Consensus Position Research Articles

The Safety of Convictions in the Court of Appeal: Fresh Evidence in the Criminal Division Through an Empirical Lens

An academic consensus exists that the England and Wales Court of Appeal (Criminal Division) determines appeals against conviction in a narrow or an unduly restrictive manner. This consensus has developed through observation and empirical study of the Court over several decades. It is said in particular that the Court adopts a narrow approach when considering appeals which raise primarily factual issues, especially fresh evidence or ‘lurking doubt’ appeals. This article discusses two new empirical studies of the Court, one of which is a replication of Roberts’s recent study which featured in the Journal of Criminal Law in 2017. The empirical evidence in support of the allegation of a restrictive approach is explored in this article from a theoretical and methodological perspective. It is argued that the question of the Court’s approach is difficult to study empirically, and so suggestions of empirical support for a restrictive approach overreach the limits of the methods employed. This is not to suggest that the Court of Appeal does not make mistakes, nor even is it to suggest that the Court is not narrow or unduly restrictive. Rather, it is suggested that the empirical findings offered as evidence of the restrictive approach, which gives rise to the consensus position, are weak and should be treated with caution, especially in the light of the author’s two new empirical studies of the Court.

Global Consensus Position Statement on the use of Testosterone Therapy for Women

This Statement is being simultaneously published in the journals Climacteric, Maturitas, Journal of Sexual Medicine, and Journal of Clinical Endocrinology and Metabolism on behalf of the International Menopause Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, and The Endocrine Society, respectively. This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynaecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Ignatius of Antioch and Scripture

Abstract This article challenges a consensus position in Ignatian studies by arguing that Ignatius’s use of scripture has been underestimated and exploring two proposals for ways in which scripture influenced Ignatius. The essay first addresses the weak foundations of the consensus, namely, Ignatius’s report about his visit to Philadelphia and the small number of direct citations. It then explores two suggestions for how Ignatius displays his indebtedness to an early Jewish thought-world. First, Ignatius employs scriptural imagery in his letters. Second, he alludes to language that is found in several places across the Old Testament. Although the number of explicit citations is small, an expanded understanding of Ignatius’s use of Jewish scripture that takes into account imagery and allusions sheds light on Ignatius’s awareness of scripture and is in keeping with the practices of other early Christian texts.

Recommendations for Management and Treatment of Nonalcoholic Steatohepatitis.

The prevalence of nonalcoholic liver disease (NAFLD) is increasing worldwide in conjunction with the epidemic increase in obesity and metabolic risk factors. Consequently, NAFLD has become a leading indication for liver transplantation. Although genetic factors play an important role in the pathogenesis of NAFLD, detrimental lifestyle trends favoring a calorically unrestricted diet rich in carbohydrates and unsaturated fat, prolonged sedentary periods or limited physical activity have major metabolic implications. In aggregate these physiological dysregulations constitute the main risk factors for the metabolic syndrome and NAFLD. The cornerstone of the treatment of NAFLD, is lifestyle changes, including modifications to diet and physical activity, to reduce body weight and liver fat, however adherence is notoriously poor and the epidemic of NAFLD continues to grow unimpeded. In the face of this unmet clinical need, the pharmacologic therapy of NAFLD has been expanding as the varied mechanistic pathways of NAFLD are elucidated. Beyond these approaches to treating NAFLD, the prevention of other liver diseases is additionally important. Chief among these is alcoholic liver disease, and heavy use is detrimental irrespective of underlying NAFLD. However, the impact of mild to moderate alcohol use in patients with mild or nonadvanced forms NAFLD is undefined. This article summarizes the results of the International Liver Transplantation Society consensus meeting on NAFLD in liver transplantation. It describes the available evidence and provides consensus guidance on the lifestyle and pharmacologic therapies of NAFLD, and the consensus position on alcohol use in patients with NAFLD.

