Panel Rankings Research Articles

Designing Prefaculty Competencies for Diverse Learners Through a Modified Delphi Process

Faculty diversity in academic medicine may better prepare the next generation of equity-minded health care practitioners and leaders. Prefaculty development is an emerging concept to support trainees in achieving key knowledge, skills, and experiences to become successful faculty. To outline competencies, with corresponding milestones, to support the academic career development of learners, inclusive of racial, ethnic, sexual, and gender identities minoritized in medicine. Using a modified Delphi process, a national working group consisting of 13 members was established. The group used the published literature and listening sessions with diverse stakeholders to draft a set of competencies and milestones in July 2022. Diverse expert panelists reviewed the draft set over 2 rounds between September 2022 and January 2023. The group considered qualitative data to further refine the draft set between rounds. Consensus was reached when competencies and milestones were rated as agree or strongly agree on importance or appropriateness by 75% or greater of expert panelists after the second round. A final set of competencies and milestones was generated in February 2023. Data from round 1 were analyzed in October 2022 and data from round 2 were analyzed in January 2023. The development of prefaculty competencies with corresponding milestones by expert panel rankings and comments. The national working group consisted of 13 members who represented diversity across racial, ethnic, and gender identities and academic and career tracks. The working group developed an initial set of 36 competencies and corresponding milestones across 12 domains. After 2 rounds, consensus among 46 expert panelists generated a final list of 32 competencies with corresponding milestones across 11 domains. A total of 26 panelists (56.5%) were women, 11 (23.9%) were Black or African American, 17 (37.0%) were Latina/o/x/e, Hispanic, or of Spanish origin, and 10 (21.7%) were White. Competency domains were divided into 2 groups: foundational (academic career choice and professional identity, mentorship, networking, financial skills, diversity and inclusion, personal effectiveness and self-efficacy, and leadership) and focused (education, community engagement, research, and clinical medicine). Consensus for inclusion or elimination of items was greater than 90% between the 2 rounds. There was consensus among the working group and expert panelists regarding the importance and appropriateness of the competencies and milestones for diverse trainees to successfully obtain faculty positions. Institutions and national organizations can use these competencies as a framework to develop curricula that support diverse learners' career development toward academia.

Effects of different spices on the bioactive compounds, antioxidant activity, and sensory qualities of kale crisps

SummaryThe study investigated the effect of different spices–cardamom, chilli, ginger, and turmeric on the bioactive compounds, antioxidant activity, colour, and sensory attributes of kale crisps. Specifically, the antioxidant capacity was ranked as follows: kale crisps with turmeric > chilli ≈ ginger > cardamom ≈ control crisps. The analysis using HPLC‐MS/MS focused on 15 specific compounds. Kale crisps contained predominantly chlorogenic and isochlorogenic acids, with turmeric crisps having the highest levels. Turmeric kale crisps exhibited the best sensory properties for overall appearance and crispness. The study found that kale crisps have a high folate content, with ginger crisps containing the highest amounts. Cardamom kale crisps preserved high folate content but had a strong aroma and bitter flavour. The study found lightness (L*) positively correlated with aroma desirability, while redness (a*) negatively correlated with flavour desirability. The chilli kale crisps had a strong flavour and lost their green colour the most, resulting in a lower panel ranking despite high antioxidant potential. This study indicates that kale crisps, especially those with turmeric, may represent a valuable source of bioactive compounds and functional properties. Sensory evaluation indicated their high levels of acceptability.

Development of outcome measures for giant cell arteritis for use in clinical trials and standard practice.

