Panel Assessment Research Articles

Enhancing Face Validity in Teaching Quality with Six Sigma Approach for Sustainable Development Goals (SDG)

Objective: The Teacher Teaching Quality Instrument using the Six Sigma approach (T²Qi-6σ) is a new tool for assessing teaching quality in primary and secondary schools. As such, it is essential to carefully review each item in T²Qi-6σ for face validity, including an assessment of language use, sentence structure, vocabulary appropriateness, and spelling accuracy. This is useful in providing the empirical evidence for supporting sustainable development goals (SDG) initiatives specially to enhance the quality of item assessment. Theoretical Framework: This study aims to test the face validity of T²Qi-6σ using Content Validity Ratio (CVR) analysis by Lawshe (1975). This CVR adapted to be used for face validity even the method mainly applied for establishing content validity. Method: A total of ten assessors were selected using a purposive sampling technique consisting of six test takers and four language experts. The face validity of the T²Qi-6σ involves as many as 125 items with five primary constructs based on Six Sigma: define, measure, analyze, improve, and control. Results and Discussion: The quantitative findings of the study indicate that the instrument demonstrates strong face validity, with 113 items meeting the minimum CVR value (N=10, CVRcritical = 0.62). Efforts have been made to enhance 12 items that initially did not meet the minimum CVR value. In total, 125 items T²Qi-6σ show great promise as a psychometric measurement tool to enhance the quality of teaching among educators. Research Implications: T²Qi-6σ assists educators in enhancing their self-competence and teaching quality, offering benefits and implications for theory, the field of measurement, and the implementation of the Six Sigma approach in education in Malaysia. Originality/Value: The assessment of CVR indicates that T²Qi-6σ demonstrates high face validity and suitability for use. The consensus among the panel of assessors evaluating face validity clearly demonstrates that T²Qi-6σ is appropriate and relevant for use in the study aimed at enhancing the quality of teacher instruction through the Six Sigma approach. The use of Six Sigma aims to broaden the knowledge base for quality assessment in education, which has traditionally relied on similar methods. It would be intriguing to evaluate the impact of the Six Sigma DMAIC model in the Malaysian education sector.

Early metabolic and hemodynamic indicators of kidney dysfunction in mice offspring from parental low protein diet

BackgroundParental malnutrition, particularly a low-protein diet (LPD), causes oligonephropathy at birth and predisposes offspring to hypertension and chronic kidney disease later in life. The onset of adult kidney disease varies based on genetics and environmental factors, often with subclinical alterations in kidney function being overlooked. This study aimed to examine changes in kidney morphology before significant kidney function decline in the offspring of mice fed a low-protein diet.MethodsUsing a combination of histological analysis, kidney metabolic and hemodynamic panel assessments, and advanced statistical techniques such as Linear Discriminant Analysis (LDA) and Principal Component Analysis (PCA), we investigated the initial impact of a maternal low-protein diet (LPD) on kidney development and function. Our study utilized 12-week-old F1 mice from F0 parents fed either a low-protein diet (LPD) or a normal-protein diet (NPD) before the onset of hypertension.ResultsThe offspring (F1 generation) of parents (F0 generation) fed an LPD show reduced body weight from birth to P20. The kidney weight was also reduced compared to F1 offspring from parents fed an NPD. At 12 weeks of age, body weight normalized, but kidney weight remained low. Offspring of parents fed an LPD displayed abnormal kidney morphology, including dilated tubules, oligonephropathy, and fluid-filled cysts which had worsened with age. A kidney metabolic panel analysis at 12 weeks revealed a slight but consistent increase in urine albumin, plasma creatinine, mean urea, and BUN concentrations. Although no significant changes in hemodynamic variables were observed, 2/12 mice, both males, showed alterations in systolic blood pressure, suggesting sex-specific effects when comparing F1 mice from F0 fed either diet. Overall, kidney metabolic changes were strongly correlated to parental LPD.ConclusionOur findings indicate that significant kidney damage must accumulate in the F1 generation from parents fed an LPD before any detectable changes in blood pressure occur. Our study suggests that small variations in kidney metabolic function may point to early kidney damage and should not be overlooked in the offspring of these malnourished mice and likely humans.

