Nine-point Likert Scale Research Articles

Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey.

Treating older trauma patients requires a focus on the confluence of age-related physiological changes and the impact of the injury itself. Therefore, the primary way to improve the care of geriatric trauma patients is through the development of universal, systematic multidisciplinary research. To achieve this, the Coalition for National Trauma Research has developed the National Trauma Research Action Plan that has generated a comprehensive research agenda spanning the continuum of geriatric trauma care from prehospital to rehabilitation. Experts in geriatric trauma care and research were recruited to identify current gaps in clinical geriatric research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines ensuring heterogeneity and generalizability. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. The consensus was defined as more than 60% of panelists agreeing on the priority category. A total of 24 subject matter experts generated questions in 109 key topic areas. After editing for duplication, 514 questions were included in the priority ranking. By round 3, 362 questions (70%) reached 60% consensus. Of these, 161 (44%) were high, 198 (55%) medium, and 3 (1%) low priority. Among the questions prioritized as high priority, questions related to three types of injuries (i.e., rib fracture, traumatic brain injury, and lower extremity injury) occurred with the greatest frequency. Among the 25 highest priority questions, the key topics with the highest frequency were pain management, frailty, and anticoagulation-related interventions. The most common types of research proposed were interventional clinical trials and comparative effectiveness studies, outcome research, and health care systems research.

Identifying critical behaviours for building engagement in telepractice early intervention: An international e-Delphi study.

BackgroundEngagement of the child, parent and professional may facilitate positive outcomes for young children with communication disorders receiving early intervention (EI) via telepractice. Despite reported positive outcomes of engagement in a family‐centred model of EI, there is limited research exploring the nature engagement in the telepractice environment and guiding professionals on how to best interact with young children and their families.AimTo identify a set of critical behaviours for building engagement in telepractice EI.Methods & ProceduresA two‐round modified e‐Delphi study was conducted. Participants were international experts in the field of paediatric communication disorders and telepractice EI from diverse allied health and education backgrounds. The experts used a nine‐point Likert scale to rate the importance of a predetermined set of critical behaviours for building engagement in telepractice EI across three different aspects of the telepractice interaction: (1) getting to know each other; (2) family‐centred telepractice; and (3) telepractice specific considerations.Outcomes & ResultsA total of 30 experts completed round 1, with 21 participants from round 1 completing round 2 (70% response rate). Across the two rounds, a total of 64 of the 109 items presented (58.71%) achieved consensus as critical behaviours for building engagement in telepractice EI.Conclusions & ImplicationsThe present study identified a set of individual aspects of the telepractice interaction that participants, particularly professionals, may need to intentionally address to engage with families of young children with communication disorders receiving EI via telepractice. The results from this study will contribute to the development of an observational tool to measure engagement in the telepractice EI environment.What this paper addsWhat is already known on the subject A growing body of research suggests telepractice is a feasible alternative for families of young children with communication disorders who lack access to high‐quality EI. The engagement of families through family‐centred care has long been recommended for children enrolled in EI. Although there is growing uptake of telepractice EI, limited research is available guiding professionals on how to engage with families of young children with communication disorders via telepractice. What this paper adds to existing knowledge This study provides a set of 64 telepractice‐specific behaviours deemed critical to engagement for all participants of the telepractice interaction. The display of these behaviours could assist professionals to better engage with families of young children within the telepractice environment. What are the potential or actual clinical implications of this work? The findings of this study provide a set of telepractice‐specific behaviours that professionals may need to deliberately display and encourage while interacting with young children with communication disorders and their families. Professionals displaying these behaviours could potentially enhance the engagement of families receiving EI services via telepractice. This set of critical behaviours will be refined with the aim of developing an evidence‐based observational tool to measure engagement in the context of telepractice EI.

Methodological quality assessment criteria for the evaluation of laboratory-based studies included in systematic reviews within the specialty of Endodontology: A development protocol.

