on the one hand and for open green landscapes on the other hand. Allocating green corridors between fragmented core green areas may provide a partial solution to these conflicts. Decisions regarding green corridor development require the assessment of alternative allocations based on multiple criteria evaluations. Analytical Hierarchy Process provides a methodology for both a structured and consistent extraction of such evaluations and for the search for consensus among experts regarding weights assigned to the different criteria. Implementing this methodology using 15 Israeli experts—landscape architects, regional planners, and geographers—revealed inherent differences in expert opinions in this field beyond professional divisions. The use of Agglomerative Hierarchical Clustering allowed to identify clusters representing common decisions regarding criterion weights. Aggregating the evaluations of these clusters revealed an important dichotomy between a pragmatist approach that emphasizes the weight of statutory criteria and an ecological approach that emphasizes the role of the natural conditions in allocating green landscape corridors.

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.

Development of a Logistics Support Framework for Defense Mapping Agency (DMA) Automated Systems

DTIC Science & Technology

1990-09-01

cycle of a particular system. This research identified principles of management , design or system life cycle processes, and ILS elements needed to...Delphi results gathered from DMA expert opinions. The principles of management , depicted in the Logistics Systems Management Matrix (LSMM) portrayed...review were used to form the Delphi survey questions in Chapter III. As shown in Figure 2, the LSMM is a three-dimensional model with thp principles of management on

[Neurosis as a mental disease--controversies surrounding insurance certification].

PubMed

Jabłoński, Christian; Kobek, Mariusz; Kowalczyk-Jabłońska, Dorota

2011-01-01

In the years 2008-2009, experts from the Department of Forensic Medicine in Katowice issued a dozen of expert opinions on the nature of the neurosis, addressing the question whether neurosis is a mental disease as understood under the general insurance conditions or whether neurosis is a mental disease as such. All the submitted cases involved policemen who had been diagnosed as neurotic and were refused insurance payments since the insurance company claimed payments could not have been effected due to the diagnosis of mental disease, meaning neurosis in the discussed cases. The plaintiffs invoked the fact that medical terminology describes such states as "mental disorders". In the article, the authors present the adopted model of opinionating, make an attempt at explaining the controversy and discuss the subtleties of medical terminology and the core differences between the terms "mental disorder" and "mental disease" as employed in medico-legal opinionating in such cases.

Pragmatic Divestment of KC-135 Navigators in the Special Operations Air Refueling Mission

DTIC Science & Technology

2015-03-26

publicly expressed opinions, and the bandwagon effect of majority opinion. This technique replaces direct debate by a carefully designed program of... effective , comprehensive solution. Ultimately, the panel of experts arrived at conclusions supporting the hypothesis that navigator divestment and SOAR...manpower, personnel, and training effects after navigators are phased out

The evolution of PBMA: towards a macro-level priority setting framework for health regions.

PubMed

Mitton, Craig R; Donaldson, Cam; Waldner, Howard; Eagle, Chris

2003-11-01

To date, relatively little work on priority setting has been carried out at a macro-level across major portfolios within integrated health care organizations. This paper describes a macro marginal analysis (MMA) process for setting priorities and allocating resources in health authorities, based on work carried out in a major urban health region in Alberta, Canada. MMA centers around an expert working group of managers and clinicians who are charged with identifying areas for resource re-allocation on an ongoing basis. Trade-offs between services are based on locally defined criteria and are informed by multiple inputs such as evidence from the literature and local expert opinion. The approach is put forth as a significant improvement on historical resource allocation patterns.

Stem cell research ethics: consensus statement on emerging issues.

PubMed

Caulfield, Timothy; Ogbogu, Ubaka; Nelson, Erin; Einsiedel, Edna; Knoppers, Bartha; McDonald, Michael; Brunger, Fern; Downey, Robin; Fernando, Kanchana; Galipeau, Jacques; Geransar, Rose; Griener, Glenn; Grenier, Glenn; Hyun, Insoo; Isasi, Rosario; Kardel, Melanie; Knowles, Lori; Kucic, Terrence; Lotjonen, Salla; Lyall, Drew; Magnus, David; Mathews, Debra J H; Nisbet, Matthew; Nisker, Jeffrey; Pare, Guillaume; Pattinson, Shaun; Pullman, Daryl; Rudnicki, Michael; Williams-Jones, Bryn; Zimmerman, Susan

2007-10-01

This article is a consensus statement by an international interdisciplinary group of academic experts and Canadian policy-makers on emerging ethical, legal and social issues in human embryonic stem cells (hESC) research in Canada. The process of researching consensus included consultations with key stakeholders in hESC research (regulations, stem cell researchers, and research ethics experts), preparation and distribution of background papers, and an international workshop held in Montreal in February 2007 to discuss the papers and debate recommendations. The recommendations provided in the consensus statement focus on issues of immediate relevance to Canadian policy-makers, including informed consent to hESC research, the use of fresh embryos in research, management of conflicts of interest, and the relevance of public opinion research to policy-making.

Study on Failure of Third-Party Damage for Urban Gas Pipeline Based on Fuzzy Comprehensive Evaluation.

PubMed

Li, Jun; Zhang, Hong; Han, Yinshan; Wang, Baodong

2016-01-01

Focusing on the diversity, complexity and uncertainty of the third-party damage accident, the failure probability of third-party damage to urban gas pipeline was evaluated on the theory of analytic hierarchy process and fuzzy mathematics. The fault tree of third-party damage containing 56 basic events was built by hazard identification of third-party damage. The fuzzy evaluation of basic event probabilities were conducted by the expert judgment method and using membership function of fuzzy set. The determination of the weight of each expert and the modification of the evaluation opinions were accomplished using the improved analytic hierarchy process, and the failure possibility of the third-party to urban gas pipeline was calculated. Taking gas pipelines of a certain large provincial capital city as an example, the risk assessment structure of the method was proved to conform to the actual situation, which provides the basis for the safety risk prevention.

Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions.

PubMed

Seidling, Hanna M; Stützle, Marion; Hoppe-Tichy, Torsten; Allenet, Benoît; Bedouch, Pierrick; Bonnabry, Pascal; Coleman, Jamie J; Fernandez-Llimos, Fernando; Lovis, Christian; Rei, Maria Jose; Störzinger, Dominic; Taylor, Lenka A; Pontefract, Sarah K; van den Bemt, Patricia M L A; van der Sijs, Heleen; Haefeli, Walter E

2016-04-01

While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures.

[Münchausen syndrome by proxy in a forensic psychiatric evaluation--the description of a case and ethical controversy].

PubMed

Heitzman, Janusz; Opio, Małgorzata; Ruzikowska, Alfreda; Pilszyk, Anna

2012-01-01

Presentation of the difficulties in diagnosing Münchausen syndrome by proxy. Comparison of four different conclusions in forensic psychiatric opinions issued in one case, due to the need of answering to the questions of the court, in what periods and why was the deterioration of the child's health, in connection with an allegation that the mother has acted to his detriment. In the first medical-legal opinion the treating physician, while being the head of the ward and the person informing the police of the action against a child by the mother, recognised Münchausen syndrome by proxy. The second opinion was delivered by a psychologist, who stated that the mother distinguished the introspective attitude characterised by excessive, exaggerated accuracy, thoroughness, and did not give a unambiguous answer to the questions of the court. In the third opinion the experts accepted that the functioning of the subject does not create a threat to life and health of the child. The fourth opinion developed by the authors of this paper noted that in the analysed medical records of the childs' hospitalisation, no arguments were found to recognise Münchausen syndrome by proxy. RESULTS. In the conducted extended ambulant study of the subject and the analysis of the medical documentation of the 31 hospitalisations of the child showed that the improvement of the child's health was not associated in exclusion of pushing aside the mother from the child, but was the result of the consistency of the therapeutic treatment team, the continuation and the modification of the treatment. In appointing the expert, the art. 196 of the Code of Criminal Procedure should be considered, which states that the expert should not be the treating doctor, because his opinion loses value impartiality. Diagnosis of Münchausen Syndrome by proxy itself stirs up numerous controversies..

Ethical Issues in Expert Opinions and Testimony.

ERIC Educational Resources Information Center

Weed, Roger O.

2000-01-01

This article provides an overview of ethical issues in private for-profit practice, with particular focus on expert testimony, using examples from a sample of claims filed with the National Association of Rehabilitation Professionals in the Private Sector and malpractice insurance companies. Complaints most frequently involve issues related to…

Pupil Transportation.

ERIC Educational Resources Information Center

Bete, Tim, Ed.

1998-01-01

Presents the opinions of four transportation experts on issues related to school buses. The experts respond to the following questions: will advertisements placed on buses be used to generate district revenue; will compressed natural gas or liquefied natural gas become standard fuel for school buses; and will school bus seat belts be mandatory and…

Expert Concept Mapping Study on Mobile Learning

ERIC Educational Resources Information Center

Borner, Dirk; Glahn, Christian; Stoyanov, Slavi; Kalz, Marco; Specht, Marcus

2010-01-01

Purpose: The present paper introduces concept mapping as a structured participative conceptualization approach to identify clusters of ideas and opinions generated by experts within the domain of mobile learning. Utilizing this approach, the paper aims to contribute to a definition of key domain characteristics by identifying the main educational…

Comparing Powerpoint Experts' and University Students' Opinions about Powerpoint Presentations

ERIC Educational Resources Information Center

Mackiewicz, Jo

2008-01-01

Technical communication instructors want to help students, as well as professionals, design effective PowerPoint presentations. Toward this end, I compare the advice of academic and industry experts about effective PowerPoint presentation design to survey responses from university students about slide text, visual elements, animations, and other…

School Security.

ERIC Educational Resources Information Center

Bete, Tim, Ed.

1998-01-01

Presents the opinions of four security experts on the issue of guns in schools. The experts respond to the following questions: will schools ever be free of weapons; will card access systems become common in public schools; will metal detectors solve school security problems; and will students ever be issued bullet-proof vests along with…

Expert Opinions on Improving Femicide Data Collection across Europe: A Concept Mapping Study.

PubMed

Vives-Cases, Carmen; Goicolea, Isabel; Hernández, Alison; Sanz-Barbero, Belen; Gill, Aisha K; Baldry, Anna Costanza; Schröttle, Monika; Stöckl, Heidi; Stoeckl, Heidi

2016-01-01

Femicide, defined as the killings of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Despite its high prevalence or widespread prevalence, only a few countries have specific registries about this issue. This study aims to assemble expert opinion regarding the strategies which might feasibly be employed to promote, develop and implement an integrated and differentiated femicide data collection system in Europe at both the national and international levels. Concept mapping methodology was followed, involving 28 experts from 16 countries in generating strategies, sorting and rating them with respect to relevance and feasibility. The experts involved were all members of the EU-Cost-Action on femicide, which is a scientific network of experts on femicide and violence against women across Europe. As a result, a conceptual map emerged, consisting of 69 strategies organized in 10 clusters, which fit into two domains: "Political action" and "Technical steps". There was consensus among participants regarding the high relevance of strategies to institutionalize national databases and raise public awareness through different stakeholders, while strategies to promote media involvement were identified as the most feasible. Differences in perceived priorities according to the level of human development index of the experts' countries were also observed.

Evaluation of a procedure to assess the adverse effects of illicit drugs.

PubMed

van Amsterdam, J G C; Best, W; Opperhuizen, A; de Wolff, F A

2004-02-01

The assessment procedure of new synthetic illicit drugs that are not documented in the UN treaty on psychotropic drugs was evaluated using a modified Electre model. Drugs were evaluated by an expert panel via the open Delphi approach, where the written score was discussed on 16 items, covering medical, health, legal, and criminalistic issues of the drugs. After this face-to-face discussion the drugs were scored again. Taking the assessment of ketamine as an example, it appeared that each expert used its own scale to score, and that policymakers do not score deviant from experts trained in the medical-biological field. Of the five drugs evaluated by the panel, p-methoxy-metamphetamine (PMMA), gamma-hydroxybutyric acid (GHB), and 4-methylthio-amphetamine (MTA) were assessed as more adverse than ketamine and psilocine and psilocybine-containing mushrooms. Whereas some experts slightly adjusted during the assessment procedure their opinion on ketamine and PMMA, the opinion on mushrooms was not affected by the discussion held between the two scoring rounds. All experts rank the five drugs in a similar way on the adverse effect scale i.e., concordance scale of the Electre model, indicating unanimity in the expert panel with respect to the risk classification of these abused drugs.

[The role of the physician in expert testimony leading to an arrest].

PubMed

Marek, Z; Baran, E

1989-01-01

The authors have offered several problems related to a topic of medical professional activities of physicians being in contact with the administration of justice. There are presented opinions based on existent regulations and experiences associated with juridical expert activities of the authors. These opinions are about two problems that, according to obtained data, are made of controversies which stand between first-aid or ambulance doctors and law officers. The first problem deals with differences of opinion on obligations of physicians to examine drunk patients and to meet the requirements to put them into a sober room or--if there are any for a temporary stay into a prison. There has been also stated an opinion that this activity of physicians is included in a normal range of their professional duties. The second matter is concerned with the correctness of physicians' proceedings dealing with individuals arrested by militia and giving medical evidences that faces a problem whether stay in prison can or cannot constitute a threat for their life or health. It's been also founded that--in those cases--a physician has to be called a medicolegal opinion. The professional obligations of physicians still don't include this function and therefore it has to be granted separately.

Development of community based curriculum on ophthalmology for under graduate medical course in Bangladesh.

PubMed

Khan, A K; Hussain, A Z M I

2012-08-01

The curriculum represents the expression of educational ideas in practice. Ophthalmic education is the corner stone to improve eye care globally. Curriculum needs continuous modification varying in different geographic locations. Though 90% of common conditions are either preventable or curable but emphasis on the common conditions is inadequate. This is a stepwise descriptive study aiming to develop a community based ophthalmology curriculum for undergraduate medical course in Bangladesh conducted during March 2007 to February 2008 at UniSA School of Public Health and Life Sciences, University of South Asia, Banani, Dhaka. Delphi technique, a modified qualitative method was used to accumulate data and reaching a consensus opinion for developing the curriculum. Study approach includes two iterative rounds and finally a workshop. Iteration of round-I was "What are the eye diseases with overall knowledge of their management one MBBS physician should acquire"; followed by a list of eye diseases and topics for expert opinion. The response was collated. Iteration round-II was "How much a MBBS student should have percentage of knowledge, attitude and skills on each topic while being taught". The response was collated and presented to panel of expert ophthalmologists for discussion and validation. In the round-I Delphi, 400 (62%) out to total 641 ophthalmologist were randomly selected dividing in categories (62% in each) of Professor-22, Associate Professor-12, Assistant Professor-26, Consultant-27, ophthalmologists working in NGO-56 and ophthalmologists in private sector-257. Sixty (15%) responded with opinion. In the round-II, 200 (31%) including 60 of round-I, selected randomly but proportionately as before. Forty five (22.5%) responded with opinion. Result collated. The results and opinion of respondents were presented at a workshop attended by 24 (80%), out of 30 invited expert ophthalmic specialists for discussion, criticism, opinion, addition, modification and finally for validation. On the basis of the opinion of the respondents, reviewing literature, analyzing the ocular disease pattern in Bangladesh and also analyzing the present ophthalmology curriculum, a community and need based ophthalmology curriculum for undergraduate medical course in Bangladesh was developed. This research would help developing community and need based ophthalmology curriculum for undergraduate medical course in Bangladesh.

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.

Development of a dynamic framework to explain population patterns of leisure-time physical activity through agent-based modeling.

PubMed

Garcia, Leandro M T; Diez Roux, Ana V; Martins, André C R; Yang, Yong; Florindo, Alex A

2017-08-22

Despite the increasing body of evidences on the factors influencing leisure-time physical activity, our understanding of the mechanisms and interactions that lead to the formation and evolution of population patterns is still limited. Moreover, most frameworks in this field fail to capture dynamic processes. Our aim was to create a dynamic conceptual model depicting the interaction between key psychological attributes of individuals and main aspects of the built and social environments in which they live. This conceptual model will inform and support the development of an agent-based model aimed to explore how population patterns of LTPA in adults may emerge from the dynamic interplay between psychological traits and built and social environments. We integrated existing theories and models as well as available empirical data (both from literature reviews), and expert opinions (based on a systematic expert assessment of an intermediary version of the model). The model explicitly presents intention as the proximal determinant of leisure-time physical activity, a relationship dynamically moderated by the built environment (access, quality, and available activities) - with the strength of the moderation varying as a function of the person's intention- and influenced both by the social environment (proximal network's and community's behavior) and the person's behavior. Our conceptual model is well supported by evidence and experts' opinions and will inform the design of our agent-based model, as well as data collection and analysis of future investigations on population patterns of leisure-time physical activity among adults.

[Adolescent arsonists--psychodynamics, family dynamics and attempt at framing a typology based on 40 expert opinions].

PubMed

Klosinski, G; Bertsch, S L

2001-02-01

Psychiatric, psychological and medical data of 40 adolescent firesetters are obtained from a retrospective analysis of expert opinions which have been drawn up by the Department of Child and Adolescent Psychiatry in Tübingen over a period of 16 years (1981-1997). This analysis mainly focusses on the patients' physical and psychosexual development, their social integration and competence and their family dynamics. It further concentrates on the psychic situation at the time of the offense, the reasons and motives given for firesetting (by the patient and by the expert) and specific psychological test results. According to the results three different characteristic groups can be found: 1st a group of offenders who have set fires to their parents' house, 2nd firesetters being member of the firebrigade, and 3rd an unspecific inhomogeneous group of firesetters.

Expert opinions on success factors for upper-limb prostheses.

PubMed

Schultz, Aimee E; Baade, Susan P; Kuiken, Todd A

2007-01-01

The goal of this study was to gather the opinions of prosthetics experts on the most important factors for the successful use of upper-limb (UL) prostheses, compare them with those of prosthesis users, and ultimately direct research efforts in this field. UL prosthetics experts were asked to compare the importance of the comfort, function, and cosmesis of a prosthetic device for a transhumeral amputee. Categories were subdivided into weight, socket-interface comfort, power, agility, color, and shape. The majority of those who responded viewed comfort as the most important factor for a unilateral amputee and considered socket-interface comfort to be more important than weight. Function was considered to be the most important factor for a bilateral amputee, with agility considered more important than power. Cosmesis was consistently reported as being less important than comfort and function, and shape was considered more important than color.

Use of the Delphi method in resolving complex water resources issues

USGS Publications Warehouse

Taylor, J.G.; Ryder, S.D.

2003-01-01

The tri-state river basins, shared by Georgia, Alabama, and Florida, are being modeled by the U.S. Fish and Wildlife Service and the U.S. Army Corps of Engineers to help facilitate agreement in an acrimonious water dispute among these different state governments. Modeling of such basin reservoir operations requires parallel understanding of several river system components: hydropower production, flood control, municipal and industrial water use, navigation, and reservoir fisheries requirements. The Delphi method, using repetitive surveying of experts, was applied to determine fisheries' water and lake-level requirements on 25 reservoirs in these interstate basins. The Delphi technique allowed the needs and requirements of fish populations to be brought into the modeling effort on equal footing with other water supply and demand components. When the subject matter is concisely defined and limited, this technique can rapidly assess expert opinion on any natural resource issue, and even move expert opinion toward greater agreement.

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Devereaux, Asha V; Tosh, Pritish K; Hick, John L; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M; Shah, Umair A; Fagbuyi, Daniel B; Skippen, Peter; Dichter, Jeffrey R; Kissoon, Niranjan; Christian, Michael D; Upperman, Jeffrey S

2014-10-01

Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.

Opinions of University Music Teachers on the Musical Competencies Necessary for Primary Education Teachers

ERIC Educational Resources Information Center

Begic, Jasna Šulentic; Begic, Amir; Škojo, Tihana

2017-01-01

This paper describes the research conducted in the Republic of Croatia during the 2012/13 academic year. We have gathered opinions from experts, i.e. teaching methods teachers from seven faculties of teacher education, regarding the music teaching competencies necessary for primary education teachers teaching music in the first several grades of…

Analysis of the Federal Aviation Administration’s Host Computer Acquisition Process and Potential Application in Department of Defense Acquisitions

DTIC Science & Technology

1988-09-01

defense programs lost far more to inefficient procedures than to fraud and dishonesty * (President’s Commission, l986c:15). Based on the Commission...recommendations from current studies, lessons learned from a successful program, and DOD expert opinions to develop an acquisition management strategy that...established for the alternative(s) selected in the preceding phase. 5. In the concept demonstration/validation phase the technical risk and economic

Identifying opportunities for nature engagement in cancer care practice and design: protocol for four-round modified electronic Delphi.

PubMed

Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope

2017-03-08

Opportunities to engage with nature have shown relevance in experiences of health and recovery of patients with cancer and are attracting interest in cancer care practice and design. Such healthcare innovations can widen the horizon of possible supportive care solutions but require deliberate and rigorous investigation to ensure responsible action is taken and wastage avoided. This protocol outlines a study designed to solicit knowledge from relevant experts drawn from a range of healthcare practitioners, management representatives, designers and researchers to explore levels of opinion consensus for determining opportunities for, and barriers to, providing helpful nature engagement in cancer care settings. A 4-round modified electronic Delphi methodology will be used to conduct a structured, iterative feedback process for querying and synthesising expert opinion. Round 1 administers an open-ended questionnaire to a panel of selected, relevant experts who will consider the own recommendations of patients with cancer for nature engagement (drawn from a preceding investigation) before contributing salient issues (items) with relevance to the topic. Round 2 circulates anonymised summaries of responses back to the experts who verify and, if they wish, reconsider their own responses. Rounds 3 and 4 determine and rank experts' top 10 items using a 10-point Likert-type scale. Descriptive statistics (median and mean scores) will be calculated to indicate the items' relative importance. Levels of consensus will be explored with consensus defined as 75% agreement. Ethics approval for this study was obtained from the Institution's Human Research Ethics Committee (blinded for review). It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Child's Concept of Pain: An International Survey of Pediatric Pain Experts.

PubMed

Pate, Joshua W; Hush, Julia M; Hancock, Mark J; Moseley, G Lorimer; Butler, David S; Simons, Laura E; Pacey, Verity

2018-01-15

A child's 'concept of pain' refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts' opinions of: (1) the importance and usefulness of assessing a child's concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child's concept of pain; and (3) important domains of a child's concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child's concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8-12 years. Experts considered that all seven of the proposed domains of a child's concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child's concept of pain.

“Can It Read My Mind?” – What Do the Public and Experts Think of the Current (Mis)Uses of Neuroimaging?

PubMed Central

Wardlaw, Joanna M.; O'Connell, Garret; Shuler, Kirsten; DeWilde, Janet; Haley, Jane; Escobar, Oliver; Murray, Shaun; Rae, Robert; Jarvie, Donald; Sandercock, Peter; Schafer, Burkhard

2011-01-01

Emerging applications of neuroimaging outside medicine and science have received intense public exposure through the media. Media misrepresentations can create a gulf between public and scientific understanding of the capabilities of neuroimaging and raise false expectations. To determine the extent of this effect and determine public opinions on acceptable uses and the need for regulation, we designed an electronic survey to obtain anonymous opinions from as wide a range of members of the public and neuroimaging experts as possible. The surveys ran from 1st June to 30 September 2010, asked 10 and 21 questions, respectively, about uses of neuroimaging outside traditional medical diagnosis, data storage, science communication and potential methods of regulation. We analysed the responses using descriptive statistics; 660 individuals responded to the public and 303 individuals responded to the expert survey. We found evidence of public skepticism about the use of neuroimaging for applications such as lie detection or to determine consumer preferences and considerable disquiet about use by employers or government and about how their data would be stored and used. While also somewhat skeptical about new applications of neuroimaging, experts grossly underestimated how often neuroimaging had been used as evidence in court. Although both the public and the experts rated highly the importance of a better informed public in limiting the inappropriate uses to which neuroimaging might be put, opinions differed on the need for, and mechanism of, actual regulation. Neuroscientists recognized the risks of inaccurate reporting of neuroimaging capabilities in the media but showed little motivation to engage with the public. The present study also emphasizes the need for better frameworks for scientific engagement with media and public education. PMID:21991367

Contemporary management of paraesophaegeal hernias: establishing a European expert consensus.

PubMed

Bonrath, E M; Grantcharov, T P

2015-08-01

The surgical treatment of paraesophageal hernias remains a challenge due to the lack of consensus regarding principles of operative treatment. The objectives of this study were to achieve consensus on key topics through expert opinion using a Delphi methodology. A Delphi survey combined with a face-to-face meeting was conducted. A panel of European experts in foregut surgery from high-volume centres generated items in the first survey round. In subsequent rounds, the panel rated agreement with statements on a 5-point Likert-type scale. Internal consistency (consensus) was predefined as Cronbach's α > .80. Items that >70 % of the panel either rated as irrelevant/unimportant, or relevant/important were selected as consensus items, while topics that did not reach this cut-off were termed "undecided/controversial". Three survey rounds were completed: 19 experts from 10 countries completed round one, 18 continued through rounds two and three. Internal consistency was high in rounds two and three (α > .90). Fifty-eight additional/revised items derived from comments and free-text entries were included in round three. In total, 118 items were rated; consensus agreement was achieved for 70 of these. Examples of consensus topics are the relevance of the disease profile for assessing surgical urgency and complexity, the role of clinical history as the mainstay of patient follow-up, indications for revision surgery, and training and credentialing recommendations. Topics with the most "undecided/controversial" items were follow-up, postoperative care and surgical technique. This Delphi study achieved expert consensus on key topics in the operative management of paraesophageal hernias, providing an overview of the current opinion among European foregut surgeons. Moreover, areas with substantial variability in opinions were identified reflecting the current lack of empirical evidence and opportunities for future research.

Standardized severe maternal morbidity review: rationale and process.

PubMed

Kilpatrick, Sarah J; Berg, Cynthia; Bernstein, Peter; Bingham, Debra; Delgado, Ana; Callaghan, William M; Harris, Karen; Lanni, Susan; Mahoney, Jeanne; Main, Elliot; Nacht, Amy; Schellpfeffer, Michael; Westover, Thomas; Harper, Margaret

2014-08-01

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician-gynecologists, maternal-fetal medicine subspecialists, certified nurse-midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

Expectations of recovery and functional outcomes following thoracolumbar trauma: an evidence-based medicine process to determine what surgeons should be telling their patients.

PubMed

Schouten, Rowan; Lewkonia, Peter; Noonan, Vanessa K; Dvorak, Marcel F; Fisher, Charles G

2015-01-01

The aim of this study was to define the expected functional and health-related quality of life outcomes following common thoracolumbar injuries on the basis of consensus expert opinion and the best available literature. Patient expectations are primarily determined by the information provided by health care professionals, and these expectations have been shown to influence outcome in various medical and surgical conditions. This paper presents Part 2 of a multiphase study designed to investigate the impact of patient expectations on outcomes following spinal injury. Part 1 demonstrated substantial variability in the information surgeons are communicating to patients. Defining the expected outcomes following thoracolumbar injury would allow further analysis of this relationship and enable surgeons to more accurately and consistently inform patients. Expert opinion was assembled by distributing questionnaires comprising 4 cases representative of common thoracolumbar injuries to members of the Spine Trauma Study Group (STSG). The 4 cases included a thoracolumbar junction burst fracture treated nonoperatively or with posterior transpedicular instrumentation, a low lumbar (L-4) burst fracture treated nonoperatively, and a thoracolumbar junction flexion-distraction injury managed with posterior fusion. For each case, 5 questions about expected outcomes were posed. The questions related to the proportion of patients who are pain free, the proportion who have regained full range of motion, and the patients' recreational activity restrictions and personal care and social life limitations, all at 1 year following injury, as well as the timing of return to work and length of hospital stay. Responses were analyzed and combined with the results of a systematic literature review on the same injuries to define the expected outcomes. The literature review identified 38 appropriate studies that met the preset inclusion criteria. Published data were available for all injuries, but not all outcomes were available for each type of injury. The survey was completed by 31 (57%) of 53 surgeons representing 24 trauma centers across North America (15), Europe (5), India (1), Mexico (1), Japan (1) and Israel (1). Consensus expert opinion supplemented the available literature and was used exclusively when published data were lacking. For example, 1 year following cast or brace treatment of a thoracolumbar burst fracture, the expected outcomes include a 40% chance of being pain free, a 70% chance of regaining pre-injury range of motion, and an expected ability to participate in high-impact exercise and contact sport with no or minimal limitation. Consensus expert opinion predicts reemployment within 4-6 months. The length of inpatient stay averages 4-5 days. This synthesis of the best available literature and consensus opinion of surgeons with extensive clinical experience in spine trauma reflects the optimal methodology for determining functional prognosis after thoracolumbar trauma. By providing consistent, accurate information surgeons will help patients develop realistic expectations and potentially optimize outcomes.

Investigating the Role of an Inquiry-Based Biology Lab Course on Student Attitudes and Views toward Science

ERIC Educational Resources Information Center

Jeffery, Erica; Nomme, Kathy; Deane, Thomas; Pollock, Carol; Birol, Gülnur

2016-01-01

Students' academic experiences can influence their conceptualization of science. In contrast experts hold particular beliefs, perceptions, opinions, and attitudes about science that are often absent in first-year undergraduate students. Shifts toward more expert-like attitudes and views have been linked to improved student engagement,…

Voices from the Field: 30 Expert Opinions on America 2000, The Bush Administration Strategy To "Reinvent" America's Schools.

ERIC Educational Resources Information Center

Institute for Educational Leadership, Washington, DC.

"America 2000," President Bush's national strategy for "Reinventing America's Schools" is evaluated by 30 invited experts in the following papers: "Bottom-up Reform From the Top Down" (John E. Chubb); "Would Choice + Competition Yield Quality Education?" (Richard F. Elmore); "The Federal Education Role…

Value-Added Models: What the Experts Say

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey; Pivovarova, Margarita; Geiger, Tray J.

2016-01-01

Being an expert involves explaining how things are supposed to work, and, perhaps more important, why things might not work as supposed. In this study, researchers surveyed scholars with expertise in value-added models (VAMs) to solicit their opinions about the uses and potential of VAMs for teacher-level accountability purposes (for example, in…

ACR Appropriateness Criteria® management of locoregionally advanced squamous cell carcinoma of the vulva.

PubMed

Kidd, Elizabeth; Moore, David; Varia, Mahesh A; Gaffney, David K; Elshaikh, Mohamed A; Erickson, Beth; Jhingran, Anuja; Lee, Larissa J; Mayr, Nina A; Puthawala, Ajmel A; Rao, Gautam G; Small, William; Wahl, Andrew O; Wolfson, Aaron H; Yashar, Catheryn M; Yuh, William; Cardenes, Higinia Rosa

2013-08-01

Locoregionally advanced vulvar cancer (LRAVC) is a rare disease that presents many challenging medical decisions. An expert panel was convened to reach consensus on the most appropriate pretreatment assessment and therapeutic interventions in LRAVC patients. The American College of Radiology Appropriateness Criteria are evidenced-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journal and the application of a well-established consensus methodology (modified Delphi) to rate appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to formulate recommendations. Three clinical variants were developed to address common scenarios in the management of LRAVC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches, with numerical ratings and descriptive commentary. In combining available medical literature and expert opinion, this manuscript may serve as an aid for other practitioners in the appropriate management of patients with LRAVC.

On Consistency Test Method of Expert Opinion in Ecological Security Assessment.

PubMed

Gong, Zaiwu; Wang, Lihong

2017-09-04

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert's individual judgment level, ability and the consistency of the expert's overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment.

Revisiting the False Confession Problem.

PubMed

Alvarez-Toro, Viviana; Lopez-Morales, Cesar A

2018-03-01

Despite the existence of important safeguards in our criminal legal system, innocent suspects often succumb to forceful and deceptive interrogation techniques. Among those over-represented members of the false confessor population are minors, people with cognitive and intellectual disabilities, and those with psychiatric disorders. Some of the confessions made by these at-risk populations can hardly be considered voluntary or reliable, but they are generally admitted at trial, regardless of their prejudicial effect. Forensic psychiatrists should become more involved in the overall process of evaluating confessions, not only testifying in courts, but also assisting policymakers in reforming the interrogation process and influencing the legal process. Thus, forensic psychiatrists may give their expert opinion by providing proper training to police interrogators and examining videotaped interrogations. In addition, forensic experts can be instrumental in contributing to three legal solutions that we propose to the false confession problem: a constitutional approach, an evidence law approach, and a jury instruction approach. Each of these approaches requires forensic psychiatrists to help judges and jurors understand the coercive nature of the interrogation process and its effect on suspects' behavior. © 2018 American Academy of Psychiatry and the Law.

Fault lines in forensic medical toxicology in Ireland exposed through replies of pathologists and coroners to anonymous questionnaires.

PubMed

Tormey, William P; Borovickova, Ingrid; Moore, Tara M

2014-01-01

The attitudes and experiences of pathologists and coroners to the provision of biochemical forensic toxicology in the Republic of Ireland were determined using separate questionnaires to each group anonymously. Replies were received from 36/88 (41%) of pathologists and 19/71 (27%) of coroners. 37% of coroners considered that histopathologists give an adequate opinion in forensic toxicology yet 58% of pathologists reported that they did not have adequate access to expert medical interpretative toxicological opinion. For drug-drug interactions and metabolic diseases, 69% of pathologists were unhappy with the processes and 68% of coroner replies did not know if vitreous samples were used appropriately. There is a clear requirement for retraining of coroners and for the appointment of medical toxicology expertise to improve the quality of service for coroners.