Genetic Diversity and DNA Barcoding of Yam Accessions from Southern Nigeria

Knowledge of genetic diversity and barcoding of yam is lacking in Enugu and Ebonyi States of southern Nigeria. Therefore, DNA barcoding was used to facilitate identification and biodiversity studies of yam species from Southern Nigeria. Seventy five yam accessions were collected from Enugu and Ebonyi States, including International Institute of Tropical Agriculture for DNA extraction and amplification using a chloroplast DNA (cpDNA) ribulose-1,5-bisphosphate carboxylase (rbcL) marker. There was high level of similarity among the accessions and presence of 534 conserved and 7 variable sites. A transversional mutation of G/T at a consensus position of 335 was identified followed by transitions at 362 (A/G), 368 (A/G), 371 (C/T) and 391 (C/T) within the accessions. Phylogeny resolved the yam accessions into ten major groups with their bootstrap values ranging from 0 - 100. Phylogenetic diversity was highest in group X, followed by VII, VI and IX. The inter-group genetic distance based on Kimura 2-parameter model ranged from 0.5000 ± 0.4770 - 5.0560 ± 2.5760, while the intra-group had 0.5250 ± 0.5000 - 2.0103 ± 1.2579. The mean genetic diversity within the entire population was 0.7970 ± 0.06910. BLAST analysis of total bit score, query coverage, and percentage identity were in the ranges of 411 - 1011, 99% - 100% and 97% - 100%, respectively. However, the rbcL could not resolve the yam accessions well following the comparative assessment of some discrepancies in the detected number of species from phylogenetic groupings, genetic diversity indices and NCBI BLAST hits, thereby, exposing the inefficiency of this marker in discriminating the yam accessions. It was demonstrated that rbcL is not an effective marker; therefore, it should not be recommended as a standard-alone marker of choice for DNA barcoding of yam accessions, especially, when accurate identification, discrimination and estimation of genetic diversity of this vital crop are of paramount importance for crop improvement and germplasm conservation.

Lung transplantation: a review of the optimal strategies for referral and patient selection.

One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates who are sufficiently unwell, in fact possessing a terminal respiratory illness, but otherwise fit and able to undergo major surgery and a prolonged recuperation and rehabilitation stage combined with ongoing adherence to complex medical therapies. The choice of potential candidate and the timing of that referral is at times perhaps more art than science, but there are a number of solid guidelines for specific illnesses to assist the interested clinician. In this regard, the relationship between the referring clinician and the lung transplant unit is a critical one. It is an ongoing and dynamic process of education and two way communication, which is a marker of the professionalism of a highly performing unit. Lung transplantation is ultimately a team effort where the recipient is the key player. That principle has been enshrined in the three consensus position statements regarding selection criteria for lung and heart-lung transplantation promulgated by the International Society for Heart and Lung Transplantation over the last two decades. During this period, the number of indications for lung transplantation have broadened and the number of contraindications reduced. Risk management is paramount in the pre- and perioperative period to effect early successful outcomes. While it is not the province of this review to reiterate the detailed listing of those factors, an overview position will be developed that describes the rationale and evidence for selected criteria where that exists. Importantly, the authors will attempt to provide an historical and experiential basis for making these important and life-determining decisions. The reviews of this paper are available via the supplementary material section.

A Consensus Position Paper From REAL-PANLAR Group About the Methodological Approach for the Accreditation Process of Centers of Excellence in Rheumatoid Arthritis in Latin America.

By 2015, the World Health Organization reported that 1% of the world population suffered from rheumatoid arthritis (RA) and in Latin America (LA) between 0.5% and 1%. Previously, in May 2014, a consensus meeting was held in Barranquilla, Colombia, where the Project for Implementation and Accreditation of Centers of Excellence (CoE) in RA in LA was established, which then became an official special group of the Pan American League of Associations for Rheumatology (PANLAR). The aim of this study was to define the methodological approach for the accreditation process of CoE in RA in LA. A meeting was held in April 2015 with participation of the members of the REAL-PANLAR Steering Committee, and representatives of several LA countries, with the support of 2 experts in accreditation processes and models in Colombia. Then, in November 2015 in San Francisco and in November 2016 in Washington, the REAL-PANLAR Steering Committee met to discuss some final aspects of the project. The following steps for accreditation were defined: application for accreditation, issuance of the concept of assessment of the entity, accreditation decision, and monitoring accreditation. This is the second REAL-PANLAR consensus paper with the purpose to define the parameters for the accreditation process for future CoE in RA in LA.

Recommendations About Multiple Sclerosis Management During Pregnancy, Partum and Post-Partum: Consensus Position of The Portuguese Multiple Sclerosis Study Group and The Portuguese Society of Obstetrics and Maternal-Fetal Medicine

Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare providers involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues, and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and the postpartum period, uncertainties have been complicated by the increase in recent years of the number of available treatments. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period.

