Expert Opinion Research Articles

Cancer Surveillance in Solid Organ Transplant Recipients With a Pretransplant History of Malignancy: Multidisciplinary Collaborative Expert Opinion.

With improved medical treatments, the prognosis for many malignancies has improved, and more patients are presenting for transplant evaluation with a history of treated cancer. Solid organ transplant (SOT) recipients with a prior malignancy are at higher risk of posttransplant recurrence or de novo malignancy, and they may require a cancer surveillance program that is individualized to their specific needs. There is a dearth of literature on optimal surveillance strategies specific to SOT recipients. A working group of transplant physicians and cancer-specific specialists met to provide expert opinion recommendations on optimal cancer surveillance after transplantation for patients with a history of malignancy. Surveillance strategies provided are mainly based on general population recurrence risk data, immunosuppression effects, and limited transplant-specific data and should be considered expert opinion based on current knowledge. Prospective studies of cancer-specific surveillance models in SOT recipients should be supported to inform posttransplant management of this high-risk population.

Expert insights into future trajectories: assessing cost reductions and scalability of carbon dioxide removal technologies

IntroductionTo achieve net-zero targets, it is essential to evaluate and model the costs and scalability of emerging carbon dioxide removal technologies like direct air capture with CO2 storage (DACCS) and bioenergy with carbon capture and storage (BECCS). Yet such efforts are often impeded by varying assessments of the climate impact and potential contributions of these technologies. This study explores the future costs and scalability of DACCS and BECCS to advance net-zero goals.MethodsWe analyze expert opinions on these technologies’ potential costs and deployment scales for 2030, 2040, and 2050. Data was collected from 34 experts, comprising 21 DACCS and 13 BECCS specialists. They provided 90% confidence interval estimates and ‘best estimates’ for future costs and deployment under two International Energy Agency (IEA) policy scenarios—Stated Policies (STEPS) and Net Zero Emissions by 2050 (NZE).ResultsWe find that BECCS costs start at a lower level but decrease more slowly, whereas DACCS costs decline more steeply from a higher initial cost. However, DACCS estimates varied significantly among experts, showing no convergence over time. Regarding potential scalability, both technologies are associated with substantially higher deployment under the NZE scenario. Yet the combined estimated capacity of DACCS and BECCS by 2050 is only about a quarter of the CO2 removals projected by the IEA for its NZE scenario (1.9 GtCO2).DiscussionThis study provides valuable insights into the future of DACCS and BECCS technologies in Europe, especially since our experts expect that DACCS and BECCS costs will be even higher (and deployment scales lower) than those predicted by recent IEA tracking, opening future research directions.

Eksplorasi Layanan Konseling Kelompok dalam Mengembangkan Kreativitas Siswa: Tinjauan Literatur

This research aims to find out more details about group counseling services. One of the effective guidance and counseling services for developing student creativity is group counseling services. This research uses library research methods with data originating from various sources such as books, articles, journals, documents, and others. In the discussion we explain the basic concepts of group counseling, including 1). Definition of group counseling according to expert opinion 2). Goals of Group Counseling 3). Principles of Group Counseling 4). Group Counseling Function 5). Benefits of Group Counseling 6). Group Counseling Component 7). Group Dynamics 8). Group Counseling Process and Stages.

A capture-recapture modeling framework emphasizing expert opinion in disease surveillance.

In disease surveillance, capture-recapture methods are commonly used to estimate the number of diseased cases in a defined target population. Since the number of cases never identified by any surveillance system cannot be observed, estimation of the case count typically requires at least one crucial assumption about the dependency between surveillance systems. However, such assumptions are generally unverifiable based on the observed data alone. In this paper, we advocate a modeling framework hinging on the choice of a key population-level parameter that reflects dependencies among surveillance streams. With the key dependency parameter as the focus, the proposed method offers the benefits of (a) incorporating expert opinion in the spirit of prior information to guide estimation; (b) providing accessible bias corrections, and (c) leveraging an adapted credible interval approach to facilitate inference. We apply the proposed framework to two real human immunodeficiency virus surveillance datasets exhibiting three-stream and four-stream capture-recapture-based case count estimation. Our approach enables estimation of the number of human immunodeficiency virus positive cases for both examples, under realistic assumptions that are under the investigator's control and can be readily interpreted. The proposed framework also permits principled uncertainty analyses through which a user can acknowledge their level of confidence in assumptions made about the key non-identifiable dependency parameter.