Transformation in the pharmaceutical industry: transformation-induced quality risks--a survey.

PubMed

Shafiei, Nader; Ford, James L; Morecroft, Charles W; Lisboa, Paulo J; Taylor, Mark J; Mouzughi, Yusra

2013-01-01

This paper is the fourth in a series that explores ongoing transformation in the pharmaceutical industry and its impact on pharmaceutical quality from the perspective of risk identification. The aim of this paper is to validate proposed quality risks through elicitation of expert opinion and define the resultant quality risk model. Expert opinion was obtained using a questionnaire-based survey with participants with recognized expertise in pharmaceutical regulation, product lifecycle, or technology. The results of the survey validate the theoretical and operational evidence in support of the four main pharmaceutical transformation triggers previously identified. The quality risk model resulting from the survey indicated a firm relationship between the pharmaceutical quality risks and regulatory compliance outcomes during the marketing approval and post-marketing phases of the product lifecycle and a weaker relationship during the pre-market evaluation phase. In this paper through conduct of an expert opinion survey the proposed quality risks carried forward from an earlier part of the research are validated and resultant quality risk model is defined. The survey results validate the theoretical and operational evidence previously identified. The quality risk model indicates that transformation-related risks have a larger regulatory compliance impact during product approval, manufacturing, distribution, and commercial use than during the development phase.

Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase.

PubMed

Martorell, A; Alonso, E; Echeverría, L; Escudero, C; García-Rodríguez, R; Blasco, C; Bone, J; Borja-Segade, J; Bracamonte, T; Claver, A; Corzo, J L; De la Hoz, B; Del Olmo, R; Dominguez, O; Fuentes-Aparicio, V; Guallar, I; Larramona, H; Martín-Muñoz, F; Matheu, V; Michavila, A; Ojeda, I; Ojeda, P; Piquer, M; Poza, P; Reche, M; Rodríguez Del Río, P; Rodríguez, M; Ruano, F; Sánchez-García, S; Terrados, S; Valdesoiro, L; Vazquez-Ortiz, M

Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts. Copyright © 2017 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Physical examination and laboratory tests in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion.

PubMed

Pham, Thao; Gossec, Laure; Fautrel, Bruno; Combe, Bernard; Flipo, René-Marc; Goupille, Philippe; Le Loët, Xavier; Mariette, Xavier; Puéchal, Xavier; Wendling, Daniel; Schaeverbeke, Thierry; Sibilia, Jean; Sany, Jacques; Dougados, Maxime

2005-05-01

To develop recommendations for the physical and laboratory-test follow-up of patients with rheumatoid arthritis (RA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed. A scientific committee selected 7-10 questions using the Delphi consensus procedure. Evidence-based responses to each question were sought in the literature and were then used by a panel to develop recommendations. To fill in gaps in knowledge from the literature, the panelists relied on their personal opinion. The seven questions dealt with the physical and laboratory-test follow-up of RA and the factors predicting disease severity. The literature review identified 799 articles whose title and abstract suggested relevance to the study. Elimination of articles that provided no data on the study topic left 128 original articles. The panel developed seven recommendations, one for each question, which were accepted by consensus. Recommendations about the physical and laboratory-test follow-up of patients with RA seen in everyday practice were developed. Because they constitute an objective foundation built by consensus among experts, should improve the uniformity and quality of care provided to RA patients in everyday practice.

Guidelines for using the Delphi Technique to develop habitat suitability index curves

USGS Publications Warehouse

Crance, Johnie H.

1987-01-01

Habitat Suitability Index (SI) curves are one method of presenting species habitat suitability criteria. The curves are often used with the Habitat Evaluation Procedures (HEP) and are necessary components of the Instream Flow Incremental Methodology (IFIM) (Armour et al. 1984). Bovee (1986) described three categories of SI curves or habitat suitability criteria based on the procedures and data used to develop the criteria. Category I curves are based on professional judgment, with 1ittle or no empirical data. Both Category II (utilization criteria) and Category III (preference criteria) curves have as their source data collected at locations where target species are observed or collected. Having Category II and Category III curves for all species of concern would be ideal. In reality, no SI curves are available for many species, and SI curves that require intensive field sampling often cannot be developed under prevailing constraints on time and costs. One alternative under these circumstances is the development and interim use of SI curves based on expert opinion. The Delphi technique (Pill 1971; Delbecq et al. 1975; Linstone and Turoff 1975) is one method used for combining the knowledge and opinions of a group of experts. The purpose of this report is to describe how the Delphi technique may be used to develop expert-opinion-based SI curves.

The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process.

PubMed

Marino, Luise V; Johnson, Mark J; Hall, Nigel J; Davies, Natalie J; Kidd, Catherine S; Daniels, M Lowri; Robinson, Julia E; Richens, Trevor; Bharucha, Tara; Darlington, Anne-Sophie E

2018-04-29

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Different contributions of internal reviewers and external experts to labelling decisions on therapeutic indications in new drug reviews in Japan.

PubMed

Yokota, M; Kusama, M; Matsuki, N; Ono, S

2013-12-01

External experts play an important role in shaping regulatory decisions in the new drug review process in the United States, Europe and Japan. No rigorous study has been performed addressing how and to what extent external experts, in contrast to internal reviewers in the agency, influence the regulatory decisions during new drug reviews. We examined their contributions in Japanese regulatory reviews in contrast to the internal reviewers, focusing on the labelling decision on therapeutic indications. With the data set of 219 new molecular entities (NMEs) approved in Japan from 2000 to 2009, we observed how proposed indications in labelling were modified in a stepwise manner during the review process and conducted multinomial logistic analysis to examine the possible mechanism behind. We found that interim assessment of indications by the internal reviewers was modified substantially by the influence of the external experts in about 20% of the 219 NMEs. Our analysis suggested that internal reviewers provided their opinion mainly based on strict review discipline, whereas external experts added flexibility and reality to their reviews. Our analysis revealed different evaluations between internal reviewers and external experts during regulatory discussions in new drug reviews and how the external panel contributes to changing internal decisions. This study provides a new and quantitative approach to better label setting by emphasizing the contributions of each stakeholder in new drug reviews, which would improve the efficiency, quality and transparency of new drug reviews to enhance public health. © 2013 John Wiley & Sons Ltd.

Multi-criteria decision analysis tools for prioritising emerging or re-emerging infectious diseases associated with climate change in Canada.

PubMed

Cox, Ruth; Sanchez, Javier; Revie, Crawford W

2013-01-01

Global climate change is known to result in the emergence or re-emergence of some infectious diseases. Reliable methods to identify the infectious diseases of humans and animals and that are most likely to be influenced by climate are therefore required. Since different priorities will affect the decision to address a particular pathogen threat, decision makers need a standardised method of prioritisation. Ranking methods and Multi-Criteria Decision approaches provide such a standardised method and were employed here to design two different pathogen prioritisation tools. The opinion of 64 experts was elicited to assess the importance of 40 criteria that could be used to prioritise emerging infectious diseases of humans and animals in Canada. A weight was calculated for each criterion according to the expert opinion. Attributes were defined for each criterion as a transparent and repeatable method of measurement. Two different Multi-Criteria Decision Analysis tools were tested, both of which used an additive aggregation approach. These were an Excel spreadsheet tool and a tool developed in software 'M-MACBETH'. The tools were trialed on nine 'test' pathogens. Two different methods of criteria weighting were compared, one using fixed weighting values, the other using probability distributions to account for uncertainty and variation in expert opinion. The ranking of the nine pathogens varied according to the weighting method that was used. In both tools, using both weighting methods, the diseases that tended to rank the highest were West Nile virus, Giardiasis and Chagas, while Coccidioidomycosis tended to rank the lowest. Both tools are a simple and user friendly approach to prioritising pathogens according to climate change by including explicit scoring of 40 criteria and incorporating weighting methods based on expert opinion. They provide a dynamic interactive method that can help to identify pathogens for which a full risk assessment should be pursued.

Multi-Criteria Decision Analysis Tools for Prioritising Emerging or Re-Emerging Infectious Diseases Associated with Climate Change in Canada

PubMed Central

Cox, Ruth; Sanchez, Javier; Revie, Crawford W.

2013-01-01

Global climate change is known to result in the emergence or re-emergence of some infectious diseases. Reliable methods to identify the infectious diseases of humans and animals and that are most likely to be influenced by climate are therefore required. Since different priorities will affect the decision to address a particular pathogen threat, decision makers need a standardised method of prioritisation. Ranking methods and Multi-Criteria Decision approaches provide such a standardised method and were employed here to design two different pathogen prioritisation tools. The opinion of 64 experts was elicited to assess the importance of 40 criteria that could be used to prioritise emerging infectious diseases of humans and animals in Canada. A weight was calculated for each criterion according to the expert opinion. Attributes were defined for each criterion as a transparent and repeatable method of measurement. Two different Multi-Criteria Decision Analysis tools were tested, both of which used an additive aggregation approach. These were an Excel spreadsheet tool and a tool developed in software ‘M-MACBETH’. The tools were trialed on nine ‘test’ pathogens. Two different methods of criteria weighting were compared, one using fixed weighting values, the other using probability distributions to account for uncertainty and variation in expert opinion. The ranking of the nine pathogens varied according to the weighting method that was used. In both tools, using both weighting methods, the diseases that tended to rank the highest were West Nile virus, Giardiasis and Chagas, while Coccidioidomycosis tended to rank the lowest. Both tools are a simple and user friendly approach to prioritising pathogens according to climate change by including explicit scoring of 40 criteria and incorporating weighting methods based on expert opinion. They provide a dynamic interactive method that can help to identify pathogens for which a full risk assessment should be pursued. PMID:23950868

The necessity of repeated assessment of imaging studies contained in medical records in medico-legal opinions.

PubMed

Borowska-Solonynko, A

The paper presents two case reports of living victims, in which imaging studies of the chest conducted at a medical facility were an essential part of the medico-legal opinion. The first case was that of a young male hospitalized due to CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. The other case was that of a six week old baby hospitalized due to chest X-ray evidence of right hand side rib fractions. The chest X-ray was performed due to one bruise found on the baby's forehead and two small bruises on the back, which gave rise to suspicions of child abuse. In both cases, expert witnesses in radiology definitively excluded the presence of any fractures. These cases indicate that a new assessment of imaging studies contained in medical records is needed. Expert opinions based solely on the description of imaging studies may result in grave consequences.

Guiding Principles for Student Leadership Development in the Doctor of Pharmacy Program to Assist Administrators and Faculty Members in Implementing or Refining Curricula

PubMed Central

Boyle, Cynthia J.; Janke, Kristin K.

2013-01-01

Objective. To assist administrators and faculty members in colleges and schools of pharmacy by gathering expert opinion to frame, direct, and support investments in student leadership development. Methods. Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define doctor of pharmacy (PharmD) student leadership instruction. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes to begin the generation of student leadership development guiding principles and competencies. Statements were identified as guiding principles when they were perceived as foundational to the instructional approach. Round 2 grouped responses for agreement rating and comment. Group consensus with a statement as a guiding principle was set prospectively at 80%. Round 3 allowed rating and comment on guidelines, modified from feedback in round 2, that did not meet consensus. The principles were verified by identifying common contemporary leadership development approaches in the literature. Results. Twelve guiding principles, related to concepts of leadership and educational philosophy, were defined and could be linked to contemporary leadership development thought. These guiding principles describe the motivation for teaching leadership, the fundamental precepts of student leadership development, and the core tenets for leadership instruction. Conclusions. Expert opinion gathered using a Delphi process resulted in guiding principles that help to address many of the fundamental questions that arise when implementing or refining leadership curricula. The principles identified are supported by common contemporary leadership development thought. PMID:24371345

Future Targets for Female Sexual Dysfunction.

PubMed

Farmer, Melissa; Yoon, Hana; Goldstein, Irwin

2016-08-01

Female sexual function reflects a dynamic interplay of central and peripheral nervous, vascular, and endocrine systems. The primary challenge in the development of novel treatments for female sexual dysfunction is the identification and targeted modulation of excitatory sexual circuits using pharmacologic treatments that facilitate the synthesis, release, and/or receptor binding of neurochemicals, peptides, and hormones that promote female sexual function. To develop an evidence-based state-of-the-art consensus report that critically integrates current knowledge of the therapeutic potential for known molecular and cellular targets to facilitate the physiologic processes underlying female sexual function. State-of-the-art review representing the opinions of international experts developed in a consensus process during a 1-year period. Expert opinion was established by grading the evidence-based medical literature, intensive internal committee discussion, public presentation, and debate. Scientific investigation is urgently needed to expand knowledge and foster development of future treatments that maintain genital tissue integrity, enhance genital physiologic responsiveness, and optimize positive subjective appraisal of internal and external sexual cues. This article critically condenses the current knowledge of therapeutic manipulation of molecular and cellular targets within biological systems responsible for female sexual physiologic function. Future treatment targets include pharmacologic modulation of emotional learning circuits, restoration of normal tactile sensation, growth factor therapy, gene therapy, stem cell-based therapies, and regenerative medicine. Concurrent use of centrally and peripherally acting therapies could optimize treatment response. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Guiding principles for student leadership development in the doctor of pharmacy program to assist administrators and faculty members in implementing or refining curricula.

PubMed

Traynor, Andrew P; Boyle, Cynthia J; Janke, Kristin K

2013-12-16

To assist administrators and faculty members in colleges and schools of pharmacy by gathering expert opinion to frame, direct, and support investments in student leadership development. Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define doctor of pharmacy (PharmD) student leadership instruction. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes to begin the generation of student leadership development guiding principles and competencies. Statements were identified as guiding principles when they were perceived as foundational to the instructional approach. Round 2 grouped responses for agreement rating and comment. Group consensus with a statement as a guiding principle was set prospectively at 80%. Round 3 allowed rating and comment on guidelines, modified from feedback in round 2, that did not meet consensus. The principles were verified by identifying common contemporary leadership development approaches in the literature. Twelve guiding principles, related to concepts of leadership and educational philosophy, were defined and could be linked to contemporary leadership development thought. These guiding principles describe the motivation for teaching leadership, the fundamental precepts of student leadership development, and the core tenets for leadership instruction. Expert opinion gathered using a Delphi process resulted in guiding principles that help to address many of the fundamental questions that arise when implementing or refining leadership curricula. The principles identified are supported by common contemporary leadership development thought.

Consensus development on the essential competencies for Iranian public health nutritionists.

PubMed

Sadeghi-Ghotbabadi, Farzaneh; Shakibazadeh, Elham; Omidvar, Nasrin; Mortazavi, Fathieh; Kolahdooz, Fariba

2015-03-01

To assess key experts' opinion regarding essential competencies required for effective public health nutrition practice within the health-care system of Iran. Qualitative study using the modified Delphi technique through an email-delivered questionnaire. Iran. Fifty-five experts were contacted through email. The inclusion criterion for the study panel was being in a relevant senior-level position in nutrition science or public health nutrition in Iran. In the first round, forty-two out of fifty-five experts responded to the questionnaire (response rate=76 %). A sixty-five-item questionnaire was designed with nine competency areas, including 'nutrition science', 'planning and implementing nutritional interventions', 'health and nutrition services', 'advocacy and communication', 'assessment and analysis', 'evaluation', 'cultural, social and political aspects', 'using technology' and 'leadership and management'. All experts who had participated in the first round completed a modified version of the questionnaire with seventy-seven items in the second round. The experts scored 'nutrition science' as the most essential competency area, while more applied areas such as 'management and leadership' were less emphasized. In both rounds, the mean difference between the opinions of the necessity of each area was 5.6 %. The Iranian experts had general agreement on most of the core competency areas of public health nutritionists. The results indicated the need for capacity building and revisions to educational curricula for public health nutritionist programmes, with more emphasis on skill-based competency development.

Position Statement of the Israeli Society for Musculoskeletal Medicine on Intramuscular Stimulation for Myofascial Pain Syndrome-A Delphi Process.

PubMed

Ratmansky, Motti; Minerbi, Amir; Kalichman, Leonid; Kent, John; Wende, Osnat; Finestone, Aharon S; Vulfsons, Simon

2017-04-01

To develop consensus on a position paper on the use of intramuscular stimulation (IMS) for the treatment of myofascial pain syndrome (MPS) by physicians in Israel. The Israeli Society of Musculoskeletal Medicine ran a modified Delphi process to gather opinions from a multidisciplinary expert panel. Eight experts in the treatment of MPS were chosen and asked to participate, and six participated. The position paper was iterated three times. After three iterations, general consensus was reached by all six experts. The general statement that was agreed on was: "IMS is one of the preferred treatments for myofascial pain syndrome. The treatment is evidence-based, effective, safe, and inexpensive. The position of the Israeli Society of Musculoskeletal Medicine is that the treatment should be taught and used by all primary care physicians and those physicians in other areas of medicine who deal with pain in their work." The position paper is a basis for clinical work and education programs for physicians interested in a better understanding and ability to treat patients with a musculoskeletal complaint or manifestation of disease. © 2016 World Institute of Pain.

Rating scale for the assessment of competence in ultrasound-guided peripheral vascular access - a Delphi Consensus Study.

PubMed

Primdahl, Stine C; Todsen, Tobias; Clemmesen, Louise; Knudsen, Lars; Weile, Jesper

2016-09-21

Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study. We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale. Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure. We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.

Final Technical Report on Quantifying Dependability Attributes of Software Based Safety Critical Instrumentation and Control Systems in Nuclear Power Plants

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

Smidts, Carol; Huang, Funqun; Li, Boyuan

With the current transition from analog to digital instrumentation and control systems in nuclear power plants, the number and variety of software-based systems have significantly increased. The sophisticated nature and increasing complexity of software raises trust in these systems as a significant challenge. The trust placed in a software system is typically termed software dependability. Software dependability analysis faces uncommon challenges since software systems’ characteristics differ from those of hardware systems. The lack of systematic science-based methods for quantifying the dependability attributes in software-based instrumentation as well as control systems in safety critical applications has proved itself to be amore » significant inhibitor to the expanded use of modern digital technology in the nuclear industry. Dependability refers to the ability of a system to deliver a service that can be trusted. Dependability is commonly considered as a general concept that encompasses different attributes, e.g., reliability, safety, security, availability and maintainability. Dependability research has progressed significantly over the last few decades. For example, various assessment models and/or design approaches have been proposed for software reliability, software availability and software maintainability. Advances have also been made to integrate multiple dependability attributes, e.g., integrating security with other dependability attributes, measuring availability and maintainability, modeling reliability and availability, quantifying reliability and security, exploring the dependencies between security and safety and developing integrated analysis models. However, there is still a lack of understanding of the dependencies between various dependability attributes as a whole and of how such dependencies are formed. To address the need for quantification and give a more objective basis to the review process -- therefore reducing regulatory uncertainty -- measures and methods are needed to assess dependability attributes early on, as well as throughout the life-cycle process of software development. In this research, extensive expert opinion elicitation is used to identify the measures and methods for assessing software dependability. Semi-structured questionnaires were designed to elicit expert knowledge. A new notation system, Causal Mechanism Graphing, was developed to extract and represent such knowledge. The Causal Mechanism Graphs were merged, thus, obtaining the consensus knowledge shared by the domain experts. In this report, we focus on how software contributes to dependability. However, software dependability is not discussed separately from the context of systems or socio-technical systems. Specifically, this report focuses on software dependability, reliability, safety, security, availability, and maintainability. Our research was conducted in the sequence of stages found below. Each stage is further examined in its corresponding chapter. Stage 1 (Chapter 2): Elicitation of causal maps describing the dependencies between dependability attributes. These causal maps were constructed using expert opinion elicitation. This chapter describes the expert opinion elicitation process, the questionnaire design, the causal map construction method and the causal maps obtained. Stage 2 (Chapter 3): Elicitation of the causal map describing the occurrence of the event of interest for each dependability attribute. The causal mechanisms for the “event of interest” were extracted for each of the software dependability attributes. The “event of interest” for a dependability attribute is generally considered to be the “attribute failure”, e.g. security failure. The extraction was based on the analysis of expert elicitation results obtained in Stage 1. Stage 3 (Chapter 4): Identification of relevant measurements. Measures for the “events of interest” and their causal mechanisms were obtained from expert opinion elicitation for each of the software dependability attributes. The measures extracted are presented in this chapter. Stage 4 (Chapter 5): Assessment of the coverage of the causal maps via measures. Coverage was assessed to determine whether the measures obtained were sufficient to quantify software dependability, and what measures are further required. Stage 5 (Chapter 6): Identification of “missing” measures and measurement approaches for concepts not covered. New measures, for concepts that had not been covered sufficiently as determined in Stage 4, were identified using supplementary expert opinion elicitation as well as literature reviews. Stage 6 (Chapter 7): Building of a detailed quantification model based on the causal maps and measurements obtained. Ability to derive such a quantification model shows that the causal models and measurements derived from the previous stages (Stage 1 to Stage 5) can form the technical basis for developing dependability quantification models. Scope restrictions have led us to prioritize this demonstration effort. The demonstration was focused on a critical system, i.e. the reactor protection system. For this system, a ranking of the software dependability attributes by nuclear stakeholders was developed. As expected for this application, the stakeholder ranking identified safety as the most critical attribute to be quantified. A safety quantification model limited to the requirements phase of development was built. Two case studies were conducted for verification. A preliminary control gate for software safety for the requirements stage was proposed and applied to the first case study. The control gate allows a cost effective selection of the duration of the requirements phase.« less

Identifying the Essential Elements of Effective Science Communication: What Do the Experts Say?

ERIC Educational Resources Information Center

Bray, Belinda; France, Bev; Gilbert, John K.

2012-01-01

Experts in science communication were asked to identify the essential elements of a science communication course for post-graduate students. A Delphi methodology provided a framework for a research design that accessed their opinions and allowed them to contribute to, reflect on and identify 10 essential elements. There was a high level of…

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...

Qualitative Methods in the Development of a Bilingual and Bicultural Quality of Life Outcomes Measure for Pediatric Patients With Craniofacial Conditions.

PubMed

Tapia, Viridiana Juarez; Drizin, Julia Helene; Dalle Ore, Cecilia; Nieto, Marcelo; Romero, Yajahira; Magallon, Sandra; Nayak, Rohith; Sigler, Alicia; Malcarne, Vanessa; Gosman, Amanda

2017-05-01

Craniofacial surgeons treat patients with diverse craniofacial conditions (CFCs). Yet, little is known about the health-related quality of life (HRQoL) impact of diverse CFCs. Currently, there are no suitable instruments that measure the HRQoL of patients with diverse CFCs from the perspective of children and parents. The objective of this study was to develop the items and support the content validity of a comprehensive patient and parent-reported outcomes measure. An iterative process consisting of a systematic literature review, expert opinion and in-depth interviews with patients and parents of patients with diverse CFCs was used. The literature review and expert opinion were used to generate in-depth interview questions. We interviewed 127 subjects: 80 parents of patients ages 0 to 18 years or older and 47 patients ages 7 to 18 years or older. English and Spanish speakers were represented in our sample. The majority of subjects originated from the United States and Mexico (83%). Craniofacial conditions included were cleft lip/palate, craniosynostosis, craniofacial microsomia, microtia, and dermatological conditions. Semistructured interviews were conducted until content saturation was achieved. Line-by-line analysis of interview transcripts identified HRQoL themes. Themes were interpreted and organized into larger domains that represent the conceptual framework of CFC-associated HRQoL. Themes were operationalized into items that represent the HRQoL issues of patients for both parent and patient versions. Six final bilingual and bicultural scales based on the domains derived from the literature review, expert opinion, and in-depth interviews were developed: (1) "Social Impact," (2) "Psychological Function," (3) "Physical Function," (4) "Family Impact," (5) "Appearance," And (6) "Finding Meaning." Some cultural differences were identified: in contrast to children from Mexico and other developing nations, families from the United States did not report public harassment or extremely negative public reactions to patients' CFC. Religion and spirituality were common themes in interviews of Spanish-speaking subjects but less common in interviews of English-speaking subjects. Qualitative methods involving pediatric patients with diverse CFCs and their parents in the item development process support the content validity for this bilingual and bicultural HRQoL instrument. The items developed in this study will now undergo psychometric testing in national multisite studies for validation.

Expert Opinions on Improving Femicide Data Collection across Europe: A Concept Mapping Study

PubMed Central

Vives-Cases, Carmen; Goicolea, Isabel; Hernández, Alison; Sanz-Barbero, Belen; Gill, Aisha K.; Baldry, Anna Costanza; Schröttle, Monika; Stoeckl, Heidi

2016-01-01

Femicide, defined as the killings of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Despite its high prevalence or widespread prevalence, only a few countries have specific registries about this issue. This study aims to assemble expert opinion regarding the strategies which might feasibly be employed to promote, develop and implement an integrated and differentiated femicide data collection system in Europe at both the national and international levels. Concept mapping methodology was followed, involving 28 experts from 16 countries in generating strategies, sorting and rating them with respect to relevance and feasibility. The experts involved were all members of the EU-Cost-Action on femicide, which is a scientific network of experts on femicide and violence against women across Europe. As a result, a conceptual map emerged, consisting of 69 strategies organized in 10 clusters, which fit into two domains: “Political action” and “Technical steps”. There was consensus among participants regarding the high relevance of strategies to institutionalize national databases and raise public awareness through different stakeholders, while strategies to promote media involvement were identified as the most feasible. Differences in perceived priorities according to the level of human development index of the experts’ countries were also observed. PMID:26859885

Comparison of expert and nonexpert swimmers' opinions about the value, potency, and activity of four standard swimming strokes and underwater undulatory swimming.

PubMed

Collard, L; Oboeuf, A

2009-04-01

Underwater undulatory swimming (UUS) is often perceived to be a nonessential aspect of aquatic propulsion. Given their solid theoretical and practical training in swimming, physical education students should be capable of judging the true value of the "fifth stroke," since it appears to be the most efficient technique in high level, competitive swimming. To compare opinions and connotations associated with the stroke and the four official strokes (butterfly, backstroke, breaststroke, and crawl), 198 students (32 of whom were expert swimmers; M age = 20.6 yr., SD = 1.2), were surveyed using the semantic differential of Osgood, Suci, and Tannenbaum. Although answers of expert and nonexpert swimmers differed significantly (p < .01, except for the breaststroke), participants considered overall that undulatory stroke was less attractive, less powerful, and less rapid than the four surface strokes (d = 2.88 for the expert swimmers). Putting one arm in front of the other and repeating the sequence still remains the most solidly held representation of "the right way" to swim. However, the high observed standard deviations for the underwater undulatory stimulus (SD > or = 1.1 with SD max = 3 for the expert swimmers) attests to the view being less strongly held by swimming specialists.

Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery.

PubMed

van de Velde, C J H; Boelens, P G; Tanis, P J; Espin, E; Mroczkowski, P; Naredi, P; Pahlman, L; Ortiz, H; Rutten, H J; Breugom, A J; Smith, J J; Wibe, A; Wiggers, T; Valentini, V

2014-04-01

The first multidisciplinary consensus conference on colon and rectal cancer was held in December 2012, achieving a majority of consensus for diagnostic and treatment decisions using the Delphi Method. This article will give a critical appraisal of the topics discussed during the meeting and in the consensus document by well-known leaders in surgery that were involved in this multidisciplinary consensus process. Scientific evidence, experience and opinions are collected to support multidisciplinary teams (MDT) with arguments for medical decision-making in diagnosis, staging and treatment strategies for patients with colon or rectal cancer. Surgery is the cornerstone of curative treatment for colon and rectal cancer. Standardizing treatment is an effective instrument to improve outcome of multidisciplinary cancer care for patients with colon and rectal cancer. In this article, a review of the following focuses; Perioperative care, age and colorectal surgery, obstructive colorectal cancer, stenting, surgical anatomical considerations, total mesorectal excision (TME) surgery and training, surgical considerations for locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC), surgery in stage IV colorectal cancer, definitions of quality of surgery, transanal endoscopic microsurgery (TEM), laparoscopic colon and rectal surgery, preoperative radiotherapy and chemoradiotherapy, and how about functional outcome after surgery? Copyright © 2013 Elsevier Ltd. All rights reserved.

Four Common Simplifications of Multi-Criteria Decision Analysis do not hold for River Rehabilitation

PubMed Central

2016-01-01

River rehabilitation aims at alleviating negative effects of human impacts such as loss of biodiversity and reduction of ecosystem services. Such interventions entail difficult trade-offs between different ecological and often socio-economic objectives. Multi-Criteria Decision Analysis (MCDA) is a very suitable approach that helps assessing the current ecological state and prioritizing river rehabilitation measures in a standardized way, based on stakeholder or expert preferences. Applications of MCDA in river rehabilitation projects are often simplified, i.e. using a limited number of objectives and indicators, assuming linear value functions, aggregating individual indicator assessments additively, and/or assuming risk neutrality of experts. Here, we demonstrate an implementation of MCDA expert preference assessments to river rehabilitation and provide ample material for other applications. To test whether the above simplifications reflect common expert opinion, we carried out very detailed interviews with five river ecologists and a hydraulic engineer. We defined essential objectives and measurable quality indicators (attributes), elicited the experts´ preferences for objectives on a standardized scale (value functions) and their risk attitude, and identified suitable aggregation methods. The experts recommended an extensive objectives hierarchy including between 54 and 93 essential objectives and between 37 to 61 essential attributes. For 81% of these, they defined non-linear value functions and in 76% recommended multiplicative aggregation. The experts were risk averse or risk prone (but never risk neutral), depending on the current ecological state of the river, and the experts´ personal importance of objectives. We conclude that the four commonly applied simplifications clearly do not reflect the opinion of river rehabilitation experts. The optimal level of model complexity, however, remains highly case-study specific depending on data and resource availability, the context, and the complexity of the decision problem. PMID:26954353

Assessment of the severity of asthma by an expert system. Description and evaluation.

PubMed

Redier, H; Daures, J P; Michel, C; Proudhon, H; Vervloet, D; Charpin, D; Marsac, J; Dusser, D; Brambilla, C; Wallaert, B

1995-02-01

Asthmaexpert, an expert system (ES), was produced at the special request of several clinicians in order to better understand the medical decisions made clinical experts in managing an asthmatic patient. We describe and evaluate this knowledge base, focusing mainly on assessment of the severity of asthma. After compiling data from a patient, Asthmaexpert assesses the severity of the disease and identifies the trigger factors involved, suggests any further investigations that may be required, and offers a treatment strategy. Implemented with Nexpert and Hypercard, it runs on a MacIntosh personal computer. The validation stage involved eight clinical experts who provided 20 case report forms (CRF) with their conclusions about management of asthma. The CRF were then programmed into the ES, which provided its own conclusions about the same subjects. Afterward, all the experts evaluated the conclusions given by ES or by their colleagues in a double-blind manner. One hundred twenty-seven CRF were available. The reliability of the experts' opinions was good, with a substantial consensus between them when assessing severity scores (kappa = 0.27 to 0.54). There was no difference in concordance of opinions on severity scores either between the experts who designed the system and ES or between the other experts and ES (weighted kappa = 0.72 and 0.69, respectively). Experts judged that the severity scores given by ES were as good as those proposed by their colleagues, and that the overall conclusions given by ES were as good as or better than those given by their colleagues. The conclusions drawn by ES were given a good rating.(ABSTRACT TRUNCATED AT 250 WORDS)

Explosion probability of unexploded ordnance: expert beliefs.

PubMed

MacDonald, Jacqueline Anne; Small, Mitchell J; Morgan, M G

2008-08-01

This article reports on a study to quantify expert beliefs about the explosion probability of unexploded ordnance (UXO). Some 1,976 sites at closed military bases in the United States are contaminated with UXO and are slated for cleanup, at an estimated cost of $15-140 billion. Because no available technology can guarantee 100% removal of UXO, information about explosion probability is needed to assess the residual risks of civilian reuse of closed military bases and to make decisions about how much to invest in cleanup. This study elicited probability distributions for the chance of UXO explosion from 25 experts in explosive ordnance disposal, all of whom have had field experience in UXO identification and deactivation. The study considered six different scenarios: three different types of UXO handled in two different ways (one involving children and the other involving construction workers). We also asked the experts to rank by sensitivity to explosion 20 different kinds of UXO found at a case study site at Fort Ord, California. We found that the experts do not agree about the probability of UXO explosion, with significant differences among experts in their mean estimates of explosion probabilities and in the amount of uncertainty that they express in their estimates. In three of the six scenarios, the divergence was so great that the average of all the expert probability distributions was statistically indistinguishable from a uniform (0, 1) distribution-suggesting that the sum of expert opinion provides no information at all about the explosion risk. The experts' opinions on the relative sensitivity to explosion of the 20 UXO items also diverged. The average correlation between rankings of any pair of experts was 0.41, which, statistically, is barely significant (p= 0.049) at the 95% confidence level. Thus, one expert's rankings provide little predictive information about another's rankings. The lack of consensus among experts suggests that empirical studies are needed to better understand the explosion risks of UXO.

[Evaluation of the social care program for persons with severe mental disorders: a Delphi study].

