The impact of new and emerging technologies in the commercial aviation maintenance, repair, and overhaul industry a Delphi study

NASA Astrophysics Data System (ADS)

Gray, Janet

Purpose. The purpose of this study was to identify new or emerging technological trends and events that are likely to occur between now and 2017 that will have an impact on the commercial aviation maintenance, repair, and overhaul (MRO) industry. Further, it was the purpose of this study to examine those technological trends and events believed to provide the greatest impact and, given the experts' analysis, identify the feasibility of implementation. Methodology. This descriptive study utilized the Delphi method with a panel of twenty-four experts comprised of practitioners, theorists, and futurists. A priority matrix was utilized to determine the impact and feasibility of trend and events. Findings. The experts identified fifty-three trends and events that will impact the commercial aviation maintenance, repair, and overhaul (MRO) industry. Analysis of the priority matrix revealed eighteen trends and events were of high priority and high feasibility. Conclusions. The responses from the expert panel were examined and the findings analyzed. The following are the conclusions constructed from the data provided by the Delphi panel of experts: (1) the need to respond to the demands of the maintenance, repair, and overhaul (MRO) industry such as down time, efficiency, cost, and environmental concerns by implementing new technology, (2) the demand to integrate and implement new technology as indicative of the priority matrix scoring high importance/high feasibility, (3) to proactively address the inadequate professional development in new technologies, and (4) the consensus reached by the panel of experts of importance and feasibility of implementation of new technologies encompass eighteen trends and events. Implications and recommendations for action. The implementation of new and emerging technological advances in the commercial aviation maintenance, repair, and overhaul (MRO) industry between now and 2017 will be dependent on the technologies' capacity to reduce downtime and increase efficiency. In order to maintain America's global leadership in aviation, integration of innovated technology is key.

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

PubMed

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

2010-04-01

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

The Gender Equity Expert Panel: A Dissemination Model.

ERIC Educational Resources Information Center

Fox, Lynn; Ortman, Patricia

2000-01-01

Describes the purposes and evolution of the Gender Equity Expert Panel, a federally sponsored effort to recognize interventions, products, and practices promoting gender equity. Explains key aspects of the Panel, shares lessons learned, and explores the Panel's potential value for furthering the cause of gender equity in education and as a model…

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-09-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

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

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

PubMed Central

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

2016-01-01

For many societally important science-based decisions, data are inadequate, unreliable or non-existent, and expert advice is sought. In such cases, procedures for eliciting structured expert judgments (SEJ) are increasingly used. This raises questions regarding validity and reproducibility. This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert’s statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values. Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels, but at the cost of informativeness; (3) performance-based weighting increased informativeness, while retaining accuracy; (4) due to study constraints individual experts’ accuracies were generally lower than in other SEJ studies, and (5) there was a negative correlation between experts' informativeness and statistical accuracy which attenuated as accuracy improved, revealing that the least accurate experts drive the negative correlation. It is shown, however, that performance-based weighting has the ability to yield statistically accurate and informative combinations of experts' judgments, thereby offsetting this contrary influence. The present findings suggest that application of SEJ on a large scale is feasible, and motivate the development of enhanced training and tools for remote elicitation of multiple, internationally-dispersed panels. PMID:26930595

Environmental factors and puberty timing: Expert panel research needs

EPA Science Inventory

An expert panel reviewed the literature on endocrine disrupting chemicals (EDCs), body size and puberty. The panel concluded that available experimental animal and human data support a possible role of EDCs and body size in relation to alterations in pubertal onset and progressio...

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...

Expert Panel Consensus for and Analysis of Key Attributes on Websites Devoted to Weight Control

ERIC Educational Resources Information Center

Brown, Stephen L.; Land, Diane; Johnson, Chandrika; Miller, Kim

2014-01-01

Background: Obesity presents major challenges to public health in the United States. Trials of web-based interventions for weight control suggest that the Internet is a promising option for program delivery. Purpose: This study sought consensus among experts regarding critical components of successful weight control and to systematically examine…

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.

PubMed

Wei, A C; Devitt, K S; Wiebe, M; Bathe, O F; McLeod, R S; Urbach, D R

2014-04-01

Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery

PubMed Central

Wei, A.C.; Devitt, K.S.; Wiebe, M.; Bathe, O.F.; McLeod, R.S.; Urbach, D.R.

2014-01-01

Background Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. Methods The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. Results The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Conclusions Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery. PMID:24764704

Non-Binding Arbitration

DTIC Science & Technology

1990-09-01

costs. However, the panel did not accept of an expert in public contract law , and the documentation of costs submitted by two experts on cement...construction expert, and both panel recommended a payment of parties agreed to the contract law expert, $57,000. who was to serve as the neutral party. The...particular needs and of the contract language, or by applying situation. relevant principles from contract law . The arbitrator felt the contractor had

Pantex Falling Man - Independent Review Panel Report.

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

Bertolini, Louis; Brannon, Nathan; Olson, Jared

2014-11-01

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

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

PubMed

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

2017-01-01

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

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

PubMed

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

2015-02-01

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

Setting and validating the pass/fail score for the NBDHE.

PubMed

Tsai, Tsung-Hsun; Dixon, Barbara Leatherman

2013-04-01

This report describes the overall process used for setting the pass/fail score for the National Board Dental Hygiene Examination (NBDHE). The Objective Standard Setting (OSS) method was used for setting the pass/fail score for the NBDHE. The OSS method requires a panel of experts to determine the criterion items and proportion of these items that minimally competent candidates would answer correctly, the percentage of mastery and the confidence level of the error band. A panel of 11 experts was selected by the Joint Commission on National Dental Examinations (Joint Commission). Panel members represented geographic distribution across the U.S. and had the following characteristics: full-time dental hygiene practitioners with experience in areas of preventive, periodontal, geriatric and special needs care, and full-time dental hygiene educators with experience in areas of scientific basis for dental hygiene practice, provision of clinical dental hygiene services and community health/research principles. Utilizing the expert panel's judgments, the pass/fail score was set and then the score scale was established using the Rasch measurement model. Statistical and psychometric analysis shows the actual failure rate and the OSS failure rate are reasonably consistent (2.4% vs. 2.8%). The analysis also showed the lowest error of measurement, an index of the precision at the pass/fail score point and that the highest reliability (0.97) are achieved at the pass/fail score point. The pass/fail score is a valid guide for making decisions about candidates for dental hygiene licensure. This new standard was reviewed and approved by the Joint Commission and was implemented beginning in 2011.

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

ERIC Educational Resources Information Center

Association of American Medical Colleges, Washington, DC.

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

Tackling reliability and construct validity: the systematic development of a qualitative protocol for skill and incident analysis.

PubMed

Savage, Trevor Nicholas; McIntosh, Andrew Stuart

2017-03-01

It is important to understand factors contributing to and directly causing sports injuries to improve the effectiveness and safety of sports skills. The characteristics of injury events must be evaluated and described meaningfully and reliably. However, many complex skills cannot be effectively investigated quantitatively because of ethical, technological and validity considerations. Increasingly, qualitative methods are being used to investigate human movement for research purposes, but there are concerns about reliability and measurement bias of such methods. Using the tackle in Rugby union as an example, we outline a systematic approach for developing a skill analysis protocol with a focus on improving objectivity, validity and reliability. Characteristics for analysis were selected using qualitative analysis and biomechanical theoretical models and epidemiological and coaching literature. An expert panel comprising subject matter experts provided feedback and the inter-rater reliability of the protocol was assessed using ten trained raters. The inter-rater reliability results were reviewed by the expert panel and the protocol was revised and assessed in a second inter-rater reliability study. Mean agreement in the second study improved and was comparable (52-90% agreement and ICC between 0.6 and 0.9) with other studies that have reported inter-rater reliability of qualitative analysis of human movement.

Non-Binding Arbitration. Alternative Dispute Resolution Series

DTIC Science & Technology

1990-09-01

However, the panel did not accept of an expert in public contract law , and the documentation cf costs submitted by two experts on cement construction. The...expert, and both panel recommended a payment of parties agreed to the contract law expert, $57,000. who was to serve as the neutral party. The attorneys...applying situation. relevant principles from contract law . The arbitrator felt the contractor had justi- Plannin to Use Non-Binding Arbitration fied claims

Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students.

PubMed

Humbert, Aloysius J; Johnson, Mary T; Miech, Edward; Friedberg, Fred; Grackin, Janice A; Seidman, Peggy A

2011-01-01

The Script Concordance test (SCT) measures clinical reasoning in the context of uncertainty by comparing the responses of examinees and expert clinicians. It uses the level of agreement with a panel of experts to assign credit for the examinee's answers. This study describes the development and validation of a SCT for pre-clinical medical students. Faculty from two US medical schools developed SCT items in the domains of anatomy, biochemistry, physiology, and histology. Scoring procedures utilized data from a panel of 30 expert physicians. Validation focused on internal reliability and the ability of the SCT to distinguish between different cohorts. The SCT was administered to an aggregate of 411 second-year and 70 fourth-year students from both schools. Internal consistency for the 75 test items was satisfactory (Cronbach's alpha = 0.73). The SCT successfully differentiated second- from fourth-year students and both student groups from the expert panel in a one-way analysis of variance (F(2,508) = 120.4; p < 0.0001). Mean scores for students from the two schools were not significantly different (p = 0.20). This SCT successfully differentiated pre-clinical medical students from fourth-year medical students and both cohorts of medical students from expert clinicians across different institutions and geographic areas. The SCT shows promise as an easy-to-administer measure of "problem-solving" performance in competency evaluation even in the beginning years of medical education.

ACHP | News | Expert Panel Report Submitted to Council

Science.gov Websites

executive summary of its report. The full report is scheduled to be presented to the ACHP for action at : Expert Panel Report Executive Summary Press Release Posted February 23, 2009 Return to Top

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

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

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

USGS Publications Warehouse

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

2016-01-01

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

Knowledge of Fecal Calprotectin and Infliximab Trough Levels Alters Clinical Decision-making for IBD Outpatients on Maintenance Infliximab Therapy.

PubMed

Huang, Vivian W; Prosser, Connie; Kroeker, Karen I; Wang, Haili; Shalapay, Carol; Dhami, Neil; Fedorak, Darryl K; Halloran, Brendan; Dieleman, Levinus A; Goodman, Karen J; Fedorak, Richard N

2015-06-01

Infliximab is an effective therapy for inflammatory bowel disease (IBD). However, more than 50% of patients lose response. Empiric dose intensification is not effective for all patients because not all patients have objective disease activity or subtherapeutic drug level. The aim was to determine how an objective marker of disease activity or therapeutic drug monitoring affects clinical decisions regarding maintenance infliximab therapy in outpatients with IBD. Consecutive patients with IBD on maintenance infliximab therapy were invited to participate by providing preinfusion stool and blood samples. Fecal calprotectin (FCP) and infliximab trough levels (ITLs) were measured by enzyme linked immunosorbent assay. Three decisions were compared: (1) actual clinical decision, (2) algorithmic FCP or ITL decisions, and (3) expert panel decision based on (a) clinical data, (b) clinical data plus FCP, and (c) clinical data plus FCP plus ITL. In secondary analysis, Receiver-operating curves were used to assess the ability of FCP and ITL in predicting clinical disease activity or remission. A total of 36 sets of blood and stool were available for analysis; median FCP 191.5 μg/g, median ITLs 7.3 μg/mL. The actual clinical decision differed from the hypothetical decision in 47.2% (FCP algorithm); 69.4% (ITL algorithm); 25.0% (expert panel clinical decision); 44.4% (expert panel clinical plus FCP); 58.3% (expert panel clinical plus FCP plus ITL) cases. FCP predicted clinical relapse (area under the curve [AUC] = 0.417; 95% confidence interval [CI], 0.197-0.641) and subtherapeutic ITL (AUC = 0.774; 95% CI, 0.536-1.000). ITL predicted clinical remission (AUC = 0.498; 95% CI, 0.254-0.742) and objective remission (AUC = 0.773; 95% CI, 0.622-0.924). Using FCP and ITLs in addition to clinical data results in an increased number of decisions to optimize management in outpatients with IBD on stable maintenance infliximab therapy.

78 FR 41979 - Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... .E95 2007]. The Agency then convened a panel of medical experts in the field of neurology (MEP) on May... a comprehensive literature review and convened a panel of medical experts in epilepsy and neurology...

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

PubMed

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-08-01

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

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

ERIC Educational Resources Information Center

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

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

21 CFR 516.141 - Qualified expert panels.

Code of Federal Regulations, 2010 CFR

2010-04-01

... its consideration. Such information should be submitted directly to the Director, OMUMS, when notified... an officer, director, trustee, general partner or employee: (i) Is currently receiving or seeking... potential qualified expert panel member must submit to the Director, OMUMS, the following information...

Expert Panels, Consumers, and Chemistry.

ERIC Educational Resources Information Center

Rehfeldt, Thomas K.

2000-01-01

Studied the attributes, properties, and consumer acceptance of antiperspirant products through responses of 400 consumers (consumer data), expert panel data, and analytical data about the products. Results show how the Rasch model can provide the tool necessary to combine data from several sources. (SLD)

ACR Appropriateness Criteria® Routine Chest Radiography.

PubMed

McComb, Barbara L; Chung, Jonathan H; Crabtree, Traves D; Heitkamp, Darel E; Iannettoni, Mark D; Jokerst, Clinton; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

2016-03-01

Chest radiographs are sometimes taken before surgeries and interventional procedures on hospital admissions and outpatients. This manuscript summarizes the American College of Radiology review of the literature and recommendations on routinely performed chest radiographies in these settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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

PubMed

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

2015-01-01

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

NETS1HD: study protocol for development of a core outcome set for use in determining the overall success of Hirschsprung's disease treatment.

PubMed

Allin, Benjamin; Bradnock, Timothy; Kenny, Simon; Walker, Gregor; Knight, Marian

2016-12-07

Use of core outcome sets in research has been proposed as a method for countering the problems caused by heterogeneity of outcome measure reporting. Heterogeneity of outcome measure reporting occurs in Hirschsprung's disease (HD) research and is limiting the development of a robust evidence base to support clinical practice. Candidate outcome measures have been identified through a systematic review. These outcome measures will form the starting point for a three-phase online Delphi process to be carried out in parallel by three panels of experts. Panel 1 is a neonatal panel; panel 2 is a non-neonatal panel; and panel 3 is a lay panel. In round 1, experts will be asked to score the previously identified outcome measures from 1 to 9 based on how important they think the measures are in determining the overall success of their/their child's/their patient's HD. In round 2, experts will be presented with the same list of outcome measures and graphical representations of how their panel scored that outcome in round 1. They will be asked to re-score the outcome measure, taking into account how important other members of their panel felt it to be. In round 3, experts will again be asked to re-score each outcome measure, but this time they will receive a graphical representation of the distribution of scores from all three panels, which they should take into account when re-scoring. Following round 3 of the Delphi process, 40 experts will be invited to attend a face-to-face consensus meeting. Participants will be invited in a purposive manner to obtain balance between the different panels. Results of the Delphi process will be discussed, and outcomes will be re-scored. Outcome measures where >70% of participants at the meeting scored it 7-9 and <15% scored it 1-3 will form the core outcome set. Development of a core outcome set will help to reduce heterogeneity of outcome measure reporting in HD. This will increase the quality of research taking place and ultimately improve care provided to infants with HD.

Content Validity of National Post Marriage Educational Program Using Mixed Methods

PubMed Central

MOHAJER RAHBARI, Masoumeh; SHARIATI, Mohammad; KERAMAT, Afsaneh; YUNESIAN, Masoud; ESLAMI, Mohammad; MOUSAVI, Seyed Abbas; MONTAZERI, Ali

2015-01-01

Background: Although the validity of content of program is mostly conducted with qualitative methods, this study used both qualitative and quantitative methods for the validation of content of post marriage training program provided for newly married couples. Content validity is a preliminary step of obtaining authorization required to install the program in country's health care system. Methods: This mixed methodological content validation study carried out in four steps with forming three expert panels. Altogether 24 expert panelists were involved in 3 qualitative and quantitative panels; 6 in the first item development one; 12 in the reduction kind, 4 of them were common with the first panel, and 10 executive experts in the last one organized to evaluate psychometric properties of CVR and CVI and Face validity of 57 educational objectives. Results: The raw data of post marriage program had been written by professional experts of Ministry of Health, using qualitative expert panel, the content was more developed by generating 3 topics and refining one topic and its respective content. In the second panel, totally six other objectives were deleted, three for being out of agreement cut of point and three on experts' consensus. The validity of all items was above 0.8 and their content validity indices (0.8–1) were completely appropriate in quantitative assessment. Conclusion: This study provided a good evidence for validation and accreditation of national post marriage program planned for newly married couples in health centers of the country in the near future. PMID:26056672

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

NASA Astrophysics Data System (ADS)

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

2004-05-01

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

Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say.

PubMed

Hebert, Lauren M; Watson, Anne C; Madrigal, Vanessa; October, Tessie W

2017-12-01

When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented. We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative. Single-center PICU of a tertiary medical center. Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014. We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits. When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical decision.

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

EPA Science Inventory

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

Identification of competencies for patient education in physiotherapy using a Delphi approach.

PubMed

Forbes, Roma; Mandrusiak, Allison; Smith, Michelle; Russell, Trevor

2018-06-01

Patient education is a critical part of physiotherapy practice however an empirically derived set of competencies for its use does not exist. This study aimed to generate a set of competencies for patient education in physiotherapy using a consensus approach. A Delphi study with two rounds using a panel of expert physiotherapists within Australia was undertaken. In the first round, the panel of 12 specialist physiotherapists identified competencies required for patient education in the physiotherapy setting. Framework analysis was applied to develop a set of competencies that were assessed in the second round where ≥80% agreement of importance from the panel indicated consensus. Response rates of specialist physiotherapists agreeing to participate were 67% for the first round and 100% for the second round. Analysis following the first round produced 25 competencies. The second round resulted in agreement on a final set of 22 competencies. This study developed a concise list of competencies for patient education with a high level of expert agreement. By identifying the key competencies in this area, there is potential to benchmark patient education training and assessment of physiotherapists for improved educational and professional outcomes. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

TWRS vadose zone contamination issue expert panel report

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

Shafer, D.S.

1997-05-01

When members were first canvassed for participation in the Vadose Zone Expert Panel the stated purpose for convening the Panel was to review a controversial draft report, the SX Tank Farm Report. This report was produced by a DOE Grand Junction Project Office (GJPO) contractor, RUST Geotech, now MACTEC-ERS, for the DOE Richland Office (DOERL). Three meetings were planned for June, July and August, 1995 to review the draft report and to complete a Panel report by mid-September. The Expert Panel has found its efforts confounded by various non-technical issues. The Expert Panel has chosen to address some of themore » non-technical issues in this Preface rather than to dilute the technical discussion that follows in the body of this independent expert panel status report (Panel Report). Rather than performing a straightforward manuscript review, the Panel was asked to resolve conflicting interpretations of gamma-ray logging measurements performed in vadose zone boreholes (drywells) surrounding the high-level radioactive wastes of the SX tank farm. There are numerous and complex technical issues that must be evaluated before the vertical and radial extent of contaminant migration at the SX tank farm can be accurately assessed. When the Panel first met in early June, 1996, it quickly became apparent that the scientific and technical issues were obscured by policy and institutional affairs which have polarized discussion among various segments of the Hanford organization. This situation reflects the kinds of institutional problems described separately in reports by the National Research Council of the National Academy of Sciences (NAS/NRC), The Hanford Tanks Environmental Impacts and Policy Choices and BmTiers to Science: Technical Management of the Department of Energy Environmental Remediation Program. The Vadose Zone Characterization Program, appears to be caught between conflicting pressures and organizational mandates, some imposed from outside DOE-RL and some self-imposed. The institutional problems they encountered include having both Tank Waste Remediation System (TWRS), the parent organization of the Vadose Zone Characterization Program and Environmental Restoration (ER), each under different regulatory controls and different organizational units, seeking to defend the status quo and discount many of the Panel`s conclusions and recommendations. The results presented in the SX Tank Farm Report, especially the visualizations, have created concern in the public sector, both on a local, personal level and on a national political level.« less

Analysis of the Technical Writing Profession through the DACUM Process.

ERIC Educational Resources Information Center

Nolan, Timothy; Green, Marc

To help develop a curriculum program for technical writers, Cincinnati Technical College used the Developing a Curriculum (DACUM) method to produce a technical writing skills profile. DACUM develops an occupation analysis through a modified brainstorming process by a panel of expert workers under the direction of a qualified coordinator. This…

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.

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

EPA Science Inventory

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

21 CFR 516.141 - Qualified expert panels.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS NEW ANIMAL DRUGS FOR MINOR USE AND MINOR SPECIES Index of Legally... of requesting the addition of a new animal drug to the index. A qualified expert panel may not be...

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

PubMed

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

2015-01-01

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

Developing performance indicators for clinical governance in dimensions of risk management and clinical effectiveness.

PubMed

Azami-Aghdash, Saber; Tabrizi, Jafar Sadegh; Sadeghi-Bazargani, Homayoun; Hajebrahimi, Sakineh; Naghavi-Behzad, Mohammad

2015-04-01

This study has been designed and conducted to develop domestic indicators for evaluating the performance of clinical governance in dimensions of risk management and clinical effectiveness. This study implemented a 5-stage process including conducting a comprehensive literature review, expert panel (∼ 1000 h per person per session, 11 experts), semi-structured interviews, a 2-round Delphi study (33 experts were in attendance) and a final expert panel (8 experts were in attendance). East Azerbaijan-Iran Province. Fifty-six specialists and experts in different fields of medical sciences. Importance and applicability of indicators. Using a thorough literature review, 361 indicators (129 risk management indicators in 4 dimensions and 232 clinical effectiveness indicators in 18 dimensions) were found. After conducting expert panels and interviews, the number of indicators decreased to 168 cases (65 risk management indicators in 4 dimensions and 103 clinical effectiveness indicators in 12 dimensions). Two rounds of Delphi identified four indicators that were omitted. The members of the final expert panel agreed on 113 indicators (43 risk management indicators in 4 dimensions and 70 clinical effectiveness indicators in 11 dimensions). In this study, indicators for assessing clinical governance in domains of risk management and clinical effectiveness were designed that can be used by policy-makers and other authorities for improving the quality of services and evaluating the performance of clinical governance. Those indicators can be used with slight modifications in other countries having healthcare systems similar to that of Iran. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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

PubMed

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

2008-01-01

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

Perceptions regarding workplace hazards at a veterinary teaching hospital.

PubMed

Weaver, Dustin R; Newman, Lee S; Lezotte, Dennis C; Morley, Paul S

2010-07-01

To assess perceptions of personnel working at a veterinary teaching hospital regarding risks of occupational hazards and compare those perceptions with assessments made by occupational safety experts. Cross-sectional study. A representative sample of personnel (n = 90) working at the veterinary teaching hospital at Colorado State University and a panel of 3 occupational safety experts. Hospital personnel ranked perceptions of 14 physical, chemical, and biological workplace hazards and listed the injuries, illnesses, and near misses they had experienced. The expert panel provided consensus rankings of the same 14 hazards for 9 sections of the facility. Risk perceptions provided by the 2 sources were compared. Risk perceptions did not differ significantly between hospital personnel and the expert panel for most of the site-specific comparisons (94/126 [75%]). Personnel perceived greater risks for some physical hazards (loud noises, sharps injuries, and ionizing radiation) and some chemical or materials exposures (insecticides or pesticides and tissue digester emissions). In contrast, the expert panel perceived greater risks for physical hazards (bite or crush and restraining and moving animals), chemical exposures (anesthetic waste gas), and biological exposures (Toxoplasma gondii, antimicrobial-resistant bacteria, and allergens). Participants and safety experts had similar perceptions about occupational risks, but there were important differences where hospital personnel apparently overestimated or underappreciated the risks for workplace hazards. This type of study may be useful in guiding development of optimal workplace safety programs for veterinary hospitals.

Development of a core outcome set for use in determining the overall success of gastroschisis treatment.

PubMed

Allin, Benjamin; Ross, Andrew; Marven, Sean; J Hall, Nigel; Knight, Marian

2016-07-27

Gastroschisis research is limited in quality by the presence of significant heterogeneity in outcome measure reporting (PloS One 10(1):e0116908, 2015). Using core outcome sets in research is one proposed method for addressing this problem (Trials 13:103, 2012; Clin Rheumatol 33(9):1313-1322, 2014; Health Serv Res Policy 17(1):1-2, 2012). Ultimately, standardising outcome measure reporting will improve research quality and translate into improvements in patient care. Candidate outcome measures have been identified through systematic reviews. These outcome measures will form the starting point for an online, three-phase Delphi process that will be carried out in parallel by three panels of experts. Panel 1 is a neonatal panel, panel 2 is a non-neonatal panel and panel 3 is a lay panel. In round 1, experts will be asked to score the previously identified outcome measures from 1-9 based on how important they think the measures are in determining the overall success of their/their child's/their patient's gastroschisis treatment. In round 2, experts will be presented with the same list of outcome measures and with graphical representations of how their panel scored that outcome in round 1. They will be asked to re-score the outcome measure taking into account how important other members of their panel felt it to be. In round 3, experts will again be asked to re-score each outcome measure, but this time they will receive a graphical representation of the distribution of scores from all three panels which they should take into account when re-scoring. Following round 3 of the Delphi process, 40 experts will be invited to attend a face-to-face consensus meeting. Participants will be invited in a purposive manner to obtain balance between the different panels. The results of the Delphi process will be discussed, and outcomes re-scored. Outcome measures where > 70 % of the participants at the meeting scored them as 7-9 and < 15 % scored them as 1-3 will form the core outcome set. Development of a core outcome set will help to reduce the heterogeneity of the outcome measure reporting in gastroschisis. This will increase the quality of research taking place and ultimately improve care provided to infants with gastroschisis.

Translation and Cross-Cultural Adaptation of the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema into Portuguese Language.

PubMed

Ferreira, Kamila Rodrigues; Carvalho, Raquel Boechat de Moura; de Andrade, Mauro Figueiredo Carvalho; Thuler, Luiz Claudio Santos; Bergmann, Anke

2016-02-01

The objective of the study is to describe the process of translation and cross-cultural adaptation of the Lymphoedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) into (Brazilian) Portuguese. The process was comprised of five steps - translation, back translation, revision by an expert panel, pretest, and final translation. The first translation was performed by two professionals of the healthcare area, and the back translation was performed by two translators. An expert panel assessed the questions for semantics and idiomatic, cultural, and conceptual equivalence. The pretest was conducted on 10 patients with lymphedema. Small differences were identified between the translated and back-translated versions, which were revised by the expert panel. The patients included in the pretest found 10 questions difficult to understand; these questions were reassessed by the same expert panel. The results of the translation and cross-cultural adaptation of the Lymph-ICF-LL resulted in a Brazilian Portuguese version, which still requires validation with various samples of the local population. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Test blueprints for psychiatry residency in-training written examinations in Riyadh, Saudi Arabia

PubMed Central

Gaffas, Eisha M; Sequeira, Reginald P; Namla, Riyadh A Al; Al-Harbi, Khalid S

2012-01-01

Background The postgraduate training program in psychiatry in Saudi Arabia, which was established in 1997, is a 4-year residency program. Written exams comprising of multiple choice questions (MCQs) are used as a summative assessment of residents in order to determine their eligibility for promotion from one year to the next. Test blueprints are not used in preparing examinations. Objective To develop test blueprints for the written examinations used in the psychiatry residency program. Methods Based on the guidelines of four professional bodies, documentary analysis was used to develop global and detailed test blueprints for each year of the residency program. An expert panel participated during piloting and final modification of the test blueprints. Their opinion about the content, weightage for each content domain, and proportion of test items to be sampled in each cognitive category as defined by modified Bloom’s taxonomy were elicited. Results Eight global and detailed test blueprints, two for each year of the psychiatry residency program, were developed. The global test blueprints were reviewed by experts and piloted. Six experts participated in the final modification of test blueprints. Based on expert consensus, the content, total weightage for each content domain, and proportion of test items to be included in each cognitive category were determined for each global test blueprint. Experts also suggested progressively decreasing the weightage for recall test items and increasing problem solving test items in examinations, from year 1 to year 4 of the psychiatry residence program. Conclusion A systematic approach using a documentary and content analysis technique was used to develop test blueprints with additional input from an expert panel as appropriate. Test blueprinting is an important step to ensure the test validity in all residency programs. PMID:23762000

Test blueprints for psychiatry residency in-training written examinations in Riyadh, Saudi Arabia.

PubMed

Gaffas, Eisha M; Sequeira, Reginald P; Namla, Riyadh A Al; Al-Harbi, Khalid S

2012-01-01

The postgraduate training program in psychiatry in Saudi Arabia, which was established in 1997, is a 4-year residency program. Written exams comprising of multiple choice questions (MCQs) are used as a summative assessment of residents in order to determine their eligibility for promotion from one year to the next. Test blueprints are not used in preparing examinations. To develop test blueprints for the written examinations used in the psychiatry residency program. Based on the guidelines of four professional bodies, documentary analysis was used to develop global and detailed test blueprints for each year of the residency program. An expert panel participated during piloting and final modification of the test blueprints. Their opinion about the content, weightage for each content domain, and proportion of test items to be sampled in each cognitive category as defined by modified Bloom's taxonomy were elicited. Eight global and detailed test blueprints, two for each year of the psychiatry residency program, were developed. The global test blueprints were reviewed by experts and piloted. Six experts participated in the final modification of test blueprints. Based on expert consensus, the content, total weightage for each content domain, and proportion of test items to be included in each cognitive category were determined for each global test blueprint. Experts also suggested progressively decreasing the weightage for recall test items and increasing problem solving test items in examinations, from year 1 to year 4 of the psychiatry residence program. A systematic approach using a documentary and content analysis technique was used to develop test blueprints with additional input from an expert panel as appropriate. Test blueprinting is an important step to ensure the test validity in all residency programs.

Delphi in Criminal Justice Policy: A Case Study on Judgmental Forecasting

ERIC Educational Resources Information Center

Loyens, Kim; Maesschalck, Jeroen; Bouckaert, Geert

2011-01-01

This article provides an in-depth case study analysis of a pilot project organized by the section "Strategic Analysis" of the Belgian Federal Police. Using the Delphi method, which is a judgmental forecasting technique, a panel of experts was questioned about future developments of crime, based on their expertise in criminal or social…

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

PubMed Central

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

2008-01-01

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

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

PubMed

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

2008-12-09

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

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

PubMed

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

2017-06-01

The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached. Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs.

Development and validation of an asthma first aid knowledge questionnaire.

PubMed

Luckie, Kate; Pang, Tsz Chun; Kritikos, Vicky; Saini, Bandana; Moles, Rebekah Jane

2018-05-01

There is no gold standard outcome assessment for asthma first-aid knowledge. We therefore aimed to develop and validate an asthma first-aid knowledge questionnaire (AFAKQ) to be used before and after educational interventions. The AFAKQ was developed based on a content analysis of existing asthma knowledge questionnaires and current asthma management guidelines. Content and face validity was performed by a review panel consisting of expert respiratory physicians, researchers and parents of school aged children. A 21 item questionnaire was then pilot tested among a sample of caregivers, health professionals and pharmacy students. Exploratory Factor analysis was performed to determine internal consistency. The initial 46 item version of the AFAKQ, was reduced to 21 items after revision by the expert panel. This was then pilot tested amongst 161 participants and further reduced to 14 items. The exploratory factor analysis revealed a parsimonious one factor solution with a Cronbach's Alpha of 0.77 with the 14 item AFAKQ. The AFAKQ is a valid tool ready for application in evaluating the impact of educational interventions on asthma first-aid knowledge. Copyright © 2017 Elsevier Inc. All rights reserved.

75 FR 2545 - National Toxicology Program (NTP); Center for the Evaluation of Risks to Human Reproduction...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... infants, and (3) public concern for effects on infant or child development. Following receipt of public... whether exposure to soy infant formula is a hazard to human development. The expert panel also identified... Expert Panel Report on Soy Infant Formula; Request for Public Comment AGENCY: National Institute of...

A Delphi Study on Staff Bereavement Training in the Intellectual and Developmental Disabilities Field

ERIC Educational Resources Information Center

Gray, Jennifer A.; Truesdale, Jesslyn

2015-01-01

The Delphi technique was used to obtain expert panel consensus to prioritize content areas and delivery methods for developing staff grief and bereavement curriculum training in the intellectual and developmental disabilities (IDD) field. The Delphi technique was conducted with a panel of 18 experts from formal and informal disability caregiving,…

Model curriculum outline for Alternatively Fueled Vehicle (AFV) automotive technician training in light and medium duty CNG and LPG

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

NONE

This model curriculum outline was developed using a turbo-DACUM (Developing a Curriculum) process which utilizes practicing experts to undertake a comprehensive job and task analysis. The job and task analysis serves to establish current baseline data accurately and to improve both the process and the product of the job through constant and continuous improvement of training. The DACUM process is based on the following assumptions: (1) Expert workers are the best source for task analysis. (2) Any occupation can be described effectively in terms of tasks. (3) All tasks imply knowledge, skills, and attitudes/values. A DACUM panel, comprised of sixmore » experienced and knowledgeable technicians who are presently working in the field, was given an orientation to the DACUM process. The panel then identified, verified, and sequenced all the necessary job duty areas and tasks. The broad duty categories were rated according to relative importance and assigned percentage ratings in priority order. The panel then rated every task for each of the duties on a scale of 1 to 3. A rating of 3 indicates an {open_quotes}essential{close_quotes} task, a rating of 2 indicates an {open_quotes}important{close_quotes} task, and a rating of 1 indicates a {open_quotes}desirable{close_quotes} task.« less

Science Advisory Panel Meeting on PBPK Modeling Postponed

EPA Pesticide Factsheets

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

77 FR 68773 - FIFRA Scientific Advisory Panel; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... for physical chemical properties that cannot be easily tested in in vitro systems or stable enough for.... Quantitative structural-activity relationship (QSAR) models and estrogen receptor (ER) expert systems development. High-throughput data generation and analysis (expertise focused on how this methodology can be...

Analysis of Coaching Science Research Published from 1970-2001

ERIC Educational Resources Information Center

Gilbert, Wade D.; Trudel, Pierre

2004-01-01

The study followed a four-phase design. In Phase I an exhaustive search was conducted for all English language coaching research published in journals from 1970 to 2001. In Phase II, copies of the research were obtained. An expert panel conducted a manual search and a review in Phase III to address validity. Analysis of the research was completed…

Reliability and validity evidence of the Assessment of Language Use in Social Contexts for Adults (ALUSCA).

PubMed

Valente, Ana Rita S; Hall, Andreia; Alvelos, Helena; Leahy, Margaret; Jesus, Luis M T

2018-04-12

The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. The instrument is reliable and presented evidences of construct validity.

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

ERIC Educational Resources Information Center

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

2014-01-01

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

Research Synthesis Methods in an Age of Globalized Risks: Lessons from the Global Burden of Foodborne Disease Expert Elicitation.

PubMed

2016-02-01

We live in an age that increasingly calls for national or regional management of global risks. This article discusses the contributions that expert elicitation can bring to efforts to manage global risks and identifies challenges faced in conducting expert elicitation at this scale. In doing so it draws on lessons learned from conducting an expert elicitation as part of the World Health Organizations (WHO) initiative to estimate the global burden of foodborne disease; a study commissioned by the Foodborne Disease Epidemiology Reference Group (FERG). Expert elicitation is designed to fill gaps in data and research using structured, transparent methods. Such gaps are a significant challenge for global risk modeling. Experience with the WHO FERG expert elicitation shows that it is feasible to conduct an expert elicitation at a global scale, but that challenges do arise, including: defining an informative, yet feasible geographical structure for the elicitation; defining what constitutes expertise in a global setting; structuring international, multidisciplinary expert panels; and managing demands on experts' time in the elicitation. This article was written as part of a workshop, "Methods for Research Synthesis: A Cross-Disciplinary Approach" held at the Harvard Center for Risk Analysis on October 13, 2013. © 2016 Society for Risk Analysis.

Educational Progress: Cities Mobilize To Improve Their Schools.

ERIC Educational Resources Information Center

Hill, Paul T.; And Others

This report identifies the strategies that multiproblem urban school districts have used to make major improvements in recent years. A panel of experts familiar with urban school systems nominated over 30 candidate urban districts for study. The following districts were chosen for analysis: (1) Atlanta (Georgia); (2) Cincinnati (Ohio); (3) Memphis…

Single-Case Designs Technical Documentation

ERIC Educational Resources Information Center

Kratochwill, T. R.; Hitchcock, J.; Horner, R. H.; Levin, J. R.; Odom, S. L.; Rindskopf, D. M; Shadish, W. R.

2010-01-01

In an effort to expand the pool of scientific evidence available for review, the What Works Clearinghouse (WWC) assembled a panel of national experts in single-case design (SCD) and analysis to draft SCD Standards. SCDs are adaptations of interrupted time-series designs and can provide a rigorous experimental evaluation of intervention effects.…

Next Stage for Testing Envisioned

ERIC Educational Resources Information Center

Sparks, Sarah D.

2013-01-01

Emerging technology and research on learning have the potential to dramatically improve assessments, if educators and policymakers take a more balanced approach to using them. That's the conclusion of two years of analysis by the Gordon Commission on the Future of Assessment in Education, a panel of top education research and policy experts that…

A Delphi Study and Initial Validation of Counselor Supervision Competencies

ERIC Educational Resources Information Center

Neuer Colburn, Anita A.; Grothaus, Tim; Hays, Danica G.; Milliken, Tammi

2016-01-01

The authors addressed the lack of supervision training standards for doctoral counseling graduates by developing and validating an initial list of supervision competencies. They used content analysis, Delphi polling, and content validity methods to generate a list, vetted by 2 different panels of supervision experts, of 33 competencies grouped…

Poor planning, communication lead to missteps in care of Ebola patient.

