Consensus Procedure Research Articles

Recommendations to improve use and dissemination of patient versions of oncological clinical practice guidelines in Germany: results of a multi-stakeholder workshop

BackgroundOncological patients have high information needs that are often unmet. Patient versions of oncological clinical practice guidelines (PVG) translate clinical practice guidelines into laypersons’ language and might help to address patients’ information needs. Currently, 30 oncological PVG have been published in Germany and more are being developed. Following a large multi-phase project on oncological PVGs in Germany, recommendations to improve use and dissemination of PVG were adopted in a multi-stakeholder workshop.MethodsOrganisations representing users of PVGs (patients, medical personnel, and multipliers), creators, initiators/funding organisations of PVGs, and organisations with methodological expertise in the development of clinical practice guidelines or in patient health information were invited to participate. The workshop included a World Café for discussion of pre-selected recommendations and structured consensus procedure for of all recommendations. Recommendations with agreement of > 75% were approved, and in case of ≤ 75% agreement, recommendations were rejected.ResultsThe workshop took place on 24th April 2023 in Cologne, Germany. Overall, 23 people from 24 organisations participated in the discussion. Of 35 suggested recommendations 28 recommendations reached consensus and were approved. The recommendations referred to the topics dissemination (N = 13), design and format (N = 7), (digital) links (N = 5), digitalisation (N = 4), up-to-dateness (N = 3), and use of the PVG in collaboration between healthcare providers and patients (N = 3).ConclusionThe practical recommendations consider various perspectives and can help to improve use and dissemination of oncological PVG in Germany. The inclusion of different stakeholders could facilitate the transfer of the results into practice.

Assessing Severity and Need for Delivery in Early Onset Preeclampsia Before 32 Weeks of Gestation: a Delphi Consensus Procedure.

Preeclampsia is a potentially life-threatening hypertensive pregnancy disorder that carries an acute risk of an unfavorable outcome of the pregnancy but also has consequences for the long-term health of the mother. Women who develop the early form of pre-eclampsia before the 32nd week of pregnancy have the highest risk and are also the most difficult to treat. The severity of pre-eclampsia is not characterized uniformly in Germany, so that the indication for delivery is rather individualized. The aim of this study was to reach a consensus on parameters that could serve as criteria for describing the severity of pre-eclampsia based on the urgency of delivery. To this end, a Delphi procedure was used to present a scenario in which a woman was admitted for preeclampsia before 32 gestational weeks and after completion of antenatal steroid therapy. Clinicians specialized in maternal-fetal medicine from German-speaking countries completed five rounds of a modified Delphi questionnaire. Presented parameters were selected by the section "Hypertensive Pregnancy Diseases and Fetal Growth Restriction" of the German Society of Gynecology and Obstetrics after reviewing the literature. These included objectifiable laboratory or clinical parameters as well as subjective symptoms of the patient. In addition, nine fetal parameters were taken into account. The clinicians were asked to rate presented parameters as an indication for delivery on a Likert scale from 0 to 4 (no indication to absolute indication without delay). For each item, the predefined cut-off for group consensus was ≥70% agreement. A total of 126 experts were approached. Sixty-nine experts (54.8%) took part in the first round; of those 50 completed the entire Delphi procedure. A consensus was reached on 14 parameters to be considered rapid preparation for delivery without delay (4 points on the Likert scale). These were among others hepatic hematoma or liver capsule rupture, acute liver failure with fulminant coagulation disorder or disseminated intravascular coagulation, eclampsia, pathologic findings in imaging (e.g. cMRI) or electrocardiogram arranged for new onset of headache or retrosternal pain, respectively. Twenty-six parameters were rated as factors that should be considered in the decision without being absolute (1 to 3 points), and 13 parameters should have no influence on the decision to deliver (0 points). No consensus on severe hypertension as an indication for delivery could be reached for blood pressure values below 220/140mmHg. A consensus was reached on whether to deliver in preeclampsia typic clinical findings and symptoms. The results can serve as guidance for current clinical practice and for the definition of clinical endpoints in intervention studies. Nevertheless, the isolated criteria are a theoretical construction since the combined deterioration or summation of several factors rather than a single factor most likely influences the decision to deliver and reflect the severity of preeclampsia. Moreover, the degree of hypertension as an indication for delivery remains controversial, unless the patient suffers additionally from complaints. Future research should be enforced to incorporate long-term risks for the mother into a decision aid.