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

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

Unraveling the Complexities of Beef Marination: Effect of Marinating Time, Marination Treatments, and Breed.

The present study focused on evaluating the effects of beef marination on quality traits and consumer acceptability. In this context, m. longissimus thoracis et lumborum and m. semimembranosus samples (n = 192) were obtained from Aberdeen Angus, Hereford, Charolais, and Limousine bulls and were marinated with milk (pasteurized, 100%), garlic and olive oil (2.35 g/500 mL), and lemon (citrus) juice (31% orange juice, 31% lemon juice, 38% distilled water) for 12, 24, and 72 h. Marinade components were selected based on traditional culinary practices and their scientifically proven effects on meat quality. Beef samples on day 0 and non-marinated samples were used as control groups. Beef color, water holding capacity, pH, cooking loss, and Warner-Bratzler shear force were measured three times for each sample. A taste panel assessment was performed to determine the sensory characteristics. Statistical analysis was performed using general linear model (GLM) procedures followed by Tukey's post-hoc comparison. Results revealed that marination time, as well as its two- and three-way interactions, significantly influenced beef quality parameters. These results indicate that the cattle breed is an important factor in evaluating the effectiveness of beef marination applications. The olive oil-garlic marinade was the most preferred by the panel across both types of muscle, as indicated by sensory evaluation results. The findings will not only enrich the scientific literature but also have practical implications for the beef industry.

A 37-year follow-up after Skoog lip repair of unilateral cleft lip and palate: what is the long-term verdict on lip appearance by different panels?

BackgroundThe study examined long-term lip appearance after Skoog’s lip repair in unilateral cleft, lip, and palate (UCLP) patients. To include different views, three different panels respectively, rated level of lip appearance and desire for improvement. The secondary aim was to investigate the correlation between the self-reported satisfaction of UCLP patients and controls with the panel assessments.MethodsCropped frontal photographs of the lips of 74 UCLP-treated individuals and 61 non-cleft individuals were assessed twice by three panels of five cleft surgeons (Professional panel), nine laymen (Layman panel), and five individuals with CLP (Cleft panel) using a web-based platform, at a mean follow-up of 37 years post-lip surgery.ResultsAll three panels rated the lip appearance of UCLP patients worse than that of the controls (p < 0.001). The Professional panel reported higher satisfaction levels and less desire to change lip appearance than the Layman and Cleft panels. Intra-rater agreements were, in general, moderate in the Professional panel ICC (0.57–0.82) and Laymen panel ICC (0.63–0.73) and poor in the Cleft panel ICC (0.21–0.36). The inter-rater agreement was, in general, poor in all panels. No significant correlation was found between the patient’s Self-assessments and any of the panel assessments.ConclusionsAll panels’ rated lip appearance of adults born with UCLP treated with Skoog’s technique as worse than that of non-cleft controls. The study highlights a significant discrepancy between the Professional panel’s more favorable assessment and the more critical views of the laymen and cleft panels, contradicting the initial hypothesis of uniform perception across panels. The lack of correlation between patient self-assessment and panel assessments underscores the subjective nature of lip satisfaction, emphasizing the need for personalized patient care strategies in CLP treatment outcomes.Level of evidenceNot gradable.

