Consensus Judgment Research Articles

Possible genotoxic modes of action for naphthalene

This report provides a summary of deliberations conducted under the charge for members of Module D participating in the Naphthalene State-of-the-Science Symposium (NS 3), Monterey, CA, October 9–12, 2006. The charge directed the panel to ascertain to the best of its ability a consensus judgment of the state-of-the-science concerning the potential for a genotoxic mode of action for naphthalene and its metabolites, with implications for low-dose extrapolations of cancer risk estimates for exposed populations. Where scientific uncertainties remained, the panel was asked to identify which scientific uncertainties (if any) could be resolved through targeted, timely, cost-effective research. The report provides a brief summary of naphthalene genotoxicity; identifies those areas where there is a general scientific consensus regarding the effects of naphthalene; identifies areas of uncertainty regarding the effects of naphthalene; and key questions that currently limit our ability to assess the genotoxic risks of naphthalene. The report also outlines a set of six studies that could resolve some of these key uncertainties.

Fuzzy consensus measure on verbal opinions

In the group decision-making process, consensus is an important indication of group agreement or reliability. Traditional methods to measure consensus refer mostly to gauging variance among the participants' opinions by transforming them into numbers in the interval scale. In this study we propose a new value-based measure, in which verbal opinions are transformed into values by means of fuzzy membership functions. To understand how the proposed method performs, we conduct two experiments to compare its performance with the variance-based methods and entropy measure. The results show that our method is more appropriate to account for participants' consensus judgments based on verbal opinions.

Deliberative mapping: a novel analytic-deliberative methodology to support contested science-policy decisions

This paper discusses the methodological development of Deliberative Mapping (DM), a participatory, multi-criteria, option appraisal process that combines a novel approach to the use of quantitative decision analysis techniques with some significant innovations in the field of participatory deliberation. DM is a symmetrical process, engaging “specialists” and “citizens” in the same appraisal process, providing for consistency of framing, mutual inter-linkage and interrogation, and substantial opportunities for face-to-face discussion. Through a detailed case study of organ transplantation options, the paper discusses the steps in DM. The analysis shows that DM is able to elicit and document consensual judgments as well as divergent views by integrating analytic and deliberative components in a transparent, auditable process that creates many opportunities for personal learning, and provides a robust decision-support tool for contested science-policy issues.

A Preliminary Investigation of the Components of a Curriculum for the Preparation of Master's-Level Addiction Counselors

This study identified the preliminary curriculum components for the preparation of graduate-level addiction counselors. A review of the related literature revealed no agreed upon standards for post baccalaureate instruction of addiction counseling. The Delphi method was used to establish curriculum items from a list of 198 previously identified work behaviors associated with graduate-level addiction counseling. A panel of 28 addiction counseling experts responded to three administrations of an evolving questionnaire and reached consensus on a final list of 89 curriculum items. Consensus of expert judgments was corroborated by a post hoc multivariate of analysis of variance (MANOVA) that revealed no significant differences in ratings of importance among panelist subgroups.

Isaiah Berlin and the plurality of histories: Two concepts of Karl Marx

This essay presents Isaiah Berlin's forceful, if somewhat neglected, case for what can be termed ‘pluralist historiography’—a perspective which seems to be of growing currency today. Drawing on Berlin's prolific critiques of scientific history, this essay shows how he presents history as a hybrid discipline—incorporating rational, interpretive and creative components—but also with a hard core of elements indispensable to effective historical writing, including grounding in the established historical facts, the exercise of empathetic imagination and their creative fusion into narrative form. Berlin thus embraces a bounded diversity of historical approaches which reveal both the diverse range of human forms of life, and a common ‘human horizon’ of basic needs, faculties and values that links them all together. This flexible approach both retains confidence in generally being able to attain a consensual judgment on the best available historical account, while also allowing for the possibility of irreducible disagreement. Drawing in particular on Berlin's ethical value pluralism, this essay argues that he regards irreducible disagreement as preferable, despite its potential inconveniences, to monist distortion. Finally, the essay illustrates the character and force of Berlin's historiography through a case study of two historical accounts of Karl Marx and the development of his thought, one offered by Berlin himself and the other by his erstwhile student and friend Gerald Cohen. It stresses in particular the two writers' distinctive approaches, divergent conclusions, and their mutual admiration and respect nonetheless. Finally, it suggests while readers may legitimately disagree with one another in their comparative judgments of the two accounts of Marx, and that this type of dispute may have an unfortunate polarizing effect on the historical discipline, that there are at least some consolations to be found in it. These consolations indeed help to explain the growing influence of pluralist historiography today.

