Levels Of Consensus Research Articles

Multidimensional Adult and Child Poverty in India—Establishing Consensus About Socially Perceived Necessities for a New Measure of Poverty

This article describes the use of the Consensual Approach to poverty measurement in a pilot survey conducted in Telangana state in 2020/21. Respondents were asked about whether a series of items and activities, ranging from two pairs of all-weather shoes to attending important social functions were essential for adults and children and whether they had them or could take part. Households that answered negatively were then asked why. Following the approach pioneered by Mack and Lansley, households whose lack was enforced were identified as deprived. We found high levels of endorsement for a wide range of items such as three meals a day, school uniforms and equipment, health facilities and transport access as well as the ability to afford clothing, social activities and savings. We also found similar levels of consensus over a wide range of necessities across religion, location, caste and education. The results underscore the importance of dimensions and specific deprivations that are not entirely captured by existing monetary and multidimensional poverty approaches used in India. This reinforces the call for child-centric methodologies such as United Nations International Children’s Emergency Fund (UNICEF’s) Multiple Overlapping Deprivation Analysis (MODA), which distinguish between age groups and their evolving needs. Our results also suggest that simply relying on existing Demographic and Health Survey (DHS) and Multiple Indicator Cluster Surveys (MICS) surveys leads to underestimation of the extent to which widely endorsed needs are satisfied. Furthermore, our findings challenge policymakers to consider expanding the measurement of poverty to include the public’s perception of necessities, which will enrich the index with culturally specific and socially validated indicators.

Research Priorities in Neuroeducation: Exploring the Views of Early Career Neuroscientists and Educators

The field of neuroeducation, which integrates neuroscience findings into educational practice, has gained significant attention in recent years. Establishing research priorities in neuroeducation is crucial for guiding future studies and ensuring that the field benefits both neuroscience and education. This study aimed to address the need for collaboration between neuroscientists and educators by conducting a priority-setting exercise with early career professionals from both fields. Using the nominal group technique (NGT) with interquartile range (IQR) analysis, we identified seven key priorities in neuroeducation and assessed the level of consensus on these priorities. The top-ranked priorities were “Emotional and Mental Well-being”, “Neurodiversity and Special Education Needs”, and “Active and Inclusive Teaching Methods”, though IQR analysis revealed varying levels of consensus. Lower-ranked priorities, such as “Role of Technology on Learning and the Brain”, showed a higher consensus. This discrepancy between ranking and consensus highlights the complex nature of neuroeducation, reflecting differing perspectives between neuroscientists and educators. These findings suggest the need for interdisciplinary collaboration to bridge these gaps and foster evidence-based practices. We recommend that future research focuses on the specific neural mechanisms underlying emotional well-being, strategies for supporting neurodivergent learners, and practical approaches to integrating inclusive teaching methods in diverse educational contexts.

Definition and recommendations of advance care planning: A Delphi study in five Asian sectors.

In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning. To develop a consensus definition of advance care planning and provide recommendations for patient-centered and family-based initiatives in Asia. A five-round Delphi study was performed. The rating of a definition and 84 recommendations developed based on systematic reviews was performed by experts with clinical or research expertise using a 7-point Likert scale. A median = 1 and an inter-quartile range = 0-1 were considered very strong agreement and very strong consensus, respectively. The Delphi study was carried out by multidisciplinary experts on advance care planning in five Asian sectors (Hong Kong/Japan/Korea/Singapore/Taiwan). Seventy-seven of 115 (67%) experts rated the statements. Advance care planning is defined as "a process that enables individuals to identify their values, to define goals and preferences for future medical treatment and care, to discuss these values, goals, and preferences with family and/or other closely related persons, and health-care providers, and to record and review these preferences if appropriate." Recommendations in the domains of considerations for a person-centered and family-based approach, as well as elements, roles and tasks, timing for initiative, policy and regulation, and evaluations received high levels of agreement and consensus. Our definition and recommendations can guide practice, education, research, and policy-making in advance care planning for Asian populations. Our findings will aid future research in crafting culturally sensitive advance care planning interventions, ensuring Asians receive value-aligned care.

Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech and language therapists.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.

An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease.

