Expert Panel Assessment Research Articles

Assessing the Impact of New Silk Road Initiatives on Kazakhstan's Business Environment

This study conducts a comprehensive evaluation of four major regional economic integration initiatives along the New Silk Road in Eurasia: The Eurasian Economic Union (EAEU), the Silk Road Economic Belt (SREB), the New Silk Road (NSR), and the Central Asia Regional Economic Cooperation (CAREC) program. By employing an expert-based analysis method, the research assesses the initiatives from the perspective of the Kazakhstani business environment, identifying critical criteria for successful economic integration, including intra-union trade, market expansion, supply chain optimization, regulatory harmonization, and access to financing. Drawing parallels with the historical Silk Road's focus on trade and economic prosperity, this research employs an expert-based analysis method to assess these modern initiatives from the perspective of the Kazakhstani business environment. Through structured expert panel assessments and statistical analysis, the study determines which initiatives offer the most tangible benefits to businesses in Kazakhstan and the broader region. The findings indicate that the SREB initiative scored highest overall, particularly in fostering regional economic development and business growth, with a total score of 197, followed by the EAEU with 181. The findings reveal that the SREB initiative scored highest overall, followed by the EAEU, indicating their strong potential for fostering regional economic development and business growth. This study provides valuable insights for policymakers and businesses navigating the complex landscape of Eurasian economic integration. It offers a framework for evaluating the effectiveness of new Silk Road initiatives in promoting regional prosperity and cooperation, with particular relevance to Kazakhstan's position in Central Asia.

Real-world assessment of comprehensive genome profiling impact on clinical outcomes: A single-institution study in Japan.

Comprehensive genome profiling (CGP) has revolutionized healthcare by offering personalized medicine opportunities. However, its real-world utility and impact remain incompletely understood. This study examined the extent to which CGP leads to genomically matched therapy and its effectiveness. We analyzed data from advanced solid tumor patients who underwent CGP panel between December 2019 and May 2023 at the Osaka International Cancer Institute. Patient demographics, specimen details, and expert panel assessments were collected. Turnaround time (TAT) and genomically matched therapy outcomes were analyzed. Gene alterations and their co-occurrence patterns were also assessed. Among 1437 patients, 1096 results were available for analysis. The median TAT was 63 [28-182] days. There were 667 (60.9%) cases wherein recommended clinical trials were presented and there were 12 (1.1%) cases that could be enrolled in the trial and 25 (2.3%) cases that could lead to therapies under insurance reimbursement. The median progression free survival of the trial treatment was 1.58 months (95% CI: 0.66-4.37) in clinical trials and 3.66 months (95% CI: 2.14-7.13) in treatment under insurance. Pathologic germline variants were confirmed in 15 patients (1.3%). Co-alteration of CDKN2A, CDKN2B, and MTAP was significantly observed in overall population. The effectiveness of the genomically matched therapy based on the CGP panel was unsatisfactory. Expansion of clinical trials and utilization of remote clinical trials are required to ensure that the results of the CGP panel can be fully returned to patients.

Development and Pilot Validation of the DuMAND Checklist to Screen for Duchenne Muscular Dystrophy-Associated Neurobehavioral Difficulties (DuMAND).

Patients with Duchenne muscular dystrophy (DMD) face a higher risk of neurobehavioral problems, yet an international consensus on screening, assessing, and managing these difficulties is lacking. This report introduces the term Duchenne Muscular Dystrophy-Associated Neurobehavioral Difficulties (DuMAND) to comprehensively cover the spectrum of neurobehavioral issues in DMD patients, including behavior, psychiatric disorders, and various cognitive, academic, and psychosocial deficits. To facilitate screening, the DuMAND Checklist, a 43-item tool with five subscales, was developed. DuMAND categories were derived through literature review, parent (48 mothers and 37 fathers), and expert (n = 28) input and feedback. The DuMAND Checklist subscales were developed iteratively, incorporating item selection, expert panel (n = 10) assessment for face validity, comprehensiveness, and a pilot validation study in a DMD sample (n = 20). DuMAND encompasses five categories: cognition and learning, social responsiveness, emotion regulation, externalizing behavior, and eating and sleeping. Preliminary validation of the DuMAND Checklist indicates acceptable-to-excellent internal consistency and construct validity. By introducing the DuMAND concept, this study seeks to inspire a consensus approach for screening, assessing, and managing neurobehavioral issues in DMD. Incorporating screening, using the DuMAND Checklist, in addition to medical follow-up will facilitate early intervention, addressing a critical gap in identification of neurobehavioral disorders in DMD. Future research is needed to further evaluate psychometric properties of the DuMAND Checklist and investigate the natural course of DuMAND.