Developments in outcome measures in the rheumatic diseases are promoted by the development of successful treatments. Giant cell arteritis (GCA) is a multifaceted disorder and, therefore, measurement of multiple outcomes is relevant to this illness. It is a privilege to analyze and monitor/transfer long-term patients' management outcomes particularly if the same outcomes are used in practice and in trials. To classify the outcome measures for GCA with a discriminative ability to identify the disease activity status and response to therapy. This study was composed of two steps, instrument design (item generation) and judgmental evidence. A panel of 13 experts was used to validate the instrument through quantitative (content validity) and qualitative (cognitive interviewing) methods. Content validity index was used to assess content validity quantitatively. Five items achieved high content validity where item-content validity index score was >0.79, and in the meantime achieved high content validity response score reflecting greater agreement among panel members. Through qualitative methods, items were improved until saturation was achieved. This agreed with the expert panel ranking of the items included in GCA disease outcome measures set. For daily clinical practice, outcome measures should reflect the patients' disease activity status and have to be easily assessed and recorded. The study identified composite outcome measures for GCA able to assess the disease state and monitor response to therapy. Key Points • Despite the cohort studies published in giant cell arteritis (GCA), there are no fully validated outcome measures for use in standard practice or clinical trials. • There is a gap in international standards for assessing GCA disease activity. • Identifying disease specific outcome measures is vital for monitoring response to therapy, treatment case series and therapeutic clinical trials in GCA. • This study was carried out aiming to classify the outcome measures for GCA with a discriminative ability to identify the disease activity status and response to therapy.

Identification of research priorities for suicide prevention in Nepal: a Delphi study

BackgroundSuicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal.MethodsThe Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses.ResultsForty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as ‘very important’ or ‘important’, 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions.ConclusionsThis is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.

Assessment of vaccination service delivery and quality: a cross-sectional survey of over 1300 health facilities from 29 districts in Sindh, Pakistan conducted between 2017–18

BackgroundRoutine childhood immunization coverage in Pakistan remains sub-par, in part, due to suboptimal utilization of existing vaccination services. Quality of vaccine delivery can affect both supply and demand for immunization, but data for immunization center quality in Pakistan is sparse and in Sindh province in Southern Pakistan, no comprehensive health facility assessment has ever been conducted at a provincial level. We assessed health facilities, specifically immunization centers, and their associated health workers throughout the province to summarize quality of immunization centers. MethodsAn exhaustive list of health facilities obtained from Sindh’s provincial government was included in our analysis, comprising a total of 1396 public, private, and public-private health facilities. We adapted a health facility and health worker assessment survey developed by BASICS and EPI-Sindh to record indicators pertaining to health facility infrastructure, processes and human resources. Using expert panel ranking, we developed critical criteria (the presence of a cold box/refrigerator, vaccinator and vaccination equipment at the immunization center) to indicate the bare minimum items required by immunization centers to vaccinate children. We also categorized other infrastructure, process, and human resource items to determine high, low and moderate function requirements to ascertain quality. We evaluated presence of critical criteria, calculated scores for high, moderate and low function requirements, and displayed frequencies of infrastructure, process and human resource indicators for all immunization centers across Sindh. We analyzed results at the division level and utilized a two-sample independent clustered t-test to test differences in average function requirement scores between facilities that met critical criteria and those that did not.ResultsOut of the 1396 health facilities assessed across Sindh province from October 2017 to January 2018, 1236 (88.5%) were operational while 1209 (86.6%) offered vaccination services (immunization centers). Only 793 (65.6%; 793/1209) immunization centers met the critical criteria of having all the following items: vaccinator, a cold box or refrigerator and vaccine supplies. Of the 416 (34.4%; 416/1209) immunization centers that did not meet the critical criteria, most of the centers did not have a cold box or refrigerator (28.3%; 342/1209), followed by lack of vaccines (19.9%; 240/1209), and a vaccinator (13.0%; 157/1209). Of the 2153 healthcare workers interviewed, 1875 (87.1%) were vaccinators, of which 1745 (81.0%; 1745/2153) were male, and had an average of 12.4 years of schooling. A total of 1805 (96.3%; 1805/1875), 1655 (88.3%; 1655/1875) and 1387 (74.0%; 1387/1875) of the vaccinators were trained in vaccination, cold chain and inventory management respectively.ConclusionOne out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. While the majority of health workers (>80%) were trained on vaccination and cold chain management, the proportion trained on inventory management was comparatively low. Our findings therefore suggest that suboptimal immunization center quality is partly due to inadequate infrastructure and inefficient processes contributed to an extent, by low levels of inventory management training among vaccinators. Our study presents critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within a low-middle income country setting.