The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

Core values and competencies of public health nurses: A Delphi survey

Objectives This study aimed to clarify the core values and competencies of public health nurses (PHNs) who contribute to improve health issues in transitioning societies, based on a consensus among PHN-related organizations, including practitioners and education researchers.Methods A draft defining the core values and competencies of PHNs was developed through five consultation sessions with 20 executives and nominees of organizations in each area of PHN practice, education, and research to collect, categorize, and refine the items. The expert panel comprised 534 nominees from six PHN-related organizations, and three rounds of Delphi surveys were conducted. The consensus criteria were ≥70% for agreement and ≥80% for firm agreement.Results In the first round, 272 expert panel nominees (50.9%) responded, and 217 responded in all rounds. The draft was revised based on the feedback from each round. By round 3, >90% agreed on the core value and competency frameworks and definitions.Conclusion The Delphi survey revealed the three core value frameworks and definitions of "social justice in health," "human rights and autonomy," and "health and safety" and eight core competencies of "professional autonomy and responsibility," "scientific research and use of information science and technology," "population-based assessment and analysis," "practices for health enhancement and prevention," "building systems to improve public health," "management of healthy community development," "person/community-centered collaboration and cooperation," and "communication for consensus and solutions," with a firm agreement. Eventually, these frameworks would be the bases for creating national standards of practice, education, and research to satisfy the consensus levels of PHNs and PHN-related organizations.

Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study.

For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message-based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions.

A Large-Scale Group Decision-Making Model Considering Expert Authority Degree and Relationship Evolution Under Social Network

In Large-Scale Group Decision-Making (LSGDM), effectively implementing consensus models is pivotal for managing decision complexity. While trust-based LSGDM has garnered attention, there remains a need for deeper insights into the dynamics of interexpert trust and the impact of authority effects on the decision-making process. This study introduces a sophisticated model for large-scale group decision-making, incorporating considerations of expert “trustworthiness-authority.” Initially, the study assesses the trustworthiness of experts based on social network relationships and opinion similarity while using background information and consensus levels to establish their authority. Subsequently, experts are categorized into four distinct regions based on their trustworthiness and authority assessments. Furthermore, tailored consensus adjustment methods are proposed for each region based on social contagion theory to facilitate consensus achievement. Additionally, a case study is conducted to demonstrate the rationality and effectiveness of the proposed LSGDM model, considering expert “trustworthiness-authority.” Finally, the necessity and superiority of the proposed model are further verified through comparison analysis and sensitivity analysis.

People Attribute a Range of Highly-Varied and Socially-Bound Meanings to Naturalistic Sad Facial Expressions

Depictions of sadness are commonplace, and here we aimed to discover and catalogue the complex and nuanced ways that people interpret sad facial expressions. We used a rigorous qualitative methodology to build a thematic framework from 3,243 open-ended responses from 41 people who participated in 2020 and described what they thought sad expressors in 80 images were thinking, feeling, and/or intending to do. Face images were sourced from a novel set of naturalistic expressions (ANU Real Facial Expression Database), as well as a traditional posed expression database (Radboud Faces Database). The resultant framework revealed clear themes around the expressors’ thoughts (e.g., acceptance, contemplation, disbelief), social needs (e.g., social support or withdrawal), social behaviours/intentions (e.g., mock or manipulate), and the precipitating events (e.g., social or romantic conflict). Expressions that were perceived as genuine were more frequently described as thinking deeply, reflecting, or feeling regretful, whereas those perceived as posed were more frequently described as exaggerated, overamplified, or dramatised. Overall, findings highlight that facial expressions — even with high levels of consensus about the emotion category they belong to — are interpreted in nuanced and complex ways that emphasise their role as other-oriented social tools, and convey semantically related emotion categories that share smooth gradients with one another. Our novel thematic framework also provides an important foundation for future work aimed at understanding variation in the social functions of sadness, including exploring potential differences in interpretations across cultural settings.

Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.

Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%). One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

A Trustworthy and Responsible Decision-Making Framework for Resource Management in Food-Energy-Water Nexus: A Control-Theoretical Approach

This paper introduces a hybrid framework for trustworthy and responsible natural resource management, aimed at building bottom-up trust to enhance cooperation among decision makers in the Food, Energy, and Water sectors. Cooperation is highly critical for the adoption and application of resource management alternatives (solutions), including those generated by AI-based recommender systems, in communities due to significant impact of these sectors on the environment and the economic productivity of affected communities. While algorithms can recommend solutions, effectively communicating and gaining community acceptance of these solutions is crucial. Our research stands out by emphasizing the collaboration between humans and machines, which is essential for addressing broader challenges related to climate change and the need for expert trade-off handling in the management of natural resources. To support future decision-making, we propose a successful control-theory model based on previous decision-making and actor behavior. We utilize control theory to depict how community decisions can be affected by how much individuals trust and accept proposed solutions on irrigation water rights and crop operations in an iterative and interactive decision support environment. This model interacts with stakeholders to collect their feedback on the acceptability of solutions, while also examining the influence of consensus levels, trust sensitivities, and the number of decision-making rounds on the acceptance of proposed solutions. Furthermore, we investigate a system of multiple decision-making and explore the impact of learning actors who adjust their trust sensitivities based on solution acceptance and the number of decision-making rounds. Additionally, our approach can be employed to evaluate and refine potential policy modifications. Although we assess potential outcomes using hypothetical actions by individuals, it is essential to emphasize our primary objective of developing a tool that accurately captures real human behavior and fosters improved collaboration in community decision-making. Ultimately, our aim is to enhance the harmony between AI-based recommender systems and human values, promoting a deeper understanding and integration between the two.

Empowering STEAM Learning Implementation through Investigating Indonesian Teacher Experts’ Views with a Delphi Method

STEAM education has been increasingly adopted by teachers globally in educational settings spanning from elementary school to high school level. However, the challenge is in ensuring that STEAM education adaptation remains relevant to students. In this study, we examined Indonesian teacher experts’ points of view on the pedagogical guidelines for assisting teachers in developing STEAM lessons that are relevant for their students in the Indonesian context. This study employed the Delphi method and involved the participation of eighty teacher experts during a series of three rounds of evaluation processes by analyzing the consensus levels and agreement between rounds. Data were obtained through an online form and subsequently analyzed by descriptive qualitative methods to investigate the quality of several design principles and acquire teacher experts’ recommendations. The findings revealed the consensus between the three rounds on the quality of the design principles. Moreover, the results of this study highlight main dimensions involving technology usage, assessment, contextual problems, integrated STEAM learning, and classroom implementation, which might contribute to advancing knowledge in the field of STEAM education. Therefore, the findings provide recommendations for future research and explorations by focusing on the main dimensions that should be prioritized.

A bilateral negotiation mechanism by dynamic harmony threshold for group consensus decision making

This article proposes a framework for bilateral negotiation mechanism to deal the case the concordant decision-makers (DMs) coalition cannot be constructed, which resolves the limitations of the existing group decision making methods. Bilateral negotiation means a process in which any two involved DMs change their own opinions based on each other’s opinions, avoiding the formation of group coalitions and the coercion of individual DMs. It can not only improve group consensus by interaction between individual DMs, but also considers the limited compromise behavior of DMs in the consensus bargaining process. The key contributions of this article contain: (1) It investigates the concept of ‘harmony threshold’ by combining the consensus levels of individual DMs and the number of group members to explain the limited compromise behavior of DMs. (2) it proposes a novel bilateral negotiation consensus mechanism with personalized compromise behavior with the group consensus threshold as the objective function and personalized harmony thresholds as constraints to help any two discording DMs partly to adopt each other’s opinions. And (3) It develops the ranking difference level (RDL) to measure the deviation degree between the final ranking of alternatives and all the DMs’ original rankings of alternatives. The research found that the proposed mechanism can reduce consensus cost by 40% and ranking difference by 5%.