Editorial. Shifting the Paradigm in Type 2 Diabetes Treatment. A Pragmatic Approach of the ADA/EASD 2018 Consensus: The Diabetes Decalogue

On 5th of October 2018, at the 54th Annual Meeting of the European Association for the Study of Diabetes the two major professional associations from the field of Diabetes: the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) presented a consensus position paper regarding the new paradigm of Type 2 Diabetes Mellitus (T2DM) treatment

Canada\u2019s Physical Literacy Consensus Statement: process and outcome

BackgroundHealthy movement behaviours of Canadian children and youth have been found to be suboptimal; this is associated with declines in physical fitness, increases in obesity, and elevated chronic disease risk. Physical literacy is an evolving construct representing foundational domains upon which physically active lifestyles are based. Many sectors and organizations in Canada are embracing physical literacy in their programs, practices, policies, and research; however, the use of inconsistent definitions and conceptualizations of physical literacy had been identified by stakeholders as hindering promotion and advancement efforts.MethodsWith leadership from ParticipACTION, organizations from the physical activity, public health, sport, physical education, and recreation sectors collaborated to create a physical literacy consensus definition and position statement for use by all Canadian organizations and individuals. The process involved an environmental scan, survey of related evidence, stakeholder consultations, and creation of a Steering Committee. From this background work a consensus statement was drafted, shared with stakeholders, revised, and ratified.ResultsCanada’s Physical Literacy Consensus Statement was launched in June 2015 at the International Physical Literacy Conference in Vancouver, British Columbia. To further promote the Consensus Statement, the Sport for Life Society developed and simultaneously released the “Vancouver Declaration”, which contained additional guidance on physical literacy. Both the Consensus Statement and the Declaration endorsed the International Physical Literacy Association’s definition of physical literacy, namely “the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life”.ConclusionsSector partners hope that the Consensus Statement, with its standardized definition, brings greater harmony, synergy, and consistency to physical literacy efforts in Canada and internationally. Going forward, the impact of this initiative on the sector, and the more distal goal of increasing habitual physical activity levels, should be assessed.

Consensus statement: osteoporosis prevention and treatment in Latin America\u2014current structure and future directions

BackgroundOsteoporosis is a common disorder affecting populations worldwide. In Latin America, an aging population combined with limited health care resources result in osteoporosis quickly becoming a condition of considerable magnitude with disproportionate morbidity and mortality.AimTo review the current state of prevention, diagnosis, and treatment of osteoporosis in Latin America and to develop strategies and recommendations that may be adopted in the region, an expert panel of clinicians and scientists was assembled to develop a consensus statement outlining future directions.MethodThe panel conducted a comprehensive literature review of publications mainly related to osteoporosis in Latin America, and at an in-person meeting developed a consensus position to address the relevant issues.ResultsThe epidemiology, burden, diagnosis, and treatment of osteoporosis in the region were discussed with particular attention to issues unique to the region. A series of recommendations were developed encompassing virtually all aspects of the disease, including improved public and health professional awareness, better diagnostic processes, improved access to care, and greater engagement by health policy makers, government, and a wide variety of private organizations.ConclusionsThe panel concluded that a comprehensive approach to osteoporosis prevention and treatment in Latin America is urgently needed.

A holistic approach to healthy ageing: how can people live longer, healthier lives?

Although lifespan is increasing, there is no evidence to suggest that older people are experiencing better health in their later years than previous generations. Nutrition, at all stages of life, plays an important role in determining health and wellbeing. A roundtable meeting of UK experts on nutrition and ageing considered key aspects of the diet-ageing relationship and developed a consensus position on the main priorities for research and public health actions that are required to help people live healthier lives as they age. The group consensus highlighted the requirement for a life course approach, recognising the multifactorial nature of the impact of ageing. Environmental and lifestyle influences at any life stage are modified by genetic factors and early development. The response to the environment at each stage of life can determine the impact of lifestyle later on. There are no key factors that act in isolation to determine patterns of ageing and it is a combination of environmental and social factors that drives healthy or unhealthy ageing. Too little is known about how contemporary dietary patterns and sedentary lifestyles will impact upon healthy ageing in future generations and this is a priority for future research. There is good evidence to support change to lifestyle (i.e. diet, nutrition and physical) activity in relation to maintaining or improving body composition, cognitive health and emotional intelligence, immune function and vascular health. Lifestyle change at any stage of life may extend healthy lifespan, although the impact of early changes appears to be greatest.

Intergenerational perceptions of household wellbeing in India’s Western and Eastern Ghats

India is home to the largest number of people living in poverty in the world. To inform poverty alleviation strategies, we sought local insights on wellbeing trajectories from three generations of respondents in three communities in the Western and Eastern Ghats. An integrated thematic analysis was carried out using qualitative information from focus group discussions (FGDs) and a survey instrument. Overall, we found most households had a positive perspective regarding their wellbeing over time; when divided into research locations, the Odisha site (Jeypore) was the most optimistic, the Kerala site (Wayanad) had no consensus position, and the Tamil Nadu site (Kolli Hills) was most pessimistic. Scheduled tribe (ST) and non-ST households were similar in their wellbeing perceptions despite the ongoing social and economic marginalization of ST households. Common negative events experienced were health (death or alcoholism) and climate disasters (drought or flooding), and common positive events were asset inheritance or government schemes. An important insight was changing importance of events between generations: elder generations valued labour migration, interim generations valued asset inheritance, and the current generation valued government schemes. We conclude that significant events play a major role in wellbeing perceptions among these communities, and understanding the evolving forms of significant events between generations can provide insights towards designing effective poverty alleviation strategies for the future.