The new injury severity score underestimates true injury severity in a resource-constrained setting

BackgroundThe new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa. MethodsThis was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type. ResultsOf 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18–80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol. ConclusionNISS may under-estimate the ‘true’ injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.

Validitas Isi Instrumen TPACK pada Calon Guru Kimia menggunakan Aplikasi Model Rasch

This research aims to assess the content validity of the instrument used to measure Technological Pedagogical Content Knowledge (TPACK) in prospective chemistry teachers. The evaluation encompasses a thorough analysis of the instrument's alignment with the knowledge domains being measured, ensuring that the instrument covers key aspects of TPACK that are relevant to the context of teaching chemistry. Content validity reflects the representation and relevance of a set of items used to measure a concept carried out through rational analysis of the contents of the test through an expert panel assessment. This validity refers to the accuracy of the measurement based on the contents of the instrument to ensure that the scale of the items used has fulfilled the entire concept of the item or the suitability of the item. The instrument used in this study was assessed by nine validators consisting of two chemistry education experts and seven chemistry teachers. The assessment is done by determining the appropriateness or relevance of the test contents to be used through rational analysis by a competent panel or through expert judgment. The instrument validations in this study were 20 multiple choice questions. The assessment is done by giving a score of 1-4 on each item. This research is a quantitative descriptive study using Rasch model analysis. The analysis showed that the exact agreement was 71.4% and the expected agreement was 73.8%. Based on measurements showing relevant items in this research instrument, there are 17, among others number 1, 10, 11, 14, 5, 8, 19, 20, 18, 3, 6, 12, 13, 15, 17, 4 and 9. While there are 3 items that are irrelevant and need to be corrected, including number 16, 2 and 7.

Outcomes of Different Quality of Life Assessment Modalities After Breast Cancer Therapy

Improvement in clinical understanding of the priorities of patients with breast cancer (BC) regarding postoperative aesthetic outcomes (AOs) is needed. To assess expert panel and computerized evaluation modalities against patient-reported outcome measures (PROMs), the gold standard of AO assessment, in patients after surgical management of BC. Embase, MEDLINE, PsycINFO, PubMed, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were interrogated from inception through August 5, 2022. Search terms included breast conserving AND aesthetic outcome AND breast cancer. Ten observational studies were eligible for inclusion, with the earliest date of database collection on December 15, 2022. Studies with at least 1 pairwise comparison (PROM vs expert panel or PROM vs computerized evaluation with Breast Cancer Conservation Treatment cosmetic results [BCCT.core] software) were considered eligible if they included patients who received BC treatment with curative intent. Studies reporting solely on risk reduction or benign surgical procedures were excluded to ensure transitivity. Two independent reviewers extracted study data with an independent cross-check from a third reviewer. The quality of included observational studies was assessed using the Newcastle-Ottawa Scale, and the level of evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Confidence in network meta-analysis results was analyzed with the Confidence in Network Meta-analysis semiautomated tool. Effect size was reported using random-effects odds ratios (ORs) and cumulative ratios of ORs with 95% credibility intervals (CrIs). The primary outcome of this network meta-analysis was modality (expert panel or computer software) discordance from PROMs. Four-point Likert responses across PROMs, expert panel assessment, and BCCT.core evaluation of AOs were assessed. A total of 10 observational studies including 3083 patients (median [IQR] age, 59 [50-60] years; median [range] follow-up, 39.0 [22.5-80.5] months) with reported AOs were assessed and homogenized in 4 distinct Likert response groups (excellent, very good, satisfactory, and bad). Overall network incoherence was low (χ22 = 0.35; P = .83). Overall, panel and software modalities graded AO outcomes worse than PROMs. Specifically, for excellent vs all other responses, the panel to PROM ratio of ORs was 0.30 (95% CrI, 0.17-0.53; I2 = 86%) and the BCCT.core to PROM ratio of ORs was 0.28 (95% CrI, 0.13-0.59; I2 = 95%), while the BCCT.core to panel ratio of ORs was 0.93 (95% CrI, 0.46-1.88; I2 = 88%). In this study, patients scored AOs higher than both expert panels and computer software. Standardization and supplementation of expert panel and software AO tools with racially, ethnically, and culturally inclusive PROMs is needed to improve clinical evaluation of the journey of patients with BC and to prioritize components of therapeutic outcomes.