A Social Network Analysis of a Multi-sector Service System for Intimate Partner Violence in a Large US City

About one in four women in the US report having experienced some form of intimate partner violence (IPV) during their lifetime and an estimated 15.5 million children live in families in which IPV occurred in the past year. Families of young children with IPV experiences often face complex needs and require well-coordinated efforts among service providers across social and health sectors. One promising partnership aims to support pregnant and parenting IPV survivors through coordination between IPV agencies and community-based maternal and early childhood home visiting programs. This study used social network analysis (SNA) to understand the interconnectedness of the system of IPV prevention and intervention for families with young children in a large US city. The SNA included 43 agencies serving this population across various service domains spanning IPV, legal, maternal and child health, and public benefit programs. An SNA survey collected data on four forms of collaboration between agencies, including formal administrative relationship, referral reciprocity, case consultation, and shared activities in community committees/organizing bodies. Density and centrality were the primary outcomes of interest. A community detection analysis was performed as a secondary analysis. The overall level of interconnectedness between the 43 responding agencies was low. Making referrals to each other was the most common form of collaboration, with a network density of 30%. IPV agencies had the highest average number of connections in the networks. There was a high level of variation in external collaborations among home visiting agencies, with several home visiting agencies having very few connections in the community but one home visiting program endorsing collaborative relationships with upwards of 38 partner agencies in the network. In serving families at risk for IPV, home visiting agencies were most likely to have referral relationships with mental health provider agencies and substance use disorder service agencies. A community detection analysis identified distinct communities within the network and demonstrated that certain agency types were more connected to one another while others were typically siloed within the network. Notably, the IPV and home visiting communities infrequently overlapped. Sensitivity analyses showed that survey participants’ knowledge of their agencies’ external collaborations varied by their work roles and agencies overall had low levels of consensus about their connectedness to one another. We identified a heterogeneous service system available to families of young children at-risk for or experiencing IPV. Overall inter-agency connectedness was low, with many siloed agencies and a lack of shared knowledge of community resources. Understanding current collaborations, silos, and centrality of agencies is an effective public health tool for allocating scarce resources across diverse service sectors to efficiently improve the system serving families experiencing IPV.

Newborn screening in metachromatic leukodystrophy – European consensus-based recommendations on clinical management

IntroductionMetachromatic leukodystrophy (MLD) is a rare autosomal recessive lysosomal storage disorder resulting from arylsulfatase A enzyme deficiency, leading to toxic sulfatide accumulation. As a result affected individuals exhibit progressive neurodegeneration. Treatments such as hematopoietic stem cell transplantation (HSCT) and gene therapy are effective when administered pre-symptomatically. Newborn screening (NBS) for MLD has recently been shown to be technically feasible and is indicated because of available treatment options. However, there is a lack of guidance on how to monitor and manage identified cases. This study aims to establish consensus among international experts in MLD and patient advocates on clinical management for NBS-identified MLD cases. MethodsA real-time Delphi procedure using eDELPHI software with 22 experts in MLD was performed. Questions, based on a literature review and workshops, were answered during a seven-week period. Three levels of consensus were defined: A) 100%, B) 75–99%, and C) 50–74% or >75% but >25% neutral votes. Recommendations were categorized by agreement level, from strongly recommended to suggested. Patient advocates participated in discussions and were involved in the final consensus. ResultsThe study presents 57 statements guiding clinical management of NBS-identified MLD patients. Key recommendations include timely communication by MLD experts with identified families, treating early-onset MLD with gene therapy and late-onset MLD with HSCT, as well as pre-treatment monitoring schemes. Specific knowledge gaps were identified, urging prioritized research for future evidence-based guidelines. DiscussionConsensus-based recommendations for NBS in MLD will enhance harmonized management and facilitate integration in national screening programs. Structured data collection and monitoring of screening programs are crucial for evidence generation and future guideline development. Involving patient representatives in the development of recommendations seems essential for NBS programs.