Seizure Detection in Adult ICU Patients Based on Changes in EEG Synchronization Likelihood

Seizures are common in Intensive Care Unit (ICU) patients, and may increase neuronal injury. To explore the possible value of synchronization likelihood (SL) for the automatic detection of seizures in adult ICU patients. We included EEGs from ICU patients with a variety of diagnoses. The gold standard for further analyses was the consensus judgment of three clinical neurophysiologists who classified 150 scalp EEG epochs as "definitely epileptiform," "definitely non epileptiform," or "uncertain." SL estimates the statistical interdependencies between two time series, such as two EEG channels. We computed the average synchronization by calculating the SL between one channel and every other channel, and taking the mean of these values. The mean SL in the 38 "definitely epileptiform" epochs ranged from 0.095 to 0.386 (mean 0.189; SD 0.066). In the 34 "definitely nonepileptiform" epochs the mean SL ranged from 0.087 to 0.158 (mean 0.115; SD 0.016; p < 0.0005). The area under the ROC curve was 0.812 (95% Confidence Interval 0.725 to 0.898). The mean SL may distinguish between seizure and nonseizure epochs, and may prove helpful to monitor epileptic activity in ICU patients.

Unhappiness and dissatisfaction in doctors cannot be predicted by selectors from medical school application forms: A prospective, longitudinal study

BackgroundPersonal statements and referees' reports are widely used on medical school application forms, particularly in the UK, to assess the suitability of candidates for a career in medicine. However there are few studies which assess the validity of such information for predicting unhappiness or dissatisfaction with a career in medicine. Here we combine data from a long-term prospective study of medical student selection and training, with an experimental approach in which a large number of assessors used a paired comparison technique to predict outcome.MethodsData from a large-scale prospective study of students applying to UK medical schools in 1990 were used to identify 40 pairs of doctors, matched by sex, for whom personal statements and referees' reports were available, and who in a 2002/3 follow-up study, one pair member was very satisfied and the other very dissatisfied with medicine as a career. In 2005, 96 assessors, who were experienced medical school selectors, doctors, medical students or psychology students, used information from the doctors' original applications to judge which member of each pair of doctors was the happier, more satisfied doctor.ResultsNone of the groups of assessors were significantly different from chance expectations in using applicants' personal statements and the referees' reports to predict actual future satisfaction or dissatisfaction, the distribution being similar to binomial expectations. However judgements of pairs of application forms from pairs of doctors showed a non-binomial distribution, indicating consensus among assessors as to which doctor would be the happy doctor (although the consensus was wrong in half the cases). Assessors taking longer to do the task concurred more. Consensus judgements seem mainly to be based on referees' predictions of academic achievement (even though academic achievement is not actually a valid predictor of happiness or satisfaction).ConclusionAlthough widely used in medical student selection to assess motivation, interest and commitment to a medical career, the personal statement and the referee's report cannot validly be used by assessors, including experienced medical school selectors, to identify doctors who will subsequently be dissatisfied with a medical career.