The Vaiont landslide: re-assessment of the evidence leads to rejection of the consensus

There appears to be a clear general consensus in the literature regarding four critical issues that define the problem of the October 1963 Vaiont landslide and its behaviour that are central to the disaster: (1) the 1963 failure was a reactivation of an ancient landslide; (2) failure took place along thin clay seams (already at residual strength); (3) the sliding surface had a ‘chair’ shape with a (sub)horizontal base; and (4) failure was triggered by inundation of the toe of the slide mass by rising reservoir levels. The key to understanding the Vaiont landslide is the failure surface geometry, which was controlled by the structural geology. It now appears that the so-called chair structure (that was assumed to define the shape of the failure surface) does not exist, and without it, the first consensual point is untenable, and the fourth may not contain the whole truth. We have systematically re-examined the published evidence and undertaken our own new research in order to test the logical and geotechnical validity of the four elements of the consensus. Glacial processes can account for the pre-failure morphology of the landslide site; the clay seams must therefore have been at peak shear strength as there was no ancient landslide. Tectonic processes can account for the failure surface geometry, which does not have a ‘chair’ shape, as well as small-scale structures; and rainfall appears to have been an essential element in the initiation and development of the landslide. Our findings largely contradict the consensus position and thus form the basis of a new overarching hypothesis for the landslide that should account for all of the observed and known features, events and data.

Embedded Written Documents as Colonial Mimicry in Ezra-Nehemiah

The unity of the final form of Ezra-Nehemiah has long been the consensus position among scholars in the field. This article challenges that consensus by comparing and contrasting the use of embedded written documents in Ezra 7 and Nehemiah 10 through the theoretical lens of colonial mimicry. I argue that the Artaxerxes rescript in Ezra 7 strategically mimics imperial discourse by assuming that propagandistic Persian rhetoric to Babylon and Egypt should also naturally apply to Yehud despite its peripheral status. By contrast, Nehemiah 10 invokes indigenous Judean writing to challenge the legitimacy of imperial domination. The sharply differing political programs articulated by these two texts, combined with literary and manuscript evidence from antiquity, suggests that the canonical book of Ezra-Nehemiah is an outlier among ancient Judean texts in juxtaposing the figures of Ezra and Nehemiah.

When and How to Perform Cultures on Chronic Wounds?

The purpose of this Evidence-Based Report Card was to examine current best evidence related to when and how to perform cultures on chronic wounds to guide clinicians in determining the appropriate treatment. (1) When should cultures be performed on chronic wounds? and (2) What is the best method or technique to perform a culture on a chronic wound? A search of the literature was performed, resulting in 45 publications relevant to the topic. Following a review of titles and abstracts, 7 studies were identified that met inclusion criteria. Key search terms used were "chronic wound," "chronic infected wound," "wound culture," "specimen collection," and "wound swab." Strength of the evidence was rated based on the methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. Seven studies were identified as pertinent to the topic on wound culture and meeting inclusion criteria. The study designs included 1 randomized controlled trial, 1 quasi-experimental comparative study, 1 systematic review, 1 scoping literature review, 1 integrative literature review, and 2 professional organization expert panel reviews (consensus statement and position statement). Of the 7 studies, 3 studies suggest that classic signs of infection may not always be present but culturing may be indicated when additional signs such as pain, necrotic tissue, prolonged or delayed healing, and wound bed deterioration occur. Four studies report that a quantitative culture of wound tissue is the gold standard to obtain a wound culture, but the swab method is an acceptable alternative option. Two articles demonstrate the Levine technique is more reliable than the Z-technique to determine microbial load in the wound bed. The strength of the evidence was identified as 2 level A studies, 1 level B study, and 4 level C studies. Using Johns Hopkins methodology, the quality of the studies was deemed either high quality or good quality. Evidence indicates that identification of potential chronic wound infection should be considered early using clinical signs such as pain, necrotic tissue, delayed healing, and wound deterioration (in addition to classic signs of infection) to determine the need for collecting a culture (Strength of Recommendation Taxonomy [SORT] level 2); and when a culture is deemed necessary, swab culture using the Levine method is a clinically practical alternative if performed correctly (SORT level 1).