PubMed

Brugos, A; Arbeloa, B; Astrain, M V; López, S; Otero, M; Monreal, C; Rubio, C; Pérez-Nievas, F

2007-01-01

In January 2005 the Government of Navarre approved the "Care Program for Persons with Severe Mental Disorder" (PA-TMG). This article is intended to ascertain the opinion of experts regarding the PA-TMG. To identify the elements of agreement in the evaluation of positive aspects and aspects that can be improved. To make recommendations on the basis of their opinions. A Delphi study was designed with 34 experts in health or social care of mentally ill persons. By means of repeated questionnaires, ideas that achieved a consensus of (3)90% were identified and a level of priority was assigned. The percentages of agreement and descriptive statistics of priority were presented, and the recommendations of analysis of the areas of consensus were drawn up. Out of the 34 participating experts, 25 (71.4%) completed the study: 1 sociologist, 5 social workers, 3 psychiatrists, 5 psychologists, one representative of the families, 3 occupational therapists, 1 technician in social integration and 6 family doctors. Sixty-four percent evaluated the Plan positively, and 72% were of the opinion that it was drawn up without sufficient professional participation. All thought that it could be improved by widening the participation of experts. The principal ideas on which there was consensus were: socio-health care must be guaranteed by the public administration; good systems of information and evaluation must be established; the Plan must have its own budget; professional follow-up of the patient by the different mechanisms must be guaranteed; a lot of the decision making must be decentralised; access to social benefits for these patients must be universalised.

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

Disorders of orgasm and ejaculation in men.

PubMed

Rowland, David; McMahon, Chris G; Abdo, Carmita; Chen, Juza; Jannini, Emmanuele; Waldinger, Marcel D; Ahn, Tai Young

2010-04-01

Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. To provide recommendations and guidelines concerning current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 25 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge of disorders of orgasm and ejaculation represent the opinion of seven experts from seven countries developed in a process over a 2-year period. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Premature ejaculation management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. Behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Retrograde ejaculation is managed by education, patient reassurance, pharmacotherapy, or bladder neck reconstruction. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic atiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. Additional research is required to further the understanding of the disorders of ejaculation and orgasm.

Evaluation of food provision and nutrition support at the London 2012 Olympic Games: the opinion of sports nutrition experts.

PubMed

Pelly, Fiona; Meyer, Nanna L; Pearce, Jeni; Burkhart, Sarah J; Burke, Louise M

2014-12-01

The aim of this study was to evaluate the food provision and nutrition support at the London 2012 Olympic (OG) and Paralympic Games (PG) from the perspective of sports nutrition experts attending the event. Participants (n = 15) were asked to complete an online survey and rate on a Likert scale menu qualities, food safety, sustainability practices, nutrition labeling, and provision for cultural needs, dietary regimes and specific situations. Open-ended responses were incorporated to explore expert opinion and areas for improvement. Participants rated their overall experience of the food provision as 7.6 out of 10 (range 5 to 10), with the majority (n = 11) rating it greater than 7. The variety, accessibility, presentation, temperature, and freshness of menu items rated as average to good. A below average rating was received for recovery food and beverages, provision of food for traveling to other venues, taking suitable snacks out of the dining hall and provision of food at other venues. However, the variety and accessibility of choices for Ramadan, and provision of post-competition food were rated highly. A number of comments were received about the lack of gluten free and lower energy/fat items. The inclusion of allergens on nutrition labeling was considered more important than nutrient content. While dietetic review of the menu in advance of the OG and PG is clearly a valuable process that has resulted in improvements in the food supply, there are still areas that need to be addressed that are currently not implemented during the event.

Is the doctor hostile? obstructive impairments and the hostility rule in federal black lung claims

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

Cogan, T.F.

1995-11-01

There is little doubt that an Administrative Law Judge may discount the opinion of a doctor as hostile if that doctor renders an opinion that is contrary to something fundamental to the Act, whether that fundamental aspect be contained in the regulations or in the Act itself. Among those things fundamental to the Act is that legal Coal Workers Pneumoconiosis manifests itself in many kinds of impairments, including obstructive impairments and those restrictive. What is less clear, however, is whether an ALJ must reject an opinion where the expert testifies that CWP cannot cause obstructive impairments. It is the positionmore » of this article that ALJ has a duty to reject such an opinion, either in its entirety, if the dogma infects all of the doctor`s opinions, or so much of those opinions as are infected.« less

Abatacept therapy and safety management.

PubMed

Pham, Thao; Bachelez, Hervé; Berthelot, Jean-Marie; Blacher, Jacques; Claudepierre, Pascal; Constantin, Arnaud; Fautrel, Bruno; Gaujoux-Viala, Cécile; Goëb, Vincent; Gossec, Laure; Goupille, Philippe; Guillaume-Czitrom, Séverine; Hachulla, Eric; Lequerré, Thierry; Marolleau, Jean-Pierre; Martinez, Valérie; Masson, Charles; Mouthon, Luc; Puéchal, Xavier; Richette, Pascal; Saraux, Alain; Schaeverbeke, Thierry; Soubrier, Martin; Viguier, Manuelle; Vittecoq, Olivier; Wendling, Daniel; Mariette, Xavier; Sibilia, Jean

2012-03-01

To develop and/or update fact sheets about abatacept treatment, in order to assist physicians in the management of patients with inflammatory joint disease. 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable 2. identification and review of publications relevant to each topic 3. development and/or update of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The experts were rheumatologists and invited specialists in other fields (dermatologist, cardiologist, pediatric rheumatologist, endocrinologist, hematologist, immunologist, infectiologist), and they had extensive experience with the management of chronic inflammatory diseases, such as rheumatoid arthritis (RA). They were members of the CRI (Club Rhumatismes et Inflammation), a section of the French Rheumatology Society (Societe Francaise de Rhumatologie). Each fact sheet was revised by several experts and the overall process was coordinated by three experts. Several topics of major interest were selected: contraindications of abatacept treatment; management of adverse effects and concomitant diseases that may develop during abatacept treatment; and management of common situations such as pregnancy, surgery, patient older than 75 years of age, and patients with co-morbidities (such as dialysis, hemoglobinopathy, or splenectomy). After a review of the literature and discussion among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA, initiation and monitoring of the abatacept treatment, management of patients with specific past histories, and specific clinical situations such as pregnancy 2. diseases other than RA, such as juvenile idiopathic arthritis, spondylarthropathies, or autoimmune diseases (systemic lupus erythematosus and other systemic autoimmune diseases) 3. models of letters for informing the rheumatologist and general practitioner 4. patient information about the use of abatacept in RA 5. and data on the new abatacept formulation for subcutaneous administration (approved by the FDA in August 2011 for patients with moderate-to-severe RA). These fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on abatacept. They will be available continuously on www.cri-net.com and will be updated at appropriate intervals. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Meta-knowledge for charity: Learnings from a non-market-based prediction platform for climate scientists

NASA Astrophysics Data System (ADS)

Kriss, P.

2016-12-01

We present the results from Vision Prize, an online platform for capturing expert opinion on climate risks and solutions. Expert panelists provided their own opinions, and also predicted the views of their scientific colleagues. This approach (Prelec, 2004 Nature) gives new insight into the level of scientific consensus on various issues, which in some cases may be just as important as knowing the majority view. Questions ranged from causal attributions of past events to predictions about future risks and beliefs about possible solutions. Across all topics, we find that our expert participants agree with each other more than they think they do, often in surprising ways. Data collection for the Vision Prize project was run in collaboration with Environmental Research Web (IOP). Panelists were pre-screened to ensure they have relevant expertise and independently collected h-scores provide an approximate measure of research impact of those giving each response. Charity prizes were awarded for exceptional meta-knowledge, according to Prelec's algorithm.

Study on Failure of Third-Party Damage for Urban Gas Pipeline Based on Fuzzy Comprehensive Evaluation

PubMed Central

Li, Jun; Zhang, Hong; Han, Yinshan; Wang, Baodong

2016-01-01

Focusing on the diversity, complexity and uncertainty of the third-party damage accident, the failure probability of third-party damage to urban gas pipeline was evaluated on the theory of analytic hierarchy process and fuzzy mathematics. The fault tree of third-party damage containing 56 basic events was built by hazard identification of third-party damage. The fuzzy evaluation of basic event probabilities were conducted by the expert judgment method and using membership function of fuzzy set. The determination of the weight of each expert and the modification of the evaluation opinions were accomplished using the improved analytic hierarchy process, and the failure possibility of the third-party to urban gas pipeline was calculated. Taking gas pipelines of a certain large provincial capital city as an example, the risk assessment structure of the method was proved to conform to the actual situation, which provides the basis for the safety risk prevention. PMID:27875545

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.

A Child’s Concept of Pain: An International Survey of Pediatric Pain Experts

PubMed Central

Hush, Julia M.; Hancock, Mark J.; Moseley, G. Lorimer; Butler, David S.; Pacey, Verity

2018-01-01

A child’s ‘concept of pain’ refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts’ opinions of: (1) the importance and usefulness of assessing a child’s concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child’s concept of pain; and (3) important domains of a child’s concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child’s concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8–12 years. Experts considered that all seven of the proposed domains of a child’s concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child’s concept of pain. PMID:29342976

Experiencing Art: The Influence of Expertise and Painting Abstraction Level

PubMed Central

Pihko, Elina; Virtanen, Anne; Saarinen, Veli-Matti; Pannasch, Sebastian; Hirvenkari, Lotta; Tossavainen, Timo; Haapala, Arto; Hari, Riitta

2011-01-01

How does expertise influence the perception of representational and abstract paintings? We asked 20 experts on art history and 20 laypersons to explore and evaluate a series of paintings ranging in style from representational to abstract in five categories. We compared subjective esthetic judgments and emotional evaluations, gaze patterns, and electrodermal reactivity between the two groups of participants. The level of abstraction affected esthetic judgments and emotional valence ratings of the laypersons but had no effect on the opinions of the experts: the laypersons’ esthetic and emotional ratings were highest for representational paintings and lowest for abstract paintings, whereas the opinions of the experts were independent of the abstraction level. The gaze patterns of both groups changed as the level of abstraction increased: the number of fixations and the length of the scanpaths increased while the duration of the fixations decreased. The viewing strategies – reflected in the target, location, and path of the fixations – however indicated that experts and laypersons paid attention to different aspects of the paintings. The electrodermal reactivity did not vary according to the level of abstraction in either group but expertise was reflected in weaker responses, compared with laypersons, to information received about the paintings. PMID:21941475

Recommendations for the prescription of physical exercise for patients with spondyloarthritis.

PubMed

Flórez García, Mariano Tomás; Carmona, Loreto; Almodóvar, Raquel; Fernández de Las Peñas, César; García Pérez, Fernando; Pérez Manzanero, M Ángeles; García García, José Manuel; Soriano Segarra, Lidón; Jiménez Díaz, José Fernando; Mendoza Laiz, Nuria; de Miguel Mendieta, Eugenio; Torre Alonso, Juan Carlos; Linares Ferrando, Luis Francisco; Collantes Estévez, Eduardo; Sanz Sanz, Jesús; Zarco Montejo, Pedro

2017-08-11

To develop expert-based recommendations on physical activity and exercise for patients with spondyloarthritis (SpA). Two discussion groups, one of physical therapists, rehabilitation physicians, and professionals of physical activity and sports, and another of rheumatologists interested in SpA, were held to discuss the results of a survey of rheumatologists on exercise and two focus groups with patients on barriers to exercise. Preliminary recommendations were drafted. These were submitted to the opinion of the experts in both groups according to a two round Delphi methodology. Twenty one recommendations covering general aspects of exercise, adaptation to patient, how to deliver messages, pain management, and type of exercise and monitoring were issued. The level of agreement varied slightly between expert groups but it was high overall. Items with poor agreement were removed from the consensus. We present recommendations on when and how to prescribe and monitor exercise in patients with SpA based on the opinion of experts in exercise and in SpA. We must now test whether these recommendations are useful for clinical practice and have an effect on patients with SpA seen by rheumatologists. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Identifying factors for optimal development of health-related websites: a delphi study among experts and potential future users.

PubMed

Schneider, Francine; van Osch, Liesbeth; de Vries, Hein

2012-02-14

The Internet has become a popular medium for offering tailored and targeted health promotion programs to the general public. However, suboptimal levels of program use in the target population limit the public health impact of these programs. Optimizing program development is considered as one of the main processes to increase usage rates. To distinguish factors potentially related to optimal development of health-related websites by involving both experts and potential users. By considering and incorporating the opinions of experts and potential users in the development process, involvement in the program is expected to increase, consequently resulting in increased appreciation, lower levels of attrition, and higher levels of sustained use. We conducted a systematic three-round Delphi study through the Internet. Both national and international experts (from the fields of health promotion, health psychology, e-communication, and technical Web design) and potential users were invited via email to participate. During this study an extensive list of factors potentially related to optimal development of health-related websites was identified, by focusing on factors related to layout, general and risk information provision, questionnaire use, additional services, and ease of use. Furthermore, we assessed the extent to which experts and potential users agreed on the importance of these factors. Differences as well as similarities among experts and potentials users were deduced. In total, 20 of 62 contacted experts participated in the first round (32% response rate); 60 of 200 contacted experts (30% response rate) and 210 potential users (95% response rate) completed the second-round questionnaire, and 32 of 60 contacted experts completed the third round (53% response rate). Results revealed important factors consented upon by experts and potential users (eg, ease of use, clear structure, and detailed health information provision), as well as differences regarding important factors consented upon by experts (eg, visual aids, self-monitoring tool, and iterative health feedback) or by potential users only (eg, bread crumb navigation and prevention of receiving spam). This study is an important first step in determining the agreed-upon factors that should be taken into account when developing online health promotion programs. The public health impact of these programs will be improved by optimizing the development process in line with these factors.

Determining production level under uncertainty using fuzzy simulation and bootstrap technique, a case study

NASA Astrophysics Data System (ADS)

Hamidi, Mohammadreza; Shahanaghi, Kamran; Jabbarzadeh, Armin; Jahani, Ehsan; Pousti, Zahra

2017-12-01

In every production plant, it is necessary to have an estimation of production level. Sometimes there are many parameters affective in this estimation. In this paper, it tried to find an appropriate estimation of production level for an industrial factory called Barez in an uncertain environment. We have considered a part of production line, which has different production time for different kind of products, which means both environmental and system uncertainty. To solve the problem we have simulated the line and because of the uncertainty in the times, fuzzy simulation is considered. Required fuzzy numbers are estimated by the use of bootstrap technique. The results are used in production planning process by factory experts and have had satisfying consequences. Opinions of these experts about the efficiency of using this methodology, has been attached.

A Bayesian approach for calibrating probability judgments

NASA Astrophysics Data System (ADS)

Firmino, Paulo Renato A.; Santana, Nielson A.

2012-10-01

Eliciting experts' opinions has been one of the main alternatives for addressing paucity of data. In the vanguard of this area is the development of calibration models (CMs). CMs are models dedicated to overcome miscalibration, i.e. judgment biases reflecting deficient strategies of reasoning adopted by the expert when inferring about an unknown. One of the main challenges of CMs is to determine how and when to intervene against miscalibration, in order to enhance the tradeoff between costs (time spent with calibration processes) and accuracy of the resulting models. The current paper dedicates special attention to this issue by presenting a dynamic Bayesian framework for monitoring, diagnosing, and handling miscalibration patterns. The framework is based on Beta-, Uniform, or Triangular-Bernoulli models and classes of judgmental calibration theories. Issues regarding the usefulness of the proposed framework are discussed and illustrated via simulation studies.

Management of uncertainties on parameters elicited by experts - Applications to sea-level rise and to CO2 storage operations risk assessment

NASA Astrophysics Data System (ADS)

Manceau, Jean-Charles; Loschetter, Annick; Rohmer, Jérémy; Le Cozannet, Gonéri; Lary Louis, de; Guénan Thomas, Le; Ken, Hnottavange-Telleen

2017-04-01

In a context of high degree of uncertainty, when very few data are available, experts are commonly requested to provide their opinions on input parameters of risk assessment models. Not only might each expert express a certain degree of uncertainty on his/her own statements, but the set of information collected from the pool of experts introduces an additional level of uncertainty. It is indeed very unlikely that all experts agree on exactly the same data, especially regarding parameters needed for natural risk assessments. In some cases, their opinions may differ only slightly (e.g. the most plausible value for a parameter is similar for different experts, and they only disagree on the level of uncertainties that taint the said value) while on other cases they may express incompatible opinions for a same parameter. Dealing with these different kinds of uncertainties remains a challenge for assessing geological hazards or/and risks. Extra-probabilistic approaches (such as the Dempster-Shafer theory or the possibility theory) have shown to offer promising solutions for representing parameters on which the knowledge is limited. It is the case for instance when the available information prevents an expert from identifying a unique probability law to picture the total uncertainty. Moreover, such approaches are known to be particularly flexible when it comes to aggregating several and potentially conflicting opinions. We therefore propose to discuss the opportunity of applying these new theories for managing the uncertainties on parameters elicited by experts, by a comparison with the application of more classical probability approaches. The discussion is based on two different examples. The first example deals with the estimation of the injected CO2 plume extent in a reservoir in the context of CO2 geological storage. This estimation requires information on the effective porosity of the reservoir, which has been estimated by 14 different experts. The Dempster-Shafer theory has been used to represent and aggregate these pieces of information. The results of different aggregation rules as well as those of a classical probabilistic approach are compared with the purpose of highlighting the elements each of them could provide to the decision-maker (Manceau et al., 2016). The second example focuses on projections of future sea-level rise. Based on IPCC's constraints on the projection quantiles, and on the scientific community consensus level on the physical limits to future sea-level rise, a possibility distribution of the projections by 2100 under the RCP 8.5 scenario has been established. This possibility distribution has been confronted with a set of previously published probabilistic sea-level projections, with a focus on their ability to explore high ranges of sea-level rise (Le Cozannet et al., 2016). These two examples are complementary in the sense that they allow to address various aspects of the problem (e.g. representation of different types of information, conflict among experts, sources dependence). Moreover, we believe that the issues faced during these two experiences can be generalized to many risks/hazards assessment situations. References Manceau, JC., Loschetter, A., Rohmer, J., de Lary, L., Le Guénan, T., Hnottavange-Telleen, K. (2016). Dealing with uncertainty on parameters elicited from a pool of experts for CCS risk assessment. Congrès λμ 20 (St-Malo, France). Le Cozannet G., Manceau JC., Rohmer, J. (2016). Bounding probabilistic sea-level rise projections within the framework of the possibility theory. Accepted in Environmental Research Letters.

[Commentary on 'Ethical issues in living renal transplantation'].

PubMed

Spinsanti, S

2006-01-01

Legalizing kidney market: ethics considerations. The paper by E A Friedman and A L Friedman, advocating suitable kidney sale legislation, recently published in Kidney International, has aroused some controversy among the Italian Society of Nephrology Mailing List members (ML-SIN). A previous article reviewed the main issues and summarized Italian nephrologists' opinions. Generally speaking, ML-SIN participants were critical towards this proposal; the most widespread opinion was that trade of organs for transplant purposes is unethical and that Friedman's legislative suggestion is unlikely to succeed in Italy. To complete discussion, we report also the opinion of an authoritative Ethics expert.

Experts' opinions on the management of medically unexplained symptoms in primary care. A qualitative analysis of narrative reviews and scientific editorials.

PubMed

Heijmans, Mieke; Olde Hartman, Tim C; van Weel-Baumgarten, Evelyn; Dowrick, Christopher; Lucassen, Peter L B J; van Weel, Chris

2011-08-01

The feasibility as well as the suitability of several therapies for medically unexplained symptoms (MUS) in primary care applied by the family physician (FP) appeared to be low. FPs need effective and acceptable strategies to manage these functionally impaired patients. To review important and effective elements in the treatment of patients with MUS in primary care according to experts in MUS research. We performed a systematic search of narrative reviews and scientific editorials in Medline and PsycINFO and triangulated our findings by conducting a focus group with MUS experts. We included 7 scientific editorials and 23 narrative reviews. According to MUS experts, the most important elements in the treatment of MUS are creating a safe therapeutic environment, generic interventions (such as motivational interviewing, giving tangible explanations, reassurance and regularly scheduled appointments) and specific interventions (such as cognitive approaches and pharmacotherapy). Furthermore, MUS experts indicate that a multi-component approach in which these three important elements are combined are most helpful for patients with MUS. In contrast to most specific interventions, opinions of MUS experts regarding generic interventions and creating a safe therapeutic relationship seem to be more based on theory and experience than on quantitative research. MUS experts highlight the importance of generic interventions and doctor-patient communication and relationship. However, studies showing the effectiveness of these elements in the management of MUS in primary care is still scarce. Research as well as medical practice should focus more on these non-specific aspects of the medical consultation.

Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation.

PubMed

Tempest, Stephanie; McIntyre, Anne

2006-05-30

The International Classification of Functioning, Disability and Health (ICF) is advocated as a tool to structure rehabilitation and a universal language to aid communication, within the multi-disciplinary team (MDT). The ICF may also facilitate clarification of team roles and clinical reasoning for intervention. This article aims to explore both factors in stroke rehabilitation. Following a review of the literature, a summary was presented and discussed with clinicians working within stroke rehabilitation, to gather expert opinions. The discussions were informal, being part of service development and on-going education. The clinicians summarised key themes for the potential use of the ICF within clinical practice. Two key themes emerged from the literature and expert opinion for the potential use of the ICF in stroke rehabilitation: (i) to aid communication and structure service provision, (ii) to clarify team roles and aid clinical reasoning. Expert opinion was that clarification of team roles needs to occur at a local level due to the skill mix, particular interests, setting and staffing levels within individual teams. The ICF has the potential to demonstrate/facilitate clinical reasoning, especially when different MDT members are working on the same intervention. There is potential for the ICF to be used to clarify team roles and demonstrate clinical reasoning within stroke rehabilitation. Further experiential research is required to substantiate this view.

Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis.

PubMed

Avouac, Jérôme; Huscher, Dörte; Furst, Daniel E; Opitz, Christian F; Distler, Oliver; Allanore, Yannick

2014-01-01

To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide <50% without pulmonary fibrosis). Among experts in pulmonary arterial hypertension-SSc, a core set of criteria for clinical practice to refer SSc patients for RHC has been defined by Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

Evaluation of Visual Field Progression in Glaucoma: Quasar Regression Program and Event Analysis.

PubMed

Díaz-Alemán, Valentín T; González-Hernández, Marta; Perera-Sanz, Daniel; Armas-Domínguez, Karintia

2016-01-01

To determine the sensitivity, specificity and agreement between the Quasar program, glaucoma progression analysis (GPA II) event analysis and expert opinion in the detection of glaucomatous progression. The Quasar program is based on linear regression analysis of both mean defect (MD) and pattern standard deviation (PSD). Each series of visual fields was evaluated by three methods; Quasar, GPA II and four experts. The sensitivity, specificity and agreement (kappa) for each method was calculated, using expert opinion as the reference standard. The study included 439 SITA Standard visual fields of 56 eyes of 42 patients, with a mean of 7.8 ± 0.8 visual fields per eye. When suspected cases of progression were considered stable, sensitivity and specificity of Quasar, GPA II and the experts were 86.6% and 70.7%, 26.6% and 95.1%, and 86.6% and 92.6% respectively. When suspected cases of progression were considered as progressing, sensitivity and specificity of Quasar, GPA II and the experts were 79.1% and 81.2%, 45.8% and 90.6%, and 85.4% and 90.6% respectively. The agreement between Quasar and GPA II when suspected cases were considered stable or progressing was 0.03 and 0.28 respectively. The degree of agreement between Quasar and the experts when suspected cases were considered stable or progressing was 0.472 and 0.507. The degree of agreement between GPA II and the experts when suspected cases were considered stable or progressing was 0.262 and 0.342. The combination of MD and PSD regression analysis in the Quasar program showed better agreement with the experts and higher sensitivity than GPA II.

The Brustkrebs-Studien.de website for breast cancer patients: User acceptance of a German internet portal offering information on the disease and treatment options, and a clinical trials matching service

PubMed Central

2010-01-01

Background The internet portal http://www.brustkrebs-studien.de (BKS) was launched in 2000 by the German Society of Senology (DGS) and the Baden-Württemberg Institute for Women's Health (IFG) to provide expert-written information on breast cancer online and to encourage and facilitate the participation of breast cancer patients in clinical trials. We describe the development of BKS and its applications, and report on website statistics and user acceptance. Methods Existing registries, including ClinicalTrials.gov, were analysed before we designed BKS, which combines a trial registry, a knowledge portal, and an online second opinion service. An advisory board guided the process. Log files and patient enquiries for trial participation and second opinions were analysed. A two-week user satisfaction survey was conducted online. Results During 10/2005-06/2010, the portal attracted 702,655 visitors, generating 15,507,454 page views. By 06/2010, the website's active scientific community consisted of 189 investigators and physicians, and the registry covered 163 clinical trial protocols. In 2009, 143 patients requested trial enrolment and 119 sought second opinions or individual treatment advice from the expert panel. During the two-week survey in 2008, 5,702 BKS visitors submitted 507 evaluable questionnaires. Portal acceptance was high. Respondents trusted information correctness (80%), welcomed self-matching to clinical trials (79%) and planned to use the portal in the future (76%) and recommend it to others (81%). Conclusions BKS is an established and trusted breast cancer information platform offering up-to-date resources and protocols to the growing physician and patient community to encourage participation in clinical trials. Further studies are needed to assess potential increases in trial enrolment by eligibility matching services. PMID:21126358

An integrated multi criteria approach for landfill siting in a conflicting environmental, economical and socio-cultural area.

PubMed

Eskandari, Mahnaz; Homaee, Mehdi; Mahmodi, Shahla

2012-08-01

Landfill site selection is a complicated multi criteria land use planning that should convince all related stakeholders with different insights. This paper addresses an integrating approach for landfill siting based on conflicting opinions among environmental, economical and socio-cultural expertise. In order to gain optimized siting decision, the issue was investigated in different viewpoints. At first step based on opinion sampling and questionnaire results of 35 experts familiar with local situations, the national environmental legislations and international practices, 13 constraints and 15 factors were built in hierarchical structure. Factors divided into three environmental, economical and socio-cultural groups. In the next step, the GIS-database was developed based on the designated criteria. In the third stage, the criteria standardization and criteria weighting were accomplished. The relative importance weights of criteria and subcriteria were estimated, respectively, using analytical hierarchy process and rank ordering methods based on different experts opinions. Thereafter, by using simple additive weighting method, the suitability maps for landfill siting in Marvdasht, Iran, was evaluated in environmental, economical and socio-cultural visions. The importance of each group of criteria in its own vision was assigned to be higher than two other groups. In the fourth stage, the final suitability map was obtained after crossing three resulted maps in different visions and reported in five suitability classes for landfill construction. This map indicated that almost 1224 ha of the study area can be considered as best suitable class for landfill siting considering all visions. In the last stage, a comprehensive field visit was performed to verify the selected site obtained from the proposed model. This field inspection has confirmed the proposed integrating approach for the landfill siting. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cervical cancer

MedlinePlus

... and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to ... American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care, Immunization Expert Work Group. Committee Opinion ...

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-to-date review of the literature and experts' opinions.

Designing a Method with Physician Participation to Assess and Improve Quality of Healthcare in Otolaryngology.

PubMed

Arce, José M; Martín Cleary, Catalina; Cenjor, Carlos; Ramos, Ángel; Ortiz, Alberto

2017-04-01

Patient choice of healthcare centers to be treated for specific diseases is compromised by the low accessibility of understandable information. Physicians are rarely involved in healthcare quality assessment, despite their potentially valuable input. The purpose of this study was to develop a methodology for evaluating the quality of care that specifically incorporates advice from medical specialists and provides accessible information for patients in search of high-quality healthcare. A pilot Delphi study was conducted among 28 Spanish otolaryngology experts, seeking their opinion on the quality-of-care indicators and on their ability to recommend the most suitable department for the treatment of specific otolaryngologic diseases. The average acceptance rate was 91.9% for quality-of-care indicator and 96.5% for the resources needed for improving the quality of care. Furthermore, 93% experts reported that patients frequently ask for physician advice on which center provides better care for a specific disease, 92.6% experts believe they could recommend the best centers for specific otolaryngologic diseases, and 80% experts agreed that expert opinion on the quality of care offered by different centers would be a valuable addition to quality-of-care assessment. The incorporation of physician advice into healthcare quality assessment may improve the usefulness of healthcare quality indicators for patients. Assessment tools incorporating physician advice should be developed and validated.

Influence of Professional Affiliation on Expert’s View on Welfare Measures

PubMed Central

Rousing, Tine; Forkman, Björn

2017-01-01

Simple Summary Animal welfare can be assessed from different ethical points of view, which may vary from one individual to another. This is often met by including different stakeholders’ opinions in the process of adding up welfare benefits and or welfare risks. However, in order to obtain the most reliable results, these expert panels should be balanced; since experts’ professional affiliations can influence their judgment on different welfare aspects as shown in the present study. Abstract The present study seeks to investigate the influence of expert affiliation in the weighing procedures within animal welfare assessments. Experts are often gathered with different backgrounds with differing approaches to animal welfare posing a potential pitfall if affiliation groups are not balanced in numbers of experts. At two time points (2012 and 2016), dairy cattle and swine experts from four different stakeholder groups, namely researchers (RES), production advisors (CONS), practicing veterinarians (VET) and animal welfare control officers (AWC) were asked to weigh eight different welfare criteria: Hunger, Thirst, Resting comfort, Ease of movement, Injuries, Disease, Human-animal bond and Emotional state. A total of 54 dairy cattle experts (RES = 15%, CONS = 22%, VET = 35%, AWC = 28%) and 34 swine experts (RES = 24%, CONS = 35%, AWC = 41%) participated. Between—and within—group differences in the prioritization of criteria were assessed. AWC cattle experts differed consistently from the other cattle expert groups but only significantly for the criteria Hunger (p = 0.04), and tendencies towards significance within the criteria Thirst (p = 0.06). No significant differences were found between expert groups among swine experts. Inter-expert differences were more pronounced for both species. The results highlight the challenges of using expert weightings in aggregated welfare assessment models, as the choice of expert affiliation may play a confounding role in the final aggregation due to different prioritization of criteria. PMID:29140262

The Desired Learning Outcomes of School-Based Nutrition/Physical Activity Health Education: A Health Literacy Constructed Delphi Survey of Finnish Experts

ERIC Educational Resources Information Center

Ormshaw, Michael James; Kokko, Sami Petteri; Villberg, Jari; Kannas, Lasse

2016-01-01

Purpose: The purpose of this paper is to utilise the collective opinion of a group of Finnish experts to identify the most important learning outcomes of secondary-level school-based health education, in the specific domains of physical activity and nutrition. Design/ Methodology/ Approach: The study uses a Delphi survey technique to collect the…

[Revoking the driver's license, assessment of driver competence, re-education and therapy in alcohol offenses: approaches to a necessary reorientation].

PubMed

Müller, A

1993-03-01

After representing figures and facts about drinking behaviour and drinking-driving offences of the 45 mio. drivers in Germany counter-measures for DWI-offenders are dealt with. The proceedings practised so far are critically analysed and new approaches are discussed. Primarily reviewed are special preventive measures and here particularly the selection procedure usually applied in Germany, in which on demand of the driver licensing authorities the question is to be answered by expert opinions whether there is to be reckoned with driving under the influence in die future, too. It is pointed out that the expert opinions are not valid enough for making a distinct decision in an individual case. Validity coefficients obtained in evaluation studies lie between phi = 0 and .28, raising the expectancy value of 50% resulting by chance at best only on to 65%. Moreover the psychological interview is understandably burdened with faked answers of the explored person, in several cases increased by a specific, professionally managed preparation for the testing situation. As a way out of the dilemma expert opinions prognosticating driver behaviour should be waived in favour of making diagnoses and proposals for treatment. The timing of regranting the driver license is then only determined by the revocation period pronounced by the court and by the performance of the measures recommended by the experts and demanded by the licensing authority. As a support for such a procedure a more consistent and resolute administration of the judicial revocation of driver license with longer periods for repeaters should be provided. Besides there is necessary a wider range of rehabilitation programs for drivers with alcoholic problems.

Testimony by otolaryngologists in defense of tobacco companies 2009-2014.

PubMed

Jackler, Robert K

2015-12-01

To examine expert testimony offered by otolaryngologists in defense of the tobacco industry and to assess whether opinions rendered were congruent with evidence in the scientific literature. Data sources include publically available expert witness depositions and trial testimony of board-certified otolaryngologists employed by the tobacco industry in defense of lawsuits brought by smokers suffering from head and neck cancer. The cases, adjudicated in Florida between 2009 and 2014, focused on whether smoking caused the plaintiff's cancer. The study includes nine legal cases of upper aerodigestive tract cancer involving six otolaryngologists serving as expert witnesses for the tobacco industry. Cancer sites included larynx (5), esophagus (2), mouth (1), and lung (1). Five of the six otolaryngologists consistently, over multiple cases, offered opinions that smoking did not cause the plaintiff's cancer. By highlighting an exhaustive list of potential risk factors, such as human papillomavirus (HPV), alcohol, asbestos, diesel fumes, salted fish, mouthwash, and even urban living, they created doubt in the minds of the jurors as to the role of smoking in the plaintiff's cancer. Evidence shows that this testimony, which was remarkably similar across cases, was part of a defense strategy shaped by tobacco's law firms. A small group of otolaryngologists regularly serve as experts on behalf of the tobacco industry. Examination of their opinions in relation to the scientific literature reveals a systematic bias in interpreting the data relating to the role played by smoking in head and neck cancer causation. N/A. Laryngoscope published by Wiley on behalf of the American Laryngological, Rhinological and Otological Society, Inc, “The Triological Society” and American Laryngological Association (the “Owner”).

