Adaptation Of Guidelines Research Articles

Adaptasi dan validasi Skala Stres Peran (Role Stressor Scale) dalam budaya Indonesia: Eksplorasi ekuivalensi konstruk dan analisis faktor konfirmatori

This study aims to conduct instrument adaptation of role stressor scale developed by Peterson et al. (1995) in the Indonesian language and culture. The research was performed in two studies. In study 1, the translation process and a construct equivalence test was carried out involving 6 translators, 3 expert reviewers, and 10 laypeople for cognitive debriefing. Study 2 involved 232 subjects of workers in Indonesia and examined the validity using confirmatory factor analysis. The entire adaptation process refers to the procedures of the 2016 International Test Commission (ITC) Guidelines for Test Adaptation. The CFA results showed that the measurement models of the role stressor instrument fitted the 3 factors model. Overall, this study showed that the Indonesian version of the role stressor instrument is valid and reliable, therefore, it can be utilized to measure the role stressors in Indonesia

Adaptasi dan validasi Skala Stres Peran (Role Stressor Scale) dalam budaya Indonesia: Eksplorasi ekuivalensi konstruk dan Confirmatory Factor Analysis

This study aims to conduct instrument adaptation of role stressor scale developed by Peterson et al. (1995) in the Indonesian language and culture. The research was performed in two studies. In study 1, the translation process and a construct equivalence test was carried out involving 6 translators, 3 expert reviewers, and 10 laypeople for cognitive debriefing. Study 2 involved 232 subjects of workers in Indonesia and examined the validity using confirmatory factor analysis. The entire adaptation process refers to the procedures of the 2016 International Test Commission (ITC) Guidelines for Test Adaptation. The CFA results showed that the measurement models of the role stressor instrument fitted the 3 factors model. Overall, this study showed that the Indonesian version of the role stressor instrument is valid and reliable, therefore, it can be utilized to measure the role stressors in Indonesia

Translation, cross-cultural adaptation, and validation of the Italian version of the anterior cruciate ligament\u2013return to sport after injury (ACL-RSI) scale and its integration into the K-STARTS test

BackgroundThe timing of a return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) represents a major subject of debate in sports medicine practice. Recently, the Knee Santy Athletic Return to Sport (K-STARTS) composite test was validated. This consists of a battery of physical tests and a psychological evaluation using the anterior cruciate ligament–return to sport after injury scale (ACL-RSI). This study aimed to translate the ACL-RSI and K-STARTS from English to Italian and determine the scale’s reliability and validity in an Italian context.MethodsThe translation and cultural adaptation process was performed according to the guidelines for the cross-cultural adaptation of self-report measures. The patients were asked to fill an anonymized online form created for this purpose that included the KOOS, the Lysholm, the IKDC-SKF, and the Italian translation of the ACL-RSI (ACL-RSI-It). After 1 week, the attendees were asked to repeat the ACL-RSI-It to investigate the test–retest reliability.ResultsThe final study population comprised 115 patients who underwent ACLR, with a mean follow-up of 37.37 ± 26.56 months. The ACL-RSI-It showed axcellent internal consistency (Cronbach’s α = 0.963), reliability (test–retest ICC = 0.966), and good construct validity (positive correlations with the other scales were above 75%).ConclusionsThe ACL-RSI-It is valid, reliable, and comparable to the original English version of the questionnaire for Italian-speaking patients. It can be used to assess the psychological readiness of patients for a RTS after primary and unilateral ACLR, and can be integrated into the Italian K-STARTS test.Level of evidenceLevel II.

Adaptation Frameworks for Clinical Guidelines and Proposing a Framework for Iran: A Review and Comparative Study.