PubMed

2015-11-01

A panel of experts examining the diagnosis and care of Thomas Eric Duncan, a patient diagnosed with Ebola Virus Disease (EVD) in the United States in 2014, and the cases of two nurses who contracted EVD while caring for Duncan, has unveiled its findings along with recommendations to prevent many of the missteps that occurred during the crisis. While the independent panel was convened at the direction of Texas Health Resources, the parent company of Texas Health Presbyterian Hospital in Dallas, observers and the panel itself note that the findings should help hospitals, EDs, and communities across the country prepare for the next infectious disease event. The expert panel noted that ED personnel relied too heavily on the electronic medical record (EMR) to communicate with other members of the care team, and that important information, such as the patient's travel history, was not prioritized or highlighted in the EMR. Patient satisfaction and other operational objectives took precedence over patient safety during Duncan's ED visit, according to the expert panel's findings. The clinical team failed to pick up on changes in the patient's clinical status, missing an opportunity to re-evaluate Duncan and properly diagnosis him with EVD during his first visit to the ED. Confusion over the roles and responsibilities of local and federal health authorities, and inadequate preparation for an infectious disease event led to missteps. The expert panel suggests conducting practice drills that include all participating organizations, and hospital leaders should consider infectious disease threats as well as other types of disasters.

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

PubMed

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

2016-01-01

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

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

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

Kerr, R.A.

1996-11-08

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

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.

[Semantic, item, and conceptual equivalence of the Brazilian version of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y)].

PubMed

Lima, Alex Vieira; Rech, Cassiano Ricardo; Reis, Rodrigo Siqueira

2013-12-01

The objective of this study was to describe the process of translation and cultural adaptation of the Brazilian version of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y). The original and the Portuguese versions were independently translated and back-translated into English. An expert panel performed semantic analysis and conceptual adaptations. The translated version of the NEWS-Y was applied to a sample of eight adolescents and showed adequate understanding. After minor changes identified in the translation processes, the expert panel considered the Brazilian version of the NEWS-Y semantically and conceptually equivalent. The translated version of the NEWS-Y required a few adjustments to ensure conceptual, item, and semantic adaptation. Further studies are recommended to examine other steps in the cross-cultural adaptation of the Portuguese-language NEWS-Y version in the Brazilian context.

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

NASA Astrophysics Data System (ADS)

Bruce, J. P.

2009-05-01

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

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

PubMed

Lança, Carla

2013-09-01

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

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

PubMed

Lempesi, Evangelia; Toulia, Electra; Pandis, Nikolaos

2017-04-01

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

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

PubMed Central

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

2017-01-01

Background The contributions that community–based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health–related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. Methods An Expert Panel convened to guide the review of the effectiveness of community–based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review’s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer–reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). Results The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs – through engagement with planning, implementation (including the full use of community–level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence–based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached. Conclusions Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence–based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs. PMID:28685046

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.

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.

Safety Assessment of Alkyl PEG Sulfosuccinates as Used in Cosmetics.

PubMed

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

2015-09-01

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) reviewed the safety of alkyl polyethylene glycol (PEG) sulfosuccinates, which function in cosmetics mostly as surfactants/cleansing agents. Although these ingredients may cause ocular and skin irritation, dermal penetration is unlikely because of the substantial polarity and molecular size of these ingredients. The Panel considered the negative oral carcinogenicity and reproductive and developmental toxicity data on chemically related laureths (PEG lauryl ethers) and negative repeated dose toxicity and skin sensitization data on disodium laureth sulfosuccinate supported the safety of these alkyl PEG sulfosuccinates in cosmetic products, but. The CIR Expert Panel concluded that the alkyl PEG sulfosuccinates are safe in the present practices of use and concentration when formulated to be nonirritating. © The Author(s) 2015.

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

PubMed

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

2017-11-01

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

Drug research methodology. Volume 3, The detection and quantitation of drugs of interest in body fluids from drivers

DOT National Transportation Integrated Search

1980-03-01

This report presents the findings of a workshop on the chemical analysis of human body fluids for drugs of interest in highway safety. A cross-disciplinary panel of experts reviewed the list of drugs of interest developed in a previous workshop and d...

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

PubMed

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

2018-01-01

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

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

Treesearch

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

2012-01-01

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

Extending Theory-Based Quantitative Predictions to New Health Behaviors.

PubMed

Brick, Leslie Ann D; Velicer, Wayne F; Redding, Colleen A; Rossi, Joseph S; Prochaska, James O

2016-04-01

Traditional null hypothesis significance testing suffers many limitations and is poorly adapted to theory testing. A proposed alternative approach, called Testing Theory-based Quantitative Predictions, uses effect size estimates and confidence intervals to directly test predictions based on theory. This paper replicates findings from previous smoking studies and extends the approach to diet and sun protection behaviors using baseline data from a Transtheoretical Model behavioral intervention (N = 5407). Effect size predictions were developed using two methods: (1) applying refined effect size estimates from previous smoking research or (2) using predictions developed by an expert panel. Thirteen of 15 predictions were confirmed for smoking. For diet, 7 of 14 predictions were confirmed using smoking predictions and 6 of 16 using expert panel predictions. For sun protection, 3 of 11 predictions were confirmed using smoking predictions and 5 of 19 using expert panel predictions. Expert panel predictions and smoking-based predictions poorly predicted effect sizes for diet and sun protection constructs. Future studies should aim to use previous empirical data to generate predictions whenever possible. The best results occur when there have been several iterations of predictions for a behavior, such as with smoking, demonstrating that expected values begin to converge on the population effect size. Overall, the study supports necessity in strengthening and revising theory with empirical data.

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

PubMed

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

2014-11-15

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

Developing and Testing a Model to Predict Outcomes of Organizational Change

PubMed Central

Gustafson, David H; Sainfort, François; Eichler, Mary; Adams, Laura; Bisognano, Maureen; Steudel, Harold

2003-01-01

Objective To test the effectiveness of a Bayesian model employing subjective probability estimates for predicting success and failure of health care improvement projects. Data Sources Experts' subjective assessment data for model development and independent retrospective data on 221 healthcare improvement projects in the United States, Canada, and the Netherlands collected between 1996 and 2000 for validation. Methods A panel of theoretical and practical experts and literature in organizational change were used to identify factors predicting the outcome of improvement efforts. A Bayesian model was developed to estimate probability of successful change using subjective estimates of likelihood ratios and prior odds elicited from the panel of experts. A subsequent retrospective empirical analysis of change efforts in 198 health care organizations was performed to validate the model. Logistic regression and ROC analysis were used to evaluate the model's performance using three alternative definitions of success. Data Collection For the model development, experts' subjective assessments were elicited using an integrative group process. For the validation study, a staff person intimately involved in each improvement project responded to a written survey asking questions about model factors and project outcomes. Results Logistic regression chi-square statistics and areas under the ROC curve demonstrated a high level of model performance in predicting success. Chi-square statistics were significant at the 0.001 level and areas under the ROC curve were greater than 0.84. Conclusions A subjective Bayesian model was effective in predicting the outcome of actual improvement projects. Additional prospective evaluations as well as testing the impact of this model as an intervention are warranted. PMID:12785571

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

PubMed

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

2017-01-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

1998-10-14

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

FIFRA Scientific Advisory Panel

EPA Pesticide Factsheets

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

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

PubMed

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

2017-04-04

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

Teaching statistics to nursing students: an expert panel consensus.

PubMed

Hayat, Matthew J; Eckardt, Patricia; Higgins, Melinda; Kim, MyoungJin; Schmiege, Sarah J

2013-06-01

Statistics education is a necessary element of nursing education, and its inclusion is recommended in the American Association of Colleges of Nursing guidelines for nurse training at all levels. This article presents a cohesive summary of an expert panel discussion, "Teaching Statistics to Nursing Students," held at the 2012 Joint Statistical Meetings. All panelists were statistics experts, had extensive teaching and consulting experience, and held faculty appointments in a U.S.-based nursing college or school. The panel discussed degree-specific curriculum requirements, course content, how to ensure nursing students understand the relevance of statistics, approaches to integrating statistics consulting knowledge, experience with classroom instruction, use of knowledge from the statistics education research field to make improvements in statistics education for nursing students, and classroom pedagogy and instruction on the use of statistical software. Panelists also discussed the need for evidence to make data-informed decisions about statistics education and training for nurses. Copyright 2013, SLACK Incorporated.

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

PubMed Central

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

2016-01-01

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

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

PubMed

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

2015-12-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2014-02-01

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

HUMAN HEALTH DAMAGES FROM MOBILE SOURCE AIR POLLUTION: ADDITIONAL DELPHI DATA ANALYSIS. VOLUME II

EPA Science Inventory

The report contains the results of additional analyses of the data generated by a panel of medical experts for a study of Human Health Damages from Mobile Source Air Pollution (hereafter referred to as HHD) conducted by the California Air Resources Board in 1973-75 for the U.S. E...

Should this event be notified to the World Health Organization? Reliability of the international health regulations notification assessment process.

PubMed

Haustein, Thomas; Hollmeyer, Helge; Hardiman, Max; Harbarth, Stephan; Pittet, Didier

2011-04-01

To investigate the reliability of the public health event notification assessment process under the International Health Regulations (2005) (IHR). In 2009, 193 National IHR Focal Points (NFPs) were invited to use the decision instrument in Annex 2 of the IHR to determine whether 10 fictitious public health events should be notified to WHO. Each event's notifiability was assessed independently by an expert panel. The degree of consensus among NFPs and of concordance between NFPs and the expert panel was considered high when more than 70% agreed on a response. Overall, 74% of NFPs responded. The median degree of consensus among NFPs on notification decisions was 78%. It was high for the six events considered notifiable by the majority (median: 80%; range: 76-91) but low for the remaining four (median: 55%; range: 54-60). The degree of concordance between NFPs and the expert panel was high for the five events deemed notifiable by the panel (median: 82%; range: 76-91) but low (median: 51%; range: 42-60) for those not considered notifiable. The NFPs identified notifiable events with greater sensitivity than specificity (P < 0.001). When used by NFPs, the notification assessment process in Annex 2 of the IHR was sensitive in identifying public health events that were considered notifiable by an expert panel, but only moderately specific. The reliability of the assessments could be increased by expanding guidance on the use of the decision instrument and by including more specific criteria for assessing events and clearer definitions of terms.

Expert Systems on Multiprocessor Architectures. Volume 2. Technical Reports

DTIC Science & Technology

1991-06-01

Report RC 12936 (#58037). IBM T. J. Wartson Reiearch Center. July 1987. � Alan Jay Smith. Cache memories. Coniputing Sitrry., 1.1(3): I.3-5:30...basic-shared is an instrument for ashared memory design. The components panels are processor- qload-scrolling-bar-panel, memory-qload-scrolling-bar-panel

Characterization and classification of Japanese consumer perceptions for beef tenderness using descriptive texture characteristics assessed by a trained sensory panel.

PubMed

Sasaki, Keisuke; Motoyama, Michiyo; Narita, Takumi; Hagi, Tatsuro; Ojima, Koichi; Oe, Mika; Nakajima, Ikuyo; Kitsunai, Katsuhiro; Saito, Yosuke; Hatori, Hikari; Muroya, Susumu; Nomura, Masaru; Miyaguchi, Yuji; Chikuni, Koichi

2014-02-01

Meat tenderness is an important characteristic in terms of consumer preference and satisfaction. However, each consumer may have his/her own criteria to judge meat tenderness, because consumers are neither selected nor trained like an expert sensory panel. This study aimed to characterize consumer tenderness using descriptive texture profiles such as chewiness and hardness assessed by a trained panel. Longissimus muscles cooked at four different end-point temperatures were subjected to a trained sensory panel (n=18) and consumer (n=107) tenderness tests. Multiple regression analysis showed that consumer tenderness was characterized as 'low-chewiness and low hardness texture.' Subsequently, consumers were divided into two groups by cluster analysis according to tenderness perceptions in each participant, and the two groups were characterized as 'tenderness is mainly low-chewiness' and 'tenderness is mainly low-hardness' for tenderness perception, respectively. These results demonstrate objective characteristics and variability of consumer meat tenderness, and provide new information regarding the evaluation and management of meat tenderness for meat manufacturers. © 2013.

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

ERIC Educational Resources Information Center

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

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

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

PubMed

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

2009-10-01

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

Use of cultural consensus analysis to evaluate expert feedback of median safety.

PubMed

Kim, Tae-Gyu; Donnell, Eric T; Lee, Dongmin

2008-07-01

Cultural consensus analysis is a statistical method that can be used to assess participant responses to survey questions. The technique concurrently estimates the knowledge of each survey participant and estimates the culturally correct answer to each question asked, based on the existence of consensus among survey participants. The main objectives of this paper are to present the cultural consensus methodology and apply it to a set of median design and safety survey data that were collected using the Delphi method. A total of 21 Delphi survey participants were asked to answer research questions related to cross-median crashes. It was found that the Delphi panel had agreeable opinions with respect to the association of average daily traffic (ADT) and heavy vehicle percentage combination on the risk of cross-median crashes; relative importance of additional factors, other than ADT, median width, and crash history that may contribute to cross-median crashes; and, the relative importance of geometric factors that may be associated with the likelihood of cross-median crashes. Therefore, the findings from the cultural consensus analysis indicate that the expert panel selected to participate in the Delphi survey shared a common knowledge pool relative to the association between median design and safety. There were, however, diverse opinions regarding median barrier type and its preferred placement location. The panel showed a higher level of knowledge on the relative importance regarding the association of geometric factors on cross-median crashes likelihood than on other issues considered. The results of the cultural consensus analysis of the present median design and safety survey data could be used to design a focused field study of median safety.

Validation of consensus panel diagnosis in dementia.

PubMed

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

2010-12-01

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

Curricula for Media Literacy Education According to International Experts

ERIC Educational Resources Information Center

Fedorov, Alexander; Levitskaya, Anastasia; Camarero, Emma

2016-01-01

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

Is the relationship between pattern recall and decision-making influenced by anticipatory recall?

PubMed

Gorman, Adam D; Abernethy, Bruce; Farrow, Damian

2013-01-01

The present study compared traditional measures of pattern recall to measures of anticipatory recall and decision-making to examine the underlying mechanisms of expert pattern perception and to address methodological limitations in previous studies where anticipatory recall has generally been overlooked. Recall performance in expert and novice basketball players was measured by examining the spatial error in recalling player positions both for a target image (traditional recall) and at 40-ms increments following the target image (anticipatory recall). Decision-making performance was measured by comparing the participant's response to those identified by a panel of expert coaches. Anticipatory recall was observed in the recall task and was significantly more pronounced for the experts, suggesting that traditional methods of spatial recall analysis may not have provided a completely accurate determination of the full magnitude of the experts' superiority. Accounting for anticipatory recall also increased the relative contribution of recall skill to decision-making accuracy although the gains in explained variance were modest and of debatable functional significance.

Value of biologic therapy: a forecasting model in three disease areas.

PubMed

Paramore, L Clark; Hunter, Craig A; Luce, Bryan R; Nordyke, Robert J; Halbert, R J

2010-01-01

Forecast the return on investment (ROI) for advances in biologic therapies in years 2015 and 2030, based upon impact on disease prevalence, morbidity, and mortality for asthma, diabetes, and colorectal cancer. A deterministic, spreadsheet-based, forecasting model was developed based on trends in demographics and disease epidemiology. 'Return' was defined as reductions in disease burden (prevalence, morbidity, mortality) translated into monetary terms; 'investment' was defined as the incremental costs of biologic therapy advances. Data on disease prevalence, morbidity, mortality, and associated costs were obtained from government survey statistics or published literature. Expected impact of advances in biologic therapies was based on expert opinion. Gains in quality-adjusted life years (QALYs) were valued at $100,000 per QALY. The base case analysis, in which reductions in disease prevalence and mortality predicted by the expert panel are not considered, shows the resulting ROIs remain positive for asthma and diabetes but fall below $1 for colorectal cancer. Analysis involving expert panel predictions indicated positive ROI results for all three diseases at both time points, ranging from $207 for each incremental dollar spent on biologic therapies to treat asthma in 2030, to $4 for each incremental dollar spent on biologic therapies to treat colorectal cancer in 2015. If QALYs are not considered, the resulting ROIs remain positive for all three diseases at both time points. Society may expect substantial returns from investments in innovative biologic therapies. These benefits are most likely to be realized in an environment of appropriate use of new molecules. The potential variance between forecasted (from expert opinion) and actual future health outcomes could be significant. Similarly, the forecasted growth in use of biologic therapies relied upon unvalidated market forecasts.

2005 Youth Sports National Report Card

ERIC Educational Resources Information Center

Strategies: A Journal for Physical and Sport Educators, 2006

2006-01-01

For the first time ever, Citizen Through Sports Alliance (CTSA) convened a panel of youth sports experts from across the country to evaluate youth sports in the United States and articulate its successes and failures. The panel evaluated only community-based youth sports programs, focusing on those that serve children ages 6 to 14. The panel is…

77 FR 75414 - Establishment of Department of Defense Federal Advisory Committees

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-20

... duration of the Panel, with annual renewals of appointments. Panel members, who are not full-time or permanent part- time Federal officers or employees, shall be appointed to serve as experts or consultants... conflict of interest. With the exception of travel and per diem for travel related to the Panel, members of...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-19

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

Benchmarks for Deeper Learning on Next Generation Tests: A Study of PISA. CRESST Report 855

ERIC Educational Resources Information Center

Herman, Joan L.; La Torre, Deborah; Epstein, Scott; Wang, Jia

2016-01-01

This report presents the results of expert panels' item-by-item analysis of the 2015 PISA Reading Literacy and Mathematics Literacy assessments and compares study findings on PISA's representation of deeper learning with that of other related studies. Results indicate that about 11% to 14% of PISA's total raw score value for reading and…

Enlargement Futures Project: Information and Communication Technologies. Final Report. Enlargement Futures Series.

ERIC Educational Resources Information Center

Gourova, Elissaveta; Burgelman, Jean-Claude; Bogdanowicz, Marc; Herrmann, Christoph

Trends in the development and utilization of information and communication technologies (ICT) in the 13 candidate countries for admission into the European Union(the CC13) were examined by a 12-member panel of experts and its staff. The analysis focused on the following topics: (1) the communication infrastructure available in the CC13; (2) issues…

Comparative Analysis of OECD Member Countries' Competitive Advantage in National Human Resource Development System

ERIC Educational Resources Information Center

Oh, Hunseok; Choi, Yeseul; Choi, Myungweon

2013-01-01

The purpose of this study was to assess, evaluate, and compare the competitive advantages of the human resource development systems of advanced countries. The Global Human Resource Development Index was utilized for this study, since it has been validated through an expert panel's content review and analytic hierarchy process. Using a sample of 34…

Should this event be notified to the World Health Organization? Reliability of the International Health Regulations notification assessment process

PubMed Central

Hollmeyer, Helge; Hardiman, Max; Harbarth, Stephan; Pittet, Didier

2011-01-01

Abstract Objective To investigate the reliability of the public health event notification assessment process under the International Health Regulations (2005) (IHR). Methods In 2009, 193 National IHR Focal Points (NFPs) were invited to use the decision instrument in Annex 2 of the IHR to determine whether 10 fictitious public health events should be notified to WHO. Each event’s notifiability was assessed independently by an expert panel. The degree of consensus among NFPs and of concordance between NFPs and the expert panel was considered high when more than 70% agreed on a response. Findings Overall, 74% of NFPs responded. The median degree of consensus among NFPs on notification decisions was 78%. It was high for the six events considered notifiable by the majority (median: 80%; range: 76–91) but low for the remaining four (median: 55%; range: 54–60). The degree of concordance between NFPs and the expert panel was high for the five events deemed notifiable by the panel (median: 82%; range: 76–91) but low (median: 51%; range: 42–60) for those not considered notifiable. The NFPs identified notifiable events with greater sensitivity than specificity (P < 0.001). Conclusion When used by NFPs, the notification assessment process in Annex 2 of the IHR was sensitive in identifying public health events that were considered notifiable by an expert panel, but only moderately specific. The reliability of the assessments could be increased by expanding guidance on the use of the decision instrument and by including more specific criteria for assessing events and clearer definitions of terms. PMID:21479094

How to develop a proactive formulary system.

PubMed

Crane, V S; Gonzalez, E R; Hull, B L

1994-10-01

To develop a quality formulary system, a proactive approach is necessary. This approach incorporates a prospective product and concurrent product analyses. A prospective product analysis, in turn, involves a review of current formulary agents, those likely to enter the marketplace shortly, and the formation of an expert review panel. This panel's tasks are to examine therapeutic, economic, and humanistic aspects of therapy and to set initial parameters for appropriate and cost-effective use of accepted products. Keys to a successful formulary system are to continuously monitor drug use and compliance with criteria and to work collaboratively with all institutional professionals in the development, implementation, and monitoring of the system.

A Delphi Consensus of the Crucial Steps in Gastric Bypass and Sleeve Gastrectomy Procedures in the Netherlands.

PubMed

Kaijser, Mirjam A; van Ramshorst, Gabrielle H; Emous, Marloes; Veeger, Nic J G M; van Wagensveld, Bart A; Pierie, Jean-Pierre E N

2018-04-09

Bariatric procedures are technically complex and skill demanding. In order to standardize the procedures for research and training, a Delphi analysis was performed to reach consensus on the practice of the laparoscopic gastric bypass and sleeve gastrectomy in the Netherlands. After a pre-round identifying all possible steps from literature and expert opinion within our study group, questionnaires were send to 68 registered Dutch bariatric surgeons, with 73 steps for bypass surgery and 51 steps for sleeve gastrectomy. Statistical analysis was performed to identify steps with and without consensus. This process was repeated to reach consensus of all necessary steps. Thirty-eight participants (56%) responded in the first round and 32 participants (47%) in the second round. After the first Delphi round, 19 steps for gastric bypass (26%) and 14 for sleeve gastrectomy (27%) gained full consensus. After the second round, an additional amount of 10 and 12 sub-steps was confirmed as key steps, respectively. Thirteen steps in the gastric bypass and seven in the gastric sleeve were deemed advisable. Our expert panel showed a high level of consensus expressed in a Cronbach's alpha of 0.82 for the gastric bypass and 0.87 for the sleeve gastrectomy. The Delphi consensus defined 29 steps for gastric bypass and 26 for sleeve gastrectomy as being crucial for correct performance of these procedures to the standards of our expert panel. These results offer a clear framework for the technical execution of these procedures.

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

PubMed

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

2018-04-01

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

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…

[A model for shared decision-making with frail older patients: consensus reached using Delphi technique].

PubMed

van de Pol, M H J; Fluit, C R M G; Lagro, J; Lagro-Janssen, A L M; Olde Rikkert, M G M

2017-01-01

To develop a model for shared decision-making with frail older patients. Online Delphi forum. We used a three-round Delphi technique to reach consensus on the structure of a model for shared decision-making with older patients. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the panel of experts was asked about important steps in the process of shared decision-making and the draft model was introduced. Rounds 2 and 3 were used to adapt the model and test it for 'importance' and 'feasibility'. Consensus for the dynamic shared decision-making model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). Shared decision-making with older patients is a dynamic process. It requires a continuous supportive dialogue between health care professional and patient.

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type

PubMed Central

Onega, Tracy; Smith, Megan; Miglioretti, Diana L.; Carney, Patricia A.; Geller, Berta; Kerlikowske, Karla; Buist, Diana SM; Rosenberg, Robert D.; Smith, Robert; Sickles, Edward A.; Haneuse, Sebastien; Anderson, Melissa L.; Yankaskas, Bonnie

2012-01-01

INTRODUCTIONS To assess agreement of mammography interpretations by community radiologists with consensus interpretations of an expert radiology panel, to inform approaches that improve mammography performance. METHODS From six mammography registries, 119 community-based radiologists were recruited to assess one of four randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type [mass, calcifications, asymmetric density or architectural distortion] and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the woman, breast, and lesion level. We also examined concordance in finding type between study radiologists and the expert panel. For each finding type, we determined the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls. RESULTS Recall agreement was 100% for masses and for exams with obvious findings in both cancer and non-cancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle non-cancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. CONCLUSION Agreement in mammography interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve mammography accuracy and reduce unnecessary recalls. PMID:23122345

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

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

PubMed

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

2014-08-01

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

Pharmacy executives: leadership issues and associated skills, knowledge, and abilities in the U.S. Department of Defense.

PubMed

Meadows, Andrew B; Finstuen, Kenn; Hudak, Ronald P

2003-01-01

To identify the issues or problems that current and aspiring U.S. Department of Defense (DoD) pharmacy executives will face in the future and to define the skills, knowledge, and abilities (SKAs) required to successfully address these issues. Delphi method for executive decision making. DoD. Ninety-three pharmacists serving in the military grades of lieutenant colonel/commander and colonel/captain, as well as pharmacists selected for promotion to those grades. iterations of the Delphi method for executive decision making separated by an expert panel content analysis. Round 1--participants identified five major issues believed to be of greatest importance to pharmacy executives and reported specific SKAs that might be needed to successfully manage those issues. An expert panel sorted these issues into meaningful domains, then provided an appropriate title for each domain. Round 2--on a 7-point scale, respondents rated the SKA items according to their assessment of how much a future DoD pharmacy executive would need each SKA. Response rates were 44.1% and 46.2% for Delphi rounds 1 and 2, respectively. The first round generated 62 unique issues facing pharmacy executives. The expert panel reviewed and sorted the issues into eight domains and selected an appropriate title for each domain. The domains identified by the panel were human resources, pharmacy operations/business practices, information management and technology, financial resources, formulary management, drug therapy management, pharmacy benefit management, and leadership. During round 2, 73.3% of the top 15 rated SKAs came from the drug therapy management, leadership, and formulary management domains. The three highest-rated SKAs were "ability to see the big picture," "ability to build strong relations with medical staffs," and "skills in both writing and verbal communication." The issues facing future DoD pharmacy executives will require them to expand their clinical abilities as well as their ability to collaborate and communicate with other professionals.

Standardizing Flow Cytometry Immunophenotyping Analysis from the Human ImmunoPhenotyping Consortium

PubMed Central

Finak, Greg; Langweiler, Marc; Jaimes, Maria; Malek, Mehrnoush; Taghiyar, Jafar; Korin, Yael; Raddassi, Khadir; Devine, Lesley; Obermoser, Gerlinde; Pekalski, Marcin L.; Pontikos, Nikolas; Diaz, Alain; Heck, Susanne; Villanova, Federica; Terrazzini, Nadia; Kern, Florian; Qian, Yu; Stanton, Rick; Wang, Kui; Brandes, Aaron; Ramey, John; Aghaeepour, Nima; Mosmann, Tim; Scheuermann, Richard H.; Reed, Elaine; Palucka, Karolina; Pascual, Virginia; Blomberg, Bonnie B.; Nestle, Frank; Nussenblatt, Robert B.; Brinkman, Ryan Remy; Gottardo, Raphael; Maecker, Holden; McCoy, J Philip

2016-01-01

Standardization of immunophenotyping requires careful attention to reagents, sample handling, instrument setup, and data analysis, and is essential for successful cross-study and cross-center comparison of data. Experts developed five standardized, eight-color panels for identification of major immune cell subsets in peripheral blood. These were produced as pre-configured, lyophilized, reagents in 96-well plates. We present the results of a coordinated analysis of samples across nine laboratories using these panels with standardized operating procedures (SOPs). Manual gating was performed by each site and by a central site. Automated gating algorithms were developed and tested by the FlowCAP consortium. Centralized manual gating can reduce cross-center variability, and we sought to determine whether automated methods could streamline and standardize the analysis. Within-site variability was low in all experiments, but cross-site variability was lower when central analysis was performed in comparison with site-specific analysis. It was also lower for clearly defined cell subsets than those based on dim markers and for rare populations. Automated gating was able to match the performance of central manual analysis for all tested panels, exhibiting little to no bias and comparable variability. Standardized staining, data collection, and automated gating can increase power, reduce variability, and streamline analysis for immunophenotyping. PMID:26861911

Strategy Development Workshop for Public Education on Weight and Obesity (Bethesda, Maryland, September 24-25, 1992). Summary Report.

ERIC Educational Resources Information Center

National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

This report summarizes expert panel presentations and large and small group discussions focused on identifying educational opportunities as part of a public education effort to prevent obesity. Panel 1 reported on the epidemiology of obesity and cardiovascular disease, including obesity in both children and adults. Panel 2 reported on…

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

EPA Science Inventory

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

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input.

PubMed

O'Connor, Teresia M; Mâsse, Louise C; Tu, Andrew W; Watts, Allison W; Hughes, Sheryl O; Beauchamp, Mark R; Baranowski, Tom; Pham, Truc; Berge, Jerica M; Fiese, Barbara; Golley, Rebecca; Hingle, Melanie; Kremers, Stef P J; Rhee, Kyung E; Skouteris, Helen; Vaughn, Amber

2017-09-11

Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

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

PubMed

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

2018-02-01

Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus. Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5- point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service. Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies. A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team. Copyright © 2017 European Society for Vascular Surgery. All rights reserved.

Evaluation of Screening for Retinopathy of Prematurity by ROPtool or a Lay Reader.

PubMed

Abbey, Ashkan M; Besirli, Cagri G; Musch, David C; Andrews, Chris A; Capone, Antonio; Drenser, Kimberly A; Wallace, David K; Ostmo, Susan; Chiang, Michael; Lee, Paul P; Trese, Michael T

2016-02-01

To determine if (1) tortuosity assessment by a computer program (ROPtool, developed at the University of North Carolina, Chapel Hill, and Duke University, and licensed by FocusROP) that traces retinal blood vessels and (2) assessment by a lay reader are comparable with assessment by a panel of 3 retinopathy of prematurity (ROP) experts for remote clinical grading of vascular abnormalities such as plus disease. Validity and reliability analysis of diagnostic tools. Three hundred thirty-five fundus images of prematurely born infants. Three hundred thirty-five fundus images of prematurely born infants were obtained by neonatal intensive care unit nurses. A panel of 3 ROP experts graded 84 images showing vascular dilatation, tortuosity, or both and 251 images showing no evidence of vascular abnormalities. These images were sent electronically to an experienced lay reader who independently graded them for vascular abnormalities. The images also were analyzed using the ROPtool, which assigns a numerical value to the level of vascular abnormality and tortuosity present in each of 4 quadrants or sectors. The ROPtool measurements of vascular abnormalities were graded and compared with expert panel grades with a receiver operating characteristic (ROC) curve. Grades between human readers were cross-tabulated. The area under the ROC curve was calculated for the ROPtool, and sensitivity and specificity were computed for the lay reader. Measurements of vascular abnormalities by ROPtool and grading of vascular abnormalities by 3 ROP experts and 1 experienced lay reader. The ROC curve for ROPtool's tortuosity assessment had an area under the ROC curve of 0.917. Using a threshold value of 4.97 for the second most tortuous quadrant, ROPtool's sensitivity was 91% and its specificity was 82%. Lay reader sensitivity and specificity were 99% and 73%, respectively, and had high reliability (κ, 0.87) in repeated measurements. ROPtool had very good accuracy for detection of vascular abnormalities suggestive of plus disease when compared with expert physician graders. The lay reader's results showed excellent sensitivity and good specificity when compared with those of the expert graders. These options for remote reading of images to detect vascular abnormalities deserve consideration in the quest to use telemedicine with remote reading for efficient delivery of high-quality care and to detect infants requiring bedside examination. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The Toileting Habit Profile Questionnaire: Screening for Sensory-Based Toileting Difficulties in Young Children with Constipation and Retentive Fecal Incontinence

ERIC Educational Resources Information Center

Beaudry-Bellefeuille, Isabelle; Lane, Shelly J.; Ramos-Polo, Eduardo

2016-01-01

This study examined the face and preliminary content validity of the Toileting Habit Profile Questionnaire, a tool designed to screen for sensory-based defecation difficulties in children. A panel of experts reviewed a pilot version of the questionnaire and responded to probe questions. Two reviewers conducted direct content analysis of responses;…

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

PubMed

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

2017-07-01

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

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

PubMed Central

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

2017-01-01

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

Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline.

PubMed

Ramakrishna, Naren; Temin, Sarah; Chandarlapaty, Sarat; Crews, Jennie R; Davidson, Nancy E; Esteva, Francisco J; Giordano, Sharon H; Gonzalez-Angulo, Ana M; Kirshner, Jeffrey J; Krop, Ian; Levinson, Jennifer; Modi, Shanu; Patt, Debra A; Perez, Edith A; Perlmutter, Jane; Winer, Eric P; Lin, Nancy U

2014-07-01

To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. The American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging (MRI) to screen for brain metastases, but rather should have a low threshold for MRI of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. © 2014 by American Society of Clinical Oncology.

Identifying Threshold Concepts for Information Literacy: A Delphi Study

ERIC Educational Resources Information Center

Townsend, Lori; Hofer, Amy R.; Hanick, Silvia Lin; Brunetti, Korey

2016-01-01

This study used the Delphi method to engage expert practitioners on the topic of threshold concepts--core ideas and processes in a discipline that students need to grasp in order to progress in their learning, but that are often unspoken or unrecognized by expert practitioners--for information literacy. A panel of experts considered two questions:…

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

ERIC Educational Resources Information Center

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

2006-01-01

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

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

ERIC Educational Resources Information Center

Neuman, Susan B.

2010-01-01

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

Safety of ingredients used in cosmetics.

PubMed

Bergfeld, Wilma F; Belsito, Donald V; Marks, James G; Andersen, F Alan

2005-01-01

The Cosmetic Ingredient Review (CIR) program was established in 1976 by the Cosmetics, Toiletry, and Fragrance Association, with the support of the Food and Drug Administration (FDA) and the Consumer Federation of America (CFA). CIR performs independent, expert reviews to determine if ingredients used in cosmetics are safe. CIR staff prepares summaries of available data and the CIR Expert Panel reviews the data in open, public meetings. If more data are needed, requests are made. Unpublished studies may be provided, but become public and available for review once summarized in CIR safety assessments. Tentative conclusions are supported with a rationale and public comment is sought. Taking any input into consideration, a final safety assessment monograph is issued. These monographs are submitted for publication in the peer-reviewed International Journal of Toxicology . To date, 1194 individual cosmetic ingredients have been addressed. Of these, 683 were found to be safe in cosmetics in the present practices of use and concentration. With qualifications, another 388 have been found safe for use in cosmetics; specific qualifications for each are given. Nine ingredients have been deemed unsafe for use in cosmetics and the safety issue has been described. The available data were found insufficient to support the safety of 114 ingredients; the needed data are listed. Hair dyes represent an important product category reviewed by CIR. In considering hair dyes, the CIR Expert Panel reviews experimental and clinical data specific to the particular chemical structure of each hair dye and reviews epidemiologic studies that address hair dye use that are less specific. Recently the CIR Expert Panel concluded that the available epidemiologic studies are insufficient to conclude there is a causal relationship between hair dye use and cancer and other end points. It is inevitable that new information will become available concerning ingredients for which safety assessments were completed in the early days of the program. To consider new data, the CIR Expert Panel has instituted a re-review program. Sodium lauryl sulfate (SLS), formaldehyde, and parabens are discussed as examples. Safety assessments currently underway are listed, along with high-priority ingredients from which new work will be chosen. Although supported by the cosmetics industry, the CIR program has remained independent in its decision making, based on its open, public process; the integrity of the expert panel members; the participation of the FDA and the CFA; and the cooperation of the cosmetics industry.

75 FR 44968 - Office of the Secretary, Office of the Assistant Secretary for Planning and Evaluation; Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... Trustees) establish a panel of technical experts to review the methods used in the HI and SMI annual... care, and alternate projection methodologies. The panel may also examine other methodological issues...

Mediating the Cognitive Walkthrough with Patient Groups to achieve Personalized Health in Chronic Disease Self-Management System Evaluation.

PubMed

Georgsson, Mattias; Kushniruk, Andre

2016-01-01

The cognitive walkthrough (CW) is a task-based, expert inspection usability evaluation method involving benefits such as cost effectiveness and efficiency. A drawback of the method is that it doesn't involve the user perspective from real users but instead is based on experts' predictions about the usability of the system and how users interact. In this paper, we propose a way of involving the user in an expert evaluation method by modifying the CW with patient groups as mediators. This along with other modifications include a dual domain session facilitator, specific patient groups and three different phases: 1) a preparation phase where suitable tasks are developed by a panel of experts and patients, validated through the content validity index 2) a patient user evaluation phase including an individual and collaborative process part 3) an analysis and coding phase where all data is digitalized and synthesized making use of Qualitative Data Analysis Software (QDAS) to determine usability deficiencies. We predict that this way of evaluating will utilize the benefits of the expert methods, also providing a way of including the patient user of these self-management systems. Results from this prospective study should provide evidence of the usefulness of this method modification.

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

PubMed Central

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

1998-01-01

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

Definition of an organisational model for the prevention and reduction of health and social impacts of inherited bleeding disorders.

