High Consensus Research Articles

Content validity of the Handwriting Assessment Battery (HAB-v6) for use with adults with acquired brain injury (ABI): An international Delphi study.

Occupational therapists are responsible for assessing adult handwriting following stroke and other acquired brain injuries. The Handwriting Assessment Battery (HAB) was developed for use as a diagnostic assessment tool and outcome measure. The current study aimed to investigate the content validity of version six of the Handwriting Assessment Battery (HAB-v6). A three round, online-Delphi study was conducted with an international group of expert clinicians and academics experienced in adult handwriting assessment and/or retraining. In round one, participants rated the importance of HAB-v6 domains and the six subtests and recommended modifications to administration and/or scoring procedures. In rounds two and three, participants were re-presented with several HAB-v6 domains where consensus was not reached and rated the importance of suggested modifications from round one. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using content analysis. Consumers and community members were not involved in this study. Fifteen participants from the United States of America, the United Kingdom, Canada, Israel, and Australia completed round one of the Delphi, 11 participants completed round two, and 15 participants completed round three. In round one, high consensus (>70% participant agreement) was achieved regarding the importance of 5/6 subtests of the HAB-v6; suggestions were made to modify three subtests and add new subtests. In round two, high consensus (>70% agreement) was achieved on three proposed revisions: adding two subtests and modifying instructions for the copying subtest. In round three, low consensus regarding inclusion of the dots drawing subtest remained. Based on the Delphi process, the content of five of six subtests of the HAB-v6 are valid for use by occupational therapists and others to measure adult handwriting performance, with the exception of the dots subtest, where consensus was not reached.

Towards developing a "baby translator" - An exploration of how infant appetite cues are understood.

Caregivers' feeding practices shape their child's eating patterns and subsequent health. Research shows that sensitive feeding is linked to healthy development and self-regulation but depends on caregiver responsiveness to infant needs and appetite cues. Responsive feeding (RF) is influenced both by characteristics of the caregiver and expressiveness of the infant. To investigate how infant communication is understood and whether recognition of appetite cues is associated with the viewer's eating traits, mental health and wellbeing, an online study was conducted. Participants (N=200) aged 18-55 years were recruited in June 2022 via Prolific. Recognition of infant appetite cues was measured by participant responses to video clips of infants (N=10) being fed during mealtimes (sampled at the start and end of a meal). Caregiver satiety responsiveness, intuitive eating, alexithymia, autism spectrum disorder, and mental health were assessed by validated questionnaires. Results showed a high consensus in identifying infant appetite cues, with no significant correlations with parenting status, eating traits or mental health, except for one subscale of alexithymia - Difficulty Describing Feelings (r=-.15, p=.03). Open-ended descriptions of mealtime cues showed that positive affect was observed early in the meal and more negative affect at the end of the meal. Infant cues signalling interest in eating were generally well recognised and were not significantly correlated with individual differences of the viewer except alexithymia. Further research to assess the association between alexithymia, responsiveness to infant communication cues and RF practices is warranted.

Ventral Rectopexy: An International Expert Panel Consensus and Review of Contemporary Literature.

Ventral rectopexy has become increasingly utilized in the surgical management of rectal prolapse. There is a need for a contemporary evaluation of the role of the procedure and description of its use in clinical practice. To create an international consensus on ventral rectopexy. An expert panel undertook a scoping review of the literature to identify subject domains of interest. Literature reviews were completed for each domain with subsequent development of evidence-based and practice-based statements. These were compiled and reviewed by the group over a total of nine meetings. Once statements were confirmed, supportive text was finalized, and an anonymous vote was completed using REDCap to record consensus. An international expert panel comprising colorectal surgeons who perform ventral rectopexy in a high-volume center. Statements and associated expert consensus. Eleven experts identified ten domains for review: indications, contraindications, assessment and planning, consent, operative details, prostheses, complications, follow-up, recurrence and reoperative surgery and specific considerations. After round-table review, there were 17 resultant statements for consideration. Experts agreed unanimously with the thirteen of the statements and their accompanying text, with different experts disagreeing each with four statements (91% consensus each). Paucity of high-quality data. This international group developed 17 statements with high consensus. These statements provide an up-to-date summary of the literature, identify key areas for research development and a reference point for colon and rectal surgeons who undertake ventral rectopexy as part of their practice. See Video Abstract.

Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study.

Combining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach toconventional external beam radiotherapy(cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications. A modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%). At least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine. We report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.

Expert Consensus on Developing Information and Communication Technology-Based Patient Education Guidelines for Rheumatic Diseases in the Korea.

This study aimed to identify key priorities for the development of guidelines for information and communication technology (ICT)-based patient education tailored to the needs of patients with rheumatic diseases (RDs) in the Republic of Korea, based on expert consensus. A two-round modified Delphi study was conducted with 20 rheumatology, patient education, and digital health literacy experts. A total of 35 items covering 7 domains and 18 subdomains were evaluated. Each item was evaluated for its level of importance, and the responses were rated on a 4-point Likert scale. Consensus levels were defined as "high" (interquartile range [IQR] ≤ 1, agreement ≥ 80%, content validity ratio [CVR] ≥ 0.7), "Moderate" (IQR ≥ 1, agreement 50-79%, CVR 0.5-0.7), and "Low" (IQR > 1, agreement < 50%, CVR < 0.5). Strong consensus was reached for key priorities for developing guidelines in areas such as health literacy, digital health literacy, medical terminology, user interface, and user experience design for mobile apps. Chatbot use and video (e.g., YouTube) also achieved high consensus, whereas AI-powered platforms such as ChatGPT showed moderate-to-high agreement. Telemedicine was excluded because of insufficient consensus. The key priorities identified in this study provide a foundation for the development of ICT-based patient education guidelines for RDs in the Republic of Korea. Future efforts should focus on integrating digital tools into clinical practice to enhance patient engagement and improve clinical outcomes.

Perspectives of Policymakers on Barriers to and Enablers of the Uptake of Cardiac Rehabilitation in Saudi Arabia: A Qualitative Study.

This study aimed to identify the barriers to and enablers of secondary prevention care and cardiac rehabilitation (CR) utilization by patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) from the perspective of policymakers. A qualitative study involving an interpretive descriptive design was conducted through recorded semistructured interviews with key decision-makers in cardiology care in Saudi Arabia. The analysis was guided by the updated Consolidated Framework for Implementation Research (CFIR), which informed the resulting themes. Interviews were conducted with nine key decision-makers: four directors of major cardiac centers, four heads of cardiac rehabilitation units, and one president of a specialized cardiac society. Data coding identified 16 CFIR constructs as barriers, with seven prioritized by the participants. The most frequently cited barriers included lack of CR facilities, shortage of trained staff, and insufficient knowledge of CR among cardiologists. Seventeen constructs emerged as enablers to aid in overcoming these challenges, with nine receiving high consensus among policymakers. Key enablers included implementing alternative models, such as home-based programs; enhancing cardiologists' understanding of CR benefits; and involving higher authorities for support. This study highlights the significant barriers to CR utilization and proposes solutions to facilitate the implementation of these programs from the perspective of healthcare leaders. Successful implementation requires improved communication within institutions, collaboration with the broader healthcare system, and engagement with other stakeholders, such as the private sector, to expand access and ensure comprehensive service delivery.