Active Surveillance for Low and Intermediate Risk Prostate Cancer: Opinions of North American Genitourinary Oncology Expert Radiation Oncologists.

PubMed

McClelland, Shearwood; Sandler, Kiri A; Degnin, Catherine; Chen, Yiyi; Mitin, Timur

2018-04-01

The ProtecT trial has provided level 1 evidence supporting active surveillance for prostate cancer patients with low-risk and intermediate-risk disease. The effect of these findings on the opinions of North American genitourinary (GU) experts regarding the role of active surveillance for these patients has not been previously examined. A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to appropriateness of active surveillance in patients with low-risk and intermediate-risk (Gleason 3+4) disease. Opinions regarding active surveillance were correlated with practice patterns using Fisher exact test. Forty-two radiation oncologists completed the survey. Forty percent had been in practice for more than 20 years; 90% practice at an academic center. Forty-five percent see ≥ 20 patients per month in consultation. More than 95% (40 of 42) recommended active surveillance for Gleason 6 disease, whereas only 17% recommended active surveillance for Gleason 3+4 disease. There were no demographic differences between supporters or opponents regarding active surveillance with regard to monthly patient volume, practice type, likelihood of self-identifying as an expert brachytherapist, belief in advanced imaging techniques, or preferred default external beam radiation therapy dose/fractionation for either low-risk or intermediate-risk disease. However, there was a trend toward greater support of active surveillance for Gleason 3+4 disease among experts having practiced < 10 years versus ≥ 10 years (P = .085). Active surveillance is almost universally supported by North American GU expert radiation oncologists for low-risk prostate cancer. However, there is very weak support for this strategy in Gleason 3+4 disease despite the ProtecT trial providing level 1 evidentiary support in both risk groups. There were no significant differences between experts supporting versus opposing active surveillance for either low-risk or intermediate-risk disease. These preferences might affect the design of future clinical studies, influencing the adoption of active surveillance in North American clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Fuzzy approaches to supplier selection problem

NASA Astrophysics Data System (ADS)

Ozkok, Beyza Ahlatcioglu; Kocken, Hale Gonce

2013-09-01

Supplier selection problem is a multi-criteria decision making problem which includes both qualitative and quantitative factors. In the selection process many criteria may conflict with each other, therefore decision-making process becomes complicated. In this study, we handled the supplier selection problem under uncertainty. In this context; we used minimum criterion, arithmetic mean criterion, regret criterion, optimistic criterion, geometric mean and harmonic mean. The membership functions created with the help of the characteristics of used criteria, and we tried to provide consistent supplier selection decisions by using these memberships for evaluating alternative suppliers. During the analysis, no need to use expert opinion is a strong aspect of the methodology used in the decision-making.

The role of national ethics commissions in Finland.

PubMed

Halila, Ritva

2003-08-01

There are six national ethics commissions in Finland. The National Advisory Board on Research Ethics was first established in 1991, followed by the National Advisory Board on Biotechnology and the Board on Gene Technology in 1995. The National Advisory Board on Health Care Ethics was established in 1998, followed by its Sub-Committee on Medical Research Ethics in 1999. The Co-operation Group for Laboratory Animal Sciences was established in 2001. Only the Board on Gene Technology works as a national authority and gives binding opinions and recommendations about the use of genetically modified organisms. The Sub-Committee on Medical Research Ethics acts a national research ethics committee and gives opinions about research projects. Other advisory boards do not make legally binding decisions, but their expertise gives a lot of power to their opinions and statements. The commissions work in close collaboration with each other, having regular meetings. They arrange seminars and conferences, and share information with each other. The commissions also share duties and information in international collaboration. How the voice and opinions of these commissions is heard in society lies in the wide, multi-professional expertise of their members. Large commissions and wide expertise may make it difficult to find consensus in their opinions and statements, although wide expertise may, more than discussion in a small expert group, help to further process difficult ethical issues. Collaboration between different bodies is important in order to share duties, and also to add more emphasis to the statements and opinions where different bodies share interests. In our country, the interest that national commissions share is research ethics, where the advisory boards and their members have discharged collaborative activities for years.

Improved Vote Aggregation Techniques for the Geo-Wiki Cropland Capture Crowdsourcing Game

NASA Astrophysics Data System (ADS)

Baklanov, Artem; Fritz, Steffen; Khachay, Michael; Nurmukhametov, Oleg; Salk, Carl; See, Linda; Shchepashchenko, Dmitry

2016-04-01

Crowdsourcing is a new approach for solving data processing problems for which conventional methods appear to be inaccurate, expensive, or time-consuming. Nowadays, the development of new crowdsourcing techniques is mostly motivated by so called Big Data problems, including problems of assessment and clustering for large datasets obtained in aerospace imaging, remote sensing, and even in social network analysis. By involving volunteers from all over the world, the Geo-Wiki project tackles problems of environmental monitoring with applications to flood resilience, biomass data analysis and classification of land cover. For example, the Cropland Capture Game, which is a gamified version of Geo-Wiki, was developed to aid in the mapping of cultivated land, and was used to gather 4.5 million image classifications from the Earth's surface. More recently, the Picture Pile game, which is a more generalized version of Cropland Capture, aims to identify tree loss over time from pairs of very high resolution satellite images. Despite recent progress in image analysis, the solution to these problems is hard to automate since human experts still outperform the majority of machine learning algorithms and artificial systems in this field on certain image recognition tasks. The replacement of rare and expensive experts by a team of distributed volunteers seems to be promising, but this approach leads to challenging questions such as: how can individual opinions be aggregated optimally, how can confidence bounds be obtained, and how can the unreliability of volunteers be dealt with? In this paper, on the basis of several known machine learning techniques, we propose a technical approach to improve the overall performance of the majority voting decision rule used in the Cropland Capture Game. The proposed approach increases the estimated consistency with expert opinion from 77% to 86%.

Attitudes of Crohn's Disease Patients: Infodemiology Case Study and Sentiment Analysis of Facebook and Twitter Posts.

PubMed

Roccetti, Marco; Marfia, Gustavo; Salomoni, Paola; Prandi, Catia; Zagari, Rocco Maurizio; Gningaye Kengni, Faustine Linda; Bazzoli, Franco; Montagnani, Marco

2017-08-09

Data concerning patients originates from a variety of sources on social media. The aim of this study was to show how methodologies borrowed from different areas including computer science, econometrics, statistics, data mining, and sociology may be used to analyze Facebook data to investigate the patients' perspectives on a given medical prescription. To shed light on patients' behavior and concerns, we focused on Crohn's disease, a chronic inflammatory bowel disease, and the specific therapy with the biological drug Infliximab. To gain information from the basin of big data, we analyzed Facebook posts in the time frame from October 2011 to August 2015. We selected posts from patients affected by Crohn's disease who were experiencing or had previously been treated with the monoclonal antibody drug Infliximab. The selected posts underwent further characterization and sentiment analysis. Finally, an ethnographic review was carried out by experts from different scientific research fields (eg, computer science vs gastroenterology) and by a software system running a sentiment analysis tool. The patient feeling toward the Infliximab treatment was classified as positive, neutral, or negative, and the results from computer science, gastroenterologist, and software tool were compared using the square weighted Cohen's kappa coefficient method. The first automatic selection process returned 56,000 Facebook posts, 261 of which exhibited a patient opinion concerning Infliximab. The ethnographic analysis of these 261 selected posts gave similar results, with an interrater agreement between the computer science and gastroenterology experts amounting to 87.3% (228/261), a substantial agreement according to the square weighted Cohen's kappa coefficient method (w2K=0.6470). A positive, neutral, and negative feeling was attributed to 36%, 27%, and 37% of posts by the computer science expert and 38%, 30%, and 32% by the gastroenterologist, respectively. Only a slight agreement was found between the experts' opinion and the software tool. We show how data posted on Facebook by Crohn's disease patients are a useful dataset to understand the patient's perspective on the specific treatment with Infliximab. The genuine, nonmedically influenced patients' opinion obtained from Facebook pages can be easily reviewed by experts from different research backgrounds, with a substantial agreement on the classification of patients' sentiment. The described method allows a fast collection of big amounts of data, which can be easily analyzed to gain insight into the patients' perspective on a specific medical therapy. ©Marco Roccetti, Gustavo Marfia, Paola Salomoni, Catia Prandi, Rocco Maurizio Zagari, Faustine Linda Gningaye Kengni, Franco Bazzoli, Marco Montagnani. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 09.08.2017.

Why consumers behave as they do with respect to food safety and risk information.

PubMed

Verbeke, Wim; Frewer, Lynn J; Scholderer, Joachim; De Brabander, Hubert F

2007-03-14

In recent years, it seems that consumers are generally uncertain about the safety and quality of their food and their risk perception differs substantially from that of experts. Hormone and veterinary drug residues in meat persist to occupy a high position in European consumers' food concern rankings. The aim of this contribution is to provide a better understanding to food risk analysts of why consumers behave as they do with respect to food safety and risk information. This paper presents some cases of seemingly irrational and inconsistent consumer behaviour with respect to food safety and risk information and provides explanations for these behaviours based on the nature of the risk and individual psychological processes. Potential solutions for rebuilding consumer confidence in food safety and bridging between lay and expert opinions towards food risks are reviewed. These include traceability and labelling, segmented communication approaches and public involvement in risk management decision-making.

Fire risk in San Diego County, California: A weighted Bayesian model approach

USGS Publications Warehouse

Kolden, Crystal A.; Weigel, Timothy J.

2007-01-01

Fire risk models are widely utilized to mitigate wildfire hazards, but models are often based on expert opinions of less understood fire-ignition and spread processes. In this study, we used an empirically derived weights-of-evidence model to assess what factors produce fire ignitions east of San Diego, California. We created and validated a dynamic model of fire-ignition risk based on land characteristics and existing fire-ignition history data, and predicted ignition risk for a future urbanization scenario. We then combined our empirical ignition-risk model with a fuzzy fire behavior-risk model developed by wildfire experts to create a hybrid model of overall fire risk. We found that roads influence fire ignitions and that future growth will increase risk in new rural development areas. We conclude that empirically derived risk models and hybrid models offer an alternative method to assess current and future fire risk based on management actions.

Functioning and disability in autism spectrum disorder: A worldwide survey of experts

PubMed Central

de Schipper, Elles; Mahdi, Soheil; de Vries, Petrus; Granlund, Mats; Holtmann, Martin; Karande, Sunil; Almodayfer, Omar; Shulman, Cory; Tonge, Bruce; Wong, Virginia V.C.N.; Zwaigenbaum, Lonnie

2016-01-01

Objective: This study is the second of four to prepare International Classification of Functioning, Disability and Health (ICF; and Children and Youth version, ICF(‐CY)) Core Sets for Autism Spectrum Disorder (ASD).The objective of this study was to survey the opinions and experiences of international experts on functioning and disability in ASD. Methods: Using a protocol stipulated by the World Health Organization (WHO) and monitored by the ICF Research Branch, an email‐based questionnaire was circulated worldwide among ASD experts, and meaningful functional ability and disability concepts were extracted from their responses. These concepts were then linked to the ICF(‐CY) by two independent researchers using a standardized linking procedure. Results: N = 225 experts from 10 different disciplines and all six WHO‐regions completed the survey. Meaningful concepts from the responses were linked to 210 ICF(‐CY) categories. Of these, 103 categories were considered most relevant to ASD (i.e., identified by at least 5% of the experts), of which 37 were related to Activities and Participation, 35 to Body functions, 22 to Environmental factors, and 9 to Body structures. A variety of personal characteristics and ASD‐related functioning skills were provided by experts, including honesty, loyalty, attention to detail and creative talents. Reported gender differences in ASD comprised more externalizing behaviors among males and more internalizing behaviors in females. Conclusion: The ICF(‐CY) categories derived from international expert opinions indicate that the impact of ASD on functioning extends far beyond core symptom domains. Autism Res 2016, 9: 959–969. © 2016 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research PMID:26749373

Experts' consensus on use of electronic cigarettes: a Delphi survey from Switzerland.

PubMed

Blaser, Jeremie; Cornuz, Jacques

2015-04-15

In some countries, nicotine-containing electronic cigarettes (e-cigarettes) are considered a consumer product without specific regulations. In others (eg, Switzerland), the sale of e-cigarettes containing nicotine is forbidden, despite the eagerness of many smokers to obtain them. As scientific data about efficacy and long-term safety of these products are scarce, tobacco control experts are divided on how to regulate them. In order to gain consensus among experts to provide recommendations to health authorities, we performed a national consensus study. We used a Delphi method with electronic questionnaires to bring together the opinion of Swiss experts on e-cigarettes. 40 Swiss experts from across the country. We measured the degree of consensus between experts on recommendations regarding regulation, sale, use of and general opinion about e-cigarettes containing nicotine. New recommendations and statements were added following the experts' answers and comments. There was consensus that e-cigarettes containing nicotine should be made available, but only under specific conditions. Sale should be restricted to adults, using quality standards, a maximum level of nicotine and with an accompanying list of authorised ingredients. Advertisement should be restricted and use in public places should be forbidden. These recommendations encompass three principles: (1) the reality principle, as the product is already on the market; (2) the prevention principle, as e-cigarettes provide an alternative to tobacco for actual smokers, and (3) the precautionary principle, to protect minors and non-smokers, since long-term effects are not yet known. Swiss authorities should design specific regulations to sell nicotine-containing e-cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The why, the how and the when of PGS 2.0: current practices and expert opinions of fertility specialists, molecular biologists, and embryologists

PubMed Central

Sermon, Karen; Capalbo, Antonio; Cohen, Jacques; Coonen, Edith; De Rycke, Martine; De Vos, Anick; Delhanty, Joy; Fiorentino, Francesco; Gleicher, Norbert; Griesinger, Georg; Grifo, Jamie; Handyside, Alan; Harper, Joyce; Kokkali, Georgia; Mastenbroek, Sebastiaan; Meldrum, David; Meseguer, Marcos; Montag, Markus; Munné, Santiago; Rienzi, Laura; Rubio, Carmen; Scott, Katherine; Scott, Richard; Simon, Carlos; Swain, Jason; Treff, Nathan; Ubaldi, Filippo; Vassena, Rita; Vermeesch, Joris Robert; Verpoest, Willem; Wells, Dagan; Geraedts, Joep

2016-01-01

STUDY QUESTION We wanted to probe the opinions and current practices on preimplantation genetic screening (PGS), and more specifically on PGS in its newest form: PGS 2.0? STUDY FINDING Consensus is lacking on which patient groups, if any at all, can benefit from PGS 2.0 and, a fortiori, whether all IVF patients should be offered PGS. WHAT IS KNOWN ALREADY It is clear from all experts that PGS 2.0 can be defined as biopsy at the blastocyst stage followed by comprehensive chromosome screening and possibly combined with vitrification. Most agree that mosaicism is less of an issue at the blastocyst stage than at the cleavage stage but whether mosaicism is no issue at all at the blastocyst stage is currently called into question. STUDY DESIGN, SAMPLES/MATERIALS, METHODS A questionnaire was developed on the three major aspects of PGS 2.0: the Why, with general questions such as PGS 2.0 indications; the How, specifically on genetic analysis methods; the When, on the ideal method and timing of embryo biopsy. Thirty-five colleagues have been selected to address these questions on the basis of their experience with PGS, and demonstrated by peer-reviewed publications, presentations at meetings and participation in the discussion. The first group of experts who were asked about ‘The Why’ comprised fertility experts, the second group of molecular biologists were asked about ‘The How’ and the third group of embryologists were asked about ‘The When’. Furthermore, the geographical distribution of the experts has been taken into account. Thirty have filled in the questionnaire as well as actively participated in the redaction of the current paper. MAIN RESULTS AND THE ROLE OF CHANCE The 30 participants were from Europe (Belgium, Germany, Greece, Italy, Netherlands, Spain, UK) and the USA. Array comparative genome hybridization is the most widely used method amongst the participants, but it is slowly being replaced by massive parallel sequencing. Most participants offering PGS 2.0 to their patients prefer blastocyst biopsy. The high efficiency of vitrification of blastocysts has added a layer of complexity to the discussion, and it is not clear whether PGS in combination with vitrification, PGS alone, or vitrification alone, followed by serial thawing and eSET will be the favoured approach. The opinions range from in favour of the introduction of PGS 2.0 for all IVF patients, over the proposal to use PGS as a tool to rank embryos according to their implantation potential, to scepticism towards PGS pending a positive outcome of robust, reliable and large-scale RCTs in distinct patient groups. LIMITATIONS, REASONS FOR CAUTION Care was taken to obtain a wide spectrum of views from carefully chosen experts. However, not all invited experts agreed to participate, which explains a lack of geographical coverage in some areas, for example China. This paper is a collation of current practices and opinions, and it was outside the scope of this study to bring a scientific, once-and-for-all solution to the ongoing debate. WIDER IMPLICATIONS OF THE FINDINGS This paper is unique in that it brings together opinions on PGS 2.0 from all different perspectives and gives an overview of currently applied technologies as well as potential future developments. It will be a useful reference for fertility specialists with an expertise outside reproductive genetics. LARGE SCALE DATA none. STUDY FUNDING AND COMPETING INTEREST(S) No specific funding was obtained to conduct this questionnaire. PMID:27256483

Accepted standards on how to give a Medical Research Presentation: a systematic review of expert opinion papers.

PubMed

Blome, Christine; Sondermann, Hanno; Augustin, Matthias

2017-01-01

Background: This systematic review aimed to extract recommendations from expert opinion articles on how to give a medical research presentation on a scientific conference and to determine whether the experts agree on what makes an effective or poor presentation. Methods: Presentation-related terms were searched within article titles listed in PubMed, restricting the search to English-language articles published from January 1975 to July 2015. Recommendations were extracted from the articles, grouped by content, and analyzed for frequency. Ninety-one articles were included. Among 679 different recommendations, 29 were given in more than 20% of articles each. The five most frequent recommendations were to keep slides simple, adjust the talk to the audience, rehearse, not read the talk from slides or a manuscript, and make eye contact. Results: No article gave advice that was the complete opposite of the 29 most frequent recommendations with the exception of whether a light or dark background should be used for slides. Conclusions: Researchers should comply with these widely accepted standards to be perceived as effective presenters.

Accepted standards on how to give a Medical Research Presentation: a systematic review of expert opinion papers

PubMed Central

Blome, Christine; Sondermann, Hanno; Augustin, Matthias

2017-01-01

Background: This systematic review aimed to extract recommendations from expert opinion articles on how to give a medical research presentation on a scientific conference and to determine whether the experts agree on what makes an effective or poor presentation. Methods: Presentation-related terms were searched within article titles listed in PubMed, restricting the search to English-language articles published from January 1975 to July 2015. Recommendations were extracted from the articles, grouped by content, and analyzed for frequency. Ninety-one articles were included. Among 679 different recommendations, 29 were given in more than 20% of articles each. The five most frequent recommendations were to keep slides simple, adjust the talk to the audience, rehearse, not read the talk from slides or a manuscript, and make eye contact. Results: No article gave advice that was the complete opposite of the 29 most frequent recommendations with the exception of whether a light or dark background should be used for slides. Conclusions: Researchers should comply with these widely accepted standards to be perceived as effective presenters. PMID:28293678

Scratching the surface of tomorrow's diagnostics: the Editor-in-Chief's opinion at the 15th year of Expert Review of Molecular Diagnostics.

PubMed

Lorincz, Attila; Raison, Claire

2015-01-01

Interview with Attila Lorincz by Claire Raison (Commissioning Editor) To mark the beginning of the 15th year of Expert Review of Molecular Diagnostics, the journal's Editor-in-Chief shares his expert knowledge on translational diagnostics, his opinion on recent controversies and his predictions for molecular diagnostics in 2015 and beyond. Attila Lorincz received his doctorate from Trinity College, Dublin, Republic of Ireland, and went on to become a research fellow at the University of California, Santa Barbara, CA, USA. During Professor Lorincz's research on human papillomavirus (HPV), he found several important and novel carcinogenic HPV types and pioneered the use of HPV DNA testing for clinical diagnostics. In 1988, Professor Lorincz's team produced the first HPV test to be FDA-approved for patients and in 2003, for general population cervical precancer screening. Now Professor of Molecular Epidemiology at the Centre for Cancer Prevention, Queen Mary University of London, UK, he and his team are furthering translational research into DNA methylation assays for cancer risk prediction.

[The future of telepathology. An Internet "distributed system" with "open standards"].

PubMed

Brauchli, K; Helfrich, M; Christen, H; Jundt, G; Haroske, G; Mihatsch, M; Oberli, H; Oberholzer, M

2002-05-01

With the availability of Internet, the interest in the possibilities of telepathology has increased considerably. In the foreground is thereby the need of the non-expert to bring in the opinions of experts on morphological findings by means of a fast and simple procedure. The new telepathology system iPath is in compliance with these needs. The system is based on small, but when possible independently working modules. This concept allows a simple adaptation of the system to the individual environment of the user (e.g. for different cameras, frame-grabbers, microscope steering tables etc.) and for individual needs. iPath has been in use for 6 months with various working groups. In telepathology a distinction is made between "passive" and "active" consultations but for both forms a non-expert brings in the opinion of an expert. In an active consultation both are in direct connection with each other (orally or via a chat-function), this is however not the case with a passive consultation. An active consultation can include the interactive discussion of the expert with the non-expert on images in an image database or the direct interpretation of images from a microscope by the expert. Four software modules are available for a free and as fast as possible application: (1) the module "Microscope control", (2) the module "Connector" (insertion of images directly from the microscope without a motorized microscope), (3) the module "Client-application" via the web-browser and (4) the module "Server" with a database. The server is placed in the internet and not behind a firewall. The server permanently receives information from the periphery and returns the information to the periphery on request. The only thing which the expert, the non-expert and the microscope have to know is how contact can made with the server.

Test and Measurement Expert Opinions: A Dialogue about Testing Students with Disabilities Out of Level in Large-Scale Assessments. Out-of-Level Testing Report.

ERIC Educational Resources Information Center

Minnema, Jane; Thurlow, Martha; Bielinski, John

Two focus groups of test and measurement experts were held to explore the use of out-of-level testing for students with disabilities. The participants (n=17) included state and federal level assessment personnel, test company employees, and university professors. A content analysis of the narrative results indicated that there was no clear…

Expert Systems for Civilian Personnel Administration,

DTIC Science & Technology

1985-07-01

Test results of demonstration module vs. human classifier 2. Summary of data concerning Army experts 2 The findings, recommendations, and opinions...to the field of personnel administration. This report is the results of my investigation. . There are many who deserve thanks for assistance and...prompts the doctor for information about the patient, results of tests conducted on specimens from the patient, and observations made of r 3 "I the

Identifying Relevant Acid-Base Topics in the Context of a Prenursing Chemistry Course to Better Align Health-Related Instruction and Assessment

ERIC Educational Resources Information Center

Brown, Corina E.; Henry, Melissa L. M.; Hyslop, Richard M.

2018-01-01

This study explores the acid-base topic in the context of a chemistry course taken as a prerequisite for a baccalaureate nursing program. Core findings were derived from semistructured interviews with experts in the areas of chemistry and nursing, and a multiple university survey of experts' opinions. The acid-base topic was reviewed and evaluated…

Nursing Minimum Data Sets for documenting nutritional care for adults in primary healthcare: a scoping review.

PubMed

Håkonsen, Sasja Jul; Pedersen, Preben Ulrich; Bjerrum, Merete; Bygholm, Ann; Peters, Micah D J

2018-01-01

To identify all published nutritional screening instruments that have been validated in the adult population in primary healthcare settings and to report on their psychometric validity. Within health care, there is an urgent need for the systematic collection of nursing care data in order to make visible what nurses do and to facilitate comparison, quality assurance, management, research and funding of nursing care. To be effective, nursing records should accurately and comprehensively document all required information to support safe and high quality care of patients. However, this process of documentation has been criticized from many perspectives as being highly inadequate. A Nursing Minimum Data Set within the nutritional area in primary health care could therefore be beneficial in order to support nurses in their daily documentation and observation of patients. The review considered studies that included adults aged over 18 years of any gender, culture, diagnosis and ethnicity, as well as nutritional experts, patients and their relatives. The concepts of interest were: the nature and content of any nutritional screening tools validated (regardless of the type of validation) in the adult population in primary healthcare; and the views and opinions of eligible participants regarding the appropriateness of nutritional assessment were the concept of interest. Studies included must have been conducted in primary healthcare settings, both within home care and nursing home facilities. This scoping review used a two-step approach as a preliminary step to the subsequent development of a Nursing Minimum Data Set within the nutritional area in primary healthcare: i) a systematic literature search of existing nutritional screening tools validated in primary health care; and ii) a systematic literature search on nutritional experts opinions on the assessment of nutritional nursing care of adults in primary healthcare as well as the views of patients and their relatives. Multiple databases (PubMed, CINAHL, Embase, Scopus, Swemed+, MedNar, CDC, MEDION, Health Technology Assessment Database, TRIP database, NTIS, ProQuest Dissertations and Theses, Google Scholar, Current Contents) were searched from their inception to September 2016. The results from the studies were extracted using pre-developed extraction tools to all three questions, and have been presented narratively and by using figures to support the text. Twenty-nine nutritional screening tools that were validated within a primary care setting, and two documents on consensus statements regarding expert opinion were identified. No studies on the patients or relatives views were identified. The nutritional screening instruments have solely been validated in an over-55 population. Construct validity was the type of validation most frequently used in the validation process covering a total of 25 of the 29 tools. Two studies were identified in relation to the third review question. These two documents are both consensus statement documents developed by experts within the geriatric and nutritional care field. Overall, experts find it appropriate to: i) conduct a comprehensive geriatric assessment, ii) use a validated nutritional screening instrument, and iii) conduct a history and clinical diagnosis, physical examination and dietary assessment when assessing primarily the elderly's nutritional status in primary health care.

A Bayesian Analysis of a Randomized Clinical Trial Comparing Antimetabolite Therapies for Non-Infectious Uveitis.

PubMed

Browne, Erica N; Rathinam, Sivakumar R; Kanakath, Anuradha; Thundikandy, Radhika; Babu, Manohar; Lietman, Thomas M; Acharya, Nisha R

2017-02-01

To conduct a Bayesian analysis of a randomized clinical trial (RCT) for non-infectious uveitis using expert opinion as a subjective prior belief. A RCT was conducted to determine which antimetabolite, methotrexate or mycophenolate mofetil, is more effective as an initial corticosteroid-sparing agent for the treatment of intermediate, posterior, and pan-uveitis. Before the release of trial results, expert opinion on the relative effectiveness of these two medications was collected via online survey. Members of the American Uveitis Society executive committee were invited to provide an estimate for the relative decrease in efficacy with a 95% credible interval (CrI). A prior probability distribution was created from experts' estimates. A Bayesian analysis was performed using the constructed expert prior probability distribution and the trial's primary outcome. A total of 11 of the 12 invited uveitis specialists provided estimates. Eight of 11 experts (73%) believed mycophenolate mofetil is more effective. The group prior belief was that the odds of treatment success for patients taking mycophenolate mofetil were 1.4-fold the odds of those taking methotrexate (95% CrI 0.03-45.0). The odds of treatment success with mycophenolate mofetil compared to methotrexate was 0.4 from the RCT (95% confidence interval 0.1-1.2) and 0.7 (95% CrI 0.2-1.7) from the Bayesian analysis. A Bayesian analysis combining expert belief with the trial's result did not indicate preference for one drug. However, the wide credible interval leaves open the possibility of a substantial treatment effect. This suggests clinical equipoise necessary to allow a larger, more definitive RCT.

Bridge esthetic guidelines.

DOT National Transportation Integrated Search

1975-01-01

As esthetics is not an exact science, differences of opinion occur, even between experts; however, studies had found that in most cases there were statistical preferences. These preferences are presented. For the convenience of the designer, a format...

Debating the legitimacy of a contested environmental illness: a case study of multiple chemical sensitivities (MCS).

PubMed

Phillips, Tarryn

2010-11-01

More than 20years after it was first identified, the anomalous condition, multiple chemical sensitivities (MCS), remains immersed in controversy, with a continuing debate over its causation being played out in the medico-scientific community and in the courts. This article examines why sceptical and supportive experts disagree over the condition's legitimacy as an organic condition. Drawing on ethnographic research conducted in Perth, Western Australia, the author scrutinises the decision-making practices of 16 experts (eight sceptical and eight supportive of a chemical explanation). Both groups were found to use evidence-based, inductive reasoning. However, sceptical experts tended to use a different set of evidence requirements, exhibited more faith in the efficiency of the current biomedical paradigm regarding toxicity and were less likely to acknowledge uncertainty in their field. All the experts recognised a spectrum of beliefs about the causal mechanisms of MCS. However, when they were engaged in litigation as expert witnesses due to their supportive or sceptical tendency, the oppositional legal system polarised their opinions and exacerbated the perceived divide between them. Ultimately, the adversarial medico-legal process inhibits genuine dialogue between some of the key players in the MCS debate, thus impeding understanding and consensus about the condition. © 2010 The Author. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Evaluating the appropriateness of antimicrobial treatment in hospitalized patients: a comparison of three methods.

PubMed

Reisfeld, S; Assaly, M; Tannous, E; Amarney, K; Stein, M

2018-06-01

Approximately 20-50% of antimicrobial therapy in hospitalized patients is considered inappropriate, which may be associated with increased morbidity and mortality. The best method for evaluation of appropriateness is not well defined. To evaluate the rate of appropriate antimicrobial therapy in a secondary hospital using three different methods, and determine the rate of agreement between the different methods. A point prevalence study included all adult hospitalized patients receiving systemic antimicrobial therapy during 2016, screened on a single day. Clinical, laboratory and therapeutic data were collected from patient files, and appropriateness was rated with a qualitative evaluation by expert opinion. In addition, a quantitative evaluation was performed according to 11 quality indicators (QIs) rated for each patient. A strict definition of appropriateness was fulfilled if six essential QIs were met, and a lenient definition was fulfilled if at least five QIs were met. Agreement between methods was analysed using kappa statistic. Among 106 patients included, rates of appropriateness of antimicrobial therapy ranged from 20% to 75%, depending on the method of evaluation. Very low agreement was found between the strict definition and expert opinion (kappa=0.068), and medium agreement was found between the lenient definition and expert opinion (kappa=0.45). Rates of appropriateness of antimicrobial therapy varied between evaluation methods, with low to moderate agreement between the different methods. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: an expert opinion perspective

PubMed Central

Nzioki, Japheth Mativo; Onyango, Rosebella Ogutu; Ombaka, James Herbert

2015-01-01

Introduction Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya. In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluate the efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCH services in the district. Methods This was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO. Framework analysis and quasi statistics were used in data analysis. Results Expert opinion data indicated that the CHS was efficient in providing MCH services. Factors influencing efficiency of the CHS in provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs. Conclusion Though CHS was found to be efficient in providing MCH services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed. PMID:26090046

Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics.

PubMed

Wilmshurst, Jo M; Gaillard, William D; Vinayan, Kollencheri Puthenveettil; Tsuchida, Tammy N; Plouin, Perrine; Van Bogaert, Patrick; Carrizosa, Jaime; Elia, Maurizio; Craiu, Dana; Jovic, Nebojsa J; Nordli, Doug; Hirtz, Deborah; Wong, Virginia; Glauser, Tracy; Mizrahi, Eli M; Cross, J Helen

2015-08-01

Evidence-based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or "state of the art" interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video-EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile-onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide, valproate, bromide, and the ketogenic diet are possibly effective; and for Ohtahara syndrome, there is weak evidence that most antiepileptic drugs are poorly effective. For epileptic spasms, clinical suspicion remains central to the diagnosis and is supported by EEG, which ideally is prolonged (level C recommendation). Adrenocorticotropic hormone (ACTH) is preferred for short-term control of epileptic spasms (level B recommendation), oral steroids are probably effective in short-term control of spasms (level C recommendation), and a shorter interval from the onset of spasms to treatment initiation may improve long-term neurodevelopmental outcome (level C recommendation). The ketogenic diet is the treatment of choice for epilepsy related to glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency (expert opinion, level U recommendation). The identification of patients as potential candidates for epilepsy surgery should be part of standard practice at primary and secondary level care. Tertiary care facilities with experience in epilepsy surgery should undertake the screening for epilepsy surgical candidates (level U recommendation). There is insufficient evidence to conclude if there is benefit from vagus nerve stimulation (level U recommendation). The key recommendations are summarized into an executive summary. The full report is available as Supporting Information. This report provides a comprehensive foundation of an approach to infants with seizures, while identifying where there are inadequate data to support recommended practice, and where further data collection is needed to address these deficits. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Underlying pathology and associated factors of hemiplegic shoulder pain.

PubMed

Kalichman, Leonid; Ratmansky, Motti

2011-09-01

The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.

The evaluation of (social-)psychological comfort in clothing, a possible approach

NASA Astrophysics Data System (ADS)

Matté, L. L.; Broega, A. C.