PubMed

Calizzani, Gabriele; Menichini, Ivana; Candura, Fabio; Lanzoni, Monica; Profili, Samantha; Tamburrini, Maria Rita; Fortino, Antonio; Vaglio, Stefania; Marano, Giuseppe; Facco, Giuseppina; Oliovecchio, Emily; Franchini, Massimo; Coppola, Antonio; Arcieri, Romano; Bon, Cinzia; Saia, Mario; Nuti, Sabina; Morfini, Massimo; Liumbruno, Giancarlo M; Di Minno, Giovanni; Grazzini, Giuliano

2014-04-01

Due to the increase in life expectancy, patients with haemophilia and other inherited bleeding disorders are experiencing age-related comorbidities that present new challenges. In order to meet current and emerging needs, a model for healthcare pathways was developed through a project funded by the Italian Ministry of Health. The project aimed to prevent or reduce the social-health burden of the disease and its complications. The National Blood Centre appointed a panel of experts comprising clinicians, patients, National and Regional Health Authority representatives. Following an analysis of the scientific and regulatory references, the panel drafted a technical proposal containing recommendations for Regional Health Authorities, which has been formally submitted to the Ministry of Health. Finally, a set of indicators to monitor haemophilia care provision has been defined. In the technical document, the panel of experts proposed the adoption of health policy recommendations summarised in areas, such as: multidisciplinary integrated approach for optimal healthcare provision; networking and protocols for emergency care; home therapy; registries/databases; replacement therapy supply and distribution; recruitment and training of experts in bleeding disorders. The recommendations became the content of proposal of agreement between the Government and the Regions. Monitoring and evaluation of haemophilia care through the set of established indicators was partially performed due to limited available data. The project provided recommendations for the clinical and organisational management of patient with haemophilia. A particular concern was given to those areas that play a critical role in the comorbidities and complications prevention. Recommendations are expected to harmonise healthcare care delivery across regional networks and building the foundation for the national haemophilia network.

Definition of an organisational model for the prevention and reduction of health and social impacts of inherited bleeding disorders

PubMed Central

Calizzani, Gabriele; Menichini, Ivana; Candura, Fabio; Lanzoni, Monica; Profili, Samantha; Tamburrini, Maria Rita; Fortino, Antonio; Vaglio, Stefania; Marano, Giuseppe; Facco, Giuseppina; Oliovecchio, Emily; Franchini, Massimo; Coppola, Antonio; Arcieri, Romano; Bon, Cinzia; Saia, Mario; Nuti, Sabina; Morfini, Massimo; Liumbruno, Giancarlo M.; Di Minno, Giovanni; Grazzini, Giuliano

2014-01-01

Introduction Due to the increase in life expectancy, patients with haemophilia and other inherited bleeding disorders are experiencing age-related comorbidities that present new challenges. In order to meet current and emerging needs, a model for healthcare pathways was developed through a project funded by the Italian Ministry of Health. The project aimed to prevent or reduce the social-health burden of the disease and its complications. Material and methods The National Blood Centre appointed a panel of experts comprising clinicians, patients, National and Regional Health Authority representatives. Following an analysis of the scientific and regulatory references, the panel drafted a technical proposal containing recommendations for Regional Health Authorities, which has been formally submitted to the Ministry of Health. Finally, a set of indicators to monitor haemophilia care provision has been defined. Results In the technical document, the panel of experts proposed the adoption of health policy recommendations summarised in areas, such as: multidisciplinary integrated approach for optimal healthcare provision; networking and protocols for emergency care; home therapy; registries/databases; replacement therapy supply and distribution; recruitment and training of experts in bleeding disorders. The recommendations became the content of proposal of agreement between the Government and the Regions. Monitoring and evaluation of haemophilia care through the set of established indicators was partially performed due to limited available data. Conclusions The project provided recommendations for the clinical and organisational management of patient with haemophilia. A particular concern was given to those areas that play a critical role in the comorbidities and complications prevention. Recommendations are expected to harmonise healthcare care delivery across regional networks and building the foundation for the national haemophilia network. PMID:24922299

Pharmacy executive leadership issues and associated skills, knowledge, and abilities.

PubMed

Meadows, Andrew B; Maine, Lucinda L; Keyes, Elizabeth K; Pearson, Kathy; Finstuen, Kenn

2005-01-01

To identify challenges that current and future pharmacy executives are facing or will face in the future and to define what skills, knowledge, and abilities (SKAs) are required to successfully negotiate these challenges. Delphi method for executive decision making. Civilian pharmacy profession. 110 pharmacists who graduated from the GlaxoSmithKline Executive Management Program for Pharmacy Leaders. Two iterations of the Delphi method for executive decision making separated by an expert panel content analysis. Round 1--participants were asked to identify five major issues they believed to be of greatest importance to pharmacy leaders in the next 5-10 years and name specific SKAs that might be needed by future leaders to successfully deal with those issues. An expert panel reviewed the issues, classified issues into specific domains, and titled each domain. Round 2-participants rated the SKAs on a 7-point scale according to their individual assessment of importance in each domain. For Delphi rounds 1 and 2, response rates were 21.8% and 18.2%, respectively. More than 100 total issue statements were identified. The expert panel sorted the issues into five domains: management and development of the pharmacy workforce, pharmacy finance, total quality management of work-flow systems, influences on the practice of pharmacy, and professional pharmacy leadership. Five of the top 15 SKAs-and all four highest ranked items--came from the professional pharmacy leadership domain, including ability to see the big picture, ability to demonstrate the value of pharmacy services, ability to lead and manage in an ethical manner, and skills for influencing an organization's senior leadership. Through successful integration of communication skills, critical thinking, and problem solving techniques, future public-sector pharmacy executives will be better equipped to effectively position their organizations and the profession for the challenges that lie ahead.

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

PubMed

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

2009-12-01

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

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

PubMed Central

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

2010-01-01

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

JETC (Japanese Technology Evaluation Center) Panel Report on High Temperature Superconductivity in Japan

NASA Technical Reports Server (NTRS)

Shelton, Duane; Gamota, George

1989-01-01

The Japanese regard success in R and D in high temperature superconductivity as an important national objective. The results of a detailed evaluation of the current state of Japanese high temperature superconductivity development are provided. The analysis was performed by a panel of technical experts drawn from U.S. industry and academia, and is based on reviews of the relevant literature and visits to Japanese government, academic and industrial laboratories. Detailed appraisals are presented on the following: Basic research; superconducting materials; large scale applications; processing of superconducting materials; superconducting electronics and thin films. In all cases, comparisons are made with the corresponding state-of-the-art in the United States.

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type.

PubMed

Onega, Tracy; Smith, Megan; Miglioretti, Diana L; Carney, Patricia A; Geller, Berta A; Kerlikowske, Karla; Buist, Diana S M; Rosenberg, Robert D; Smith, Robert A; Sickles, Edward A; Haneuse, Sebastien; Anderson, Melissa L; Yankaskas, Bonnie

2016-11-01

The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined. Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

New quality assurance program integrating "modern radiotherapy" within the German Hodgkin Study Group.

PubMed

Kriz, J; Baues, C; Engenhart-Cabillic, R; Haverkamp, U; Herfarth, K; Lukas, P; Schmidberger, H; Marnitz-Schulze, S; Fuchs, M; Engert, A; Eich, H T

2017-02-01

Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG. The expert panel developed guidelines and criteria to analyse "modern" field designs and treatment techniques. This work is based on a dataset of 11 patients treated within the sixth study generation (HD16-17). To develop a QAP of "modern RT", the expert panel defined criteria for analysing current RT procedures. The consensus of a modified QAP in ongoing and future trials is presented. With this schedule, the QAP of the GHSG could serve as a model for other study groups.

EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes

PubMed Central

van Dongen, J J M; Lhermitte, L; Böttcher, S; Almeida, J; van der Velden, V H J; Flores-Montero, J; Rawstron, A; Asnafi, V; Lécrevisse, Q; Lucio, P; Mejstrikova, E; Szczepański, T; Kalina, T; de Tute, R; Brüggemann, M; Sedek, L; Cullen, M; Langerak, A W; Mendonça, A; Macintyre, E; Martin-Ayuso, M; Hrusak, O; Vidriales, M B; Orfao, A

2012-01-01

Most consensus leukemia & lymphoma antibody panels consist of lists of markers based on expert opinions, but they have not been validated. Here we present the validated EuroFlow 8-color antibody panels for immunophenotyping of hematological malignancies. The single-tube screening panels and multi-tube classification panels fit into the EuroFlow diagnostic algorithm with entries defined by clinical and laboratory parameters. The panels were constructed in 2–7 sequential design–evaluation–redesign rounds, using novel Infinicyt software tools for multivariate data analysis. Two groups of markers are combined in each 8-color tube: (i) backbone markers to identify distinct cell populations in a sample, and (ii) markers for characterization of specific cell populations. In multi-tube panels, the backbone markers were optimally placed at the same fluorochrome position in every tube, to provide identical multidimensional localization of the target cell population(s). The characterization markers were positioned according to the diagnostic utility of the combined markers. Each proposed antibody combination was tested against reference databases of normal and malignant cells from healthy subjects and WHO-based disease entities, respectively. The EuroFlow studies resulted in validated and flexible 8-color antibody panels for multidimensional identification and characterization of normal and aberrant cells, optimally suited for immunophenotypic screening and classification of hematological malignancies. PMID:22552007

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

ERIC Educational Resources Information Center

Join Together, Boston, MA.

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

Effect of sex and carcass weight on sensory quality of goat meat of Cabrito Transmontano.

PubMed

Rodrigues, S; Teixeira, A

2009-02-01

The main purpose of this work was the characterization of Cabrito Transmontana goat kid carcass and meat, which is a Protected Origin Designation product. The effects of sex and carcass weight were studied. Sensory attributes of toughness, juiciness, flavor intensity, flavor quality, odor intensity, fiber presence (stringy), sweet intensity, and overall acceptability were evaluated in 60 males and females allocated to 3 carcass weight groups: 4, 6, and 8 kg. Sensory quality of meat was evaluated by a trained taste panel of 11 experts in 5 sessions. Generalized Procrustes analysis was performed, and 93% of total variability was explained by the 2 first factors (axes). Correlation between sensory traits and factors 1 and 2 allowed the factors to be renamed as toughness/aroma and juiciness/acceptability, respectively. Procrustes analysis indicated that a sex effect was detected by experts. Meat from males presented greater juiciness, flavor quality, and general acceptability than did meat from females. Cabrito Transmontano Protected Origin Designation includes animals from 4 to 9 kg of carcass weight. However, differences among them can be important, because the taste panel found differences between animals from distinct carcass weight ranges. Lighter weight carcasses were considered more tender with less flavor and odor intensity than heavier carcasses.

Safety Assessment of Synthetic Fluorphlogopite as Used in Cosmetics.

PubMed

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

2015-01-01

The Cosmetic Ingredient Review Expert Panel (the Panel) reviewed the safety of synthetic fluorphlogopite as used in cosmetics. Synthetic fluorphlogopite functions as a bulking agent and a viscosity-increasing agent. The Panel reviewed available animal and human data related to this ingredient along with a previous safety assessment of other magnesium silicates. The Panel concluded that synthetic fluorphlogopite was safe as cosmetic ingredients in the practices of use and concentration as given in this safety assessment. © The Author(s) 2015.

ICASE/LaRC Workshop on Adaptive Grid Methods

NASA Technical Reports Server (NTRS)

South, Jerry C., Jr. (Editor); Thomas, James L. (Editor); Vanrosendale, John (Editor)

1995-01-01

Solution-adaptive grid techniques are essential to the attainment of practical, user friendly, computational fluid dynamics (CFD) applications. In this three-day workshop, experts gathered together to describe state-of-the-art methods in solution-adaptive grid refinement, analysis, and implementation; to assess the current practice; and to discuss future needs and directions for research. This was accomplished through a series of invited and contributed papers. The workshop focused on a set of two-dimensional test cases designed by the organizers to aid in assessing the current state of development of adaptive grid technology. In addition, a panel of experts from universities, industry, and government research laboratories discussed their views of needs and future directions in this field.

IMPROVING EXPOSURE ASSESSMENT IN DISINFECTION BYPRODUCTS (DBP) EPIDEMIOLOGIC STUDIES

EPA Science Inventory

In 1997, an EPA expert panel was convened to evaluate epidemiologic studies of adverse reproductive or developmental outcomes that may be associated with drinking water DBPs. The panel recommended that further efforts be made in an existing cohort study, headed by Dr. Waller and ...

78 FR 49278 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... effective. Use of a Scientific Resolution Panel (SRP) is available to communities in support of the appeal resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent..., 121 North Wood Avenue, Woodsboro, TX 78393. Unincorporated Areas of Refugio County.. Refugio County...

Discus: investigating subjective judgment of optic disc damage.

PubMed

Denniss, Jonathan; Echendu, Damian; Henson, David B; Artes, Paul H

2011-01-01

To describe a software package (Discus) for investigating clinicians' subjective assessment of optic disc damage [diagnostic accuracy in detecting visual field (VF) damage, decision criteria, and agreement with a panel of experts] and to provide reference data from a group of expert observers. Optic disc images were selected from patients with manifest or suspected glaucoma or ocular hypertension who attended the Manchester Royal Eye Hospital. Eighty images came from eyes without evidence of VF loss in at least four consecutive tests (VF negatives), and 20 images from eyes with repeatable VF loss (VF positives). Software was written to display these images in randomized order, for up to 60 s. Expert observers (n = 12) rated optic disc damage on a 5-point scale (definitely healthy, probably healthy, not sure, probably damaged, and definitely damaged). Optic disc damage as determined by the expert observers predicted VF loss with less than perfect accuracy (mean area under receiver-operating characteristic curve, 0.78; range, 0.72 to 0.85). When the responses were combined across the panel of experts, the area under receiver-operating characteristic curve reached 0.87, corresponding to a sensitivity of ∼60% at 90% specificity. Although the observers' performances were similar, there were large differences between the criteria they adopted (p < 0.001), even though all observers had been given identical instructions. Discus provides a simple and rapid means for assessing important aspects of optic disc interpretation. The data from the panel of expert observers provide a reference against which students, trainees, and clinicians may compare themselves. The program and the analyses described in this article are freely accessible from http://www.discusproject.blogspot.com/.

Harmonization of ethics in health technology assessment: a revision of the Socratic approach.

PubMed

Hofmann, Bjørn; Droste, Sigrid; Oortwijn, Wija; Cleemput, Irina; Sacchini, Dario

2014-01-01

Ethics has been part of health technology assessment (HTA) from its beginning in the 1970s, and is currently part of HTA definitions. Several methods in ethics have been used in HTA. Some approaches have been developed especially for HTA, such as the Socratic approach, which has been used for a wide range of health technologies. The Socratic approach is used in several ways, and there is a need for harmonization to promote its usability and the transferability of its results. Accordingly, the objective of this study was to stimulate experts in ethics and HTA to revise the Socratic approach. Based on the current literature and experiences in applying methods in ethics, a panel of ethics experts involved in HTA critically analyzed the limitations of the Socratic approach during a face-to-face workshop. On the basis of this analysis a revision of the Socratic approach was agreed on after deliberation in several rounds through e-mail correspondence. Several limitations with the Socratic approach are identified and addressed in the revised version which consists of a procedure of six steps, 7 main questions and thirty-three explanatory and guiding questions. The revised approach has a broader scope and provides more guidance than its predecessor. Methods for information retrieval have been elaborated. The presented revision of the Socratic approach is the result of a joint effort of experts in the field of ethics and HTA. Consensus is reached in the expert panel on an approach that is considered to be more clear, comprehensive, and applicable for addressing ethical issues in HTA.

Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures.

PubMed

Peipert, John D; Beaumont, Jennifer L; Bode, Rita; Cella, Dave; Garcia, Sofia F; Hahn, Elizabeth A

2014-04-01

To develop and validate a new functional assessment of chronic illness therapy (FACIT) measure of satisfaction with treatment for chronic illnesses such as cancer and HIV/AIDS. To define domains and generate items, a literature review informed creation of semi-structured interview guides for patients and an international expert panel of clinicians and researchers. Patients and experts also rated 15 areas of satisfaction for relevance. The final list of items underwent further refinement by the original expert panel and a new group of clinical experts. Items were tested in four studies (primarily lung cancer) and data were pooled for analysis. Exploratory and confirmatory factor analyses (CFA), and item response theory modeling were conducted to evaluate dimensionality. Internal consistency reliability and test-retest reliability were both evaluated. Validity was evaluated by correlating the FACIT subscale scores and measures of comparable concepts and by testing the scales' ability to distinguish people according to their overall treatment satisfaction. Two instruments were created: the FACIT TS-general (G), an overall evaluation of current treatment, and the FACIT TS-patient satisfaction (PS), a measure of patient satisfaction. CFA results were not optimal for a five-factor solution for PS. Internal consistency reliability met psychometric standards (≥0.70) for all PS subscales. Construct validity was established for the PS subscales: Physician Communication, Treatment Staff Communication, Technical Competence, Confidence and Trust, and Nurse Communication. The two instruments generated here offer a new way to assess several key dimensions of patient satisfaction with treatment, especially for people with lung cancer.

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

PubMed Central

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

2016-01-01

Background The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. Methods and Findings We applied structured expert judgment using Cooke’s Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific ‘seed’ questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke’s Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the ‘target’ questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. Conclusions For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives. PMID:26784029

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

PubMed

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

2016-01-01

The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives.

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.

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

PubMed

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

2017-08-01

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

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

PubMed

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

2014-01-28

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

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

PubMed Central

2014-01-01

Background It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. Methods A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37–41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members’ satisfaction with the research method, participants were invited to provide their feedback after the final survey. Results From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Conclusion Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a mental health crisis. PMID:24467923

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

PubMed

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

2015-04-01

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

A decision-making framework for total ownership cost management of complex systems: A Delphi study

NASA Astrophysics Data System (ADS)

King, Russel J.

This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

Association between ratings of facial attractivess and patients' motivation for orthognathic surgery.

PubMed

Vargo, J K; Gladwin, M; Ngan, P

2003-02-01

To compare the judgments of facial esthetics, defects and treatment needs between laypersons and professionals (orthodontists and oral surgeons) as predictors of patient's motivation for orthognathic surgery. Two panels of expert and naïve raters were asked to evaluate photographs of orthognathic surgery patients for facial esthetics, defects and treatment needs. Results were correlated with patients' motivation for surgery. Fifty-seven patients (37 females and 20 males) with a mean age of 26.0 +/- 6.7 years were interviewed prior to orthognathic surgery treatment. Three color photographs of each patient were evaluated by a panel of 14 experts and panel of 18 laypersons. Each panel of raters were asked to evaluate the facial morphology, facial attractiveness and recommend surgical treatment (independent variables). The dependent variable was the patient's motivation for orthognathic surgery. Outcome measure--Reliability of raters were analyzed using an unweighted Kappa coefficient and a Cronbach alpha coefficient. Correlations and regression analyses were used to quantify the relationship between variables. Expert raters provided reliable ratings of certain morphological features such as excessive gingival display and classification of mandibular facial form and position. Based on the facial photographs both expert and naïve raters agreed on facial attractiveness of patients. The best predictors of patients' motivation for surgery were the naïve profile attractiveness rating and the patients' expected change in self-consciousness. Expert raters provide more reliable ratings on certain morphologic features. However, the layperson's profile attractiveness rating and the patients' expected change in self-consciousness were the best predictors for patients' motivation for surgery. These data suggest that patients' motives for treatment are not necessarily related to objectively determined need. Patients' decision to seek treatment was more correlated to laypersons' rating of attractiveness because they see what other laypersons see, and are directly or indirectly affected by others reactions to their appearance. These findings may provide useful information for clinicians in counseling patients who seek orthognathic surgery.

Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

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

Baldini, Elizabeth H., E-mail: ebaldini@partners.org; Wang, Dian; Haas, Rick L.M.

Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematicmore » review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy and toxicity.« 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…

PERMANENT PRIMER/REPLACEABLE TOPCOAT AIRCRAFT COATING SYSTEM WITH MINIMUM VOC AND CHROMIUM EXPOSURE - PHASE I

EPA Science Inventory

In Phase I, Foster-Miller, Inc., will develop the permanent primer replacement topcoat (PPRT), produce coated test panels, and analyze test panels for key performance properties. Topcoat stripping also will be demonstrated. The team includes coating experts and an aircraft ...

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

PubMed

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

2015-06-01

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

On using ethical principles of community-engaged research in translational science.

PubMed

Khodyakov, Dmitry; Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2016-05-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits," the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. Copyright © 2016 Elsevier Inc. All rights reserved.

On Using Ethical Principles of Community-Engaged Research in Translational Science

PubMed Central

Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2015-01-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of healthcare systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a re-consideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted two online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed nine ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA Appropriateness Method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be “grounded in trust.” While the academic panel endorsed “culturally appropriate” and “forthcoming with community about study risks and benefits,” the mixed academic-community panel endorsed “scientifically valid” and “ready to involve community in interpretation and dissemination” as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. PMID:26773561

Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study

PubMed Central

Rushton, A; White, L; Heap, A; Heneghan, N; Goodwin, P

2016-01-01

Objectives To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. Design Mixed-methods combining evidence synthesis, expert review and focus groups. Setting Secondary care involving 5 UK specialist spinal centres. Participants A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. Methods A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. Results The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. Conclusions A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness. PMID:26916690

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.

Pathology Imagebase-a reference image database for standardization of pathology.

PubMed

Egevad, Lars; Cheville, John; Evans, Andrew J; Hörnblad, Jonas; Kench, James G; Kristiansen, Glen; Leite, Katia R M; Magi-Galluzzi, Cristina; Pan, Chin-Chen; Samaratunga, Hemamali; Srigley, John R; True, Lawrence; Zhou, Ming; Clements, Mark; Delahunt, Brett

2017-11-01

Despite efforts to standardize histopathology practice through the development of guidelines, the interpretation of morphology is still hampered by subjectivity. We here describe Pathology Imagebase, a novel mechanism for establishing an international standard for the interpretation of pathology specimens. The International Society of Urological Pathology (ISUP) established a reference image database through the input of experts in the field. Three panels were formed, one each for prostate, urinary bladder and renal pathology, consisting of 24 international experts. Each of the panel members uploaded microphotographs of cases into a non-public database. The remaining 23 experts were asked to vote from a multiple-choice menu. Prior to and while voting, panel members were unable to access the results of voting by the other experts. When a consensus level of at least two-thirds or 16 votes was reached, cases were automatically transferred to the main database. Consensus was reached in a total of 287 cases across five projects on the grading of prostate, bladder and renal cancer and the classification of renal tumours and flat lesions of the bladder. The full database is available to all ISUP members at www.isupweb.org. Non-members may access a selected number of cases. It is anticipated that the database will assist pathologists in calibrating their grading, and will also promote consistency in the diagnosis of difficult cases. © 2017 John Wiley & Sons Ltd.

The Perspectives of the International Agencies

ERIC Educational Resources Information Center

Hollander, Astrid

2005-01-01

An Inter-agency Panel of Technical and Vocational Education and Training (TVET) experts, drawn from seven United Nations and other international agencies, was one of the highlights in the programme of UNESCO's International Experts Meeting "Learning for Work, Citizenship and Sustainability" (Bonn, Germany, 25-28 October 2004). The Panel…

EPA Announces FIFRA Science Advisory Panel Meeting on PBPK and Asks for Nominations for Panel Members

EPA Pesticide Factsheets

On June 6, 2017, the EPA published a Federal Register Notice (EPA-HQ-OPP-2017-0180) for both the meeting and seeking nominees to serve as ad hoc expert members of the FIFRA SAP on physiologically based pharmacokinetic (PBPK) modeling.

75 FR 29773 - Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Notice of...), announcement is made of a Health Care Policy and Research Special Emphasis Panel (SEP) meeting. A Special Emphasis Panel is a group of experts in fields related to health care research who are invited by the...

76 FR 8366 - Science Advisory Board Staff Office; Request for Nominations; SAB Environmental Justice Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-14

... Nominations; SAB Environmental Justice Technical Panel AGENCY: Environmental Protection Agency (EPA). ACTION... experts to serve on the SAB Environmental Justice Technical (EJT) Panel. DATES: Nominations should be...) released the Interim Guidance on Considering Environmental Justice During the Development of an Action...

Citrus Research Board-sponsored review of the University of California Riverside citrus breeding

USDA-ARS?s Scientific Manuscript database

In October 2015 the Citrus Research Board (CRB) assembled a panel of experts to review the Citrus Research Board-sponsored Citrus Research and Genetics Programs at University of California Riverside (UCR). The panel consisted of: Gennaro Fazio, USDA/ARS, Geneva, NY; Maria Angeles Forner-Giner, Insti...

75 FR 38110 - Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Notice of...), announcement is made of a Health Care Policy and Research Special Emphasis Panel (SEP) meeting. A Special Emphasis Panel is a group of experts in fields related to health care research who are invited by the...

Consensus-recommended diagnostic and therapeutic guidelines for drug-resistant epilepsy in Spain (Consenso RATE-España).

PubMed

Sánchez-Álvarez, J C; Mauri-Llerda, J A; Gil-Nagel, A; Casas-Fernández, C; Salas-Puig, J; Lahuerta, J; Sancho-Rieger, J

2012-10-01

To ascertain the opinions of an Epilepsy Expert Group and prepare a consensus document on the definition of drug-resistant epilepsy (DRE) according to the International League Against Epilepsy (ILAE) and the different healthcare levels for the patient with epilepsy in Spain. The study was conducted using the Delphi method, by means of successive rounds of questionnaires. A scientific committee prepared a preliminary document and fourteen associated questions, which were sent by e-mail to the panel of experts. They included items related to the concept of DRE, health care levels and the route between these levels for patients with DRE. A total of 41 experts answered the questionnaire. They agreed regarding the necessity and applicability of the DRE definition according to the ILAE, the need for an expert panel on epilepsy, specialist epilepsy clinics, and clinical epilepsy units stratified depending on the level of activities they carried out. There was moderate consensus on the resources and activity of the clinical units of reference and there was no consensus on the referral of patients who have suffered an epileptic seizure to an epilepsy clinic. The expert panel agreed with the definition of DRE according to the ILAE and on referring patients with DRE for a detailed study in an epilepsy clinic or epilepsy clinical unit. They highlighted the need for video-EEG monitoring in the study of patients with DRE and the need to propose other forms of treatment in selected patients. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

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

PubMed

Coulter, Ian D

2014-11-01

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

Probabilistic accident consequence uncertainty analysis -- Late health effects uncertain assessment. Volume 2: Appendices

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

Little, M.P.; Muirhead, C.R.; Goossens, L.H.J.

1997-12-01

The development of two new probabilistic accident consequence codes, MACCS and COSYMA, was completed in 1990. These codes estimate the consequence from the accidental releases of radiological material from hypothesized accidents at nuclear installations. In 1991, the US Nuclear Regulatory Commission and the Commission of the European Communities began cosponsoring a joint uncertainty analysis of the two codes. The ultimate objective of this joint effort was to systematically develop credible and traceable uncertainty distributions for the respective code input variables. A formal expert judgment elicitation and evaluation process was identified as the best technology available for developing a library ofmore » uncertainty distributions for these consequence parameters. This report focuses on the results of the study to develop distribution for variables related to the MACCS and COSYMA late health effects models. This volume contains appendices that include (1) a summary of the MACCS and COSYMA consequence codes, (2) the elicitation questionnaires and case structures, (3) the rationales and results for the expert panel on late health effects, (4) short biographies of the experts, and (5) the aggregated results of their responses.« less

[Identification of the scope of practice for dental nurses with Delphi method].

PubMed

Li, Yu-Hong; Lu, Yue-Cen; Huang, Yao; Ruan, Hong; Wu, Zheng-Yi

2016-10-01

To identify the practice scope of dental nurses under the new situations. The draft of scope of practice for dental nurses was based on theoretical analysis, literature review and consultation of advisory panel, and the final scope of practice for dental nurses was established by using the Delphi method. Statistical analysis was implemented using coefficient of variation, Kendall W with SPSS 17.0 software package. Thirty experts were consulted twice by using the Delphi method. The effective rates of two rounds of questionnaire were 100% and 73.3%, respectively. The authority coefficient was 0.837, and the P value of expert coordination coefficients W was less than 0.05. There were totally 116 suggestions from the experts, and 96 were accepted. The scope of practice for dental nurses was finally established, including 4 primary indexes and 25 secondary indexes. The scope of practice for dental nurses under the new situations is established in China through scientific methods. It is favorable for position management of dental nurses and may promote the development of nurse specialists in dental clinic.

Safety assessment of nylon as used in cosmetics.

PubMed

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

2014-01-01

The Cosmetic Ingredient Review Expert Panel (Panel) reviewed the safety of nylon polymers, which function in cosmetics primarily as bulking and opacifying agents. The Panel reviewed relevant animal and human data related to these large polymers and determined that they are not likely to penetrate the skin. Whatever residual monomers may be present were not present at a sufficient level to cause any reactions in test subjects at the maximum ingredient use concentration. Accordingly, the Panel concluded that these ingredients are safe in the present practices of use and concentration. © The Author(s) 2014.

iRENEX: a clinically informed decision support system for the interpretation of ⁹⁹mTc-MAG3 scans to detect renal obstruction.

PubMed

Garcia, Ernest V; Taylor, Andrew; Folks, Russell; Manatunga, Daya; Halkar, Raghuveer; Savir-Baruch, Bital; Dubovsky, Eva

2012-09-01

Decision support systems for imaging analysis and interpretation are rapidly being developed and will have an increasing impact on the practice of medicine. RENEX is a renal expert system to assist physicians evaluate suspected obstruction in patients undergoing mercaptoacetyltriglycine (MAG3) renography. RENEX uses quantitative parameters extracted from the dynamic renal scan data using QuantEM™II and heuristic rules in the form of a knowledge base gleaned from experts to determine if a kidney is obstructed; however, RENEX does not have access to and could not consider the clinical information available to diagnosticians interpreting these studies. We designed and implemented a methodology to incorporate clinical information into RENEX, implemented motion detection and evaluated this new comprehensive system (iRENEX) in a pilot group of 51 renal patients. To reach a conclusion as to whether a kidney is obstructed, 56 new clinical rules were added to the previously reported 60 rules used to interpret quantitative MAG3 parameters. All the clinical rules were implemented after iRENEX reached a conclusion on obstruction based on the quantitative MAG3 parameters, and the evidence of obstruction was then modified by the new clinical rules. iRENEX consisted of a library to translate parameter values to certainty factors, a knowledge base with 116 heuristic interpretation rules, a forward chaining inference engine to determine obstruction and a justification engine. A clinical database was developed containing patient histories and imaging report data obtained from the hospital information system associated with the pertinent MAG3 studies. The system was fine-tuned and tested using a pilot group of 51 patients (21 men, mean age 58.2 ± 17.1 years, 100 kidneys) deemed by an expert panel to have 61 unobstructed and 39 obstructed kidneys. iRENEX, using only quantitative MAG3 data agreed with the expert panel in 87 % (34/39) of obstructed and 90 % (55/61) of unobstructed kidneys. iRENEX, using both quantitative and clinical data agreed with the expert panel in 95 % (37/39) of obstructed and 92 % (56/61) of unobstructed kidneys. The clinical information significantly (p < 0.001) increased iRENEX certainty in detecting obstruction over using the quantitative data alone. Our renal expert system for detecting renal obstruction has been substantially expanded to incorporate the clinical information available to physicians as well as advanced quality control features and was shown to interpret renal studies in a pilot group at a standardized expert level. These encouraging results warrant a prospective study in a large population of patients with and without renal obstruction to establish the diagnostic performance of iRENEX.

Risk for suicide and risk for violence: a case for separating the current violence diagnoses.

PubMed

Smith, J E; Early, J A; Green, P T; Lauck, D L; Oblaczynski, C; Smochek, M R; Wright, G

1997-01-01

To identify accurate descriptive terms for risk for violence and risk for suicide and to provide operational definitions for these terms The Delphi technique, with two rounds, was used to differentiate the operational definitions that represent risk for suicide from those that represent risk for violence. The expert panel consisted of 23 healthcare professionals with a minimum of a master's degree. In addition to the expert panel, a control group (N = 11) participated to assess content validity. Thirty-six definitions were agreed upon for suicide, 39 for violence. These definitions represent the basic distinctions between the two behavioral manifestations.

Recruiting and retaining Arab Muslim mothers and children for research.

PubMed

Aroian, Karen J; Katz, Anne; Kulwicki, Anahid

2006-01-01

To describe successful and not-so-successful strategies for recruiting and retaining Arab Muslim immigrant women and their adolescent children for research. A longitudinal study of mother-child adjustment of Arab immigrants to the US is used for illustration. A panel of experts was assembled and provided culturally specific advice about gatekeepers, advertising, data collectors, data collection, and how to track and encourage participation at subsequent time points in the study. Most of the strategies recommended by the panel were overwhelmingly positive, including advice about data collectors, how to collect data, financial incentives, avoiding offending families, and personal contacts. Hiring data collectors who were able to establish personal and culturally appropriate relationships with study participants was the single most successful recruitment and retention strategy. Advice from cultural experts about which gatekeepers to engage and how to advertise for study participants was not productive. Researchers should not only assemble a panel of cultural experts to provide advice about group specific strategies to build trust and maintain cultural sensitivity, but also to budget generously for time for data collectors to build and maintain rapport with study populations who, like Arab immigrant women, highly value personal relationships.

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

PubMed

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

2016-06-01

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

Recruiting and Retaining Arab Muslim Mothers and Children for Research

PubMed Central

Aroian, Karen J.; Katz, Anne; Kulwicki, Anahid

2006-01-01

Purpose To describe successful and not-so-successful strategies for recruiting and retaining Arab Muslim immigrant women and their adolescent children for research. Design and Methods A longitudinal study of mother-child adjustment of Arab immigrants to the US is used for illustration. A panel of experts was assembled and provided culturally specific advice about gatekeepers, advertising, data collectors, data collection, and how to track and encourage participation at subsequent time points in the study. Findings Most of the strategies recommended by the panel were overwhelmingly positive, including advice about data collectors, how to collect data, financial incentives, avoiding offending families, and personal contacts. Hiring data collectors who were able to establish personal and culturally appropriate relationships with study participants was the single most successful recruitment and retention strategy. Advice from cultural experts about which gatekeepers to engage and how to advertise for study participants was not productive. Conclusions Researchers should not only assemble a panel of cultural experts to provide advice about group specific strategies to build trust and maintain cultural sensitivity, but also to budget generously for time for data collectors to build and maintain rapport with study populations who, like Arab immigrant women, highly value personal relationships. PMID:17044343

Video analysis of acute injuries and referee decisions during the 24th Men's Handball World Championship 2015 in Qatar.

PubMed

Andersson, S H; Cardinale, M; Whiteley, R; Popovic, N; Hansen, C; Lopez, F S; Bere, T; Bahr, R; Myklebust, G

2018-03-30

Although handball is a contact sport with a high risk of acute match injuries, their mechanisms have not yet been investigated. We aimed to describe the mechanisms of acute match injuries in elite male handball and evaluate referee performance in injury situations. Based on injury surveillance from the 24th Men's Handball World Championship 2015 in Qatar, injury situations and the referee decisions were identified on video footage. A total of 55 injury situations and 37 referee decisions were included for analysis. The injury situations were analyzed individually by five handball experts, followed by a consensus meeting. An expert referee panel performed individual blinded evaluation of the referee decisions, followed by an online consensus meeting. Injuries were evenly distributed among attackers (n = 29) and defenders (n = 26). The most frequent injury cause was contact trauma due to a tackle (n = 27). At the time of injury, attackers were most frequently performing a jump shot (n = 9), while defenders were completing a tackle (n = 10). Defenders most commonly tackled the throwing arm (n = 7) or toward the head/face region (n = 6) of injured attackers, while attackers most frequently hit injured defenders with the knee during jump shots (n = 5). Agreement between the referees and the expert panel was weak (kappa: 0.22, 95% CI 0.07 to 0.36), with substantially more lenient rule interpretation by the referees. Our results suggest that stricter refereeing and rule amendments should be considered to prevent acute match injuries in elite handball, especially in relation to tackling episodes when an attacker is performing a jump shot. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines

PubMed Central

Norris, Susan L.; Schulman, Sam; Hirsh, Jack; Eckman, Mark H.; Akl, Elie A.; Crowther, Mark; Vandvik, Per Olav; Eikelboom, John W.; McDonagh, Marian S.; Lewis, Sandra Zelman; Gutterman, David D.; Cook, Deborah J.; Schünemann, Holger J.

2012-01-01

Background: To develop the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines (AT9), the American College of Chest Physicians (ACCP) assembled a panel of clinical experts, information scientists, decision scientists, and systematic review and guideline methodologists. Methods: Clinical areas were designated as articles, and a methodologist without important intellectual or financial conflicts of interest led a panel for each article. Only panel members without significant conflicts of interest participated in making recommendations. Panelists specified the population, intervention and alternative, and outcomes for each clinical question and defined criteria for eligible studies. Panelists and an independent evidence-based practice center executed systematic searches for relevant studies and evaluated the evidence, and where resources and evidence permitted, they created standardized tables that present the quality of the evidence and key results in a transparent fashion. Results: One or more recommendations relate to each specific clinical question, and each recommendation is clearly linked to the underlying body of evidence. Judgments regarding the quality of evidence and strength of recommendations were based on approaches developed by the Grades of Recommendations, Assessment, Development, and Evaluation Working Group. Panel members constructed scenarios describing relevant health states and rated the disutility associated with these states based on an additional systematic review of evidence regarding patient values and preferences for antithrombotic therapy. These ratings guided value and preference decisions underlying the recommendations. Each topic panel identified questions in which resource allocation issues were particularly important and, for these issues, experts in economic analysis provided additional searches and guidance. Conclusions: AT9 methodology reflects the current science of evidence-based clinical practice guideline development, with reliance on high-quality systematic reviews, a standardized process for quality assessment of individual studies and the body of evidence, an explicit process for translating the evidence into recommendations, disclosure of financial as well as intellectual conflicts of interest followed by management of disclosed conflicts, and extensive peer review. PMID:22315256

An expert elicitation process to project the frequency and magnitude of Florida manatee mortality events caused by red tide (Karenia brevis)

USGS Publications Warehouse

Martin, Julien; Runge, Michael C.; Flewelling, Leanne J.; Deutsch, Charles J.; Landsberg, Jan H.