Through the Citizen Scientists&amp;rsquo; Eyes: Insights into Using Citizen Science with Machine Learning for Effective Identification of Unknown-Unknowns in Big Data

In the era of rapidly growing astronomical data, the gap between data collection and analysis is a significant barrier, especially for teams searching for rare scientific objects. Although machine learning (ML) can quickly parse large data sets, it struggles to robustly identify scientifically interesting objects, a task at which humans excel. Human-in-the-loop (HITL) strategies that combine the strengths of citizen science (CS) and ML offer a promising solution, but first, we need to better understand the relationship between human- and machine-identified samples. In this work, we present a case study from the Galaxy Zoo: Weird &amp; Wonderful project, where volunteers inspected ~200,000 astronomical images—processed by an ML-based anomaly detection model—to identify those with unusual or interesting characteristics. Volunteer-selected images with common astrophysical characteristics had higher consensus, while rarer or more complex ones had lower consensus. This suggests low-consensus choices shouldn’t be dismissed in further explorations. Additionally, volunteers were better at filtering out uninteresting anomalies, such as image artifacts, which the machine struggled with. We also found that a higher ML-generated anomaly score that indicates images’ low-level feature anomalousness was a better predictor of the volunteers’ consensus choice. Combining a locus of high volunteer-consensus images within the ML learnt feature space and anomaly score, we demonstrated a decision boundary that can effectively isolate images with unusual and potentially scientifically interesting characteristics. Using this case study, we lay important guidelines for future research studies looking to adapt and operationalize human-machine collaborative frameworks for efficient anomaly detection in big data.

Establishing Gold Standard Assessment for Young Onset Dementia: A Modified E-Delphi Consensus Survey Based in Australia.

A modified e-Delphi was used to explore subject-expert consensus to create a minimum & gold standard assessment for young-onset dementia (YOD) for clinicians based in Australia. A list of 72 statements adapted from an international study, O'Malley etal. 2020, was included in an online survey that was distributed to clinical experts in the field. Respondents were asked to rate statements on a Likert scale of 1-7 (ranging from '1' being 'not at all important' to '7' being 'absolutely essential'). The mean and standard deviation (SD) were calculated for each statement. Full consensus, designated as 'minimum standard' was defined as 100% of respondents rating statement(s) as 'absolutely essential' (7) or 'very important' (6), while high consensus, designated as 'gold standard' was defined as 80% (16 out of 20) of respondents rating statement(s) as either 'absolutely essential' or 'very important' in the assessment for YOD. The statements that had overall mean scores below 6 did not reach consensus. Full consensus was achieved on 13 statements ('minimum standard'), 80% consensus was reached on 37 statements ('gold standard'), and no consensus was reached on 35 statements. Most clinicians agreed that the diagnosis of YOD is largely based on history, with less emphasis placed on aspects of the examination and investigations conducted. History of first-degree family members with YOD and any past psychiatric symptoms were reported to be potential triggers for a YOD diagnosis. There was agreement that the routine dementia blood screen and baseline structural imaging should be a part of the diagnostic assessment criteria of YOD. Comparisons were made between the results of this Australian-based study to the original international study, which found that 55/72 statements (76%) were similarly rated. Based on the results of this modified e-Delphi study, full and high consensus was reached on 37 statements which were comparable to results in an international study. This suggests that in general, clinicians in Australia have agreement with international experts about what is important for the assessment and diagnosis of YOD. Because the statements used in the international study were used in this Australian study, consideration of what issues may be specific to the Australian context such as YOD in Aboriginal Australians and rurality may have not been ascertained. In spite of this, these results may be useful to aid clinicians in their assessment for YOD but consensus statements may change over time as development in knowledge and available tests increases.

Generalizability of consensus regarding standardized letters of evaluation competitiveness: A validity study in a national sample of emergency medicine faculty.

