Complete Round Research Articles

Heterogeneous migration routes of DNA triplet repeat slip-outs

It is unclear how the length of a repetitive DNA tract determines the onset and progression of repeat expansion diseases, but the dynamics of secondary DNA structures formed by repeat sequences are believed to play an important role. It was recently shown that three-way DNA junctions containing slip-out hairpins of CAG or CTG repeats and contiguous triplet repeats in the adjacent duplex displayed single-molecule FRET (smFRET) dynamics that were ascribed to both local conformational motions and longer-range branch migration. Here we explore these so-called "mobile" slip-out structures through a detailed kinetic analysis of smFRET trajectories and coarse-grained modeling. Despite the apparent structural simplicity, with six FRET states resolvable, most smFRET states displayed biexponential dwell-time distributions, attributed to structural heterogeneity and overlapping FRET states. Coarse-grained modeling for a (GAC)10 repeat slip-out included trajectories that corresponded to a complete round of branch migration; the structured free energy landscape between slippage events supports the dynamical complexity observed by smFRET. A hairpin slip-out with 40 CAG repeats, which is above the repeat length required for disease in several triplet repeat disorders, displayed smFRET dwell times that were on average double those of 3WJs with 10 repeats. The rate of secondary-structure rearrangement via branch migration, relative to particular DNA processing pathways, may be an important factor in the expansion of triplet repeat expansion diseases.

Knowledge user survey and Delphi process to inform development of a new risk of bias tool to assess systematic reviews with network meta-analysis (RoB NMA tool)

BackgroundNetwork meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We aimed to develop a risk of bias (RoB) tool to assess NMAs (RoB NMA...

SP2.1.8 Informed consent – Are we appropriately assessing the process?

Abstract Aims There is no standardised measure of the validity of consent. Over 300 million invasive procedures take place globally each year. This study aims to define a core outcome set (COS) for informed consent for therapy. Methods A prospective mixed method study was undertaken in line with a published protocol and the COS was developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) methodology. This included a systematic review of outcomes in studies of consent, semi-structured interviews and prioritisation of outcomes using a 2-round modified Delphi technique. Two consensus webinars were used to ratify outcomes for inclusion in the final COS. Results 36 outcome domains for valid consent were identified and developed by systematic review. 41 semi-structured interviews were conducted with key consent stakeholders (with significant patient involvement) 164 participants from key stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed round 2. 11 of 40 outcomes met the “consensus in” criteria, with 6 meeting “consensus in” in all stakeholder groups. These were included directly in the final COS and the other 5 that met “consensus in” in some but not all stakeholder groups were discussed in consensus webinars. 9 outcomes were defined for the final COS. Conclusion This is the first study to define a COS for research into informed consent for therapy. It defines what outcomes are most important to all key stakeholders in the consent process and is a step forward in standardising consent research.

NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment

BackgroundRounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework (“NET Rounding”) that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education.MethodsNET Rounding consists of nine recommendations divided into three categories: Novel rounding strategies, shared Expectations, and Time management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March–May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding’s contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings.ResultsThirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience.ConclusionsNET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.

Globe and Adnexal Trauma Terminology Survey

Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings. To update terminology for globe and adnexal trauma. A 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma-related peer-reviewed articles. Expert consensus on ocular and adnexal terms. A total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 [80%]), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 [75%]) and status of the lacrimal canaliculi (54 of 69 [78%]), nasolacrimal ducts (48 of 69 [69%]), lens (46 of 58 [80%]), retina (42 of 58 [73%]), and central and paracentral cornea (47 of 58 [81%]) be included in the revised terminology. There was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.

P-501 Sharing motherhood: same-sex female couples’ reasons for choosing shared biological motherhood