Interpersonal impressions of cleft and non-cleft adolescents: A panel assessment study of peers, laypersons, and clinicians using 3dMD images

BackgroundPatients with cleft lip and palate anomalies suffer from associated negative psychosocial effects despite undergoing reconstructive surgeries. Discrimination from others may be a contributing factor. We aim to understand whether people react differently to cleft and non-cleft subjects in questions regarding aesthetic appraisal and interpersonal impressions, as well as whether diverging opinions exist between people of different backgrounds. Materials and MethodsUsing the 3dMD system, three-dimensional craniofacial images of cleft (n=20) and non-cleft (n=5) pediatric individuals were obtained and used to create a Likert scale-based questionnaire. Participants from three different backgrounds, including adolescent peers, adult laypersons, and plastic surgeons, were recruited to complete the assessment. The resulting data was transferred to a bar graph and analyzed with the Item Response Theory- Graded Response Model to estimate the latent traits and capability of each subject. ResultsNon-cleft images obtained more positive responses than cleft images in questions of both aesthetic appraisal and interpersonal impressions. However, some of the cleft images were rated similarly, or even superior, to non-cleft images in questions regarding interpersonal impressions. Surgeons showed the greatest latent capability in differentiating between cleft and non-cleft images, followed by adult laypersons, and then adolescent peers. ConclusionDespite cleft patients experiencing drastic improvements in appearance post-repair, all subject groups responded differently to questions concerning aesthetic and social impressions of pediatric cleft and non-cleft images. Plastic surgeons were more critical than others. These findings may offer further insight to clinicians, educators, and caregivers into the social challenges faced by cleft individuals.

Dose Deintensified 3-Day Photon, Proton, or Brachytherapy: A Nonrandomized Controlled Partial Breast Irradiation Trial

BackgroundThe optimal approach for partial breast irradiation (PBI) is unknown. We investigated a novel de-intensified 3-fraction PBI regimen for photons, protons, and brachytherapy. MethodsA multicenter nonrandomized controlled trial with primary outcome of adverse cosmesis at 3 years versus pre-PBI. Eligibility criteria were ≥ age 50 years treated with breast-conserving surgery for node-negative estrogen receptor positive (ER+) invasive breast cancer or any ductal carcinoma in-situ (DCIS) measuring ≤ 2.5 cm. Photon and proton PBI were prescribed 21.9 Gy (RBE) and brachytherapy 21 Gy in 3 fractions. Radiotherapy technique and use of adjuvant endocrine therapy was selected at physician and patient discretion. ResultsBetween June 17, 2015 and July 13, 2017, 161 eligible patients were treated with photons (56), protons (49), or brachytherapy (56). Median patient age was 66.8 years. 126 (78.3%) had invasive breast cancer (all ER+) and 35 (21.7%) had DCIS (88.6% ER+). 54.0% of patients with invasive breast cancer and 25.8% of patients with ER+ DCIS initiated and adhered to prescribed endocrine therapy. The proportion of patients with adverse cosmesis (by trained nurse assessment) was 14.5% at baseline, 2.3% at 3 years (difference -12.2%, 95% CI (-100%, -6.4%)). Adverse cosmesis at last-follow-up, with median follow-up 5 years, was 5.7% by nurse assessment, 5.6% by panel assessment of digital photographs, and 5.2% by patient self-report. There were no observed clinically meaningful changes in other patient reported outcomes, and just two grade 2 or higher adverse events, both grade 2, in the brachytherapy cohort. 5-year local recurrence-free and progression-free survival were 98.0% and 95.5%, respectively. There were no local recurrences amongst 60 patients with invasive breast cancer and Ki67 ≤ 13.25%. ConclusionsDe-intensified 3-day PBI provided favorable disease control, tolerability, and cosmetic outcomes, meeting the pre-specified criteria for acceptability. This approach is an attractive option for small node-negative ER+ BC and DCIS patients. Trial registrationClinicalTrials.gov identifier NCT02453737

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

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

Predicting tactile sensory attributes of personal care emulsions based on instrumental characterizations: A review.