High-quality systematic reviews in the field of Dentistry provide the most definitive overarching evidence for clinicians, guideline developers and healthcare policy makers to judge the foreseeable risks, anticipated benefits, and potential harms of dental treatment. In the process of carrying out a systematic review, it is essential that authors appraise the methodological quality of the primary studies they include, because studies which follow poor methodology will have a potentially serious negative impact on the overall strength of the evidence and the recommendations that can be drawn. In Endodontology, systematic reviews of laboratory studies have used quality assessment criteria developed subjectively by the individual authors as there are no comprehensive, well-structured, and universally accepted criteria that can be applied objectively and universally to individual studies included in reviews. Unfortunately, these subjective criteria are likely to be inaccurately defined, unreliably applied, inadequately analysed, unreasonably biased, defective, and non-repeatable. The aim of the present paper is to outline the process to be followed in the development of comprehensive methodological quality assessment criteria to be used when evaluating laboratory studies, that is research not conducted in vivo on humans or animals, included in systematic reviews within Endodontology. The development of new methodological quality assessment criteria for appraising the laboratory-based studies included in systematic reviews within Endodontology will follow a three-stage process. First, a steering committee will be formed by the project leaders to develop a preliminary list of assessment criteria by modifying and adapting those already available, but with the addition of several new items relevant for Endodontology. The initial draft assessment criteria will be reviewed and refined by a Delphi Group (n=40) for their relevance and inclusion using a nine-point Likert scale. Second, the agreed items will then be discussed in an online or face-to-face meeting by a group of experts (n=10) to further refine the assessment criteria. Third, based on the feedback received from the online/face-to-face meeting, the steering committee will revise the quality assessment criteria and subsequently a group of authors will be selected to pilot the new system. Based on the feedback collected, the criteria may be revised further before being approved by the steering committee. The assessment criteria will be published in relevant journals, presented at national and international congresses/meetings, and will be freely available on a dedicated website. The steering committee will update the assessment criteria periodically based on feedback received from end-users.

A protocol for developing a core outcome set for ectopic pregnancy

BackgroundRandomised controlled trials (RCTs) evaluating ectopic pregnancy have reported many different outcomes, which are themselves often defined and measured in distinct ways. This level of variation results in an inability to compare results of individual RCTs. The development of a core outcome set to ensure outcomes important to key stakeholders are collected consistently will guide future research in ectopic pregnancy.Study aimTo develop and implement a core outcome set to guide future research in ectopic pregnancy.Methods and analysisWe have established an international steering group of key stakeholders, including healthcare professionals, researchers, and individuals with lived experience of ectopic pregnancy. We will identify potential outcomes from ectopic pregnancy from a comprehensive literature review of published randomised controlled trials. We will then utilise a modified Delphi method to prioritise outcomes. Subsequently, key stakeholders will be invited to score potential core outcomes on a nine-point Likert scale, ranging from 1 (not important) to 9 (critical). Repeated reflection and rescoring should promote whole and individual stakeholder group convergence towards consensus ‘core’ outcomes. We will also establish standardised definitions and recommend high-quality measurements for individual core outcomes.Trial registrationCOMET 1492. Registered in November 2019.

Development and Validation of a Scale Measuring Humanistic Professional Awareness for Healthcare Students and Providers.

ObjectiveThis study aimed to develop an appropriate scale accessing healthcare students’ and providers’ humanistic professional awareness (HPAS-HSP).MethodsFollowing a literature review, stakeholder interviews, and panel discussions for item generation, 65 items for the HPAS-HSP scale were created based on a nine-point Likert scale, with 9 indicating “strongly agree” and 1 indicating “strongly disagree.” A pilot study using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), with seven hundred twenty-five medical care students and providers in Taiwan as the total sample number of the study, was administered to examine the practicability of the HPAS-HSP scale. The statistics software SPSS and AMOS 24.0 were used to examine the psychometric properties of the scale, including internal consistency, convergent validities, discriminant validities, and exploratory and confirmatory factor analysis.ResultsThe EFA resulted in 21 items in three factors, with 66.221% of the total variance explained: “personal integrity and accountability” (9 items; 51.763% of the variance explained), “sensitivity to others” (6 items; 8.667% of the variance explained), and “medical professional competence” (6 items; 5.791% of the variance explained). The Cronbach’s alphas for the three subscales and the entire questionnaire ranged from 0.892 to 0.949. The CFA results yielded 20 items, with the same three factors, and demonstrated good model fit in the χ2/df ratio (1.130; p = 0.140), CFI (0.998), TFI (0.998), and RMSEA (0.013). The composite alphas ranged between 0.900 and 0.969. Convergent and discriminant validity also confirmed the stability and consistency of the scale.ConclusionThe statistical results demonstrated that the HPAS-HSP scale can be a measure to assess healthcare students’ and providers’ humanistic professional awareness.