Standardized letters of evaluation (SLOEs) are an important part of residency recruitment, particularly given the limited availability of other discerning factors in residency applications. While consensus regarding SLOE competitiveness has been studied within a small group of academic faculty, it remains unexplored how a more diverse group of letter readers interpret SLOEs in terms of competitiveness. A sample of 50 real SLOEs in the new SLOE format (2022 eSLOE 2.0) were selected to match the national rating distribution and anonymized. These SLOEs were ranked in order of competitiveness by 25 faculty members representing diverse demographics, geographic regions, and practice settings. Consensus levels were assessed using previously defined criteria and compared to prior results using a cutoff of ±10% to define a significant difference in consensus levels. Two models were tested to determine their ability to predict consensus rankings: a point-based system and a linear regression model. Faculty consensus in this diverse cohort was slightly below the level measured among academic emergency medicine faculty in the prior study, though no differences were greater than the ±10% cutoff. Prediction models also performed similarly to a previous study except at the tight level of agreement, where consensus was stronger in this study compared to previous results. There is greater consensus among faculty at academic institutions than at community institutions, and years of experience was not correlated with higher consensus. The degree of consensus regarding competitiveness using real SLOEs was similar in this diverse national sample compared to a prior study in a smaller and more homogenous group ranking mock SLOEs. Consensus ranks were predicted with good accuracy using both the point system and the regression model.

Influence of Information and Communication Technology-Based Training on Livestock Production Efficiency in Bwari Area Council, Abuja

This study examines the influence of ICT-based training on livestock production efficiency among farmers in Bwari Area Council, with a focus on socio-economic characteristics, ICT knowledge post-training, productivity impact, effectiveness factors, and preferred ICT tools. Using a multi-stage sampling approach, 250 livestock farmers were selected. Primary survey were collected and analyzed with descriptive and inferential statistics to meet the research objectives. The socio-economic analysis reveals a farming population primarily composed of middle-aged individuals (mean age 41.7 years), with 72% male and 64% married. Education levels varied, with 38% having secondary education. Post-training evaluations indicated that 80% of farmers were proficient in SMS alerts for disease management, 72% confident in mobile applications, and 70% experienced productivity gains using ICT tools. ICT training was found to positively impact areas like increasing awareness of government programs and subsidies (3.4), scheduling vaccinations accurately (3.3), disease prevention (3.2), and record-keeping (3.1) and feeding practices (3.0), preparing and storing livestock feeds (2.9), etc. Logit regression analysis identified significant factors influencing ICT effectiveness, including educational level (p=0.010), cooperative membership (p = 0.012), household size (p=0.032), contact with extension agents (p=0.011), and access to credit (p = 0.002), while gender, marital status, and farm size were non-significant. Kendall’s Coefficient of Concordance analysis ranked mobile applications, SMS alerts, and radio broadcasts as the most effective ICT tools, demonstrating high consensus. Partnerships with telecommunication companies and government initiatives is recommended to address connectivity barriers, ensuring that all farmers can fully utilize digital tools in their livestock management practices.

Influence of Information and Communication Technology-Based Training on Livestock Production Efficiency in Bwari Area Council, Abuja

This study examines the influence of ICT-based training on livestock production efficiency among farmers in Bwari Area Council, with a focus on socio-economic characteristics, ICT knowledge post-training, productivity impact, effectiveness factors, and preferred ICT tools. Using a multi-stage sampling approach, 250 livestock farmers were selected. Primary survey were collected and analyzed with descriptive and inferential statistics to meet the research objectives. The socio-economic analysis reveals a farming population primarily composed of middle-aged individuals (mean age 41.7 years), with 72% male and 64% married. Education levels varied, with 38% having secondary education. Post-training evaluations indicated that 80% of farmers were proficient in SMS alerts for disease management, 72% confident in mobile applications, and 70% experienced productivity gains using ICT tools. ICT training was found to positively impact areas like increasing awareness of government programs and subsidies (3.4), scheduling vaccinations accurately (3.3), disease prevention (3.2), and record-keeping (3.1) and feeding practices (3.0), preparing and storing livestock feeds (2.9), etc. Logit regression analysis identified significant factors influencing ICT effectiveness, including educational level (p=0.010), cooperative membership (p = 0.012), household size (p=0.032), contact with extension agents (p=0.011), and access to credit (p = 0.002), while gender, marital status, and farm size were non-significant. Kendall’s Coefficient of Concordance analysis ranked mobile applications, SMS alerts, and radio broadcasts as the most effective ICT tools, demonstrating high consensus. Partnerships with telecommunication companies and government initiatives is recommended to address connectivity barriers, ensuring that all farmers can fully utilize digital tools in their livestock management practices.