Abstract Study question Why do same-sex female couples choose to conceive using shared biological motherhood, where one mother uses her egg and the other gestates the pregnancy? Summary answer Couples consider factors within their family alongside pressures from wider society when choosing to conceive by shared biological motherhood. What is known already Shared biological motherhood (SBM), sometimes known as ‘reciprocal-IVF’, describes a treatment available to same-sex female couples where eggs are retrieved from one prospective mother, fertilised in-vitro with donor sperm, then carried by the other mother, meaning one partner has a gestational connection to their child, and the other has a genetic connection. SBM is growing in popularity across Europe, but it is only available in a few countries due to ongoing ethical debate. Existing research demonstrates the clinical efficacy of SBM (Bodri et al., 2017), but no research has studied the motivations and experiences of mothers who choose this treatment. Study design, size, duration In-depth, semi-structured interviews were carried out separately with genetic and gestational mothers in fifteen families created through shared biological motherhood (n = 30 parents). Children were aged between 0-3 years (M = 22 months). Data were collected between December 2019 and June 2021. Participants/materials, setting, methods Participants were recruited through the London Women’s Clinic. Of the 30 parents, 90% were working in professional or managerial occupations. Interviews addressed a range of topics including treatment choices, experiences of treatment, thoughts and feelings about pregnancy and biological relatedness (genetic and gestational), and the nature of each mother’s relationship with their infant, and with each other. Data were analysed using qualitative content analysis and reflexive thematic analysis methods (Braun & Clarke, 2006; 2019). Main results and the role of chance Preliminary analysis indicates that the reasons prospective parents choose SBM are complex as couples consider factors within their family alongside pressures from wider society. Within-family factors include the desire to have a child that shares biological connections with both parents and the opportunity to protect against rejection from the child in future. Outside the family, SBM offered both parents a social and legal legitimacy that was not guaranteed with traditional IVF. A significant minority of parents understood SBM to be ‘as close as they can get’ to heterosexual reproduction. Decisions regarding who will carry the pregnancy were mediated by parent age and the expected success rate of undergoing IVF. However, the desire to experience pregnancy and feel closeness forged through breastfeeding also shaped these decisions. Around half of families planned to, or already had, completed further round(s) of SBM with the biological roles reversed. Both genetic and gestational mothers identified contradictions in their own feelings regarding the importance of biological relationships in their family. Parents reported that the impact of their genetic or gestational link was limited in day-to-day family life, but they were still grateful that access to SBM meant they both had a biological connection to their child. Limitations, reasons for caution There is a risk of selection bias, with families who have had a more positive experience of SBM being more likely to participate in research, although the diversity observed in the narratives in the sample suggests otherwise. Wider implications of the findings The current findings support existing clinical literature showing that SBM can be a viable and meaningful route to parenthood for same-sex female couples. The complex reasons why reciprocal-IVF appeals to prospective parents should be considered by clinicians and policy makers in the debate surrounding the regulation and practice of SBM. Trial registration number N/A

667-P: Impact of Direction of Long-Haul Travel on Glycemic Control in Adults with Type 1 Diabetes (T1D) Using Multiple Daily Injections (MDI) of Insulin

Long-haul travel (flights >6 hours) can be very disruptive for people living with type 1 diabetes (T1D) . As part of a study comparing long-acting basal insulins during long-haul travel (Bevier & Castorino, et al) , we evaluated the impact of direction of travel on glucosecontrol (Abbott Freestyle Libre Pro) . Each journey began in Honolulu (HI) with a non-stop flight to New York (NY) lasting hours with a 6-hour time difference. After 72 hours, participants returned non-stop to HI. Each subject completed round trips (using either Glargine or Insulin Degludec as the basal insulin) . Participants traveled in the same direction for either basal insulin. To assess the impact of direction of travel, data using either basal insulin were combined. Overall, 21 participants (13 women, age 34.2±15.2 years, HbA1c 7.5±1.2%) completed both journeys. CGM-derived metrics comparing (a) initial 72 hours at each destination, (b) during each flight and (c) for the total journey are shown below. During sleep, TIR70-180 was 56±26% travelling East to West and 66±26% going from West to East. Although there were no significant differences in CGM-derived metrics irrespective of direction of travel, the data suggest that achieving the recommended time in range between 70-180 mg/dl is elusive for adults with T1D using MDI when travelling across multiple time zones. Disclosure W.C.Bevier: Research Support; Abbott Diabetes. H.Liu: Employee; Abbott Diabetes. K.N.Castorino: Consultant; Lilly Diabetes, Research Support; Abbott Diabetes, Dexcom, Inc., Drawbridge Health, Inc., Eyenuk, Inc., Laxmi Therapeutic Devices, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Speaker's Bureau; Dexcom, Inc. D.Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi, Consultant; Evidation Health, Research Support; Novo Nordisk A/S, Stock/Shareholder; Glooko, Inc., Hi.Health. Funding Novo Nordisk Investigator Sponsored Study - ISS-001227