Background: Clinical Practice Guidelines (CPGs) can be adapted to local conditions to prevent any resources from being wasted. Adaptation of CPGs implies a systematic view of developed guidelines through maintaining evidence-based principles in order to find the ones most relevant with patients' conditions and its integration with the cultural and regional requirements of the target population and health system facilities. The main purpose of the study was to describe, interpret and compare different frameworks for adaptation of clinical guidelines and proposing a comprehensive framework for Iran. Methods: This study was based on a review and comparative analysis of adaptation frameworks of CPGs. Initially, all adaptation frameworks were collected by systematic search in the literature. We searched the following electronic databases: PubMed, Scopus, Trip Database, Science Direct, and Google Scholar. Then, based on the stages of the comparative study, frameworks were described, interpreted, juxtaposed, and compared. Finally, a comprehensive framework for the adaptation of clinical guidelines was proposed by consulting a panel of experts. Results: Our literature search resulted in 26 frameworks, of which 18 were potentially relevant. Based on inclusion/exclusion criteria, nine frameworks were included in the study and have been described, interpreted, and compared. The proposed comprehensive framework for the adaptation of clinical guidelines consists of ten main steps. Conclusion: The proposed comprehensive framework is an appropriate tool for the adaptation of clinical guidelines in Iran that can be used in other countries. However, further validation of the framework requires case studies and expert consultation to determine its application to the adaptation of clinical guidelines.

Adaptation of Practice Guidelines to Prevent Functional Decline in Hospitalized Elderly in Iran.

In Iran, many efforts have been made to improve the Quality of Life (QOL) of the elderly; however, despite the efforts made, there is no practice guideline based on the consensus of experts that can be used to prevent the functional decline of hospitalized elderly. Accordingly, the present study was conducted with the aim of adaptation of a practice guideline to prevent the functional decline of hospitalized elderly. This study is a developmental study based on the adaptation steps of the practice guideline. First, a search was conducted in 8 databases. The only practice guideline that met the inclusion criteria was then evaluated by the research team using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) tool. After content analysis of this guideline, the recommendations were categorized in the Canadian Senior Friendly Care (sfCare) Framework and according to the community conditions. Relevant evidence was used to supplement the content. The draft practice guideline was evaluated and modified in two expert panels through the RAND technique. The categorized recommendations were developed in the eight chapters of introduction to the prevention of functional decline of the elderly, general practice guideline, organizational support, care processes, physical ecology, emotional and behavioral environment, ethics in care, and evaluation of function. To prevent functional decline in hospitalized elderly individuals according to the adaptive practice guideline, the hospital and health team need to be aware of support, care processes, and effective function appraisal to be able to provide care with coherent and coordinated solutions.

Guidelines for optimal design of radio-frequency in-vacuum coaxial transmission line for mirror cleaning service in ITER diagnostics

Several optical diagnostics in the ITER fusion reactor make use of big mirrors which are placed within the ITER vacuum vessel (VV), and therefore cannot have high accessibility. Plasma deposits developing on these mirrors may hinder the reflectivity of the mirror themselves, requiring a remote cleaning operation. The radio-frequency (RF) discharge mirror cleaning service operates a plasma discharge in the vicinity of the mirror, eroding the deposit layer and therefore cleaning the mirror remotely. In order to achieve this, RF power needs to be sent from outside the VV to the mirror, using a transmission line. Very stringent design requirements are applicable to the design of this RF line, such as vacuum compatibility, high power handling, low losses, overall matching, no cable over-heating, etc. This paper analytically addresses the design optimization of the RF mirror cleaning transmission line, taking into account ITER requirements, in order to give robust guidelines for the possible ad-hoc cable design adaptation that is to be undertaken case-by-case. The design guidelines are based on underlying transmission line theory, from which a set of design equations are drawn. The optimal design is achieved using design optimization considerations in the available design space. These guidelines are considered to be a useful design tool for optical diagnostics requiring mirror cleaning operation, and are aimed at harmonising the transmission line design procedures across the different cases.

The Validity and Reliability of the Serbian Version of the Smartphone Addiction Scale-Short Version.