A Multisensory Deficit in the Perception of Pleasantness in Parkinson's Disease.

There is growing interest in non-motor symptoms in Parkinson's disease (PD), due to the impact on quality of life. Anhedonia, the inability to experience joy and lust, has a prevalence of up to 46% in PD. The perception of pleasantness of an odor is reduced in anhedonia without PD. We previously showed a reduced hedonic olfactory perception in PD, i.e., patients evaluated odors as less pleasant or unpleasant compared to controls. This deficit correlated with anhedonia. We aimed to confirm these findings. Moreover, we hypothesized that the perception of pleasantness in PD is affected on a multisensory level and correlates with anhedonia. Therefore, we assessed olfactory, visual and acoustic evaluation of pleasantness in PD and healthy individuals. Participants had to rate the pleasantness of 22 odors, pictures, and sounds on a nine-point Likert scale. Depression, anhedonia, and apathy were assessed by means of questionnaires. Results of the pleasantness-rating were compared between groups and correlated to scores of the questionnaires. In particular pleasant and unpleasant stimuli across all three modalities are perceived less intense in PD, suggesting that a reduced range of perception of pleasantness is a multisensory phenomenon. However, only a reduction of visual hedonic perception correlated with anhedonia in PD. A correlation of reduced perception of pleasantness with apathy or depression was not present. We provide evidence for a multisensory deficit in the perception of pleasantness. Further studies should delineate the underlying neural circuity and the diagnostic value to detect neuropsychiatric symptoms in PD.

Developing a national trauma research action plan: Results from the Burn Research Gap Delphi Survey.

The 2016 National Academies of Science, Engineering and Medicine call for a national integrated, military-civilian trauma action plan to achieve zero preventable deaths and disability after injury included a proposal to establish a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma/burn care from prehospital to rehabilitation. The Burn/Reconstructive Surgery group represents one focus area for this research agenda development. Experts in burn and reconstructive surgery research identified gaps in knowledge, generated research questions and prioritized questions using a consensus driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with military and civilian representatives. Literature reviews informed the panel. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome. Participants ranked the priority of each question on a nine-point Likert scale, which was categorized to represent low, medium, and high priority items. Consensus was defined based on ≥60% panelist agreement. Subject matter experts generated 949 research questions in 29 Burn & 26 Reconstruction topics. Five hundred ninety-seven questions reached consensus. Of these, 338 (57%) were high-priority, 180 (30%), medium-priority, and 78 (13%) low-priority questions. Many high-priority questions translate to complex wound management and outcomes. Panel recognition that significant gaps in knowledge exist in understanding functional outcomes after injury underscores the importance of long-term recovery metrics even when studying acute injury or interventions such as resuscitation or inhalation injury. Funding agencies and burn/reconstructive surgery researchers should consider these gaps when they prioritize future research. Expert consensus, Level IV.

Measuring Cognitive Load: Are There More Valid Alternatives to Likert Rating Scales?

Cognitive load researchers have used varying subjective techniques based on rating scales to quantify experienced cognitive load. Although it is generally assumed that subjects can introspect on their cognitive processes and have no difficulty in assigning numerical values to the imposed cognitive load, little is known about how visual characteristics of the rating scales influence the validity of the cognitive load measure. In this study we look at validity of four subjective rating scales (within groups) differing in visual appearance by participants rating perceived difficulty and invested mental effort in response to working on simple and complex weekday problems. We used two numerical scales (the nine-point Likert scale most often used in Cognitive load theory research and a Visual Analogue Scale ranging between 0–100%) and two pictorial scales (a scale consisting of emoticons ranging from a relaxed blue-colored face to a stressed red-colored face and an “embodied” scale picturing nine depicted weights from 1–9 kg). Results suggest that numerical scales better reflect cognitive processes underlying complex problem solving while pictorial scales Underlying simple problem solving. This study adds to the discussion on the challenges to quantify cognitive load through various measurement methods and whether subtleties in measurements could influence research findings.