Immunological Potency, Efficacy, and Tolerance of “Gam-COVID-Vac” Vaccine among Students: Prospective Study

Background. Students, as the most active and mobile part of population, often unite into educational and informal groups, move to other regions or countries, and present a specific risk group for the spread of new coronavirus infection. Thus, they require preventive vaccination. objective. The aim of the study is to study the immunological potency, tolerance, and efficacy of Gam-COVID-Vac vaccine among students of Krasnodar. Methods. 119 seronegative students (18-30 years old) were examined. SARS-CoV-2 IgG (ELISA method) was determined 1, 3, and 6 months after two completed rounds of vaccination. Post-vaccination adverse events and COVID-19 cases were evaluated in the study. Results. SARS-CoV-2 IgG level 1 month after vaccination ranged from 6.15 to 19.38 and was to 16.39 (AU/mL) ± 1,12. Immunological potency values ranged from 4.407 to 21.5 (AU/mL) (14.74 ± 2.93) 3 months after. IgG titers were in the range of 4.14 to 17.71 (AU/mL) (10.97 ± 4.69) 6 months after. Adverse events after vaccination were revealed in 34 respondents (28.6%). Among them, local (hyperemia, pain, edema) — 21 (17.6%): slight — 90.4%, major — 9.6%; general (fever, weakness, algor, headache, arthralgia, myalgia) — 13 (10.9%): slight — 69.2%, major — 30.8%. The increase in vaccination coverage in students from 30.3 to 79.1% reduced the COVID-19 morbidity from 3.81 to 1.57%. Conclusion. Gam-COVID-Vac vaccine induced stable humoral response, demonstrated sufficient safety, and reduced morbidity 2.4-fold.

Surya Namaskar: As an Alternative for Aerobic Fitness.

"Surya Namaskar" (SN) may be used as a need-based short-duration aerobic activity in a confined space to establish as a substitute of an equivalent routine physical training in challenging stressful conditions. Noninvasive oxygen-kinetics metabolic responses between SN and endurance work on bicycle ergometry (BE) were compared across different phases of maximal oxygen uptake percentage (%VO2 max). SN, comprising three complete rounds per min (36 beats/min of a metronome; SN consists of 12 poses per round), was performed rhythmically and continuously for 5 min to simulate an incremental BE test (25 watts/2 min at 60 rpm). SN results in a significant (P < 0.05) greater increase of arteriovenous oxygen difference at 71%-80% VO2 max while keeping a low respiratory exchange ratio (P < 0.01 and 0.001) at 41%-80% VO2 max exercising state. SN could be an ideal form of aerobic exercise instead of BE.

ENERGY AWARE ROUTING FOR WIRELESS SENSOR NETWORKS

Wireless sensor networks are used in improving conditions in the practical field and real life which lead researchers and developers to further research it and work into improving this field. These networks consist of sensor nodes that can help acquire data and information about temperature and pressure dependent on the environment of the location which are sent from. After all that, we are bounded by a really important factor which can determine everything which is Energy. Since sensor nodes send data and information to web applications, they need an energy source to operate. Their main energy source is their batteries which offer limited source of energy. Hence, various protocols are introduced to help in many parameters of a wireless sensor network such as increasing lifetime and decreasing consumption of energy, in other words, increasing the Energy Efficiency (EF). In this paper, we evaluate consumption of average energy for various protocols used in this context after each complete logical round for these protocols, such as Energy Efficient Clustering Scheme and Stable Election Protocol. Finally, we used Matlab tool to generate results which indicate that the protocol used in this paper is efficient and reliable.