Ambivalence and transnational intergenerational solidarity: the perspective of highly educated Portuguese women emigrant daughters

Existing literature has highlighted solidarity across generations as a crucial mechanism for transfers and maintaining cohesion within families. However, researching solidarity across generations among transnational families is still an underexplored area, especially from the viewpoint of highly skilled female migrants. This study explored the way highly educated Portuguese adult daughters, living transnationally, perceive the existing solidarity ties with their parents, in times of transition, such as during the process of migration. By using a cluster analysis approach to explore the statistical associations between ambivalence and intergenerational solidarity dimensions, this study provides insight into the migrant solidarity types incorporating the role of ambivalence in forging a typology of transnational intergenerational relationships. The sample comprised 248 daughters who volunteered to provide information in an online survey. Participants gave their full consent to partake in this study, and this study was approved by the ethical committee of the authors’ institution. Measures of intergenerational solidarity dimensions, perceived ambivalence, sociocultural adaptation, acculturation, and social well-being in the destination country were included in the survey. Model-based cluster analysis resulted in three clusters: low ambivalence with strong cohesion, autonomous with affection and low ambivalence, and ambivalent functional ties with low affection. These clusters differed significantly in terms of intergenerational solidarity dimensions, perceived ambivalence, and in several other measures addressed. Perceived high parent-daughter ambivalent ties were associated with high levels of functional contacts and financial exchange. That pattern was also associated with lower levels of affection and consensus, being most frequently found in older daughters, mostly when single, economically inactive, or unemployed. Low perceived ambivalent parent-daughter ties were the most frequently found (around 80%), with two different types of intergenerational relationships being revealed, namely the low ambivalence with strong cohesion type and the autonomous with affection and low ambivalence type. Half (50%) of the daughters that perceived low parent-daughter ambivalent ties have associated the highest intergenerational solidarity, being, in general, better adapted to the migration context and slightly younger on average. The other half, less well acculturated, living abroad for longer, in countries with stronger welfare state systems and less reliance on families as providers of care, are more associated with an autonomous relationship type with low solidarity, but high affection. These results suggest that there might be a spillover effect: those who fare well in the country of migration, have better relations with their families at home—either being very interdependent or very independent, but always with good affective quality and low ambivalence.

Financial market shocks and portfolio rebalancing

PurposeThe intention of the empirics is to contribute to the general understanding of investor responses to market price shocks. The authors review assumptions about investor behavior in response to price shocks and investigate alternative rebalancing heuristics.Design/methodology/approachThe authors use market data over 40 years to define market shocks. Portfolio rebalancing implements constrained Markowitz mean-variance (MV) heuristics.FindingsMomentum rebalancing in portfolio management outperforms contrarian rebalancing in the study interval. Sensitivity analysis by decade, sector constraints and proportion of security holdings bought or sold continue to support momentum rebalancing.Research limitations/implicationsThe results are consistent with under-responding to price shocks at consensus levels in financial markets. The theoretical background provides a basis for experimental lab studies of shocks of different magnitudes under conditions in which participants have information on the levels of other participants and a condition in which they can only observe their previous estimates.Practical implicationsManaging portfolios in the face of price disturbances of different magnitudes is informed by empirical studies and their implications for investor behavior.Originality/valueThis is the first study the authors can locate that uses market data with alternative rebalancing heuristics to estimate price returns from the respective heuristics over a time interval of 40 years. The authors support the results with sensitivity estimates and consider implications for the underlying agent heuristics in light of background studies.

Physical rehabilitation for people with advanced dementia who fracture their hip – expert consensus process

Purpose Hip fracture is common in older people – with prevalence even higher for people with dementia. Research often excludes people with dementia – especially those in the more advanced stages. Therefore, the most appropriate interventions remain unknown. The main aim of this study was to gain consensus about the core considerations needed to deliver a physical intervention for people with advanced dementia who fracture their hip. Materials and Methods: An expert consensus process was undertaken, using Nominal Group Technique, to explore the key considerations when delivering rehabilitation. Data collection was undertaken in January 2023 and involved an online group discussion followed by voting and off-line rating. Qualitative content analysis and quantitative analysis of consensus scoring was undertaken. An international group of seven highly specialised physiotherapists took part. Results 59 statements were agreed following the process. Content analysis was used to categorise these statements according to the International Classification of Functioning, Disability and Health. Although consensus levels were high, there was disagreement in several areas. Conclusion The statements provide an overarching understanding of the multidisciplinary expertise that is needed to effectively deliver rehabilitation interventions to this population. People with dementia require highly skilled and trained professionals, providing holistic and person-centred approaches to deliver rehabilitation interventions. IMPLICATIONS FOR REHABILITATION The expert consensus provides an overarching understanding of the multidisciplinary expertise that is needed to effectively deliver rehabilitation interventions to this population. Physiotherapy - or other interventions - cannot be used in isolation. People with dementia require highly skilled and trained professionals, providing holistic and person-centred approaches to deliver rehabilitation interventions. While our focus was on hip fracture, we suggest these statements can be used for people with advanced dementia with a variety of other conditions.