P–454 Oocyte vitrification for fertility preservation in women with benign gynecological disease: French national clinical guidelines with a modified Delphi consensus process

Abstract Study question Is there consensual clinical practices about fertility preservation (FP) for benign gynecological diseases BGD)? Summary answer A consensus study using the modified Delphi method identified 28 consensual practices concerning oocyte vitrification for fertility preservation in women with benign gynecological disease. What is known already Clinical Practical international guidelines are still published in oncology for offering standardized information and care for adults and children with cancer. Recently, the ESHRE Female Fertility Preservation Guideline Development Group published recommendations for healthcare professionals involved in fertility preservation for post-pubertal women and transgender adolescents and young adults. However, benign gynecological indications weren’t distinctly individualized of malignant conditions. There’s a lack of large cohort studies assessing the risks and outcome of FP for benign gynecological diseases. Healthcare professionals need consensus for defining the “good” indications of FP for benign gynecological diseases that could impair fertility. Study design, size, duration A steering group composed by 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices concerning fertility preservation for benign gynecological disease. Then, 114 key stakeholders including various healthcare professionals (n = 108) and patient representatives(n = 6) were asked to answer at two rounds of a modified Delphi via an online survey from February to September 2020. Participants/materials, setting, methods Participants had to score 42 items for the first round and 31 for the second round using a nine-point Likert scale. These statements were distributed into five categories: Information to deliver to age-reproductive women with a BGD (n = 9), technical aspect of fertility preservation for BGD (n = 6), indications of FP for endometriosis (n = 13), indications of FP for none-endometriosis BGD (n = 10), idiopathic diminished ovarian reserve in the absence of gynecologic and endocrinologic diseases (n = 4). Main results and the role of chance Survey response of stakeholders was 75% (86 out of 114) for the round 1 and 87% (75 out of 86) for the round 2. Consensus recommendations were achieved for 28 items, and no consensus between stakeholders was achieved in the remaining items. Stakeholders rated the importance of an age-specific information concerning the risk of diminished ovarian reserve after surgery and the necessity to inform about the benefice/ risk balance of oocyte vitrification, in particular about the chance of live-birth according to the age at the time of oocyte vitrification. They endorsed oocyte vitrification as the reference FP technique for those benign indications. Experts rejected to determine lower and upper age limits in women for fertility preservation. FP shouldn’t be offered in rAFS stages I and II endometriosis without endometriomas. Limitations, reasons for caution Experts were only French native speakers from France, and Belgium. It would have been interesting to conduct this survey with experts from other continents. Wider implications of the findings: At our knowledge, we present here the first guideline s focusing on FP in women with BGD, following a designed scientific Delphi procedure. These guidelines could be useful for gynecologists to better inform women with benign gynecological diseases about the indication or not to offer a FP procedure. Trial registration number Not applicable

Dancing Improves Emotional Regulation in Women With Methamphetamine Use Disorder But Use of a Cycle Ergometer Does Not.

BackgroundEmotional regulation is crucial to people who receive a diagnosis of methamphetamine (MA) use disorder. Although evidence that exercise improves emotional regulation is robust, little is known about whether exercise will improve emotional processing in women with MA use disorder.MethodsIn the present study, 36 women with MA use disorder aged 20 to 34 years and residing in the Drug Rehabilitation Bureau of Mogan Mountain in Zhejiang province were assigned to 1 of 2 exercise intervention groups-dancing or stationary cycling. Both types of exercise were performed at 65–75% of the maximum heart rate for 30 min. Immediately before and after the exercise bout, the participants were asked to score their feelings using a nine-point Likert scale as they viewed emotionally negative, positive, or neutral images in blocks of 20 images each, for a total of 60 images. Concurrent with viewing the images and self-rating their emotions, the women also underwent functional near-infrared spectroscopy to assess changes in brain activity.ResultsThere were no significant differences in the demographic or MA use characteristics assessed for the women between the two exercise groups. We found main effect of image valence (F2,33 = 69.61, p < 0.01), significant interaction effect of time and image valence was found (F2,33 = 4.27, p < 0.05) and trend increase in the self-rated emotional scale score for viewing negative images in both groups after 30-min exercise intervention, and the dancing group presented more significant trends than cycling group. In addition, activation in the dorsolateral prefrontal cortex of dancers, but not of cyclists, while viewing negative images was significantly lower after vs. before dancing (F2,33 = 5.43, p < 0.05). This result suggested that 30 min of dancing decreased neural activity in women with MA use disorder while they viewed negative images specifically in a brain region known to guide the selection of appropriate behaviors, and to shift attention.Taken together, the findings of this study suggest that for women with MA abuse disorder, 30 min of dancing, rather than of stationary cycling, may ameliorate negative emotional reactions by decreasing attention to negative stimuli.