Toward genetic counseling practice standards for diagnostic testing in amyotrophic lateral sclerosis and frontotemporal dementia

Objective: Genetic counseling and diagnostic genetic testing are considered part of the multidisciplinary care of individuals with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). We aimed to investigate the ideal components of genetic counseling for ALS/FTD diagnostic testing amongst various stakeholders using an online, modified Delphi survey. Methods: Experts in genetic counseling and testing for ALS/FTD were purposively then snowball recruited and included genetic health professionals, health professionals outside of genetics and consumer experts (patients, relatives, and staff representatives from ALS/FTD support organizations). First-round items were informed by two systematic literature reviews and qualitative interviews with patients and families who had experienced diagnostic testing. Analysis of each round informed the development of the subsequent round and the final results. Results: Forty-six experts participated in the study, 95.65% completed both rounds. After round one, items were updated based on participant responses and were presented again for consensus in round two. After round two, a high level of consensus (≥80% agreement) was achieved on 16 items covering various topics related to genetic counseling service delivery, before and after diagnostic testing is facilitated. Conclusions: Genetic counseling for individuals with ALS/FTD and their families should include the provision of client-centered counseling, education and support throughout. The items developed are adaptable to varied healthcare settings and may inform a standard of genetic counseling practice for health professionals who facilitate testing and counseling discussions. This area of work is timely, given demand for testing is likely to increase as more genotype-driven clinical trials become available.

Development of a Core Outcome Set for Children Aged 1-18 Years with Gastroesophageal Reflux Disease

To develop a core outcome set for clinical studies assessing gastroesophageal reflux disease (GERD) in children. This core outcome set was developed using a 2-round Delphi technique and adhering to the Outcome Measures in Rheumatology Initiative (OMERACT 2.0) recommendations. Healthcare professionals (HCPs) and (parents of) children (age 1-18years) with a GERD diagnosis (ie, the presence of bothersome symptoms), listed up to 5 harmful and/or beneficial outcomes that they considered important in the treatment of GERD. Outcomes mentioned by more than 10% of participants were put forward and rated and prioritized by HCPs, parents, and children in a second round. Outcomes with the highest rank formed the draft core outcome set. The final core outcome set was created during an online consensus meeting between an expert panel. The first round was completed by 118 of 125 HCPs (94%), 146 of 146 parents (100%), and 69 of 70 children (99%). A total of 80 of 118 HCPs (68%), 130 of 140 parents (93%), and 77 children (100%) completed round 2. "Adequate relief," "evidence of esophagitis," "feeding difficulties," "heartburn (≥4years)," "hematemesis," "regurgitation," "sleeping difficulties," "vomiting," and "adverse events" were included in the final core outcome set for GERD in children aged 1-18years. We identified a total set of 9 core outcomes and suggest these outcomes to be minimally measured in clinical studies assessing GERD in children. Implementation of this core outcome set is likely to increase comparison between studies and may thus provide future recommendations to improve treatment of GERD in children.

Delphi panel for consensus on the optimal management of dabrafenib plus trametinib-related pyrexia in patients with melanoma.

Dabrafenib and trametinib combination therapy (dab + tram) is indicated to treat BRAF V600 mutation-positive unresectable/metastatic melanoma and as adjuvant treatment for resected stage III disease. Dab + tram-related pyrexia may require early therapy discontinuation. A modified Delphi panel was conducted to develop consensus on the optimal management of dab + tram-related pyrexia in patients with melanoma. In all, 10 UK oncologists experienced in melanoma management participated in a three-round modified Delphi study (Round 1: one-to-one interview; Rounds 2 and 3: email survey). In each round, participants rated the extent of their agreement with statements about defining and managing dab + tram-related pyrexia. Consensus was defined as >80% agreement for critical management (CM) and >60% for non-critical management (NCM) statements. All 10 participants completed Round 1; 9 completed Rounds 2 and 3. Consensus was reached on 42/66 statements (20 CM and 22 NCM). Drug-related pyrexia was agreed as being strictly an elevation of body temperature, although other symptoms may be present (89% agreement). Panelists agreed on the need for simple and generic guidance on dab + tram-related pyrexia management that does not differentiate between patient groups (100%), and that management of first and second dab + tram-related pyrexia episodes should be the same regardless of treatment intent (100%). Regarding CM, participants agreed that both dab and tram should be interrupted for pyrexia (100%) without considering the use of steroids (89%); patients on dab + tram presenting to non-oncology services with pyrexia should be directed to an oncology-specific service as soon as possible and assessed for infection (100%). NCM statements on steroid use following dab + tram interruption and when to restart dab + tram did not reach consensus. These consensus statements provide a framework on optimal management of dab + tram-related pyrexia in patients with melanoma which should inform future guidelines.