Translation and cultural adaptation of the WHO generic tuberculosis patient cost survey to an Egyptian context.

Tuberculosis (TB) represents a major health problem having serious financial impact on a substantial proportion of patients. This has necessitated the development of a valid tool for measuring TB-related expenditure by patients and their households so that appropriate measures can be taken to reduce the financial burden. To translate and culturally validate the generic WHO tuberculosis patient cost survey within the Egyptian context. The instrument was translated and culturally adapted using forward-translation, back-translation, expert panel assessment, pretesting, cognitive interviewing, and appraisal by the developer. A final Arabic version with modifications to 35 descriptors of the original tool was produced after review by an expert committee and cognitive interviews with patients. Twelve questions were modified, 13 response options were changed, 6 questions were added, and 4 questions were removed. Pretesting of the tool ensured that the final version is culturally sensitive and fit for assessing the costs incurred by TB patients in an Egyptian context. Policymakers are encouraged to use the WHO tuberculosis patient cost survey tool for assessing the expenditure of TB patients with a view to developing appropriate policies to reduce the financial burden of patients.

How Valid and Reliable Is the International Dysphagia Diet Standardisation Initiative (IDDSI) When Translated into Another Language?

Swallowing difficulties are estimated to affect 590 million people worldwide and the modification of food and fluids is considered the cornerstone of dysphagia management. Contemporary practice uses the International Dysphagia Diet Standardisation Initiative (IDDSI), however, the validity and reliability of IDDSI when translated into another language has not been investigated. This study describes the translation process and confirms the validity and reliability of IDDSI when translated into another language (Swedish). The translation used a 12-step process based on the World Health Organization recommendations. Validity was tested using Content Validity Index (CVI) based on three ratings by a panel of 10–12 experts (Dietitians and Speech-Language Pathologists [SLPs]). The translation was rated for linguistic correlation as well as understandability and applicability in a Swedish context. Inter-rater reliability was calculated using Intraclass Correlation Coefficient (ICC) from 20 SLP assessments of 10 previously published patient cases. Significant improvement (p < 0.05) of CVI between Expert Panel assessments was shown for linguistic correlation (improvement from 0.74–0.98) and understandability/applicability (improvement from 0.79–0.93 across ratings). Excellent validity (Item-CVI > 0.78 and Scale-CVI/Average > 0.8) and very high inter-rater reliability (ICC > 0.9) were demonstrated. Results show that, when using a multi-step translation process, a translated version of IDDSI (into Swedish) demonstrates high validity and reliability. This further contributes to the evidence for use of IDDSI.

Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study.

BackgroundThe restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions.ObjectiveThis study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home.MethodsThis is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software.ResultsOf 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment.ConclusionsThe COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines.

Rapid assessment of mine rehabilitation areas with airborne LiDAR and deep learning: bauxite strip mining in Queensland, Australia

Rehabilitation of disturbed sites is a complex process requiring constant monitoring and assessment, with current methods being somewhat obsolete, manual, and rather fraught with risk in terms of beneficial outcomes of the evaluation. This study challenges the status quo of manual assessments and build a new methodology to recognise a clear need for a quasi-automated and reliable remote sensing method to achieve rapid mine rehabilitation monitoring. The aim of this study was to innovate and develop an ensemble analytic methodology for the use of airborne LiDAR, in conjunction with deep learning, to rapidly evaluate the rehabilitation status of post-mined areas. Airborne LiDAR datasets, obtained via an Optech ORION m/c 200 sensor, were collected over bauxite mining operations on the western coast of Cape York Peninsula, Queensland, Australia. These datasets were processed into a 3 D point cloud using the Esri ArcGIS Pro platform. An ensemble analytical approach was developed, leading with a Convolutional Neural Network (CNN) algorithm, which was trained to recognise, then classify images of the reference site (natural ecosystems) and active rehabilitation areas. The result of this classification was then leveraged, training in turn a support vector machine (SVM) algorithm which assessed the entire LiDAR collection, resulting in a predictive surface of rehabilitation status. This surface, as the final analytical product, was assessed for validity using ground-truth plot data and an ordinary least squares regression model, as well as comparison to subject matter expert evaluation through a Delphi expert panel assessment. The results indicate that the predictive surface, as the final analytical product, had statistically significant correlation coefficient with multiple attributes (or predictor) that correlated with the rehabilitation status interpretation. These predictor variables were primarily structural in nature and included the canopy height, sub-canopy height, key species as a proportion of canopy, herbaceous ground cover percentage, litter ground cover percentage, and distance from haul road (p < 0.05). A Delphi expert collaboration comprised of ten environmental science subject matter experts and 600 observations, indicated a high precision (r = 0.89 at p < 0.05) of the prediction surface when compared with a subject expert panels assessment, as well as a high Total Deviation Index (TDI) of 16% (p < 0.05). This indicated positive agreement between the panel’s assessment and the predictive surface. This study suggests that airborne LiDAR and deep learning ensemble analytics can be used as a rapid means to estimate the rehabilitation status of disturbed sites.