Legal Aspects of Using Blockchain Technologies in the Field of E-Commerce on SDG'S

Objective: The objective of this study is legal aspects of blockchain. Theoretical Framework: Blockchain is one of the most prominent technologies and it has become a driving factor in business transformation. Method: Methods of historical and logical analysis and comparison, expert opinions, system analysis and forecasting were used. The research materials included legal aspects, in particular, in the development of blockchain technology. Results and Discussion: Blockchain, like any electronic technology, can have different forms of social implementation. Their openness is manifested in the fact that anyone can become a network node participating in the consensus procedure. Information in public blockchains is actually and legally publicly available. The listed qualities ensure a high level of security of public blockchains and a high level of users’ trust toward them. Research Implications: The legal regulation of digital technologies is becoming an important tool for ensuring a balance between public and private interests, benefits and risks of the digital age. Originality/Value: The global blockchain market will grow significantly in the coming years. The new vector of blockchain technology will be aimed at accelerating the pace of digitalization, financial inclusion and enhancing security. There is no doubt that blockchain is a disruptive technology and will continue to dominate the business world in the coming years.

French consensus procedure for neuropsychological assessment in multiple sclerosis

Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.

Robust Detection of Gene Amplification in Formalin-Fixed Paraffin-Embedded Samples by Fluorescence in situ Hybridization.

Focal gene amplification, such as extrachromosomal DNA (ecDNA), plays an important role in cancer development and therapy resistance. While sequencing-based methodologies enable an unbiased identification of ecDNA, cytogenetic-based techniques, such as fluorescence in situ hybridization (FISH), remain time and cost-effective for identifying ecDNA in clinical specimens. The application of FISH in formalin-fixed paraffin-embedded (FFPE) tissue samples offers a unique avenue for detecting amplified genes, particularly when viable specimens are not available for karyotype examination. However, there is a lack of consensus procedures for this technique. This protocol provides comprehensive, fully optimized, step-by-step instructions for conducting FISH to detect gene amplification, including ecDNA, in FFPE tissue samples which present unique challenges that this protocol aims to overcome and standardize. By following this protocol, researchers can reproducibly acquire high-quality imaging data to assess gene amplification.

Lightweight adaptive Byzantine fault tolerant consensus algorithm for distributed energy trading

With the rapid development of smart grid, constructing distributed energy trading market (DETM) based on blockchain to coordinate distributed energy resources (DER) has become a future direction. However, existing consensus algorithms of blockchain face many challenges in large-scale energy trading scenarios, such as high resource overhead, slow transaction procedure. To solve the above crucial problems for wide deployment of distributed energy trading, this study proposes a novel consensus algorithm named Lightweight adaptive Byzantine fault tolerant consensus (LA-BFT), and a reputation calculation method based on behavioral characteristics for selection of consensus nodes. The LA-BFT consists of two parts: (i) weak consensus for normal cases. By introducing threshold signature mechanism, weak consensus simplifies the consensus process to achieve linear communication complexity O(n). (ii) byzantine node detection scheme is enable for malicious cases. With consensus committee, the detection scheme can detect the potential byzantine nodes by cross-validation, which ensures transaction safety. The reputation calculation method is presented to cooperate with LA-BFT to elect leaders and candidates for consensus procedure. Once a round of consensus is completed, the reputation of each node needs to be updated, only nodes with high reputation are eligible to become leaders or committee nodes in the next round. With the reputation calculation method, honest nodes and byzantine nodes can be effectively identified, ensuring the security of the consensus process. Numerical results indicate that LA-BFT exhibits superior performance on communication overhead and bandwidth occupancy in large-scale concurrent energy trading scenarios. When the number of nodes is 50, under normal scenarios, LA-BFT’s communication overhead is notably lower, constituting a mere 6.02% of PBFT and 24.26% of SHBFT, while bandwidth occupancy amounts to merely 5.55% of PBFT and 9.76% of SHBFT.