Grand Challenges in global eye health: a global prioritisation process using Delphi method

SummaryBackgroundWe undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations.MethodsDrawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists.FindingsBetween Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity.InterpretationThis list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges.FundingThe Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission.TranslationsFor the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

International consensus on clinical severity scale use in evaluating Niemann\u2013Pick disease Type C in paediatric and adult patients: results from a Delphi Study

BackgroundSeveral scales have been developed in the past two decades to evaluate Niemann–Pick disease Type C (NPC) severity in clinical practice and trials. However, a lack of clarity concerning which scale to use in each setting is preventing the use of standardised assessments across the world, resulting in incomparable data sets and clinical trial outcome measures. This study aimed to establish agreed approaches for the use of NPC severity scales in clinical practice and research.MethodsA Delphi method of consensus development was used, comprising three survey rounds. In Round 1, participants were asked nine multiple-choice and open-ended questions to gather opinions on the six severity scales and domains. In Rounds 2 and 3, questions aimed to gain consensus on the opinions revealed in Round 1 using a typical Likert scale.ResultsNineteen experts, active in NPC paediatric and adult research and treatment, participated in this study. Of these, 16/19 completed Rounds 1 and 2 and 19/19 completed Round 3. Consensus (defined as ≥ 70% agreement or neutrality, given the study aim to identify the severity scales that the clinical community would accept for international consistency) was achieved for 66.7% of the multiple-choice questions in Round 2 and 83% of the multiple-choice questions in Round 3. Consensus was almost reached (68%) on the use of the 5-domain NPCCSS scale as the first choice in clinical practice. Consensus was reached (74%) for the 17-domain NPCCSS scale as the first choice in clinical trial settings, but the domains measured in the 5-domain scale should be prioritised as the primary endpoints. Experts called for educational and training materials on how to apply the NPCCSS (17- and 5-domains) for clinicians working in NPC.ConclusionsIn achieving a consensus on the use of the 17-domain NPCCSS scale as the first choice for assessing clinical severity of NPC in clinical trial settings but prioritising the domains in the 5-domain NPCCSS scale for routine clinical practice, this study can help to inform future discussion around the use of the existing NPC clinical severity scales. For routine clinical practice, the study helps provide clarity on which scale is favoured by a significant proportion of a representative body of experts, in this case, the 5-domain NPCCSS scale.

Key performance and training parameters in primary total hip arthroplasty - an expert consensus using the Delphi technique.

Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome. The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3. 50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching. The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.

Managing tourism safety and risk: Using the Delphi expert consensus method in developing the event tourism security self-beliefs scale

Safety and security issues are one of the biggest challenges in the field of tourism, and limited data is available regarding the profiles for individuals who are responsible for the safety of the event tourism industry. This eDelphi study used a methodology with a panel of event security experts to complete several rounds of questionnaires utilizing write-in answers (qualitative content) as well as Likert-scale agreement/ranking (quantitative data) to develop a new survey instrument. Results from content adequacy identify a new instrument consisting of 13 items related to an employee's obligation, 11 items related to an employer's obligation, 11 items related to self-beliefs, six items related to hospitality culture, and six items related to motivation. The developed scale was constructed through consensus among experts in the field of risk management and can be used as a valid instrument for use by tourism managers and event organizers.

Effects of Introducing Rest Intervals in Functional Fitness Training

Background: Functional Fitness Training (FFT) is a new exercise modality prioritizing functional multi-joint movements executed at high intensity as a circuit. Objective: To examine the impacts of introducing rest intervals in a FFT workout compared to “rounds for time” (RFT) FFT. Materials and Methods: Participants were 25 resistance-trained adults who completed two FFT workouts 1 week apart. The study design was crossover such that in a given session half the participants completed the standard and the other half the adapted FFT (FFTadapted). The workouts consisted of the same exercises (circuit of four rounds of exercises), but one (FFTadapted) included preset rest intervals (three sets of 1 min after each completed round). Before and after the workouts, countermovement jump ability and blood lactate were measured. Heart rate (HR) and ratings of perceived exertion (RPE) were measured post-exercise. Results: For both the standard and adapted protocols, mean HR was 90% age-predicted maximum. Final RPE was also similar for both workouts (~15–15.5) and indicated a “hard” work intensity. Both FFTs took the same time to complete (~13 min). Furthermore, no significant differences were observed in jump ability between FFTs. In contrast, lactate (15.11 ± 3.64 vs. 13.48 ± 3.64 mmol·L−1, p &lt; 0.05), measured 3 min post-exercise, was significantly lower in FFTadapted. Conclusions: In FFTadapted, there was a significant reduction in RPE and blood lactate concentrations after exercise, while there were no significant differences in either HR or jumping ability, compared to a FFT workout in RFT methodology.