Wilderness First Responder: Are Skills Soon Forgotten?

Wilderness first responders are trained to provide competent medical care in wilderness settings or until evacuation for more advanced treatment can be obtained. In light of the isolated environments in which they are called upon to respond to illnesses and injuries, their ability to effectively apply their training is crucial. Despite the responsibility assigned to them, there is an absence of research assessing the skill and knowledge retention of wilderness first responders, creating a gap in understanding whether a deficit in their ability to perform exists between certifications. Without such research, it is important to review knowledge and skill retention in related responder groups. The literature over the past 4 decades documents the loss over time of skills and knowledge across an array of trained responders, both professional and laypeople. Although the findings reviewed suggest that WFRs will exhibit a similar pattern of increasing skill loss beginning shortly after certification and a slower, but concurrent, decrease in knowledge, research is needed to document or refute this assumption.

Power, Control and Citizenship: The Uluru Statement from the Heart as Active Citizenship

Who governs and how they govern is central to the questions of power, control and citizenship that are at the core of a democratic society. The Uluru Statement from the Heart is the outcome of the 12 First Nations Regional Dialogues culminating in the National Constitutional Convention at Uluru in May 2017. There the First Peoples from across the country formed a consensus position on the form constitutional recognition should take. This article argues that the Uluru Statement from the Heart affirms a commitment to ‘active citizenship’ that draws from a belief in the equal power of the governors and the governed. This understanding of the Uluru Statement from the Heart enables it to be promoted as a document for all Australians, both in the spirit of reconciliation and in its affirmation of a commitment to an equality underpinning Australian citizenship in the 21st century. By examining how citizenship in Australia has evolved as a legal concept and by reflecting on how law is a fundamental tool for providing a ‘meaningful limitation of the lawgiver’s power in favour of the agency of the legal subject’, this article examines the Uluru Statement from the Heart as a commitment to the importance of recognising the nature of the proper relationship between the law giver and those subject to the law — the citizenry. To exercise power within a democratic framework, as opposed to brute force or sheer will over the subject, involves recognising the agency of the citizenry. This idea not only enables reconciliation to be a meaningful and restorative act but one that recalibrates the exercise of power in Australia to benefit all Australians by affirming a commitment to all Australians equal citizenship as active agents.

Equally Well: together we are making a difference

The associations between mental health and addiction issues and relatively poor physical health outcomes have been well established over many decades. The situation in New Zealand is very similar to other relatively wealthy countries. People who experience mental health and addiction issues die much earlier than their counterparts in the general population, with a two to three times greater risk of premature death. Two-thirds of this premature mortality is due to preventable and treatable physical illness, particularly cardiovascular diseases and cancers (Cunningham et al, 2014). The reasons behind this disparity are complex and interrelated. They include factors relating directly to treatment such as the use of cardio metabolic effects of psychotropic medication, and greater exposure to known risk factors for chronic diseases such as smoking, obesity and a lack of exercise (Te Pou, 2014). However, more recent research has highlighted the role of the healthcare system in exacerbating this disparity, with diagnostic overshadowing being a significant issue along with the separation of mental health and addiction services and the workforce from general medicine, particularly primary care. Equally Well is a large and growing collaboration of people and organisations across the country committed to taking action to improve physical health outcomes. It is using the principles of collective impact to bring about change at both a system and service delivery level across the health and health-related sectors. An Equally Well consensus position paper, launched in September 2014, has already seen more than 70 organisations endorse it, formally acknowledging this health disparity and showing their commitment to taking action in their sphere of influence. Leaders in health policy and professional development, funding and planning, universities, primary care and mental health and addiction treatment services have agreed to work in partnership with people with lived experience of these challenges, to effect change. This presentation will provide an overview of the issues, supporting evidence and the solutions. It will cover up to date examples of how policy and strategy has been affected by this collaborative and highlight some of the best practice initiatives being undertake in New Zealand, particularly those that involve integrated care between specialist mental health and addiction services and primary care. This will be an opportunity to hear first hand how the Equally Well collaboration works to affect change at multiple levels by multiple people as well as to gain insights into the online discussion forum where wicked issues are discussed and examples of solutions shared. The aim will be that delegates leave inspired to take action in their sphere of influence. References : 1. Cunningham. R., Peterson. D., Sarfati. D. & Stanley. J. Premature mortality in adults using New Zealand psychiatric services. New Zealand Medical Journal(127) 31-41 2014 2. Te Pou, The physical health of people with a serious mental illness and/or addiction. An evidence review. Auckland: Te Pou o Te Whakaaro Nui. 2014

Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)

Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.