2017-11-20

Red tides (blooms of the harmful alga Karenia brevis) are one of the major sources of mortality for the Florida manatee (Trichechus manatus latirostris), especially in southwest Florida. It has been hypothesized that the frequency and severity of red tides may increase in the future because of global climate change and other factors. To improve our ecological forecast for the effects of red tides on manatee population dynamics and long-term persistence, we conducted a formal expert judgment process to estimate probability distributions for the frequency and relative magnitude of red-tide-related manatee mortality (RTMM) events over a 100-year time horizon in three of the four regions recognized as manatee management units in Florida. This information was used to update a population viability analysis for the Florida manatee (the Core Biological Model). We convened a panel of 12 experts in manatee biology or red-tide ecology; the panel met to frame, conduct, and discuss the elicitation. Each expert provided a best estimate and plausible low and high values (bounding a confidence level of 80 percent) for each parameter in each of three regions (Northwest, Southwest, and Atlantic) of the subspecies’ range (excluding the Upper St. Johns River region) for two time periods (0−40 and 41−100 years from present). We fitted probability distributions for each parameter, time period, and expert by using these three elicited values. We aggregated the parameter estimates elicited from individual experts and fitted a parametric distribution to the aggregated results.Across regions, the experts expected the future frequency of RTMM events to be higher than historical levels, which is consistent with the hypothesis that global climate change (among other factors) may increase the frequency of red-tide blooms. The experts articulated considerable uncertainty, however, about the future frequency of RTMM events. The historical frequency of moderate and intense RTMM (combined) in the Southwest region was 0.35 (80-percent confidence interval [CI]: 0.21−0.52), whereas the forecast probability was 0.48 (80-percent CI: 0.30−0.64) over a 40-year projected time horizon. Moderate and intense RTMM events are expected to continue to be most frequent in the Southwest region, to increase in mean frequency in the Northwest region (historical frequency of moderate and intense RTMM events [combined] in the Northwest region was 0, whereas the forecast probability was 0.12 [80-percent CI: 0.02−0.39] over a 40-year projected time horizon) and in the Atlantic region (historical frequency of moderate and intense RTMM events [combined] in the Atlantic region was 0.05 [80-percent CI: 0.005–0.18], whereas the forecast probability was 0.11 [80-percent CI: 0.03−0.25] over a 40-year projected time horizon), and to remain absent from the Upper St. Johns River region. The impact of red-tide blooms on manatee mortality has been measured for the Southwest region but not for the Northwest and Atlantic regions, where such events have been rare. The expert panel predicted that the median magnitude of RTMM events in the Atlantic and Northwest regions will be much smaller than that in the Southwest; given the large uncertainties, however, they acknowledged the possibility that these events could be larger in their mortality impacts than in the Southwest region. By its nature, forecasting requires expert judgment because it is impossible to have empirical evidence about the future. The large uncertainties in parameter estimates over a 100-year timeframe are to be expected and may also indicate that the training provided to panelists successfully minimized one common pitfall of expert judgment, that of overconfidence. This study has provided useful and needed inputs to the Florida manatee population viability analysis associated with an important and recurrent source of mortality from harmful algal blooms.

Safety assessment of Vitis vinifera (grape)-derived ingredients as used in cosmetics.

PubMed

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

2014-01-01

The Cosmetic Ingredient Review Expert Panel (Panel) assessed the safety of 24 Vitis vinifera (grape)-derived ingredients and found them safe in the present practices of use and concentration in cosmetics. These ingredients function in cosmetics mostly as skin-conditioning agents, but some function as antioxidants, flavoring agents, and/or colorants. The Panel reviewed the available animal and clinical data to determine the safety of these ingredients. Additionally, some constituents of grapes have been assessed previously for safety as cosmetic ingredients by the Panel, and others are compounds that have been discussed in previous Panel safety assessments. © The Author(s) 2014.

Unleashing Expert Judgment in the IPCC's Fifth Assessment Report

NASA Astrophysics Data System (ADS)

Freeman, P. T.; Mach, K. J.; Mastrandrea, M.; Field, C. B.

2016-12-01

IPCC assessments are critical vehicles for evaluating and synthesizing existing knowledge about climate change, its impacts, and potential options for adaptation and mitigation. In these assessments, rigorous expert judgment is essential for characterizing current scientific understanding including persistent and complex uncertainties related to climate change. Over its history the IPCC has iteratively developed frameworks for evaluating and communicating what is known and what is not known about climate change science. In this presentation, we explore advances and challenges in approaches to evaluating and communicating expert judgment in the Intergovernmental Panel on Climate Change's Fifth Assessment Report (IPCC AR5). We present an analysis of the frequency of the use of calibrated degree-of-certainty terms in the policymaker summaries from the IPCC's AR5 and Fourth Assessment Report (AR4). We find that revised guidance for IPCC author teams in the AR5 improved the development of balanced judgments on scientific evidence across disciplines. Overall, degree-of-certainty terms are more abundant in the AR5 policymaker summaries compared to those of the AR4, demonstrating an increased commitment to extensively and transparently characterizing expert judgments underpinning report conclusions. This analysis also shows that while working groups still favor different degree-of-certainty scales in the AR5, authors employed a wider array of degree-of-certainty scales to communicate expert judgment supporting report findings compared to the policymaker summaries of the AR4. Finally, our analysis reveals greater inclusion of lower-certainty findings in the AR5 as compared to the AR4, critical for communicating a fuller range of possible climate change impacts and response options. Building on our findings we propose a simpler, more transparent, and more rigorous framework for developing and communicating expert judgments in future climate and environmental assessments.

Genetic testing for cystic fibrosis. National Institutes of Health Consensus Development Conference Statement on genetic testing for cystic fibrosis.

PubMed

1999-07-26

To provide health care providers, patients, and the general public with a responsible assessment of the optimal practices for genetic testing for cystic fibrosis (CF). A nonfederal, nonadvocate, 14-member panel representing the fields of genetics, obstetrics, internal medicine, nursing, social work, epidemiology, pediatrics, psychiatry, genetic counseling, bioethics, health economics, health services research, law, and the public. In addition, 21 experts from these same fields presented data to the panel and a conference audience of 500. The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Genetic testing for CF should be offered to adults with a positive family history of CF, to partners of people with CF, to couples currently planning a pregnancy, and to couples seeking prenatal care. The panel does not recommend offering CF genetic testing to the general population or newborns. The panel advocates active research to develop improved treatments for people with CF and continued investigation into the understanding of the pathophysiology of the disease. Comprehensive educational programs targeted to health care professionals and the public should be developed using input from people living with CF and their families and from people from diverse racial and ethnic groups. Additionally, genetic counseling services must be accurate and provide balanced information to afford individuals the opportunity to make autonomous decisions. Every attempt should be made to protect individual rights, genetic and medical privacy rights, and to prevent discrimination and stigmatization. It is essential that the offering of CF carrier testing be phased in over a period to ensure that adequate education and appropriate genetic testing and counseling services are available to all persons being tested.

Early Adolescence: Perspectives and Recommendations to the National Science Foundation.

ERIC Educational Resources Information Center

Katzenmeyer, Conrad G., Ed.; Rivkin, Mary S., Ed.

Contained in this publication is the final report of a panel of experts, convened by the Assistant Director for Science Education of the National Science Foundation, interested in science education for early adolescence. The document also contains three appendices. Appendix A lists members of the panel and their professional affiliation. Appendix…

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

EPA Science Inventory

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

Symposium on formulation and application of microbials for spruce budworm and gypsy moth control

Treesearch

J. A. Armstrong; W. G. Yendol

1985-01-01

This panel of experts from Canada and the United States has been brought together to discuss control techniques and strategies employed against these important defoliators - the spruce budworm and the gypsy moth. In selecting the panel we have chosen people with experience ranging from research to control.

Contemporary Issues in Medicine--Medical Informatics and Population Health: Report II of the Medical School Objectives Project.

ERIC Educational Resources Information Center

Academic Medicine, 1999

1999-01-01

The report of the Association of American Medical Colleges' Medical School Objectives Program presents the work of two expert panels. One, on medical informatics, identified five important physician roles: lifelong learner, clinician, educator, researcher, and manager. Another panel established a definition for "population health…

75 FR 58383 - Science Advisory Board Staff Office Request for Nominations of Experts for the Review of Great...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-24

... Action Plan identifies outcome-oriented performance goals, objectives, measurable ecological targets, and.... In an effort to obtain nominations of diverse candidates, EPA encourages nominations of women and men...) skills working in committees, subcommittees and advisory panels; and, for the Panel as a whole, (f...

Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline.

PubMed

Kindler, Hedy L; Ismaila, Nofisat; Armato, Samuel G; Bueno, Raphael; Hesdorffer, Mary; Jahan, Thierry; Jones, Clyde Michael; Miettinen, Markku; Pass, Harvey; Rimner, Andreas; Rusch, Valerie; Sterman, Daniel; Thomas, Anish; Hassan, Raffit

2018-05-01

Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .

Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review

PubMed Central

Arab, Juan P; Candia, Roberto; Zapata, Rodrigo; Muñoz, Cristián; Arancibia, Juan P; Poniachik, Jaime; Soza, Alejandro; Fuster, Francisco; Brahm, Javier; Sanhueza, Edgar; Contreras, Jorge; Cuellar, M Carolina; Arrese, Marco; Riquelme, Arnoldo

2014-01-01

AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice. METHODS: NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts. RESULTS: A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not yet been established. CONCLUSION: Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events. PMID:25232252

Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

PubMed Central

Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.

2011-01-01

Background The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives The objective was to develop a consensus document, “Geriatric Competencies for Emergency Medicine Residents,” by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. PMID:20370765

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

PubMed

Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

2010-03-01

The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

CAEP 2015 Academic Symposium: Leadership within the emergency medicine academic community and beyond.

PubMed

Sinclair, Doug; Worthington, James R; Joubert, Gary; Holroyd, Brian R; Stempien, James; Letovsky, Eric; Rutledge, Tim; LeBlanc, Constance; Pitters, Carrol; McCallum, Andrew; Carr, Brendan; Gerace, Rocco; Stiell, Ian G; Artz, Jennifer D; Christenson, Jim

2016-05-01

A panel of emergency medicine (EM) leaders endeavoured to define the key elements of leadership and its models, as well as to formulate consensus recommendations to build and strengthen academic leadership in the Canadian EM community in the areas of mentorship, education, and resources. The expert panel comprised EM leaders from across Canada and met regularly by teleconference over the course of 9 months. From the breadth of backgrounds and experience, as well as a literature review and the development of a leadership video series, broad themes for recommendations around the building and strengthening of EM leadership were presented at the CAEP 2015 Academic Symposium held in Edmonton, Alberta. Feedback from the attendees (about 80 emergency physicians interested in leadership) was sought. Subsequently, draft recommendations were developed by the panel through attendee feedback, further review of the leadership video series, and expert opinion. The recommendations were distributed to the CAEP Academic Section for further feedback and updated by consensus of the expert panel. The methods informed the panel who framed recommendations around four themes: 1) leadership preparation and training, 2) self-reflection/emotional intelligence, 3) academic leadership skills, and 4) gender balance in academic EM leadership. The recommendations aimed to support and nurture the next generation of academic EM leaders in Canada and included leadership mentors, availability of formal educational courses/programs in leadership, self-directed education of aspiring leaders, creation of a Canadian subgroup with the AACEM/SAEM Chair Development Program, and gender balance in leadership roles. These recommendations serve as a roadmap for all EM leaders (and aspiring leaders) to build on their success, inspire their colleagues, and foster the next generation of Canadian EM academic leaders.

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

Glotzer, S. C.; Kim, S.; Cummings, P. T.

This WTEC panel report assesses the international research and development activities in the field of Simulation- Based Engineering and Science (SBE&S). SBE&S involves the use of computer modeling and simulation to solve mathematical formulations of physical models of engineered and natural systems. SBE&S today has reached a level of predictive capability that it now firmly complements the traditional pillars of theory and experimentation/observation. As a result, computer simulation is more pervasive today – and having more impact – than at any other time in human history. Many critical technologies, including those to develop new energy sources and to shift themore » cost-benefit factors in healthcare, are on the horizon that cannot be understood, developed, or utilized without simulation. A panel of experts reviewed and assessed the state of the art in SBE&S as well as levels of activity overseas in the broad thematic areas of life sciences and medicine, materials, and energy and sustainability; and in the crosscutting issues of next generation hardware and algorithms; software development; engineering simulations; validation, verification, and uncertainty quantification; multiscale modeling and simulation; and SBE&S education. The panel hosted a U.S. baseline workshop, conducted a bibliometric analysis, consulted numerous experts and reports, and visited 59 institutions and companies throughout East Asia and Western Europe to explore the active research projects in those institutions, the computational infrastructure used for the projects, the funding schemes that enable the research, the collaborative interactions among universities, national laboratories, and corporate research centers, and workforce needs and development for SBE&S.« less

ACR appropriateness criteria jaundice.

PubMed

Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

2013-06-01

A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-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 journals and the application of a well-established consensus methodology (modified Delphi) to rate the 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 recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Transcultural adaptation into Spanish of the Patient empowerment in long-term conditions questionnaire].

PubMed

Garcimartin, Paloma; Pardo-Cladellas, Yolanda; Verdú-Rotellar, Jose-Maria; Delgado-Hito, Pilar; Astals-Vizcaino, Monica; Comin-Colet, Josep

2017-12-22

To describe the process of translation and cultural adaptation of the Patient empowerment in long-term condition to the Spanish language. Translation, cross-cultural adaptation, and pilot testing (cognitive debriefing) LOCATION: Primary and Hospital care. Ten patients admitted to a cardiology department of a University Hospital MAIN MEASUREMENTS: 1) Direct translation, 2) conciliation and synthesis of the versions by expert panel, 3) back- translation, 4) agreement on the back-translated version with the author of the original version, 5) analysis of comprehensibility through cognitive interviews. There were no differences between the direct-translated versions. The expert panel introduced changes in 23 out of the 47 items of the questionnaire. The author of the original version agreed with the version of the back-translation. In the cognitive interviews, patients reported high difficulty in one item and low difficulty in 4. The Spanish version of the Patient Empowerment in long-term conditions questionnaire is semantically and conceptually equivalent to the original tool. The assessment of the psychometric properties of the Spanish version of the questionnaire will be carried out at a later stage. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Patient involvement in drug licensing: a case study.

PubMed

Britten, Nicky; Denford, Sarah; Harris-Golesworthy, Faith; Jibson, Steph; Pyart, Nigel; Stein, Ken

2015-04-01

Embodied health movements work on the boundary between lay and expert knowledge. Consumer groups, depending on their goals, may increase or decrease pharmaceuticalization. This paper reports a small case study about the retrospective evaluation of a specific second line treatment for type 2 diabetes by an existing patient involvement group. The group is part of a research collaboration between academia and the health service in England, and shares some characteristics of embodied health movements. We used the case study to explore whether an institutionally funded non activist patient group can make a more balanced contribution to drug licensing decisions than that made by either access-oriented or injury-oriented consumer groups, without being co-opted by an institutional agenda. The questions we wished to address were how this group evaluated existing mechanisms for licensing drugs; how they balanced scientific and lay knowledge; how they made their decisions; and how they viewed their experiences as panel members. The five panel members were interviewed before and after the panel discussion in July 2013. They were critical of current licensing processes, and used their own embodied experiences of medicines to evaluate expert knowledge. Their decisions on the panel were informed either by a balancing of benefits and harms, or by trust in experts. The case study suggests that such a group may have the potential both to balance the pro-pharmaceuticalization impact of access-oriented groups and to influence forms of pharmaceutical governance. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2017-01-01

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

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.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

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

Integrating Science and Management to Assess Forest Ecosystem Vulnerability to Climate Change

Treesearch

Leslie A. Brandt; Patricia R. Butler; Stephen D. Handler; Maria K. Janowiak; P. Danielle Shannon; Christopher W. Swanston

2017-01-01

We developed the ecosystem vulnerability assessment approach (EVAA) to help inform potential adaptation actions in response to a changing climate. EVAA combines multiple quantitative models and expert elicitation from scientists and land managers. In each of eight assessment areas, a panel of local experts determined potential vulnerability of forest ecosystems to...

Changing Perspectives on the Benefits of Newborn Screening

ERIC Educational Resources Information Center

Bailey, Donald B., Jr.; Beskow, Laura M.; Davis, Arlene M.; Skinner, Debra

2006-01-01

The likelihood of benefit is fundamental to decision making about newborn screening. But benefit is construed in different ways by different stakeholders. This article begins with a review of benefit as considered historically by various expert panels and organizations. We then show how 78 conditions fared when experts recently rated them on…

Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

ERIC Educational Resources Information Center

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

2010-01-01

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

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.

Developing a competency framework for U.S. state food and feed testing laboratory personnel.

PubMed

Kaml, Craig; Weiss, Christopher C; Dezendorf, Paul; Ishida, Maria; Rice, Daniel H; Klein, Ron; Salfinger, Yvonne

2014-01-01

A competency-based training curriculum framework for U.S. state food and feed testing laboratories personnel is being developed by the International Food Protection Training Institute (IFPTI) and three partners. The framework will help laboratories catalog existing training courses/modules, identify training gaps, inform training curricula, and create career-spanning professional development learning paths, ensuring consistent performance expectations and increasing confidence in shared test results. Ultimately, the framework will aid laboratories in meeting the requirements of ISO/IEC 17025 (2005) international accreditation and the U.S. Food Safety Modernization Act (U.S. Public Law 111-353). In collaboration with the Association of Food and Drug Officials, the Association of Public Health Laboratories, and the Association of American Feed Control Officials, IFPTI is carrying out the project in two phases. In 2013, an expert panel of seven subject matter experts developed competency and curriculum frameworks for five professional levels (entry, mid-level, expert, supervisor/manager, and senior administration) across four competency domains (technical, communication, programmatic, and leadership) including approximately 80 competencies. In 2014 the expert panel will elicit feedback from peers and finalize the framework.

A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis

PubMed Central

Stockfleth, Eggert; Peris, Ketty; Guillen, Carlos; Cerio, Rino; Basset-Seguin, Nicole; Foley, Peter; Sanches, José; Culshaw, Alex; Erntoft, Sandra; Lebwohl, Mark

2015-01-01

Background Topical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. Objectives To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis. Methods An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Results Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated. Conclusions The recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy. PMID:25865875

Ingredientes Farmacéuticos Activos Potencialmente Inapropiados en Adultos Mayores: Lista IFAsPIAM: Panel de Consenso Argentino.

PubMed

Marzi, Marta M; Pires, Miryam S; Quaglia, Nora B

2018-04-18

To perform a list agreed by Argentinean experts and adapted to the local context containing potentially inappropriate (PI) medications in old people (OP) usingthe Delphi consensus technique optimized for this subject. A preliminary list of potentially inappropriate medications (PIM) was drawn up based on foreign PIM lists and a selective search in the scientific literature. The iterative Delphi process was used to submit the active pharmaceutical ingredients (APIs) of the preliminary PIM list to the panel of Argentinean experts. The analysis of theanswers to determine the arrival to the consensus was carried out applying three criteria specially defined for this purpose. After two Delphi rounds, it was not reached agreement about 12 APIs. The List of explicit criteria for PIAPIs for use in OP (IFAsPIAM List) was finally constituted by 128 APIs corresponding to 9 groups of the ATC classification system to which they were organized. In addition to each API, information justifying the unfavorable benefit/risk profile and therapeutic alternatives or recommendations/precautions was recorded. The group with the most PI APIs was N (NervousSystem) (60; 47%) followed by groups C (Cardiovascular) and M (Musculoskeletal). This study presents the first Latin American list of PIM in OP developed using an expert consensus technique. The IFAs PIAM List would contribute to the rational use of drugs in elderly population, constituting a valuable tool in Argentinean public health. Copyright © 2018. Published by Elsevier Inc.

Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery

PubMed Central

Nina, Vinicius José da Silva; Jatene, Fabio B.; Sevdalis, Nick; Mejía, Omar Asdrúbal Vilca; Brandão, Carlos Manuel de Almeida; Monteiro, Rosangela; Caneo, Luiz Fernando; Scudeller, Paula Gobi; Mendes, Augusto Dimitry; Mendes, Vinícius Giuliano; Romano, Bellkiss Wilma

2017-01-01

Introduction Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study. PMID:29267606

Safety Assessment of Pentaerythrityl Tetraesters as Used in Cosmetics.

PubMed

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

2015-09-01

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) reviewed the safety of 16 pentaerythrityl tetraester compounds as used in cosmetics. These ingredients mostly function as hair-conditioning agents, skin-conditioning agents-miscellaneous and binders, skin-conditioning agents-occlusive, viscosity-increasing agents-nonaqueous, and skin-conditioning agents-emollient. The Panel reviewed the available animal and human data related to these ingredients and previous safety assessments of the fatty acid moieties. The Panel concluded that pentaerythrityl tetraisostearate and the other pentaerythrityl tetraester compounds were safe in the practices of use and concentration as given in this safety assessment. © The Author(s) 2015.

Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis.

PubMed

Long, Sandra; Monsen, Karen A; Pieczkiewicz, David; Wolfson, Julian; Khairat, Saif

2017-10-12

For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer's household, number of visits to providers outside the consumer's insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care. ©Sandra Long, Karen A. Monsen, David Pieczkiewicz, Julian Wolfson, Saif Khairat. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 12.10.2017.

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.

[The debate concerning performance-based financing in Africa South of the Sahara: analysis of the nature].

PubMed

Manitu, Serge Mayaka; Meessen, Bruno; Lushimba, Michel Muvudi; Macq, Jean

2015-01-01

Performance-based financing (PBF) is a strategy designed to link thefunding of health services to predetermined results. Payment by an independent strategic purchaser is subject to verification of effective achievement of health outcomes in terms ofquantity and quality. This article investigates the complex tensions observed in relation to performance based financing (PBF) and identifies some reasons for disagreement on this approach. This study was essentially qualitative. Interviews were conducted with a panel of experts on PBF mobilizing their ability to reflect on the various arguments and positions concerning this financing mechanism. To enhance our analyses, we proposed a framework based on the main reasonsfor scientific or political controversies and factors involved in their emergence. Analysis of the information collected therefore consisted of combining experts verbatim reports with corresponding factors of controversies of our framework. Graphic representations of the differences were also established. Tensions concerning PBF are based on facts (experts' interpretation ofPBF), principles and values (around each expert's conceptual framework), balances of power between experts but also inappropriate behavior in the discussion process. Viewpoints remain isolated, each individual experience and an overview are lacking, which can interfere with decision-making and maintain the Health system reform crisis. Potential solutions to reduce these tensions are proposed. Our study shows that experts have difficulties agreeing on a theoretical priority approach to PBE. A good understanding of the nature of the tensions and an improvement in the quality of dialogue will promote a real dynamic of change and the proposal of an agenda of PBF actions.

Assessing management of raptor predation management for snowy plover recovery

Treesearch

Bruce G. Marcot; Daniel C. Elbert

2015-01-01

On February 4, 2014, a seven-member expert panel provided objective technical information on the potential effectiveness and feasibility of activities to manage raptors (northern harriers and great horned owls) to aid the recovery of western snowy plovers. The panel discussed and scored the 26 raptor control techniques in nine main categories of habitat modification,...

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

ERIC Educational Resources Information Center

Karr, Alan

2011-01-01

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

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

ERIC Educational Resources Information Center

Royce, Sherry

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

Application of Guided Inquiry System Technique (GIST) to Controlled Ecological Life Support Systems (CELSS)

NASA Technical Reports Server (NTRS)

Aroeste, H.

1982-01-01

Guided Inquiry System Technique, a global approach to problem solving, was applied to the subject of Controlled Ecological Life Support Systems (CELSS). Nutrition, food processing, and the use of higher plants in a CELSS were considered by a panel of experts. Specific ideas and recommendations gleaned from discussions with panel members are presented.

Collaborating to Move Research Forward: Proceedings of the 10th Annual Bladder Cancer Think Tank.

PubMed

Kamat, Ashish M; Agarwal, Piyush; Bivalacqua, Trinity; Chisolm, Stephanie; Daneshmand, Sia; Doroshow, James H; Efstathiou, Jason A; Galsky, Matthew; Iyer, Gopa; Kassouf, Wassim; Shah, Jay; Taylor, John; Williams, Stephen B; Quale, Diane Zipursky; Rosenberg, Jonathan E

2016-04-27

The 10th Annual Bladder Cancer Think Tank was hosted by the Bladder Cancer Advocacy Network and brought together a multidisciplinary group of clinicians, researchers, representatives and Industry to advance bladder cancer research efforts. Think Tank expert panels, group discussions, and networking opportunities helped generate ideas and strengthen collaborations between researchers and physicians across disciplines and between institutions. Interactive panel discussions addressed a variety of timely issues: 1) data sharing, privacy and social media; 2) improving patient navigation through therapy; 3) promising developments in immunotherapy; 4) and moving bladder cancer research from bench to bedside. Lastly, early career researchers presented their bladder cancer studies and had opportunities to network with leading experts.

Aeromedical decision making--it may be time for a paradigm change.

PubMed

Steinkraus, Lawrence W; Rayman, Russell B; Butler, William P; Marsh, Royden W; Ercoline, William; Cowl, Clayton T

2012-10-01

Recent events in the U-2 and F-22 fleets have challenged aeromedical experts, highlighting the need for better in-flight aircrew physiologic and cognitive monitoring capability. Existing aerospace medicine risk assessment tools, while necessary, are no longer sufficient to affect positive safety changes given the evolving nature of the aerospace environment. Cognition and its sub-elements are now primary measures for the "Fit to Fly" decision. We must investigate practical methodologies for determining dynamic aircrew physiologic and cognitive function preflight (selection, retention) and in-flight (selection, retention, performance enhancement). In 2010, a panel of aeromedical experts met to address current paradigms and suggest possible solutions. This commentary briefly summarizes panel findings and recommendations.

Safety Assessment of Chlorphenesin as Used in Cosmetics.

PubMed

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

2014-05-26

Chlorphenesin functions as a biocide in cosmetics and is used at concentrations up to 0.32% in rinse-off products and up to 0.3% in leave-on products. The Cosmetic Ingredient Review Expert Panel (Panel) noted that chlorphenesin was well absorbed when applied to the skin of rats; however, any safety concern was minimized because available data demonstrated an absence of toxicity. The Panel concluded that chlorphenesin is safe in the present practices of use and concentration. © The Author(s) 2014.

Automated database-guided expert-supervised orientation for immunophenotypic diagnosis and classification of acute leukemia

PubMed Central

Lhermitte, L; Mejstrikova, E; van der Sluijs-Gelling, A J; Grigore, G E; Sedek, L; Bras, A E; Gaipa, G; Sobral da Costa, E; Novakova, M; Sonneveld, E; Buracchi, C; de Sá Bacelar, T; te Marvelde, J G; Trinquand, A; Asnafi, V; Szczepanski, T; Matarraz, S; Lopez, A; Vidriales, B; Bulsa, J; Hrusak, O; Kalina, T; Lecrevisse, Q; Martin Ayuso, M; Brüggemann, M; Verde, J; Fernandez, P; Burgos, L; Paiva, B; Pedreira, C E; van Dongen, J J M; Orfao, A; van der Velden, V H J

2018-01-01

Precise classification of acute leukemia (AL) is crucial for adequate treatment. EuroFlow has previously designed an AL orientation tube (ALOT) to guide towards the relevant classification panel (T-cell acute lymphoblastic leukemia (T-ALL), B-cell precursor (BCP)-ALL and/or acute myeloid leukemia (AML)) and final diagnosis. Now we built a reference database with 656 typical AL samples (145 T-ALL, 377 BCP-ALL, 134 AML), processed and analyzed via standardized protocols. Using principal component analysis (PCA)-based plots and automated classification algorithms for direct comparison of single-cells from individual patients against the database, another 783 cases were subsequently evaluated. Depending on the database-guided results, patients were categorized as: (i) typical T, B or Myeloid without or; (ii) with a transitional component to another lineage; (iii) atypical; or (iv) mixed-lineage. Using this automated algorithm, in 781/783 cases (99.7%) the right panel was selected, and data comparable to the final WHO-diagnosis was already provided in >93% of cases (85% T-ALL, 97% BCP-ALL, 95% AML and 87% mixed-phenotype AL patients), even without data on the full-characterization panels. Our results show that database-guided analysis facilitates standardized interpretation of ALOT results and allows accurate selection of the relevant classification panels, hence providing a solid basis for designing future WHO AL classifications. PMID:29089646

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support

PubMed Central

2010-01-01

Background Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. Method This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. Results EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. Discussion This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research. PMID:20920289

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support.

PubMed

Gibert, Karina; García-Alonso, Carlos; Salvador-Carulla, Luis

2010-09-30

Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research.

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

None, None

This document summarizes the recommendations and evaluations provided by an independent external panel of experts at the 2013 U.S. Department of Energy Bioenergy Technologies Office's Peer Review meeting.

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

PubMed Central

2014-01-01

Background Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services. Methods/Design This study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario. Discussion Using a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies. PMID:24669765

Practical Applications of a Space Station

NASA Technical Reports Server (NTRS)

1984-01-01

The potential uses of a special station for civil and commercial applications is examined. Five panels of experts representing user-oriented communities, and a sixth panel which dealth with system design considerations, based their studies on the assumption that the station would be a large platform, capable of housing a wide array of diverse instruments, and could be either manned or unmanned. The Earth's Resources Panel dealt with applications of remote sensing for resource assessment. The Earth's Environment Panel dealt with the Earth's atmosphere and its impact on society. The Ocean Operations Panel looked at both science and applications. The Satellite Communications Panel assessed the potential role of a space station in the evolution of commercial telecommunication services up to the year 2000. The Materials Science and Engineering panel focused on the utility of a space station environment for materials processing.

How a concerned family member, friend or member of the public can help someone with gambling problems: a Delphi consensus study.

PubMed

Bond, Kathy S; Jorm, Anthony F; Miller, Helen E; Rodda, Simone N; Reavley, Nicola J; Kelly, Claire M; Kitchener, Betty A

2016-02-03

Gambling is an enjoyable recreational pursuit for many people. However, for some it can lead to significant harms. The Delphi expert consensus method was used to develop guidelines for how a concerned family member, friend or member of the public can recognise the signs of gambling problems and support a person to change their gambling. A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for supporting a person with gambling problems. These items were rated over three rounds by two international expert panels comprising people with a lived experience of gambling problems and professionals who treat people with gambling problems or research gambling problems. A total of 66 experts (34 with lived experience and 32 professionals) rated 412 helping statements according to whether they thought the statements should be included in these guidelines. There were 234 helping statements that were endorsed by at least 80 % of members of both of the expert panels. These endorsed statements were used to develop the guidelines. Two groups of experts were able to reach substantial consensus on how someone can recognise the signs of gambling problems and support a person to change.

77 FR 43089 - Evaluation of an Up-and-Down Procedure for Acute Dermal Systemic Toxicity Testing: Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Systemic Toxicity Testing: Request for Nominations for an Independent Expert Panel and Submission of... systemic toxicity testing. NICEATM requests nominations of scientific experts who can be considered for the...) Test Guideline 425 in 2001 (OECD, 2001). The oral UDP reduces animal use by up to 70% compared to the...

"A Prophecy for the Arts" in Higher Education

ERIC Educational Resources Information Center

Merrion, Margaret

2009-01-01

This article presents a Delphi study that captured a myriad of predictions that represent the best thinking of a panel of creative minds, experts in a variety of arts and with many years of experience as arts leaders. Predictions provide a set of interlinked challenges and opportunities. In this study, the experts forecast changes in students that…

The Essential Components of Coach Training for Mental Health Professionals: A Delphi Study

ERIC Educational Resources Information Center

Moriarity, Marlene Therese

2010-01-01

Purpose. The purpose of this study was to discover how coach training experts define coaching and what they would identify to be the essential components of a coach training program for mental health professionals. Methods. A panel of nine experts, through an iterative Delphi process of responding to three rounds of questionnaires, provided…

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

ERIC Educational Resources Information Center

Weinrach, Stephen G.

1996-01-01

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

An index of effluent aquatic toxicity designed by partial least squares regression, using acute and chronic tests and expert judgements.

PubMed

Vindimian, Éric; Garric, Jeanne; Flammarion, Patrick; Thybaud, Éric; Babut, Marc

1999-10-01

The evaluation of the ecotoxicity of effluents requires a battery of biological tests on several species. In order to derive a summary parameter from such a battery, a single endpoint was calculated for all the tests: the EC10, obtained by nonlinear regression, with bootstrap evaluation of the confidence intervals. Principal component analysis was used to characterize and visualize the correlation between the tests. The table of the toxicity of the effluents was then submitted to a panel of experts, who classified the effluents according to the test results. Partial least squares (PLS) regression was used to fit the average value of the experts' judgements to the toxicity data, using a simple equation. Furthermore, PLS regression on partial data sets and other considerations resulted in an optimum battery, with two chronic tests and one acute test. The index is intended to be used for the classification of effluents based on their toxicity to aquatic species. Copyright © 1999 SETAC.

An index of effluent aquatic toxicity designed by partial least squares regression, using acute and chronic tests and expert judgments

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

Vindimian, E.; Garric, J.; Flammarion, P.

1999-10-01

The evaluation of the ecotoxicity of effluents requires a battery of biological tests on several species. In order to derive a summary parameter from such a battery, a single endpoint was calculated for all the tests: the EC10, obtained by nonlinear regression, with bootstrap evaluation of the confidence intervals. Principal component analysis was used to characterize and visualize the correlation between the tests. The table of the toxicity of the effluents was then submitted to a panel of experts, who classified the effluents according to the test results. Partial least squares (PLS) regression was used to fit the average valuemore » of the experts' judgments to the toxicity data, using a simple equation. Furthermore, PLS regression on partial data sets and other considerations resulted in an optimum battery, with two chronic tests and one acute test. The index is intended to be used for the classification of effluents based on their toxicity to aquatic species.« less

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

PubMed Central

2012-01-01

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

Priorities for implementing nutritional science into practice to optimize military performance.

PubMed

Elfenbaum, Pamela; Crawford, Cindy; Enslein, Viviane; Berry, Kevin

2017-06-01

The Metabolically Optimized Brain study explores nutritional science believed to be ready to place into practice to help improve US service member mission-readiness and performance. To this end, an implementation expert panel considered how the US Department of Defense Subsistence Food Service Program, which is operated by each branch of the military in dining facilities within the continental United States, could apply the best nutritional science in a cost-effective manner. The work of this panel was facilitated through a series of thematic conversations guided by evidence generated through systematic reviews, which were performed to identify systems and process gaps and propose possible solutions. The expert panel used a Delphi method of multiple voting, and ultimately proposed 11 systems changes, of which 6 were ranked as highest priority. The proposed highest priority changes were then discussed by the participants with additional stakeholders. The process described here highlights how experts from different sectors operating in a complex system of subsystems can come together to cross talk, identify gaps, and propose mutually beneficial system and process changes to improve the alignment of nutritional science and institutional food-service practice. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

PubMed Central

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

2018-01-01

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

A Screening Tool to Identify Spasticity in Need of Treatment

PubMed Central

Zorowitz, Richard D.; Wein, Theodore H.; Dunning, Kari; Deltombe, Thierry; Olver, John H.; Davé, Shashank J.; Dimyan, Michael A.; Kelemen, John; Pagan, Fernando L.; Evans, Christopher J.; Gillard, Patrick J.; Kissela, Brett M.

2017-01-01

Objective To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology. Design Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity symptoms and impact on daily function and sleep. Spasticity expert panelists evaluated items pooled from existing questionnaires to gain consensus on the screening tool content. The study also included cognitive interviews of 20 patients with varying spasticity etiologies to determine if the draft screening tool was understandable and relevant to patients with spasticity. Results The Delphi panel reached an initial consensus on 21 of 47 items for the screening tool and determined that the tool should have no more than 11 to 15 items and a 1-month recall period for symptom and impact items. After 2 rounds of review, 13 items were selected and modified by the expert panelists. Most patients (n = 16 [80%]) completed the cognitive interview and interpreted the items as intended. Conclusions Through the use of a Delphi panel and patient interviews, a 13-item spasticity screening tool was developed that will be practical and easy to use in routine clinical practice. PMID:27552355

Devising a consensus definition and framework for non-technical skills in healthcare to support educational design: A modified Delphi study.

PubMed

Gordon, Morris; Baker, Paul; Catchpole, Ken; Darbyshire, Daniel; Schocken, Dawn

2015-01-01

Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency- or outcome-based framework for non-technical skills training in healthcare. The authors set out to devise such a framework using a modified Delphi approach. An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Sixteen experts participated. The final framework consists of 16 competencies for all and eight specific competencies for team leaders. The consensus definition describes non-technical skills as "a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system". The authors have produced a new competency framework, through the works of an International expert panel, which is not discipline specific that can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field.

Application of Delphi expert panel in joint venture projects

NASA Astrophysics Data System (ADS)

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

2018-02-01

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

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant.

PubMed

Van Den Neste, Eric; Casasnovas, Olivier; André, Marc; Touati, Mohamed; Senecal, Delphine; Edeline, Véronique; Stamatoullas, Aspasia; Fornecker, Luc; Deau, Bénédicte; Gastinne, Thomas; Reman, Oumédaly; Gaillard, Isabelle; Borel, Cécile; Brice, Pauline; Fermé, Christophe

2013-08-01

The Hodgkin's Lymphoma Committee of the Lymphoma Study Association (LYSA) gathered in 2012 to prepare guidelines on the management of transplant-eligible patients with relapsing or refractory Hodgkin's lymphoma. The working group is made up of a multidisciplinary panel of experts with a significant background in Hodgkin's lymphoma. Each member of the panel of experts provided an interpretation of the evidence and a systematic approach to obtain consensus was used. Grades of recommendation were not required since levels of evidence are mainly based on phase II trials or standard practice. Data arising from randomized trials are emphasized. The final version was endorsed by the scientific council of the LYSA. The expert panel recommends a risk-adapted strategy (conventional treatment, or single/double transplantation and/or radiotherapy) based on three risk factors at progression (primary refractory disease, remission duration < 1 year, stage III/IV), and an early evaluation of salvage chemosensitivity, including (18)fluorodeoxy glucose-positron emission tomography interpreted according to the Deauville scoring system. Most relapsed or refractory Hodgkin's lymphoma patients chemosensitive to salvage should receive high-dose therapy and autologous stem-cell transplantation as standard. Efforts should be made to increase the proportion of chemosensitive patients by alternating non-cross-resistant chemotherapy lines or exploring the role of novel drugs.

Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

PubMed Central

Basger, Benjamin Joseph; Chen, Timothy Frank; Moles, Rebekah Jane

2012-01-01

Objective To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. Design RAND/UCLA appropriateness method. Participants A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. Main outcome measure Agreement on all criteria. Results Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. Conclusions A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals. PMID:22983875

Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR)

PubMed Central

Purcell, Susan E; Rhea, Karen; Maier, Philip; First, Michael; Zweede, Lisa; Sinisterra, Manuela; Nunn, M Brad; Austin, Marie-Paule; Brodey, Inger S

2018-01-01

Background The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. Objective This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. Results The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. Conclusions The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians. PMID:29572204

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

Yang, Joyce

This document summarizes the recommendations and evaluations provided by an independent external panel of experts at the 2011 U.S. Department of Energy Biomass Program’s Algae Platform Review meeting.

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

PubMed

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

2017-04-01

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

Developing an occupational skills profile for the emerging profession of "big-data-enabled professional"

NASA Astrophysics Data System (ADS)

Kastens, K. A.; Malyn-Smith, J.; Ippolito, J.; Krumhansl, R.

2014-12-01

In August of 2014, the Oceans of Data Institute at Education Development Center, Inc. (EDC) is convening an expert panel to begin the process of developing an occupational skills profile for the "big-data-enabled professional." We define such a professional as an "individual who works with large complex data sets on a regular basis, asking and answering questions, analyzing trends, and finding meaningful patterns, in order to increase the efficiency of processes, make decisions and predictions, solve problems, generate hypotheses, and/or develop new understandings." The expert panel includes several geophysicists, as well as data professionals from engineering, higher education, analytical journalism, forensics, bioinformatics, and telecommunications. Working with experienced facilitators, the expert panel will create a detailed synopsis of the tasks and responsibilities characteristic of their profession, as well as the skills, knowledge and behaviors that enable them to succeed in the workplace. After the panel finishes their work, the task matrix and associated narrative will be vetted and validated by a larger group of additional professionals, and then disseminated for use by educators and employers. The process we are using is called DACUM (Developing a Curriculum), adapted by EDC and optimized for emergent professions, such as the "big-data-enabled professional." DACUM is a well-established method for analyzing jobs and occupations, commonly used in technical fields to develop curriculum and training programs that reflect authentic work tasks found in scientific and technical workplaces. The premises behind the DACUM approach are that: expert workers are better able to describe their own occupation than anyone else; any job can be described in terms of the tasks that successful workers in the occupation perform; all tasks have direct implications for the knowledge, skills, understandings and attitudes that must be taught and learned in preparation for the targeted career. At AGU, we will describe the process and present the finalized occupational profile.

Practice gaps in the care of mitral valve regurgitation: Insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel.

PubMed

Wang, Andrew; Grayburn, Paul; Foster, Jill A; McCulloch, Marti L; Badhwar, Vinay; Gammie, James S; Costa, Salvatore P; Benitez, Robert Michael; Rinaldi, Michael J; Thourani, Vinod H; Martin, Randolph P

2016-02-01

The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation. The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR. A key project element was a set of surveys distributed to primary care and cardiovascular physicians (cardiologists and cardiothoracic surgeons). Survey and other gap analysis findings were presented to a panel of 10 expert advisors from specialties of general cardiology, cardiac imaging, interventional cardiology, and cardiac surgeons with expertise in valvular heart disease, especially MR, and cardiovascular education. The panel was charged with assessing the relative importance and potential means of remedying identified gaps to improve care for patients with MR. The survey results identified several knowledge and practice gaps that may limit implementation of evidence-based recommendations for MR care. Specifically, half of primary care physicians reported uncertainty regarding timing of intervention for patients with severe primary or functional MR. Physicians in all groups reported that quantitative indices of MR severity were frequently not reported in clinical echocardiographic interpretations, and that these measurements were not consistently reviewed when provided in reports. In the treatment of MR, nearly 30% of primary care physician and general cardiologists did not know the volume of mitral valve repair surgeries by their reference cardiac surgeons and did not have a standard source to obtain this information. After review of the survey results, the expert panel summarized practice gaps into 4 thematic areas and offered proposals to address deficiencies and promote better alignment with the 2014 ACC/American Heart Association valvular disease guidelines. Important knowledge and skill gaps exist that may impede optimal care of the patient with MR. Focused educational and practice interventions should be developed to reduce these gaps. Copyright © 2015 Elsevier Inc. All rights reserved.

A multimedia psychosocial support program for couples receiving infertility treatment: a feasibility study.

PubMed

Cousineau, Tara M; Lord, Sarah E; Seibring, Angel R; Corsini, Evelyn A; Viders, Jessie C; Lakhani, Shaheen R

2004-03-01

To develop and test the feasibility of a theory-driven, psychosocial support CD-ROM prototype for couples in infertility treatment. Focus group meetings with reproductive health experts, semistructured interviews with infertility patients, and content analysis of an infertility message board to determine content domains of the CD-ROM. Usability and acceptance testing of prototype CD-ROM based on predetermined feasibility criteria. Private offices and fertility centers. Expert panel of 5 reproductive health specialists; interviews with 62 individuals with infertility (35 women, 27 men); feasibility study with 12 patients and 12 experts in reproductive medicine and infertility support. None. Product usability/acceptance test. Participant feedback and content analysis informed the development of a prototype patient education CD-ROM that uses audio, video, interactive tasks, and personalized feedback. Over 80% of participants successfully completed usability tasks, and over 90% rated prototype satisfaction as "good" to "excellent." Some areas were noted for improvement in navigation and refinement in delivery of instructions. Results strongly indicate an interest in an infertility multimedia support tool. Multimedia methods may serve as an effective, innovative psychosocial intervention for infertility patients and overcome barriers of limited local access to educational and support services.

Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.

ERIC Educational Resources Information Center

National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

Studies have shown that high blood cholesterol levels play a role in the development of coronary heart disease in adults, and that the process leading to atherosclerosis begins in childhood. To address the problem of high cholesterol levels in children, the Panel on Blood Cholesterol Levels recommends complementary approaches for individuals and…

A Comparative Study of the Perceptions of Professional Staff on Their Contribution to Student Outcomes

ERIC Educational Resources Information Center

Regan, Julie-Anne; Dollard, Emma; Banks, Nicci

2014-01-01

This study examined the perceptions of professional staff on their contribution to student outcomes. An online Delphi survey method was used to collect data from two expert panels: professional staff based in faculties and professional staff based in central university departments. The aim of this method is for the panels to reach consensus. The…

Reaching Consensus on Essential Biomedical Science Learning Objectives in a Dental Curriculum.

PubMed

Best, Leandra; Walton, Joanne N; Walker, Judith; von Bergmann, HsingChi

2016-04-01

This article describes how the University of British Columbia Faculty of Dentistry reached consensus on essential basic biomedical science objectives for DMD students and applied the information to the renewal of its DMD curriculum. The Delphi Method was used to build consensus among dental faculty members and students regarding the relevance of over 1,500 existing biomedical science objectives. Volunteer panels of at least three faculty members (a basic scientist, a general dentist, and a dental specialist) and a fourth-year dental student were formed for each of 13 biomedical courses in the first two years of the program. Panel members worked independently and anonymously, rating each course objective as "need to know," "nice to know," "irrelevant," or "don't know." Panel members were advised after each round which objectives had not yet achieved a 75% consensus and were asked to reconsider their ratings. After a maximum of three rounds to reach consensus, a second group of faculty experts reviewed and refined the results to establish the biomedical science objectives for the renewed curriculum. There was consensus on 46% of the learning objectives after round one, 80% after round two, and 95% after round three. The second expert group addressed any remaining objectives as part of its review process. Only 47% of previous biomedical science course objectives were judged to be essential or "need to know" for the general dentist. The consensus reached by participants in the Delphi Method panels and a second group of faculty experts led to a streamlined, better integrated DMD curriculum to prepare graduates for future practice.

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

PubMed

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

2015-04-01

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

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

PubMed

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

2005-04-01

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

An inventory of methods suitable to assess additive-induced characterising flavours of tobacco products.

PubMed

Talhout, Reinskje; van de Nobelen, Suzanne; Kienhuis, Anne S

2016-04-01

Products with strong non-tobacco flavours are popular among young people, and facilitate smoking initiation. Similar to the U.S. Food and Drug Administration Tobacco Control Act, the new European Tobacco Product Directive (TPD) prohibits cigarettes and roll-your-own tobacco with a characterising flavour other than tobacco. However, no methods are prescribed or operational to assess characterising flavours. This is the first study to identify, review and synthesize the existing peer-reviewed and tobacco industry literature in order to provide an inventory of methods suitable to assess characterising flavours. Authors gathered key empirical and theoretical papers examining methods suitable to assess characterising flavours. Scientific literature databases (PubMed and Scopus) and tobacco industry documents were searched, based on several keyword combinations. Inclusion criteria were relevance for smoked tobacco products, and quality of data. The findings reveal that there is a wide variation in natural tobacco flavours. Flavour differences from natural tobacco can be described by both expert and consumer sensory panels. Most methods are based on smoking tests, but odour evaluation has also been reported. Chemical analysis can be used to identify and quantify levels of specific flavour additives in tobacco products. As flavour perception is subjective, and requires human assessment, sensory analysis in consumer or expert panel studies is necessitated. We recommend developing validated tests for descriptive sensory analysis in combination with chemical-analytical measurements. Testing a broad range of brands, including those with quite subtle characterizing flavours, will provide the concentration above which an additive will impart a characterising flavour. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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.

Genetic Testing Integration Panels (GTIPs): A novel approach for considering integration of direct-to-consumer and other new genetic tests into patient care

PubMed Central

Uhlmann, Wendy R.; Sharp, Richard R.

2014-01-01

There has been a dramatic increase in the number of genetic tests available but few tests have practice guidelines. In addition, many tests have become available outside of genetics clinics through direct-to-consumer (DTC) companies and several offer tests not considered standard of care. To address several practical challenges associated with the rapid introduction of clinical and DTC genetic tests, we propose that genetic counselors and geneticists organize expert panels in their institutions to discuss the integration of new tests into patient care. We propose the establishment of Genetic Testing Integration Panels (GTIPs) to bring together local experts in medical genetics, genetic counseling, bioethics and law, health communication and clinical laboratory genetics. We describe key features of this approach and consider some of the potential advantages and limitations of using a GTIP to address the many clinical challenges raised by rapidly emerging clinical and DTC genetic tests. PMID:22246561

Safety Assessment of Alkyl PEG/PPG Ethers as Used in Cosmetics.

PubMed

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

2016-07-01

The Cosmetic Ingredient Review (CIR) Expert Panel assessed the safety of 131 alkyl polyethylene glycol (PEG)/polypropylene glycol ethers as used in cosmetics, concluding that these ingredients are safe in the present practices of use and concentration described in this safety assessment when formulated to be nonirritating. Most of the alkyl PEG/PPG ethers included in this review are reported to function in cosmetics as surfactants, skin-conditioning agents, and/or emulsifying agents. The alkyl PEG/PPG ethers share very similar physiochemical properties as the alkyl PEG ethers, which were reviewed previously by the CIR Expert Panel and found safe when formulated to be nonirritating. The alkyl PEG ethers differ by the inclusion of PPG repeat units, which are used to fine-tune the surfactant properties of this group. The Panel relied heavily on data on analogous ingredients, extracted from the alkyl PEG ethers and PPG reports, when making its determination of safety. © The Author(s) 2016.

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

PubMed

Becker, S M

2001-12-01

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

Best practices for transfusion for patients with sickle cell disease

PubMed Central

Wun, Ted; Hassell, Kathryn

2010-01-01

The β-globin gene mutation in sickle cell anemia results in anemia and repeated bouts of vascular occlusion. The cumulative effect of these vasocclusive events is progressive damage to many organs including the kidneys, lungs, and brain. The transfusion of red blood cells (RBC) can ameliorate many of these complications, but can be associated with both acute and chronic complications, including iron overload. The objective of the Best Practices in Transfusion Medicine for Patients with Sickle Cell Disease (SCD) Conference was to review the available published evidence and clinical experience surrounding the use of RBC transfusions for sickle cell disease by a panel of experts. The expert panel developed explicit clinical guidelines for the use of RBC in SCD patients. The panel also made recommendations for further research. A set of guidelines were produced for dissemination to pertinent stakeholders. If implemented, these clinical pathways have the potential to optimize the use of red blood cell transfusions in SCD.

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.

Information and communication technology

NASA Technical Reports Server (NTRS)

Edelson, Burton I.; Pelton, Joseph N.; Bostian, Charles W.; Brandon, William T.; Chan, Vincent W. S.; Hager, E. Paul; Helm, Neil R.; Jennings, Raymond D.; Kwan, Robert K.; Mahle, Christoph E.

1994-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of U.S. experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members traveled to Europe, Japan, and Russia to gather information firsthand. They visited 17 sites in Europe, 20 in Japan, and 4 in Russia. These included major manufacturers, government organizations, service providers, and associated research and development facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of U.S. industry. The report details the information collected and compares it to U.S. activities.

Satellite communications systems and technology. Executive Summary

NASA Technical Reports Server (NTRS)

Edelson, Burton I.; Pelton, Joseph N.; Bostian, Charles W.; Brandon, William T.; Chan, Vincent W. S.; Hager, E. Paul; Helm, Neil R.; Jennings, Raymond D.; Kwan, Robert; Mahle, Christoph E.

1993-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of US experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members travelled to Europe, Japan, and Russia to gather information first-hand. They visited 17 sites in Europe, 20 sites in Japan, and four in Russia. These included major manufacturers, government organizations, service providers, and associated R&D facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of US industry. The report details the information collected and compares it to US activities.

Safety Assessment of Polyether Lanolins as Used in Cosmetics.

PubMed

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

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of 39 polyether lanolin ingredients as used in cosmetics. These ingredients function mostly as hair conditioning agents, skin conditioning agent-emollients, and surfactant-emulsifying agents. The Panel reviewed available animal and clinical data, from previous CIR safety assessments of related ingredients and components. The similar structure, properties, functions, and uses of these ingredients enabled grouping them and using the available toxicological data to assess the safety of the entire group. The Panel concluded that these polyether lanolin ingredients are safe in the practices of use and concentration as given in this safety assessment.

The Stammering Information Programme: a Delphi study.

PubMed

Berquez, Ali E; Cook, Frances M; Millard, Sharon K; Jarvis, Effie

2011-09-01

To find out what information children, parents and education staff feel would be important to know to support a child who stutters in the educational environment, in order to develop appropriate resources. A Delphi study was carried out to seek the opinions of experts about the information to include. A structured six stage process was completed in order to gain consensus within four expert panels: children who stutter (CWS) aged 7-11 (n=25); young people who stutter aged 12-18 (n=27); parents of children and young people who stutter aged 2-18 (n=67); and members of the education workforce (n=35). In response to the questions, 538 statements were generated across the four expert panels, categorised and reduced to 276. Of the 154 rating questionnaires sent out, 99 were returned (64.2% response rate). The top 32 statements, which were those most highly rated and with the greatest consensus, were retained to inform the resources. This study demonstrates the value of including service users when devising materials aimed for the benefit of CWS. The methodology employed ensured that ideas, perceptions and needs were representative of a range of people who experience stuttering from different perspectives. The results indicated that each expert panel had different priorities of what should be included. The resulting resources may therefore be considered to have high content validity and would be predicted to meet the needs of those who require them. The reader will be able to (1) define the Delphi Approach (2) discuss the development of a user led resource for raising awareness about stuttering. Copyright © 2011 Elsevier Inc. All rights reserved.

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

PubMed

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

2017-08-01

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

Direction and Integration of Experimental Ground Test Capabilities and Computational Methods

NASA Technical Reports Server (NTRS)

Dunn, Steven C.

2016-01-01

This paper groups and summarizes the salient points and findings from two AIAA conference panels targeted at defining the direction, with associated key issues and recommendations, for the integration of experimental ground testing and computational methods. Each panel session utilized rapporteurs to capture comments from both the panel members and the audience. Additionally, a virtual panel of several experts were consulted between the two sessions and their comments were also captured. The information is organized into three time-based groupings, as well as by subject area. These panel sessions were designed to provide guidance to both researchers/developers and experimental/computational service providers in defining the future of ground testing, which will be inextricably integrated with the advancement of computational tools.

Development and validation of the simulation-based learning evaluation scale.

PubMed

Hung, Chang-Chiao; Liu, Hsiu-Chen; Lin, Chun-Chih; Lee, Bih-O

2016-05-01

The instruments that evaluate a student's perception of receiving simulated training are English versions and have not been tested for reliability or validity. The aim of this study was to develop and validate a Chinese version Simulation-Based Learning Evaluation Scale (SBLES). Four stages were conducted to develop and validate the SBLES. First, specific desired competencies were identified according to the National League for Nursing and Taiwan Nursing Accreditation Council core competencies. Next, the initial item pool was comprised of 50 items related to simulation that were drawn from the literature of core competencies. Content validity was established by use of an expert panel. Finally, exploratory factor analysis and confirmatory factor analysis were conducted for construct validity, and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Two hundred and fifty students who had experienced simulation-based learning were invited to participate in this study. Two hundred and twenty-five students completed and returned questionnaires (response rate=90%). Six items were deleted from the initial item pool and one was added after an expert panel review. Exploratory factor analysis with varimax rotation revealed 37 items remaining in five factors which accounted for 67% of the variance. The construct validity of SBLES was substantiated in a confirmatory factor analysis that revealed a good fit of the hypothesized factor structure. The findings tally with the criterion of convergent and discriminant validity. The range of internal consistency for five subscales was .90 to .93. Items were rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). The results of this study indicate that the SBLES is valid and reliable. The authors recommend that the scale could be applied in the nursing school to evaluate the effectiveness of simulation-based learning curricula. Copyright © 2016 Elsevier Ltd. All rights reserved.

An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings.

PubMed

Smits, M J; Loots, C M; van Wijk, M P; Bredenoord, A J; Benninga, M A; Smout, A J P M

2015-05-01

Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard. Twenty-one experts from 10 countries were asked to mark GER presence for adult and pediatric pH-I patterns in an online pre-assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER. Majority consensus was reached for 35/79 episodes in the online pre-assessment (interrater κ = 0.332). Mean agreement between pre-assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH-I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard. Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter 'retrograde propagation pattern' is an indicator of GER in difficult pH-I patterns. © 2015 John Wiley & Sons Ltd.

Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study.

PubMed

Rushton, A; White, L; Heap, A; Calvert, M; Heneghan, N; Goodwin, P

2016-02-25

To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. Mixed-methods combining evidence synthesis, expert review and focus groups. Secondary care involving 5 UK specialist spinal centres. A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness. 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.

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

PubMed Central

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

2017-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2017-11-01

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

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

PubMed

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

2016-06-01

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

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

PubMed Central

Estey, Elihu; Grimwade, David; Amadori, Sergio; Appelbaum, Frederick R.; Büchner, Thomas; Dombret, Hervé; Ebert, Benjamin L.; Fenaux, Pierre; Larson, Richard A.; Levine, Ross L.; Lo-Coco, Francesco; Naoe, Tomoki; Niederwieser, Dietger; Ossenkoppele, Gert J.; Sanz, Miguel; Sierra, Jorge; Tallman, Martin S.; Tien, Hwei-Fang; Wei, Andrew H.; Löwenberg, Bob; Bloomfield, Clara D.

2017-01-01

The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease. PMID:27895058

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.

PubMed

Schneider, Harry P; Baca, John M; Carpenter, Brian B; Dayton, Paul D; Fleischer, Adam E; Sachs, Brett D

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Assessing and evaluating multidisciplinary translational teams: a mixed methods approach.

PubMed

Wooten, Kevin C; Rose, Robert M; Ostir, Glenn V; Calhoun, William J; Ameredes, Bill T; Brasier, Allan R

2014-03-01

A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed-methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed-methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team-type taxonomy. Based on team maturation and scientific progress, teams were designated as (a) early in development, (b) traditional, (c) process focused, or (d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored.

Perceptual aspects of reproduced sound in car cabin acoustics.

PubMed

Kaplanis, Neofytos; Bech, Søren; Tervo, Sakari; Pätynen, Jukka; Lokki, Tapio; van Waterschoot, Toon; Jensen, Søren Holdt

2017-03-01

An experiment was conducted to determine the perceptual effects of car cabin acoustics on the reproduced sound field. In-car measurements were conducted whilst the cabin's interior was physically modified. The captured sound fields were recreated in the laboratory using a three-dimensional loudspeaker array. A panel of expert assessors followed a rapid sensory analysis protocol, the flash profile, to perceptually characterize and evaluate 12 acoustical conditions of the car cabin using individually elicited attributes. A multivariate analysis revealed the panel's consensus and the identified perceptual constructs. Six perceptual constructs characterize the differences between the acoustical conditions of the cabin, related to bass, ambience, transparency, width and envelopment, brightness, and image focus. The current results indicate the importance of several acoustical properties of a car's interior on the perceived sound qualities. Moreover, they signify the capacity of the applied methodology in assessing spectral and spatial properties of automotive environments in laboratory settings using a time-efficient and flexible protocol.

Report on the technical review workshop on the reference dose for Aroclor 1016. Held in Washington, DC on May 24-25, 1994

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

NONE

1994-11-01

The report includes information and material from a technical review workshop organized by the U.S. Environmental Protection Agency`s (EPA`s) Risk Assessment Forum for EPA`s Reference Dose/Reference Concentration (RfD/RfC) Work Group. The meeting was held in Washington, DC, at the Barcelo Washington Hotel on May 24-25, 1994. The subject of the technical review was the Integrated Risk Information System (IRIS) RfD entry for Aroclor 1016, a polychlorinated biphenyl (PCB). The expert technical review panel was convened to independently evaluate whether the RfD for Aroclor 1016 is based on a scientifically responsible analysis that represents full consideration of the available data andmore » clean articulation of that analysis in the IRIS RfD entry. EPA also requested panel members to consider four broad options for the Aroclor 1016 RfD as potential recommendations to the RfD/RfC Work Group.« less

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

Treesearch

Byung-kyu Lee; Wilbur F. LaPage

2002-01-01

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

A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis.

PubMed

Stockfleth, Eggert; Peris, Ketty; Guillen, Carlos; Cerio, Rino; Basset-Seguin, Nicole; Foley, Peter; Sanches, José; Culshaw, Alex; Erntoft, Sandra; Lebwohl, Mark

2015-01-01

Topical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis. An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated. The recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy. © 2015 The Authors. International Journal of Dermatology published by John Wiley & Sons Ltd on behalf of International Society of Dermatology.

A study of autopsy procedures in Ghana: implications for the use of autopsy data in epidemiological analyses

PubMed Central

Fobil, Julius N.; Kumoji, Robert; Armah, Henry B.; Aryee, Eunice; Bilson, Francis; Carboo, Derick; Rodrigues, Frederick K.; Meyer, Christian G.; May, Juergen; Kraemer, Alexander

2011-01-01

The study of cause of death certification remains a largely neglected field in many developing countries, including Ghana. Yet, mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana, autopsies remain the appropriate option for determining the cause of deaths occurring in homes and those occurring within 48 hours after admission into health facilities. Although these organ-based autopsies may generate convincing results and are considered the gold standard tools for ascertainments of causes of death, procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel, it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis. PMID:28299049

Analysis of nutrition judgments using the Nutrition Facts Panel.

PubMed

González-Vallejo, Claudia; Lavins, Bethany D; Carter, Kristina A

2016-10-01

Consumers' judgments and choices of the nutritional value of food products (cereals and snacks) were studied as a function of using information in the Nutrition Facts Panel (NFP, National Labeling and Education Act, 1990). Brunswik's lens model (Brunswik, 1955; Cooksey, 1996; Hammond, 1955; Stewart, 1988) served as the theoretical and analytical tool for examining the judgment process. Lens model analysis was further enriched with the criticality of predictors' technique developed by Azen, Budescu, & Reiser (2001). Judgment accuracy was defined as correspondence between consumers' judgments and the nutritional quality index, NuVal(®), obtained from an expert system. The study also examined several individual level variables (e.g., age, gender, BMI, educational level, health status, health beliefs, etc.) as predictors of lens model indices that measure judgment consistency, judgment accuracy, and knowledge of the environment. Results showed varying levels of consistency and accuracy depending on the food product, but generally the median values of the lens model statistics were moderate. Judgment consistency was higher for more educated individuals; judgment accuracy was predicted from a combination of person level characteristics, and individuals who reported having regular meals had models that were in greater agreement with the expert's model. Lens model methodology is a useful tool for understanding how individuals perceive the nutrition in foods based on the NFP label. Lens model judgment indices were generally low, highlighting that the benefits of the complex NFP label may be more modest than what has been previously assumed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Open Workshop on Solar Technologies: Proceedings

NASA Astrophysics Data System (ADS)

1980-07-01

The deliberations, conclusions, and recommendations of six panels asked to provide advice to the Department of Energy on the subject of solar energy are detailed. Introductory speeches by seven experts, excerpts from the succeeding two half days of discussion, the final reports for the panel chairpersons, and subsequent discussion and questioning are included. Approximately 125 findings and recommendations were developed by the six panels covering a wide variety of topics. Major recurring themes were recommendations for increased funding, federal program improvement, conservation, outreach programs small business funding, and solar training programs.

Resistance to discontinuing breast cancer screening in older women: A qualitative study.

PubMed

Housten, Ashley J; Pappadis, Monique R; Krishnan, Shilpa; Weller, Susan C; Giordano, Sharon H; Bevers, Therese B; Volk, Robert J; Hoover, Diana S

2018-06-01

Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. We used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. Women ≥70 years of age who reported having a screening mammogram in the past 3 years and/or reported that they intended to continue screening in the future were recruited for in-depth interviews. Participants who intended to continue screening were asked to describe how the following hypothetical scenarios would impact a decision to discontinue screening: health concerns or limited life expectancy, a physician's recommendation to discontinue, reluctance to undergo treatment, and recommendations from experts or governmental panels to stop screening. Semi-structured, face-to-face interviews were audio-recorded. Data coding and analysis followed inductive and deductive approaches. Regardless of the scenario, participants (n = 29) expressed a strong intention to continue screening. Based on the hypothetical physician recommendations, intentions to continue screening appeared to remain strong. They did not envision a change in their health status that would lead them to discontinue screening and were skeptical of expert/government recommendations. There were no differences observed according to age, race/ethnicity, or education. Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels. Copyright © 2018 John Wiley & Sons, Ltd.

A new intelligent electronic nose system for measuring and analysing livestock and poultry farm odours.

PubMed

Pan, Leilei; Yang, Simon X

2007-12-01

This paper introduces a new portable intelligent electronic nose system developed especially for measuring and analysing livestock and poultry farm odours. It can be used in both laboratory and field. The sensor array of the proposed electronic nose consists of 14 gas sensors, a humidity sensor, and a temperature sensor. The gas sensors were especially selected for the main compounds from the livestock farm odours. An expert system called "Odour Expert" was developed to support researchers' and farmers' decision making on odour control strategies for livestock and poultry operations. "Odour Expert" utilises several advanced artificial intelligence technologies tailored to livestock and poultry farm odours. It can provide more advanced odour analysis than existing commercially available products. In addition, a rank of odour generation factors is provided, which refines the focus of odour control research. Field experiments were conducted downwind from the barns on 14 livestock and poultry farms. Experimental results show that the predicted odour strengths by the electronic nose yield higher consistency in comparison to the perceived odour intensity by human panel. The "Odour Expert" is a useful tool for assisting farmers' odour management practises.

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

PubMed

1998-12-09

To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence. A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health. The literature was searched through MEDLINE and other National Library of Medicine and online databases from January 1994 through September 1997 and an extensive bibliography of 941 references was provided to the panel and the conference audience. Experts prepared abstracts for their presentations as speakers at the conference with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs.

ACR appropriateness Criteria® second and third trimester bleeding.

PubMed

Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

2013-12-01

Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the 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 recommend imaging or treatment.

Behavioral intervention technologies: evidence review and recommendations for future research in mental health.

PubMed

Mohr, David C; Burns, Michelle Nicole; Schueller, Stephen M; Clarke, Gregory; Klinkman, Michael

2013-01-01

A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes. This study on the findings of the technical expert panel. Videoconferencing and standard telephone technologies to deliver psychotherapy have been well validated. Web-based interventions have shown efficacy across a broad range of mental health outcomes. Social media such as online support groups have produced disappointing outcomes when used alone. Mobile technologies have received limited attention for mental health outcomes. Virtual reality has shown good efficacy for anxiety and pediatric disorders. Serious gaming has received little work in mental health. Research focused on understanding reach, adherence, barriers and cost is recommended. Improvements in the collection, storage, analysis and visualization of big data will be required. New theoretical models and evaluation strategies will be required. Finally, for BITs to have a public health impact, research on implementation and application to prevention is required. Copyright © 2013 Elsevier Inc. All rights reserved.

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions.

PubMed

Fray, Mike; Hignett, Sue

2013-01-01

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation. Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

A Chinese Mandarin translation and validation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS).

PubMed

Wang, W; Lopez, V; Thompson, D R

2006-09-01

To evaluate the validity, reliability, and cultural relevance of the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (MIDAS) as a disease-specific quality of life measure. The cultural relevance and content validity of the Chinese Mandarin version of the MIDAS (CM-MIDAS) was evaluated by an expert panel. Measurement performance was tested on 180 randomly selected Chinese MI patents. Thirty participants from the primary group completed the CM-MIDAS for test-retest reliability after 2 weeks. Reliability, validity and discriminatory power of the CM-MIDAS were calculated. Two items were modified as suggested by the expert panel. The overall CM-MIDAS had acceptable internal consistency with Cronbach's alpha coefficient 0.93 for the scale and 0.71-0.94 for the seven domains. Test-retest reliability by intraclass correlations was 0.85 for the overall scale and 0.74-0.94 for the seven domains. There was acceptable concurrent validity with significant (p < 0.05) correlations between the CM-MDAS and the Chinese Version of the Short Form 36. The principal components analysis extracted seven factors that explained 67.18% of the variance with high factor loading indicating good construct validity. Empirical data support CM-MIDAS as a valid and reliable disease-specific quality of life measure for Chinese Mandarin speaking patients with myocardial infarction.

Mars Up Close

NASA Image and Video Library

2014-08-05

Guest attending the National Geographic “Mars Up Close” panel discussion, look at full scale models of the Spirit/Opportunity, left, and Curiosity, Mars rovers, Tuesday, August 5, 2014, at the National Geographic Society headquarters in Washington. Guest listened to a panel of distinguished space scientists and Mars experts involved in current Mars exploration that shared what we’ve learned from Curiosity and the other Mars rovers. Photo Credit: (NASA/Bill Ingalls)

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group.

PubMed

Silverman, S L; Kupperman, E S; Bukata, S V

2016-07-01

We used the RAND UCLA appropriateness method to decide appropriateness of use of osteoporosis medication after incident fracture and potential for fracture healing and make suggestions for trial design for clinical and preclinical research. To develop appropriateness criteria to assist in the use and study of osteoporosis medications in patients with recent fracture and in the potential use of osteoporosis medications to enhance delayed fracture healing. To promote further research by suggesting preclinical and clinical trial design for studies where fracture healing is the endpoint. RAND/UCLA appropriateness method (RUAM). A panel of experts, both members and non-members of the International Osteoporosis Foundation Fracture Working Group, were identified consisting of geriatricians, rheumatologists, orthopedists, endocrinologists, and internists. This resulted in a round 1 panel of 15 panelists, round 2 panel of 15 members, and a round 3 panel of 14 members. Agreement on statements and scenarios using RUAM. Three rounds of voting by panelists took place. Agreement in a third round was reached for 111 statements and scenarios, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. An expert panel validated a set of statements and scenarios about the use of osteoporosis medications after incident fracture and use of these medications to enhance delayed fracture healing and made recommendations for study designs to investigate the effect of osteoporosis medications on fracture healing. The result of this exercise is intended to assist in improving patient care by identifying the appropriateness of use of osteoporosis medications after fracture and in fracture healing and to make suggestions for further preclinical and clinical research.

International consensus criteria for the diagnosis of Raynaud's phenomenon.

PubMed

Maverakis, Emanual; Patel, Forum; Kronenberg, Daniel G; Chung, Lorinda; Fiorentino, David; Allanore, Yannick; Guiducci, Serena; Hesselstrand, Roger; Hummers, Laura K; Duong, Chris; Kahaleh, Bashar; Macgregor, Alexander; Matucci-Cerinic, Marco; Wollheim, Frank A; Mayes, Maureen D; Gershwin, M Eric

2014-01-01

Vasoconstriction accompanied by changes in skin color is a normal physiologic response to cold. The distinction between this normal physiology and Raynaud's phenomenon (RP) has yet to be well characterized. In anticipation of the 9th International Congress on Autoimmunity, a panel of 12 RP experts from 9 different institutes and four different countries were assembled for a Delphi exercise to establish new diagnostic criteria for RP. Relevant investigators with highly cited manuscripts in Raynaud's-related research were identified using the Web of Science and invited to participate. Surveys at each stage were administered to participants via the on-line SurveyMonkey software tool. The participants evaluated the level of appropriateness of statements using a scale of 1 (extremely inappropriate) through 9 (extremely appropriate). In the second stage, panel participants were asked to rank rewritten items from the first round that were scored as "uncertain" for the diagnosis of RP, items with significant disagreement (Disagreement Index > 1), and new items suggested by the panel. Results were analyzed using the Interpercentile Range Adjusted for Symmetry (IPRAS) method. A 3-Step Approach to diagnose RP was then developed using items the panelists "agreed" were "appropriate" diagnostic criteria. In the final stage, the panel was presented with the newly developed diagnostic criteria and asked to rate them against previous models. Following the first two iterations of the Delphi exercise, the panel of 12 experts agreed that 36 of the items were "appropriate", 12 items had "uncertain" appropriateness, and 13 items were "inappropriate" to use in the diagnostic criteria of RP. Using an expert committee, we developed a 3-Step Approach for the diagnosis of RP and 5 additional criteria for the diagnosis of primary RP. The committee came to an agreement that the proposed criteria were "appropriate and accurate" for use by physicians to diagnose patients with RP. Published by Elsevier Ltd.

International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon

PubMed Central

Maverakis, Emanual; Patel, Forum; Kronenberg, Daniel; Chung, Lori; Fiorentino, David; Allanore, Yannick; Guiducci, Serena; Hesselstrand, Roger; Hummers, Laura; Duong, Chris; Kahaleh, Bashar; Macgregor, Alexander; Matucci-Cerinic, Marco; Wollheim, Frank; Mayes, Maureen; Gershwin, M. Eric

2014-01-01

Vasoconstriction accompanied by changes in skin color is a normal physiologic response to cold. The distinction between this normal physiology and Raynaud’s phenomenon (RP) has yet to be well characterized. In anticipation of the 9th International Congress on Autoimmunity, a panel of 12 RP experts from 9 different institutes and four different countries were assembled for a Delphi exercise to establish new diagnostic criteria for RP. Relevant investigators with highly cited manuscripts in Raynaud’s-related research were identified using the Web of Science and invited to participate. Surveys at each stage were administered to participants via the on-line SurveyMonkey software tool. The participants evaluated the level of appropriateness of statements using a scale of 1 (extremely inappropriate) through 9 (extremely appropriate). In the second stage, panel participants were asked to rank rewritten items from the first round that were scored as “uncertain” for the diagnosis of RP, items with significant disagreement (Disagreement Index > 1), and new items suggested by the panel. Results were analyzed using the Interpercentile Range Adjusted for Symmetry (IPRAS) method. A 3-Step Approach to diagnose RP was then developed using items the panelists “agreed” were “appropriate” diagnostic criteria. In the final stage, the panel was presented with the newly developed diagnostic criteria and asked to rate them against previous models. Following the first two iterations of the Delphi exercise, the panel of 12 experts agreed that 36 of the items were “appropriate,” 12 items had “uncertain” appropriateness, and 13 items were “inappropriate” to use in the diagnostic criteria of RP. Using an expert committee, we developed a 3-Step Approach for the diagnosis of RP and 5 additional criteria for the diagnosis of primary RP. The committee came to an agreement that the proposed criteria were “appropriate and accurate” for use by physicians to diagnose patients with RP. PMID:24491823

2017 Project Peer Review Report

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

None, None

This document summarizes the recommendations and evaluations provided by an independent external panel of experts at the 2017 U.S. Department of Energy Bioenergy Technologies Office's Peer Review meeting.

78 FR 32679 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... support of the appeal resolution process. SRPs are independent panels of experts in hydrology, hydraulics... 91730. Unincorporated Areas of San Public Works Department, Water Bernardino County. Resources...