Addressing pandemic-wide systematic errors in the SARS-CoV-2 phylogeny.

The SARS-CoV-2 genome occupies a unique place in infection biology - it is the most highly sequenced genome on earth (making up over 20% of public sequencing datasets) with fine scale information on sampling date and geography, and has been subject to unprecedented intense analysis. As a result, these phylogenetic data are an incredibly valuable resource for science and public health. However, the vast majority of the data was sequenced by tiling amplicons across the full genome, with amplicon schemes that changed over the pandemic as mutations in the viral genome interacted with primer binding sites. In combination with the disparate set of genome assembly workflows and lack of consistent quality control (QC) processes, the current genomes have many systematic errors that have evolved with the virus and amplicon schemes. These errors have significant impacts on the phylogeny, and therefore over the last few years, many thousands of hours of researchers time has been spent in "eyeballing" trees, looking for artefacts, and then patching the tree. Given the huge value of this dataset, we therefore set out to reprocess the complete set of public raw sequence data in a rigorous amplicon-aware manner, and build a cleaner phylogeny. Here we provide a global tree of 4,471,579 samples, built from a consistently assembled set of high quality consensus sequences from all available public data as of June 2024, viewable at https://viridian.taxonium.org . Each genome was constructed using a novel assembly tool called Viridian ( https://github.com/iqbal-lab-org/viridian ), developed specifically to process amplicon sequence data, eliminating artefactual errors and mask the genome at low quality positions. We provide simulation and empirical validation of the methodology, and quantify the improvement in the phylogeny. We hope the tree, consensus sequences and Viridian will be a valuable resource for researchers.

Disease Modification in Asthma: Are We on the Right Way? A Multidisciplinary Expert Delphi Consensus (MODIASTHMA Consensus).

With the advent of biological therapies, emerging concepts regarding establishing new targets in asthma management, such as disease modification, have entered the debate among the scientific community. The definitions that form the conceptual basis of this goal need to be agreed upon. A multidisciplinary expert group was assembled as the steering committee. A systematic literature review was conducted to identify the scientific background for constructing appropriate definitions. Based on the literature review and the clinical experience of the experts, the committee built a list of statements that could be applied to establish the definition of disease modification in asthma. After that, a Delphi validation was performed to assess the appropriateness of the list of statements. The questionnaire included a total of 22 statements, divided into "Essential criteria for disease modification in asthma" (5 statements) and "Disease modification indicators and other considerations" (17 statements). Panelists used a 9-point Likert scale to measure agreement on each statement. The cut-off point for high consensus was defined as a minimum score of 7 and had to be reached by at least two-thirds of the experts. A total of 192 asthma experts voted on statements anonymously. Of those, 104 (54%) were Pneumologists, 65 (34%) were allergologists, and 23 (12%) were Pediatricians. An interim analysis of round 1 data was performed. All statements reached consensus on the first round, with a median score above 7 in all cases. In conclusion, in this Delphi study, a large number of experts in the management of severe asthma from different specialties agreed on the clinical-functional and pathophysiological aspects to be considered in order to try to achieve disease modification.

Recruit, integrate, and retain: Internationally educated nurses mobility to the Nordic region: A two-round policy Delphi study

The global shortage of nurses has increased the migration of internationally educated nurses (IENs) to the Nordic region, necessitating policies for their migration and workplace integration. This study aimed to identify expert opinions on migration and integration policies for IENs to inform future policy development. A two-round policy Delphi study was conducted. The first round used qualitative content analysis to identify policy statements, and the second round used a quantitative descriptive approach to validate them. Response rates exceeded 75% in both rounds. Experts identified 36 statements across six themes. High consensus policies included employer contract compliance (96.9%), credential approval (96.9%), language proficiency initiatives (96.9%), diversity, equality, inclusion and belonging (DEIB) training (87.5%), and bilateral agreements (87.5%). The study emphasizes the importance of credential recognition for IENs before migration and their ongoing professional development, highlighting the need for DEIB training for leaders.