Emulsions in the form of creams, lotions, gels or foams are the most widely used personal care formulations to improve the condition and feel of the skin. Achieving an optimal balance between their performance, effectiveness and sensory profile is essential, with the sensory profile being a key factor in consumer satisfaction and the success of these products in the market. Well-established methods using highly trained and semi-trained panels (e.g. Spectrum descriptive analysis, Flash Profile method, Quantitative Descriptive Analysis method and 'Check-all-that-apply') are available and commonly used for the sensory assessment of personal care products. Nevertheless, a common drawback among all these methods is their inherent cost, both in terms of financial resources and time requirements. In recent years, research studies have emerged to address this limitation by investigating potential correlations between tactile sensory attributes and instrumental data associated with the physical characteristics of topical formulations. In other words, significant efforts have been invested in the development of robust instrumental methods specifically designed to accurately predict the sensory description that a panel of assessors could establish. These methods are not only faster, cheaper and more objective compared to traditional sensory testing, but they can also be applied to formulations that have not undergone extensive safety and toxicological testing. This review summarizes the most relevant findings, trends and current challenges in predicting tactile sensory attributes of personal care emulsions based on instrumental parameters.

Using mobile air cleaners in school classrooms for aerosol removal: Which, where and how

Mobile air cleaners (MACs) have been proposed as a supplementary solution to combat the spread of respiratory aerosols in school classrooms. To determine which, where and how to use MACs, seven small- and medium-sized MACs were selected and assessed for different settings and configurations by 1) a decay test for determining the clean air delivery rate (CADR), and 2) a perception test with a panel of subjects, together with physical measurements, of noise and air movement. The findings show that to achieve the desired CADR (appr. 1000 m3/h for 30 students per classroom), the key factors are the induced airflow pattern and the location of the MACs. MACs with an upward air supply toward the occupied zone showed much higher CADR (max. 775–1332 m3/h) than those with a horizontal air supply (max. 219–333 m3/h). Moreover, using multiple devices simultaneously was crucial when the room size was increased, and combining mechanical ventilation could improve aerosol removal. Achieving a sufficient CADR would always lead to a noise level above the limit of 35 dB(A), yet sometimes the rating of the panel was more than 50% acceptable. The air velocities mostly fulfilled the requirement (&lt;0.2 m/s), which aligned with the positive panel assessment. Hence, the evaluation by a panel of subjects can help to optimize the use of MACs in a classroom.

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

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

Capturing longer term surgical outcome measures as part of routine care of breast cancer patients

IntroductionThe transition away from routine clinical follow up after breast cancer towards imaging surveillance and patient-initiated contact limits opportunities for patients and doctors to communicate about the long-term effects of treatment. The ABS oncoplastic guidelines (2021) recommend that post-operative 2D images and patient-reported outcomes (PROMs) are routinely collected but give no guidance as to how best to implement this. MethodsFrom December 2019 until March 2024, women due for their year 3 or 5 surveillance mammogram at The Royal Marsden Sutton site were invited to complete a BREAST-Q questionnaire and attend medical photography. Panel assessment of photographs was undertaken. Results were presented to the oncoplastic MDT, including summary PROMs and illustrative case presentations. Free-text comments were shared with the relevant teams. Associations between demographic or clinic-pathological factors and uptake were investigated. ResultsOf the 1211 women invited, 246 patients (20.3 %) completed BREAST-Q questionnaires, 182 (15.0 %) attended for medical photography and 114 (9.4 %) completed both. Uptake was not associated with age, ethnicity or surgical factors but patients with higher BMI were less likely to respond to the questionnaire. Patients who had undergone complex oncoplastic procedures were more likely to respond than those who had simple procedures. Patient-reported outcome results were in line with the published literature. ConclusionReviewing images with their paired PROMs and discussing free-text feedback was instructive for the team. Work is needed to identify barriers to patient participation and improve uptake to be representative of the overall patient population. Quantifying appearance in photographs would help summarise aesthetic outcome data.