Contextual similarities in psychological flexibility: the Brazil-Portugal transcultural adaptation of Psy-Flex

Psychological Flexibility is an essential concept in Contextual Behavioural Sciences. The development of instruments is vital for its study, and it is an opportunity to reflect on this concept. Among the measures of this construct, Psy-Flex shows promise due to comprehensiveness in assessing the six facets of psychological flexibility and its pragmatic value. In the present study, we sought to translate Psy-Flex to Portuguese and adapt it transculturally for use in Portugal and Brazil. The translation was done independently by Brazilian and Portuguese researchers, and a consensus procedure was done to identify a synthesis. A total of 873 adults from Portugal and Brazil were involved in this study. The participants completed several questionnaires with ACT-related measures (e.g., cognitive fusion, mindful attention) and instruments measuring conceptually related variables (e.g., positive mental health). The results show good psychometric properties of PsyFlex. The one-factor structure of the original instrument was confirmed in both the Portuguese and Brazilian samples. Confirmatory factor analysis revealed a good fit of the model to the data (CFI = 0.985, RMSEA = 0.055) of both countries. Furthermore, the Psy-Flex showed convergent validity with related measures in a conceptually expected way. As a transcultural instrument, we argue that both the similarities and differences across samples suggest the broad human nature of psychological flexibility while retaining its context sensitivity.

Drug Traceability using Blockchain

The medicine supply tracking system that has been built uses blockchain-based technology to address the widespread problem of counterfeit pharmaceuticals. The solution utilizes the decentralized structure of blockchain to guarantee confidentiality and transparency in the prescribed medicine distribution chain. The blockchain tracks an individual drug's path from producer to customer, providing auditable and immutable documentation of its legitimacy and provenance. Smart contracts automate procedures and enforce pre-established guidelines. "Examples include confirming the authenticity of medicines and triggering alarms for questionable activity. The technique reduces the possibility of counterfeit medicines entering the market by eliminating the need for trust in middlemen through decentralized consensus procedures. In the end, the blockchain-based medicine traceability system improves patient safety by enabling the quick identification and removal of fake medicines from the market.

Leveraging Policy Solutions for Diabetes Disparities: Suggestions for Improving the National Clinical Care Commission Report's Recommendations for Hispanic/Latino Populations.

In the U.S., Hispanic/Latino populations face increased disparities in both the prevalence and management of type 2 diabetes mellitus (T2DM). This article critically examines the multifaceted nature of T2DM disparities among Hispanic/Latino populations in the U.S. and identifies key factors contributing to T2DM prevalence within these communities, including socioeconomic status, cultural influences, and healthcare access. Utilizing a modified expert consensus procedure, we evaluate the ways in which the National Clinical Care Commission (NCCC) recommendations apply to the Hispanic/Latino community as well as propose recommendations for improved efficacy. Through a comprehensive analysis of government-community health initiatives, food security, environmental exposures, and housing inequalities, we emphasize the need for targeted interventions and health policies to effectively address and dismantle these disparities. Overall, while the National Clinical Care Commission's recommendations provide a valuable framework for the implementation of policies pertaining to diabetes management and prevention in the general population, our analysis suggests that recommendations may be strengthened by considering the unique cultural, social, and economic needs of the Hispanic/Latino population moving forward.