The prevalence of constipation and its relation to sweet taste preference among patients receiving methadone maintenance treatment

BackgroundPreference for sweet-tasting foods, weight gain, and constipation characterize patients receiving methadone maintenance treatment (MMT). The prevalence of constipation in MMT and its relation to preference for sweet taste and body mass index (BMI) are undetermined. MethodsA random sample of 83 patients was interviewed for constipation with the Patient Assessment Constipation Quality of Life (PAC-QOL) questionnaire. They rated taste intensity and reward of sweet, salty, and sour solutions by means of a nine-point Likert scale. Data on their BMI, drugs in urine, methadone dose, and serum levels were analyzed. ResultsForty-two patients reported minimum to severe constipation. They characterized as having longer durations of opioid usage before MMT and worse sleep quality than non-constipated patients (logistic regression). Constipation intensity was inversely correlated with duration in MMT and linearly correlated with the Patient Assessment Constipation Quality of Life score. Patients with constipation rated reward to sweet taste significantly higher with no differences in taste intensity compared to non-constipated patients. Patients with high methadone serum levels (≥750 ng/mL) rated taste intensity significantly lower compared to those with normal methadone serum levels (<750 ng/mL), and the lowest rates were reported among patients with no constipation and high methadone serum levels. ConclusionsConstipation was highly prevalent among MMT patients and associated with poor sleep and lower quality of life. The relation to preference for sweets, as reflected by higher reward rating, strongly supports the need for nutritional intervention to alleviate constipation symptoms and improve quality of life and sleep.

Exploring perspectives on COVID-19 risk, protective behavior and control measures

Public perceptions and behaviors in relation to COVID-19 have been at the forefront of public health policy to mitigate the transmission of the infection and reduce the burden on healthcare infrastructure. This study assesses people’s perspectives towards COVID-19, especially concerning disease risk, adherence to protective measures, and the effectiveness of the imposed prevention and control measures. An explorative study based on Q-method was conducted in Erbil, the Kurdistan Region. The study involved a purposively selected sample of 40 persons representing different educational, social, and economic levels. 41 statements were extracted that covered various aspects of the impact of COVID-19 on the lives of people and their perspectives about these experiences, using 41 statements answerable with a nine-point Likert scale, with responses ranging from ‘least agree’ to ‘most agree’. Data analysis involved a by-person factor analysis using PQMethod 2.35. Three distinct viewpoints and one consensus perspective were identified. Viewpoint 1, confidence and adherence to protective measures, centers on compliance with the main protective measures, the seriousness of COVID-19, and the effectiveness of the public health preventive measures. Viewpoint 2, apprehensiveness and noncompliance, focuses on extreme apprehension from the disease and concerns about the public health policies against COVID-19. Viewpoint 3, inattentive, emphasizes the lack of awareness and adherence to protective measures by the people and the ineffectiveness of the public health preventive measures. The primary aspects distinguishing the three viewpoints included risk perception, protective behavioral response, and public health preventive measures. Risk perception can potentially guide appropriate protective behavior. To strengthen preventive measures and comply with protective behaviors, different approaches that can address the needs of different groups of people are required. The focus should be on increasing risk awareness, reducing anxiety, and explaining the justification and effectiveness of public health policy preventive measures.

A protocol for developing, disseminating, and implementing a core outcome set for adenomyosis research.