Main Report

PubMed Central

2006-01-01

Background: States vary widely in their use of newborn screening tests, with some mandating screening for as few as three conditions and others mandating as many as 43 conditions, including varying numbers of the 40+ conditions that can be detected by tandem mass spectrometry (MS/MS). There has been no national guidance on the best candidate conditions for newborn screening since the National Academy of Sciences report of 19751 and the United States Congress Office of Technology Assessment report of 1988,2 despite rapid developments since then in genetics, in screening technologies, and in some treatments. Objectives: In 2002, the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services (DHHS) commissioned the American College of Medical Genetics (ACMG) to: Conduct an analysis of the scientific literature on the effectiveness of newborn screening.Gather expert opinion to delineate the best evidence for screening for specified conditions and develop recommendations focused on newborn screening, including but not limited to the development of a uniform condition panel.Consider other components of the newborn screening system that are critical to achieving the expected outcomes in those screened. Methods: A group of experts in various areas of subspecialty medicine and primary care, health policy, law, public health, and consumers worked with a steering committee and several expert work groups, using a two-tiered approach to assess and rank conditions. A first step was developing a set of principles to guide the analysis. This was followed by developing criteria by which conditions could be evaluated, and then identifying the conditions to be evaluated. A large and broadly representative group of experts was asked to provide their opinions on the extent to which particular conditions met the selected criteria, relying on supporting evidence and references from the scientific literature. The criteria were distributed among three main categories for each condition: The availability and characteristics of the screening test;The availability and complexity of diagnostic services; andThe availability and efficacy of treatments related to the conditions. A survey process utilizing a data collection instrument was used to gather expert opinion on the conditions in the first tier of the assessment. The data collection format and survey provided the opportunity to quantify expert opinion and to obtain the views of a diverse set of interest groups (necessary due to the subjective nature of some of the criteria). Statistical analysis of data produced a score for each condition, which determined its ranking and initial placement in one of three categories (high scoring, moderately scoring, or low scoring/absence of a newborn screening test). In the second tier of these analyses, the evidence base related to each condition was assessed in depth (e.g., via systematic reviews of reference lists including MedLine, PubMed and others; books; Internet searches; professional guidelines; clinical evidence; and cost/economic evidence and modeling). The fact sheets reflecting these analyses were evaluated by at least two acknowledged experts for each condition. These experts assessed the data and the associated references related to each criterion and provided corrections where appropriate, assigned a value to the level of evidence and the quality of the studies that established the evidence base, and determined whether there were significant variances from the survey data. Survey results were subsequently realigned with the evidence obtained from the scientific literature during the second-tier analysis for all objective criteria, based on input from at least three acknowledged experts in each condition. The information from these two tiers of assessment was then considered with regard to the overriding principles and other technology or condition-specific recommendations. On the basis of this information, conditions were assigned to one of three categories as described above:Core Panel;Secondary Targets (conditions that are part of the differential diagnosis of a core panel condition.); andNot Appropriate for Newborn Screening (either no newborn screening test is available or there is poor performance with regard to multiple other evaluation criteria). ACMG also considered features of optimal newborn screening programs beyond the tests themselves by assessing the degree to which programs met certain goals (e.g., availability of educational programs, proportions of newborns screened and followed up). Assessments were based on the input of experts serving in various capacities in newborn screening programs and on 2002 data provided by the programs of the National Newborn Screening and Genetics Resource Center (NNSGRC). In addition, a brief cost-effectiveness assessment of newborn screening was conducted. Results: Uniform panel A total of 292 individuals determined to be generally representative of the regional distribution of the United States population and of areas of expertise or involvement in newborn screening provided a total of 3,949 evaluations of 84 conditions. For each condition, the responses of at least three experts in that condition were compared with those of all respondents for that condition and found to be consistent. A score of 1,200 on the data collection instrument provided a logical separation point between high scoring conditions (1,200–1,799 of a possible 2,100) and low scoring (<1,000) conditions. A group of conditions with intermediate scores (1,000–1,199) was identified, all of which were part of the differential diagnosis of a high scoring condition or apparent in the result of the multiplex assay. Some are identified by screening laboratories and others by diagnostic laboratories. This group was designated as a “secondary target” category for which the program must report the diagnostic result. Using the validated evidence base and expert opinion, each condition that had previously been assigned to a category based on scores gathered through the data collection instrument was reconsidered. Again, the factors taken into consideration were: 1) available scientific evidence; 2) availability of a screening test; 3) presence of an efficacious treatment; 4) adequate understanding of the natural history of the condition; and 5) whether the condition was either part of the differential diagnosis of another condition or whether the screening test results related to a clinically significant condition. The conditions were then assigned to one of three categories as previously described (core panel, secondary targets, or not appropriate for Newborn Screening). Among the 29 conditions assigned to the core panel are three hemoglobinopathies associated with a Hb/S allele, six amino acidurias, five disorders of fatty oxidation, nine organic acidurias, and six unrelated conditions (congenital hypothyroidism (CH), biotinidase deficiency (BIOT), congenital adrenal hyperplasia (CAH), classical galactosemia (GALT), hearing loss (HEAR) and cystic fibrosis (CF)). Twenty-three of the 29 conditions in the core panel are identified with multiplex technologies such as tandem mass spectrometry (MS/MS) or high pressure liquid chromatography (HPLC). On the basis of the evidence, six of the 35 conditions initially placed in the core panel were moved into the secondary target category, which expanded to 25 conditions. Test results not associated with potential disease in the infant (e.g., carriers) were also placed in the secondary target category. When newborn screening laboratory results definitively establish carrier status, the result should be made available to the health care professional community and families. Twenty-seven conditions were determined to be inappropriate for newborn screening at this time. Conditions with limited evidence reported in the scientific literature were more difficult to evaluate, quantify and place in one of the three categories. In addition, many conditions were found to occur in multiple forms distinguished by age-of-onset, severity, or other features. Further, unless a condition was already included in newborn screening programs, there was a potential for bias in the information related to some criteria. In such circumstances, the quality of the studies underlying the data such as expert opinion that considered case reports and reasoning from first principles determined the placement of the conditions into particular categories. Newborn screening program optimization – Assessment of the activities of newborn screening programs, based on program reports, was done for the six program components: education; screening; follow-up; diagnostic confirmation; management; and program evaluation. Considerable variation was found between programs with regard to whether particular aspects (e.g., prenatal education program availability, tracking of specimen collection and delivery) were included and the degree to which they are provided. Newborn screening program evaluation systems also were assessed in order to determine their adequacy and uniformity with the goal being to improve interprogram evaluation and comparison to ensure that the expected outcomes from having been identified in screening are realized. Conclusions: The state of the published evidence in the fast-moving worlds of newborn screening and medical genetics has not kept up with the implementation of new technologies, thus requiring the considerable use of expert opinion to develop recommendations about a core panel of conditions for newborn screening. Twenty-nine conditions were identified as primary targets for screening from which all components of the newborn screening system should be maximized. An additional 25 conditions were listed that could be identified in the course of screening for core panel conditions. Programs are obligated to establish a diagnosis and communicate the result to the health care provider and family. It is recognized that screening may not have been maximized for the detection of these secondary conditions but that some proportion of such cases may be found among those screened for core panel conditions. With additional screening, greater training of primary care health care professionals and subspecialists will be needed, as will the development of an infrastructure for appropriate follow-up and management throughout the lives of children who have been identified as having one of these rare conditions. Recommended actions to overcome barriers to an optimal newborn screening system include: The establishment of a national role in the scientific evaluation of conditions and the technologies by which they are screened;Standardization of case definitions and reporting procedures;Enhanced oversight of hospital-based screening activities;Long-term data collection and surveillance; andConsideration of the financial needs of programs to allow them to deliver the appropriate services to the screened population.

Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors

PubMed Central

Lindeman, Neal I.; Cagle, Philip T.; Beasley, Mary Beth; Chitale, Dhananjay Arun; Dacic, Sanja; Giaccone, Giuseppe; Jenkins, Robert Brian; Kwiatkowski, David J.; Saldivar, Juan-Sebastian; Squire, Jeremy; Thunnissen, Erik; Ladanyi, Marc

2014-01-01

Objective To establish evidence-based recommendations for the molecular analysis of lung cancers that are required to guide EGFR- and ALK-directed therapies, addressing which patients and samples should be tested, and when and how testing should be performed. Participants Three cochairs without conflicts of interest were selected, one from each of the 3 sponsoring professional societies: College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. Writing and advisory panels were constituted from additional experts from these societies. Evidence Three unbiased literature searches of electronic databases were performed to capture articles published from January 2004 through February 2012, yielding 1533 articles whose abstracts were screened to identify 521 pertinent articles that were then reviewed in detail for their relevance to the recommendations. Evidence was formally graded for each recommendation. Consensus Process Initial recommendations were formulated by the cochairs and panel members at a public meeting. Each guideline section was assigned to at least 2 panelists. Drafts were circulated to the writing panel (version 1), advisory panel (version 2), and the public (version 3) before submission (version 4). Conclusions The 37 guideline items address 14 subjects, including 15 recommendations (evidence grade A/B). The major recommendations are to use testing for EGFR mutations and ALK fusions to guide patient selection for therapy with an epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) inhibitor, respectively, in all patients with advanced-stage adenocarcinoma, regardless of sex, race, smoking history, or other clinical risk factors, and to prioritize EGFR and ALK testing over other molecular predictive tests. As scientific discoveries and clinical practice outpace the completion of randomized clinical trials, evidence-based guidelines developed by expert practitioners are vital for communicating emerging clinical standards. Already, new treatments targeting genetic alterations in other, less common driver oncogenes are being evaluated in lung cancer, and testing for these may be addressed in future versions of these guidelines. PMID:23551194

Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors

PubMed Central

Lindeman, Neal I.; Cagle, Philip T.; Beasley, Mary Beth; Chitale, Dhananjay Arun; Dacic, Sanja; Giaccone, Giuseppe; Jenkins, Robert Brian; Kwiatkowski, David J.; Saldivar, Juan-Sebastian; Squire, Jeremy; Thunnissen, Erik; Ladanyi, Marc

2014-01-01

Objective To establish evidence-based recommendations for the molecular analysis of lung cancers that are that are required to guide EGFR- and ALK-directed therapies, addressing which patients and samples should be tested, and when and how testing should be performed. Participants Three cochairs without conflicts of interest were selected, one from each of the 3 sponsoring professional societies: College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. Writing and advisory panels were constituted from additional experts from these societies. Evidence Three unbiased literature searches of electronic databases were performed to capture articles published published from January 2004 through February 2012, yielding 1533 articles whose abstracts were screened to identify 521 pertinent articles that were then reviewed in detail for their relevance to the recommendations. Evidence was formally graded for each recommendation. Consensus Process Initial recommendations were formulated by the cochairs and panel members at a public meeting. Each guideline section was assigned to at least 2 panelists. Drafts were circulated to the writing panel (version 1), advisory panel (version 2), and the public (version 3) before submission (version 4). Conclusions The 37 guideline items address 14 subjects, including 15 recommendations (evidence grade A/B). The major recommendations are to use testing for EGFR mutations and ALK fusions to guide patient selection for therapy with an epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) inhibitor, respectively, in all patients with advanced-stage adenocarcinoma, regardless of sex, race, smoking history, or other clinical risk factors, and to prioritize EGFR and ALK testing over other molecular predictive tests. As scientific discoveries and clinical practice outpace the completion of randomized clinical trials, evidence-based guidelines developed by expert practitioners are vital for communicating emerging clinical standards. Already, new treatments targeting genetic alterations in other, less common driver oncogenes are being evaluated in lung cancer, and testing for these may be addressed in future versions of these guidelines. PMID:23552377

Development of Australian clinical practice outcome standards for graduates of critical care nurse education.

PubMed

Gill, Fenella J; Leslie, Gavin D; Grech, Carol; Boldy, Duncan; Latour, Jos M

2015-02-01

To develop critical care nurse education practice standards. Critical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification. An eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds. For the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice. Of 105 experts who agreed to participate, 92 (88%) completed survey round I; 85 (92%) round II; and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance - median 7 (IQR 6-7); 14 were rated as having a moderate level of importance - median 6 (IQR 5-7); and nine were rated as having a low level of importance - median 4 (IQR 4-6)-6 (IQR 4-6). The majority of the panel rated graduate level of practice as 'demonstrates independently' or 'teaches or supervises others' for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient- and family-focused approach. The graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes. © 2014 John Wiley & Sons Ltd.

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

PubMed

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

2007-11-01

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

Reliability and agreement on embryo assessment: 5 years of an external quality control programme.

PubMed

Martínez-Granados, Luis; Serrano, María; González-Utor, Antonio; Ortiz, Nereyda; Badajoz, Vicente; López-Regalado, María Luisa; Boada, Montserrat; Castilla, Jose A

2018-03-01

An external quality-control programme for morphology-based embryo quality assessment, incorporating a standardized embryo grading scheme, was evaluated over a period of 5 years to determine levels of inter-observer reliability and agreement between practising clinical embryologists at IVF centres and the opinions of a panel of experts. Following Guidelines for Reporting Reliability and Agreement Studies, the Gwet index and proportion of positive (Ppos) and negative agreement were calculated. For embryo morphology assessment, a substantial degree of reliability was measured between the centres and the panel of experts (Gwet index: 0.76; 95% CI 0.70 to 0.84). The agreement was higher for good- versus poor-quality embryos. When multinucleation or vacuoles were observed, low levels of reliability were obtained (Ppos: 0.56 and 0.43, respectively). In blastocysts, the characteristic that presented the largest discrepancy was that related to the inner cell mass. In decisions about the final disposition of the embryo, reliability between centre and the panel of experts was moderate (Gwet index: 0.51; 95% CI 0.41 to 0.60). In conclusion, the ability of clinical embryologists to evaluate the presence of multinucleation and vacuoles in the early cleavage embryo, and to determine the category of the inner cell mass in blastocysts, needs to be improved. Copyright © 2017 Reproductive Healthcare Ltd. All rights reserved.

Sensory representation of typicality of Cabernet franc wines related to phenolic composition: impact of ripening stage and maceration time.

PubMed

Cadot, Yves; Caillé, Soline; Samson, Alain; Barbeau, Gérard; Cheynier, Véronique

2012-06-30

Phenolics are responsible for important sensory properties of red wines, including colour, astringency, and possibly bitterness. From a technical viewpoint, the harvest date and the maceration duration are critical decisions for producing red wine with a distinctive style. But little is known about the evolution of phenolics and of their extractability during ripening to predict the composition of the wine and related sensory properties. The aim of this study was to understand the relationship between the sensory profile of the wines and (i) the ripening stage of the berries (harvest date) and (ii) the extraction time (maceration duration). Phenolic acids, flavonols, anthocyanins and proanthocyanidins of Vitis Vinifera var. Cabernet franc were measured in grapes and in wines from two stages of maturity and with two maceration durations. Phenolic composition was analysed by high performance liquid chromatography, after fractionation and thiolysis for proanthocyanidins. The distinctive style of wines was investigated by descriptive analysis (trained panel), Just About Right profiles and typicality assessment (wine expert panel). Relationships between phenolics and sensory attributes were established by multidimensional analysis, and phenolics were classified according to sensory data by ANOVA and PLS regressions. Astringency, bitterness, colour intensity and alcohol significantly increased with ripening and astringency and colour intensity increased with maceration time. Grape anthocyanins increased and thiolysis yield significantly decreased with ripening. In wine, proanthocyanidins increased, and mean degree of polymerisation and thiolysis yield decreased with longer extraction time. The high impact of harvest date on the sensory profiles could be due to changes in anthocyanin and sugar contents, but also to an evolution of proanthocyanidins. Moreover, proanthocyanidin composition was affected by maceration time as suggested by the decrease of thiolysis yield. Our results suggest that the wine sensory quality established by the expert panel, is linked as expected to grape quality at harvest, reflected by sugar and anthocyanin contents, but also by thiolysis yield, which requires elucidation. Copyright © 2012 Elsevier B.V. All rights reserved.

[Systematic detection of physical child abuse at emergency rooms].

PubMed

Sittig, J S; Uiterwaal, C S P M; Moons, K G M; Russel, I M B; Nievelstein, R A J; Nieuwenhuis, E E S; van de Putte, E M

2016-01-01

The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Our main outcome measure was physical child abuse; secondary outcome measure was injury due to neglect and need for help. 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.

78 FR 20941 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... panels of experts in hydrology, hydraulics, and other pertinent sciences established to review... Scarborough Street, Richland, MS 38218. Pearl River Valley Water Supply Pearl River Valley Water Supply...

75 FR 6030 - EPA Science Advisory Board Staff Office Request for Nominations of Experts for the SAB Lead (Pb...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... requesting public nominations of experts to form an SAB Ad Hoc Panel to review EPA's draft technical analyses... residential dust. OPPT is developing draft technical analyses that will be used to support: (a) Possible... that the SAB conduct a review of these draft technical analyses. The SAB was established by 42 U.S.C...

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

Treesearch

Byung-kyu Lee; Wilbur F. LaPage

2003-01-01

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

Concepts and Contexts in Engineering and Technology Education: An International and Interdisciplinary Delphi Study

ERIC Educational Resources Information Center

Rossouw, Ammeret; Hacker, Michael; de Vries, Marc J.

2011-01-01

Inspired by a similar study by Osborne et al. we have conducted a Delphi study among experts to identify key concepts to be taught in engineering and technology education and relevant and meaningful contexts through which these concepts can be taught and learnt. By submitting the outcomes of the Delphi study to a panel of experts in a two-day…

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study

PubMed Central

2013-01-01

Background Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. Methods A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. Results Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. Conclusions This study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector. PMID:24171839

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

NASA Technical Reports Server (NTRS)

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

2008-01-01

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

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

PubMed

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

2014-12-02

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

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

DOE Solar Energy Technologies Program

This document summarizes the recommendations and evaluations provided by an independent external panel of experts at the DOE Solar Energy Technologies Program's 2010 Program Review meeting, held on May 24?27, 2010, in Washington, D.C.

Dental Care Every Day: A Caregiver's Guide

MedlinePlus

... oral health professionals and caregivers who contributed their time and expertise to reviewing and pretesting the Practical Oral Care series. Expert Review Panel • Mae Chin, RDH, MEd, University ...

Development and training of a learning expert system in an autonomous mobile robot via simulation

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

Spelt, P.F.; Lyness, E.; DeSaussure, G.

1989-11-01

The Center for Engineering Systems Advanced Research (CESAR) conducts basic research in the area of intelligent machines. Recently at CESAR a learning expert system was created to operate on board an autonomous robot working at a process control panel. The authors discuss two-computer simulation system used to create, evaluate and train this learning system. The simulation system has a graphics display of the current status of the process being simulated, and the same program which does the simulating also drives the actual control panel. Simulation results were validated on the actual robot. The speed and safety values of using amore » computerized simulator to train a learning computer, and future uses of the simulation system, are discussed.« less

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel.

PubMed

Döhner, Hartmut; Estey, Elihu; Grimwade, David; Amadori, Sergio; Appelbaum, Frederick R; Büchner, Thomas; Dombret, Hervé; Ebert, Benjamin L; Fenaux, Pierre; Larson, Richard A; Levine, Ross L; Lo-Coco, Francesco; Naoe, Tomoki; Niederwieser, Dietger; Ossenkoppele, Gert J; Sanz, Miguel; Sierra, Jorge; Tallman, Martin S; Tien, Hwei-Fang; Wei, Andrew H; Löwenberg, Bob; Bloomfield, Clara D

2017-01-26

The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease. © 2017 by The American Society of Hematology.

Progress of the Enhanced Hanford Single Shell Tank (SST) Integrity Project

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

Venetz, Theodore J.; Washenfelder, Dennis J.; Boomer, Kayle D.

2015-01-07

To improve the understanding of the single-shell tanks (SSTs) integrity, Washington River Protection Solutions, LLC (WRPS), the USDOE Hanford Site tank contractor, developed an enhanced Single-Shell Tank Integrity Project (SSTIP) in 2009. An expert panel on SST integrity, consisting of various subject matters experts in industry and academia, was created to provide recommendations supporting the development of the project. This panel developed 33 recommendations in four main areas of interest: structural integrity, liner degradation, leak integrity and prevention, and mitigation of contamination migration. In late 2010, seventeen of these recommendations were used to develop the basis for the M-45-10-1 Changemore » Package for the Hanford Federal Agreement and Compliance Order, which is also known as the Tri-Party Agreement.« less

Assessing and Evaluating Multidisciplinary Translational Teams: A Mixed Methods Approach

PubMed Central

Wooten, Kevin C.; Rose, Robert M.; Ostir, Glenn V.; Calhoun, William J.; Ameredes, Bill T.; Brasier, Allan R.

2014-01-01

A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team type taxonomy. Based on team maturation and scientific progress, teams were designated as: a) early in development, b) traditional, c) process focused, or d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored. PMID:24064432

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

PubMed

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

2015-11-01

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

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers.

PubMed

Bond, Kathy S; Chalmers, Kathryn J; Jorm, Anthony F; Kitchener, Betty A; Reavley, Nicola J

2015-06-03

There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties. A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n = 33), financial institution staff (n = 54), mental health professionals (n = 31), consumers (n = 20) and carers (n = 24). A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties. A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.

Development and initial validity of the in-hand manipulation assessment.

PubMed

Klymenko, Gabrielle; Liu, Karen P Y; Bissett, Michelle; Fong, Kenneth N K; Welage, Nandana; Wong, Rebecca S M

2018-04-01

A review of the literature related to in-hand manipulation (IHM) revealed that there is no assessment which specifically measures this construct in the adult population. This study reports the face and content validity of an IHM assessment for adults with impaired hand function based on expert opinion. The definition of IHM skills, assessment tasks and scoring methods identified from literature was discussed in a focus group (n = 4) to establish face validity. An expert panel (n = 16) reviewed the content validity of the proposed assessment; evaluating the representativeness and relevance of encompassing the IHM skills in the proposed assessment tasks, the clarity and importance to daily life of the task and the clarity and applicability to clinical environment of the scoring method. The content validity was calculated using the content validity index for both the individual task and all tasks together (I-CVI and S-CVI). Feedback was incorporated to create the assessment. The focus group members agreed to include 10 assessment tasks that covered all IHM skills. In the expert panel review, all tasks received an I-CVI above 0.78 and S-CVI above 0.80 in representativeness and relevance ratings, representing good content validity. With the comments from the expert panel, tasks were modified to improve the clarity and importance to daily life. A four-point Likert scale was identified for assessing both the completion of the assessment tasks and the quality of IHM skills within the task performance. Face and content validity were established in this new IHM assessment. Further studies to examine psychometric properties and use within clinical practice are recommended. © 2018 Occupational Therapy Australia.

Recommendations for selecting drug-drug interactions for clinical decision support.

PubMed

Tilson, Hugh; Hines, Lisa E; McEvoy, Gerald; Weinstein, David M; Hansten, Philip D; Matuszewski, Karl; le Comte, Marianne; Higby-Baker, Stefanie; Hanlon, Joseph T; Pezzullo, Lynn; Vieson, Kathleen; Helwig, Amy L; Huang, Shiew-Mei; Perre, Anthony; Bates, David W; Poikonen, John; Wittie, Michael A; Grizzle, Amy J; Brown, Mary; Malone, Daniel C

2016-04-15

Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. We recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated and more research to identify methods to safely reduce repetitive and less-relevant alerts. An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.

PubMed

Anolik, Rachel A; Allori, Alexander C; Pourtaheri, Navid; Rogers, Gary F; Marcus, Jeffrey R

2016-05-01

The purpose of this study was to evaluate the utility of a previously validated interfrontal angle for classification of severity of metopic synostosis and as an aid to operative decision-making. An expert panel was asked to study 30 cases ranging from minor to severe metopic synostosis. Based on computed tomographic images of the skull and clinical photographs, they classified the severity of trigonocephaly (1 = normal, 2 = mild, 3 = moderate, and 4 = severe) and management (0 = nonoperative and 1 = operative). The severity scores and management reported by experts were then pooled and matched with the interfrontal angle computed from each respective computed tomographic scan. A threshold was identified at which most experts agree on operative management. Expert severity scores were higher for more acute interfrontal angles. There was a high concordance at the extremes of classifications, severe (4) and normal (1) (p < 0.0001); however, between interfrontal angles of 114.3 and 136.1 degrees, there exists a "gray zone," with severe discordance in expert rankings. An operative threshold of 118.2 degrees was identified, with the interfrontal angle able to predict the expert panel's decision to proceed with surgery 87.6 percent of the time. The interfrontal angle has been previously validated as a simple, accurate, and reproducible means for diagnosing trigonocephaly, but must be obtained from computed tomographic data. In this article, the authors demonstrate that the interfrontal angle can be used to further characterize the severity of trigonocephaly. It also correlated with expert decision-making for operative versus nonoperative management. This tool may be used as an adjunct to clinical decision-making when the decision to proceed with surgery may not be straightforward. Diagnostic, V.

Autism Program Quality Indicators: A Self-Review and Quality Improvement Guide for Programs Serving Young Students with Autism Spectrum Disorders, Fall 2004

ERIC Educational Resources Information Center

Librera, William, L.; Bryant, Isaac; Gantwerk, Barbara; Tkach, Barbara

2004-01-01

This document is the direct result of a panel of nearly three dozen autism experts in New Jersey from the fields of education, medicine and psychology. The panel reviewed research findings and best practice models with a major emphasis on the conclusions and recommendations of the National Research Council and on documents from other states,…

High-Risk Drinking in College: What We Know and What We Need To Learn. Final Report of the Panel on Contexts and Consequences.

ERIC Educational Resources Information Center

National Inst. on Alcohol Abuse and Alcoholism (DHHS), Rockville, MD.

Alcohol on college campuses is not a new problem, but recent concerns have centered on heavy episodic drinking, binge drinking. To address these concerns, the National Advisory Council on Alcohol Abuse and Alcoholism established two panels of nongovernmental experts to help develop a national research agenda. This report represents the work of one…

ACES. Accelerated Corrosion Expert Simulator

DTIC Science & Technology

2010-02-01

Composites Coating Systems Organic Inorganic Ceramic Materials 22 Inputs and Dimensions Xi Thickness Hardness Strength Ductility Abrasion Resistance...GPU 25 T-Handle Latch 10-Year ACT Material/ Coating Configuration Die Cast Zinc T-Handle Carbon Steel Pin CS Shank CS T-Washer Carbon Steel Dish E- coat ...CARC Zinc Plating Cadmium Plated BoltE- coat /CARC CS Panel CS Panel O-Ring E- coat /CARC Original (10-year ACT) Design Green Flag Color Qualitative

The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.

PubMed

Mokkink, Lidwine B; Terwee, Caroline B; Patrick, Donald L; Alonso, Jordi; Stratford, Paul W; Knol, Dirk L; Bouter, Lex M; de Vet, Henrica C W

2010-05-01

Aim of the COSMIN study (COnsensus-based Standards for the selection of health status Measurement INstruments) was to develop a consensus-based checklist to evaluate the methodological quality of studies on measurement properties. We present the COSMIN checklist and the agreement of the panel on the items of the checklist. A four-round Delphi study was performed with international experts (psychologists, epidemiologists, statisticians and clinicians). Of the 91 invited experts, 57 agreed to participate (63%). Panel members were asked to rate their (dis)agreement with each proposal on a five-point scale. Consensus was considered to be reached when at least 67% of the panel members indicated 'agree' or 'strongly agree'. Consensus was reached on the inclusion of the following measurement properties: internal consistency, reliability, measurement error, content validity (including face validity), construct validity (including structural validity, hypotheses testing and cross-cultural validity), criterion validity, responsiveness, and interpretability. The latter was not considered a measurement property. The panel also reached consensus on how these properties should be assessed. The resulting COSMIN checklist could be useful when selecting a measurement instrument, peer-reviewing a manuscript, designing or reporting a study on measurement properties, or for educational purposes.

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

PubMed

Constenla, Dagna; Lefcourt, Noah; Garcia, Cristina

2013-09-01

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

Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR).

PubMed

Brodey, Benjamin; Purcell, Susan E; Rhea, Karen; Maier, Philip; First, Michael; Zweede, Lisa; Sinisterra, Manuela; Nunn, M Brad; Austin, Marie-Paule; Brodey, Inger S

2018-03-23

The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians. ©Benjamin Brodey, Susan E Purcell, Karen Rhea, Philip Maier, Michael First, Lisa Zweede, Manuela Sinisterra, M Brad Nunn, Marie-Paule Austin, Inger S Brodey. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.03.2018.

Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

PubMed

1997-01-01

An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

Leveraging Health Care Simulation Technology for Human Factors Research: Closing the Gap Between Lab and Bedside.

PubMed

Deutsch, Ellen S; Dong, Yue; Halamek, Louis P; Rosen, Michael A; Taekman, Jeffrey M; Rice, John

2016-11-01

We describe health care simulation, designed primarily for training, and provide examples of how human factors experts can collaborate with health care professionals and simulationists-experts in the design and implementation of simulation-to use contemporary simulation to improve health care delivery. The need-and the opportunity-to apply human factors expertise in efforts to achieve improved health outcomes has never been greater. Health care is a complex adaptive system, and simulation is an effective and flexible tool that can be used by human factors experts to better understand and improve individual, team, and system performance within health care. Expert opinion is presented, based on a panel delivered during the 2014 Human Factors and Ergonomics Society Health Care Symposium. Diverse simulators, physically or virtually representing humans or human organs, and simulation applications in education, research, and systems analysis that may be of use to human factors experts are presented. Examples of simulation designed to improve individual, team, and system performance are provided, as are applications in computational modeling, research, and lifelong learning. The adoption or adaptation of current and future training and assessment simulation technologies and facilities provides opportunities for human factors research and engineering, with benefits for health care safety, quality, resilience, and efficiency. Human factors experts, health care providers, and simulationists can use contemporary simulation equipment and techniques to study and improve health care delivery. © 2016, Human Factors and Ergonomics Society.

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

PubMed

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

2016-07-01

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

Safety Assessment of Nitrocellulose and Collodion as Used in Cosmetics.

PubMed

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

2016-07-01

The Cosmetic Ingredient Review Expert Panel (the Panel) assessed the safety of nitrocellulose and collodion as used in cosmetics, concluding that these ingredients are safe in the present practices of use and concentration in cosmetic formulations. Both ingredients are used almost exclusively in nail product formulations. The maximum concentration of use of nitrocellulose in nail polish and enamels is 22%; for collodion, the maximum reported concentration of use in nail polish and enamel is 14%. The Panel reviewed available animal and clinical data in making its determination of safety. © The Author(s) 2016.

Acupuncture.

PubMed

The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Acupuncture. The statement provides state-of-the-art information regarding the appropriate use of acupuncture, and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas of study that deserve further investigation. Upon completion, the reader should possess a clear working clinical knowledge of the state-of-the-art regarding this topic. The target audience of physicians for this statement includes, but is not limited to, family practitioners, medical acupuncturists, psychiatrists, and specialists in pain medicine. A non-Federal, nonadvocate, 12-member panel representing the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health policy, epidemiology, statistics, physiology, biophysics, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1,200. The literature was searched through Medline, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool.

PubMed

Hull, L; Bicknell, C; Patel, K; Vyas, R; Van Herzeele, I; Sevdalis, N; Rudarakanchana, N

2016-07-01

To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additional exemplar behaviours contributing to effective teamwork and enhanced patient safety in endovascular surgery (using real-time observation, focus groups, and semistructured interviews of multidisciplinary teams). Stage 3 included content validation of exemplar behaviours using expert consensus according to established psychometric recommendations and evaluation of structure, content, feasibility, and usability of the Endovascular Observational Teamwork Assessment Tool (Endo-OTAS) by an expert multidisciplinary panel. Stage 4 included final team expert review of exemplars. OTAS core team behaviours were maintained (communication, coordination, cooperation, leadership team monitoring). Of the 114 OTAS behavioural exemplars, 19 were modified, four removed, and 39 additional endovascular-specific behaviours identified. Content validation of these 153 exemplar behaviours showed that 113/153 (73.9%) reached the predetermined Item-Content Validity Index rating for teamwork and/or patient safety. After expert team review, 140/153 (91.5%) exemplars were deemed to warrant inclusion in the tool. More than 90% of the expert panel agreed that Endo-OTAS is an appropriate teamwork assessment tool with observable behaviours. Some concerns were noted about the time required to conduct observations and provide performance feedback. Endo-OTAS is a novel teamwork assessment tool, with evidence for content validity and relevance to endovascular teams. Endo-OTAS enables systematic objective assessment of the quality of team performance during endovascular procedures. Copyright © 2016. Published by Elsevier Ltd.

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.

Management of Hypoparathyroidism: Summary Statement and Guidelines.

PubMed

Brandi, Maria Luisa; Bilezikian, John P; Shoback, Dolores; Bouillon, Roger; Clarke, Bart L; Thakker, Rajesh V; Khan, Aliya A; Potts, John T

2016-06-01

Hypoparathyroidism is a rare disorder characterized by hypocalcemia and absent or deficient PTH. This report presents a summary of current information about epidemiology, presentation, diagnosis, clinical features, and management and proposes guidelines to help clinicians diagnose, evaluate, and manage this disorder. Participants in the First International Conference on the Management of Hypoparathyroidism represented a worldwide constituency with acknowledged interest and expertise in key basic, translational, and clinical aspects of hypoparathyroidism. Three Workshop Panels were constituted to address questions for presentation and discussion at the Conference held in Florence, Italy, May 7-9, 2015. At that time, a series of presentations were made, followed by in-depth discussions in an open forum. Each Workshop Panel also met in closed sessions to formulate the three evidence-based reports that accompany this summary statement. An Expert Panel then considered this information, developed summaries, guidelines, and a research agenda that constitutes this summary statement. Preceding the conference, each Workshop Panel conducted an extensive literature search as noted in the individual manuscripts accompanying this report. All presentations were based upon the best peer-reviewed information taking into account the historical and current literature. This report represents the Expert Panel's synthesis of the conference material placed in a context designed to be relevant to clinicians and those engaged in cutting-edge studies of hypoparathyroidism. This document not only provides a summary of our current knowledge but also places recent advances in its management into a context that should enhance future advances in our understanding of hypoparathyroidism.

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

PubMed Central

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

2016-01-01

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

Definition of a COPD self-management intervention: International Expert Group consensus.

PubMed

Effing, Tanja W; Vercoulen, Jan H; Bourbeau, Jean; Trappenburg, Jaap; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W M A; Bucknall, Christine; Dewan, Naresh A; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J A; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L; Singh, Sally; Zuwallack, Richard; Benzo, Roberto; Goldstein, Roger; Partridge, Martyn R; van der Palen, Job

2016-07-01

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step. The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.

A Method for Functional Task Alignment Analysis of an Arthrocentesis Simulator.

PubMed

Adams, Reid A; Gilbert, Gregory E; Buckley, Lisa A; Nino Fong, Rodolfo; Fuentealba, I Carmen; Little, Erika L

2018-05-16

During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation. Potential performance checklist items were gathered from published arthrocentesis guidelines and aggregated into a performance checklist using Lawshe's method. An expert panel used this performance checklist and an FTA analysis questionnaire to evaluate a simulator's ability to respond to the physical actions required by the performance checklist. Thirteen items, from a pool of 39, were included on the performance checklist. Experts had mixed reviews of the simulator's FTA and its suitability for use in simulation. Unexpectedly, some positive FTA was found for several tasks where the simulator lacked functionality. By developing a detailed list of specific tasks required to complete a clinical procedure, and surveying experts on the simulator's response to those actions, educators can gain insight into the simulator's clinical accuracy and suitability. Unexpected of positive FTA ratings of function deficits suggest that further revision of the survey method is required.

Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network

PubMed Central

Dubé, Eve; Gagnon, Dominique; Ouakki, Manale; Bettinger, Julie A.; Guay, Maryse; Halperin, Scott; Wilson, Kumanan; Graham, Janice; Witteman, Holly O.; MacDonald, Shannon; Fisher, William; Monnais, Laurence; Tran, Dat; Gagneur, Arnaud; Guichon, Juliet; Saini, Vineet; Heffernan, Jane M.; Meyer, Samantha; Driedger, S. Michelle; Greenberg, Joshua; MacDougall, Heather

2016-01-01

“Vaccine hesitancy” is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada. PMID:27257809

21 CFR 516.111 - Scope of this subpart.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Investigational exemptions for indexing purposes; (b) Submissions to FDA of requests for determination of eligibility of a new animal drug for indexing; (c) Establishment and operation of expert panels; (d...

21 CFR 516.111 - Scope of this subpart.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Investigational exemptions for indexing purposes; (b) Submissions to FDA of requests for determination of eligibility of a new animal drug for indexing; (c) Establishment and operation of expert panels; (d...

21 CFR 516.111 - Scope of this subpart.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Investigational exemptions for indexing purposes; (b) Submissions to FDA of requests for determination of eligibility of a new animal drug for indexing; (c) Establishment and operation of expert panels; (d...

78 FR 20939 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... panels of experts in hydrology, hydraulics, and other pertinent sciences established to review... regarding the SRP process can be found online at http://floodsrp.org/pdfs/srp_fact_sheet.pdf . The...

77 FR 18846 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... panels of experts in hydrology, hydraulics, and other pertinent sciences established to review... Incorporated Areas Maps Available for Inspection Online at: http://www.dnr.sc.gov/water/flood/comaps.html City...

78 FR 8179 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... panels of experts in hydrology, hydraulics, and other pertinent sciences established to review.../dnr/water/7359.htm Town of Medaryville Town Hall, 409 East Main Street, Medaryville, IN 47957. Town of...

77 FR 18841 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent....gov/water/flood/comaps.html City of Greenville City Hall, 206 South Main Street, Greenville, SC 29602...

78 FR 5824 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent..., and Incorporated Areas Maps Available for Inspection Online at: http://www.in.gov/dnr/water/6396.htm...

Considerations on photochemical genotoxicity. II: report of the 2009 International Workshop on Genotoxicity Testing Working Group.