Non‐affective Acute Remitting Psychosis: a preliminary report from Iran

To investigate the concept of 'Non-affective Acute Remitting Psychosis' (NARP) in a group of patients with first episode psychosis in Iran. This is a 24-month follow-up study of 54 patients with first-episode psychosis admitted consecutively to a psychiatric hospital in Tehran, Iran. At the end of follow-up, consensus judgments were made on fulfillment of the NARP criteria as well as illness course and treatment. NARP was defined as a psychotic illness with acute onset (developed within 1 week), short duration (remission within 6 months), and the absence of prominent mood symptoms. Of 49 patients who completed the follow-up, 15 (30.6%) had NARP, accounting for 60% of non-affective psychoses. Ten patients with NARP remained relapse free, four had a very short-lived relapse, and only one developed a chronic illness. Throughout the follow-up, patients with NARP received fewer months of treatment than did patients with other non-affective psychoses. The high proportion of NARP among patients with first episode psychosis, and the favorable course is in keeping with previous studies in developing countries.

The how and why of disagreement among perceivers: An exploration of person models

Impression formation has been conceptualized as a process whereby perceivers form person models of others, describing what the person is like and why (Park, DeKay, & Kraus, 1994). If they exist, person models could help explain why there appears to be little consensus in personality judgments; perceivers forming different models of a person would also view them differently on trait and affect ratings. Two experiments were conducted to test assumptions of the person-model paradigm using naturalistic targets. The structure of person models was examined, along with their content. Results demonstrated that three distinct person models emerge for each target and that the majority of perceivers can easily identify with one of the three models. We found that person models were valid across different groups of perceivers, and that the models differed in terms of masculinity–femininity and affect. Implications for the person model formulation process are discussed.

The effects of alternative supplementary display formats on balanced scorecard judgments

Using the Balanced Scorecard (BSC) to evaluate performance is a complex judgment task involving a large set of performance measures. Commercially available BSC software provides capabilities for providing decision guidance to the user through the design of supplementary information displays. This study compares the judgment performance of decision makers who received BSC data for two divisions of a simulated company in one of three formats: (1) individual BSCs for each division, (2) individual divisional BSCs supplemented by a side-by-side tabular summary of each division's performance, and (3) individual divisional BSCs supplemented by a side-by-side graphical comparison of each division's performance. Providing supplemental tabular displays did not improve judgment consensus, relative to viewing separate displays, but did improve consistency between performance evaluation and bonus allocation decisions. Consensus for participants using supplemental graphical displays was lower than that for participants viewing separate displays for each division. Further, participants given supplemental graphical displays exhibited lower judgment consensus and lower consistency between performance evaluation and bonus allocation decisions than those using supplemental tables. Inconsistency and lack of consensus are likely to create perceptions of unfairness, thereby increasing dissatisfaction with and resistance to continued use of the BSC. Thus, our findings indicate the need for care when designing and implementing BSC decision aids.

Development of a Refined Database of Mammalian Relative Potency Estimates for Dioxin-like Compounds

The toxic equivalency factor (TEF) approach has been widely accepted as the most feasible method available at present for evaluating potential health risks associated with exposure to mixtures of dioxin-like compounds (DLCs). The current mammalian TEFs for the DLCs were established by the World Health Organization (WHO) following the meeting of an international expert panel in June of 1997. The TEFs recommended by WHO were determined based on a consensus of scientific judgment and were presented as point estimates. However, the relative potency estimates (REPs) underlying the TEFs were derived from a heterogeneous data set and often span several orders of magnitude. In this article, we present a refined database of mammalian REPs that we believe will facilitate better characterization of the variability and uncertainty inherent in the data. The initial step involved reviewing the REP database used by the WHO panel during its review in 1997. A set of criteria was developed to identify REPs that were determined to be the most representative measure of a biological response and of adequate quality for use in quantitative analyses. REPs were determined to be inappropriate for use in quantitative analyses if any of the established exclusion criteria were met. Comparison of data records to the established exclusion criteria resulted in the identification of a substantial number of REPs believed to be inappropriate for use in quantitative analyses. Next, studies published after 1997 were added to the database. The availability of such a refined database will improve risk assessment for this class of compounds by including additional information from new studies and facilitating the use of quantitative approaches in the further development of TEFs.