Background and Objectives: Smartphone use has been rapidly increasing worldwide, which has brought possible smartphone addiction into the focus of research. In order to identify potential smartphone addicts, several scales were developed to assess smartphone addiction. Among them, the Smartphone Addiction Scale was frequently used. The study aimed to test the reliability and validity of the Serbian version of the SAS-SV and estimate smartphone addiction prevalence among medical students. Materials and Methods: The study was conducted in December 2018 on a convenience sample of 323 third-year medical students. The cross-cultural adaptation was performed following the well-established guidelines for cross-cultural adaptation of self-reported measures. Exploratory factor analysis was used to examine the structure of the questionnaire. Factor extraction was performed by principal component analysis with Varimax rotation. For test–retest reliability, students completed the questionnaire twice within seven days. Results: The Serbian version of the SAS-SV showed good internal consistency (Cronbach’s alpha = 0.89) and excellent reliability for test–retest scores (ICC = 0.94, 95% CI = 0.92–0.96). Factor analysis supported the extraction of one factor, which explained 51.538% of the variance. To explore convergent validity furthermore, the SAS-SV was correlated with time indicators of smartphone use. According to cut-off values for the SAS-SV score, 19.5% of students could be regarded as “addicted”, and often spent more time on smartphones and social networks on working days and weekends than “not addicted” students. Conclusions: The Serbian version of the SAS-SV is a reliable and valid instrument for detecting smartphone addiction among university students. Further research on this issue is encouraged to enable a better understanding of this ever-increasing public health issue.

Dental Setting Design Guideline Adaptation in the COVID-19 Pandemic in Northern Thailand

Abstract Criteria for dental clinic design in Thailand are recommended by the Design and Construction Division, Department of Health Service Support, Ministry of Public Health. During the Coronavirus disease pandemic (COVID-19), there were several procedures regarding dental operations and infection prevention suggested by researchers and international health organizations, including the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO). However, some criteria still have discrepancies in practice, since they have no definite correct answers. This research describes the dental clinic redesign for COVID-19 control using dental setting design guidelines in both Thailand and foreign countries. The re-designed planning of the clinic was reviewed by dentists, engineers, and physicians. The issue of concern is the cost and the design’s value in the disinfection of facilities. Significant proven methods of disinfection are used in this paper, including functional re-consideration, negative air pressure rooms, filters, Ultra-Violet devices, and ozonators. This research contributes to the literature by providing a functional diagram for dental clinic adjustment in the COVID-19 situation. The 12 air changes per hour (ACH) ventilation combined with management protocol ensures that patients’ safety is a priority and provides a feasible option for adaptation in a developing country such as Thailand. Keywords: Architectural design, COVID-19, Dental clinic, Guideline, Planning

Bronchiolitis diagnosis, treatment, and prevention in children: an evidence-based clinical practice guideline adapted for the use in Egypt based on the \u2018Adapted ADAPTE\u2019 Methodology

BackgroundThe presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’.ResultsThe Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settingsConclusionOur experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.

Method of private algorithms of physician actions for adaptation of clinical guidelines to medical practice

<h3></h3> Современное здравоохранение — высокоразвитая система, в которой лечащий врач имеет огромный арсенал диагностических и лечебных средств, помощников и консультантов, а основой всех достижений, открытий и постоянного развития является медицинская наука. В таких условиях задача врача — найти уже известные медицине синдромы у конкретного пациента, сформулировать диагноз и назначить лечение, эффективность которого уже доказана. Для достижения данной задачи используются стандартизованные подходы к ведению больных, задачи этих подходов — обеспечить единообразие врачебных действий и максимальное качество медицинской помощи, защитить медицинскую практику от врачебных неточностей и ошибок, устранить влияние субъективизма в лечении больного. Однако решение этих задач достигается далеко не всегда, так как клинические протоколы обычно используются в качестве средства контроля врача в тех ситуациях, когда ошибка уже совершена, но не в качестве инструмента поддержки принятия врачебных решений, когда ошибку можно не допустить. Предмет данной статьи — критический взгляд на имеющиеся клинические рекомендации лечения когнитивных расстройств у лиц пожилого и старческого возраста, обоснование их слабой применимости как инструмента для унификации действий врача-психиатра. В качестве решения предлагается алгоритмический подход ведения пациентов (метод частных алгоритмов действий врача, предложенный проф. В.М. Тавровским), который подразумевает создание и использование алгоритмической модели действий врача в медицинской практике.