AUTOIMMUNE MYOCARDITIS IN MELANOMA IMMUNOTHERAPY–COMPLEX CLINICA PRESENTATION AND ADVERSE THERAPEUTIC RESPONSE

Abstract A 68–year–old Caucasian female presented to the ED with cardiac chest pain and dyspnea. The patient had a history of arterial hypertension and was equipped with a biventricular pacemaker due to atrial fibrillation with low ventricular response. She had recently been diagnosed with metastatic melanoma and initiated treatment with nivolumab and ipilimumab two weeks prior. Troponin levels were elevated (700 ng/ml), and no ST–segment elevation was observed on the electrocardiogram (ECG). In suspicion of NSTEMI–ACS, coronary angiography was performed, revealing an intact epicardial coronary circulation without stenotic lesions. The echocardiogram showed borderline left ventricular systolic function (EF 50%), and the right ventricle exhibited initial signs of reduced systolic function (TAPSE, 15 mm; S RV, 9.5 m/s). The following day, there was a deterioration in hemodynamics and respiratory exchange, with evidence of apical and mid–distal interventricular septum hypokinesia of the left ventricle (EF 40%) and dilated right ventricle (BD 4.8 cm; MD 4 cm) with severely reduced systolic function (TAPSE 10 mm, S RV 7 m/s, FAC, 20%), and severe tricuspid regurgitation. Urgent computed tomography pulmonary angiography (CTPA) excluded pulmonary embolism. Additionally, there was a new troponin increase (5000 ng/ml) and elevated hepatic biomarkers. The clinical picture raised suspicion of myocarditis related to immune checkpoint inhibitor therapy. Corticosteroid therapy was initiated with a daily administration of methylprednisolone 1000 mg. Diagnostic confirmation was sought through autoimmune panel and viral marker assessments, which yielded negative results. Endomyocardial biopsy (EMB) revealed CD4 and CD8–positive lymphocytic infiltration and myocardial necrosis. Despite initial clinical improvement, an arrhythmic storm developed. Despite treatment with a defibrillator, intravenous antiarrhythmic therapy (beta–blocker, amiodarone, and lidocaine), and sedation, the patient unfortunately succumbed. Immune checkpoint inhibitors (ICIs) have been revolutionary in the treatment of many solid tumors. However, the dysregulation of immune mechanisms can rarely (2%) lead to autoimmune events involving multiple organs. Myocarditis, despite optimal treatment, is characterized by a mortality rate exceeding 50%, representing a significant challenge in the Intensive Care Unit.

Tailoring cytomegalovirus prophylaxis based on T cell immunity panel assessment in kidney transplant patients at high risk of cytomegalovirus.

Valganciclovir prophylaxis against cytomegalovirus (CMV) is recommended for solid organ transplant recipients, but is associated with drawbacks, including expense and leukopenia. Our center adopted a strategy of serial assessment with a CMV-specific T cell immunity panel (CMV-TCIP) and cessation of valganciclovir prophylaxis upon demonstration of adequate CD4+ responses in kidney transplant patients at high risk of CMV disease. We retrospectively reviewed adult recipients of a kidney or pancreas transplant between August 2019 and July 2021 undergoing serial CMV-TCIP monitoring. Included patients were considered high risk for CMV, defined by donor positive (D+)/recipient negative (R-) CMV IgG serostatus, or recipient positive (R+) patients who received induction with a lymphocyte-depleting agent. Prophylaxis was discontinued after a patient's first CMV-specific CD4+ T cell value of ≥0.20%. Risk of clinically significant CMV infection (csCMVi) in those who underwent early discontinuation of CMV prophylaxis and predictors of CMV T cell immunity were analyzed. Of 54 included patients, 22 stopped prophylaxis early due to CMV-specific CD4+ T cell immunity at a median of 4.7 (IQR: 3.8-5.4) months after transplant. No instances of csCMVi were observed in the 22 patients who had prophylaxis discontinued early, of whom 19/22 were CMV R+ and 3/22 were CMV D+/R-. Donor/recipient CMV serostatus was predictive of immunity (p <.001). Early discontinuation of valganciclovir prophylaxis in patients with CMV CD4+ T cellular immunity appears safe and potentially beneficial in this preliminary series, especially in R+ patients. Further study is warranted, given that truncated prophylaxis may yield patient-level benefits.