Mortality in Individuals With Severe Deficiency of α1-Antitrypsin*

To clarify the mortality rate and causes of death of individuals with alpha(1)-antitrypsin (AAT) deficiency, the Death Review Committee (DRC) of the National Heart, Lung, and Blood Institute Registry of Individuals with Severe AAT Deficiency reviewed all available medical records regarding the deaths of study subjects during Registry follow-up (up to 7.2 years). Individual determinations by each member of the three-person DRC led to consensus judgments regarding the underlying cause and the immediate and contributing causes of death. Of the 1,129 Registry subjects, 204 died (18.1%) [approximately 3%/yr]. Record availability permitted detailed review in 120 decedents, and death certificates were available in 56 of the remaining 84 subjects (67%). Emphysema and cirrhosis were the most common underlying causes of death (72% and 10%, respectively), with malignancy and diverticulitis accounting for 3% of deaths each. To assess attributable mortality, standardized mortality ratio analysis was performed and indicated that excess mortality was ascribable entirely to lung and liver disease. We conclude that severe AAT deficiency poses a significant threat to health, that severe airflow obstruction is a major determinant of mortality, and that liver and lung disease account for the excess mortality in affected individuals. These findings support current efforts to enhance diagnostic recognition and treatment of AAT-deficient individuals.

Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax

(2005). Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax. Acta Chirurgica Belgica: Vol. 105, No. 3, pp. 265-267.

Treatment Guidelinesfor Depression in the Asia Pacific Region: A Review of Current Developments

This paper examines the development of treatment guidelines, medication algorithms and clinical pathway guides for depression in countries participating in the SEBoD Initiative. A systematic review of the extent of development of treatment guidelines, medication algorithms or clinical pathway guides for depression in participating countries. Most countries in the Asia Pacific region have commenced the development of treatment guidelines, medication algorithms or clinical pathway guides. The promoters of such efforts have included a range of professional and government bodies. Most efforts have borrowed heavily on existing international guidelines. There is a significant emphasis on medication practices in most countries, with less emphasis on the role of psychological or other non-pharmacological approaches. There has been insufficient emphasis on integrating local classification, assessment and cultural practices into the provision of high quality care. Important additional measures, including practice surveys and consensus judgements, have been undertaken in some countries. The development of a genuine quality improvement movement for depression treatments is in its infancy in the Asia Pacific region. However, there is now the capacity to bring together such efforts at a regional level and, in doing so, promote standards for best care, more community and professional involvement and the uptake of a wider variety of treatment approaches.

The psychological impact of September 11 terrorism on Australian inpatients

This paper examines the development of treatment guidelines, medication algorithms and clinical pathway guides for depression in countries participating in the SEBoD Initiative. A systematic review of the extent of development of treatment guidelines, medication algorithms or clinical pathway guides for depression in participating countries. Most countries in the Asia Pacific region have commenced the development of treatment guidelines, medication algorithms or clinical pathway guides. The promoters of such efforts have included a range of professional and government bodies. Most efforts have borrowed heavily on existing international guidelines. There is a significant emphasis on medication practices in most countries, with less emphasis on the role of psychological or other non-pharmacological approaches. There has been insufficient emphasis on integrating local classification, assessment and cultural practices into the provision of high quality care. Important additional measures, including practice surveys and consensus judgements, have been undertaken in some countries. The development of a genuine quality improvement movement for depression treatments is in its infancy in the Asia Pacific region. However, there is now the capacity to bring together such efforts at a regional level and, in doing so, promote standards for best care, more community and professional involvement and the uptake of a wider variety of treatment approaches.

Documenting pathways to dementia care: relative validity of questionnaire, interview, and medical record formats.