2017-10-01

This paper presents the first results of a PhD research on psychological comfort of clothing. In order to understand and conceptualize the psychological aspects of clothing comfort, a variation of the Delphi Method was used to seek opinions from experts. This method was chosen because of its consensus-building features. The results were obtained from a qualitative text analysis, conducted over the experts’ responses to the first round of questions. The analytic process shed some light on the formation of the psychological comfort concept as well as the potential attributes to be evaluated when assessing this comfort dimension.

Interdisciplinary and participatory approaches: the key to effective groundwater management

NASA Astrophysics Data System (ADS)

Barthel, Roland; Foster, Stephen; Villholth, Karen G.

2017-11-01

The challenges of a changing world, which are progressively threatening sustainable use of groundwater resources, can only be rationally and effectively addressed through close collaboration between experts and practitioners from different disciplines. Furthermore, science and management need to build on stakeholder opinions and processes in order to generate useful knowledge and positive outcomes in terms of sustainable and equitable groundwater management. This essay provides a discussion of the status of and vision for participatory and inter-disciplinary approaches to groundwater evaluation and management as well as a conceptual framework and relevant research questions that will facilitate such approaches.

Using experts feedback in clinical case resolution and arbitration as accuracy diagnosis methodology.

PubMed

Rodríguez-González, Alejandro; Torres-Niño, Javier; Valencia-Garcia, Rafael; Mayer, Miguel A; Alor-Hernandez, Giner

2013-09-01

This paper proposes a new methodology for assessing the efficiency of medical diagnostic systems and clinical decision support systems by using the feedback/opinions of medical experts. The methodology behind this work is based on a comparison between the expert feedback that has helped solve different clinical cases and the expert system that has evaluated these same cases. Once the results are returned, an arbitration process is carried out in order to ensure the correctness of the results provided by both methods. Once this process has been completed, the results are analyzed using Precision, Recall, Accuracy, Specificity and Matthews Correlation Coefficient (MCC) (PRAS-M) metrics. When the methodology is applied, the results obtained from a real diagnostic system allow researchers to establish the accuracy of the system based on objective facts. The methodology returns enough information to analyze the system's behavior for each disease in the knowledge base or across the entire knowledge base. It also returns data on the efficiency of the different assessors involved in the evaluation process, analyzing their behavior in the diagnostic process. The proposed work facilitates the evaluation of medical diagnostic systems, having a reliable process based on objective facts. The methodology presented in this research makes it possible to identify the main characteristics that define a medical diagnostic system and their values, allowing for system improvement. A good example of the results provided by the application of the methodology is shown in this paper. A diagnosis system was evaluated by means of this methodology, yielding positive results (statistically significant) when comparing the system with the assessors that participated in the evaluation process of the system through metrics such as recall (+27.54%) and MCC (+32.19%). These results demonstrate the real applicability of the methodology used. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Future of Forest Management on NIPF Lands in the South: Results of an Expert Opinion Survey

Treesearch

Steverson O. Moffat; Frederick W. Cubbage; Anthony J. Cascio; Raymond M. Sheffield

1998-01-01

A survey was sent to each state forester in the 13 states in the Southeast and South Central Regions to ask their opinions regarding the future of forest management on NIPF lands in their state. The results indicate that changes are in store for NIPF lands between now and 2020. Planted pine is projected to increase 7% in area in the South, largely at the expense of...

Who are the opinion leaders? The physicians, pharmacists, patients, and direct-to-consumer prescription drug advertising.

PubMed

Lee, Annisa Lai

2010-09-01

A popular perception holds that physicians prescribe requested drugs to patients influenced by mass mediated direct-to-consumer prescription drug advertising. The phenomenon poses a serious challenge to the two-step flow model, which emphasizes the influence of opinion leaders on their followers and their legitimating power over the informing power of the mass media. This study investigates a 2002 Food and Drug Administration (FDA) survey and finds that patients searching for drug information through mass and hybrid media in newspapers and magazines' small print, the Internet, and toll-free numbers are more likely to seek information through interpersonal communication channels like health care providers. Patients using small print, toll-free numbers, one's own physician, and other physicians are associated with influencing their physicians with various drug-requesting behaviors. But physicians only prescribe requested drugs to patients who are influenced by other health care providers, such as pharmacists and other physicians, not the mass media. The influence of expert opinion leaders of drugs is so strong that the patients even would switch from their own unyielding physicians who do not prescribe drugs as advised by the pharmacists. Physicians and patients all are influenced more by other expert opinion leaders of drugs than by the mass media and therefore still uphold the basic tenet of the two-step model.

Development of the International Classification of Functioning, Disability and Health core sets for hand conditions--results of the World Health Organization International Consensus process.

PubMed

Rudolf, Klaus-Dieter; Kus, Sandra; Chung, Kevin C; Johnston, Marie; LeBlanc, Monique; Cieza, Alarcos

2012-01-01

A formal decision-making and consensus process was applied to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. To convene an international panel to develop the ICF Core Sets for Hand Conditions (HC), preparatory studies were conducted, which included an expert survey, a systematic literature review, a qualitative study and an empirical data collection process involving persons with hand conditions. A consensus conference was convened in Switzerland in May 2009 that was attended by 23 healthcare professionals, who treat hand conditions, representing 22 countries. The preparatory studies identified a set of 743 ICF categories at the second, third or fourth hierarchical level. Altogether, 117 chapter-, second-, or third-level categories were included in the comprehensive ICF Core Set for HC. The brief ICF Core Set for HC included a total of 23 chapter- and second-level categories. A formal consensus process integrating evidence and expert opinion based on the ICF led to the formal adoption of the ICF Core Sets for Hand Conditions. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings.

Accreditation standards for undergraduate forensic science programs

NASA Astrophysics Data System (ADS)

Miller, Marilyn Tebbs

Undergraduate forensic science programs are experiencing unprecedented growth in numbers of programs offered and, as a result, student enrollments are increasing. Currently, however, these programs are not subject to professional specialized accreditation. This study sought to identify desirable student outcome measures for undergraduate forensic science programs that should be incorporated into such an accreditation process. To determine desirable student outcomes, three types of data were collected and analyzed. All the existing undergraduate forensic science programs in the United States were examined with regard to the input measures of degree requirements and curriculum content, and for the output measures of mission statements and student competencies. Accreditation procedures and guidelines for three other science-based disciplines, computer science, dietetics, and nursing, were examined to provide guidance on accreditation processes for forensic science education programs. Expert opinion on outcomes for program graduates was solicited from the major stakeholders of undergraduate forensic science programs-forensic science educators, crime laboratory directors, and recent graduates. Opinions were gathered by using a structured Internet-based survey; the total response rate was 48%. Examination of the existing undergraduate forensic science programs revealed that these programs do not use outcome measures. Of the accreditation processes for other science-based programs, nursing education provided the best model for forensic science education, due primarily to the balance between the generality and the specificity of the outcome measures. From the analysis of the questionnaire data, preliminary student outcomes, both general and discipline-specific, suitable for use in the accreditation of undergraduate forensic science programs were determined. The preliminary results were reviewed by a panel of experts and, based on their recommendations, the outcomes identified were revised and refined. The results of this study were used to identify student outcomes and to suggest accreditation standards and an accreditation process for undergraduate forensic science programs based on those outcomes.

Complications of pelvic organ prolapse surgery and methods of prevention.

PubMed

de Tayrac, Renaud; Sentilhes, Loic

2013-11-01

The aim was to review complications associated with pelvic organ prolapse surgery. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Transvaginal mesh has a higher re-operation rate than native tissue vaginal repairs (grade A). If a synthetic mesh is placed via the vaginal route, it is recommended that a macroporous polypropylene monofilament mesh should be used. At sacral colpopexy mesh should not be introduced or sutured via the vaginal route and silicone-coated polyester, porcine dermis, fascia lata and polytetrafluoroethylene meshes are not recommended as grafts. Hysterectomy should also be avoided (grade B). There is no evidence to recommend routine local or systemic oestrogen therapy before or after prolapse surgery using mesh. The first cases should be undertaken with the guidance of an experienced surgeon in the relevant technique (grade C). Expert opinion suggests that by whatever the surgical route pre-operative urinary tract infections are treated, smoking is ceased and antibiotic prophylaxis is undertaken. It is recommended that a non-absorbable synthetic mesh should not be inserted into the rectovaginal septum when a rectal injury occurs. The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after a bladder injury has been repaired, if the repair is considered to be satisfactory. It is possible to perform a hysterectomy in association with the introduction of a non-absorbable synthetic mesh inserted vaginally, but this is not recommended routinely.

Expert Elicitation Methods in Quantifying the Consequences of Acoustic Disturbance from Offshore Renewable Energy Developments.

PubMed

Donovan, Carl; Harwood, John; King, Stephanie; Booth, Cormac; Caneco, Bruno; Walker, Cameron

2016-01-01

There are many developments for offshore renewable energy around the United Kingdom whose installation typically produces large amounts of far-reaching noise, potentially disturbing many marine mammals. The potential to affect the favorable conservation status of many species means extensive environmental impact assessment requirements for the licensing of such installation activities. Quantification of such complex risk problems is difficult and much of the key information is not readily available. Expert elicitation methods can be employed in such pressing cases. We describe the methodology used in an expert elicitation study conducted in the United Kingdom for combining expert opinions based on statistical distributions and copula-like methods.

Attitudes of Crohn’s Disease Patients: Infodemiology Case Study and Sentiment Analysis of Facebook and Twitter Posts

PubMed Central

2017-01-01

Background Data concerning patients originates from a variety of sources on social media. Objective The aim of this study was to show how methodologies borrowed from different areas including computer science, econometrics, statistics, data mining, and sociology may be used to analyze Facebook data to investigate the patients’ perspectives on a given medical prescription. Methods To shed light on patients’ behavior and concerns, we focused on Crohn’s disease, a chronic inflammatory bowel disease, and the specific therapy with the biological drug Infliximab. To gain information from the basin of big data, we analyzed Facebook posts in the time frame from October 2011 to August 2015. We selected posts from patients affected by Crohn’s disease who were experiencing or had previously been treated with the monoclonal antibody drug Infliximab. The selected posts underwent further characterization and sentiment analysis. Finally, an ethnographic review was carried out by experts from different scientific research fields (eg, computer science vs gastroenterology) and by a software system running a sentiment analysis tool. The patient feeling toward the Infliximab treatment was classified as positive, neutral, or negative, and the results from computer science, gastroenterologist, and software tool were compared using the square weighted Cohen’s kappa coefficient method. Results The first automatic selection process returned 56,000 Facebook posts, 261 of which exhibited a patient opinion concerning Infliximab. The ethnographic analysis of these 261 selected posts gave similar results, with an interrater agreement between the computer science and gastroenterology experts amounting to 87.3% (228/261), a substantial agreement according to the square weighted Cohen’s kappa coefficient method (w2K=0.6470). A positive, neutral, and negative feeling was attributed to 36%, 27%, and 37% of posts by the computer science expert and 38%, 30%, and 32% by the gastroenterologist, respectively. Only a slight agreement was found between the experts’ opinion and the software tool. Conclusions We show how data posted on Facebook by Crohn’s disease patients are a useful dataset to understand the patient’s perspective on the specific treatment with Infliximab. The genuine, nonmedically influenced patients’ opinion obtained from Facebook pages can be easily reviewed by experts from different research backgrounds, with a substantial agreement on the classification of patients’ sentiment. The described method allows a fast collection of big amounts of data, which can be easily analyzed to gain insight into the patients’ perspective on a specific medical therapy. PMID:28793981

Improving the Distribution of Rural Health Houses Using Elicitation and GIS in Khuzestan Province (the Southwest of Iran).

PubMed

Mohammadi, Ali; Valinejadi, Ali; Sakipour, Sara; Hemmat, Morteza; Zarei, Javad; Askari Majdabadi, Hesamedin

2017-08-27

Rural health houses constitute a major provider of some primary health services in the villages of Iran. Given the challenges of providing health services in rural areas, health houses should be established based on the criteria of health network systems (HNSs). The value of these criteria and their precedence over others have not yet been thoroughly investigated. The present study was conducted to propose a model for improving the distribution of rural health houses in HNSs. The present applied study was conducted in Khuzestan province in the southwest of Iran in 2014-2016. First, the descriptive and spatial data required were collected and entered into ArcGIS after modifications, and the Geodatabase was then created. Based on the criteria of the HNS and according to experts' opinions, the main criteria and the sub-criteria for an optimal site selection were determined. To determine the criteria's coefficient of importance (ie, their weight), the main criteria and the sub-criteria were compared in pairs according to experts' opinions. The results of the pairwise comparisons were entered into Expert Choice and the weight of the main criteria and the sub-criteria were determined using the analytic hierarchy process (AHP). The application layers were then formed in geographic information system (GIS). A model was ultimately proposed in the GIS for the optimal distribution of rural health houses by overlaying the weighting layers and the other layers related to villages and rural health houses. Based on the experts' opinions, six criteria were determined as the main criteria for an optimal site selection for rural health houses, including welfare infrastructures, population, dispersion, accessibility, corresponding routes, distance to the rural health center and the absence of natural barriers to accessibility. Of the main criteria proposed, the highest weight was given to "population" (0.506). The priorities suggested in the proposed model for establishing rural health houses are presented within five zoning levels -from excellent to very poor. The results of the study showed that the proposed model can help provide a better picture of the distribution of rural health houses. The GIS is recommended to be used as a means of making the HNS more efficient. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The role of communication in breast cancer screening: a qualitative study with Australian experts.

PubMed

Parker, Lisa M; Rychetnik, Lucie; Carter, Stacy M

2015-10-19

One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts' opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers' breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here's why; Screening is available please consider whether it's right for you. There was a similar level of support for all three approaches. Experts' reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims.

Determining the Criteria and Their Weights for Medical Schools' Ranking: A National Consensus.

PubMed

Mojtahedzadeh, Rita; Mohammadi, Aeen; Kohan, Noushin; Gharib, Mitra; Zolfaghari, Mitra

2016-06-01

Delphi as a consensus development technique enables anonymous, systematic refinement of expert opinion with the aim of arriving at a combined or consensual position. In this study, we determined the criteria and their weights for Iranian Medical Schools' ranking through a Delphi process. An expert committee devised 13 proposed criteria with 32 indicators with their weights, which were arranged hierarchically in the form of a tree diagram. We used the Delphi technique to reach a consensus on these criteria and weights among the deans of 38 public Iranian medical schools. For this purpose, we devised and sent a questionnaire to schools and asked them to suggest or correct the criteria and their weights. We repeated this process in two rounds till all the schools reached an acceptable consensus on them. All schools reached a consensus on the set of 13 criteria and 30 indicators and their weights in three main contexts of education, research and facilities, and equipment which were used for Medical Schools' ranking. Using Delphi technique for devising the criteria and their weights in evaluation processes such as ranking makes their results more acceptable among universities.

A teaching skills assessment tool inspired by the Calgary-Cambridge model and the patient-centered approach.

PubMed

Sommer, Johanna; Lanier, Cédric; Perron, Noelle Junod; Nendaz, Mathieu; Clavet, Diane; Audétat, Marie-Claude

2016-04-01

The aim of this study was to develop a descriptive tool for peer review of clinical teaching skills. Two analogies framed our research: (1) between the patient-centered and the learner-centered approach; (2) between the structures of clinical encounters (Calgary-Cambridge communication model) and teaching sessions. During the course of one year, each step of the action research was carried out in collaboration with twelve clinical teachers from an outpatient general internal medicine clinic and with three experts in medical education. The content validation consisted of a literature review, expert opinion and the participatory research process. Interrater reliability was evaluated by three clinical teachers coding thirty audiotaped standardized learner-teacher interactions. This tool contains sixteen items covering the process and content of clinical supervisions. Descriptors define the expected teaching behaviors for three levels of competence. Interrater reliability was significant for eleven items (Kendall's coefficient p<0.05). This peer assessment tool has high reliability and can be used to facilitate the acquisition of teaching skills. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Sociology as a Major Factor for the Psychiatrie-Enquete in the Federal Republic of Germany - Results from Expert Interviews and Document Analyses].

PubMed

Söhner, Felicitas; Fangerau, Heiner; Becker, Thomas

2018-05-01

This paper examines the influence of sociology as a discipline on the Psychiatrie-Enquete by analysing interviews with expert (psychiatrist, psychologist, sociologist etc.) witnesses of the Enquete process and by analysing pertinent documents. 24 interviews were conducted and analysed using qualitative secondary analysis. Sociological texts and research results influenced the professional development of psychiatrists at the time. Cross-talk between psychiatry and sociology developed through seminal sociological analyses of psychiatric institutions and the interest taken in medical institutions in a number of sociological texts. Inter-disciplinary joint studies (of sociologists and psychiatrists) affected the research interest and professional behaviour of psychiatrists involved in the process on the way to the Psychiatrie-Enquete. Tenacity of psychiatrists' systems of opinion was dissolved by impulses from the sociological thought community. The forms of contact between the psychiatric and the sociological thought collective which we could reconstruct are an example of the evolution of knowledge and practice through transdisciplinary communication. © Georg Thieme Verlag KG Stuttgart · New York.

Description and pilot results from a novel method for evaluating return of incidental findings from next-generation sequencing technologies.

PubMed

Goddard, Katrina A B; Whitlock, Evelyn P; Berg, Jonathan S; Williams, Marc S; Webber, Elizabeth M; Webster, Jennifer A; Lin, Jennifer S; Schrader, Kasmintan A; Campos-Outcalt, Doug; Offit, Kenneth; Feigelson, Heather Spencer; Hollombe, Celine

2013-09-01

The aim of this study was to develop, operationalize, and pilot test a transparent, reproducible, and evidence-informed method to determine when to report incidental findings from next-generation sequencing technologies. Using evidence-based principles, we proposed a three-stage process. Stage I "rules out" incidental findings below a minimal threshold of evidence and is evaluated using inter-rater agreement and comparison with an expert-based approach. Stage II documents criteria for clinical actionability using a standardized approach to allow experts to consistently consider and recommend whether results should be routinely reported (stage III). We used expert opinion to determine the face validity of stages II and III using three case studies. We evaluated the time and effort for stages I and II. For stage I, we assessed 99 conditions and found high inter-rater agreement (89%), and strong agreement with a separate expert-based method. Case studies for familial adenomatous polyposis, hereditary hemochromatosis, and α1-antitrypsin deficiency were all recommended for routine reporting as incidental findings. The method requires <3 days per topic. We establish an operational definition of clinically actionable incidental findings and provide documentation and pilot testing of a feasible method that is scalable to the whole genome.

Marigold (Calendula officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration.

PubMed

Basch, Ethan; Bent, Steve; Foppa, Ivo; Haskmi, Sadaf; Kroll, David; Mele, Michelle; Szapary, Philippe; Ulbricht, Catherine; Vora, Mamta; Yong, Sophanna

2006-01-01

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology and dosing.

Disorders Related to (And Sometimes Confused with) OCD

MedlinePlus

... perfectionism problems. Do not like their OCD “symptoms” Autism Spectrum Disorders To learn more: Read the Expert Opinion on Asperger’s and OCD. Visit the Autism Speaks Website . People with Autism Spectrum Disorders and ...

An evidence-based systematic review of saffron (Crocus sativus) by the Natural Standard Research Collaboration.

PubMed

Ulbricht, Catherine; Conquer, Julie; Costa, Dawn; Hollands, Whitney; Iannuzzi, Carmen; Isaac, Richard; Jordan, Joseph K; Ledesma, Natalie; Ostroff, Cathy; Serrano, Jill M Grimes; Shaffer, Michael D; Varghese, Minney

2011-03-01

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration.

PubMed

Ulbricht, Catherine; Basch, Ethan; Bent, Steve; Boon, Heather; Corrado, Michelle; Foppa, Ivo; Hashmi, Sadaf; Hammerness, Paul; Kingsbury, Eileen; Smith, Michael; Szapary, Philippe; Vora, Mamta; Weissner, Wendy

2006-01-01

Here presented is an evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Healing of the bone with anti-fracture drugs.

PubMed

Vannucci, Letizia; Brandi, Maria Luisa

2016-12-01

Fracture healing is a complex physiological process. As impaired fracture healing is more frequent in osteoporotic subjects, anti-osteoporotic drugs could have some impact on this process. Areas covered: We reviewed the current literature to evaluate the effects of these drugs on fracture healing and their potential role in supporting this process, especially when impaired. A PubMed/Medline search was undertaken combining the terms 'fracture healing', 'anti-resorptive drugs', 'anabolic agents', 'anti-osteoporotic drugs'. Expert opinion: As clinical evidence on the role of anti-osteoporotic drugs in the process of fracture healing consists mainly of case reports or studies with a relatively small number of patients, large randomized clinical trials are needed in order to extend to the human setting the promising results on these agents as inductors or co-adjuvants of bone healing derived from animal studies.

Whisper: Tracing the Spatiotemporal Process of Information Diffusion in Real Time.

PubMed

Cao, Nan; Lin, Yu-Ru; Sun, Xiaohua; Lazer, D; Liu, Shixia; Qu, Huamin

2012-12-01

When and where is an idea dispersed? Social media, like Twitter, has been increasingly used for exchanging information, opinions and emotions about events that are happening across the world. Here we propose a novel visualization design, "Whisper", for tracing the process of information diffusion in social media in real time. Our design highlights three major characteristics of diffusion processes in social media: the temporal trend, social-spatial extent, and community response of a topic of interest. Such social, spatiotemporal processes are conveyed based on a sunflower metaphor whose seeds are often dispersed far away. In Whisper, we summarize the collective responses of communities on a given topic based on how tweets were retweeted by groups of users, through representing the sentiments extracted from the tweets, and tracing the pathways of retweets on a spatial hierarchical layout. We use an efficient flux line-drawing algorithm to trace multiple pathways so the temporal and spatial patterns can be identified even for a bursty event. A focused diffusion series highlights key roles such as opinion leaders in the diffusion process. We demonstrate how our design facilitates the understanding of when and where a piece of information is dispersed and what are the social responses of the crowd, for large-scale events including political campaigns and natural disasters. Initial feedback from domain experts suggests promising use for today's information consumption and dispersion in the wild.

Oxytocin facilitation of acceptance of social advice is dependent upon the perceived trustworthiness of individual advisors.

PubMed

Luo, Ruixue; Xu, Lei; Zhao, Weihua; Ma, Xiaole; Xu, Xiaolei; Kou, Juan; Gao, Zhao; Becker, Benjamin; Kendrick, Keith M

2017-09-01

The neuropeptide oxytocin may increase social cohesion by making us more willing to trust others and/or to conform to their opinions. Here we investigated whether intranasal oxytocin can influence acceptance of advice given on solving everyday social problems by either individual expert (psychologist) or non-expert advisors with or without influencing their perceived likeability or trustworthiness. In a double-blind, between-subject, placebo-control design study in 160 male and female subjects, intranasal oxytocin (24IU) only significantly enhanced acceptance of advice given by female psychologists who were rated as the most trustworthy advisors. However, oxytocin itself did not alter either trustworthiness or likeability ratings. The oxytocin effect on acceptance of the female psychologist's advice was not maintained after a week, with subjects mainly reverting to their original solutions. These findings suggest that while oxytocin can transiently increase acceptance of advice from the most trustworthy individuals this is because it makes subjects more likely to conform to their opinions rather than enhancing their perceived trustworthiness or likeability. Thus in every day contexts oxytocin may primarily promote social cohesion by facilitating conformity towards the opinions of the most trusted individuals. Copyright © 2017. Published by Elsevier Ltd.

Q-Sample Construction: A Critical Step for a Q-Methodological Study.

PubMed

Paige, Jane B; Morin, Karen H

2016-01-01

Q-sample construction is a critical step in Q-methodological studies. Prior to conducting Q-studies, researchers start with a population of opinion statements (concourse) on a particular topic of interest from which a sample is drawn. These sampled statements are known as the Q-sample. Although literature exists on methodological processes to conduct Q-methodological studies, limited guidance exists on the practical steps to reduce the population of statements to a Q-sample. A case exemplar illustrates the steps to construct a Q-sample in preparation for a study that explored perspectives nurse educators and nursing students hold about simulation design. Experts in simulation and Q-methodology evaluated the Q-sample for readability, clarity, and for representativeness of opinions contained within the concourse. The Q-sample was piloted and feedback resulted in statement refinement. Researchers especially those undertaking Q-method studies for the first time may benefit from the practical considerations to construct a Q-sample offered in this article. © The Author(s) 2014.

Documenting Matured Science: The BACC-Type Assessment Reports

NASA Astrophysics Data System (ADS)

Reckermann, M.; Omstedt, A. T.

2016-12-01

The BACC-type reports (BALTEX and Baltic Earth Assessment of Climate Change for the Baltic Sea region, BACC 2008 and BACC II 2015) represent an approach to assessing and making available current knowledge on regional climate change and its regional impacts on the physical, biogeochemical and biological environment (ecosystems, socio-economic sphere). The BACC assessments have originated in the BALTEX scientific research community (now Baltic Earth) and are coordinated by the International Baltic Earth Secretariat. The assessments are produced by teams of scientists from the region, led by lead authors who recruit experts from relevant topics to contribute. The report of 2015 was compiled by a different group of authors as 2008 to warrant independence of personal opinions and bias. The process is not externally funded and completely based on published scientific evidence, and not biased by political or economic interest groups. The BACC-type reports aim to bring together consolidated knowledge that has broad consensus in the scientific community, but also acknowledging issues for which contradicting opinions are found in the literature, so that no consensus can be reached ("consensus on dissensus"). An international steering committee is responsible for overlooking the process, and all manuscripts are anonymously peer-reviewed by independent international experts. Outreach to stakeholders and the public is an inherent aspect of this approach to document mature science. For the Baltic Sea, there is a close collaboration with HELCOM, the intergovernmental Baltic Marine Environment Protection Commission and the major regional science-policy interface in the Baltic Sea region. A summary for non-scientists was produced for the first BACC report and is in preparation for the second. Other BACC-type reports published are the climate report for the greater Hamburg area (published in 2011), and the NOSCCA report (North Sea Climate Change Assessment), published in 2016.

A Stakeholder-Informed Approach to the Identification of Criteria for the Prioritization of Zoonoses in Canada

PubMed Central

Ng, Victoria; Sargeant, Jan M.

2012-01-01

Background Zoonotic diseases account for over 60% of all communicable diseases causing illness in humans and 75% of recently emerging infectious diseases. As limited resources are available for the control and prevention of zoonotic diseases, it is necessary to prioritize diseases in order to direct resources into those with the greatest needs. The selection of criteria for prioritization has traditionally been on the basis of expert opinion; however, details of the methods used to identify criteria from expert opinion often are not published and a full range of criteria may not be captured by expert opinion. Methodology/Principal Findings This study used six focus groups to identify criteria for the prioritization of zoonotic diseases in Canada. Focus groups included people from the public, animal health professionals and human health professionals. A total of 59 criteria were identified for prioritizing zoonotic diseases. Human-related criteria accounted for the highest proportion of criteria identified (55%), followed by animal-related criteria (26%) then pathogen/disease-related criteria (19%). Similarities and differences were observed in the identification and scoring of criteria for disease prioritization between groups; the public groups were strongly influenced by the individual-level of disease burden, the responsibility of the scientific community in disease prioritization and the experiences of recent events while the professional groups were influenced by the societal- and population-level of disease burden and political and public pressure. Conclusions/Significance This was the first study to describe a mixed semi-quantitative and qualitative approach to deriving criteria for disease prioritization. This was also the first study to involve the opinion of the general public regarding disease prioritization. The number of criteria identified highlights the difficulty in prioritizing zoonotic diseases. The method presented in this paper has formulated a comprehensive list of criteria that can be used to inform future disease prioritization studies. PMID:22238648

32 CFR 536.39 - Use of experts, consultants and appraisers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... information protected by HIPAA is involved, the source must sign an agreement designed to protect the patient's privacy rights. ... an independent consultant's opinion or an IME. (c) The use of outside consultants and appraisers...

32 CFR 536.39 - Use of experts, consultants and appraisers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... information protected by HIPAA is involved, the source must sign an agreement designed to protect the patient's privacy rights. ... an independent consultant's opinion or an IME. (c) The use of outside consultants and appraisers...

32 CFR 536.39 - Use of experts, consultants and appraisers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... information protected by HIPAA is involved, the source must sign an agreement designed to protect the patient's privacy rights. ... an independent consultant's opinion or an IME. (c) The use of outside consultants and appraisers...

32 CFR 536.39 - Use of experts, consultants and appraisers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... information protected by HIPAA is involved, the source must sign an agreement designed to protect the patient's privacy rights. ... an independent consultant's opinion or an IME. (c) The use of outside consultants and appraisers...

32 CFR 536.39 - Use of experts, consultants and appraisers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... information protected by HIPAA is involved, the source must sign an agreement designed to protect the patient's privacy rights. ... an independent consultant's opinion or an IME. (c) The use of outside consultants and appraisers...

[The proof of paternity. An andrological-forensic challenge in historical perspective].

PubMed

Albrecht, K; Schultheiss, D

2004-10-01

For centuries, difficulties have occurred in determining unresolved paternities. In addition to the modern standard methods, such as the examination of DNA or serological proof, expert opinion on fertility once played an important role. The andrological difference between incapability to fertilise and the inability to participate in sexual intercourse was also distinguished historically. Of special significance was the discovery of spermatozoa by the medical student Johan Ham in 1677 and their further investigation by Antoni van Leeuwenhoek.Recently, modern DNA methods have also been applied for historical investigations. Illustrious examples are the DNA analysis in the case of Kaspar Hauser of Ansbach and the dispute about Thomas Jefferson, President of the U.S., fathering a child by one of his slaves. In this discourse, a medicinal-forensic review of the development of expert opinion, illustrated with historical case studies, is given.

The relative importance of information sources in consumers' choice of hospitals.

PubMed

Gooding, S K

1995-01-01

The research presented focuses on an examination of the relative importance of word-of-mouth, expert opinion, external communication, and past experience in the context of hospital choice. Past research has examined the effect of each individually and various combinations of the four sources, but not all four simultaneously. Results of the present study suggest that past experience plays a greater role in hospital choice than other information sources, including expert opinion. The strength of word-of-mouth as a source of information is also verified. The implications of this research include the following: (1) health care researchers need to incorporate word-of-mouth when investigating informations sources, and (2) local hospitals need to be aware of "negative perceptions" and strive for consumer satisfaction. Health care delivery systems incorporating consumer-based choice render these findings especially valuable as researchers and practitioners address the challenges that these evolving systems will bring.

A proposed adaptation of the European Foundation for Quality Management Excellence Model to physical activity programmes for the elderly - development of a quality self-assessment tool using a modified Delphi process

PubMed Central

2011-01-01

Background There has been a growing concern in designing physical activity (PA) programmes for elderly people, since evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Complete programme evaluations are a necessary prerequisite to continuous quality improvements. Being able to refine, adapt and create tools that are suited to the realities and contexts of PA programmes for the elderly in order to support its continuous improvement is, therefore, crucial. Thus, the aim of this study was to develop a self-assessment tool for PA programmes for the elderly. Methods A 3-round Delphi process was conducted via the Internet with 43 national experts in PA for the elderly, management and delivery of PA programmes for the elderly, sports management, quality management and gerontology, asking experts to identify the propositions that they considered relevant for inclusion in the self-assessment tool. Experts reviewed a list of proposed statements, based on the criteria and sub-criteria from the European Foundation for Quality Management Excellence Model (EFQM) and PA guidelines for older adults and rated each proposition from 1 to 8 (disagree to agree) and modified and/or added propositions. Propositions receiving either bottom or top scores of greater than 70% were considered to have achieved consensus to drop or retain, respectively. Results In round 1, of the 196 originally-proposed statements (best practice principles), the experts modified 41, added 1 and achieved consensus on 93. In round 2, a total of 104 propositions were presented, of which experts modified 39 and achieved consensus on 53. In the last round, of 51 proposed statements, the experts achieved consensus on 19. After 3 rounds of rating, experts had not achieved consensus on 32 propositions. The resulting tool consisted of 165 statements that assess nine management areas involved in the development of PA programmes for the elderly. Conclusion Based on experts' opinions, a self-assessment tool was found in order to access quality of PA programmes for the elderly. Information obtained with evaluations would be useful to organizations seeking to improve their services, customer satisfaction and, consequently, adherence to PA programmes, targeting the ageing population. PMID:21958203

Forensic medicine experts' opinion on medico-legal autopsies in hospital deaths: a questionnaire survey.

PubMed

D'Souza, Deepak Herald; Pant, Sadip; Menezes, Ritesh George

2013-10-01

Medico-legal autopsy is conducted routinely in some countries and selectively in others in hospital deaths. This study was conducted to evaluate the views of the forensic medicine experts regarding this matter. A questionnaire pro forma was sent to sixty-five forensic medicine experts practicing in different medical institutions all around India. Designations and experiences of the participants were noted by requests in the same questionnaire. Their specific experience in conducting medico-legal autopsy in hospital deaths was also requested for. Responses were charted in frequency distribution tables and analyzed using SPSS, version 17.0. One-third of the participants felt that a medico-legal autopsy was necessary in all the hospital death cases as defined in the present study. Ten percent of the participants opined that a medico-legal autopsy was unnecessary in hospital deaths. The majority of the experts mentioned finding the cause of death, followed by finding the manner of death and collecting the evidentiary materials, as the reasons for medico-legal autopsy in hospital deaths. Twenty percent of the participants felt that internal findings at autopsy poorly matched with the case records. All the experts agreed that external autopsy findings matched with the hospital case records. Nearly two-third of the participants felt that it was difficult in some cases to interpret the autopsy findings without case records from the hospital where the deceased was treated. Our findings suggest that the exercise of carrying out medico-legal autopsy routinely in every hospital death as evident in the Indian framework is often unnecessary as per the experts' opinion. Autopsy findings in hospital deaths often correlate with hospital case records.