Towards Improved Auditory-Perceptual Assessment of Timbres: Comparing Accuracy and Reliability of Four Deconstructed Timbre Assessment Models

Timbre is a central quality of singing, yet remains a complex notion poorly understood in psychoacoustic studies. Previous studies note how no single acoustic variable or combinations of variables consistently predict timbre dimensions. Timbre varies on a continuum from darkest to lightest. These extremes are associated with laryngeal and vocal tract adjustments related to smaller and larger vocal tract area and variations in vocal fold vibratory characteristics. Perceptually, timbre assessment is influenced by spectral characteristics and formant frequency adjustments, though these dimensions are not independently perceived. Perceptual studies repeatedly demonstrate difficulties in correlating variations in timbre stimuli to specific measures. A recent study demonstrated how acoustic predictive salience of voice category and voice weight across pitches contribute to timbre assessments and concludes that timbre may be related to as-of-yet unknown factor(s). The purpose of this study was to test four different models for assessing timbre; one model focused on specific anatomy, one on listener intuition, one utilising auditory anchors, and one using expert raters in a deconstructed timbre model with 5 specific dimensions. MethodsFour independent panels were conducted with separate cohorts of professional singing teachers. 41 assessors took part in the anatomically focused panel, 54 in the intuition-based panel, 30 in the anchored panel, and 12 in the expert listener panel. Stimuli taken from live performances of well-known singers were used for all panels, representing all genders, genres, and styles across a large pitch range. All stimuli are available as supplementary materials. Fleiss’ kappa values, descriptive statistics, and significance tests are reported for all panel assessments. ResultsPanel 1 through 4 varied in overall accuracy and agreement. The intuitionbased model showed overall 45% average accuracy (SD ±4%), k=0.289 (<0.001) compared to overall 71% average accuracy (SD ±3%), k=0.368 (<0,001) of the anatomical focused panel. The auditory-anchored model showed overall 75% average accuracy (SD ±8%), k=0.54 (<0.001) compared with overall 83% average accuracy and agreement of k=0.63 (<0.001) for panel 4. Results revealed that highest accuracy and reliability was achieved in a deconstructed timbre model and that providing anchoring improved reliability but with no further increase in accuracy. ConclusionDeconstructing timbre into specific parameters improved auditory perceptual accuracy and overall agreement. Assessing timbre along with other perceptual dimensions improves accruacy and reliability. Panel assessors’ expert level of listening skills remain an important factor in obtaining reliable and accurate assessments of auditory stimuli for timbre dimensions. Anchoring improved reliability but with no further increase in accuracy. The study suggests that timbre assessment can be improved by approaching the percept through a prism of 5 specific dimensions each related to specific physiology and auditory-perceptual subcategories. Further tests are needed with framework-naïve listeners, non-musically educated listeners, artificial intelligence comparisons, and synthetic stimuli to further test the reliability.

Development of a Novel HS-GC/MS Method Using the Total Ion Spectra Combined with Machine Learning for the Intelligent and Automatic Evaluation of Food-Grade Paraffin Wax Odor Level.