Mobile-based brief interventions targeting cannabis-impaired driving among youth: A Delphi study

IntroductionBrief interventions delivered using mobile technologies have become popular to reduce youth alcohol use, however, few have been applied to cannabis use and driving under the influence of cannabis (DUIC). This Delphi study sought to create and compare consensus among a panel of experts (potential intervention developers) and a panel of youth (intervention audience) on the characteristics to prioritize in a youth DUIC mobile-based brief intervention. MethodsA two-round two-panel Delphi study was conducted among 26 professionals with expertise in youth substance use and impaired driving and 20 youth who use cannabis. Participants ranked the importance of 45 evidence-informed intervention characteristics using a 7-point Likert scale. Characteristics that received an interquartile deviation score ≤ 1 (indicating consensus) and a median score of ≥6 (indicating importance) in both panels were considered shared priorities. Differences in panel rankings were quantified using Mann-Whitney U tests. ResultsConsensus was achieved for 41 characteristics in the professional panel and 34 in the youth panel, with ratings generally higher among professionals. Overall, 16 shared priorities emerged. These include critical theoretical characteristics (e.g., self-efficacy, motivation, overcoming barriers), practical characteristics (e.g., mobile availability, estimates of intervention length, ability to input behaviours) and core contents (e.g., real-life stories, education on the risks/dangers, appropriate messaging). Youth's perceptions on the dangers of DUIC received the most support for an intervention outcome. ConclusionsFindings can inform the development of mobile-based brief interventions for youth, an essential step in reducing DUIC among youth and addressing this public health concern.

The generation gap in direct democracy: Age vs. cohort effects

We document a generation gap in direct democracy outcomes across a wide range of topics that is causally related to aging. To this end, we combine different sources of postelection survey data covering more than 300 Swiss referenda and four decades. Young voters are more likely to support initiatives that favor their own generation in the present, e.g., a lower retirement age or increased unemployment benefits, or in favor of all generations in the future, e.g., environment protection. To estimate the causal effect of aging on political attitudes, we propose a novel unconstrained panel rank regression approach that separately identifies age and cohort effects. The aging effect on political attitudes is robust for controlling for arbitrary cohort effects and appears to be driven by expected utility maximization and not by habituation-induced status-quo bias.

A novel Scale to Assess Palliative Care Patients' Experience of Feeling Heard and Understood

ContextPatient experience of palliative care serves as an important indicator of quality and patient-centeredness. ObjectivesTo develop a novel patient-reported scale measuring ambulatory palliative care patients’ experience of feeling heard and understood by their providers. MethodsWe used self-reported patient experience data collected via mixed-mode survey administration. We conducted an exploratory factor analysis (EFA) and an expert panel ranking exercise to reduce the 10-item set based on underlying dimensionality. We then used item response theory (IRT) to calibrate remaining items based on psychometric properties and test information and precision. We considered item-level fit and examined the standardized local dependence chi-square statistics. We evaluated candidate items for differential item functioning by survey mode. We evaluated the test-retest reliability and validity of the final scale. ResultsThe EFA yielded a single factor (9/10 items had loadings > 0.80 on the single factor). We removed two items with the lowest factor loadings and ranked by the expert panel as being least reflective of the overall construct. IRT calibration of the remaining eight items showed high slopes (range 2.66 – 5.18); location parameters were all negative (range -0.90 - -0.36). We removed two more items based on local dependence indices and item-level fit. Combining psychometric information with the expert ratings we established the final 4-item scale, which was reliable (Cronbach's alpha = 0.84; polychoric correlation coefficient = 0.72) and had good convergent validity. ConclusionsThis novel multi-item Feeling Heard and Understood scale can be used to measure and improve ambulatory palliative care patient experience.