EvalDepApps: How to evaluate depression management based on evidence and end users

Abstract The use of apps is increasing in the field of mental health due to their ease of use and accessibility, although there is not enough evidence on their effectiveness and safety. EvalDepApps aims to develop an evaluation tool for depression management apps. A systematic review with meta-analysis (SRMA) was performed to evaluate the efficacy and safety of apps for depression, and to identify the evaluation criteria used. PRISMA methodology was followed. The MEDLINE, PsycINFO, and Embase databases were consulted. The risk of bias was assessed with the RoB2 scale. An online 2 rounds Delphi was carried out to prioritize the most relevant criteria identified. 44 people (26 professionals, 18 patients) were invited. They were asked to rate the importance of each criterion on a Likert scale (1 - 6). Those that obtained a high consensus were selected; those with a medium were submitted to the 2nd round. Empathization (6) and co-design (6) sessions were held with patients (23) and professionals (33) in Catalonia, the Canary Islands and Andalusia to identify what relevant aspects the tool should have. Twenty-nine studies were included in the SRMA (67% unclear bias), finding a significant effect of mHealth interventions in reducing depressive symptoms compared to non-active control (Hedges g = −0.62, 95% CI: −0.87 to − 0.37, I2 = 87%). In Round 1 of the Delphi (59% participation) 24 criteria obtained a high consensus, 20 a medium and 7 a low. In Round 2 (52% participation), 4 criteria reached high consensus. The empathy sessions showed that the actions most requested by patients were reduce anxiety, and information about their condition; for professionals, suicide prevention. Regarding co-design, it was proposed that the tool provide ranking of the apps, recommendation systems and a very visual format. The RSMA and Delphi guarantee that the tool will be based on scientific evidence and expert judgment, while empathization and co-design that it will fit with the needs of end users. Key messages • It is relevant to evaluate the quality of health apps, especially those addressed to vulnerable populations such as people with depression. • It is crucial that the development of evaluation tools for digital health interventions will be developed based on evidence-based but also includes end users.

Observations indicate regionally misleading wetting and drying trends in CMIP6

We evaluate trends in terrestrial water storage over 1950–2100 in CMIP6 climate models against a new global reanalysis from assimilating GRACE and GRACE-FO satellite observations into a hydrological model. To account for different timescales in our analysis, we select regions in which the influence of interannual variability is relatively small and observed trends are assumed to be representative of the development over longer periods. Our results reveal distinct biases in drying and wetting trends in CMIP6 models for several world regions. Specifically, we see high model consensus for drying in the Amazon, which disagrees with the observed wetting. Other regions show a high consensus of models and observations suggesting qualitatively correctly simulated trends, e.g., for the Mediterranean and parts of Central Africa. A high model agreement might therefore falsely indicate a robust trend in water storage if it is not assessed in light of the observed developments. This underlines the potential use of maintaining an adequate observational capacity of water storage for climate change assessments.

Unsupervised clustering of longitudinal clinical measurements in electronic health records.