Defining Incidence of Acute Compartment Syndrome in the Research Setting: A Proposed Method From the PACS Study.

To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy. Prospective observational study. Seven Level 1 trauma centers. One hundred eighty-two adults with severe tibia fractures. Diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver-operator curve) of an expert panel's assessment of likelihood ACS compared with fasciotomy as the reference diagnostic standard. The interrater reliability of the expert panel as measured by the Krippendorff alpha. Expert panel consensus was determined using the percent of panelists in the majority group of low (expert panel likelihood of ≤0.3), uncertain (0.3-0.7), or high (>0.7) likelihood of ACS. Comparing fasciotomy (the diagnostic standard) and the expert panel's assessment as the diagnostic classification (test), the expert panel's determination of uncertain or high likelihood of ACS (threshold >0.3) had a sensitivity of 0.90 (0.70, 0.99), specificity of 0.95 (0.90, 0.98), PPV of 0.70 (0.50, 0.86), and NPV of 0.99 (0.95, 1.00). When a threshold of >0.7 was set as a positive diagnosis, the expert panel assessment had a sensitivity of 0.67 (0.43, 0.85), specificity of 0.98 (0.95, 1.00), PPV of 0.82 (0.57, 0.96), and NPV of 0.96 (0.91, 0.98). In our study, the retrospective assessment of an expert panel of the likelihood of ACS has good specificity and excellent NPV for fasciotomy, but only low-to-moderate sensitivity and PPV. The discordance between the expert panel-assessed likelihood of ACS and the decision to perform fasciotomy suggests that concern regarding potential diagnostic bias in studies of ACS is warranted. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Development and validation of a cognitive, affective and behaviour questionnaire on pet-associated zoonotic diseases (CAB-ZDQ).

BackgroundZoonoses among household pets are recognized as disease and infections transmitted between animals and humans. World Health Organization‐estimated zoonotic diseases have contributed about one billion cases of illness and millions of mortalities every year. Despite the emerging and re‐emerging zoonotic disease, most pet owners are unaware of the risks posed by their pets. As there are a lack of studies assessing infections at home, this study aimed to develop and validate a cognitive, affective and behaviour questionnaire (CAB‐ZDQ) to assess household pets’ zoonotic diseases.MethodsThis paper covers detailed explanation on the various developmental and validation process stages of the CAB zoonotic disease questionnaire development. The development phase comprised thorough literature search, focus group discussion, expert panel assessment and review. The validation process included pre‐test and pilot testing, data analysis of results, analysis of internal consistency and the development of the final version of the questionnaire. Participants selected represented main ethnicities, gender, levels of education and population type (urban/rural) in the Klang Valley area.ResultsThe items in the questionnaire has undergone various changes in structurally and linguistically. The final refined CAB questionnaire consists of 14 items cognitive (no items removed at pilot phase), nine items affective (one item removed at pilot phase) and five items behaviour (no items removed from pre‐test phase), respectively. Reliability analysis revealed Cronbach's alpha values were 0.700 (cognitive) and 0.606 (affective) which indicated good internal consistency after item reduction.ConclusionsThe developed questionnaire has proved its feasibility in assessing the Malaysian general population cognitive, affective and behavior regarding the household pets’ zoonotic diseases.