One of the shortcomings of the pathways-to-care literature is the lack of empirical support for the validity of the data collection methods. This study uses three common formats to collect retrospective pathways-to-care data for adults who have been diagnosed with possible or probable Alzheimer's disease (AD) and compares indicators to evaluate their relative validity. Forty family caregivers of adults diagnosed with possible or probable AD were recruited from the caregiver registry of the Boston University Alzheimer's Disease Core Center (BU ADCC). In each of three formats (questionnaire, structured interview, and medical record review), data were collected regarding four key events in the pathway to dementia care: first appearance of symptoms, first verbalized recognition of symptoms, first effort to seek professional help, and first diagnosis by a professional. In addition to the dates of these events, researchers attempted to determine: the first verbalized concern about the symptoms, who first sought professional help, what professional was first approached, and what professional made the first diagnosis. In a consensus meeting, data collected in all three formats were reviewed, and a consensus on the most likely answers to all questions was recorded and compared to data collected in each format. The results suggest that the three formats are not equivalent in terms of concurrent validity. While substantial agreement is found among data collection methods, the validity of the structured interview format and the medical record review is most consistently supported by the data in this study. Questionnaire data resulted in underestimates of delays and correlated poorly with other data sources, including the consensus judgment. Recommendations for pathways-to-care data collection procedures that maximize validity are discussed.

Gender and Leadership Perceptions Among African Americans

Guided by Eagly's (1987) social role theory and Fiske's (1993) model of status effects in dyads, we studied leadership perceptions within and between gender among African American college students engaged in a problem solving task. Variance components in leadership judgments replicated the pattern of findings reported by Malloy and Janowski (1992), and extended them by showing more consensus in leadership judgments of men by both men and women. Furthermore, there was more consensus in women's judgments of men than in men's judgments of women, and men more accurately predicted how they were judged by women than by men. Reliable self-other agreement of leadership judgments was only observed for men (self) when judged by women. Results revealed a gender bias in leadership perceptions among African Americans that is similar to that observed among European Americans, and were more consistent with a gender inequality model than with a gender equality model.

Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?

Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM-IV classification, compared with the DSM-III, DSM-III-R, and ICD-10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups. A cross-sectional study was performed on patients (age > or = 70 years) in seven acute geriatric wards (n = 230) and in seven nursing-homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM-III, DSM-III-R, DSM-IV, and clinical criteria of ICD-10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM-IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini-Mental State Examination scores, when available. According to the DSM-III, DSM-IIIR, DSM-IV and ICD-10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non-demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM-IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia. DSM-IV criteria of delirium identify new, often non-demented, subjects as being delirious, while ICD-10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia.

Agreement in personality judgments within and between nonoverlapping social groups in collectivist cultures.

The social context hypothesis states that people behave differently in different social groups because group norms and context-specific interpersonal relationships uniquely affect behavior. Consequently, a person who is a member of different, nonoverlapping social groups (i. e., the members of different groups are unacquainted) should be judged consensually on personality traits within each group; however, between groups there should be less agreement in judgments. This research focused on cultural moderation of the social context effect in two collective cultures (China and Mexico) with different norms for interpersonal relationships. Among Chinese, there was greater consensus in trait judgments within groups than between groups, whereas in Mexico, agreement within and between groups was equivalent. Culturally based relationship norms that affect cross-context consistency of behavior and, in turn, the consistency of trait judgments across groups were described.

Individual and Small Group Accuracy in Judging Truthful and Deceptive Communication

We examined accuracy in detecting the truths and lies of 10 videotaped students who offered their opinions on the death penalty or smoking in public. Student lie detectors were randomly assigned to either the individual condition, where they reported their veracity judgments and confidence independently, or the small group condition, where they recorded their judgments privately and then deliberated with 5 other students before making a consensus judgment of lie, truth, or hung. Results indicated that small group judgments were more accurate than individual judgments when judging deceptive but not truthful communication. Small group individuals also reported greater confidence in their abilities after the task. Finally, groups with a greater number of hung judgments were more accurate, likely due to their employing hung judgments for the most difficult to judge stimulus communicators. These results raise implications for real life group judgments, particularly in light of the increasing availability of technology.