Defining the Bobath concept using the Delphi technique.

PubMed

Raine, Sue

2006-03-01

The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. Although they recognize that over the last half-century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes. The aim of the present study was to use the Delphi technique to enable experts in the field to define the current Bobath concept. A four-round Delphi study design was used. The sample included all members of the British Bobath Tutor's Association, who are considered experts in the field. Initial statements were identified from the literature, with respondents generating additional statements during the study. The level of agreement was determined using a five-point Likert scale. The respondents were then provided with feedback on group opinions and given an opportunity to re-rate each statement. The level of group consensus was set at 80%. Fifteen experts took part. The response rate was 85% in the first round, and 93% in each subsequent round. Ten statements from the literature were rated with a further 12 generated by the experts. Thirteen statements achieved consensus for agreement and seven for disagreement. The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens.

Expert opinion as 'validation' of risk assessment applied to calf welfare.

PubMed

Bracke, Marc B M; Edwards, Sandra A; Engel, Bas; Buist, Willem G; Algers, Bo

2008-07-14

Recently, a Risk Assessment methodology was applied to animal welfare issues in a report of the European Food Safety Authority (EFSA) on intensively housed calves. Because this is a new and potentially influential approach to derive conclusions on animal welfare issues, a so-called semantic-modelling type 'validation' study was conducted by asking expert scientists, who had been involved or quoted in the report, to give welfare scores for housing systems and for welfare hazards. Kendall's coefficient of concordance among experts (n = 24) was highly significant (P < 0.001), but low (0.29 and 0.18 for housing systems and hazards respectively). Overall correlations with EFSA scores were significant only for experts with a veterinary or mixed (veterinary and applied ethological) background. Significant differences in welfare scores were found between housing systems, between hazards, and between experts with different backgrounds. For example, veterinarians gave higher overall welfare scores for housing systems than ethologists did, probably reflecting a difference in their perception of animal welfare. Systems with the lowest scores were veal calves kept individually in so-called "baby boxes" (veal crates) or in small groups, and feedlots. A suckler herd on pasture was rated as the best for calf welfare. The main hazards were related to underfeeding, inadequate colostrum intake, poor stockperson education, insufficient space, inadequate roughage, iron deficiency, inadequate ventilation, poor floor conditions and no bedding. Points for improvement of the Risk Assessment applied to animal welfare include linking information, reporting uncertainty and transparency about underlying values. The study provides novel information on expert opinion in relation to calf welfare and shows that Risk Assessment applied to animal welfare can benefit from a semantic modelling approach.

[Possibilities of medical opinionating in cases associated with "exposure to direct danger of death or serious health damage"].

PubMed

Konopka, Tomasz; Skupień, Elzbieta

2008-01-01

In the opinion of some forensic medicine experts, assessment of potential consequences in keeping with Article 160 of the Polish Penal code, which refers to the crime of "exposure to direct danger of death or severe health damage", lies within the competence of medicolegal specialists. This view is accepted by courts and prosecution offices. However, the knowledge of physicians in the field of predicting consequences which did not occur is only somewhat better than that of lawyers. In simple cases, e.g. in trauma involving a sensitive area of the body, passing an opinion confirming a serious danger is not associated with any major problems. Similarly, no problems arise when passing an opinion on the lack of such a danger e.g. in the case of traumawithout any injuries. In complex cases, however, which include the majority of medical error cases, passing an opinion on exposure to direct danger of death or severe health damage may be not feasible.

A Follow-Up Web-Based Survey: Test and Measurement Expert Opinions on the Psychometric Properties of Out-of-Level Tests. Out-of-Level Testing Report.

ERIC Educational Resources Information Center

Bielinski, John; Minnema, Jane; Thurlow, Martha

A Web-based survey of 25 experts in testing theory and large-scale assessment examined the utility of out-of-level testing for making decisions about students and schools. Survey respondents were given a series of scenarios and asked to judge the degree to which out-of-level testing would affect the reliability and validity of test scores within…

Using Media Centers in Education. The NATUL Project. Teacher Use of Library Media Centers in the Future: A National Needs Assessment by Use of Delphi-Fault Tree Analysis for Instructional Development.

ERIC Educational Resources Information Center

Wood, Rulon Kent

This study was designed to arrive at a possible consensus of expert opinions as related to teacher use of library media centers in American public education, and to analyze the essential teacher skills and knowledge suggested by the experts through this systematic methodology. This provided a national needs assessment to serve as a basis for…

a Novel Approach to Support Majority Voting in Spatial Group Mcdm Using Density Induced Owa Operator for Seismic Vulnerability Assessment

NASA Astrophysics Data System (ADS)

Moradi, M.; Delavar, M. R.; Moshiri, B.; Khamespanah, F.

2014-10-01

Being one of the most frightening disasters, earthquakes frequently cause huge damages to buildings, facilities and human beings. Although the prediction of characteristics of an earthquake seems to be impossible, its loss and damage is predictable in advance. Seismic loss estimation models tend to evaluate the extent to which the urban areas are vulnerable to earthquakes. Many factors contribute to the vulnerability of urban areas against earthquakes including age and height of buildings, the quality of the materials, the density of population and the location of flammable facilities. Therefore, seismic vulnerability assessment is a multi-criteria problem. A number of multi criteria decision making models have been proposed based on a single expert. The main objective of this paper is to propose a model which facilitates group multi criteria decision making based on the concept of majority voting. The main idea of majority voting is providing a computational tool to measure the degree to which different experts support each other's opinions and make a decision regarding this measure. The applicability of this model is examined in Tehran metropolitan area which is located in a seismically active region. The results indicate that neglecting the experts which get lower degrees of support from others enables the decision makers to avoid the extreme strategies. Moreover, a computational method is proposed to calculate the degree of optimism in the experts' opinions.

Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: a systematic literature review and meta-analysis.

PubMed

Banal, F; Dougados, M; Combescure, C; Gossec, L

2009-07-01

To evaluate the ability of the widely used ACR set of criteria (both list and tree format) to diagnose RA compared with expert opinion according to disease duration. A systematic literature review was conducted in PubMed and Embase databases. All articles reporting the prevalence of RA according to ACR criteria and expert opinion in cohorts of early (<1 year duration) or established (>1 year) arthritis were analysed to calculate the sensitivity and specificity of ACR 1987 criteria against the "gold standard" (expert opinion). A meta-analysis using a summary receiver operating characteristic (SROC) curve was performed and pooled sensitivity and specificity were calculated with confidence intervals. Of 138 publications initially identified, 19 were analysable (total 7438 patients, 3883 RA). In early arthritis, pooled sensitivity and specificity of the ACR set of criteria were 77% (68% to 84%) and 77% (68% to 84%) in the list format versus 80% (72% to 88%) and 33% (24% to 43%) in the tree format. In established arthritis, sensitivity and specificity were respectively 79% (71% to 85%) and 90% (84% to 94%) versus 80% (71% to 85%) and 93% (86% to 97%). The SROC meta-analysis confirmed the statistically significant differences, suggesting that diagnostic performances of ACR list criteria are better in established arthritis. The specificity of ACR 1987 criteria in early RA is low, and these criteria should not be used as diagnostic tools. Sensitivity and specificity in established RA are higher, which reflects their use as classification criteria gold standard.

End points for validating early warning scores in the context of rapid response systems: a Delphi consensus study.

PubMed

Pedersen, N E; Oestergaard, D; Lippert, A

2016-05-01

When investigating early warning scores and similar physiology-based risk stratification tools, death, cardiac arrest and intensive care unit admission are traditionally used as end points. A large proportion of the patients identified by these end points cannot be saved, even with optimal treatment. This could pose a limitation to studies using these end points. We studied current expert opinion on end points for validating tools for the identification of patients in hospital wards at risk of imminent critical illness. The Delphi consensus methodology was used. We identified 22 experts based on objective criteria; 17 participated in the study. Each expert panel member's suggestions for end points were collected and distributed to the entire expert panel in anonymised form. The experts reviewed, rated and commented the suggested end points through the rounds in the Delphi process, and the experts' combined rating of the usefulness of each suggestion was established. A gross list of 86 suggestions for end points, relating to 13 themes, was produced. No items were uniformly recognised as ideal. The themes cardiac arrest, death, and level of care contained the items receiving highest ratings. End points relating to death, cardiac arrest and intensive care unit admission currently comprise the most obvious compromises for investigating early warning scores and similar risk stratification tools. Additional end points from the gross list of suggested end points could become feasible with the increased availability of large data sets with a multitude of recorded parameters. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Development of an Expert Judgement Elicitation and Calibration Methodology for Risk Analysis in Conceptual Vehicle Design

NASA Technical Reports Server (NTRS)

Unal, Resit; Keating, Charles; Conway, Bruce; Chytka, Trina

2004-01-01

A comprehensive expert-judgment elicitation methodology to quantify input parameter uncertainty and analysis tool uncertainty in a conceptual launch vehicle design analysis has been developed. The ten-phase methodology seeks to obtain expert judgment opinion for quantifying uncertainties as a probability distribution so that multidisciplinary risk analysis studies can be performed. The calibration and aggregation techniques presented as part of the methodology are aimed at improving individual expert estimates, and provide an approach to aggregate multiple expert judgments into a single probability distribution. The purpose of this report is to document the methodology development and its validation through application to a reference aerospace vehicle. A detailed summary of the application exercise, including calibration and aggregation results is presented. A discussion of possible future steps in this research area is given.

Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness.

PubMed

John, Jasmine Mary; Navneetham, Janardhan; Nagendra, H R

2017-08-01

Mental health promotion among adolescents has been a key area of intervention for professionals working with children and adolescents. The opinions of experts in the field of mental health have taken to frame a trans-disciplinary intervention for adolescent girls on self awareness. To discuss the development and validation of a structured intervention by combining the knowledge from different disciplines in helping adolescents enhancing self awareness. Both qualitative and quantitative methodologies were followed for the development and validation of the module. First phase of the development of intervention module was the framing of intervention module after conducting in-depth interviews with experts in both mental health and yoga fields. Six experts each from mental health and yoga field were chosen for interview through convenient sampling. Validated interview guides were used for the process. The framed intervention module was given to six mental health experts and six yoga experts for content validation. The experts rated the usefulness of the intervention on a scale 0-4 (4=extremely helpful). The themes derived in the interviews were importance of self awareness, autonomy of self, physical level of self understanding, self regulation of emotions and self monitoring. The interviews were consolidated to frame the intervention module consisting of eight sessions having two parts in each session. Part one of each session is activities and interactions on mental health and part two is guided instructions for body focused meditation. Sessions were finalized with rating and suggestions from the experts. The final version of the module was pilot tested and had found to have enhanced self awareness among adolescent girls. Integration of multiple disciplines brought in novel perspectives in intervention.

Experts opinion on the use of normative data for functional capacity evaluation in occupational and rehabilitation medicine and disability claims.

PubMed

Soer, Remko; Reneman, Michiel F; Frings-Dresen, Monique H W; Kuijer, P Paul; Kuijer, P Paul F M

2014-12-01

Application of normative values for functional capacity evaluation (FCE) is controversial for the assessment of clients for work ability. The objective of this study was to study when clinicians and researchers consider normative values of FCE useful or of no use for their purposes. A focus group meeting was organized among 43 FCE experts working in insurance, occupational and/or rehabilitation medicine from eight countries during the first international FCE research meeting on October 25th, 2012 in the Netherlands. Participants were asked to rate to which degree they agree or disagree with a statement concerning their position toward normative values for FCE on a 10 cm VAS ranging from 0 (completely disagree) to 100 (completely agree) at T0 and T1. Arguments for aspects that are useful and of no use for normative values were systematically collected during the meeting and afterwards independently clustered by two researchers in higher order topics. Baseline opinion of participants on their position toward normative values was 49 ± 29 points. After the meeting, mean VAS was 55 ± 23 (p = 0.07), indicating that participants did not significantly change their opinion toward normative values. Based on arguments provided by the experts, seven higher order topics were constructed namely 'Comparison with job demands or treatment goals'; 'Comparison with co-workers physical ability'; 'Sincerity of effort'; 'Validity for work ability and return to work'; 'Experience of referrer with assessment method'; 'Clinimetrics compared to alternative assessment methods or reference values'; and 'Ease of use for clinician and stakeholders'. Although experts state useful aspects for the use of normative values of FCE for these assessments, it may also lead to over-interpretation of results, leading to dualistic statements concerning work ability, with potential harmful consequences for work ability of patients.

Maturity analysis of the innovation system in the livestock industries of West Sumatra, Indonesia

NASA Astrophysics Data System (ADS)

Suresti, A.; Dinata, U. G. S.; Wati, R.

2018-02-01

The main objective of this study was to analyse the ANIS of Livestock industry in West Sumatera according to its main determinants. This research aims to know and understand the maturity level of the regional innovationsystem of West Sumatra livestock industries, including recommendation for improvements. The maturity level of the regional innovation system was analyzed with the ANIS method by using an opinion survey to some experts from businessmen, government and universities. This expert opinion survey was conducted to measure expert perceptions on the implementations of determinants of west Sumatera regional innovations systems on livestock industries on macro level (innovations policy), mezzo level (innovation institutions and programs) and micro level (innovation capacity). By using Likert method, the result showed maturity level for the West Sumatra livestock industries innovation system was still develop. This is caused by low maturity in the macro and meso determinants which are at the central and regional government side. This research result may be useful as recommendations for the government for improving the maturity level and may be a basic for incoming researches to identify regional innovation system determinants with low maturity to improve.

What is healthy food? Objective nutrient profile scores and subjective lay evaluations in comparison.

PubMed

Bucher, T; Müller, B; Siegrist, M

2015-12-01

To date, it is unclear how consumers evaluate the healthiness of individual foods and meals and how consumers' perceptions are related to expert opinions. This knowledge is essential for efficient communication of nutrition information with the goal of promoting healthy eating. This study used the fake food buffet method to investigate health perceptions of selected meals and of 54 individual foods and beverages. Lay consumers' subjective healthiness evaluations of meals and foods were compared to objective nutrient profile scores, which were previously shown to correlate highly with expert opinions. The results show that nutrition profile scores and lay evaluations were highly correlated, which indicates that lay people used similar criteria as experts to evaluate the healthiness of foods. However, lay consumers tended to neglect the amount of saturated fat, protein and sodium for their judgments. Also, it was found that while lay consumers were quite able to evaluate single food products, they had difficulties in evaluating entire meals. Future interventions should focus particularly on educating the consumer about the negative effects of diets high in salt and saturated fat and they should improve the consumer's abilities to evaluate entire meals. Copyright © 2015 Elsevier Ltd. All rights reserved.

Expert elicitation, uncertainty, and the value of information in controlling invasive species

USGS Publications Warehouse

Johnson, Fred A.; Smith, Brian J.; Bonneau, Mathieu; Martin, Julien; Romagosa, Christina; Mazzotti, Frank J.; Waddle, J. Hardin; Reed, Robert; Eckles, Jennifer Kettevrlin; Vitt, Laurie J.

2017-01-01

We illustrate the utility of expert elicitation, explicit recognition of uncertainty, and the value of information for directing management and research efforts for invasive species, using tegu lizards (Salvator merianae) in southern Florida as a case study. We posited a post-birth pulse, matrix model in which four age classes of tegus are recognized: hatchlings, 1 year-old, 2 year-olds, and 3 + year-olds. This matrix model was parameterized using a 3-point process to elicit estimates of tegu demographic rates in southern Florida from 10 herpetology experts. We fit statistical distributions for each parameter and for each expert, then drew and pooled a large number of replicate samples from these to form a distribution for each demographic parameter. Using these distributions, as well as the observed correlations among elicited values, we generated a large sample of matrix population models to infer how the tegu population would respond to control efforts. We used the concepts of Pareto efficiency and stochastic dominance to conclude that targeting older age classes at relatively high rates appears to have the best chance of minimizing tegu abundance and control costs. We conclude that expert opinion combined with an explicit consideration of uncertainty can be valuable in conducting an initial assessment of what control strategy, effort, and monetary resources are needed to reduce and eventually eliminate the invader. Scientists, in turn, can use the value of information to focus research in a way that not only increases the efficacy of control, but minimizes costs as well.

Clinical and Para Clinical Information Needs of Infertility Electronic Health Records in Iran: A Delphi Study.

PubMed

Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana

2017-09-01

infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.

Using cytology to increase small animal practice revenue.

PubMed

Hodges, Joanne

2013-11-01

Diagnostic cytology is a useful, noninvasive test with practical foundations in high-quality medicine and applications to practice building. Cytology will generate practice revenue whether assessed in-house or sent to a clinical pathologist. Thorough in-house evaluation is adequate in some cases, but expert opinion is important in many cases. Specimen slides should at least be reviewed in-house for assessment of cellularity and potential artifacts before submission to a reference laboratory. Reference laboratories also provide special stains and advanced molecular diagnostics to help further characterize many neoplastic processes, search for organisms, identify pigments, and address other important aspects of the lesion. Copyright © 2013 Elsevier Inc. All rights reserved.

Developing a framework to review near-miss maternal morbidity in India: a structured review and key stakeholder analysis.

PubMed

Bhattacharyya, Sanghita; Srivastava, Aradhana; Knight, Marian

2014-11-13

In India there is a thrust towards promoting institutional delivery, resulting in problems of overcrowding and compromise to quality of care. Review of near-miss obstetric events has been suggested to be useful to investigate health system functioning, complementing maternal death reviews. The aim of this project was to identify the key elements required for a near-miss review programme for India. A structured review was conducted to identify methods used in assessing near-miss cases. The findings of the structured review were used to develop a suggested framework for conducting near-miss reviews in India. A pool of experts in near-miss review methods in low and middle income countries (LMICs) was identified for vetting the framework developed. Opinions were sought about the feasibility of implementing near-miss reviews in India, the processes to be followed, factors that made implementation successful and the associated challenges. A draft of the framework was revised based on the experts' opinions. Five broad methods of near-miss case review/audit were identified: Facility-based near-miss case review, confidential enquiries, criterion-based clinical audit, structured case review (South African Model) and home-based interviews. The opinion of the 11 stakeholders highlighted that the methods that a facility adopts should depend on the type and number of cases the facility handles, availability and maintenance of a good documentation system, and local leadership and commitment of staff. A proposed framework for conducting near-miss reviews was developed that included a combination of criterion-based clinical audit and near-miss review methods. The approach allowed for development of a framework for researchers and planners seeking to improve quality of maternal care not only at the facility level but also beyond, encompassing community health workers and referral. Further work is needed to evaluate the implementation of this framework to determine its efficacy in improving the quality of care and hence maternal and perinatal morbidity and mortality.

[The transparency commission: evaluation and re-evaluation].

PubMed

Bergmann, J F

The purpose of the French Transparency Commission is to provide scientific advice concerning the usefulness, interest and good use of drugs. The work of the Transparency Commission lies at the interface between the French or European marketing approval procedures and the health and economic prerequisites of the French community. The opinion of the French Transparency Commission is used to assess the medical service provided by a new drug and the improvement of this medical service subsequent to its use. This opinion is taken into consideration for establishing the reimbursement rate applied by the social security organizations and the selling price set by the administration. The expert opinions and recommendations established by the Transparency Commission participate in implementing good use of drugs.

A teledentistry system for the second opinion.

PubMed

Gambino, Orazio; Lima, Fausto; Pirrone, Roberto; Ardizzone, Edoardo; Campisi, Giuseppina; di Fede, Olga

2014-01-01

In this paper we present a Teledentistry system aimed to the Second Opinion task. It make use of a particular camera called intra-oral camera, also called dental camera, in order to perform the photo shooting and real-time video of the inner part of the mouth. The pictures acquired by the Operator with such a device are sent to the Oral Medicine Expert (OME) by means of a current File Transfer Protocol (FTP) service and the real-time video is channeled into a video streaming thanks to the VideoLan client/server (VLC) application. It is composed by a HTML5 web-pages generated by PHP and allows to perform the Second Opinion both when Operator and OME are logged and when one of them is offline.

Mental Health Counselor Preparation: Experts' Opinions.

ERIC Educational Resources Information Center

Ginter, Earl J.

1991-01-01

Explored mental health counselors' and counselor educators' perceptions of the training mental health counselors receive. Qualitative interviews were conducted with 12 mental health counselors or counselor educators. Key issues that emerged from interviews concerned licensure movement, what distinguishes mental health counseling, variability of…

Adhesions and endometriosis: challenges in subfertility management : (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group).

PubMed

De Wilde, R L; Alvarez, J; Brölmann, H; Campo, R; Cheong, Y; Lundorff, P; Pawelczyk, L; Roman, H; di Spiezio Sardo, A; Wallwiener, M

2016-08-01

There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.

Treatment of acute burn blisters in unscheduled care settings.

PubMed

Payne, Sarah; Cole, Elaine

2012-09-01

Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.

CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.

PubMed

Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G

2009-03-01

In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

The construction of the indicators of professional competence for exercise instructors of the elderly.

PubMed

Lan, Hsiao-Ching; Li, Chih-Ping; Zheng, Hao-Wei

2015-09-25

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

The construction of the indicators of professional competence for exercise instructors of the elderly.

PubMed

Lan, Hsiao-Ching; Li, Chih-Ping; Zheng, Hao-Wei

2015-01-01

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines.

PubMed

Krishna, M T; Ewan, P W; Diwakar, L; Durham, S R; Frew, A J; Leech, S C; Nasser, S M

2011-09-01

This guidance for the management of patients with hymenoptera venom allergy has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and pediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are epidemiology, risk factors, clinical features, diagnostic tests, natural history of hymenoptera venom allergy and guidance on undertaking venom immunotherapy (VIT). There are also separate sections on children, elevated baseline tryptase and mastocytosis and mechanisms underlying VIT. Finally, we have made recommendations for potential areas of future research. © 2011 Blackwell Publishing Ltd.

Future Research Opportunities in Peri-Prosthetic Joint Infection Prevention.

PubMed

Berbari, Elie; Segreti, John; Parvizi, Javad; Berríos-Torres, Sandra I

Peri-prosthetic joint infection (PJI) is a serious complication of prosthetic joint arthroplasty. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSI). Recently, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) published the Guideline for Prevention of Surgical Site Infection. This targeted update applies evidence-based methodology in drafting recommendations for potential strategies to reduce the risk of SSI both across surgical procedures and specifically in prosthetic joint arthroplasty. A panel of PJI content experts identified nine PJI prevention research opportunities based on both evidence gaps identified through the guideline development process (transfusion, immunosuppressive therapy, anticoagulation, orthopedic space suit, and biofilm) and expert opinion (anesthesia, operative room environment, glycemic control, and Staphylococcus aureus nasal screening and decolonization. This article offers a road map for PJI prevention research.

Comments of statistical issue in numerical modeling for underground nuclear test monitoring

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

Nicholson, W.L.; Anderson, K.K.

1993-03-01

The Symposium concluded with prepared summaries by four experts in the involved disciplines. These experts made no mention of statistics and/or the statistical content of issues. The first author contributed an extemporaneous statement at the Symposium because there are important issues associated with conducting and evaluating numerical modeling that are familiar to statisticians and often treated successfully by them. This note expands upon these extemporaneous remarks. Statistical ideas may be helpful in resolving some numerical modeling issues. Specifically, we comment first on the role of statistical design/analysis in the quantification process to answer the question ``what do we know aboutmore » the numerical modeling of underground nuclear tests?`` and second on the peculiar nature of uncertainty analysis for situations involving numerical modeling. The simulations described in the workshop, though associated with topic areas, were basically sets of examples. Each simulation was tuned towards agreeing with either empirical evidence or an expert`s opinion of what empirical evidence would be. While the discussions were reasonable, whether the embellishments were correct or a forced fitting of reality is unclear and illustrates that ``simulation is easy.`` We also suggest that these examples of simulation are typical and the questions concerning the legitimacy and the role of knowing the reality are fair, in general, with respect to simulation. The answers will help us understand why ``prediction is difficult.``« less

Pesticide applicators questionnaire content validation: A fuzzy delphi method.

PubMed

Manakandan, S K; Rosnah, I; Mohd Ridhuan, J; Priya, R

2017-08-01

The most crucial step in forming a set of survey questionnaire is deciding the appropriate items in a construct. Retaining irrelevant items and removing important items will certainly mislead the direction of a particular study. This article demonstrates Fuzzy Delphi method as one of the scientific analysis technique to consolidate consensus agreement within a panel of experts pertaining to each item's appropriateness. This method reduces the ambiguity, diversity, and discrepancy of the opinions among the experts hence enhances the quality of the selected items. The main purpose of this study was to obtain experts' consensus on the suitability of the preselected items on the questionnaire. The panel consists of sixteen experts from the Occupational and Environmental Health Unit of Ministry of Health, Vector-borne Disease Control Unit of Ministry of Health and Occupational and Safety Health Unit of both public and private universities. A set of questionnaires related to noise and chemical exposure were compiled based on the literature search. There was a total of six constructs with 60 items in which three constructs for knowledge, attitude, and practice of noise exposure and three constructs for knowledge, attitude, and practice of chemical exposure. The validation process replicated recent Fuzzy Delphi method that using a concept of Triangular Fuzzy Numbers and Defuzzification process. A 100% response rate was obtained from all the sixteen experts with an average Likert scoring of four to five. Post FDM analysis, the first prerequisite was fulfilled with a threshold value (d) ≤ 0.2, hence all the six constructs were accepted. For the second prerequisite, three items (21%) from noise-attitude construct and four items (40%) from chemical-practice construct had expert consensus lesser than 75%, which giving rise to about 12% from the total items in the questionnaire. The third prerequisite was used to rank the items within the constructs by calculating the average fuzzy numbers. The seven items which did not fulfill the second prerequisite similarly had lower ranks during the analysis, therefore those items were discarded from the final draft. Post FDM analysis, the experts' consensus on the suitability of the pre-selected items on the questionnaire set were obtained, hence it is now ready for further construct validation process.

Short-term leprosy forecasting from an expert opinion survey.

PubMed

Deiner, Michael S; Worden, Lee; Rittel, Alex; Ackley, Sarah F; Liu, Fengchen; Blum, Laura; Scott, James C; Lietman, Thomas M; Porco, Travis C

2017-01-01

We conducted an expert survey of leprosy (Hansen's Disease) and neglected tropical disease experts in February 2016. Experts were asked to forecast the next year of reported cases for the world, for the top three countries, and for selected states and territories of India. A total of 103 respondents answered at least one forecasting question. We elicited lower and upper confidence bounds. Comparing these results to regression and exponential smoothing, we found no evidence that any forecasting method outperformed the others. We found evidence that experts who believed it was more likely to achieve global interruption of transmission goals and disability reduction goals had higher error scores for India and Indonesia, but lower for Brazil. Even for a disease whose epidemiology changes on a slow time scale, forecasting exercises such as we conducted are simple and practical. We believe they can be used on a routine basis in public health.

Short-term leprosy forecasting from an expert opinion survey

PubMed Central

Deiner, Michael S.; Worden, Lee; Rittel, Alex; Ackley, Sarah F.; Liu, Fengchen; Blum, Laura; Scott, James C.; Lietman, Thomas M.

2017-01-01

We conducted an expert survey of leprosy (Hansen’s Disease) and neglected tropical disease experts in February 2016. Experts were asked to forecast the next year of reported cases for the world, for the top three countries, and for selected states and territories of India. A total of 103 respondents answered at least one forecasting question. We elicited lower and upper confidence bounds. Comparing these results to regression and exponential smoothing, we found no evidence that any forecasting method outperformed the others. We found evidence that experts who believed it was more likely to achieve global interruption of transmission goals and disability reduction goals had higher error scores for India and Indonesia, but lower for Brazil. Even for a disease whose epidemiology changes on a slow time scale, forecasting exercises such as we conducted are simple and practical. We believe they can be used on a routine basis in public health. PMID:28813531

Using expert opinion to quantify accuracy and reliability of nondestructive evaluation on bridges : [project brief].

DOT National Transportation Integrated Search

2015-08-01

Research is currently being conducted to improve bridge inspection practices. One potential : improvement is the use of nondestructive testing equipment to supplement visual inspection. To : consider the costs and benefits of this equipment, data abo...

Climate change : expert opinion on the economics of policy options to address climate change

DOT National Transportation Integrated Search

2008-05-01

Panelists identified key strengths and limitations of alternative policy approaches that should be of assistance to the Congress in weighing the potential benefits and costs of different policies for addressing climate change. Many panelists said tha...

78 FR 8195 - Biweekly Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... of the bases for the contention and a concise statement of the alleged facts or expert opinion which..., ``Allowable Value for Primary Containment and Drywell Isolation Instrumentation,'' Function 3.c, ``Reactor Core Isolation Cooling (RCIC) Steam Supply Line Pressure--Low.'' This TS allowable value will be...

An evidence-based systematic review of gymnema (Gymnema sylvestre R. Br.) by the Natural Standard Research Collaboration.

PubMed

Ulbricht, Catherine; Abrams, Tracee Rae; Basch, Ethan; Davies-Heerema, Theresa; Foppa, Ivo; Hammerness, Paul; Rusie, Erica; Tanguay-Colucci, Shaina; Taylor, Sarah; Ulbricht, Catherine; Varghese, Minney; Weissner, Wendy; Woods, Jen

2011-09-01

An evidence-based systematic review of gymnema (Gymnema sylvestre R. Br.), including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium.

PubMed

Kecojevic, Aleksandar; Lindsell, Christopher J; Lyons, Michael S; Holtgrave, David; Torres, Gretchen; Heffelfinger, James; Brown, Jeremy; Couture, Eileen; Jung, Julianna; Connell, Samantha; Rothman, Richard E

2011-07-01

Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion. Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives. Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective. Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized. Copyright © 2011. Published by Mosby, Inc.

MANAGEMENT OF DIABETES DURING AIR TRAVEL: A SYSTEMATIC LITERATURE REVIEW OF CURRENT RECOMMENDATIONS AND THEIR SUPPORTING EVIDENCE.

PubMed

Pavela, James; Suresh, Rahul; Blue, Rebecca S; Mathers, Charles H; Belalcazar, L Maria

2018-02-01

Individuals with diabetes are increasingly seeking pretravel advice, but updated professional recommendations remain scant. We performed a systematic review on diabetes management during air travel to summarize current recommendations, assess supporting evidence, and identify areas of future research. A systematic review of the English literature on diabetes management during air travel was undertaken utilizing PubMed and MEDLINE. Publications regarding general travel advice; adjustment of insulin and noninsulin therapies; and the use of insulin pumps, glucometers and subcutaneous glucose sensors at altitude were included. Gathered information was used to create an updated summary of glucose-lowering medication adjustment during air travel. Sixty-one publications were identified, most providing expert opinion and few offering primary data (47 expert opinion, 2 observational studies, 2 case reports, 10 device studies). General travel advice was uniform, with increasing attention to preflight security. Indications for oral antihyperglycemic therapy adjustments varied. There were few recommendations on contemporary agents and on nonhypoglycemic adverse events. There was little consensus on insulin adjustment protocols, many antedating current insulin formulations. Most publications advocated adjusting insulin pump time settings after arrival; however, there was disagreement on timing and rate adjustments. Glucometers and subcutaneous glucose sensors were reported to be less accurate at altitude, but not to an extent that would preclude their clinical use. Recommendations for diabetes management during air travel vary significantly and are mostly based on expert opinion. Data from systematic investigation on glucose-lowering medication adjustment protocols may support the development of a future consensus statement. CSII = continuous subcutaneous insulin infusion (device) DPP-4 = dipeptidyl peptidase 4 EGA = error grid analysis GDH = glucose dehydrogenase GOX = glucose oxidase GLP1 = glucagon-like peptide-1 NPH = neutral protamine Hagedorn SGLT2 = sodium-glucose cotransporter-2.

Two for one: a self-management plan coupled with a prescription sheet for children with asthma.

PubMed

Ducharme, Francine M; Noya, Francisco; McGillivray, David; Resendes, Sandy; Ducharme-Bénard, Stéphanie; Zemek, Roger; Bhogal, Sanjit Kaur; Rouleau, Rachel

2008-10-01

Despite strong recommendations in the asthma guidelines, the use of written self-management plans remains low among asthmatic patients. To develop a written self-management plan, based on scientific evidence and expert opinions, in a format intended to facilitate its dispensing by health care professionals, and to test the perception of its relevance and clarity by asthmatic children, adolescents and adults. Inspired by previously tested self-management plans, surveys of asthma educators, expert opinions and the 2004 Canadian Asthma Guidelines, the authors simultaneously developed French and English versions of a written self-management plan that coupled with a prescription. The self-management plan was tested in parents and their asthmatic children (aged one to 17 years), and it was revised until 85% clarity and perceived relevance was achieved. Ninety-seven children and their parents were interviewed. Twenty per cent had a self-management plan. On the final revision, nearly all items were clear and perceived relevant by 85% or more of the interviewees. Two self-management plans were designed for clinics and acute care settings, respectively. The plans are divided into three control zones identified by symptoms with optional peak flow values and symbolized by traffic light colours. They are designed in triplicate format with a prescription slip, a medical chart copy and a patient copy. The written self-management plans, based on available scientific evidence and expert opinions, are clear and perceived to be relevant by children, adolescents and their parents. By incorporating the prescription and chart copies, they were designed to facilitate dispensing by physicians in both clinics and acute care settings.