The intensity of the odor in food-grade paraffin waxes is a pivotal quality characteristic, with odor panel ratings currently serving as the primary criterion for its assessment. This study presents an innovative method for assessing odor intensity in food-grade paraffin waxes, employing headspace gas chromatography with mass spectrometry (HS/GC-MS) and integrating total ion spectra with advanced machine learning (ML) algorithms for enhanced detection and quantification. Optimization was conducted using Box-Behnken design and response surface methodology, ensuring precision with coefficients of variance below 9%. Analytical techniques, including hierarchical cluster analysis (HCA) and principal component analysis (PCA), efficiently categorized samples by odor intensity. The Gaussian support vector machine (SVM), random forest, partial least squares regression, and support vector regression (SVR) algorithms were evaluated for their efficacy in odor grade classification and quantification. Gaussian SVM emerged as superior in classification tasks, achieving 100% accuracy, while Gaussian SVR excelled in quantifying odor levels, with a coefficient of determination (R2) of 0.9667 and a root mean square error (RMSE) of 6.789. This approach offers a fast, reliable, robust, objective, and reproducible alternative to the current ASTM sensory panel assessments, leveraging the analytical capabilities of HS-GC/MS and the predictive power of ML for quality control in the petrochemical sector's food-grade paraffin waxes.

Long-term anticoagulant therapy in the aspect of secondary prevention of recurrent pulmonary embolism

Aim. To determine differences in laboratory coagulation parameters using routine and integral monitoring methods in patients depending on anticoagulant therapy &gt;12 months after pulmonary embolism (PE) with a high recurrence risk.Material and methods. The study included 72 patients who, according to indications, received long-term anticoagulant therapy &gt;12 months due to a high risk of recurrent thromboembolism. During the follow-up period (15-20 months from the first pulmonary embolism episode), the plasma coagulation parameters were studied using a conventional panel and D-dimer assessment, as well as a thrombin generation test and thrombodynamics. Patients adherent to prolonged anticoagulation were included in group 1. During the collection period, 8 patients independently stopped taking anticoagulants, despite the high risk of recurrent pulmonary embolism (group 2).Results. There were no significant differences in coagulation parameters and D-dimer levels between the studied groups of patients. In the group of patients continuing to take anticoagulants, there was an increase in clot growth delay parameters in comparison with patients of group 2 according to the thrombodynamics results (p=0,046) and the thrombin generation test in platelet-poor plasma in comparison with reference values (p=0,001).Conclusion. Long-term anticoagulant therapy effectively prevents recurrent venous thromboembolism. In patients after primary pulmonary embolism who refuse anticoagulation, the clot growth delay values are shortened, which indicates an increased risk of recurrent venous thromboembolism. The most stable plasma coagulation parameters are observed in patients taking direct oral anticoagulants.

Education about planetary health and sustainable healthcare: A national Delphi panel assessment of its integration into health professions education in South Africa

Background. Education about planetary health (PH) and sustainable healthcare (SH), or education for sustainable healthcare (ESH), enables health professionals to help protect public health and healthcare from climate change and environmental degradation. The Association for Medical Education in Europe Consensus (AMEE Consensus) Statement on Planetary Health and Education for Sustainable Healthcare has proposed a set of ESH learning objectives, activities and assessments for adaptation to different health professions education (HPE) contexts. The national audit phase of a mixed methods study in South Africa (SA) found that awareness of ESH and its curriculum development is emerging. The African Medical Education Directives for Specialists (AfriMEDS) is a competency framework for undergraduate medical students in SA that defines key competencies and enabling competencies related to seven roles of a health professional. Objectives. To recruit a national Delphi panel of health professions educators to assess the applicability of the AMEE Consensus learning objectives, activities and assessments to HPE in SA; to elicit panellists’ perceptions of the main barriers and opportunities for ESH in faculties; and to compare learning objectives recommended by AMEE and the panel for key competencies and enabling competencies within the AfriMEDS framework. Methods. Nine educators from three different disciplines and six national faculties of health sciences participated in two rounds of a Delphi process and in follow-up discussions. In round 1, they rated the AMEE Consensus learning objectives, activities and assessments, and proposed additional ones. In round 2, they rated the score-ranked AMEE lists, as well as relevant additions from round 1. All panellists participated in further discussions regarding applicability, and highlighted the potential barriers and opportunities for integrating ESH into their faculties. The lead author then matched the panel’s learning objectives with enabling competencies related to all seven health professional roles described by AfriMEDS. Results. All panellists recognised the importance of ESH in SA and the need for eco-ethical leadership by health professionals. All 13 AMEE Consensus learning objectives, as well as three additional objectives from the panel, were matched most frequently with AfriMEDS-enabling competencies related to the roles of leader and manager (n=9), communicator (n=8) and healthcare practitioner (n=7). Panellists highly ranked learning activities and assessments that are authentic, multiprofessional and require systems thinking. They perceived the lack of capable educators and curriculum overload to be the main barriers to integration of ESH, as well as the need for strong leaders, disciplinary champions and trained educators. Conclusions. Situating the selected learning objectives within the AfriMEDS competency framework provides a good basis for developing aligned learning activities and assessments of ESH. Strong leadership, capable educators and multidisciplinary collaboration are important enablers of integrating ESH into HPE in SA.