Adaptation of ISTH Guidelines on Vaccine Induced Thrombocytopenic Thrombosis to Clinical Practice and Analysis of Patient Cases

The International Society on Thrombosis and Haemostasis (ISTH) published guidelines for the diagnosis and treatment on Vaccine-Induced Thrombotic Thrombocytopenia (VITT) in April of 2021. Guidelines were inclusive of those persons at risk for VITT, screening, initial evaluation, and treatment. A study was conducted to evaluate case reports of patients with VITT in regard to diagnostic testing and treatment options as recommended by the ISTH. Ten case reports were identified employing the PubMed database where VITT was diagnosed in patients who received the Astra Zeneca vaccine. The average fibrinogen level was 166.9 mg/dL, the average platelet count was 47.2 x 10 9 /L, and the average D-Dimer level was 39.3 mg/L. All cases of VITT exhibited a positive anti-PF4 assay. Anticoagulants administered to patients varied across cases however all patients received IVIG to increase platelet counts in patients. A one sample t test was performed to ascertain if statistical significance was present comparing average fibrinogen, platelet count, and D-Dimer levels to normal values. Statistical significance was found with platelet count and D- Dimer parameters. Organizations like the ISTH has provided timely therapeutic information and guidance to clinicians in combating SARS-CoV2 related clinical manifestations. These findings serve to illuminate the nexus between ISTH VITT guidelines and clinical adaptation.

Arabic version of the anterior cruciate ligament return to sport index: Translation and cross-cultural adaptation

Purpose: Several factors influence the decision to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). The literature revealed a link between psychological factors and RTS rates following ACL injury. The anterior cruciate ligament return to sport index (ACL-RSI) scale was created to assess the psychological impact of an ACL injury. A rigorous process of cross-cultural adaptation and validation is required to achieve equivalence between the original publication and the target version of the scale to administer the ACL-RSI to Arabic speakers. The purpose of this research is to translate and culturally adapt (ACL-RSI) for Arabic people who have ACLR.Materials and Methods: Translation and backward translation of the English version of the ACL-RSI were performed in accordance with the guidelines for cross-cultural adaptation. Following translation, 105 ACLR patients were recruited to complete Arabic version of RAND-36-item health survey, Arabic version of the knee injury and osteoarthritis outcome score and visual analog scales, along with the Arabic (ACL-RSI) scale. We looked at test–retest reliability, internal consistency, construct validity, and content validity.Results: The internal consistency was excellent (Cronbach's = 0.94). The test–retest reliability was high, with an intraclass correlation coefficient (ICC) of 0.92 and a standard error of measurement of 4.41. There was a good construct validity with no floor or ceiling effects, as well as good convergent and divergent validity.Conclusions: This study confirmed that the Arabic (ACL-RSI) scale has good measurement properties, demonstrated that this instrument is an excellent tool to evaluate psychological factors for Arabic patients with ACLR.

Korean Clinical Imaging Guidelines for Justification of Diagnostic Imaging Study for COVID-19

흉부영상의 적절한 활용을 위해 한국형 코로나바이러스 감염증(이하 COVID-19) 흉부영상 진단 시행 가이드라인을 개발하였다. 8가지 문장형 핵심 질문을 선정하고, 근거기반 임상영상 가이드라인 수용개작 방법론에 의거하여 권고안을 작성하였다. 권고 내용은 다음과 같다. COVID-19 확진자와 접촉한 증상이 없는 사람에 대하여 COVID-19의 진단을 위하여 흉부영상검사(흉부X선검사 또는 CT)를 사용하지 않는 것이 적절하다. COVID-19가 의심되는 증상이 있으나 reverse transcription polymerase chain reaction 검사를 이용할 수 없는 경우 흉부영상검사 사용을 고려할 수 있다. COVID-19가 확인된 환자에게 병원 입원을 결정하기 위하여 임상 평가 및 검사실 검사와 함께 흉부영상검사를 고려할 수 있다. COVID-19 입원 환자의 증상 경중 및 위험요인의 유무에 따라 흉부영상검사를 고려할 수 있으며, 치료 방법을 결정하거나 수정하는데 이용할 수 있다. COVID-19 환자에서 객혈 또는 폐색전증이 의심되는 경우 CT 혈관조영술을 시행할 수 있다. 증상이 호전된 COVID-19 환자의 퇴원 결정을 하는데 흉부영상검사를 사용하지 않는 것이 적절하다. COVID-19에서 회복된 환자를 추적 검사할 때 폐 기능 장애가 있는 환자에서 치료 가능한 폐질환과 구별하기 위해 흉부영상검사를 고려할 수 있다.