Shifting Paradigm from For-Profit Journal Indexing to Not-for-Profit Academic Journal Quality/Ranking Lists

Bibliometric analysis is important in tourism as a result of external evaluation of research quality, interest in impact and prestige factors, and study of the field’s development. Although bibliometric analysis can be applied to any type of publication the main focus is on journals. Five approaches to the evaluation of journal quality are identified: stated preference, citation-based, derived, hybrid, and expert panels. Different productivity, impact and hybrid metrics are used to identify rankings of tourism journals from Scopus/SCImago data, compared with a derived RAE ranking, and three expert panel rankings. The different rankings reinforces that bibliometric understanding of scientific impact is a multi-dimensional construct. However, bibliometric analysis does not occur in an institutional and policy vacuum. The institutional context of government and private organization evaluations of research quality increasingly determine which metrics are applied, with subsequent effects on performance evaluation, career development and future direction of tourism studies. Keywords: journal impact; journal prestige; journal ranking; SCImago; Scopus; institutional context; neoliberalism; economization This is a draft of an accepted paper. DOI:10.1016/j.tourman.2010.07.001 For the authoritative version please consult the journal website

A clinical research priority setting study for issues related to the use of methamphetamine and emerging drugs of concern in Australia.

IntroductionThis study aimed to gather a range of opinions, including those of affected people (consumers, concerned others) to identify clinical research priorities for methamphetamine and emerging drugs of concern in Australia, to guide the work of the National Centre for Clinical Research on Emerging Drugs (NCCRED).MethodsA priority setting study was conducted (February–March 2019) in four phases: online stakeholder survey, thematic analysis of responses, rapid literature review, expert panel ranking of priorities against predetermined criteria.ResultsForty‐seven respondents completed the survey, including people identifying as one or more of: researcher (53%, n = 25), clinician (45%; n = 21), family/friend/caregiver of someone who uses methamphetamine/emerging drugs (15%, n = 7) and consumer of methamphetamine/emerging drugs (13%, n = 6). Expert panel, evidence‐informed top‐ranked clinical research priorities for methamphetamine were: strategies to overcome barriers to intervention uptake, pilot medication trials for adults seeking treatment, and communication strategies regarding evidence‐based treatments. For emerging drugs of concern, top‐ranked priorities were: piloting community‐located drug checking, feasibility of social media/other opportunities to alert consumers of emerging risks, GHB overdose and withdrawal management, and impacts of an early warning information system on reducing harms.Discussion and ConclusionsWe demonstrate feasibility of a structured, collaborative clinical research priority setting process. Results have informed the establishment of NCCRED; using the identified priorities to guide seed funding, fellowships/scholarships and research programs. Broader uptake of this methodology by policymakers/research funders would assist to embed areas of concern identified by affected communities and other stakeholders in research prioritisation.

Assessment of immunization service delivery in Pakistan: A cross-sectional survey of health facilities