Combining qualitative and quantitative methodology to assess prospects for novel crops in a warming climate

ContextClimate change will alter the global distribution of climatically suitable space for many species, including agricultural crops. In some locations, warmer temperatures may offer opportunities to grow novel, high value crops, but non-climatic factors also inform agricultural decision-making. These non-climatic factors can be difficult to quantify and incorporate into suitability assessments, particularly for uncertain futures. ObjectiveTo demonstrate how qualitative and quantitative techniques can be combined to assess crop suitability with consideration for climatic and non-climatic factors. MethodsWe carried out a horizon scanning exercise that used Delphi methodology to identify possible novel crops for a region in south-west England. We show how the results of the expert panel assessment could be combined with a crop suitability model that only considered climate to identify the best crops to grow in the region. Results and conclusionsWhilst improving climate and crop models will enhance the ability to identify environmental constraints to growing novel crops, we propose horizon scanning as a useful tool to understand constraints on crop suitability that are beyond the parameterisation of these models and that may affect agricultural decisions. SignificanceA similar combination of qualitative and quantitative approaches to assessing crop suitability could be used to identify potential novel crops in other regions and to support more holistic assessments of crop suitability in a changing world.

Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study.

BackgroundThe low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care.ObjectiveThe aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction.MethodsThis mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals’ satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed.ResultsA total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application’s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were consistent to affirm they were very satisfied with the CDSS.ConclusionsThe CDSS was applicable in the context of primary health care settings in low-income regions, with good user satisfaction and potential to improve adherence to evidence-based practices.

The EBJIS definition of periprosthetic joint infection

AimsThe diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition.MethodsThis paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance.ResultsThis process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI.ConclusionThe definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice.Cite this article: Bone Joint J 2021;103-B(1):18–25.

Can Zoos Ever Be Big Enough for Large Wild Animals? A Review Using an Expert Panel Assessment of the Psychological Priorities of the Amur Tiger (Panthera tigris altaica) as a Model Species.

Simple SummaryThe reduction in space available to wild animals in zoos and aquariums is widely perceived to be detrimental to their welfare by scientists and the general public alike. Evidence suggests that naturally wide-ranging carnivores are more likely to suffer in captivity than those that travel less widely. Using the Amur tiger as a representative for wide-ranging species frequently held in zoos, an expert panel assessment was undertaken to identify psychological priorities in order to see how the negative welfare impacts of reduced ranging opportunities might be most effectively overcome. This assessment highlights that whilst reduced access to space may be central to compromised welfare for many species, there may be more effective strategies in safeguarding welfare than simply making captive habitats marginally bigger. Central to this for Amur tigers is providing appropriate mental stimulation rather than focusing only on behaviours linked to hunting. Various strategies intended to safeguard welfare are discussed for Amur tigers, which can also be considered for other wide-ranging species.The ecology of large, wide-ranging carnivores appears to make them vulnerable to conservation challenges in the wild and welfare challenges in captivity. This poses an ethical dilemma for the zoo community and supports the case that there is a need to reconsider prevailing management paradigms for these species in captivity. Whilst the welfare challenges wide ranging carnivores face have been attributed to reduced ranging opportunities associated with the decreased size of captive habitats, attempts to augment wild carnivore welfare in captivity typically focus on behaviours linked to hunting. Thus far, this has yet to result in the systematic elimination of signs of compromised welfare amongst captive carnivores. Here an assessment is carried out to identify the likely welfare priorities for Amur tigers, which, as one of the widest ranging terrestrial carnivores, serves as an excellent exemplar for species experiencing extreme compression of their ranging opportunities in captivity. These priorities are then used to consider novel strategies to address the welfare challenges associated with existing management paradigms, and in particular, attempt to overcome the issue of restricted space. The insights generated here have wider implications for other species experiencing substantive habitat compression in captivity. It is proposed here that the impact of habitat compression on captive carnivore welfare may not be a consequence of the reduction in habitat size per se, but rather the reduction in cognitive opportunities that likely covary with size, and that this should inform strategies to augment welfare.

Identifying potential threats to soil biodiversity.