GLSBIoT: GWO-based enhancement for lightweight scalable blockchain for IoT with trust based consensus

Blockchain technology, which has gained much attention from researchers, faces challenges when applied to resource-constrained devices in the Internet of Things (IoT). These challenges include significant network overhead and energy-intensive processes. We propose a trust-based ensemble consensus and Grey Wolf Optimization (GWO) algorithm to address these limitations. The trust-based ensemble consensus leverages Proof of Work (PoW) and Proof of Stake (PoS) consensus procedures to improve trust levels within the network. To boost scalability and throughput without sacrificing the security and privacy of IoT data, we utilize sidechaining with the efficient GWO algorithm, allowing the construction of parallel chains connected to the main blockchain. Our experimental results outperformed conventional models by increasing throughput by 12.5% while decreasing mining delay by 19.5% and energy usage by 18.3%. The conducted security analysis reveals the presented lightweight framework is robust against Finney, DoS, Sybil, and Masquerade attacks. These improvements suggest the potential of this approach to provide privacy, integrity, and anonymity in blockchain-enabled IoT systems for smart city applications.

Developing a pragmatic consensus procedure supporting the ICH S1B(R1) weight of evidence carcinogenicity assessment.

The ICH S1B carcinogenicity global testing guideline has been recently revised with a novel addendum that describes a comprehensive integrated Weight of Evidence (WoE) approach to determine the need for a 2-year rat carcinogenicity study. In the present work, experts from different organizations have joined efforts to standardize as much as possible a procedural framework for the integration of evidence associated with the different ICH S1B(R1) WoE criteria. The framework uses a pragmatic consensus procedure for carcinogenicity hazard assessment to facilitate transparent, consistent, and documented decision-making and it discusses best-practices both for the organization of studies and presentation of data in a format suitable for regulatory review. First, it is acknowledged that the six WoE factors described in the addendum form an integrated network of evidence within a holistic assessment framework that is used synergistically to analyze and explain safety signals. Second, the proposed standardized procedure builds upon different considerations related to the primary sources of evidence, mechanistic analysis, alternative methodologies and novel investigative approaches, metabolites, and reliability of the data and other acquired information. Each of the six WoE factors is described highlighting how they can contribute evidence for the overall WoE assessment. A suggested reporting format to summarize the cross-integration of evidence from the different WoE factors is also presented. This work also notes that even if a 2-year rat study is ultimately required, creating a WoE assessment is valuable in understanding the specific factors and levels of human carcinogenic risk better than have been identified previously with the 2-year rat bioassay alone.

Navigating the Future of Secure and Efficient Intelligent Transportation Systems using AI and Blockchain

Introduction/Background This study explores the limitations of conventional encryption in real-world communications due to resource constraints. Additionally, it delves into the integration of Deep Reinforcement Learning (DRL) in autonomous cars for trajectory management within Connected And Autonomous Vehicles (CAVs). This study unveils the resource-constrained real-world communications, conventional encryption faces challenges that hinder its feasibility. This introduction sets the stage for exploring the integration of DRL in autonomous cars and the transformative potential of Blockchain technology in ensuring secure data transfer, especially within the dynamic landscape of the transportation industry. Materials and Methods The research methodology involves implementing DRL techniques for autonomous car trajectory management within the context of connected and autonomous CAVs. Additionally, a detailed exploration of Blockchain technology deployment, consensus procedures, and decentralized data storage mechanisms. Results Results showcase the impracticality of conventional encryption in resource-constrained real-world communications. Moreover, the implementation of DRL and Blockchain technology proves effective in optimizing autonomous car subsystems, reducing training costs, and establishing secure, globally accessible government-managed transportation for enhanced data integrity and accessibility. Discussion The discussion delves into the implications of the study's findings, emphasizing the transformative potential of DRL in optimizing autonomous car subsystems. Furthermore, it explores the broader implications of Blockchain technology in revolutionizing secure, decentralized data transfer within the transportation industry. Conclusion In conclusion, the study highlights the impracticality of conventional encryption in real-world communications and underscores the significant advancements facilitated by DRL in autonomous vehicle trajectory management. The integration of Blockchain technology not only ensures secure data transfer but also paves the way for a globally accessible transportation blockchain, reshaping the future landscape of the industry.