National Comprehensive Cancer Network Guideline Recommendations of Cancer Drugs With Accelerated Approval

Many cancer drugs are approved under the US Food and Drug Administration (FDA) accelerated approval pathway based on preliminary evidence. It is unclear how this limited evidence is integrated into the National Comprehensive Cancer Network (NCCN) guidelines, which are common references for clinicians and are used by public and private payers to determine reimbursement for oncology treatments. To analyze the NCCN guidelines' assessments for cancer drug indications that received FDA accelerated approval compared with cancer drug indications that received FDA regular approval. This cross-sectional study analyzes FDA-approved indications for cancer drugs that were granted accelerated approval from program inception in 1992 to June 30, 2022. For each drug, the FDA-approved labeling was reviewed to identify all indications. All analyses were performed at the drug-indication level. The exposure was FDA regulatory status as of October 2022, including regular approval, accelerated approval, accelerated approval converted to regular approval, and withdrawn accelerated approval. The level of evidence and consensus (category 1, 2A, 2B, and 3) and treatment preference (preferred, alternative preferred, other recommended, and useful in certain circumstances) ratings assigned by NCCN committees as of February 2023. A total of 315 oncology indications for 100 drugs were analyzed. These indications included 156 (50%) with regular approval, 60 (38%) with accelerated approval, 78 (49%) with accelerated approval that was converted to regular approval, and 21 (13%) with withdrawn accelerated approvals. Among all indications, 105 (33%) were rated by the NCCN as having category 1 evidence, 185 (59%) with category 2A, 6 (2%) with category 2B, and 2 (1%) with category 3 evidence. Compared with indications with regular approval, those with accelerated approval were less frequently assigned category 1 evidence (47% vs 3%; P < .001) and were less often listed as preferred treatment options (58% vs 40%; P = .008). Among the 21 withdrawn accelerated approval indications, 8 (38%) remained in the NCCN guidelines, with most having level 2A evidence ratings. This study found that cancer drug indications with accelerated approval were less likely to be assigned high-level evidence ratings and preferred status in the NCCN guidelines compared with indications with regular approval; most accelerated and regular approval drugs had low-quality evidence ratings but high levels of consensus among oncologists on NCCN committees. Greater clarity on the thresholds and definitions of evidence levels would make the NCCN guidelines more useful to clinicians, patients, and payers.

Consensus reaching process using personalized modification rules in large-scale group decision-making

Managing complex decision-making scenarios often hinges on the effectiveness of large-scale group decision-making (LSGDM). When confronted with a significant number of decision-makers (DMs) in LSGDM, each contributing unique backgrounds and perspectives, addressing the issues of reducing dimensionality and fostering consensus becomes a crucial aspect of the decision-making process. This paper addresses these challenges through several innovative approaches. First, we employ clustering methods to reduce the dimensionality of DMs. We introduce a novel fuzzy c-means clustering method that takes into account both the evaluation values and ranking of alternatives. This reduction in dimensionality serves to simplify the decision complexity and enhance the coherence of decision-related information among DMs placed within the same cluster. Once the clustering phase is complete, we propose a weight solution method for DMs within each group. This method combines the consensus level with the Spearman correlation coefficient of DMs, providing an effective means to determine the weights. Additionally, we introduce a weight solution method for each group based on the average consensus level and the number of DMs it contains. In the consensus reaching process (CRP), we implement a personalized modification rule. This rule takes into consideration the evolving consensus levels and the regret psychology exhibited by different DMs at different points in time. This dynamic approach significantly reduces both the cost and time required for consensus modifications. Finally, to validate the applicability of the proposed method, we apply it to a real-life case. Comprehensive qualitative and quantitative comparative analyses are conducted to evaluate the proposed method, along with a stability analysis of the parameters involved.