Secondary Bilateral Cleft Rhinoplasty: Achieving an Aesthetic Result.

Secondary rhinoplasty in patients with bilateral cleft lip poses ongoing challenges and requires a reliable method for achieving optimal outcomes. The purpose of this study was to establish a safe and effective method for secondary bilateral cleft rhinoplasty. A consecutive series of 92 skeletally matured patients with bilateral cleft lip and nasal deformity were included. All had undergone secondary open rhinoplasty, performed by a single surgeon with a bilateral reverse-U flap and septal extension graft, between 2013 and 2021. Medical records of these 92 patients were reviewed to assess the clinical course. A 3-dimensional (3D) anthropometric analysis and panel assessment of 32 patients were performed to evaluate the aesthetic improvement, with an age-, sex-, and ethnicity-matched normal control group for comparisons. The methods showed statistically significant improvement in addressing a short columella (columellar height), short nasal bridge (nasal bridge length), de-projected nasal tip (nasal tip projection, nasal dorsum angle), poorly defined nasal tip (nasal tip angle, dome height, and panel assessment), and transversely oriented nostrils (columellar height, alar width, nostril type). Importantly, these improvements were accompanied by a low complication rate of 4%. However, upper lip deficiency over the upper lip angle and labial-columellar angle remained without significant improvement. In this study we described effective secondary rhinoplasty, which was composed of a bilateral reverse-U flap and septal extension graft, with acceptable outcome. The 3D anthropometric analysis and panel assessment clarified that our rhinoplasty procedure could bring the nasal morphology in these patients closer to the normal data.

Dental Cavity Grading: Comparing Algorithm Reliability and Agreement with Expert Evaluation.

The current study introduces a novel, algorithm-based software developed to objectively evaluate dental cavity preparations. The software aims to provide an alternative or complement to traditional, subjective assessment methods used in operative dentistry education. The software was tested on cavity preparations carried out by 70 participants on artificial molar teeth. These cavities were also independently assessed by an experienced academic panel. The software, using 3D imaging, calculated cavity dimensions and assigned an error score based on deviation from ideal measurements. Statistical analyses included sensitivity, specificity, positive predictive value, negative predictive value, Cohen's kappa, the intraclass correlation coefficient (ICC3k), Spearman's rho, Kendall's tau correlation coefficients, and a confusion matrix. The software demonstrated a high degree of accuracy and agreement with the panel assessments. The average software and panel scores were 64.1 and 60.91, respectively. Sensitivity (0.98) was high, specificity (0.55) was moderate, and the ICC3k value (0.857) indicated a strong agreement between the software and the panel. Further, Spearman's rho (0.73) and Kendall's tau (0.56) suggested a strong correlation between the two grading methods. The results support the algorithm-based software as a valid and reliable tool for dental cavity preparation assessments. The software's potential use in dental education is promising, though future research is necessary to validate and optimize this technology for wider application.