How the implementation of a school for people with Parkinson's disease can succeed-Results of aconsensus study and aformative evaluation

As the most rapidly increasing neurodegenerative disease worldwide, Parkinson's disease is highly relevant to society. Successful treatment requires active patient participation. Patient education has been successfully implemented for many chronic diseases, such as diabetes and could also provide people with Parkinson's disease with skills to manage the disease better and to participate in shared decision making. To prepare the implementation of aconcept for patient education for people with Parkinson's disease, astructured consensus study was conducted and apilot project formatively evaluated. The structured consensus study included experts from all over Germany. It consisted of two online surveys and an online consensus conference. The formative evaluation was conducted as three focus groups. Transcripts were evaluated using content-structuring qualitative content analysis. From the consensus procedure 59consented statements emerged, mainly regarding the contents of apatient school and agroup size of 6-8persons. Only two statements could not be consented. The formative evaluation detected atendency towards a positive attitude for adigital training format and avery positive evaluation of the contents. Overall, important recommendations for apatient school can be drawn from this study. The following subjects require further investigation: format, inclusion criteria, group composition and inclusion of caregivers.

Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders. The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs. A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data. Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties. The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study).

We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments. A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.

Crafting Resilient Consensus Mechanisms for The Web3.0 Network Through Edge Intelligence

The era of independent, secure, and scalable networks and applications that Web3.0 promised has arrived. The resilience and reliability of the network are directly tied to the architecture of the consensus mechanisms used in this context. In the paper "Crafting resilient consensus mechanisms for the Web3.0 network through edge intelligence," the authors describe a novel approach to strengthening consensus protocols by leveraging edge computing and artificial intelligence. The primary purpose of this project is to improve Web 3.0 security by implementing consensus methods based on edge intelligence. The goal of this attempt is to reduce the inefficiencies, scalability challenges, and environmental concerns associated with more conventional approaches such as proof-of-work and proof-of-stake. The proposed method combines real-time network research with local transaction verification. This eventually leads to more scalable, secure, and effective consensus procedures, which increases the resilience and greatly decreases the cost of Web3.0 networks.The proposed method recognizes the inefficiencies, lack of scalability, and environmental unfriendliness of standard consensus procedures like the Proof of Work (PoW) and Proof of Stake (PoS) consensus processes. This approach makes use of edge intelligence in real time to assess the state of the network and make appropriate adjustments in response. What emerges is a consensus process that is greener, more scalable, and more successful overall. In addition, we provide the local transaction verification (LTV) technique, which allows edge nodes to validate transactions locally, therefore reducing latency and maximizing transaction efficiency. Our findings demonstrate how edge intelligence might improve Web3.0 consensus processes. Extensive simulations and tests show that the suggested approaches outperform conventional consensus mechanisms in terms of efficiency, security, and scalability. Cost reductions for Web3.0 network operators are also emphasized to emphasize the value of our strategy. Consensus procedures for Web3.0 networks that include edge intelligence provide a viable path toward attaining the required resilience, efficiency, and scalability. This study lays the way for a new age of distributed systems, guaranteeing the resiliency and flexibility essential to the success of Web3.0