Adenomyosis is a common benign gynaecological condition that has been associated with heavy and/or painful periods, subfertility and poor obstetric outcomes including miscarriage and preterm delivery. Studies evaluating treatments for adenomyosis have reported a wide range of outcomes and outcome measures. This variation in outcomes and outcome measures prevents effective data synthesis, thereby hampering the ability of meta-analyses to draw useful conclusions and inform clinical practice. Our aim is to develop a minimum set of outcomes to be reported in all future studies that investigate any uterus-sparing intervention for treating uterine adenomyosis. Wide adoption of 'core outcomes' into research on adenomyosis would reduce the heterogeneity of studies and make data synthesis easier. This will ultimately lead to comparable, prioritised, and patient-centred conclusions from meta-analyses and guidelines. Outcomes identified from a systematic review of the literature will form a long list, agreed by an international steering group representing key stakeholders, including healthcare professionals, researchers, and public research partners. Through a modified Delphi process, key stakeholders will score outcomes from the agreed long list on a nine-point Likert scale that ranges from 1 (not important) to 9 (critical). Following the Delphi process, the refined outcome set will be finalised by the steering group. Finally, the steering group will develop recommendations for high-quality measures for each outcome. The study was prospectively registered with Core Outcome Measures in Effectiveness Trials Initiative; number 1649. The implementation of the core outcome set for adenomyosis in future trials will enhance the availability of comparable data to facilitate more patient-centred evidence-based care. The core outcome set will facilitate the generation of clinically important and patient centred outcomes for studies evaluating treatments for adenomyosis.

Nurse-sensitive outcomes in district nursing care: A Delphi study.

To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses' scope and domain of practice and that are influenced by nursing inputs and interventions. A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. District nursing care in the community care setting in the Netherlands. Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient's autonomy, the patient's ability to make decisions regarding the provision of care, the patient's satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.

How can we optimise the pharmaceutical analysis of radiopharmaceutical pediatric prescriptions?

ObjectivesIn France, dispensation is defined by the validation of a prescription associated with a pharmaceutical analysis, preparation of medication and provision of information necessary for proper use. There are very...

The Role of Temporal Contingency and Integrity of Visual Inputs in the Sense of Agency: A Psychophysical Study.

The sense of agency is a subjective feeling that one's own actions drive action outcomes. Previous studies have focused primarily on the temporal contingency between actions and sensory inputs as a possible mechanism for the sense of agency. However, the contribution of the integrity of visual inputs has not been systematically addressed. In the current study, we developed a psychophysical task to examine the role of visual inputs as well as temporal contingencies toward the sense of agency. Specifically, participants were required to track a target on a sinusoidal curve on a computer screen. Visual integrity of sensory inputs was manipulated by gradually occluding a computer cursor, and participants were asked to report the sense of agency on a nine-point Likert scale. Temporal contingency was manipulated by varying the delay between finger movements on a touchpad and cursor movements. The results showed that the sense of agency was influenced by both visual integrity and temporal contingency. These results are discussed in the context of current models that have proposed that the sense of agency emerges from the comparison of visual inputs with motor commands.

Development of a core outcome set for clinical trials aimed at improving antimicrobial stewardship in care homes

BackgroundDiverse outcomes reported in clinical trials of antimicrobial stewardship (AMS) interventions in care homes have hindered evidence synthesis. Our main objective was to develop a core outcome set (COS) for use in trials aimed at improving AMS in care homes.MethodsA refined inventory of outcomes for AMS interventions in care homes, compiled from a previous study, was rated in a three-round international Delphi survey with 82 participants, using a nine-point Likert scale (from 1, unimportant, to 9, critical). This was followed by an online consensus exercise with 12 participants from Northern Ireland to finalise the COS content. Subsequently, a suitable outcome measurement instrument (OMI) was selected for each outcome in the COS by: identifying existing OMIs through a literature search and experts’ suggestions, assessing the quality of OMIs, and selecting one OMI for each core outcome via a two-round international Delphi survey with 59 participants.ResultsOf 14 outcomes initially presented, consensus was reached for inclusion of five outcomes in the COS after the three-round Delphi survey and the online consensus exercise, comprising the total number of antimicrobial courses prescribed, appropriateness of antimicrobial prescribing, days of therapy per 1000 resident-days, rate of antimicrobial resistance, and mortality related to infection. Of 17 potential OMIs identified, three were selected for the two-round Delphi exercise after the quality assessment. Consensus was reached for selection of two OMIs for the COS.ConclusionThis COS is recommended to be used in clinical trials aimed at improving AMS in care homes.