Abstract Background Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to the poor quality of service delivery. This study aims to summarize the quality of immunization centers throughout the Sindh province, Pakistan, by assessing all Government vaccination facilities and their associated health workers. Methods A health facility and worker assessment survey adapted from tools developed by BASICS and EPI-Sindh was used to record facility infrastructure, processes, and human resources. Using expert panel ranking, we developed critical criteria to indicate items immunization centers need to be operational (vaccinator, a cold box or refrigerator, and vaccine supplies) as well as high, low, and moderate function requirements and their respective scores. Results Out of 1396 centers assessed, 1236 (88.5%) were operational, while 1209 (86.6%) offered immunization services. Only 793 (66.0%) of the functional immunization facilities met the critical criteria. The average scores for high, moderate, and low function requirements were significantly lower for centers that did not meet the critical criteria. Of 2,153 healthcare workers interviewed, 1874 (87.1%) were vaccinators. 1805 (96.3%), 1655 (88.3%), and 1387 (74.0%) were trained in vaccination, cold chain, and inventory, respectively. Discussion One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. Health workers have adequate training and experience, suggesting that sub-optimal vaccination center quality is due to inadequate infrastructure and inefficient processes. Our study presents innovative and critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within an LMIC setting. Key messages Every 2 out of 5 facilities in Sindh Province lacked essential equipment for immunizations such as vaccines, vaccinator and cold box for vaccination. In all health facilities, the health workers appear sufficiently trained, indicating that poor quality may be due to missing infrastructure and inefficient processes in resource-constrained settings.

A rank approach for studying cross-currency bases and the covered interest rate parity

We use a panel rank cointegration approach to check for the stability conditions of the cross-country money market interest rate basis. Using weekly information on short-term interest rates and spot and forward exchange rates for a set of 20 European economies between 2005 and 2017, we show that in most cases these bases are non-stationary, implying the failure of the covered interest rate parity condition. Concretely, a mean-reverting behavior is encountered in only two cases. The first includes Greece, Italy and Portugal, while the second Belgium, France and Germany.

The effect of public funding on research output: the New Zealand Marsden Fund

ABSTRACTWe estimate the impact of the NZ Marsden Fund on research success, by comparing the subsequent performance of funded and unfunded researchers. We control for selection bias using the Marsden panel rankings. We find that funding is associated with a 6%–15% increase in publications and an 11%–22% increase in citation-weighted papers for research teams. We attempt to pin down the dynamic structure of this effect by looking at the research trajectories of individual researchers, but this model yields inconsistent results. We find no systematic evidence that Marsden panel rankings are predictive of subsequent success.

Consensus about cardiac patients and families’ competencies in emergency situations: use of a multi-partite Delphi method

Background: Cardiovascular diseases (CVD) are a real public health issue in France. CVDs are generally chronic diseases, punctuated by emergency situation. When a cardiac crisis occurs, the patient and his family are confronted with complex situations that they must manage in priority. The primary aim of this pilot study was to characterise the decision-making competencies that the patient and his close relations must mobilise in such situations, by clarifying diverging and converging opinions among a panel of experts. The objective is to obtain a unique and convergent final opinion of a group of experts. Methods: We conducted a Classical Delphi method during 18-month with 196 members of “Heart and Health” clubs and 82 CVD specialists in one area of France. The Delphi process consist of five rounds of questionnaires (Q) administrated by post to an expert panel. The first questionnaire asks the experts about their opinions on a topic in an open-ended manner: Q1 defined the concept of crisis. These responses are then analysed by the researchers and sent back to the expert panel in the form of statements or new questions. The expert panel rate or rank the questions within the second questionnaire according to their expert opinion on the subject: Q2 identified the emergency situations (frequency and severity); Round continue until a consensus is reached on some or all of the items as required: Q3 ranked the competencies required and the actions likely to be implemented in those situations (feasibility and limitations); and Q4 determined the conditions in which they are mobilised. The Wilcoxon-test was used to compare how the choices regarding these competencies in emergency situations changed from before (Q3) to after (Q4) the responses were submitted to the entire panel (p The panellists reported, clarified and prioritised 20 competencies. Competencies C2 (Recognising the warning signs) and C3 (Calling emergency medical) services ) got a very strong consensus immediately (agreement ≥ 90%) and acquiring them is a high priority. The decision-making competencies C20 (Making emergency decisions ) and organisational competencies C10 (Preparing the medical record ) take precedence over the emotional competencies C14 (Articulating one’s experience) and C15 (Articulating one’s emotions) . Sharing opinions among the panellists led to a significant change in scores for 16 competencies between Q3 and Q4. Conclusions: Using a formal approach, our study produced a solid expert consensus on the competencies needed by CVD patients (and their families) for managing crises, which can help guide clinicians in their practice. Our study helps shift the balance in the care relationship, where, traditionally, health care professionals (HCP) develop the educational programsand define the competencies to be acquired by patients.