PubMed

Lynch, Anthony M; Guzzie, Peggy J; Bauer, Daniel; Gocke, Elmar; Itoh, Satoru; Jacobs, Abby; Krul, Cyrille A M; Schepky, Andreas; Tanaka, Noriho; Kasper, Peter

2011-08-16

A workshop to reappraise the previous IWGT recommendations for photogenotoxicity testing [E. Gocke, L. Muller, P.J. Guzzie, S. Brendler-Schwaab, S. Bulera, C.F. Chignell, L.M. Henderson, A. Jacobs, H. Murli, R.D. Snyder, N. Tanaka, Considerations on photochemical genotoxicity: report of the International Workshop on Genotoxicity Test Procedures working group, Environ. Mol. Mutagen., 35 (2000) 173-184] was recently held as part of the 5th International Workshop on Genotoxicity Testing (IWGT) meeting in Basel, Switzerland (August 17-19, 2009). An Expert Panel was convened from regulatory, academic and industrial scientists (with several members serving on the original panel) and chaired by Dr Peter Kasper (BfArM, Germany). The aim of the workshop was to review progress made in photo(geno)toxicity testing over the past decade; a period which saw the introduction of several regulatory photosafety guidances in particular in Europe and the USA. Based on current regulatory guidelines a substantial proportion of compounds trigger the requirements for photosafety testing. Moreover, there has been growing concern within industry about the performance of the in vitro photosafety tests in the "real world" of compound development. Therefore, the expert group reviewed the status of the current regulatory guidance's and the impact these have had on compound development in the context of the various triggers for photosafety testing. In addition, the performance of photogenotoxicity assays (old and new) was discussed, particularly in view of reports of pseudophotoclastogencity. The Expert Panel finished with an assessment of the positioning of photogenotoxicity testing within a photosafety testing strategy. The most significant conclusion made by the Expert Panel was that photogenotoxicity testing should no longer be recommended as part of the standard photosafety testing strategy. In addition, progress was made on the refinement of triggers for photosafety testing. For example, there was support for harmonisation of methods to determine the Molar Extinction Coefficient (MEC) and a consensus agreement that there should be no requirement for testing of compounds with a MEC<1000Lmol(-1)cm(-1). Copyright © 2011 Elsevier B.V. All rights reserved.

Principles for interactions with biopharmaceutical companies: the development of guidelines for patient advocacy organizations in the field of rare diseases.

PubMed

Stein, Susan; Bogard, Elizabeth; Boice, Nicole; Fernandez, Vivian; Field, Tessa; Gilstrap, Alan; Kahn, Susan R; Larkindale, Jane; Mathieson, Toni

2018-01-22

Rare diseases are a global public health concern, affecting an estimated 350 million individuals. Only 5% of approximately 7000 known rare diseases have a treatment, and only about half have a patient advocacy organization. Biopharmaceutical companies face complex challenges in developing treatments for rare diseases. Patient advocacy organizations may play a major role by positively influencing research and development, clinical trials, and regulations. Thus, collaboration among patient advocacy organizations and industry is essential to bring new therapeutics to patients. We identified an unmet need for guidelines on day-to-day decision-making by rare disease patient advocacy organizations when working with biopharmaceutical partners. We convened an Independent Expert Panel experienced in collaborations between patient advocacy organizations and biopharmaceutical companies (April 2017) to develop consensus guidelines for these relationships. The guidelines were based on an original version by the International Fibrodysplasia Ossificans Progressiva Association (IFOPA). The Expert Panel reviewed and broadened these to be applicable to all patient advocacy organizations. Comments on the draft Guidelines were provided first by Panel participants and subsequently by six independent experts from patient advocacy organizations and industry. The Panel comprised four experts from the rare disease community who lead patient advocacy organizations; three leaders who perform advocacy functions within biopharmaceutical companies; and two facilitators, both having leadership experience in rare diseases and industry. The finalized Guidelines consist of four main sections: Identification and Engagement With Companies, Patient Engagement and Patient Privacy, Financial Contributions, and Clinical Trial Communication and Support. The Guidelines address the daily considerations, choices, and consequences of patient advocacy organizations as they engage with biopharmaceutical companies, and offer recommendations for volunteer/paid leaders of the organizations on how to interact in a thoughtful, responsible, ethical way that engenders trust. These Guidelines recommend best practices and standards for interactions between patient advocacy organizations and industry that will ultimately have a positive effect on the development of novel treatments. Patient advocacy organizations will be provided free access to these Guidelines to help bring clarification to day-to-day decision-making around their interactions, and for use as a living document with the potential for regular revisions and updates.

Social media for health promotion in diabetes: study protocol for a participatory public health intervention design.

PubMed

Gabarron, E; Bradway, M; Fernandez-Luque, L; Chomutare, T; Hansen, A H; Wynn, R; Årsand, E

2018-06-05

Participatory health approaches are increasingly drawing attention among the scientific community, and could be used for health promotion programmes on diabetes through social media. The main aim of this project is to research how to best use social media to promote healthy lifestyles with and within the Norwegian population. The design of the health promotion intervention (HPI) will be participatory, and will involve both a panel of healthcare experts and social media users following the Norwegian Diabetes Association. The panel of experts will agree on the contents by following the Delphi method, and social media users will participate in the definition of the HPI by expressing their opinions through an adhoc online questionnaire. The agreed contents between both parties to be used in the HPI will be posted on three social media channels (Facebook, Twitter and Instagram) along 24 months. The 3 months before starting the HPI, and the 3 months after the HPI will be used as control data. The effect of the HPI will be assessed by comparing formats, frequency, and reactions to the published HPI messages, as well as comparing potential changes in five support-intended communication behaviours expressed on social media, and variations in sentiment analysis before vs during and after the HPI. The HPI's effect on social media users' health-related lifestyles, online health behaviours, and satisfaction with the intervention will be assessed every 6 months through online questionnaires. A separate questionnaire will be used to assess the panel of experts' satisfaction and perceptions of the benefits for health professionals of a HPI as this one. The time constraints of today's medical practice combined with the piling demand of chronic conditions such as diabetes make any additional request of extra time used by health care professionals a challenge. Social media channels provide efficient, ubiquitous and user-friendly platforms that can encourage participation, engagement and action necessary from both those who receive and provide care to make health promotion interventions successful.

Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer.

PubMed

Quan, May Lynn; Wells, Bryan J; McCready, David; Wright, Frances C; Fraser, Novlette; Gagliardi, Anna R

2010-02-01

Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure. We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review. The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level. A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.

Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative.

PubMed

Penciner, Rick; Woods, Robert A; McEwen, Jill; Lee, Richard; Langhan, Trevor; Bandiera, Glen

2013-01-01

There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators. We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada. Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided. This study established a national consensus defining the core competencies for EM clerkship in Canada.

Japanese Clinical Guidelines for Endoscopic Treatment of Pancreatolithiasis.

PubMed

Inui, Kazuo; Igarashi, Yoshinori; Irisawa, Atsushi; Ohara, Hirotaka; Tazuma, Susumu; Hirooka, Yoshiki; Fujita, Naotaka; Miyakawa, Hiroyuki; Sata, Naohiro; Shimosegawa, Tooru; Tanaka, Masao; Shiratori, Keiko; Sugiyama, Masanori; Takeyama, Yoshifumi

2015-10-01

In addition to surgery, procedures for patients with pancreatolithiasis are developing; therefore, establishing practical guidelines for the management of pancreatolithiasis is required. Three committees (the professional committee for asking clinical questions (CQs) and statements by Japanese endoscopists, the expert panel committee for rating statements by the modified Delphi method, and the evaluating committee by moderators) were organized. Eight endoscopists and a surgeon for pancreatolithiasis made the CQs and statements from a total of 694 reports of published literature by PubMed search (from 1983 to 2012). The expert panelists individually rated these clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than 7 on a 9-point scale from the panel was regarded as valid. The professional committee made 3, 7, and 10 CQs and statements for the concept and pathogenesis, diagnosis, and treatment, respectively. The expert panelists regarded them as valid after a 2-round modified Delphi approach. After evaluation by the moderators, the Japanese clinical guidelines for pancreatolithiasis were established. Further discussions and studies for international guidelines are needed.

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).

2011 Biomass Program Platform Peer Review. Thermochemical Conversion

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

Grabowski, Paul E.

This document summarizes the recommendations and evaluations provided by an independent external panel of experts at the 2011 U.S. Department of Energy Biomass Program’s Thermochemical Conversion Platform Review meeting.

The Health Benefits of Exercise (Part 1 of 2).

ERIC Educational Resources Information Center

Physician and Sportsmedicine, 1987

1987-01-01

A panel of eight experts discuss the cardiovascular, lipoprotein, weight control, and psychological benefits of exercise on health. The challenge of motivating people to exercise regularly is explored. (Author/MT)

77 FR 44651 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent... Online at: http://www.dnr.sc.gov/water/flood/comaps.html Town of Springfield Town Hall, 1505 Georgia...

77 FR 55856 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-11

... resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent... Inspection Online at: http://www.dnr.sc.gov/water/flood/comaps.html City of Florence Planning, Research and...

A Data Scientist's Guide to Start-Ups.

PubMed

Provost, Foster; Webb, Geoffrey I; Bekkerman, Ron; Etzioni, Oren; Fayyad, Usama; Perlich, Claudia

2014-09-01

In August 2013, we held a panel discussion at the KDD 2013 conference in Chicago on the subject of data science, data scientists, and start-ups. KDD is the premier conference on data science research and practice. The panel discussed the pros and cons for top-notch data scientists of the hot data science start-up scene. In this article, we first present background on our panelists. Our four panelists have unquestionable pedigrees in data science and substantial experience with start-ups from multiple perspectives (founders, employees, chief scientists, venture capitalists). For the casual reader, we next present a brief summary of the experts' opinions on eight of the issues the panel discussed. The rest of the article presents a lightly edited transcription of the entire panel discussion.

Safety Assessment of Alkyl Esters as Used in Cosmetics.

PubMed

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

2015-09-01

The Cosmetic Ingredient Review Expert Panel (Panel) assessed the safety of 237 alkyl esters for use in cosmetics. The alkyl esters included in this assessment have a variety of reported functions in cosmetics, with skin-conditioning agent being the most common function. The Panel reviewed available animal and clinical data in making its determination of safety on these ingredients, and where there were data gaps, similarity in structure, properties, functions, and uses of these ingredients allowed for extrapolation of the available toxicological data to assess the safety of the entire group. The Panel concluded that these ingredients are safe in cosmetic formulations in the present practices of use and concentration when formulated to be nonirritating. © The Author(s) 2015.

Safety Assessment of Dialkyl Sulfosuccinate Salts as Used in Cosmetics.

PubMed

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

2016-11-01

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of 8 dialkyl sulfosuccinate salts for use in cosmetics, finding that these ingredients are safe in cosmetics in the present practices of use and concentration when formulated to be nonirritating. The dialkyl sulfosuccinate salts primarily function as surfactants in cosmetics. The Panel reviewed the new and existing available animal and clinical data in making its determination of safety. The Panel found it appropriate to extrapolate the data on diethylhexyl sodium sulfosuccinate to assess the safety of the entire group because all of the diesters are of a similar alkyl chain length, all are symmetrically substituted, and all have similar functions in cosmetic formulations. © The Author(s) 2016.

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

PubMed

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

2016-03-01

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

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

PubMed

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

2015-01-01

There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories. Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization. The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively. Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.

The Aesthetic Turn in Mental Health: Reflections on an Explorative Study into Practices in the Arts Therapies.

PubMed

Samaritter, Rosemarie

2018-04-23

The paper will draw on materials from arts therapies literature and comments from experts’ panels to discuss some specific characteristics of the arts therapies and to investigate the role of aesthetic engagement for resilience and mental well-being. The arts increasingly find their way as interventions in mental health domains. However, explorations into the specific mechanisms that underpin the therapeutic effect of arts-based activities are still scarce. Qualitative data were collected from a thematic literature review and expert comments on meaningful working procedures in arts therapies. Analysis of multiple data sources revealed core themes and core procedures that occur across arts therapy modalities. This paper presents a practice informed model of arts-based methods in mental health that may serve as a conceptual frame of reference for arts therapists and as study material on the applicability of arts therapy interventions for specific mental health settings.

Viewers' perceptions of a YouTube music therapy session video.

PubMed

Gregory, Dianne; Gooding, Lori G

2013-01-01

Recent research revealed diverse content and varying levels of quality in YouTube music therapy videos and prompted questions about viewers' discrimination abilities. This study compares ratings of a YouTube music therapy session video by viewers with different levels of music therapy expertise to determine video elements related to perceptions of representational quality. Eighty-one participants included 25 novices (freshmen and sophomores in an introductory music therapy course), 25 pre-interns (seniors and equivalency students who had completed all core Music Therapy courses), 26 professionals (MT-BC or MT-BC eligibility) with a mean of 1.75 years of experience, and an expert panel of 5 MT-BC professionals with a mean of 11 years of experience in special education. After viewing a music therapy special education video that in previous research met basic competency criteria and professional standards of the American Music Therapy Association, participants completed a 16-item questionnaire. Novices' ratings were more positive (less discriminating) compared to experienced viewers' neutral or negative ratings. Statistical analysis (ANOVA) of novice, pre-intern, and professional ratings of all items revealed significant differences p, .05) for specific therapy content and for a global rating of representational quality. Experienced viewers' ratings were similar to the expert panel's ratings. Content analysis of viewers' reasons for their representational quality ratings corroborated ratings of therapy-specific content. A video that combines and clearly depicts therapy objectives, client improvement, and the effectiveness of music within a therapeutic intervention best represent the music therapy profession in a public social platform like YouTube.

Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease.

PubMed

Riesco Miranda, Juan Antonio; Alcázar, Bernardino; Alfageme, Inmaculada; Casanova, Ciro; Celli, Bartolomé; de-Torres, Juan P; Jiménez Ruiz, Carlos A

2017-10-01

To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

PubMed

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

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

PubMed

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

2016-11-01

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

The alternative route: hanging out the unmentionables for better decision making in health information technology.

PubMed

Kibbe, David C; McLaughlin, Curtis P

2008-01-01

Expert panels and policy analysts have often ignored potential contributions to health information technology (IT) from the Internet and Web-based applications. Perhaps they are among the "unmentionables" of health IT. Ignoring those unmentionables and relying on established industry experts has left us with a standards process that is complex and burdened by diverse goals, easy for entrenched interests to dominate, and reluctant to deal with potentially disruptive technologies. We need a health IT planning process that is more dynamic in its technological forecasting and inclusive of IT experts from outside the industry.

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

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

To evaluate practice patterns in the management of cow's milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey. This study was based on experts' views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment. According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89-92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively. Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

New Asthma Guidelines What You Should Know

MedlinePlus

... Bar Home Current Issue Past Issues Special Section New Asthma Guidelines: What You Should Know Past Issues / ... and chairs the Expert Panel that established the new guidelines. The report gives health care professionals new ...

Asthma - what to ask the doctor - adult

MedlinePlus

... I have a fire in my fireplace or wood-burning stove? What sort of changes do I ... 42. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management ...

Ankle Sprains. A Round Table.

ERIC Educational Resources Information Center

Physician and Sportsmedicine, 1986

1986-01-01

Types of ankle sprains, surgical versus nonsurgical treatment, tape versus brace for support, rehabilitation, exercise, and prevention of ankle sprains are discussed by a panel of experts. An acute ankle taping technique is illustrated. (MT)

77 FR 76501 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... resolution process. SRPs are independent panels of experts in hydrology, hydraulics, and other pertinent... Inspection Online at: http://www.in.gov/dnr/water/6647.htm City of Portland Jay County Department of Building...

An Ophthalmologic Summit for On-Orbit Care

NASA Technical Reports Server (NTRS)

Bacal, Kira; McCulley, Phyllis; Paul, Bonnie

2004-01-01

Ophthalmologic issues are a source of concern for NASA flight surgeons, due to the remote nature of the space station as well as the microg ravity environment. Methods: A panel of external consultants was conv ened to evaluate the adequacy of the current in-flight medical system for the diagnosis and treatment of ophthalmologic issues. Participants were acknowledged experts in their field who also had experience in operational medicine. Results: Nine extramural experts provided assi stance, and six of them participated in a face to face meeting held a t NASA-Johnson Space Center. Changes were recommended for the space s tation pharmacopoeia, and diagnostic, therapeutic, and deorbit criteria protocols for a variety of ocular conditions were developed. Discus sion: The results of the panel provide an evidence based approach to the diagnosis and care of ophthalmologic conditions on the International Space Station

Atrial Arrhythmias in Astronauts. Summary of a NASA Summit

NASA Technical Reports Server (NTRS)

Barr, Yael; Watkins, Sharmila; Polk, J. D.

2011-01-01

This slide presentation reviews the findings of a panel of heart experts brought together to study if atrial arrhythmias more prevalent in astronauts, and potential risk factors that may predispose astronauts to atrial arrhythmias. The objective of the panel was to solicit expert opinion on screening, diagnosis, and treatment options, identify gaps in knowledge, and propose relevant research initiatives. While Atrial Arrhythmias occur in approximately the same percents in astronauts as in the general population, they seem to occur at younger ages in astronauts. Several reasons for this predisposition were given: gender, hypertension, endurance training, and triggering events. Potential Space Flight-Related Risk factors that may play a role in precipitating lone atrial fibrillation were reviewed. There appears to be no evidence that any variable of the space flight environment increases the likelihood of developing atrial arrhythmias during space flight.

A WOUND CARE AND INTRAVENOUS ACCESS SUMMIT FOR ON-ORBIT CARE

NASA Technical Reports Server (NTRS)

Scheuring, R.; Paul, B.; Gillis, D.; Bacal, K.; McCulley, P.; Polk, J.; Johnson-Throop, K.

2005-01-01

Wound care issues and the ability to establish intravenous (IV) access among injured or ill crew members are a source of concern for NASA flight surgeons. Indeed, the microgravity environment and the remote nature of the International Space Station (ISS) pose unique challenges in diagnosing and treating an injured astronaut. Therefore, it is necessary to identify and adapt the best evidence based terrestrial practices regarding wound care, hemostasis, and IV access for use on the ISS. Methods: A panel of consultants was convened to evaluate the adequacy of the current ISS in-flight medical system for diagnosis and treatment of wounds and establishing IV access by a nonclinician crew medical officer. Participants were acknowledged experts in terrestrial wound care and/or operational medicine. Prior to the meeting, each panelist was encouraged to participate in a pre-summit online forum. Results: Eight external experts participated in a face-to-face meeting held at NASA-Johnson Space Center. Recommendations were made to augment the space station pharmacopoeia, as well as current wound care diagnostic, therapeutic, and deorbit criteria protocols. Additionally, suggestions were offered regarding IV access techniques and devices for use in the microgravity environment. Discussion: The results of the expert panel provide an evidence-based approach to the diagnosis and care of wounds in an injured astronaut on aboard the ISS. The results of the panel underscored the need for further research in wound therapy and IV access devices.

Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis.

PubMed

Möller, Ingrid; Loza, Estibaliz; Uson, Jacqueline; Acebes, Carlos; Andreu, Jose Luis; Batlle, Enrique; Bueno, Ángel; Collado, Paz; Fernández-Gallardo, Juan Manuel; González, Carlos; Jiménez Palop, Mercedes; Lisbona, María Pilar; Macarrón, Pilar; Maymó, Joan; Narváez, Jose Antonio; Navarro-Compán, Victoria; Sanz, Jesús; Rosario, M Piedad; Vicente, Esther; Naredo, Esperanza

To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. These recommendations will help clinicians use US and MRI in RA patients. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

PubMed Central

Fakeye, Oludolapo; Mondestin, Valerie; Rubin, David M.; Localio, Russell; Feudtner, Chris

2015-01-01

OBJECTIVE: To develop guidelines for performing an initial skeletal survey (SS) for children <24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion. METHODS: Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children <24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS. RESULTS: Panelists agreed that SS is “appropriate” for 62% (136/219) of scenarios, and “inappropriate” for children ≥12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is “necessary” for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants <6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children <12 months. CONCLUSIONS: The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising. PMID:25601982

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

PubMed

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

2005-05-01

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

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

PubMed

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

2018-05-01

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

Development of a model of the tobacco industry's interference with tobacco control programmes

PubMed Central

Trochim, W; Stillman, F; Clark, P; Schmitt, C

2003-01-01

Objective: To construct a conceptual model of tobacco industry tactics to undermine tobacco control programmes for the purposes of: (1) developing measures to evaluate industry tactics, (2) improving tobacco control planning, and (3) supplementing current or future frameworks used to classify and analyse tobacco industry documents. Design: Web based concept mapping was conducted, including expert brainstorming, sorting, and rating of statements describing industry tactics. Statistical analyses used multidimensional scaling and cluster analysis. Interpretation of the resulting maps was accomplished by an expert panel during a face-to-face meeting. Subjects: 34 experts, selected because of their previous encounters with industry resistance or because of their research into industry tactics, took part in some or all phases of the project. Results: Maps with eight non-overlapping clusters in two dimensional space were developed, with importance ratings of the statements and clusters. Cluster and quadrant labels were agreed upon by the experts. Conclusions: The conceptual maps summarise the tactics used by the industry and their relationships to each other, and suggest a possible hierarchy for measures that can be used in statistical modelling of industry tactics and for review of industry documents. Finally, the maps enable hypothesis of a likely progression of industry reactions as public health programmes become more successful, and therefore more threatening to industry profits. PMID:12773723

Construction of Nutrition Literacy Indicators for College Students in Taiwan: A Delphi Consensus Study.

PubMed

Liao, Li-Ling; Lai, I-Ju

2017-10-01

To use the Delphi process to select nutrition literacy (NL) indicators for Taiwan college students. Initial formulation of 8 principal indicators and 77 subindicators, followed by a 2-round Delphi survey and final selection of indicators. A total of 28 nutrition experts selected through snowball sampling; 100% response rate. An expert panel scored and ranked NL themes and indicators for relevance, representativeness, and importance. Quantitative analysis. For principal indicators, the defined cutoff was mean (relevance and representativeness) > 4 and SD < 1. For subindicators, screening criteria were: (1) >20 experts ranked the nutrition theme's importance in the top 50% of the 12 themes; (2) mean (relevance and representativeness) > 4 and SD < 1 and >20 experts ranked the indicator's importance in the top 50% of all indicators within a domain. Consensus was reached on 8 principal indicators and 28 subindicators in 8 themes, including 10 in understand, 8 in analyze, 5 in appraise, and 5 in apply. An initial set of NL indicators was developed for Taiwan college students, serving as a basis to develop Taiwan College's Nutrition Literacy Scale and providing information on nutrition education. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Third Annual Workshop on Space Operations Automation and Robotics (SOAR 1989)

NASA Technical Reports Server (NTRS)

Griffin, Sandy (Editor)

1990-01-01

Papers presented at the Third Annual Workshop on Space Operations Automation and Robotics (SOAR '89), hosted by the NASA Lyndon B. Johnson Space Center at Houston, Texas, on July 25 to 27, 1989, are given. Approximately 100 technical papers were presented by experts from NASA, the USAF, universities, and technical companies. Also held were panel discussions on Air Force/NASA Artificial Intelligence Overview and Expert System Verification and Validation.

ACR Appropriateness Criteria Myelopathy.

PubMed

Roth, Christopher J; Angevine, Peter D; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fries, Ian Blair; Holly, Langston T; Kendi, Ayse Tuba Karaqulle; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; O'Toole, John E; Sharma, Aseem; Shetty, Vilaas S; West, O Clark; Cornelius, Rebecca S; Bykowski, Julie

2016-01-01

Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Barriers for introducing a health technology assessment organization to inform health care decision-making in the Spanish National Health System].

PubMed

Artells, Juan José; Peiró, Salvador; Meneu, Ricard

2014-01-01

To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.

The Development and Validation of a Generic Instrument, QoDoS, for Assessing the Quality of Decision Making.

PubMed

Donelan, Ronan; Walker, Stuart; Salek, Sam

2016-01-01

The impact of decision-making during the development and the regulatory review of medicines greatly influences the delivery of new medicinal products. Currently, there is no generic instrument that can be used to assess the quality of decision-making. This study describes the development of the Quality of Decision-Making Orientation Scheme QoDoS(©) instrument for appraising the quality of decision-making. Semi-structured interviews about decision-making were carried out with 29 senior decision makers from the pharmaceutical industry (10), regulatory authorities (9) and contract research organizations (10). The interviews offered a qualified understanding of the subjective decision-making approach, influences, behaviors and other factors that impact such processes for individuals and organizations involved in the delivery of new medicines. Thematic analysis of the transcribed interviews was carried out using NVivo8® software. Content validity was carried out using qualitative and quantitative data by an expert panel, which led to the developmental version of the QoDoS. Further psychometric evaluations were performed, including factor analysis, item reduction, reliability testing and construct validation. The thematic analysis of the interviews yielded a 94-item initial version of the QoDoS(©) with a 5-point Likert scale. The instrument was tested for content validity using a panel of experts for language clarity, completeness, relevance and scaling, resulting in a favorable agreement by panel members with an intra-class correlation coefficient value of 0.89 (95% confidence interval = 0.56, 0.99). A 76-item QoDoS(©) (version 2) emerged from content validation. Factor analysis produced a 47-item measure with four domains. The 47-item QoDoS(©) (version 3) showed high internal consistency (n = 120, Cronbach's alpha = 0.89), high reproducibility (n = 20, intra-class correlation = 0.77) and a mean completion time of 10 min. Reliability testing and construct validation was successfully performed. The QoDoS(©) is both reliable and valid for use. It has the potential for extensive use in medicines development by both the pharmaceutical industry and regulatory authorities. The QoDoS(©) can be used to assess the quality of decision-making and to inform decision makers of the factors that influence decision-making.

NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Di-n-Butyl Phthalate (DBP).

PubMed

2003-04-01

TThe National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for di-n-butyl phthalate (DBP) to cause adverse effects on reproduction and development in humans. DBP is one of 7 phthalate chemicals evaluated by the NTP CERHR Phthalates Expert Panel. These phthalates were selected for evaluation because of high production volume, extent of human exposures, use in children's products, and/or published evidence of reproductive or developmental toxicity. Unlike many phthalates, DBP is not currently used as a plasticizer in polyvinyl chloride plastics. DBP is a component of latex adhesives and is used in cosmetics and other personal care products, as a plasticizer in cellulose plastics, and as a solvent for dyes. The results of this evaluation on DBP are published in a NTP-CERHR monograph which includes: 1) the NTP Brief, 2) the Expert Panel Report on the Reproductive and Developmental Toxicity of Di-n-Butyl Phthalate, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to DBP on human development and reproduction. First, although DBP could possibly affect human reproduction and development if exposures are sufficiently high, the NTP concludes that there is negligible concern for reproductive toxicity in exposed adults. Second, the NTP concludes that there is minimal concern for developmental effects when pregnant women are exposed to DBP levels estimated by the panel (2-10 mug/kg body weight/day). There is no direct evidence that exposure of people to DBP adversely affects reproduction or development, but studies reviewed by the expert panel show that oral exposure to high doses of DBP (>/=100 mg/kg body weight/day) may adversely affect the prenatal and early postnatal development in rodents. Finally, based on exposure estimates in women of reproductive age, the NTP concludes that there is some concern for DBP causing adverse effects to human development, particularly development of the male reproductive system. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available electronically in PDF format on the CERHR web site (http://cerhr.niehs.nih.gov) and in printed text or CD-ROM from the CERHR (National Institute of Environmental Health Sciences, P.O. Box 12233, MD EC-32, Research Triangle Park, NC; fax: 919-316-4511).

Let's Talk About Water: Using Film Screenings to Engage Students and the Public in Water Science and Policy

NASA Astrophysics Data System (ADS)

Saleem Arrigo, J. A.; Berry, K.; Hooper, R. P.; Lilienfeld, L.

2013-12-01

"Let's Talk about Water" is a film symposium designed to bring together experts and the public to talk about the complex water issues facing society. The format of the event is quite simple: a panel of experts and the audience view a water documentary (such as "FLOW", "Liquid Assets", or "Gasland") together and there is an extended moderated discussion period following the film between the panel and the audience. Over the course of several events, we have developed best practices that make this simple format very effective. A film creates a context of subject and language for the discussion--it gets the audience and the panel on the same page. The moderators must actively manage the discussion, both challenging the panelists with follow up questions, asking questions to simplify the language the expert is using, and passing a question among panelists to bring out different points of view. The panelists are provided with the film in advance to view and, most importantly, meet the day before the event to discuss the film. This makes for a much more convivial discussion at the event. We have found that these discussions can easily be sustained for 90 to 120 minutes with active audience participation. We have found key element of the event is local relevance. Films should be carefully chosen to resonate with the audience, and the local host is critical in defining the audience, goals and identified panel members. Having local experts from universities and representatives from local water authorities and environmental groups bring a sense of community and a confidence in the audience that the panel members have local knowledge that is important for sustaining discussion. The discussion begins with points raised by the movie (are these issues real? Do they apply here? What are the scientific, engineering, and policy solutions to these problems?) and then segues into a discussion about career opportunities in the water sector, volunteer opportunities in the community or other ways for the audience to get involved. This format has been applied at college campuses with a target audience of lower-level undergraduates, in several universities in the United States and Canada. Additionally, we have held public events (at the NY Public Library, concurrent with World Water Week) and have documented experiences for other educators and researchers who want to employ this format. CUAHSI has created best practice "tips," hosting guides documenting our experiences with individual films, and other information on our website.

Conference Proceedings of Applications of Mesh Generation to Complex 3-D Configurations Held at the Specialists’ Meeting of the Fluid Dynamics Panel in Leon, Norway on 24th-25th May 1989

DTIC Science & Technology

1990-03-01

Computations, edited by I. Babu ka, 0. C . Zienkiewicz, J. Gago, and E. R. de A. Oliveira ( John Wiley and Sons, New York, 1986), p. 281. [4] B. Wedan and J...GENERATION TO COMPLEX 3-D CONFIGURATIONS ., " c 1- For Papers presented and discussion- held at the Specialists’ Meeting of the Fluid Dynamics Panel in...the Panels which are composed of experts appointed by the National Delegates. the Consultant and Fxch., ., c Progi amime and the Aerospace Applications

Safety Assessment of Amino Acid Alkyl Amides as Used in Cosmetics.

PubMed

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

The Cosmetic Ingredient Review Expert Panel (Panel) reviewed the product use, formulation, and safety data of 115 amino acid alkyl amides, which function as skin and hair conditioning agents and as surfactants-cleansing agents in personal care products. Safety test data on dermal irritation and sensitization for the ingredients with the highest use concentrations, lauroyl lysine and sodium lauroyl glutamate, were reviewed and determined to adequately support the safe use of the ingredients in this report. The Panel concluded that amino acid alkyl amides are safe in the present practices of use and concentration in cosmetics, when formulated to be nonirritating.

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

PubMed Central

Maher, Toby M.; Kolb, Martin; Poletti, Venerino; Nusser, Richard; Richeldi, Luca; Vancheri, Carlo; Wilsher, Margaret L.; Antoniou, Katerina M.; Behr, Jüergen; Bendstrup, Elisabeth; Brown, Kevin; Calandriello, Lucio; Corte, Tamera J.; Crestani, Bruno; Flaherty, Kevin; Glaspole, Ian; Grutters, Jan; Inoue, Yoshikazu; Kokosi, Maria; Kondoh, Yasuhiro; Kouranos, Vasileios; Kreuter, Michael; Johannson, Kerri; Judge, Eoin; Ley, Brett; Margaritopoulos, George; Martinez, Fernando J.; Molina-Molina, Maria; Morais, António; Nunes, Hilario; Raghu, Ganesh; Ryerson, Christopher J.; Selman, Moises; Spagnolo, Paolo; Taniguchi, Hiroyuki; Tomassetti, Sara; Valeyre, Dominique; Wijsenbeek, Marlies; Wuyts, Wim; Hansell, David; Wells, Athol

2017-01-01

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (κw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the C-index. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53–0.72, p<0.0001) than academic physicians (κw=0.56, IQR 0.45–0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45–0.64, p<0.0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0–0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70–0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72–0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts. PMID:28860269

[Translation, cultural adaptation and validation of the Salt Knowledge Questionnaire to the Spanish language].

PubMed

Quinteros-Reyes, C; Marcionelli-Sandhaus, T; Mayta-Tristán, P

2017-11-03

In order to reduce salt consumption in Spanish speaking countries it is necessary to know the level of salt knowledge in the population. However, there are no tools in Spanish to measure salt knowledge, but the only valid tool of measurement is the 'Salt Knowledge Questionnaire' (SKQ) developed in Australia, in English. A validation study was conducted in three phases: (Phase1) Translation of the original Australian version into Spanish; (Phase2) Cultural adaptation based on a Spanish-speaking population such as Peru and following criteria used in the development of the original questionnaire which was evaluated by a panel of experts; (Phase3) Construct validity by comparing the scores of three groups (experts, medical students and non-experts) and reliability by performing a test retest. The translation of the SKQ into Spanish maintained a semantic equivalence with the original questionnaire and a panel of experts accepted the cultural adaptation. The SKQ enables discrimination between those who know and those who do not because differences of scores were found between the group of experts, students and non-experts (P<.001). A good overall internal consistency of the instrument was found (KR20=0.69) and a good overall intraclass correlation (0.79) and no test variations in test-retest (P>.05). The SKQ questionnaire in Spanish is valid, reliable and is a suitable first tool to measure knowledge about salt in the Spanish language. It is considered possible to adapt it culturally to the Spanish-speaking country that wishes to use it. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

[Applying the Modified Delphi Technique to Develop the Role of HIV Case Managers and Essential Nursing Competencies in HIV Care].

PubMed

Ko, Nai-Ying; Hsieh, Chia-Yin; Chen, Yen-Chin; Tsai, Chen-Hsi; Liu, Hsiao-Ying; Liu, Li-Fang

2015-08-01

Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.

77 FR 49796 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

... than 2.2 million people were injured. Medical costs and productivity losses associated with traffic... H). Academic Researchers Discussion 3 1 1 3 Guide--Online Expert Panel-- (Attachment I). CDC Staff...

U.S. Space Program Benefits to Education. Hearing before the Subcommittee on Space of the Committee on Science, Space, and Technology. U.S. House of Representatives, One Hundred Second Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Science, Space and Technology.

This hearing was held to review the educational benefits of the U.S. Space Program. Testimony was given by three panels of experts related to this topic. The three panels consisted of: (1) Daniel S. Goldin, Administrator, National Aeronautics and Space Administration (NASA); Dan Brandenstein, Captain, U.S. Navy, NASA Astronaut; and Damon Butler,…

Affirmative Action in American Law Schools: A Briefing before the United States Commission on Civil Rights Held in Washington, D.C., June 16, 2006. Briefing Report

ERIC Educational Resources Information Center

US Commission on Civil Rights, 2007

2007-01-01

On June 16, 2006, a panel of experts briefed members of the U.S. Commission on Civil Rights on affirmative action in American law schools. The panel convened to debate the empirical strength of the research on the effects of racial preferences in law school admissions and the legal and policy implications of the American Bar Association's…

The Federal Investment in Science, Mathematics, Engineering, and Technology Education: Where Now? What Next? Report of the Expert Panel for the Review of Federal Education Programs in Science, Mathematics, Engineering, and Technology.

ERIC Educational Resources Information Center

Federal Coordinating Council for Science, Engineering and Technology, Washington, DC.

Despite efforts to improve the quality and equity of science, mathematics, engineering, and technology (SMET) education at all educational levels, the nation remains at risk of losing its competitive edge. This report presents the findings of a special panel convened for two purposes: (1) to review federal programs in SMET education at all levels;…

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

NASA Technical Reports Server (NTRS)

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

2009-01-01

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

Safety Assessment of Ethanolamine and Ethanolamine Salts as Used in Cosmetics.

PubMed

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

2015-09-01

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of ethanolamine and 12 salts of ethanolamine as used in cosmetics. Ethanolamine functions as a pH adjuster. The majority of the salts are reported to function as surfactants, and the others are reported to function as pH adjusters, hair fixatives, or preservatives. The Panel reviewed available animal and clinical data, as well as information from previous relevant CIR reports. Because data were not available for each individual ingredient and because the salts dissociate freely in water, the Panel extrapolated from those previous reports to support safety. The Panel concluded that these ingredients are safe in the present practices of use and concentrations (rinse-off products only) when formulated to be nonirritating, and these ingredients should not be used in cosmetic products in which N-nitroso compounds may be formed. © The Author(s) 2015.

Sensory description of marine oils through development of a sensory wheel and vocabulary.

PubMed

Larssen, W E; Monteleone, E; Hersleth, M

2018-04-01

The Omega-3 industry lacks a defined methodology and a vocabulary for evaluating the sensory quality of marine oils. This study was conducted to identify the sensory descriptors of marine oils and organize them in a sensory wheel for use as a tool in quality assessment. Samples of marine oils were collected from six of the largest producers of omega-3 products in Norway. The oils were selected to cover as much variation in sensory characteristics as possible, i.e. oils with different fatty acid content originating from different species. Oils were evaluated by six industry expert panels and one trained sensory panel to build up a vocabulary through a series of language sessions. A total of 184 aroma (odor by nose), flavor, taste and mouthfeel descriptors were generated. A sensory wheel based on 60 selected descriptors grouped together in 21 defined categories was created to form a graphical presentation of the sensory vocabulary. A selection of the oil samples was also evaluated by a trained sensory panel using descriptive analysis. Chemical analysis showed a positive correlation between primary and secondary oxidation products and sensory properties such as rancidity, chemical flavor and process flavor and a negative correlation between primary oxidation products and acidic. This research is a first step towards the broader objective of standardizing the sensory terminology related to marine oils. Copyright © 2017 Elsevier Ltd. All rights reserved.