The Blockchain in Secure and Efficient Data Sharing: A Review

Blockchain technology has received a lot of attention since its very beginning due to its unique characteristics such as decentralization, immutability, smart contracts, and consensus procedures. Today's digital systems and data exchange systems face several obstacles in the era of digital collaboration in all economic, financial, commercial, scientific, and other fields. Blockchain technology offers the ability to address a wide range of difficulties associated with digital data sharing, such as data management, security, and privacy. This assessment of data sharing based on blockchain technology includes various research publications published in prominent scientific journals between 2022 and 2024. We employ the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and its surrounding region. This study uses articles’ databases: Elsevier, Springer, IEEE Xplore, Web of Science, and MDPI. This study comprised 36 studies. We discovered that authors attempted to use blockchain technology to enable consumers and other organizations to share data, information, experiences, and process data, as well as to include various entities. Our study examines the impact of using different methods of storing data with blockchain technology on the security of that data and what depends on choosing the best method of storing data between onchain and off-chain storage, with the aim of solving many problems such as access control, data security, and privacy that are overlooked in traditional systems.

SodsBC: A Post-Quantum by Design Asynchronous Blockchain Framework

We present a new framework for asynchronous permissioned blockchain with high performance and post-quantum security. The framework contains two quantum-secure asynchronous Byzantine fault tolerance (aBFT) protocols, SodsBC and SodsBC++. We leverage concurrent preprocessing to accelerate the preparation of three cryptographic objects for the repeated consensus procedure, including common random coins as the needed randomness, secret shares of symmetric encryption keys for censorship resilience, and nested hash values for external validation predicates. The key idea behind our design is that the concurrent preprocessing mechanism can be well-supported by the consensus process of blockchains. The consumed objects in a block have been generated and globally agreed upon in a previous block. All our preprocessed objects utilize proven or commonly believed to be post-quantum cryptographic tools to resist an adversary equipped with quantum computation capabilities. We evaluate our protocols and their competitors in AWS in a typical setting where, the number of participants is 100 and each block part has 20,000 transactions. The results show that SodsBC and SodsBC++ reduce the latency of two state-of-the-art but quantum-sensitive competitors Honeybadger and Dumbo by 53% and 6%, respectively.

An updated job-exposure matrix for occupational noise: development and validation.

The aim of this study was to create a quantitative job-exposure matrix (JEM) for noise including a large set of measurements for the Swedish workforce, a detailed exposure-level assessment, spanning over an extensive time period from 1970 to 2014. The JEM was developed by 2 teams, each with an experienced occupational hygienist and an occupational safety engineer. Each pair assessed the exposure using measurements performed and reported by occupational hygienists, occupational safety engineers, or similar, from 1970 to 2014. The measurements included either the original LAeq(8h) measurements or an LAeq(8h) levels calculated from partial measurements of the working day, provided that the measurement targeted a regular task usually performed during a full workday. The collection of measurement reports was done in 2008 and 2012 by contacting clinics working in the area of occupational health or occupational safety engineers and their submitted reports were added to our own material. Noise exposure assessments were inserted at the appropriate time period for the relevant job family. The final matrix was developed in a consensus procedure and the validity was investigated by comparison of the 2 team's individual results. The noise JEM contains 321 job families with information regarding occupational noise from 1970 to 2014. The time-period label has a 5-yr scale starting in 1970. The estimated average 8 h (TWA) noise level in decibels [dB(A)] for every job family and 5-yr period was coded as 1: <70 dB(A), 2: 70 to 74 dB(A), 3: 75 to 79 dB(A), 4: 80 to 84 dB(A) or 5: 85(+) dB(A). The validation showed no systematic difference in relative position and very high agreement in the ordering of paired ordinal classifications. The JEM has also successfully been applied in several epidemiological studies. We present a JEM for occupational noise using Swedish data from 1970 to 2014 with a higher degree of sensitivity in assessed noise exposure compared with the previously existing version. Repeated application of the JEM, in epidemiological studies, has shown consistent results and contributed to yielding important findings.

An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA)

Objective: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA). Methods: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts’ responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement &lt;5%) were included in the final study report. The consistency of each round’s answers was also graded using Cohen’s kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa. Results: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making. Conclusions: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology. Clinical Impact This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.