Educating patients on osteoporosis and bone health: Can "ChatGPT" provide high-quality content?

The rise of artificial intelligence (AI) models like ChatGPT offers potential for varied applications, including patient education in healthcare. With gaps in osteoporosis and bone health knowledge and adherence to prevention and treatment, this study aims to evaluate the accuracy of ChatGPT in delivering evidence-based information related to osteoporosis. Twenty of the most common frequently asked questions (FAQs) related to osteoporosis were subcategorized into diagnosis, diagnostic method, risk factors, and treatment and prevention. These FAQs were sourced online and inputted into ChatGPT-3.5. Three orthopedic surgeons and one advanced practice provider who routinely treat patients with fragility fractures independently reviewed the ChatGPT-generated answers, grading them on a scale from 0 (harmful) to 4 (excellent). Mean response accuracy scores were calculated. To compare the variance of the means across the four categories, a one-way analysis of variance (ANOVA) was used. ChatGPT displayed an overall mean accuracy score of 91%. Its responses were graded as "accurate requiring minimal clarification" or "excellent," with a mean response score ranging from 3.25 to 4. No answers were deemed inaccurate or harmful. No significant difference was observed in the means of responses across the defined categories. ChatGPT-3.5 provided high-quality educational content. It showcased a high degree of accuracy in addressing osteoporosis-related questions, aligning closely with expert opinions and current literature, with structured and inclusive answers. However, while AI models can enhance patient information accessibility, they should be used as an adjunct rather than a substitute for human expertise and clinical judgment.

Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee.

Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.

An extended Bayesian network model for calculating dam failure probability based on fuzzy sets and dynamic evidential reasoning

Effective risk analysis is crucial for ensuring the safe operation of hydropower dams. Existing methods typically rely solely on subjective or objective data. The subjectivity of expert opinions and insufficient objective data affect the reliability of results. To reduce subjectivity in the risk analysis process and enhance the utilization of subjective and objective data, this study proposes an extended Bayesian network (BN) model for calculating the dam failure probability based on fuzzy sets (FSs) and dynamic evidential reasoning. To address the fuzziness and uncertainty of expert opinions, a Gaussian FS was introduced to transform expert opinions into fuzzy numbers. Additionally, a dynamic evidential reasoning approach was proposed to combine subjective and objective data, considering their differences, subjectivity, and potential conflicts. To maintain consistency in the fuzzification and defuzzification processes, an improved Onisawa formula was proposed. Finally, the BN was employed for probability prediction and sensitivity analyses. The model was applied to the Z hydropower dam in China. The results showed that the failure probability was 5.2 × 10−4, and the main controllable risk factors were identified. A comparative analysis was conducted and the results showed that the proposed method had a better ability to handle uncertainty, reduce subjectivity, and mitigate conflicts.

Performance Evaluation of Railway Infrastructure Managers: A Novel Hybrid Fuzzy MCDM Model