Predictors of treatment failure for non-severe childhood pneumonia in developing countries--systematic literature review and expert survey--the first step towards a community focused mHealth risk-assessment tool?

BackgroundImproved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algorithms and feasible to obtain at the community level.MethodsWe systematically reviewed prospective studies reporting independent predictors of oral antibiotic failure for children 2–59 months of age in resource-limited settings with WHO non-severe pneumonia (either fast breathing for age and/or lower chest wall indrawing without danger signs), with an emphasis on predictors not currently utilized for referral and reasonable for community health workers. We searched PubMed, Cochrane, and Embase and qualitatively analyzed publications from 1997–2014. To supplement the limited published evidence in this subject area we also surveyed respiratory experts.ResultsNine studies met criteria, seven of which were performed in south Asia. One eligible study occurred exclusively at the community level. Overall, oral antibiotic failure rates ranged between 7.8-22.9 %. Six studies found excess age-adjusted respiratory rate (either WHO-defined very fast breathing for age or 10–15 breaths/min faster than normal WHO age-adjusted thresholds) and four reported young age as predictive for oral antibiotic failure. Of the seven predictors identified by the expert panel, abnormal oxygen saturation and malnutrition were most highly favored per the panel’s rankings and comments.ConclusionsThis review identified several candidate predictors of oral antibiotic failure not currently utilized in childhood pneumonia referral algorithms; excess age-specific respiratory rate, young age, abnormal oxygen saturation, and moderate malnutrition. However, the data was limited and there are clear evidence gaps; research in rural, low-resource settings with community health workers is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0392-x) contains supplementary material, which is available to authorized users.

Incorporating stakeholder input into marine research priorities for the Aleutian Islands

Resource management agencies are required to consider stakeholder input in the selection of preferred alternatives for proposed actions. Not only do stakeholders contribute unique perspectives on the impact of alternative actions and the desirability of various policy objectives, including stakeholders in the decision process adds to the perceived legitimacy of those decisions. However, gathering stakeholder input and incorporating it into decisions can be difficult. We solicited public input on research needed to improve marine resource management decision-making for the Aleutian Islands region. Stakeholders and an expert panel were asked to use the analytical hierarchy process to rank those research needs. Spearman rank correlation tests were used to search for statistically significant differences in the rank orderings between stakeholders and the expert panel. A high level of association was found between rankings by an expert panel and those by stakeholders. Moreover, the rank orderings were robust to the inclusion or exclusion of interest-group subsets of the stakeholders and expert panel. The expert panel and stakeholders assigned highest priority to new research designed to increase basic knowledge of the Aleutian Islands marine ecosystem. Agreement between stakeholder and expert panel rankings was closest for the most and least important research needs; most substantial differences in the rankings involved research needs identified as moderately important. These results suggest that an expert panel may provide input comparable to that which could be obtained from engaging in a more extensive stakeholder process. Furthermore, these results suggest that the analytical hierarchy process can serve as a useful mechanism for organizing stakeholder input for environmental planning and resource management.

LU Factorization with Panel Rank Revealing Pivoting and Its Communication Avoiding Version