Longitudinal electronic health records (EHR) can be utilized to identify patterns of disease development and progression in real-world settings. Unsupervised temporal matching algorithms are being repurposed to EHR from signal processing- and protein-sequence alignment tasks where they have shown immense promise for gaining insight into disease. The robustness of these algorithms for classifying EHR clinical data remains to be determined. Timeseries compiled from clinical measurements, such as blood pressure, have far more irregularity in sampling and missingness than the data for which these algorithms were developed, necessitating a systematic evaluation of these methods. We applied 30 state-of-the-art unsupervised machine learning algorithms to 6,912 systematically generated simulated clinical datasets across five parameters. These algorithms included eight temporal matching algorithms with fourteen partitional and eight fuzzy clustering methods. Nemenyi tests were used to determine differences in accuracy using the Adjusted Rand Index (ARI). Dynamic time warping and its lower-bound variants had the highest accuracies across all cohorts (median ARI>0.70). All 30 methods were better at discriminating classes with differences in magnitude compared to differences in trajectory shapes. Missingness impacted accuracies only when classes were different by trajectory shape. The method with the highest ARI was then used to cluster a large pediatric metabolic syndrome (MetS) cohort (N = 43,426). We identified three unique childhood BMI patterns with high average cluster consensus (>70%). The algorithm identified a cluster with consistently high BMI which had the greatest risk of MetS, consistent with prior literature (OR = 4.87, 95% CI: 3.93-6.12). While these algorithms have been shown to have similar accuracies for regular timeseries, their accuracies in clinical applications vary substantially in discriminating differences in shape and especially with moderate to high missingness (>10%). This systematic assessment also shows that the most robust algorithms tested here can derive meaningful insights from longitudinal clinical data.

Natural resources used in the traditional medicine of the Marinaú community, Caxiuanã forest, Brazil.

The diversity of Conservation Units in Brazil, ranging from Strict Protection areas like National Parks to Sustainable Use areas such as National Forests, supports the coexistence of human populations with extensive traditional knowledge of local natural resources. This traditional and local knowledge plays a crucial role in their subsistence and has significant potential to contribute to bioprospecting initiatives, as well as to enhance research and strategies for biological conservation. The São Sebastião de Marinaú community, situated within the Caxiuanã National Forest, offers valuable opportunities for ethnobiological studies. The field study was carried out with 48 informants from the São Sebastião de Marinaú Community, Caxiuanã National Forest (CNF), Brazil, a Sustainable Use Conservation Unit. It involved participant observation, semi-structured interviews, and guided tours. Indices of Use Value (UV), Fidelity Level (FL), and Consensus Factor (ICF) indicated plant species with therapeutic potential. A total of 944 uses associated with 154 plants and 21 animals were reported. Statistical tests pointed out that factors such as gender and age are not determinants in the richness of known plants among the residents. The plants are distributed among 59 botanical families and 126 genera. They predominantly use species native to Brazil (69%), among which 47 are endemic to the Amazon. The medicines are prepared mainly by decoction of leaves and bark. According to UV, veronica (Dalbergia monetaria L.f.) was the most important. The animals used are all vertebrates, and paca (Cuniculus paca Linnaeus, 1766,) was the most cited. Bile and lard are the parts most used in the recipes. They mentioned 116 diseases, especially those of the digestive system. The ceruzeiro (Allantoma lineata (Mart. ex O.Berg) Miers) had a high consensus of local use, and no additional studies on this species exist. This study underscores the vital role of traditional communities in sustainable conservation units, as their involvement is crucial for preserving plant and animal species essential to local traditional medicine. Such research also promotes the recognition of non-timber products as valuable raw materials with potential applications in the chemical and pharmaceutical industries. Additionally, mapping the occurrence and use of species in vulnerable conditions aids in developing effective conservation strategies for these resources.

INCREASING CANCER AWARENESS THROUGH THE FUZZY DELPHI METHOD: EFFECTIVE STRATEGIES FOR THE COMMUNITY

This study examines the impact of personal, behavioral, and environmental factors on cancer awareness in the community using the Fuzzy Delphi method. Expert surveys were conducted, achieving high consensus rates (87-91%) across all domains. The analysis revealed that outcome expectations (defuzzification value: 0.95455) were the most significant personal factor, while supportive behavior (0.96364) was the most crucial behavioral aspect. In the environmental domain, health infrastructure and community support (both 0.91818) were equally important. The study emphasizes the need for holistic approaches in health promotion, highlighting the complexity of health determinants. It provides valuable insights to assist policymakers and healthcare professionals in designing more comprehensive and effective cancer awareness initiatives. Furthermore, this research establishes a foundation for future longitudinal studies, cross-cultural assessments, and the development of integrated health promotion strategies that address multiple factors simultaneously.

Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech and language therapists.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.