Modern challenges such as the liberalization of the railway sector and growing demands for sustainability, high-quality services, and user satisfaction set new standards in railway operations. In this context, railway infrastructure managers (RIMs) play a crucial role in ensuring innovative approaches that will strengthen the position of railways in the market by enhancing efficiency and competitiveness. Evaluating their performance is essential for assessing the achieved objectives, and it is conducted through a wide range of key performance indicators (KPIs), which encompass various dimensions of operations. Monitoring and analyzing KPIs are crucial for improving service quality, achieving sustainability, and establishing a foundation for research and development of new strategies in the railway sector. This paper provides a detailed overview and evaluation of KPIs for RIMs. This paper creates a framework for RIM evaluation using various scientific methods, from identifying KPIs to applying complex analysis methods. A novel hybrid model, which integrates the fuzzy Delphi method for aggregating expert opinions on the KPIs’ importance, the extended fuzzy analytic hierarchy process (AHP) method for determining the relative weights of these KPIs, and the ADAM method for ranking RIMs, has been developed in this paper. This approach enables a detailed analysis and comparison of RIMs and their performances, providing the basis for informed decision-making and the development of new strategies within the railway sector. The analysis results provide insight into the current state of railway infrastructure and encourage further efforts to improve the railway sector by identifying key areas for enhancement. The main contributions of the research include a detailed overview of KPIs for RIMs and the development of a hybrid multi-criteria decision making (MCDM) model. The hybrid model represents a significant step in RIM performance analysis, providing a basis for future research in this area. The model is universal and, as such, represents a valuable contribution to MCDM theory.

Digital literacy scale: Validity and reliability study with the rasch model

AbstractThe study aimed to develop a Likert-type measurement tool (Digital Literacy Scale, DLS) to determine the digital literacy levels of secondary school students. The validity and reliability of the developed measurement tool were verified using the Rasch model. The Rasch Model can estimate missing data and allow for small study groups (Rasch, Rasch, Probabilistic models for some intelligence and attainment tests, Danish Institute for Educational Research, 1960). Additionally, this model can verify the expected pattern of the measurement tool by calibrating it across participants and items. The content validity of DLS was ensured by expert opinion, and the construct validity was ensured by using the Rach model. In the content validity study, a 25-item pool was created for the draft DLS, and 5 items were removed from the draft DLS at this stage. Construct validity studies were carried out with the remaining 20 items using the classical test theory and item response theory (Rasch model). Exploratory Factor Analysis (EFA) and first-level Confirmatory Factor Analysis (CFA) were used within the scope of classical test theory. Then some Rasch assumptions such as dimensionlessness, local independence, monotonicity, and bias were tested for DLS. In the validity and reliability analysis of DLS, no items were eliminated, and the quantitative theoretical results were statistically confirmed. The analysis results showed that the minimum statistical values required for a good measurement tool were met. Accordingly, 20 valid and reliable compatible items that can be used to determine the digital literacy status of secondary school students were produced.

Forest policy in Nordic countries: Expert opinions on future needs, uncertainties, and recommendations

There are broad calls in national and international forest policy processes for basing decision-making on the best obtainable scientific knowledge. Simultaneously, there is also a need to accommodate plural values and objectives people and society in general have associated with forests. An essential step for building an evidence base that accommodates pluralistic understandings is to capture informant views on forest policies and the alternatives they offer to better prepare for future scenarios. This article draws on research experts’ views in Finland, Sweden, Norway, and Denmark, gathered from interviews between February and May 2023. An existing gap to bridge is understanding to what extent such views differ or correlate across the study countries. By systematizing on the similarities and differences in opinions, we develop a synopsis of future needs and uncertainties in policies across the studied countries, concluding with recommendations for determining the use of Nordic forests. Despite divergence in personal views and uncertainties about the future, most respondents saw a need for inclusive policymaking, policy coherence and integration, and changes in forest management. We find that strengthening evidence-basis, stakeholder participation, adaptive governance, and integrative forest management are challenges for future policy making.

Establishment of in-hospital nutrition support program for middle-aged and elderly patients with acute decompendated heart failure

ObjectiveTo construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization.MethodsBased on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert’s scoring and feedback, and the expert scoring was calculated.ResultsThe response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators.ConclusionThe nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.