We present block LU factorization with panel rank revealing pivoting (block LU_PRRP), a decomposition algorithm based on strong rank revealing QR panel factorization. Block LU_PRRP is more stable than Gaussian elimination with partial pivoting (GEPP), with a theoretical upper bound of the growth factor of $(1+ \tau b)^{(n/ b)-1}$, where $b$ is the size of the panel used during the block factorization, $\tau$ is a parameter of the strong rank revealing QR factorization, $n$ is the number of columns of the matrix, and for simplicity we assume that n is a multiple of b. We also assume throughout the paper that $2\leq b \ll n$. For example, if the size of the panel is $b = 64$, and $\tau = 2$, then $(1+2b)^{(n/b)-1} = (1.079)^{n-64} \ll 2^{n-1}$, where $2^{n-1}$ is the upper bound of the growth factor of GEPP. Our extensive numerical experiments show that the new factorization scheme is as numerically stable as GEPP in practice, but it is more resistant to pathological cases. The block LU_PRRP factorization does only $O(n^2 b)$ additional floating point operations compared to GEPP. We also present block CALU_PRRP, a version of block LU_PRRP that minimizes communication and is based on tournament pivoting, with the selection of the pivots at each step of the tournament being performed via strong rank revealing QR factorization. Block CALU_PRRP is more stable than CALU, the communication avoiding version of GEPP, with a theoretical upper bound of the growth factor of $(1+ \tau b)^{{n\over b}(H+1)-1}$, where $H$ is the height of the reduction tree used during tournament pivoting. The upper bound of the growth factor of CALU is $2^{n(H+1)-1}$. Block CALU_PRRP is also more stable in practice and is resistant to pathological cases on which GEPP and CALU fail.

Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting

Background Cleft-lip nasal deformity alters patient’s self-image, as well as posing unique challenges for the rhinoplastic surgeon. Objectives The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient’s self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients’ age; (3) patients’ gender; and (4) panel perceptions. Methods Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient’s subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P ≤ 0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively. Results The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings ( P > 0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics ( P = 0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients’ age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction. Conclusions Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient’s self-assessment seems unreliable to be used as an outcome measure.

Publish and perish? Bibliometric analysis, journal ranking and the assessment of research quality in tourism

Bibliometric analysis is important in tourism as a result of external evaluation of research quality, interest in impact and prestige factors, and study of the field’s development. Although bibliometric analysis can be applied to any type of publication the main focus is on journals. Five approaches to the evaluation of journal quality are identified: stated preference, citation-based, derived, hybrid, and expert panels. Different productivity, impact and hybrid metrics are used to identify rankings of tourism journals from Scopus/SCImago data, compared with a derived RAE ranking, and three expert panel rankings. The different rankings reinforces that bibliometric understanding of scientific impact is a multi-dimensional construct. However, bibliometric analysis does not occur in an institutional and policy vacuum. The institutional context of government and private organization evaluations of research quality increasingly determine which metrics are applied, with subsequent effects on performance evaluation, career development and future direction of tourism studies.

Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI)

Improving diets has considerable potential to improve health, but progress in this area has been limited, and advice to increase fruit and vegetable intake has largely gone unheeded. Our objective was to test the performance characteristics of the Overall Nutritional Quality Index (ONQI), a tool designed to help improve dietary patterns one well-informed choice at a time. The ONQI was developed by a multidisciplinary group of nutrition and public health scientists independent of food industry interests and is the basis for the NuVal Nutritional Guidance System. Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm incorporating >30 entries that represent both micro- and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes, was developed and subjected to consumer research and testing of performance characteristics. ONQI and expert panel rankings correlated highly (R = 0.92, P < 0.001). In consumer testing, approximately 80% of >800 study participants indicated that the ONQI would influence their purchase intent. ONQI scoring distinguished the more-healthful DASH (Dietary Approaches to Stop Hypertension) diet (mean score: 46) from the typical American diet according to the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (mean score: 26.5; P < 0.01). In linear regression analysis of the NHANES 2003-2006 populations (n = 15,900), the NuVal system was significantly associated with the Healthy Eating Index 2005 (P < 0.0001). Recently generated data from ongoing studies indicate favorable effects on purchase patterns and significant correlation with health outcomes in large cohorts of men and women followed for decades. NuVal offers universally applicable nutrition guidance that is independent of food industry interests and is supported by consumer research and scientific evaluation of its performance characteristics.