A decline in soil biodiversity is generally considered to be the reduction of forms of life living in soils, both in terms of quantity and variety. Where soil biodiversity decline occurs, it can significantly affect the soils’ ability to function, respond to perturbations and recover from a disturbance. Several soil threats have been identified as having negative effects on soil biodiversity, including human intensive exploitation, land-use change and soil organic matter decline. In this review we consider what we mean by soil biodiversity, and why it is important to monitor. After a thorough review of the literature identified on a Web of Science search concerning threats to soil biodiversity (topic search: threat* “soil biodiversity”), we compiled a table of biodiversity threats considered in each paper including climate change, land use change, intensive human exploitation, decline in soil health or plastic; followed by detailed listings of threats studied. This we compared to a previously published expert assessment of threats to soil biodiversity. In addition, we identified emerging threats, particularly microplastics, in the 10 years following these knowledge based rankings. We found that many soil biodiversity studies do not focus on biodiversity sensu stricto, rather these studies examined either changes in abundance and/or diversity of individual groups of soil biota, instead of soil biodiversity as a whole, encompassing all levels of the soil food web. This highlights the complexity of soil biodiversity which is often impractical to assess in all but the largest studies. Published global scientific activity was only partially related to the threats identified by the expert panel assessment. The number of threats and the priority given to the threats (by number of publications) were quite different, indicating a disparity between research actions versus perceived threats. The lack of research effort in key areas of high priority in the threats to soil biodiversity are a concerning finding and requires some consideration and debate in the research community.

Is ward round participation by clinical pharmacists a valuable use of time and money? A time and motion study.

While the benefits of multidisciplinary ward round (WR) participation by clinical pharmacists have been demonstrated, it can be time-consuming. No previous studies have compared the specific benefits of WR participation and other clinical activities. To assess the clinical impact of different clinical pharmacist activities and analyse patterns of practice based on WR involvement and timing and significance of clinical interventions. In a prospective, observational time and motion study, clinical pharmacists servicing 6 unmatched specialty areas in a major quaternary public hospital were observed and their activities documented. Pharmacists' self-recorded interventions underwent expert panel assessment for significance and potential cost savings. Workflows and interventions were analysed for the 4 pharmacists involved in WRs ('WR pharmacists') during their time 'on' and 'off' rounds and for 2 pharmacists not involved in WRs ('non-WR pharmacists') using chi-square analyses. During 170 h of observation, 267 clinical interventions (53.9% minor, 40.1% moderate, 6.0% major) were recorded. WR pharmacists spent 24.3% of their time on rounds, and 64.8% of interventions were made during this time (intervention rates: 4.5/hour on WR vs. 0.8/hour off WR vs. 1.3/hour for non-WR pharmacists). Differences in WR and non-WR pharmacists' workflows were observed, although there was no difference in time spent on clinical/patient-centred activities (p = 0.70). WR involvement was associated with significantly quicker interventions (p < 0.001). All major interventions were made by WR pharmacists; 80% were made on rounds. Major interventions were estimated to have decreased lengths of stay, intensive care requirements and procedure costs. Clinical pharmacists focussed on patient-centred activities, regardless of WR involvement. Notwithstanding differences in the WR and non-WR specialty areas, WR participation was associated with more significant and timely interventions and potential cost savings. Coupled with the subjective benefits of WR participation observed, these findings support the potential value of clinical pharmacist WR participation.

Validity, reliability, and feasibility of the Brief School Needs Inventory: Evaluating educational risk for students with chronic health conditions.

Researchers have increasingly emphasized the need to include routine educational and cognitive screening in the care plan for youth with chronic health conditions. Prior to now, a screener did not exist to asses risk/need in education in the pediatric setting; thus, this research aimed to examine the validity, reliability, and feasibility of the newly developed Brief School Needs Inventory (BSNI), which stratifies a patients level of educational risk/need in the context of a health condition. The authors developed and pilot-tested two versions of an education risk screener utilizing a mixed-methods design, which included an expert panel review process and assessments for validity, reliability, and feasibility. Ninety-eight school-age survivors of an oncologic disease were assessed for educational risk. Participants were assigned to two groups and administered either the initial (n=48) or revised (n=50) version of the screener. The final version of the screener, the BSNI, predicted educational risk in congruence with school liaisons perceived risk assessment with 94% accuracy. Liaisons also reported confidence in the results of 98% of cases for the BSNI. Similarly, expert panel results for the BSNI indicated a high degree of interrater agreement and content validity. The BSNI was found to be a valid and reliable screener for predicting educational risk for youth with oncologic conditions; future studies will examine use of the screener within other pediatric chronic populations.

P104. Evaluating Aesthetic Outcome for Breast Reconstruction; a Delphi Consensus Process for Expert Panel Assessment as a Baseline for an Objective Aesthetic Assessment Tool

P104. Evaluating Aesthetic Outcome for Breast Reconstruction; a Delphi Consensus Process for Expert Panel Assessment as a Baseline for an Objective Aesthetic Assessment Tool