A Study of Problems Faced by Engineering Students in Mathematical Subjects using Fuzzy Cognitive Mappings

Introduction: One of the main concerns and issues for educators, particularly for engineering students, has been the caliber of mathematics instruction and learning. There are many different concepts and skills that make up mathematics. The improvement of problem-solving skills is one of mathematics' key functions. Numerous colleges struggle with the issue of students quitting because of mathematics because it is frequently thought of as a topic that students find difficult to master. Objectives: The study's goal is to examine the reasons why engineering students struggle with math. In this research, using fuzzy cognitive map techniques (FCM), we analyze the challenges engineering students encounter when trying to earn grades in math-related courses. FCM is a blend of some fuzzy logic and neural network ideas. FCM is made up of collections of concepts and all the different causal relationships that connect them. Methods: We created a model of the issues and causal relationships that engineering students faced when trying to succeed in mathematics classes. Both statically and dynamically, utilizing concepts from graph theory and simulations, the model is examined. Also we applied DEMATEL one of the Multi Criteria Decision Making method. Results: The analysis reveals that the main issue is not just the students' lack of mathematical background knowledge, but also their attitude toward learning, psychological response to the first failure, and lack of effort to complete additional tasks or attend tutorials. Conclusions: Using the FCM method, a model was created for the case of problems faced by engineering college students in scoring marks in mathematical related subjects based on the opinion of a domain expert. The model was first examined statically. The model was then simulated in a dynamic and it was predicted that there should be an attitude change in teachers and as well as students. Through the above static and dynamic studies of the FCM model was identified as important and useful decision support system, since it capable to provide support to decision makers, by making predictions on various scenarios that are imposed on the FCM model.

Ongoing decision-making dilemma for treatment of de novo spinal infections: a comparison of the Spinal Infection Treatment Evaluation Score with the Spinal Instability Spondylodiscitis Score and Spine Instability Neoplastic Score.

De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician. Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score. A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis. The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.

From Laughter to Learning: Teaching Methods through Engaging Narrative Workshops

Can we increase students’ grasp and integration of research methods in political science, and do so in a fun way? We believe the answer is yes. In this article, we introduce the workshop-based narrative framework “The Tale of Folke Folkesson,” where students role-play as the methods expert group Linnaeus Opinion Laboratory (LOL). Through an interactive engagement with the story, students are exposed to the combined utility of various qualitative and quantitative techniques such as content analysis, survey research, experiments, and interviews. This methodological exercise enables students to recognize not only the individual strengths and weaknesses of each method, but also how one method can offset the limitations and/or amplify the benefits of another. Importantly for student learning, it does so in a fun and engaging way. Beyond introducing the narrative framework, we describe how educators can adapt the “Tale of Folke Folkesson” to meet their specific educational needs.

The final part of the CRESS trilogy- how to evaluate the quality of stability studies.

High quality laboratory results are critical for patient management. However, poor sample quality can impact these results and patient safety. To ensure reliable and accurate results laboratories must be aware of each analyte's stability under various storage conditions and matrices to guarantee correct and dependable outcomes. This knowledge allows laboratories to define the allowable delay between sample collection and centrifugation/analysis for all analytes to guarantee appropriate results quality and interpretation. The EFLM WG-PRE therefore established a 4-step plan to tackle this issue, aiming to standardize and harmonize stability studies for improved comparison andmeta-analysis. The plan included the development of checklists and how-to guides for performing and reporting stability studies as well as a central resource of stability data. This manuscript deals with the issue of evaluating publications and incorporating them into a central resource. To evaluate stability studies, the CRESS checklist was used to structure 20 sections used to judge the quality of studies. Each section has 4 levels of quality, with scores converted to numerical values and weighted based on expert opinion. Based on this, a final score ranging from A to D was determined. The procedure was then tested on six manuscripts and checked for agreement between expert judgements. The results demonstrated that the proposed evaluation process is a useful tool to distinguish between best in class manuscripts and those of lower quality. The EFLM WG-PRE strongly believes that the provided recommendations and checklists will help improving stability studies both in quality and standardisation.

Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol

BackgroundPeople with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs.Methods/designThe present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants’ perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique.DiscussionThis is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.

Assessment of Customs Brokerage Performance in Vietnam: A Study of the Analytic Hierarchy Process (AHP)

This study aims to apply a fact-based methodology called the Analytic Hierarchy Process (AHP) to evaluate the performance of customs brokers in Vietnam. It involves weighting the importance of factors affecting the quality of customs brokerage service based on market rules and regulatory compliance. The significance of the factors was ranked through the AHP method, based on expert opinions gathered from semi-structured interviews with 10 senior managers with over five years of service among Vietnam’s customs brokers. The results indicate that professional qualification, trade compliance and professionalism marked by high commitment, trustworthiness and adaptability with customers, are the most critical factors influencing the quality of customs brokerage service. Building upon the AHP model, the study formulates the Vietnam Customs Broker Scoring Criteria for the General Department of Vietnam Customs (GDVC).

Expert opinion on the multivitamin deficiencies observed in day-to-day practice in Indian settings

: Although there is an array of empirical evidence regarding vitamin deficiencies in isolation, there is a dearth of particular data regarding multivitamin use in Indian contexts. So, the present survey-based study aims to gather clinicians' opinions regarding the multivitamin deficiencies noted in day-to-day practice in Indian settings.The cross-sectional, multi-response study employed an 18-item questionnaire to collect current feedback, clinical observations, and the clinical experience of specialists regarding multivitamin deficiencies observed in routine practice within Indian settings.Out of 191 participants, 53.93% opined that only a few patients have folic acid deficiency in most of the patients. More than half (51.83%) of patients have vitamin B12 deficiency. About 53% of the clinicians reported that zinc deficiency was seen in a few patients. Around 43% of the clinicians reported that 11 to 12 patients with diabetes using metformin were more likely to have a multivitamin deficiency.This study offered valuable insights into the multivitamin deficiencies observed by clinicians in their daily practice among Indian patients. The survey also underscored the importance of regular monitoring of vitamin B12 levels in diabetic patients using metformin to reduce the risk of deficiency.

Cost-Effectiveness Analysis of Digital Breast Tomosynthesis and Mammography in Breast Cancer Screening: A Markov Modeling Study.

Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan's National Health Insurance program. All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings. The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2). DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.

Turning the tide on big cat trade: Expert opinion on trends and conservation lessons from the Republic of Korea.

Unsustainable trade in big cats affects all species in the genus, Panthera, and is one of the foremost threats to their conservation. To provide further insight into the impact of policy interventions intended to address this issue, we examine the case study of the Republic of Korea (South Korea), which in the early 1990s was one of the world's largest importers of tiger (Panthera tigris) bone and a major manufacturer of tiger-derived medicinal products. In 1993, South Korea became a Party to the Convention on International Trade in Endangered Species (CITES) and introduced a ban on commercial trade in CITES Appendix I-listed big cats a year later. We used an expert-based questionnaire survey and an exploration of the CITES trade database to investigate what has since happened to big cat trade in South Korea. Expert opinion suggested that big cat trade has likely substantially reduced since the early 1990s, as a result of the trade ban and broad socioeconomic changes. However, illegal trade has not been eradicated entirely and we were able to confirm that products reportedly derived from big cats were still publicly available for sale on a range of Korean online marketplaces, sometimes openly. The items most commonly reported by respondents from post-1994 trade and supported by expert-led evidence were tiger and leopard (Panthera pardus) skins and tiger bone wine. Although South Korea may provide a useful case study of a historically significant consumer country for tiger which has made strong progress in addressing unsustainable levels of big cat trade within a short period of time, there remains a need to address recalcitrant small-scale, illegal trade. We also recommend further investigation regarding reports of South Korean nationals being involved in illegal trade in tiger-derived products in Southeast Asia.