Developing an Environmental Health Sciences COVID-19 Research Agenda: Results from the NIEHS Disaster Research Response (DR2) Work Group's Modified Delphi Method.

Leveraging the community of practice recently established through the U.S. National Institute of Environmental Health Sciences (NIEHS) Disaster Research Response (DR2) working group, we used a modified Delphi method to identify and prioritize environmental health sciences Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and associated Coronavirus Disease 2019 (COVID-19) research questions. Twenty-six individuals with broad expertise across a variety of environmental health sciences subdisciplines were selected to participate among 45 self-nominees. In Round 1, panelists submitted research questions and brief justifications. In Round 2, panelists rated the priority of each question on a nine-point Likert scale. Responses were trichotomized into priority categories (low priority; medium priority; and high priority). A research question was determined to meet consensus if at least 69.2% of panelists rated it within the same priority category. Research needs that did not meet consensus in round 2 were redistributed for re-rating. Fourteen questions met consensus as high priority in round 2, and an additional 14 questions met consensus as high priority in round 3. We discuss the impact and limitations of using this approach to identify and prioritize research questions in the context of a disaster response.

The effect of an image of watchful eyes on the evaluation of the appearance of food.

It is known that an eye-like image promotes generosity. It is also known that the evaluation of the visual deliciousness of food is improved in the presence of an emotionally positive stimulus. The purpose of the present study was to examine whether the presence of open eyes (OPEN) causes generous behavior altering the evaluation of the visual deliciousness of food, and how the images of open and closed eyes (CLOSED) affect human emotions. Seventeen women participated in the present study. A picture of food was presented on a computer screen, and the participants predicted and evaluated its visual deliciousness. An image of OPEN or that of CLOSED was presented simultaneously with a picture of food. There was a significant difference between the OPEN and CLOSED conditions, as demonstrated by the scores on a nine-point Likert scale for visual deliciousness; the ratings in the OPEN condition were significantly higher than those in the CLOSED condition (p = 0.004). There was no significant difference in the image of watchful eyes for the perceived relaxation state; the ratings in the OPEN condition were not significantly higher than those in the CLOSED condition (p = 0.716). The results of the present study revealed that the evaluation of the visual deliciousness of food based on its appearance was likely due to the presence of an image of open watchful eyes, increasing the perceived visual deliciousness of the food without any changes in the participants’ emotions.

Dutch oral health care quality measures: a modified Delphi study

Objectives: Quality measures offer opportunities for evaluation and improvement of the quality of oral health care. This study describes the development of a core set of oral health care quality measures for adults in the Netherlands, which can be used in dental practice. Materials and methods: A comprehensive two-stage approach was used, consisting of: (1) identification of an initial set of measures based on appraised literature; and (2) a four-round modified RAND/UCLA Appropriateness Method to establish measures that are relevant, appropriate and important to oral health care. Measures were rated anonymously on a nine-point Likert scale, ranging from 1 (lowest rating) to 9 (highest rating), followed by a group discussion to reach consensus. Multiple key stakeholder groups in the Dutch oral health care field were involved in the Delphi rounds, including dental professionals, scientists and representatives from Dutch oral health care organisations. Results: The study resulted in a core set of 13 oral health care quality measures. The measures cover domains related to oral disease outcomes, oral treatment and preventive services, patient experiences, patient safety, and organisational aspects of oral health care. In addition, the study led to the identification of 49 structural aspects of oral health care that are important to measure. Discussion: To our knowledge, this is the first study combining appraised literature from a systematic review and a rigorous multi-stage procedure with extensive stakeholder involvement to develop a core set of oral health care quality measures. In the next phase, the measures will be tested on feasibility, reliability, and will be piloted and implemented in practice.