Early supported hospital discharge for foot disease: a co-design study

BackgroundThere are more than 10,000 admissions each year in Australia for foot disease, with an average length of hospital stay of 26 days. Early supported discharge (ESD) has been shown to improve patient satisfaction and reduce length of stay without increasing the risk of 30-day readmissions. This research aims to gain consensus on an optimal model of early supported discharge for foot disease.MethodsThree focus groups were held where preliminary components for an early discharge model, as well as inclusion and exclusion criteria, were identified with a purposefully sampled group of medical, nursing, allied health staff and consumers. Two researchers independently systematically coded focus group transcripts to identify components of an ESD model using an iterative constant comparative method. These components then formed the basis of a three phase Delphi study, with all individuals from the focus groups were invited to act as panellists. Panellists rated components for their importance with consensus established as a rating of either essential or very important by ≥80% of the panel.ResultsTwenty-nine experts (including 5 consumers) participated across the two study phases. Twenty-three (3 consumers) participated in the focus groups in phase one. Twenty-eight of the twenty-nine experts participated in the phase 2 Delphi. 21/28 completed round 1 of the Delphi (75% response rate), 22/28 completed round 2 (79% response rate), and 16/22 completed round 3 (72% response rate). Consensus was achieved for 17 (29%) of 58 components. These included changes to the way patients are managed on wards (both location and timeliness of care by the multidisciplinary team) and the addition of new workforce roles to improve co-ordination and management of the patients once they are at home.ConclusionsA model of early supported discharge that would allow individuals to return home earlier in a way that is safe, acceptable, and feasible may result in improving patient satisfaction while reducing health system burden. Future trial and implementation of the ESD model identified in this study has the potential to make a significant contribution to the experience of care for patients and to the sustainability of the health system.

Dome-Shaped Macula versus Ridge-Shaped Macula Eyes in High Myopia Based on the 12-line Radial Optical Coherence Tomography Scan Pattern. Differences in Clinical Features

Purpose: To study clinical features in patients with ridge-shaped macula (RSM) compared with those with dome-shaped macula (DSM) having been previously classified by the number of swept-source optical coherence tomography (SS-OCT) radial scans affected. Methods: Retrospective observational study including 49 highly myopic eyes from 31 patients who underwent SS-OCT. DSM eyes were defined as those that showed a complete round inward convexity in all their axes, presenting an inward convexity ≥50 µm in the 12-line radial OCT scans. Eyes that did not meet this criterion and had at least one flat radial scan were grouped into the RSM group, defined as a macular inward convexity in some meridians across the fovea, whereas the opposite perpendicularly oriented meridians were flat. Age, spherical equivalent, axial length (AL), and best-corrected visual acuity (BCVA) were collected. Height of the bulge, scleral and choroidal thicknesses, Bruch´s membrane defects, and presence of perforating scleral vessels were recorded. Results: Thirty-seven (75.5%) eyes were classified into the RSM group and 12 (24.5%) into the DSM group. Twenty-six (53.0%) eyes showed macular elevation only in the horizontal direction. Mean AL showed statistically significant differences (28.8 ± 2.7 vs. 30.5 ± 1.5 mm in the RMS vs. DSM group, respectively) and the presence of Bruch´s membrane defects was more frequently seen in DSM (p < 0.001). Mean age, spherical equivalent, BCVA, height of the inward convexity, retinal foveal thickness, foveal scleral thickness, subfoveal choroidal thickness, and the presence of perforating scleral vessels did not show significant differences between groups. Conclusion: This study shows the reliability of using the 12 equal radial OCT scans as an objective method to define and differentiate DSM versus RSM. Patients with RSM showed differences in AL compared with those with DSM, being longer in DSM, and regarding the presence of Bruch´s membrane defects, being more common in DSM. This may contribute to identifying those patients that, in daily clinical practice, have a higher risk of developing complications due to their myopia.