Research Priorities for Studies Linking Intake of Low-Calorie Sweeteners and Potentially Related Health Outcomes

PubMed Central

Bright, Oliver-John M; Wang, Ding Ding; Shams-White, Marissa; Bleich, Sara N; Foreyt, John; Franz, Marion; Johnson, Guy; Manning, Beth Trickett; Mattes, Rick; Pi-Sunyer, Xavier; Schneeman, Barbara; Parrott, James Scott; Steffen, Dan; Sylvetsky, Allison; Ziegler, Paula

2017-01-01

Abstract Background: In a world of finite research funding, efforts to prioritize future research topics are increasingly necessary. Objective: The aim of this study was to identify and prioritize the direction of future research in the broad area of low-calorie sweetener (LCS) intake and potentially related health outcomes by using a novel method that incorporates evidence mapping in the Agency for Healthcare Research and Quality's Future Research Needs (FRN) process. Methods: A diverse expert stakeholder panel was convened and engaged to identify research gaps and prioritize future research needs. An independent research team hosted a number of interactive webinars and elicited feedback through surveys and individual interviews with the stakeholder panel, which included policymakers, lay audience members, health providers, a research funder, individuals with food industry experience, and researchers of several different specialties. Results: The stakeholder panel generated and ranked a list of 18 FRN questions across 5 broad research areas. Overall, stakeholder panel members unanimously agreed that the research questions that will have the largest public health impact are those that address outcomes related to body weight, appetite, and dietary intake. Although the LCSs included in this FRN project have all been Generally Recognized as Safe by the FDA or approved as food additives, the recurrent concerns and confusions with regard to the “safety” of LCSs by consumers underscore the importance of communicating the science to the general public. Conclusion: Our project provides evidence that engaging a diverse expert stakeholder panel is an effective method of translating gaps in nutrition research into prioritized areas of future research.

How does the World Trade Organization know? The mobilization and staging of scientific expertise in the GMO trade dispute.

PubMed

Bonneuil, Christophe; Levidow, Les

2012-02-01

The World Trade Organization (WTO) dispute settlement procedure is a key arena for establishing global legal norms for what counts as relevant knowledge. As a high-profile case, the WTO trade dispute on GMOs mobilized scientific expertise in somewhat novel ways. Early on, the Panel put the dispute under the Sanitary and Phytosanitary (SPS) Agreement through a new legal ontology; it classified transgenes as potential pests and limited all environmental issues to the 'plant and animal health' category. The selection of scientific experts sought a multi-party consensus through a fast adversarial process, reflecting a specific legal epistemology. For the SPS framing, focusing on the defendant's regulatory procedures, the Panel staged scientific expertise in specific ways that set up how experts were questioned, the answers they would give, their specific role in the legal arena, and the way their statements would complement the Panel's findings. In these ways, the dispute settlement procedure co-produced legal and scientific expertise within the Panel's SPS framework. Moreover, the Panel operated a procedural turn in WTO jurisprudence by representing its findings as a purely legal-administrative judgement on whether the EC's regulatory procedures violated the SPS Agreement, while keeping implicit its own judgements on substantive risk issues. As this case illustrates, the WTO settlement procedure mobilizes scientific expertise for sophisticated, multiple aims: it recruits a source of credibility from the scientific arena, thus reinforcing the standard narrative of 'science-based trade discipline', while also constructing new scientific expertise for the main task--namely, challenging trade restrictions for being unduly cautious.

Assessment of features for automatic CTG analysis based on expert annotation.

PubMed

Chudácek, Vacláv; Spilka, Jirí; Lhotská, Lenka; Janku, Petr; Koucký, Michal; Huptych, Michal; Bursa, Miroslav

2011-01-01

Cardiotocography (CTG) is the monitoring of fetal heart rate (FHR) and uterine contractions (TOCO) since 1960's used routinely by obstetricians to detect fetal hypoxia. The evaluation of the FHR in clinical settings is based on an evaluation of macroscopic morphological features and so far has managed to avoid adopting any achievements from the HRV research field. In this work, most of the ever-used features utilized for FHR characterization, including FIGO, HRV, nonlinear, wavelet, and time and frequency domain features, are investigated and the features are assessed based on their statistical significance in the task of distinguishing the FHR into three FIGO classes. Annotation derived from the panel of experts instead of the commonly utilized pH values was used for evaluation of the features on a large data set (552 records). We conclude the paper by presenting the best uncorrelated features and their individual rank of importance according to the meta-analysis of three different ranking methods. Number of acceleration and deceleration, interval index, as well as Lempel-Ziv complexity and Higuchi's fractal dimension are among the top five features.

Probabilistic accident consequence uncertainty analysis -- Uncertainty assessment for internal dosimetry. Volume 2: Appendices

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

Goossens, L.H.J.; Kraan, B.C.P.; Cooke, R.M.

1998-04-01

The development of two new probabilistic accident consequence codes, MACCS and COSYMA, was completed in 1990. These codes estimate the consequence from the accidental releases of radiological material from hypothesized accidents at nuclear installations. In 1991, the US Nuclear Regulatory Commission and the Commission of the European Communities began cosponsoring a joint uncertainty analysis of the two codes. The ultimate objective of this joint effort was to systematically develop credible and traceable uncertainty distributions for the respective code input variables. A formal expert judgment elicitation and evaluation process was identified as the best technology available for developing a library ofmore » uncertainty distributions for these consequence parameters. This report focuses on the results of the study to develop distribution for variables related to the MACCS and COSYMA internal dosimetry models. This volume contains appendices that include (1) a summary of the MACCS and COSYMA consequence codes, (2) the elicitation questionnaires and case structures, (3) the rationales and results for the panel on internal dosimetry, (4) short biographies of the experts, and (5) the aggregated results of their responses.« less

Safety Assessment of Panax spp Root-Derived Ingredients as Used in Cosmetics.

PubMed

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

2015-01-01

The Cosmetic Ingredient Review Expert Panel (Panel) reviewed the safety of 13 Panax spp root-derived ingredients as used in cosmetics. Panax "spp" indicates that multiple species within the genus are used in cosmetics, but not all species within that genus. Four species are being considered in this safety assessment. These ingredients function mostly as skin-conditioning agents-miscellaneous, fragrance ingredients, skin-conditioning agents-humectant, skin-conditioning agents-emollient, and cosmetic astringents. The Panel reviewed available data related to these ingredients and addressed the issue of pulegone, a constituent of these ingredients and other ingredients, such as peppermint oil. The Panel concluded that these Panax spp root-derived ingredients are safe in the practices of use and concentration as given in this safety assessment. © The Author(s) 2015.

Safety Assessment of Diethanolamine and Its Salts as Used in Cosmetics.

PubMed

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

The Cosmetic Ingredient Review (CIR) Expert Panel assessed the safety of diethanolamine and its salts as used in cosmetics. Diethanolamine functions as a pH adjuster; the 16 salts included in this rereview reportedly function as surfactants, emulsifying agents, viscosity increasing agents, hair or skin conditioning agents, foam boosters, or antistatic agents. The Panel reviewed available animal and clinical data, as well as information from previous CIR reports. Since data were not available for each individual ingredient, and since the salts dissociate freely in water, the Panel extrapolated from previous reports to support safety. The Panel concluded that diethanolamine and its salts are safe for use when formulated to be nonirritating. These ingredients should not be used in cosmetic products in which N-nitroso compounds can be formed.

Safety Assessment of Talc as Used in Cosmetics.

PubMed

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

2015-01-01

The Cosmetic Ingredient Review Expert Panel (Panel) assessed the safety of talc for use in cosmetics. The safety of talc has been the subject of much debate through the years, partly because the relationship between talc and asbestos is commonly misunderstood. Industry specifications state that cosmetic-grade talc must contain no detectable fibrous, asbestos minerals. Therefore, the large amount of available animal and clinical data the Panel relied on in assessing the safety of talc only included those studies on talc that did not contain asbestos. The Panel concluded that talc is safe for use in cosmetics in the present practices of use and concentration (some cosmetic products are entirely composed of talc). Talc should not be applied to the skin when the epidermal barrier is missing or significantly disrupted. © The Author(s) 2015.

The Benefits of Racial and Ethnic Diversity in Elementary and Secondary Education. A Briefing before the United States Commission on Civil Rights Held in Washington, D.C., July 28, 2006. Briefing Report

ERIC Educational Resources Information Center

US Commission on Civil Rights, 2006

2006-01-01

On July 28, 2006, a panel of experts briefed members of the U.S. Commission on Civil Rights on the putative benefits of racial and ethnic diversity in elementary and secondary education. Four experts presented written statements to the Commissioners that assessed the social science literature on this issue. They also addressed whether or not…

Debt and Democracy in Latin America. U.S. Foreign Policy Conference (30th, Airlie House, Proceedings on Strategy for Peace, Warrenton, Virginia, October 19-21, 1989).

ERIC Educational Resources Information Center

Stanley Foundation, Muscatine, IA.

An annual assembly of a panel of experts from the public and private sectors assessed specific foreign policy issues and recommended future direction. The oneset of the debt crisis in 1982 generated fears regarding the future of democracy in Latin America. The focus on the assembled experts was on the role of external pressures and the impact of…

Identifying the relevant features of the National Digital Cadastral Database (NDCDB) for spatial analysis by using the Delphi Technique

NASA Astrophysics Data System (ADS)

Halim, N. Z. A.; Sulaiman, S. A.; Talib, K.; Ng, E. G.

2018-02-01

This paper explains the process carried out in identifying the relevant features of the National Digital Cadastral Database (NDCDB) for spatial analysis. The research was initially a part of a larger research exercise to identify the significance of NDCDB from the legal, technical, role and land-based analysis perspectives. The research methodology of applying the Delphi technique is substantially discussed in this paper. A heterogeneous panel of 14 experts was created to determine the importance of NDCDB from the technical relevance standpoint. Three statements describing the relevant features of NDCDB for spatial analysis were established after three rounds of consensus building. It highlighted the NDCDB’s characteristics such as its spatial accuracy, functions, and criteria as a facilitating tool for spatial analysis. By recognising the relevant features of NDCDB for spatial analysis in this study, practical application of NDCDB for various analysis and purpose can be widely implemented.

What affects the quality of economic analysis for life-saving investments?

PubMed

Hahn, Robert W; Kosec, Katrina; Neumann, Peter J; Wallsten, Scott

2006-06-01

Economic analysis of life-saving investments in both the public and private sectors has the potential to dramatically improve longevity and the quality of life, but only if the analyses on which decisions are based are done well. In this article, we analyze a data set that provides information on the content and quality of journal articles that measure the cost-effectiveness of life-saving investments. Our study is the first to provide a detailed multivariate analysis of factors affecting objective measures of quality. We also explore whether a series of recommendations by an expert panel convened by the U.S. Public Health Service affect the way analyses of specific life-saving investments are done. Our results suggest that four factors are positively correlated with an index we construct to measure analytical quality: (1) having at least one author affiliated with a university, (2) publication in a journal that has experience in publishing these analyses, (3) if the life-saving investment is located in the United States, and (4) if the analysis considers a measure of social costs or benefits. Somewhat surprisingly, a study's funding source and whether it is affiliated with industry are not significantly correlated with the quality index. Finally, neither time nor the panel guidelines had an impact on the index.

The Effects of Medical Conditions on Driving Performance

DOT National Transportation Integrated Search

2017-08-01

This project investigated the effect of selected medical conditions on the exposure and performance of older drivers. A review of recent literature, followed by a panel meeting with driving safety experts, prioritized four medical conditions for furt...

Junior high school occupant protection materials

DOT National Transportation Integrated Search

1989-09-06

Based on a review of existing occupant protection materials, discussions with panel of subject experts and teachers, and a series of pilot tests, a set of (draft) curriculum materials on occupant safety was developed for junior high school students. ...

From Universal Access to Universal Proficiency.

ERIC Educational Resources Information Center

Lewis, Anne C.

2003-01-01

Panel of five education experts--Elliot Eisner, John Goodlad, Patricia Graham, Phillip Schlechty, and Warren Simons--answer questions related to recent school reform efforts, such as the No Child Left Behind Act, aimed at achieving universal educational proficiency. (PKP)

Low-cost safety enhancements for stop-controlled and signalized intersections

DOT National Transportation Integrated Search

2009-05-01

The purpose of this document is to present information on suggested effective, low-cost intersection countermeasures developed using intersection safety research results and input from an intersection safety expert panel. These low-cost countermeasur...

Hospital operations management: improving organizational efficiency.

PubMed

2013-08-01

Reducing operational inefficiencies represents one of the most promising sources of potential savings in hospitals today. Health Forum convened a panel of hospital executives and industry experts to discuss the daunting challenges and big opportunities that lie ahead.

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

PubMed

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

2010-01-01

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

Review and needs assessment of materials designed to prevent tobacco use.

PubMed Central

Arkin, E B; Gitchell, J G; Pinney, J M

1995-01-01

Over the past 25 years, numerous educational materials and strategies have been developed for the prevention and control of tobacco use. However, there has been no comprehensive assessment of the available materials designed to educate the public to avoid the use of tobacco. A search for materials and a review process was conducted in the fall of 1993, and a panel of experts reviewed the materials that were collected. In conducting the search, 240 persons and organizations associated with tobacco control efforts across the United States were contacted, and 207 materials were identified and evaluated. All materials were assessed by at least two members of the expert panel. Of the 207 items, 188 were found to be acceptable according to standardized review criteria. The authors drew conclusions about the current availability of tobacco use prevention materials and present recommendations for increasing the availability of materials to community-level and other control programs. PMID:7638338

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

PubMed

Santos, Jesús; Valencia, Eulalia

2014-10-01

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

An Evaluation of Evidence for the Carcinogenic Activity of Bisphenol A

PubMed Central

Keri, Ruth A.; Ho, Shuk-Mei; Hunt, Patricia A.; Knudsen, Karen E.; Soto, Ana M.; Prins, Gail S.

2008-01-01

The National Institutes of Health (NIEHS, NIDCR) and the United States Environmental Protection Agency convened an expert panel of scientists with experience in the field of environmental endocrine disruptors, particularly with knowledge and research on Bisphenol A (BPA). Five subpanels were charged to review the published literature and previous reports in five specific areas and to compile a consensus report with recommendations. These were presented and discussed at an open forum entitled “Bisphenol A: An Expert Panel Examination of the Relevance of Ecological, In Vitro and Laboratory Animal Studies for Assessing Risks to Human Health” in Chapel Hill, NC on November 28-30, 2006. The present review consists of the consensus report on the evidence for a role of BPA in carcinogenesis, examining the available evidence in humans and animal models with recommendations for future areas of research. PMID:17706921

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

PubMed Central

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

2011-01-01

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

Outcome Criteria for Discharging the Patient With a New Ostomy From Home Health Care: A WOCN Society Consensus Conference.

PubMed

Colwell, Janice C; Kupsick, Phyllis T; McNichol, Laurie L

2016-01-01

The Wound, Ostomy and Continence Nurses Society hosted a consensus panel of expert ostomy clinicians who were tasked with identifying minimal discharge criteria for home care patients with a new fecal or urinary diversion. Shortened hospital inpatient stays, higher patient acuity, and limited access to ostomy specialists send patients with new ostomies home with multiple educational and adjustment needs related to a new stoma. The Society recognized the lack of evidence-based ostomy practice and supported the work of the panel to develop statements that defined elements of the care plan for the patient or caregiver in home care who is adapting to living with a stoma. Eighteen statements were developed that provide minimum discharge criteria for the patient with a new ostomy in the home care setting. Support based upon current evidence as well as expert opinion with implementation strategies are offered for each statement.

A European Competence Framework for Industrial Pharmacy Practice in Biotechnology.

PubMed

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

2015-07-29

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

Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes.

PubMed

Pyatak, Elizabeth A; Carandang, Kristine; Davis, Shain

2015-07-01

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.

[Not Available].

PubMed

Brosseau, Lucie; Laroche, Chantal; Sutton, Anne; Guitard, Paulette; King, Judy; Poitras, Stéphane; Casimiro, Lynn; Tremblay, Manon; Cardinal, Dominique; Cavallo, Sabrina; Laferrière, Lucie; Grisé, Isabelle; Marshall, Lisa; Smith, Jacky R; Lagacé, Josée; Pharand, Denyse; Galipeau, Roseline; Toupin-April, Karine; Loew, Laurianne; Demers, Catrine; Sauvé-Schenk, Katrine; Paquet, Nicole; Savard, Jacinthe; Tourigny, Jocelyne; Vaillancourt, Véronique

2015-08-01

To prepare a Canadian French translation of the PEDro Scale under the proposed name l'Échelle PEDro, and to examine the validity of its content. A modified approach of Vallerand's cross-cultural validation methodology was used, beginning with a parallel back-translation of the PEDro scale by both professional translators and clinical researchers. These versions were reviewed by an initial panel of experts (P1), who then created the first experimental version of l'Échelle PEDro. This version was evaluated by a second panel of experts (P2). Finally, 32 clinical researchers evaluated the second experimental version of l'Échelle PEDro, using a 5-point clarity scale, and suggested final modifications. The various items on the final version of l'Échelle PEDro show a high degree of clarity (from 4.0 to 4.7 on the 5-point scale). The four rigorous steps of the translation process have produced a valid Canadian French version of the PEDro scale.

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

PubMed

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

2012-05-15

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

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process.

PubMed

Smith, C F; Finn, G M; Stewart, J; McHanwell, S

2016-01-01

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel. © 2015 Anatomical Society.

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

PubMed

Worthen, Maria R

2007-12-01

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

Expert Panel Recommendations for Hanford Double-Shell Tank Life Extension

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

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

2001-06-29

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

Replicating human expertise of mechanical ventilation waveform analysis in detecting patient-ventilator cycling asynchrony using machine learning.

PubMed

Gholami, Behnood; Phan, Timothy S; Haddad, Wassim M; Cason, Andrew; Mullis, Jerry; Price, Levi; Bailey, James M

2018-06-01

- Acute respiratory failure is one of the most common problems encountered in intensive care units (ICU) and mechanical ventilation is the mainstay of supportive therapy for such patients. A mismatch between ventilator delivery and patient demand is referred to as patient-ventilator asynchrony (PVA). An important hurdle in addressing PVA is the lack of a reliable framework for continuously and automatically monitoring the patient and detecting various types of PVA. - The problem of replicating human expertise of waveform analysis for detecting cycling asynchrony (i.e., delayed termination, premature termination, or none) was investigated in a pilot study involving 11 patients in the ICU under invasive mechanical ventilation. A machine learning framework is used to detect cycling asynchrony based on waveform analysis. - A panel of five experts with experience in PVA evaluated a total of 1377 breath cycles from 11 mechanically ventilated critical care patients. The majority vote was used to label each breath cycle according to cycling asynchrony type. The proposed framework accurately detected the presence or absence of cycling asynchrony with sensitivity (specificity) of 89% (99%), 94% (98%), and 97% (93%) for delayed termination, premature termination, and no cycling asynchrony, respectively. The system showed strong agreement with human experts as reflected by the kappa coefficients of 0.90, 0.91, and 0.90 for delayed termination, premature termination, and no cycling asynchrony, respectively. - The pilot study establishes the feasibility of using a machine learning framework to provide waveform analysis equivalent to an expert human. Copyright © 2018 Elsevier Ltd. All rights reserved.

Expert agreed standards for the selection and development of cancer support group leaders: an online reactive Delphi study.

PubMed

Pomery, Amanda; Schofield, Penelope; Xhilaga, Miranda; Gough, Karla

2018-01-01

The aim of this study was to develop pragmatic, consensus-based minimum standards for the role of a cancer support group leader. Secondly, to produce a structured interview designed to assess the knowledge, skills and attributes of the individuals who seek to undertake the role. An expert panel of 73 academics, health professionals, cancer agency workers and cancer support group leaders were invited to participate in a reactive online Delphi study involving three online questionnaire rounds. Participants determined and ranked requisite knowledge, skills and attributes (KSA) for cancer support group leaders, differentiated ideal from required KSA to establish minimum standards, and agreed on a method of rating KSA to determine suitability and readiness. Forty-five experts (62%) participated in round 1, 36 (49%) in round 2 and 23 (31%) in round 3. In round 1, experts confirmed 59 KSA identified via a systemic review and identified a further 55 KSA. In round 2, using agreement ≥75%, 52 KSA emerged as minimum standards for support group leaders. In round 3, consensus was reached on almost every aspect of the content and structure of a structured interview. Panel member comments guided refinement of wording, re-ordering of questions and improvement of probing questions. Alongside a novel structured interview, the first consensus-based minimum standards have been developed for cancer support group leaders, incorporating expert consensus and pragmatic considerations. Pilot and field testing will be used to appraise aspects of clinical utility and establish a rational scoring model for the structured interview.

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

PubMed

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

2015-07-01

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

The Development of Quality Measures for the Performance and Interpretation of Esophageal Manometry

PubMed Central

Yadlapati, Rena; Gawron, Andrew J.; Keswani, Rajesh N.; Bilimoria, Karl; Castell, Donald O.; Dunbar, Kerry B.; Gyawali, Chandra P.; Jobe, Blair A.; Katz, Philip O.; Katzka, David A.; Lacy, Brian E.; Massey, Benson T.; Richter, Joel E.; Schnoll-Sussman, Felice; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.

2016-01-01

Background and Aims Esophageal manometry (EM) is the gold standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of EM result in discrepant diagnoses and unnecessary repeated procedures, and may negatively impact patient outcomes. A method to benchmark the procedural quality of EM is needed. The primary aim of this study was to develop quality measures for performing and interpreting EM. Methods The RAND/University of California, Los Angeles Appropriateness Methodology (RAM) was utilized. Fifteen experts in esophageal manometry were invited to be a part of the panel. Potential quality measures were identified through a literature search and interviews with experts. The expert panel ranked the proposed quality measures for appropriateness via a two-round process on the basis of RAM. Results Fourteen experts participated in all processes. A total of 29 measures were considered; 17 of these measures were ranked as appropriate and related to competency (2), pre-procedure (2), procedure (3) and interpretation (10). The latter 10 were integrated into a single composite measure. Thus, 8 final measures were determined to be appropriate quality measures for EM. Five strong recommendations were also endorsed by the experts, however they were not ranked as appropriate quality measures. Conclusions Eight formally validated quality measures for the performance and interpretation of EM were developed on the basis of RAM. These measures represent key aspects of a high-quality EM study and should be uniformly adopted. Evaluation of these measures in clinical practice is needed to assess their impact on outcomes. PMID:26499925

Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study

PubMed Central

Jackson, K A; Glyn-Jones, S; Batt, M E; Arden, N K; Newton, J L

2015-01-01

Objective Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. Methods This Dephi study used online surveys to gain concordance of expert opinion in a structured process of ‘rounds’. In this study, we asked ‘What outcome measures are useful in predicting hip OA in activity-related hip pain?’ The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. Results The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. Conclusions We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research. PMID:26419679

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

PubMed

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

2015-12-30

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

CFD Techniques for Propulsion Applications Panel Symposium (77th), Held in San Antonio, Texas on 27-31 May 1991 (Les Techniques de l’Aerodynamique Numerique pour les Applications aux Propulseurs)

DTIC Science & Technology

1992-02-01

CONCLUDING REMARKS secondary flow pattern. Probably both factors are influential. Unfortunately The present study has examined the the secondary...Panels which are compesed of experts appointed - by the National Delegates, the Consultant and Exchange Programme and the Aerospace Applications Studies ...CP 352. September 1983 /Combustion Problems in Turbine Engines AGARD CP 353, January 1984 (,rHazard Studies for Solid Propellant Rocket Motors AGARD CP

Safety Assessment of Microbial Polysaccharide Gums as Used in Cosmetics.

PubMed

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

2016-07-01

The Cosmetic Ingredient Review Expert Panel assessed the safety of 34 microbial polysaccharide gums for use in cosmetics, finding that these ingredients are safe in cosmetic formulations in the present practices of use and concentration. The microbial polysaccharide gums named in this report have a variety of reported functions in cosmetics, including emulsion stabilizer, film former, binder, viscosity-increasing agent, and skin-conditioning agent. The Panel reviewed available animal and clinical data in making its determination of safety. © The Author(s) 2016.

Developing a tool for the preparation of GMP audit of pharmaceutical contract manufacturer.

PubMed

Linna, Anu; Korhonen, Mirka; Mannermaa, Jukka-Pekka; Airaksinen, Marja; Juppo, Anne Mari

2008-06-01

Outsourcing is rapidly growing in the pharmaceutical industry. When the manufacturing activities are outsourced, control of the product's quality has to be maintained. One way to confirm contract manufacturer's GMP (Good Manufacturing Practice) compliance is auditing. Audits can be supported for instance by using GMP questionnaires. The objective of this study was to develop a tool for the audit preparation of pharmaceutical contract manufacturers and to validate its contents by using Delphi method. At this phase of the study the tool was developed for non-sterile finished product contract manufacturers. A modified Delphi method was used with expert panel consisting of 14 experts from pharmaceutical industry, authorities and university. The content validity of the developed tool was assessed by a Delphi questionnaire round. The response rate in Delphi questionnaire round was 86%. The tool consisted of 103 quality items, from which 90 (87%) achieved the pre-defined agreement rate level (75%). Thirteen quality items which did not achieve the pre-defined agreement rate were excluded from the tool. The expert panel suggested only minor changes to the tool. The results show that the content validity of the developed audit preparation tool was good.

Improving Safe and Effective Use of Drugs in Pregnancy and Lactation: Workshop Summary.

PubMed

Riley, Laura E; Cahill, Alison G; Beigi, Richard; Savich, Renate; Saade, George

2017-07-01

In February 2015, given high rates of use of medications by pregnant women and the relative lack of data on safety and efficacy of many drugs utilized in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) convened a group of experts to review the "current" state of the clinical care and science regarding medication use during the perinatal period. The expert panel chose select medications to demonstrate what existing safety and efficacy data may be available for clinicians and patients when making decisions about use in pregnancy or lactation. Furthermore, these example medications also provided opportunities to highlight where data are lacking, thus forming a list of research gaps. Last, after reviewing the existing vaccine safety surveillance system as well as the legislative history surrounding the use of drugs for pediatric diseases, the expert panel made specific recommendations concerning policy efforts to stimulate more research and regulatory attention on drugs for pregnant and lactating women. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

USGS Publications Warehouse

,

2010-01-01

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

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

PubMed

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

2016-01-01

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

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

PubMed Central

Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

2000-01-01

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

A Regional Decision Support Scheme for Pest Risk Analysis in Southeast Asia.

PubMed

Soliman, T; MacLeod, A; Mumford, J D; Nghiem, T P L; Tan, H T W; Papworth, S K; Corlett, R T; Carrasco, L R

2016-05-01

A key justification to support plant health regulations is the ability of quarantine services to conduct pest risk analyses (PRA). Despite the supranational nature of biological invasions and the close proximity and connectivity of Southeast Asian countries, PRAs are conducted at the national level. Furthermore, some countries have limited experience in the development of PRAs, which may result in inadequate phytosanitary responses that put their plant resources at risk to pests vectored via international trade. We review existing decision support schemes for PRAs and, following international standards for phytosanitary measures, propose new methods that adapt existing practices to suit the unique characteristics of Southeast Asia. Using a formal written expert elicitation survey, a panel of regional scientific experts was asked to identify and rate unique traits of Southeast Asia with respect to PRA. Subsequently, an expert elicitation workshop with plant protection officials was conducted to verify the potential applicability of the developed methods. Rich biodiversity, shortage of trained personnel, social vulnerability, tropical climate, agriculture-dependent economies, high rates of land-use change, and difficulties in implementing risk management options were identified as challenging Southeast Asian traits. The developed methods emphasize local Southeast Asian conditions and could help support authorities responsible for carrying out PRAs within the region. These methods could also facilitate the creation of other PRA schemes in low- and middle-income tropical countries. © 2016 Society for Risk Analysis.

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

PubMed

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

2018-06-05

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

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

PubMed Central

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

2016-01-01

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

Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists.

PubMed

Lewis, James S; Beadle, Beth; Bishop, Justin A; Chernock, Rebecca D; Colasacco, Carol; Lacchetti, Christina; Moncur, Joel Todd; Rocco, James W; Schwartz, Mary R; Seethala, Raja R; Thomas, Nicole E; Westra, William H; Faquin, William C

2018-05-01

Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.

Development of mental health first aid guidelines for panic attacks: a Delphi study.

PubMed

Kelly, Claire M; Jorm, Anthony F; Kitchener, Betty A

2009-08-10

Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic attacks. The Delphi method was used to reach consensus in a panel of experts. Experts included 50 professionals and 6 people who had experience of panic attacks and were active in mental health advocacy. Statements about how to assist someone who is having a panic attack were sourced through a systematic search of both professional and lay literature. These statements were rated for importance as first aid guidelines by the expert and consumer panels and guidelines were written using the items most consistently endorsed. Of 144 statements presented to the panels, 27 were accepted. These statements were used to develop the guidelines appended to this paper. There are a number of actions which are considered to be useful for members of the public to do if they encounter someone who is having a panic attack. These guidelines will be useful in revision of curricula of mental health first aid programs. They can also be used by members of the public who want immediate information about how to assist someone who is experiencing panic attacks.

Reasoning Based Quality Assurance of Medical Ontologies: A Case Study

PubMed Central

Horridge, Matthew; Parsia, Bijan; Noy, Natalya F.; Musenm, Mark A.

2014-01-01

The World Health Organisation is using OWL as a key technology to develop ICD-11 – the next version of the well-known International Classification of Diseases. Besides providing better opportunities for data integration and linkages to other well-known ontologies such as SNOMED-CT, one of the main promises of using OWL is that it will enable various forms of automated error checking. In this paper we investigate how automated OWL reasoning, along with a Justification Finding Service can be used as a Quality Assurance technique for the development of large and complex ontologies such as ICD-11. Using the International Classification of Traditional Medicine (ICTM) – Chapter 24 of ICD-11 – as a case study, and an expert panel of knowledge engineers, we reveal the kinds of problems that can occur, how they can be detected, and how they can be fixed. Specifically, we found that a logically inconsistent version of the ICTM ontology could be repaired using justifications (minimal entailing subsets of an ontology). Although over 600 justifications for the inconsistency were initially computed, we found that there were three main manageable patterns or categories of justifications involving TBox and ABox axioms. These categories represented meaningful domain errors to an expert panel of ICTM project knowledge engineers, who were able to use them to successfully determine the axioms that needed to be revised in order to fix the problem. All members of the expert panel agreed that the approach was useful for debugging and ensuring the quality of ICTM. PMID:25954373

Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)

PubMed Central

Downes, Martin J; Brennan, Marnie L; Williams, Hywel C; Dean, Rachel S

2016-01-01

Objectives The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. Design An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool. Results An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users. Conclusions CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making. PMID:27932337

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

PubMed Central

Chou, Roger; Fanciullo, Gilbert J.; Fine, Perry G.; Adler, Jeremy A.; Ballantyne, Jane C.; Davies, Pamela; Donovan, Marilee I.; Fishbain, David A.; Foley, Kathy M.; Fudin, Jeffrey; Gilson, Aaron M.; Kelter, Alexander; Mauskop, Alexander; O'Connor, Patrick G.; Passik, Steven D.; Pasternak, Gavril W.; Portenoy, Russell K.; Rich, Ben A.; Roberts, Richard G.; Todd, Knox H.; Miaskowski, Christine

2014-01-01

Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related polices. Perspective: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel following a systematic review of the evidence. PMID:19187889

The International Confederation of Midwives: Global Standards for Midwifery Education (2010) with companion guidelines.

PubMed

Thompson, Joyce B; Fullerton, Judith T; Sawyer, Angela J

2011-08-01

a 2-year study was conducted to develop Global Standards for Midwifery Education in keeping with core documents of the International Confederation of Midwives. Elements of the standards were based on evidence available in the published and unpublished literature. Companion Guidelines to assist in implementing the standards were also developed. a modified Delphi survey process was conducted in two rounds following item validation by a panel of midwifery education experts. a global survey conducted in 88 countries. midwifery educators and clinicians associated with midwifery education located in any of the ICM member association countries. Additional participants included an Expert Midwifery Resource Group, other Key Stakeholders, midwifery regulators and policy makers. A total of 241 individuals from 46 ICM member association countries and ten non-member countries responded to one or both of the survey rounds. survey respondents expressed an opinion on whether to retain or to delete any of the proposed components of the standards. Version one had 109 proposed components and version two had 111 items for consideration. a majority consensus of .80 was required to accept an item without further deliberation. The Education Standards Task Force (expert panel) made final decisions in the four instances where this level of consensus was not reached, retaining all four items. The panel also amended the wording of selected items or added new items based on feedback received from survey respondents. The final document contains 10 Preface items, 35 glossary terms, and 37 discrete standards with 27 sub-sections. Copyright © 2011 Elsevier Ltd. All rights reserved.

Using scenarios to assess possible future impacts of invasive species in the Laurentian Great Lakes

USGS Publications Warehouse

Lauber, T. Bruce; Stedman, Richard C.; Connelly, Nancy A; Rudstam, Lars G.; Ready, Richard C; Poe, Gregory L; Bunnell, David B.; Hook, Tomas O.; Koops, Marten A.; Ludsin, Stuart A.; Rutherford, Edward S; Wittmann, Marion E.

2016-01-01

The expected impacts of invasive species are key considerations in selecting policy responses to potential invasions. But predicting the impacts of invasive species is daunting, particularly in large systems threatened by multiple invasive species, such as North America’s Laurentian Great Lakes. We developed and evaluated a scenario-building process that relied on an expert panel to assess possible future impacts of aquatic invasive species on recreational fishing in the Great Lakes. To maximize its usefulness to policy makers, this process was designed to be implemented relatively rapidly and consider a range of species. The expert panel developed plausible, internally-consistent invasion scenarios for 5 aquatic invasive species, along with subjective probabilities of those scenarios. We describe these scenarios and evaluate this approach for assessing future invasive species impacts. The panel held diverse opinions about the likelihood of the scenarios, and only one scenario with impacts on sportfish species was considered likely by most of the experts. These outcomes are consistent with the literature on scenario building, which advocates for developing a range of plausible scenarios in decision making because the uncertainty of future conditions makes the likelihood of any particular scenario low. We believe that this scenario-building approach could contribute to policy decisions about whether and how to address the possible impacts of invasive species. In this case, scenarios could allow policy makers to narrow the range of possible impacts on Great Lakes fisheries they consider and help set a research agenda for further refining invasive species predictions.

Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

PubMed

Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

2017-11-01

While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review.

PubMed

Ogrinc, Greg; Headrick, Linda A; Mutha, Sunita; Coleman, Mary T; O'Donnell, Joseph; Miles, Paul V

2003-07-01

To create a framework for teaching the knowledge and skills of practice-based learning and improvement to medical students and residents based on proven, effective strategies. The authors conducted a Medline search of English-language articles published between 1996 and May 2001, using the term "quality improvement" (QI), and cross-matched it with "medical education" and "health professions education." A thematic-synthesis method of review was used to compile the information from the articles. Based on the literature review, an expert panel recommended educational objectives for practice-based learning and improvement. Twenty-seven articles met the inclusion criteria. The majority of studies were conducted in academic medical centers and medical schools and 40% addressed experiential learning of QI. More than 75% were qualitative case reports capturing educational outcomes, and 7% included an experimental study design. The expert panel integrated data from the literature review with the Dreyfus model of professional skill acquisition, the Institute for Healthcare Improvement's (IHI) knowledge domains for improving health care, and the ACGME competencies and generated a framework of core educational objectives about teaching practice-based learning and improvement to medical students and residents. Teaching the knowledge and skills of practice-based learning and improvement to medical students and residents is a necessary and important foundation for improving patient care. The authors present a framework of learning objectives-informed by the literature and synthesized by the expert panel-to assist educational leaders when integrating these objectives into a curriculum. This framework serves as a blueprint to bridge the gap between current knowledge and future practice needs.

78 FR 3069 - Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

... .E95 2007]. The Agency then convened a panel of medical experts in the field of neurology (MEP) on May... epilepsy and neurology to address key questions and make recommendations concerning new guidelines for CMV...

75 FR 16127 - Establishment of the Presidential Commission for the Study of Bioethical Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

... expert panel composed of not more than 13 members, who will be drawn from fields of bioethics, science.... The Commission has been established to replace the President's Council on Bioethics. The Council was...

Drugs and human performance fact sheets

DOT National Transportation Integrated Search

2004-03-01

A panel of international experts on drug-impaired driving met in Seattle during August 2000 to review developments in the field of drugs and human performance over the last 10 years; to identify the specific effects that both illicit and prescription...

Drugs and human performance fact sheets.

DOT National Transportation Integrated Search

2014-04-01

A panel of international experts on drug-impaired driving met in Seattle during August 2000 to review developments in the field of drugs and human performance over the last 10 years; to identify the specific effects that both illicit and prescription...

34 CFR 97.407 - Research not otherwise approvable which presents an opportunity to understand, prevent, or...

Code of Federal Regulations, 2011 CFR

2011-07-01

... panel of experts in pertinent disciplines (for example: science, medicine, education, ethics, law) and following opportunity for public review and comment, has determined either that— (1) The research in fact...

34 CFR 97.407 - Research not otherwise approvable which presents an opportunity to understand, prevent, or...

Code of Federal Regulations, 2014 CFR

2014-07-01

... panel of experts in pertinent disciplines (for example: science, medicine, education, ethics, law) and following opportunity for public review and comment, has determined either that— (1) The research in fact...

34 CFR 97.407 - Research not otherwise approvable which presents an opportunity to understand, prevent, or...

Code of Federal Regulations, 2010 CFR

2010-07-01

... panel of experts in pertinent disciplines (for example: science, medicine, education, ethics, law) and following opportunity for public review and comment, has determined either that— (1) The research in fact...