Australian guideline on management of diabetes-related foot infection: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease.

BackgroundDiabetes-related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up-to-date evidence-based guidelines to ensure optimal management of patients with diabetes-related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence-based guideline for people with a diabetes-related foot infection.MethodsFollowing Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation.ResultsOf 36 original diabetes-related foot infection IWGDF sub-recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub-recommendations’ intended population. One sub-recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence-based sub-recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes-related foot infection in Australia. Additionally, we incorporated these sub-recommendations into two clinical pathways to assist Australian health professionals to implement these evidence-based sub-recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/.ConclusionsA new national guideline for the diagnosis and management of people with diabetes-related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence-based framework to ensure best management of individuals with diabetes-related foot infections across Australia and highlight considerations for implementation and monitoring.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13047-022-00545-4.

Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis.

Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures. We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA. We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions. Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors' feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it. This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.

Spanish version of the Frontotemporal Dementia Knowledge Scale: adaptation and validation.

Frontotemporal dementia (FTD) is a neurodegenerative disease and is one of the most common causes of dementia in people under 65. There is often a significant diagnostic delay, as FTD can be confused with other psychiatric conditions. A lack of knowledge regarding FTD by health professionals is one possible cause for this diagnostic confusion. The aim of this study was to adapt and validate the Frontotemporal Dementia Knowledge Scale (FTDKS) in Spanish. A translation was done, following cross-cultural adaptation guidelines, which consisted of forward translation, blind back translation, and an analysis by a committee of experts. For the present study, 134 professionals from different health areas responded the Spanish version of the FTDKS. The statistical analysis was performed using R version 4.0.0 "Arbor day" and the Psych, sjPlot packages. The Spanish version of the FTDKS had good reliability and internal consistency (Cronbach alpha 0.74.). The sample's mean score was 19.78 (range = 4-32, SD 6.3) out of a maximum of 36 points. The results obtained show that the Spanish version has good psychometric properties. The FTDKS is applicable in our environment and can be a useful tool to evaluate the knowledge of health professionals regarding frontotemporal dementia.

Cultural Adaptation and Testing of the Italian Version of the Edmonton Functional Assessment Tool-2 (EFAT2-I).

Physiotherapy in Palliative Care (PC) is effective in the management of a series of respiratory, circulatory and motor symptoms, and often has a positive impact on the patient's mood. The Edmonton Functional Assessment Tool (EFAT) is the only existing validated tool specifically designed for functional assessment in PC, and its use has been recommended in clinical practice. To date, no Italian version of the tool has been validated. The aim of this study was to translate, cross-culturally adapt, and evaluate the psychometric properties of the Italian version of the EFAT2. After receiving formal permission from the author, Beaton guidelines for cross-cultural adaptation were followed, namely: (1) forward translation; (2) a multidisciplinary focus group (including 4 physiotherapists, 1 physician, 3 nurses, 1 occupational therapist, 1 psychologist) to assess semantic, idiomatic, experiential, and conceptual equivalence; (3) backward translation. The Content Validity Index (CVI) was used to assess content validity of the tool. Construct and concurrent validity were also evaluated. To evaluate the reliability of the EFAT2-I, reliability was measured using Cronbach alfa, item-total correlation, and Cohen's Kappa. 119 patients admitted to a Palliative Care Unit (Italy) agreed to participate in the study. The EFAT2-I mean score was 11.3, ranging from 0 to 30. Very good CVI scores were achieved, both in terms of single item validity (I-CVI) and of whole scale validity (S-CVI). Positive results were obtained from construct, concurrent validity assessment and measures of reliability. The EFAT2-I showed good psychometric properties and can be used as a rehabilitation assessment tool in palliative care settings. The validation of the Italian version will allow comparison of different centres and palliative care facilities on national and international levels.