Development of a self-administrated quality of life questionnaire for sarcopenia in elderly subjects: the SarQoL.

PubMed

Beaudart, Charlotte; Biver, Emmanuel; Reginster, Jean-Yves; Rizzoli, René; Rolland, Yves; Bautmans, Ivan; Petermans, Jean; Gillain, Sophie; Buckinx, Fanny; Van Beveren, Julien; Jacquemain, Marc; Italiano, Patrick; Dardenne, Nadia; Bruyere, Olivier

2015-11-01

The impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. The aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. Participants were recruited in an outpatient clinic in Liège, Belgium. Sarcopenic subjects aged 65 years or older. The study was articulated in the following four stages: (i) Item generation-based on literature review, sarcopenic subjects' opinion, experts' opinion, focus groups; (ii) Item reduction-based on sarcopenic subjects' and experts' preferences; (iii) Questionnaire generation-developed during an expert meeting; (iv) Pretest of the questionnaire-based on sarcopenic subjects' opinion. The final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in ∼10 min. The first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test-retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society.

The Natural Gas Dilemma in New England's Electricity Sector: Experts' Perspectives on Long Term Climate Issues and Policy Opportunities

NASA Astrophysics Data System (ADS)

Griffith, Steven

This thesis is an interpretive analysis of experts' perspectives on the climate implications of New England's reliance on natural gas for electricity generation. Specifically, this research, conducted through interviews and literature review, examines experts' opinions on the desired role of natural gas within the regional electricity sector, alternative energy resources, and state and regional policy opportunities toward the achievement of New England's ambitious long-term greenhouse gas reduction goals. Experts expressed concern about the climate dilemma posed by a dependence on natural gas. However, interviews revealed that short-term reliability and cost considerations are paramount for many experts, and therefore a reliance on natural gas is the existing reality. To incentivize renewable generation technologies for the purposes of long-term climate stabilization, experts advocated for the expanded implementation of renewable portfolio standard, net metering, and feed-in tariff policies. More broadly, interviewees expressed the need for an array of complementary state and regional policies.

A Bayesian belief network approach for assessing uncertainty in conceptual site models at contaminated sites

NASA Astrophysics Data System (ADS)

Thomsen, Nanna I.; Binning, Philip J.; McKnight, Ursula S.; Tuxen, Nina; Bjerg, Poul L.; Troldborg, Mads

2016-05-01

A key component in risk assessment of contaminated sites is in the formulation of a conceptual site model (CSM). A CSM is a simplified representation of reality and forms the basis for the mathematical modeling of contaminant fate and transport at the site. The CSM should therefore identify the most important site-specific features and processes that may affect the contaminant transport behavior at the site. However, the development of a CSM will always be associated with uncertainties due to limited data and lack of understanding of the site conditions. CSM uncertainty is often found to be a major source of model error and it should therefore be accounted for when evaluating uncertainties in risk assessments. We present a Bayesian belief network (BBN) approach for constructing CSMs and assessing their uncertainty at contaminated sites. BBNs are graphical probabilistic models that are effective for integrating quantitative and qualitative information, and thus can strengthen decisions when empirical data are lacking. The proposed BBN approach facilitates a systematic construction of multiple CSMs, and then determines the belief in each CSM using a variety of data types and/or expert opinion at different knowledge levels. The developed BBNs combine data from desktop studies and initial site investigations with expert opinion to assess which of the CSMs are more likely to reflect the actual site conditions. The method is demonstrated on a Danish field site, contaminated with chlorinated ethenes. Four different CSMs are developed by combining two contaminant source zone interpretations (presence or absence of a separate phase contamination) and two geological interpretations (fractured or unfractured clay till). The beliefs in each of the CSMs are assessed sequentially based on data from three investigation stages (a screening investigation, a more detailed investigation, and an expert consultation) to demonstrate that the belief can be updated as more information becomes available.

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

PubMed

Agca, R; Heslinga, S C; Rollefstad, S; Heslinga, M; McInnes, I B; Peters, M J L; Kvien, T K; Dougados, M; Radner, H; Atzeni, F; Primdahl, J; Södergren, A; Wallberg Jonsson, S; van Rompay, J; Zabalan, C; Pedersen, T R; Jacobsson, L; de Vlam, K; Gonzalez-Gay, M A; Semb, A G; Kitas, G D; Smulders, Y M; Szekanecz, Z; Sattar, N; Symmons, D P M; Nurmohamed, M T

2017-01-01

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

PubMed

Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

2017-02-01

The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision aid exposes and makes transparent areas of weak evidence and barriers to consensus. © 2016 John Wiley & Sons, Ltd.

Who's afraid of the G-spot?

PubMed

Jannini, Emmanuele A; Whipple, Beverly; Kingsberg, Sheryl A; Buisson, Odile; Foldès, Pierre; Vardi, Yoram

2010-01-01

No controversy can be more controversial than that regarding the existence of the G-spot, an anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others. The pros and cons data have been carefully reviewed by six scientists with different opinions on the G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International Society for the Study of Women's Sexual Health Congress in Florence in the February of 2009. To give to The Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important topic of female sexuality. Expert #1, who is JSM's Controversy section editor, reviewed histological data from the literature demonstrating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation. Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic. Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years, we still need more research on one of the most challenging aspects of female sexuality.

Prior elicitation and Bayesian analysis of the Steroids for Corneal Ulcers Trial.

PubMed

See, Craig W; Srinivasan, Muthiah; Saravanan, Somu; Oldenburg, Catherine E; Esterberg, Elizabeth J; Ray, Kathryn J; Glaser, Tanya S; Tu, Elmer Y; Zegans, Michael E; McLeod, Stephen D; Acharya, Nisha R; Lietman, Thomas M

2012-12-01

To elicit expert opinion on the use of adjunctive corticosteroid therapy in bacterial corneal ulcers. To perform a Bayesian analysis of the Steroids for Corneal Ulcers Trial (SCUT), using expert opinion as a prior probability. The SCUT was a placebo-controlled trial assessing visual outcomes in patients receiving topical corticosteroids or placebo as adjunctive therapy for bacterial keratitis. Questionnaires were conducted at scientific meetings in India and North America to gauge expert consensus on the perceived benefit of corticosteroids as adjunct treatment. Bayesian analysis, using the questionnaire data as a prior probability and the primary outcome of SCUT as a likelihood, was performed. For comparison, an additional Bayesian analysis was performed using the results of the SCUT pilot study as a prior distribution. Indian respondents believed there to be a 1.21 Snellen line improvement, and North American respondents believed there to be a 1.24 line improvement with corticosteroid therapy. The SCUT primary outcome found a non-significant 0.09 Snellen line benefit with corticosteroid treatment. The results of the Bayesian analysis estimated a slightly greater benefit than did the SCUT primary analysis (0.19 lines verses 0.09 lines). Indian and North American experts had similar expectations on the effectiveness of corticosteroids in bacterial corneal ulcers; that corticosteroids would markedly improve visual outcomes. Bayesian analysis produced results very similar to those produced by the SCUT primary analysis. The similarity in result is likely due to the large sample size of SCUT and helps validate the results of SCUT.

Forensic scientists' conclusions: how readable are they for non-scientist report-users?

PubMed

Howes, Loene M; Kirkbride, K Paul; Kelty, Sally F; Julian, Roberta; Kemp, Nenagh

2013-09-10

Scientists have an ethical responsibility to assist non-scientists to understand their findings and expert opinions before they are used as decision-aids within the criminal justice system. The communication of scientific expert opinion to non-scientist audiences (e.g., police, lawyers, and judges) through expert reports is an important but under-researched issue. Readability statistics were used to assess 111 conclusions from a proficiency test in forensic glass analysis. The conclusions were written using an average of 23 words per sentence, and approximately half of the conclusions were expressed using the active voice. At an average Flesch-Kincaid Grade level of university undergraduate (Grade 13), and Flesch Reading Ease score of difficult (42), the conclusions were written at a level suitable for people with some tertiary education in science, suggesting that the intended non-scientist readers would find them difficult to read. To further analyse the readability of conclusions, descriptive features of text were used: text structure; sentence structure; vocabulary; elaboration; and coherence and unity. Descriptive analysis supported the finding that texts were written at a level difficult for non-scientists to read. Specific aspects of conclusions that may pose difficulties for non-scientists were located. Suggestions are included to assist scientists to write conclusions with increased readability for non-scientist readers, while retaining scientific integrity. In the next stage of research, the readability of expert reports in their entirety is to be explored. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Reliability of the MDi Psoriasis® Application to Aid Therapeutic Decision-Making in Psoriasis.

PubMed

Moreno-Ramírez, D; Herrerías-Esteban, J M; Ojeda-Vila, T; Carrascosa, J M; Carretero, G; de la Cueva, P; Ferrándiz, C; Galán, M; Rivera, R; Rodríguez-Fernández, L; Ruiz-Villaverde, R; Ferrándiz, L

2017-09-01

Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

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

[comment t[Comment on] “What is AGU's proper role in society?”] AGU's role in society: Duty to the public

NASA Astrophysics Data System (ADS)

Wilshire, Howard

Bravo to William Kaula and Don Anderson for their forthright opinion, “What Is AGU's Proper Role in Society?” (Eos, April 9, 1991). In hearing preliminaries about Mission to Planet Earth at the Geological Society of America's meeting in Phoenix in 1987, I was turned off by what seemed to me to be endless self-serving proposals to probe the Earth “with our steely knives,” but with hardly a mention of how we could use the information to assist the nation in making rational decisions about the future human occupancy of Earth. I concur with Kaula and Anderson that it is not only the duty of individual scientists to speak out on controversial issues of public concern, but also the duty of professional societies to influence the public policy decision-making process in areas where our special expertise is relevant.It does not matter that opinions within the professional societies differ. Opinions within the nation differ, too. But to take no position at all because of these differences of opinion is dereliction of our duty to the public that supports us. AGU already has a mechanism for presenting a Union-endorsed position on public issues (which could serve as a model for other professional societies whose best effort is to hide under the bed). This mechanism needs to be used more aggressively so that our expert knowledge (both of facts and hypotheses) is brought to bear on matters of critical human concern.

Elicitation of neurological knowledge with argument-based machine learning.

PubMed

Groznik, Vida; Guid, Matej; Sadikov, Aleksander; Možina, Martin; Georgiev, Dejan; Kragelj, Veronika; Ribarič, Samo; Pirtošek, Zvezdan; Bratko, Ivan

2013-02-01

The paper describes the use of expert's knowledge in practice and the efficiency of a recently developed technique called argument-based machine learning (ABML) in the knowledge elicitation process. We are developing a neurological decision support system to help the neurologists differentiate between three types of tremors: Parkinsonian, essential, and mixed tremor (comorbidity). The system is intended to act as a second opinion for the neurologists, and most importantly to help them reduce the number of patients in the "gray area" that require a very costly further examination (DaTSCAN). We strive to elicit comprehensible and medically meaningful knowledge in such a way that it does not come at the cost of diagnostic accuracy. To alleviate the difficult problem of knowledge elicitation from data and domain experts, we used ABML. ABML guides the expert to explain critical special cases which cannot be handled automatically by machine learning. This very efficiently reduces the expert's workload, and combines expert's knowledge with learning data. 122 patients were enrolled into the study. The classification accuracy of the final model was 91%. Equally important, the initial and the final models were also evaluated for their comprehensibility by the neurologists. All 13 rules of the final model were deemed as appropriate to be able to support its decisions with good explanations. The paper demonstrates ABML's advantage in combining machine learning and expert knowledge. The accuracy of the system is very high with respect to the current state-of-the-art in clinical practice, and the system's knowledge base is assessed to be very consistent from a medical point of view. This opens up the possibility to use the system also as a teaching tool. Copyright © 2012 Elsevier B.V. All rights reserved.

Expert Elicitation of Multinomial Probabilities for Decision-Analytic Modeling: An Application to Rates of Disease Progression in Undiagnosed and Untreated Melanoma.

PubMed

Wilson, Edward C F; Usher-Smith, Juliet A; Emery, Jon; Corrie, Pippa G; Walter, Fiona M

2018-06-01

Expert elicitation is required to inform decision making when relevant "better quality" data either do not exist or cannot be collected. An example of this is to inform decisions as to whether to screen for melanoma. A key input is the counterfactual, in this case the natural history of melanoma in patients who are undiagnosed and hence untreated. To elicit expert opinion on the probability of disease progression in patients with melanoma that is undetected and hence untreated. A bespoke webinar-based expert elicitation protocol was administered to 14 participants in the United Kingdom, Australia, and New Zealand, comprising 12 multinomial questions on the probability of progression from one disease stage to another in the absence of treatment. A modified Connor-Mosimann distribution was fitted to individual responses to each question. Individual responses were pooled using a Monte-Carlo simulation approach. Participants were asked to provide feedback on the process. A pooled modified Connor-Mosimann distribution was successfully derived from participants' responses. Feedback from participants was generally positive, with 86% willing to take part in such an exercise again. Nevertheless, only 57% of participants felt that this was a valid approach to determine the risk of disease progression. Qualitative feedback reflected some understanding of the need to rely on expert elicitation in the absence of "hard" data. We successfully elicited and pooled the beliefs of experts in melanoma regarding the probability of disease progression in a format suitable for inclusion in a decision-analytic model. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A condition metric for Eucalyptus woodland derived from expert evaluations.

PubMed

Sinclair, Steve J; Bruce, Matthew J; Griffioen, Peter; Dodd, Amanda; White, Matthew D

2018-02-01

The evaluation of ecosystem quality is important for land-management and land-use planning. Evaluation is unavoidably subjective, and robust metrics must be based on consensus and the structured use of observations. We devised a transparent and repeatable process for building and testing ecosystem metrics based on expert data. We gathered quantitative evaluation data on the quality of hypothetical grassy woodland sites from experts. We used these data to train a model (an ensemble of 30 bagged regression trees) capable of predicting the perceived quality of similar hypothetical woodlands based on a set of 13 site variables as inputs (e.g., cover of shrubs, richness of native forbs). These variables can be measured at any site and the model implemented in a spreadsheet as a metric of woodland quality. We also investigated the number of experts required to produce an opinion data set sufficient for the construction of a metric. The model produced evaluations similar to those provided by experts, as shown by assessing the model's quality scores of expert-evaluated test sites not used to train the model. We applied the metric to 13 woodland conservation reserves and asked managers of these sites to independently evaluate their quality. To assess metric performance, we compared the model's evaluation of site quality with the managers' evaluations through multidimensional scaling. The metric performed relatively well, plotting close to the center of the space defined by the evaluators. Given the method provides data-driven consensus and repeatability, which no single human evaluator can provide, we suggest it is a valuable tool for evaluating ecosystem quality in real-world contexts. We believe our approach is applicable to any ecosystem. © 2017 State of Victoria.

Expert views on societal responses to different applications of nanotechnology: a comparative analysis of experts in countries with different economic and regulatory environments

NASA Astrophysics Data System (ADS)

Gupta, Nidhi; Fischer, Arnout R. H.; George, Saji; Frewer, Lynn J.

2013-08-01

The introduction of different applications of nanotechnology will be informed by expert views regarding which (types of) application will be most societally acceptable. Previous research in Northern Europe has indicated that experts believe that various factors will be influential, predominant among these being public perceptions of benefit, need and consumer concern about contact with nanomaterials. These factors are thought by experts to differentiate societal acceptance and rejection of nanotechnology applications. This research utilises a larger sample of experts ( N = 67) drawn from Northern America, Europe, Australasia, India and Singapore to examine differences in expert opinion regarding societal acceptance of different applications of nanotechnology within different technological environments, consumer cultures and regulatory regimes. Perceived risk and consumer concerns regarding contact with nano-particles are thought by all experts to drive rejection, and perceived benefits to influence acceptance, independent of country. Encapsulation and delivery of nutrients in food was thought to be the most likely to raise societal concerns, while targeted drug delivery was thought most likely to be accepted. Lack of differentiation between countries suggests that expert views regarding social acceptance may be homogenous, independent of local contextual factors.

Using expert opinion to quantify accuracy and reliability of nondestructive evaluation on bridges.

DOT National Transportation Integrated Search

2015-08-01

Bridge inspection is an important phase in bridge management. In 2009, a joint American Society of Civil : Engineers Structural Engineering Institute and AASHTO Ad-Hoc group was created to identify the issues : in bridge safety and to study current b...

A Time-Out Checklist for Pediatric Regional Anesthetics

NASA Technical Reports Server (NTRS)

Clebone, Anna; Burian, Barbara K.; Polaner, David M.

2017-01-01

Although pediatric regional anesthesia has a demonstrated record of safety, adverse events, especially those related to block performance issues, still may occur. To reduce the frequency of those events, we developed a Regional Anesthesia Time-Out Checklist using expert opinion and the Delphi method.

Agro-ecoregionalization of Iowa using multivariate geographical clustering

Treesearch

Carol L. Williams; William W. Hargrove; Matt Leibman; David E. James

2008-01-01

Agro-ecoregionalization is categorization of landscapes for use in crop suitability analysis, strategic agroeconomic development, risk analysis, and other purposes. Past agro-ecoregionalizations have been subjective, expert opinion driven, crop specific, and unsuitable for statistical extrapolation. Use of quantitative analytical methods provides an opportunity for...

Evaluating Physician Competency: What Difference Does It Make?

ERIC Educational Resources Information Center

Brockway, Barbara Stephens

1978-01-01

A system for evaluating clinical competency of residents was designed to test expert opinions as well as the skills of the practitioner. Four measures of clinical competency were included: data collection completeness; problem identification accuracy; interview skills; and patient and physician assessment. (Author/MH)

Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis.

PubMed

Ozgocmen, Salih; Akgul, Ozgur; Altay, Zuhal; Altindag, Ozlem; Baysal, Ozlem; Calis, Mustafa; Capkin, Erhan; Cevik, Remzi; Durmus, Bekir; Gur, Ali; Kamanli, Ayhan; Karkucak, Murat; Madenci, Ercan; Melikoglu, Meltem A; Nas, Kemal; Senel, Kazim; Ugur, Mahir

2012-06-01

  Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a need for recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommendations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.   The Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) is a scientific group of Turkish academicians (physiatrists and rheumatologists) who are experts in the rehabilitation of patients with AS. A systematic literature search summarizing the current available physiotherapy and rehabilitation trials in AS were presented to the experts before a special 2-day meeting. Experts attending this meeting first defined a framework based on the main principles and thereafter collectively constructed six major recommendations on physiotherapy and rehabilitation in AS. After the meeting an email survey was conducted to rate the strength of the recommendations.   Six key recommendations which cover the general principles of rehabilitation in AS in terms of early intervention, initial and follow-up assessments and monitoring, contraindications and precautions, key advice for physiotherapy methods and exercise were constructed.   These recommendations were developed using evidence-based data and expert opinion. The implementation of these recommendations should encourage a more comprehensive and methodical approach in the rehabilitation of patients with AS. Regular lifelong exercise is the mainstay of rehabilitation and there is a considerable need for well-designed studies which will enlighten the role of physical therapy in the management of AS. © 2011 The Authors International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

The prospects for hybrid electric vehicles, 2005-2020 : results of a Delphi Study.

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

Ng, H. K.; Santini, D. J.; Vyas, A. D.

1999-07-22

The introduction of Toyota's hybrid electric vehicle (HEV), the Prius, in Japan has generated considerable interest in HEV technology among US automotive experts. In a follow-up survey to Argonne National Laboratory's two-stage Delphi Study on electric and hybrid electric vehicles (EVs and HEVs) during 1994-1996, Argonne researchers gathered the latest opinions of automotive experts on the future ''top-selling'' HEV attributes and costs. The experts predicted that HEVs would have a spark-ignition gasoline engine as a power plant in 2005 and a fuel cell power plant by 2020. The projected 2020 fuel shares were about equal for gasoline and hydrogen, withmore » methanol a distant third. In 2020, HEVs are predicted to have series-drive, moderate battery-alone range and cost significantly more than conventional vehicles (CVs). The HEV is projected to cost 66% more than a $20,000 CV initially and 33% more by 2020. Survey respondents view batteries as the component that contributes the most to the HEV cost increment. The mean projection for battery-alone range is 49 km in 2005, 70 km in 2010, and 92 km in 2020. Responding to a question relating to their personal vision of the most desirable HEV and its likely characteristics when introduced in the US market in the next decade, the experts predicted their ''vision'' HEV to have attributes very similar to those of the ''top-selling'' HEV. However, the ''vision'' HEV would cost significantly less. The experts projected attributes of three leading batteries for HEVs and projected acceleration times on battery power alone. The resulting battery packs are evaluated, and their initial and replacement costs are analyzed. These and several other opinions are summarized.« less

A Bayesian Analysis of a Randomized Clinical Trial Comparing Antimetabolite Therapies for Non-Infectious Uveitis

PubMed Central

Browne, Erica N; Rathinam, Sivakumar R; Kanakath, Anuradha; Thundikandy, Radhika; Babu, Manohar; Lietman, Thomas M; Acharya, Nisha R

2017-01-01

Purpose To conduct a Bayesian analysis of a randomized clinical trial (RCT) for non-infectious uveitis using expert opinion as a subjective prior belief. Methods A RCT was conducted to determine which antimetabolite, methotrexate or mycophenolate mofetil, is more effective as an initial corticosteroid-sparing agent for the treatment of intermediate, posterior, and pan- uveitis. Before the release of trial results, expert opinion on the relative effectiveness of these two medications was collected via online survey. Members of the American Uveitis Society executive committee were invited to provide an estimate for the relative decrease in efficacy with a 95% credible interval (CrI). A prior probability distribution was created from experts’ estimates. A Bayesian analysis was performed using the constructed expert prior probability distribution and the trial’s primary outcome. Results 11 of 12 invited uveitis specialists provided estimates. Eight of 11 experts (73%) believed mycophenolate mofetil is more effective. The group prior belief was that the odds of treatment success for patients taking mycophenolate mofetil were 1.4-fold the odds of those taking methotrexate (95% CrI 0.03 – 45.0). The odds of treatment success with mycophenolate mofetil compared to methotrexate was 0.4 from the RCT (95% confidence interval 0.1–1.2) and 0.7 (95% CrI 0.2–1.7) from the Bayesian analysis. Conclusions A Bayesian analysis combining expert belief with the trial’s result did not indicate preference for one drug. However, the wide credible interval leaves open the possibility of a substantial treatment effect. This suggests clinical equipoise necessary to allow a larger, more definitive RCT. PMID:27982726

Expert elicitation for a national-level volcano hazard model

NASA Astrophysics Data System (ADS)

Bebbington, Mark; Stirling, Mark; Cronin, Shane; Wang, Ting; Jolly, Gill

2016-04-01

The quantification of volcanic hazard at national level is a vital pre-requisite to placing volcanic risk on a platform that permits meaningful comparison with other hazards such as earthquakes. New Zealand has up to a dozen dangerous volcanoes, with the usual mixed degrees of knowledge concerning their temporal and spatial eruptive history. Information on the 'size' of the eruptions, be it in terms of VEI, volume or duration, is sketchy at best. These limitations and the need for a uniform approach lend themselves to a subjective hazard analysis via expert elicitation. Approximately 20 New Zealand volcanologists provided estimates for the size of the next eruption from each volcano and, conditional on this, its location, timing and duration. Opinions were likewise elicited from a control group of statisticians, seismologists and (geo)chemists, all of whom had at least heard the term 'volcano'. The opinions were combined via the Cooke classical method. We will report on the preliminary results from the exercise.

Human risk factors associated with pilots in runway excursions.

PubMed

Chang, Yu-Hern; Yang, Hui-Hua; Hsiao, Yu-Jung

2016-09-01

A breakdown analysis of civil aviation accidents worldwide indicates that the occurrence of runway excursions represents the largest portion among all aviation occurrence categories. This study examines the human risk factors associated with pilots in runway excursions, by applying a SHELLO model to categorize the human risk factors and to evaluate the importance based on the opinions of 145 airline pilots. This study integrates aviation management level expert opinions on relative weighting and improvement-achievability in order to develop four kinds of priority risk management strategies for airline pilots to reduce runway excursions. The empirical study based on experts' evaluation suggests that the most important dimension is the liveware/pilot's core ability. From the perspective of front-line pilots, the most important risk factors are the environment, wet/containment runways, and weather issues like rain/thunderstorms. Finally, this study develops practical strategies for helping management authorities to improve major operational and managerial weaknesses so as to reduce the human risks related to runway excursions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Chemical pharmacotherapy options for managing adult acne.

PubMed

Vera, Nora; Patel, Nupur; Cardwell, Leah A; Saleem, Mohammed; Feldman, Steven R

2017-02-01

The incidence of adult acne is increasing worldwide. Despite clinical overlap with conventional acne, it has distinct features. Areas covered: A literature search of English-language review articles, randomized control studies and retrospective studies conducted over the past 30 years was performed using PubMed and Google Scholar. Search terms included acne, adult, topical medication, oral medication and skin of color. We highlight important clinical features and treatment modalities pertinent to the evaluation and management of adult acne. Given the relative dearth of literature detailing treatment options specific to adult acne, we offer expert opinion regarding management of the condition especially in special populations such as skin of color and pregnancy. Expert Opinion: It is unclear whether adult acne represents a distinct entity or a continuum of adolescent disease. Providers may opt to use topical medication as first-line, but should have a low threshold for switching to systemic therapy given the magnitude of psychosocial and emotional burden associated with the condition.

Geodesy- and geology-based slip-rate models for the Western United States (excluding California) national seismic hazard maps

USGS Publications Warehouse

Petersen, Mark D.; Zeng, Yuehua; Haller, Kathleen M.; McCaffrey, Robert; Hammond, William C.; Bird, Peter; Moschetti, Morgan; Shen, Zhengkang; Bormann, Jayne; Thatcher, Wayne

2014-01-01

The 2014 National Seismic Hazard Maps for the conterminous United States incorporate additional uncertainty in fault slip-rate parameter that controls the earthquake-activity rates than was applied in previous versions of the hazard maps. This additional uncertainty is accounted for by new geodesy- and geology-based slip-rate models for the Western United States. Models that were considered include an updated geologic model based on expert opinion and four combined inversion models informed by both geologic and geodetic input. The two block models considered indicate significantly higher slip rates than the expert opinion and the two fault-based combined inversion models. For the hazard maps, we apply 20 percent weight with equal weighting for the two fault-based models. Off-fault geodetic-based models were not considered in this version of the maps. Resulting changes to the hazard maps are generally less than 0.05 g (acceleration of gravity). Future research will improve the maps and interpret differences between the new models.

Mental illness and legal fitness (competence) to stand trial in New York State: expert opinion and criminal defendants' psychiatric symptoms.

PubMed

Lee, Eugene; Rosner, Richard; Harmon, Ronnie

2014-07-01

Fitness to Stand Trial is a critical concept in the adjudication of justice-involved persons. A retrospective study was conducted to examine criminal defendants' specific psychiatric symptoms and those symptoms' associations with expert opinions on Competence to Stand Trial. One hundred charts were reviewed: 50 Cases (opined as Not Fit) were compared against 50 Controls (opined as Fit) with respect to ratings on the Brief Psychiatric Rating Scale (BPRS). A significance level of 0.001 was selected a priori. Statistically significant differences were found in seven of the eighteen BPRS symptom constructs (with the highest differences in Conceptual Disorganization and Unusual Thought Content) and two of the four BPRS higher-order syndrome factors (Thinking Disorder and Hostile-Suspiciousness). Consistent with previous reports, psychotic symptoms are found in this study to be inversely associated with Fitness. Validity, reliability, and limitations of this study, as well as directions for future research, are discussed herein. © 2014 American Academy of Forensic Sciences.

[Professional liability claims against dentists].

PubMed

Moscoso Matus, Karla; Smok Vásquez, Pía

2015-03-01

The frequency and features of malpractice lawsuits against dentists in Chile are not well known. To determine the magnitude and frequency of professional liability claims against dentists. A retrospective analysis of the Medical Liability Unit of the Legal Medical Service of Chile database. This public organization deals with most professional liability claims in Chile. Between 2007 and 2012, 3,990 expert opinions about liability of health care professionals were requested. Odontology was the fifth specialty most commonly sued and dentists, the second most frequently sued professionals. Sixty nine percent of cases originated in private clinics, which is coincident with a higher frequency of dentists working in private practice. Most petitioners were adult women and most claims originated from surgical interventions and infections. In 35% of claims against dentists, a violation of Lex Artis was confirmed, compared with 9% of all expert opinions that generated in the unit. Claims against dentists are more common than previously thought and these professionals should adopt preventive measures to avoid them.

Improving Five-level Triage Form According to the Experts Viewpoint; A Qualitative Study

PubMed Central

Bazm, Ali; Khorasani, Elahe; Etemadi, Manal; Nadeali, Hadi

2015-01-01

Objectives: This study is a qualitative study being conducted in five stages at Vali-Asr Hospital of Qom in 2013. After two surveys, the experts were interviewed using focus group discussion (FDG) and study was continuing with. Data were analyzed through studying the opinions of the specialized teams’ members, summarizing and classifying the data in qualitative phase. Results: Changes proposed in the triage form communicated by Iran’s emergency department according to the participants’ opinions include informing all the patients in the emergency department of some necessary information. Therefore, three parts of medical and medicinal history, vital signs and level of consciousness were added to the first part of the form and necessary emergency facilities were also added to the third level of triage. Conclusion: Measuring each item added to the general part of the triage form provides more precise diagnosis and more scientific classification, since the level to which the patient belongs should be identified based on medical history, clinical signs and level of consciousness. PMID:27162895

[Process of construction of the national research agenda on Human Resources in Health in Peru 2011 - 2014].

PubMed

Curisinche, Maricela; Yagui, Martín; Castilla, Teresa; Cabezas, César; Escalante, Giovanni; Casas, María; Lucero, Jorge

2011-06-01

The National Health Authority of Peru, as part of the implementation of national priorities for health research in 2010 developed the process of building the national research agenda on health manpower (HM). In a scenario of technical challenges, national and international policy and under a nation-wide participatory approach with key stakeholders in the health system, training and aid HM linked to the subject, establishing a socially agreed agenda. Process consists of 3 phases: 1. National review of evidence and relevant information on RHUS, 2. Consultation with opinion leaders and subject experts, and 3. A collaborative space (national workshop) of deliberation, consensus and legitimacy of the agenda. Finally, we present the agenda consists of 30 research topics on health manpower, to be developed in the period 2011- 2014, and raises the challenges and prospects for implementation.

Predicting general criminal recidivism in mentally disordered offenders using a random forest approach.

PubMed

Pflueger, Marlon O; Franke, Irina; Graf, Marc; Hachtel, Henning

2015-03-29

Psychiatric expert opinions are supposed to assess the accused individual's risk of reoffending based on a valid scientific foundation. In contrast to specific recidivism, general recidivism has only been poorly considered in Continental Europe; we therefore aimed to develop a valid instrument for assessing the risk of general criminal recidivism of mentally ill offenders. Data of 259 mentally ill offenders with a median time at risk of 107 months were analyzed and combined with the individuals' criminal records. We derived risk factors for general criminal recidivism and classified re-offences by using a random forest approach. In our sample of mentally ill offenders, 51% were reconvicted. The most important predictive factors for general criminal recidivism were: number of prior convictions, age, type of index offence, diversity of criminal history, and substance abuse. With our statistical approach we were able to correctly identify 58-95% of all reoffenders and 65-97% of all committed offences (AUC = .90). Our study presents a new statistical approach to forensic-psychiatric risk-assessment, allowing experts to evaluate general risk of reoffending in mentally disordered individuals, with a special focus on high-risk groups. This approach might serve not only for expert opinions in court, but also for risk management strategies and therapeutic interventions.

Brainstorming transformative solutions - Sustainable Puerto ...

EPA Pesticide Factsheets

This narrative scenario depicts one of many possible futures for the island of Puerto Rico in which the goals of energy and food supply resilience have been met. Set in the year 2080, the narrative describes a series of hypothetical (but possible) events, a set of proactive governance actions and policies, and citizen responses to those events and interventions. The narrative is based on expert-opinion and extrapolation of trends in energy markets, technology, and policy development, as well as recent events in Puerto Rico. This narrative was developed as part of a futures exercise, and the outputs of a recent stakeholder and expert workshop, to inform modeling efforts underway by a coalition of researchers and local stakeholders -- an NSF-funded project entitled, Urban Resilience to Extreme Events. This narrative, which describes one of many potential energy futures for the island of Puerto Rico, uses expert opinion and extrapolation of recent trends in energy markets, technology, and policy development to describe a scenario in which Puerto Rico has achieved recently stated goals for energy and food systems resilience and sustainability. It will be used along with the outputs of a recent stakeholder workshop to inform model building. The document will be posted in the Urban Resilience to Extreme Events Research Network's blog.