Competition and climate influence in the basal area increment models for Mediterranean mixed forests

Competition plays a key role controlling tree growth in mixed forests. Contrary to monocultures, quantifying species mixing influence on tree growth suppose a challenge since the presence of two or more species requires to estimate the degree of intra- and inter-specific competition among trees. Moreover, it is well known that aridity can also influence tree growth, especially in the Mediterranean Basin. In the present context of climate change, it is essential to take into account species mixing and aridity uncertainty in the design of sustainable management guidelines for Mediterranean mixed forests. To achieve that, data from Spanish National Forest Inventory was used in this study to fit new mixed-effects basal area increment (BAI) models for 29 two-species compositions in Spain. A wide range of different competition structures (intra-specific, inter-specific, size-symmetric and size-asymmetric) and aridity conditions (in terms of the De Martonne Index) were included and tested into the BAI models. Parameter estimations were obtained for all possible species, mixtures and combinations by Maximum Likelihood (ML). Models with all the coefficients being significant (p < 0.05) were first selected. Among these models, we used Akaike Evidence Ratios for selecting the best one by species for each mixture. The best model for each species and mixture was used to analyze the competition and climatic influence on tree growth. Regarding competition influence, a common trend among mixtures was found with higher productivity in mixed than pure stands, suggesting that BAI values may increase with the increment of species diversity. Based on intra and inter-specific competition indexes, competition seemed to be the most representative biological interaction in conifer-conifer mixtures, since neutralism and facilitation may occur more frequently in conifer-broadleaved and broadleaved-broadleaved mixtures. Our findings also suggested that tree growth may be significantly limited by arid conditions, excepting for Pinus halepensis and Pinus pinea. Our rigorous modelling approach successfully uncovered not only possible mixing effect among various species but also help us to understand the effect of aridity on tree growth. Thus, models presented in this study can be used in the design and implementation of management and adaptation guidelines under future climate change scenarios.

Primary hyperparathyroidism in adults-(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society.

To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community.

Primary hyperparathyroidism in adults-(Part II) surgical management and postoperative follow-up: Position statement of the Endocrine Society of Australia, The Australian & New Zealand Endocrine Surgeons, and The Australian & New Zealand Bone and Mineral Society.

To develop evidence-based recommendations to guide the surgical management and postoperative follow-up of adults with primary hyperparathyroidism. Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing eight key questions. Diagnostic imaging does not determine suitability for surgery but can guide the planning of surgery in suitable candidates. First-line imaging includes ultrasound and either parathyroid 4DCT or scintigraphy, depending on local availability and expertise. Minimally invasive parathyroidectomy is appropriate in most patients with concordant imaging. Bilateral neck exploration should be considered in those with discordant/negative imaging findings, multi-gland disease and genetic/familial risk factors. Parathyroid surgery, especially re-operative surgery, has better outcomes in the hands of higher volume surgeons. Neuromonitoring is generally not required for initial surgery but should be considered for re-operative surgery. Following parathyroidectomy, calcium and parathyroid hormone levels should be re-checked in the first 24 h and repeated early if there are risk factors for hypocalcaemia. Eucalcaemia at 6 months is consistent with surgical cure; parathyroid hormone levels do not need to be re-checked in the absence of other clinical indications. Longer-term surveillance of skeletal health is recommended. This position statement provides up-to-date guidance on evidence-based best practice surgical and postoperative management of adults with primary hyperparathyroidism.