Water supply management using an extended group fuzzy decision-making method: a case study in north-eastern Iran

NASA Astrophysics Data System (ADS)

Minatour, Yasser; Bonakdari, Hossein; Zarghami, Mahdi; Bakhshi, Maryam Ali

2015-09-01

The purpose of this study was to develop a group fuzzy multi-criteria decision-making method to be applied in rating problems associated with water resources management. Thus, here Chen's group fuzzy TOPSIS method extended by a difference technique to handle uncertainties of applying a group decision making. Then, the extended group fuzzy TOPSIS method combined with a consistency check. In the presented method, initially linguistic judgments are being surveyed via a consistency checking process, and afterward these judgments are being used in the extended Chen's fuzzy TOPSIS method. Here, each expert's opinion is turned to accurate mathematical numbers and, then, to apply uncertainties, the opinions of group are turned to fuzzy numbers using three mathematical operators. The proposed method is applied to select the optimal strategy for the rural water supply of Nohoor village in north-eastern Iran, as a case study and illustrated example. Sensitivity analyses test over results and comparing results with project reality showed that proposed method offered good results for water resources projects.

Evaluation of Nine Consensus Indices in Delphi Foresight Research and Their Dependency on Delphi Survey Characteristics: A Simulation Study and Debate on Delphi Design and Interpretation.

PubMed

Birko, Stanislav; Dove, Edward S; Özdemir, Vural

2015-01-01

The extent of consensus (or the lack thereof) among experts in emerging fields of innovation can serve as antecedents of scientific, societal, investor and stakeholder synergy or conflict. Naturally, how we measure consensus is of great importance to science and technology strategic foresight. The Delphi methodology is a widely used anonymous survey technique to evaluate consensus among a panel of experts. Surprisingly, there is little guidance on how indices of consensus can be influenced by parameters of the Delphi survey itself. We simulated a classic three-round Delphi survey building on the concept of clustered consensus/dissensus. We evaluated three study characteristics that are pertinent for design of Delphi foresight research: (1) the number of survey questions, (2) the sample size, and (3) the extent to which experts conform to group opinion (the Group Conformity Index) in a Delphi study. Their impacts on the following nine Delphi consensus indices were then examined in 1000 simulations: Clustered Mode, Clustered Pairwise Agreement, Conger's Kappa, De Moivre index, Extremities Version of the Clustered Pairwise Agreement, Fleiss' Kappa, Mode, the Interquartile Range and Pairwise Agreement. The dependency of a consensus index on the Delphi survey characteristics was expressed from 0.000 (no dependency) to 1.000 (full dependency). The number of questions (range: 6 to 40) in a survey did not have a notable impact whereby the dependency values remained below 0.030. The variation in sample size (range: 6 to 50) displayed the top three impacts for the Interquartile Range, the Clustered Mode and the Mode (dependency = 0.396, 0.130, 0.116, respectively). The Group Conformity Index, a construct akin to measuring stubbornness/flexibility of experts' opinions, greatly impacted all nine Delphi consensus indices (dependency = 0.200 to 0.504), except the Extremity CPWA and the Interquartile Range that were impacted only beyond the first decimal point (dependency = 0.087 and 0.083, respectively). Scholars in technology design, foresight research and future(s) studies might consider these new findings in strategic planning of Delphi studies, for example, in rational choice of consensus indices and sample size, or accounting for confounding factors such as experts' variable degrees of conformity (stubbornness/flexibility) in modifying their opinions.

Evaluation and revision of checklists for screening facilities and municipal governmental programs for gastric cancer and colorectal cancer screening in Japan.

PubMed

Higashi, Takahiro; Machii, Ryoko; Aoki, Ayako; Hamashima, Chisato; Saito, Hiroshi

2010-11-01

To evaluate the appropriateness of current checklists created by a governmental committee to assess screening programs run by municipal governments and service provider facilities for gastric and colorectal cancer, and to accumulate expert opinions to provide insights aimed at the next revision. We convened an expert panel that consisted of physicians nominated by regional offices of the Japanese Society for Gastrointestinal Cancer Screening and radiology technicians nominated by the technician chapter of the society. The panel rated the appropriateness of each checklist item on a scale of 1-9 (1, extremely inappropriate; 9, extremely appropriate) twice, between which they had a face-to-face discussion meeting. During the process they were allowed to propose modifications and additions to the items. In the first round of rating, the panelists rated all 57 and 56 checklists items for gastric and colorectal cancer, respectively, as appropriate based on an acceptance rule determined a priori. During the process of the face-to-face discussion, however, the panel proposed modifications to 23 (40%) and 22 (39%) items, respectively, and the addition of 27 new items each. After integrating overlapping items and rating again for appropriateness, 66 and 64 items, respectively, were accepted as the revised checklist set. The expert panel considered current checklists for colorectal and gastric cancer-screening programs and facilities to be suitable. Their proposals for a new set of checklist items will help further improve the checklists.

Challenges faced with the implementation of Web-Based Data Query Systems for population health: development of a questionnaire based on expert consensus.

PubMed

Ahuja, Manik; Aseltine, Robert; Warren, Nicholas; Reisine, Susan; Williams, Pam Holtzclaw; Cislo, Andy

2018-01-01

State health agencies (SHA) and local health agencies (LHA) face several challenges with the dissemination of local health data using Web-Based Data Query Systems (WDQS). To help guide future research, this study aimed to utilize expert consensus to identify the most relevant items that contribute to these challenges. A total of 17 researchers and public health professionals agreed to participate in a three-round Delphi process. In round 1, four topics were represented on a 42-item questionnaire using a 5-point Likert scale, along with free-text responses. Free-text responses were analyzed leading to a series of items for a second Delphi round. Participants were given an opportunity to revise results in round 3 for items that did not meet consensus in round 1 or round 2. Consensus on expert opinions was defined at interquartile range (IQR) ≤ 1. The experts reached consensus on a total of 21 (50%) of the 42 items presented in the initial questionnaire. Eleven of the 15 (73%) of the items extracted from the free-text responses met consensus. Items in consensus from this pilot study were used to develop an instrument for a broader survey across Behavioral Risk Factor Surveillance System (BRFSS) coordinators across all 50 US states. Experts confirmed that software development costs, inadequate human resources, data sharing gaps, a lack of political support, and poor data quality contribute significantly to challenges in their data implementation. The findings from this pilot study inform us of items of public health significance that will help guide future research.

Selecting the best bank that offered Islamic personal loan package by using consistent fuzzy preference relations (CFPR)

NASA Astrophysics Data System (ADS)

Kadir, Norhidayah A.; Sarudin, Ezzah Suraya; Hamid, Fairus; Shamsuddin, Nor Diyana Ahmad

2014-10-01

There are various thoughts and opinions when it comes to how people think of their selected banks. Therefore, to choose the best bank with a good personal loan package can be a bit tricky especially for first time customer. This research offers a guide in choosing the right bank for applying personal loan package by highlighting the important criteria that applicants should take into consideration. In order to cater the problem above, we used Consistent Fuzzy Preference Relations (CFPR). Based on expert and public opinions, the important criteria in selecting an Islamic personal loan package are interest rate, tenure of loan, processing period and security of the loan. We developed questionnaire with the criteria mention earlier and distributed it among academic staffs and non academic staffs at Faculty of Computer and Mathematical Sciences (FSKM), UiTM Shah Alam. Based on the questionnaire, we found that four banks have been selected for multiple reasons. Before we could determine the best bank, calculations are divided into 2 phases which are criteria weights determination and ranking of alternatives. We implemented these phases to get the aggregation result and to obtain the ranking in descending order. As a result, our objectives have been achieved. As a conclusion, CFPR can help others in the decision making process.

The use and value of polling to determine public opinion on GMOs in Europe: limitations and ways forward.

PubMed

Desaint, Nilsy; Varbanova, Mariana

2013-01-01

In this article, we review and assess existing surveys that attempt to gauge public opinion about GM crops. This review shows that consumer surveys can be something of a blunt instrument. Questionnaires, however well-constructed and professionally delivered, are answered in a vacuum of knowledge and elicit misleading responses. People recurrently admit they lack information on the technology behind GM food. It is a part of the general unfamiliarity with the food production process with which people show equal, if not greater, concern. Lacking control over a process involving such an emotive subject like food makes people uneasy and reluctant to accept "unknowns". In addition, if people give answers to hypothetical questions, they do so as "cautious citizens" rather than consumers and this is not a good guide to actual behavior in real life. Qualitative studies using focus groups can be a much better guide to how people really feel about issues, but they also need expert facilitation and analysis to be of real value. An even better guide to acceptance and purchasing behavior (if that is the objective) is to put people in a situation where they are actually making a choice of whether or not to buy GM products.

Achieving quality in cardiovascular imaging: proceedings from the American College of Cardiology-Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging.

PubMed

Douglas, Pamela; Iskandrian, Ami E; Krumholz, Harlan M; Gillam, Linda; Hendel, Robert; Jollis, James; Peterson, Eric; Chen, Jersey; Masoudi, Frederick; Mohler, Emile; McNamara, Robert L; Patel, Manesh R; Spertus, John

2006-11-21

Cardiovascular imaging has enjoyed both rapid technological advances and sustained growth, yet less attention has been focused on quality than in other areas of cardiovascular medicine. To address this deficit, representatives from cardiovascular imaging societies, private payers, government agencies, the medical imaging industry, and experts in quality measurement met, and this report provides an overview of the discussions. A consensus definition of quality in imaging and a convergence of opinion on quality measures across imaging modalities was achieved and are intended to be the start of a process culminating in the development, dissemination, and adoption of quality measures for all cardiovascular imaging modalities.

Development of digital stethoscope for telemedicine.

PubMed

Lakhe, Aparna; Sodhi, Isha; Warrier, Jyothi; Sinha, Vineet

2016-01-01

The stethoscope is a medical acoustic device which is used to auscultate internal body sounds, mainly the heart and lungs. A digital stethoscope overcomes the limitations of a conventional stethoscope as the sound data is transformed into electrical signals which can be amplified, stored, replayed and, more importantly, sent for an expert opinion, making it very useful in telemedicine. With the above in view, a low cost digital stethoscope has been developed which is interfaceble with mobile communication devices. In this instrument sounds from various locations can be captured with the help of an electret condenser microphone. Captured sound is filtered, amplified and processed digitally using an adaptive line enhancement technique to obtain audible and distinct heart sounds.

I.S.Mu.L.T - Rotator Cuff Tears Guidelines

PubMed Central

Oliva, Francesco; Piccirilli, Eleonora; Bossa, Michela; Via, Alessio Giai; Colombo, Alessandra; Chillemi, Claudio; Gasparre, Giuseppe; Pellicciari, Leonardo; Franceschetti, Edoardo; Rugiero, Clelia; Scialdoni, Alessandro; Vittadini, Filippo; Brancaccio, Paola; Creta, Domenico; Buono, Angelo Del; Garofalo, Raffaele; Franceschi, Francesco; Frizziero, Antonio; Mahmoud, Asmaa; Merolla, Giovanni; Nicoletti, Simone; Spoliti, Marco; Osti, Leonardo; Padulo, Johnny; Portinaro, Nicola; Tajana, Gianfranco; Castagna, Alex; Foti, Calogero; Masiero, Stefano; Porcellini, Giuseppe; Tarantino, Umberto; Maffulli, Nicola

2015-01-01

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. PMID:26958532

Using a fuzzy DEMATEL method for analyzing the factors influencing subcontractors selection

NASA Astrophysics Data System (ADS)

Kozik, Renata

2016-06-01

Subcontracting is a long-standing practice in the construction industry. This form of project organization, if manage properly, could provide the better quality, reduction in project time and costs. Subcontractors selection is a multi-criterion problem and can be determined by many factors. Identifying the importance of each of them as well as the direction of cause-effect relations between various types of factors can improve the management process. Their values could be evaluated on the basis of the available expert opinions with the application of a fuzzy multi-stage grading scale. In this paper it is recommended to use fuzzy DEMATEL method to analyze the relationship between factors affecting subcontractors selection.

Neuropsychologist experts and neurolaw: cases, controversies, and admissibility challenges.

PubMed

Kaufmann, Paul M

2013-01-01

Clinical neuropsychologists engage increasingly in forensic consulting activities because such expert opinions are generally relevant, reliable and helpful in resolving certain legal claims, especially those related to traumatic brain injury. Consequently, practitioners of law, medicine and psychology would benefit from understanding the nature of neuropsychological evidence, the standards for its admissibility, and its expanding role in neurolaw. This article reviews important evidentiary rules regulating relevance, preliminary questions, and expert testimony, while tracing federal key court decisions and progeny. Civil and criminal cases are detailed to illustrate the application of these rules and case law to neuropsychological evidence, with suggestions for overcoming motions to exclude such evidence. Expert neuropsychologists have a role in forensic consultation on brain trauma cases, even as the interdisciplinary dialog and understanding among law, medicine, and psychology continues to expand. Copyright © 2013 John Wiley & Sons, Ltd.

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.].

PubMed

Medrano López, C; García-Guereta, L; Fernández Pineda, L; Malo Concepción, P; Maroto Alvaro, E; Santos de Soto, J; Lirio Casero, J; Suárez Cabrera, P; Caballero Martínez, F

2010-06-01

Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review. Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Safe and effective prescription of exercise in acute exacerbations of chronic obstructive pulmonary disease: rationale and methods for an integrated knowledge translation study.

PubMed

Camp, Pat; Reid, W Darlene; Yamabayashi, Cristiane; Brooks, Dina; Goodridge, Donna; Chung, Frank; Marciniuk, Darcy D; Neufeld, Andrea; Hoens, Alsion

2013-01-01

Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions. To report the rationale for and methods of a study to develop evidence-informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD. The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and⁄or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD. Clinical decision-making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework. The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an 'activity as tolerated' approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision-making tools for use by patients and their health care providers.

[Incest--forensic genetic approach].

PubMed

Raczek, Ewa

2012-01-01

The paper presents intimate relationships between biologically and legally close relatives, complicated in the social, culture and religion perspective. (art. 201 of the Penal Code), but it chiefly addresses problems associated with giving opinion on the fatherhood towards the incestuous child. The report calls for a broader interest in this issue from expert witnesses in forensic genetics, as well as encourages them to publish examples taken from their own professional experience that may unquestionably be helpful to other practitioners in this field and above all will lead to extending educational methods related to widely understood DNA analysis in giving an opinion on arguable fatherhood.

The Galbraith judgment and the defence of diminished responsibility in Scotland.

PubMed

Hodelet, Nicola; Darjee, Rajan

2005-10-01

New case law on diminished responsibility in Scotland (Galbraith v. HM Advocate 2001) re-defined the defence and clarified the role of expert witnesses. We examined how this judgment affected the use of the defence, provision of expert evidence and the outcome of trials. We studied homicide cases in one area of Scotland in the year before and the year after the new judgment. Results indicated little change in the number of cases where the defence was used, but a difference in how psychiatrists set out their opinions.

Research Needs Related to Naphthalene Assessment (2005, Workshop)

EPA Science Inventory

EPA has announced the release of the final report from the 2005 peer consultation workshop which sought expert opinion on research needs related to the mode of action of the inhalation carcinogenicity of naphthalene. This report is a summary of the main points of presentations an...

78 FR 8964 - Environmental Impact and Related Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-07

... designed so that no significant impact will occur. FTA is deleting, however, some items in the list of... supporting documentation, which includes, but is not limited to, comparative benchmarking and expert opinion... fall within the ten broad categories. Comparative benchmarking provides support for the new CEs by...

Motivation of employers to encourage their employees to use safety belts (phase 2).

DOT National Transportation Integrated Search

1983-08-01

An employer manual is developed which offers guidelines for the elements of a successful safety bell program. The guidelines are based upon the model developed as a result of site visits to successful programs and synthesis of expert opinion. A needs...

A King over Egypt, Which Knew Not Joseph.

ERIC Educational Resources Information Center

Coffman, William E.

1993-01-01

Although it is true that today's education needs improvement, schools today are not all bad. The opinions of the following five experts, whose views are worth hearing are introduced: (1) Thomas Hopkins; (2) Ralph Tyler; (3) E. F. Lindquist; (4) Walter Cook; and (5) Harold Benjamin. (SLD)

Women-Family in Quality Perspective

ERIC Educational Resources Information Center

Fatimah, Rika P. L.; Aziz, J. Abdul; Ibrahim, K.

2008-01-01

Bringing together women and family in quality perspective brings about interesting discussions in this paper. By integrating previous studies and considering expert opinions, we determine the variables and dimensions with respect to women's existence regarding their roles both in the family and at work. Many activities carried out by women…

Aviation Forecasting in ICAO

NASA Technical Reports Server (NTRS)

Mcmahon, J.

1972-01-01

Opinions or plans of qualified experts in the field are used for forecasting future requirements for air navigational facilities and services of international civil aviation. ICAO periodically collects information from Stators and operates on anticipated future operations, consolidates this information, and forecasts the future level of activity at different airports.

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

The 10 Hottest Technologies in Telecom.

ERIC Educational Resources Information Center

Flanagan, Patrick

1996-01-01

Synthesizes opinions of experts regarding technologies deemed most likely to enter the telecommunications mainstream by 1998, including: (1) the Java programming language; (2) voice- over frame relay; (3) virtual local area networks (LANs); (4) cable modems; (5) gigabit LANs; (6) Internet appliances; (7) personal satellite phones; (8) intranets;…

Pacifiers: Are They Good for Your Baby?

MedlinePlus

... 26, 2017. Bencosme J. Pacifiers for infants: What nurses need to know. Nursing. 2016;46:53. Butler R, et al. Pacifier use, finger sucking, and infant sleep. Behavioral Sleep Medicine. 2016;14:615. Hoecker J (expert opinion). Mayo Clinic, Rochester, Minn. July 1, 2017. July 22, 2017 ...

"Irreconcilable Differences" between Parent and Child: A Case Report of Interactional Pathology.

ERIC Educational Resources Information Center

Tooley, Kay M.

1978-01-01

The article presents two illustrative case reports of an unusual type of child abuse: parents who use their child as a representative of their own unacceptable impulses, thereby perceiving the youngster as evil and seeking experts to confirm their mistaken opinions. (Author/DLS)

Sports-Related Wrist Injuries in Adults

PubMed Central

Chen, Neal C.; Jupiter, Jesse B.; Jebson, Peter J. L.

2009-01-01

Background: Wrist injuries are common in sports. Those who are involved in the care of athletes should be familiar with hand and wrist anatomy, common wrist injuries, and clinical examination; they should also know how to recognize emergent problems. Level of Evidence: Level V, expert opinion. PMID:23015908

Setting health research priorities using the CHNRI method: VI. Quantitative properties of human collective opinion

PubMed Central

Yoshida, Sachiyo; Rudan, Igor; Cousens, Simon

2016-01-01

Introduction Crowdsourcing has become an increasingly important tool to address many problems – from government elections in democracies, stock market prices, to modern online tools such as TripAdvisor or Internet Movie Database (IMDB). The CHNRI method (the acronym for the Child Health and Nutrition Research Initiative) for setting health research priorities has crowdsourcing as the major component, which it uses to generate, assess and prioritize between many competing health research ideas. Methods We conducted a series of analyses using data from a group of 91 scorers to explore the quantitative properties of their collective opinion. We were interested in the stability of their collective opinion as the sample size increases from 15 to 90. From a pool of 91 scorers who took part in a previous CHNRI exercise, we used sampling with replacement to generate multiple random samples of different size. First, for each sample generated, we identified the top 20 ranked research ideas, among 205 that were proposed and scored, and calculated the concordance with the ranking generated by the 91 original scorers. Second, we used rank correlation coefficients to compare the ranks assigned to all 205 proposed research ideas when samples of different size are used. We also analysed the original pool of 91 scorers to to look for evidence of scoring variations based on scorers' characteristics. Results The sample sizes investigated ranged from 15 to 90. The concordance for the top 20 scored research ideas increased with sample sizes up to about 55 experts. At this point, the median level of concordance stabilized at 15/20 top ranked questions (75%), with the interquartile range also generally stable (14–16). There was little further increase in overlap when the sample size increased from 55 to 90. When analysing the ranking of all 205 ideas, the rank correlation coefficient increased as the sample size increased, with a median correlation of 0.95 reached at the sample size of 45 experts (median of the rank correlation coefficient = 0.95; IQR 0.94–0.96). Conclusions Our analyses suggest that the collective opinion of an expert group on a large number of research ideas, expressed through categorical variables (Yes/No/Not Sure/Don't know), stabilises relatively quickly in terms of identifying the ideas that have most support. In the exercise we found a high degree of reproducibility of the identified research priorities was achieved with as few as 45–55 experts. PMID:27350874

Setting health research priorities using the CHNRI method: VI. Quantitative properties of human collective opinion.

PubMed

Yoshida, Sachiyo; Rudan, Igor; Cousens, Simon

2016-06-01

Crowdsourcing has become an increasingly important tool to address many problems - from government elections in democracies, stock market prices, to modern online tools such as TripAdvisor or Internet Movie Database (IMDB). The CHNRI method (the acronym for the Child Health and Nutrition Research Initiative) for setting health research priorities has crowdsourcing as the major component, which it uses to generate, assess and prioritize between many competing health research ideas. We conducted a series of analyses using data from a group of 91 scorers to explore the quantitative properties of their collective opinion. We were interested in the stability of their collective opinion as the sample size increases from 15 to 90. From a pool of 91 scorers who took part in a previous CHNRI exercise, we used sampling with replacement to generate multiple random samples of different size. First, for each sample generated, we identified the top 20 ranked research ideas, among 205 that were proposed and scored, and calculated the concordance with the ranking generated by the 91 original scorers. Second, we used rank correlation coefficients to compare the ranks assigned to all 205 proposed research ideas when samples of different size are used. We also analysed the original pool of 91 scorers to to look for evidence of scoring variations based on scorers' characteristics. The sample sizes investigated ranged from 15 to 90. The concordance for the top 20 scored research ideas increased with sample sizes up to about 55 experts. At this point, the median level of concordance stabilized at 15/20 top ranked questions (75%), with the interquartile range also generally stable (14-16). There was little further increase in overlap when the sample size increased from 55 to 90. When analysing the ranking of all 205 ideas, the rank correlation coefficient increased as the sample size increased, with a median correlation of 0.95 reached at the sample size of 45 experts (median of the rank correlation coefficient = 0.95; IQR 0.94-0.96). Our analyses suggest that the collective opinion of an expert group on a large number of research ideas, expressed through categorical variables (Yes/No/Not Sure/Don't know), stabilises relatively quickly in terms of identifying the ideas that have most support. In the exercise we found a high degree of reproducibility of the identified research priorities was achieved with as few as 45-55 experts.

Adaptation and Validation of the Brief Sexual Opinion Survey (SOS) in a Colombian Sample and Factorial Equivalence with the Spanish Version

PubMed Central

Sierra, Juan Carlos; Soler, Franklin

2016-01-01

Attitudes toward sexuality are a key variable for sexual health. It is really important for psychology and education to have adapted and validated questionnaires to evaluate these attitudes. Therefore, the objective of this research was to adapt, validate and calculate the equivalence of the Colombia Sexual Opinion Survey as compared to the same survey from Spain. To this end, a total of eight experts were consulted and 1,167 subjects from Colombia and Spain answered the Sexual Opinion Survey, the Sexual Assertiveness Scale, the Massachusetts General Hospital-Sexual Functioning Questionnaire, and the Sexuality Scale. The evaluation was conducted by online and the results show adequate qualitative and quantitative properties of the items, with adequate reliability and external validity and compliance with the strong invariance between the two countries. Consequently, the Colombia Sexual Opinion Survey is a valid and reliable scale and its scores can be compared with the ones from the Spain survey, with minimum bias. PMID:27627114

Professional opinion concerning the effectiveness of bracing relative to observation in adolescent idiopathic scoliosis.

PubMed

Dolan, Lori A; Donnelly, Melanie J; Spratt, Kevin F; Weinstein, Stuart L

2007-01-01

To determine if community equipoise exists concerning the effectiveness of bracing in adolescent idiopathic scoliosis. Bracing is the standard of care for adolescent idiopathic scoliosis despite the lack of strong reasearch evidence concerning its effectiveness. Thus, some researchers support the idea of a randomized trial, whereas others think that randomization in the face of a standard of care would be unethical. A random of Scoliosis Research Society and Pediatric Orthopaedic Society of North America members were asked to consider 12 clinical profiles and to give their opinion concerning the radiographic outcomes after observation and bracing. An expert panel was created from the respondents. They expressed a wide array of opinions concerning the percentage of patients within each scenario who would benefit from bracing. Agreement was noted concerning the risk due to bracing for post-menarchal patients only. : This study found a high degree of variability in opinion among clinicians concerning the effectiveness of bracing, suggesting that a randomized trial of bracing would be ethical.

Adaptation and Validation of the Brief Sexual Opinion Survey (SOS) in a Colombian Sample and Factorial Equivalence with the Spanish Version.

PubMed

Vallejo-Medina, Pablo; Marchal-Bertrand, Laurent; Gómez-Lugo, Mayra; Espada, José Pedro; Sierra, Juan Carlos; Soler, Franklin; Morales, Alexandra

2016-01-01

Attitudes toward sexuality are a key variable for sexual health. It is really important for psychology and education to have adapted and validated questionnaires to evaluate these attitudes. Therefore, the objective of this research was to adapt, validate and calculate the equivalence of the Colombia Sexual Opinion Survey as compared to the same survey from Spain. To this end, a total of eight experts were consulted and 1,167 subjects from Colombia and Spain answered the Sexual Opinion Survey, the Sexual Assertiveness Scale, the Massachusetts General Hospital-Sexual Functioning Questionnaire, and the Sexuality Scale. The evaluation was conducted by online and the results show adequate qualitative and quantitative properties of the items, with adequate reliability and external validity and compliance with the strong invariance between the two countries. Consequently, the Colombia Sexual Opinion Survey is a valid and reliable scale and its scores can be compared with the ones from the Spain survey, with minimum bias.

What is the value of occupational therapy in return to work for breast cancer patients? A qualitative inquiry among experts.

PubMed

Désiron, H A M; Donceel, P; Godderis, L; Van Hoof, E; de Rijk, A

2015-03-01

An increasing number of patients are confronted with breast cancer (BC) and functional limitations after treatment. Occupational therapy (OT) is successful in return to work (RTW), but not yet available for BC patients. This paper explores experts' opinions on OT interventions for RTW in BC patients in the Belgian context. Primary data were topic-interviews with all heads of OT departments in Flemish University Hospitals (n = 5). Secondary data were four focus group interviews with care professionals in oncological rehabilitation (n = 41). All data were transcribed and thematic analysis was used. Integrated in multidisciplinary teamwork, OT interventions should have a holistic and client-centred approach, start early in the rehabilitation process, include workplace visits and contacts with relevant stakeholders, and use goal setting to start up tailor made rehabilitation, linking assessment of abilities and work. Occupational therapists are regarded as professionals who can effectively answer BC patients unmet needs regarding RTW due to their skill to bridge between care and workplace. According to the experts, OT interventions supporting RTW in BC patients are useful when integrated in regular healthcare. They agree on the components but organisational barriers should be removed, for example not providing reimbursement for including this type of support trough healthcare insurance. © 2014 John Wiley & Sons Ltd.

Discourse and policy making on consumer protection in the areas of mobile telecommunication and tanning.

PubMed

Schweikardt, Christoph; Rosentreter, Michael; Gross, Dominik

2012-01-01

Perceived health risks from electromagnetic fields in mobile telecommunication and from UV radiation in tanning have become regulation issues in Germany during the last decade. Health risk messages from government expert bodies and the main stakeholders in these areas as well as subsequent consumer protection policy making are investigated. Publications and websites of government expert bodies and the main stakeholders as well as debates in Federal Parliament were analysed to compare argumentation patterns and parliamentary decision-making processes. In both areas, the public received competing health risk messages from the industries and their critics. As a government expert body, the Federal Office for Radiation Protection (BfS) held the view that alleged health risks from electromagnetic telecommunication were not proven, and propagated the precautionary principle. This opinion did not endanger the agreement of 2001 between the government and mobile telecommunication operators. After the failure to obtain voluntary commitment from the tanning industry, by contrast, the BfS recommended stricter consumer protection legislation, which was subsequently implemented. The BfS was in a key position to demand the prerogative of interpretation concerning mutually excluding health risk messages and to provide the argumentation which led the way to non-ionic radiation health protection measures.

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning

PubMed Central

Portman, Michelle E.; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity. PMID:27183224

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning.

PubMed

Portman, Michelle E; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity.

Patient rights protection in the Czech Republic: challenges of a transition from Communism to a modern legal system.

PubMed

Dostal, O

2007-03-01

The post-Communist countries in Central Europe, including the Czech Republic, underwent a rapid transformation of their legal systems, within which the concept of patient rights passed through revolutionary changes. This process however often left significant gaps in patient rights protection. There are practical difficulties for patients in defending their rights before the courts, such as problems with obtaining evidence and independent expert opinions, long delays and high costs of court proceedings, strict burden of proof rules and low compensation levels. Modern patient rights often collide with the systems of health care provision that are still unprepared for patient autonomy and responsibility. The experience gained in the transition process might be applicable also to other countries that undergo changes from traditional to modern system of patient rights protection.

Improving Operational System Performance of Internet of Things (IoT) in Indonesia Telecomunication Company

NASA Astrophysics Data System (ADS)

Dachyar, M.; Risky, S. A.

2014-06-01

Telecommunications company have to improve their business performance despite of the increase customers every year. In Indonesia, the telecommunication company have provided best services, improving operational systems by designing a framework for operational systems of the Internet of Things (IoT) other name of Machine to Machine (M2M). This study was conducted with expert opinion which further processed by the Analytic Hierarchy Process (AHP) to obtain important factor for organizations operational systems, and the Interpretive Structural Modeling (ISM) to determine factors of organization which found drives the biggest power. This study resulted, the greatest weight of SLA & KPI handling problems. The M2M current dashboard and current M2M connectivity have power to affect other factors and has important function for M2M operations roomates system which can be effectively carried out.

What Constitutes Commercial Bias Compared with the Personal Opinion of Experts?

ERIC Educational Resources Information Center

Cornish, Jean K.; Leist, James C.

2006-01-01

Introduction: The presence of commercial messages in continuing medical education (CME) is an ongoing cause of concern. This study identifies actions perceived by CME participants to convey commercial bias from CME faculty. Methods: A questionnaire listing actions associated with CME activities was distributed to 230 randomly selected participants…

Multicultural Counseling: An Ethical Issue for School Counselors.

ERIC Educational Resources Information Center

Hobson, Suzanne M.; Kanitz, H. Mike

1996-01-01

Discusses the ethical issues school counselors face when deciding whether to engage in multicultural counseling without having had multicultural training. Illustrates how theories that seem to be free of bias may be based on cultural assumptions, provides a historical overview of multicultural counseling, and addresses divergent expert opinions in…

Sex Therapy: Advances in Paradigms, Nomenclature, and Treatment

ERIC Educational Resources Information Center

Althof, Stanley

2010-01-01

Objective: The author reviews the historical paradigms that have influenced the treatment of sexual problems, changes in the diagnostic nomenclature, and recent innovations in sex therapy. Methods: The author reviews the literature and provides expert opinion. Results: The author gives a historical overview of how theoretical models of…

Electronic-Imen-Delphi (EID): An Online Conferencing Procedure.

ERIC Educational Resources Information Center

Passig, David; Sharbat, Aviva

2000-01-01

Examines the efficiency of the Imen-Delphi (ID) technique as an electronic procedure for conferencing that helps participants clarify their opinions and expectations regarding preferable and possible futures. Describes an electronic version of the original ID procedure and tested its efficiency among a group of experts on virtual reality and…

Supplier Relationships and Training. Contractor Report.

ERIC Educational Resources Information Center

Tornatzky, Louis G.; And Others

A study was undertaken to describe how changes in the network of transactions that occur between manufacturers and suppliers have affected the scope and nature of training and related human resource practices within supplier firms. Data came from the published literature, expert opinion, and a phone survey of 15 individuals ranging from…

Minimally Invasive Mitral Valve Surgery III

PubMed Central

Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

2016-01-01

Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

12 CFR 911.7 - Availability of unpublished information by testimony.

Code of Federal Regulations, 2011 CFR

2011-01-01

... not authorize a current employee or agent to provide expert or opinion testimony for a private party... testimony of a former or current employee or agent available only through written interrogatories or... hearing. (2) If the Finance Board has authorized testimony in connection with a legal proceeding, the...

Plan for the Development of Library Service in Montana.

ERIC Educational Resources Information Center

Warncke, Ruth

This plan for the development of Montana library service is based on the experiences of other states, opinions of library experts, written information on Montana libraries, visits to several libraries, and attendance at meetings of the Montana Library Association and its committees. Specific recommendations include: moving the State Library…

32 CFR 536.53 - Evaluation of claims-general rules and guidelines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... a professional negligence claim, the claimant will submit an expert opinion when requested. State... representative. Contributory negligence has given way to comparative negligence in most United States jurisdictions. In most foreign countries, comparative negligence is the rule of law. Note to § 536.53: For...

Is There a Safe Level of Exposure to a Carcinogen?

ERIC Educational Resources Information Center

Hrudey, Steve E.; Krewski, Daniel

1995-01-01

Presents an approach to estimating the "safe" levels of low-dose exposure to carcinogens that involves working upward from the smallest conceivable chronic dose instead of extrapolating downward from high exposures. Discusses expert and public opinion and other issues related to quantitative cancer risk assessment. (LZ)