Specialist Panels Research Articles

Singapore’s Experience in Managing the COVID-19 Pandemic: Key Lessons from the Ground

Singapore managed the COVID-19 pandemic in the past three years and gleaned valuable lessons on patient management when the public healthcare system was inundated with COVID-19 patients. There were several initiatives, which included setting up of community treatment facilities to help hospitals manage in-patient loads that did not require acute monitoring, leveraging telemedicine, and developing heuristics to sort patients based on their clinical disposition to various care pathways and to effectively manage patients of different medical needs. These initiatives were implemented in the second year of the epidemic in 2021 and did not include the dormitory-based migrant workers and migrant workers in the construction, maritime and production sectors who were under the care of the Assurance, Care and Engagement Group (ACE) in the Ministry of Manpower that had its own set of treatment management measures. The different care pathways ensured that patients received appropriate levels of care and allowed healthcare facilities to focus on more acute cases. In 2022 alone, 23,159 patients were discharged from community treatment facilities against the background of 1.9 million COVID-19 patients. These initiatives would not be possible without the oversight of an advisory board comprising senior leadership from the healthcare clusters and the Ministry of Health to align clinical governance with medical policies, and prompt and immense support from medical specialist panels. The strong public-private partnership forged in the process was instrumental in the successful operation of community facilities and implementation of patient care protocols, coupled with harnessing information technology and leveraging on emerging data to refine care protocols.

Singapore’s Experience in Managing the COVID-19 Pandemic: Key Lessons from the Ground

Singapore managed the COVID-19 pandemic in the past three years and gleaned valuable lessons on patient management when the public healthcare system was inundated with COVID-19 patients. There were several initiatives, which included setting up of community treatment facilities to help hospitals manage in-patient loads that did not require acute monitoring, leveraging telemedicine, and developing heuristics to sort patients based on their clinical disposition to various care pathways and to effectively manage patients of different medical needs. These initiatives were implemented in the second year of the epidemic in 2021 and did not include the dormitory-based migrant workers and migrant workers in the construction, maritime and production sectors who were under the care of the Assurance, Care and Engagement Group (ACE) in the Ministry of Manpower that had its own set of treatment management measures. The different care pathways ensured that patients received appropriate levels of care and allowed healthcare facilities to focus on more acute cases. In 2022 alone, 23,159 patients were discharged from community treatment facilities against the background of 1.9 million COVID-19 patients. These initiatives would not be possible without the oversight of an advisory board comprising senior leadership from the healthcare clusters and the Ministry of Health to align clinical governance with medical policies, and prompt and immense support from medical specialist panels. The strong public-private partnership forged in the process was instrumental in the successful operation of community facilities and implementation of patient care protocols, coupled with harnessing information technology and leveraging on emerging data to refine care protocols.

The biographic and professional influences on adoption and fostering panel members’ recommendation-making

In the UK, decisions to approve adoptive parents and foster carers and authorise adoptions rest with specialist panels. While their formal role and function are clear, there is concern that their composition and the biographies and background characteristics of members could introduce bias and influence the decisions made. This article examines the validity of these criticisms with findings from a study of eight agencies, 15 panels and 22 members. It was found that the panel system achieves its aims in terms of having a representative constitution and providing considered recommendations in a timely manner to senior managers, but that individual biography affects panel members in carrying out their role to an unexpectedly high degree, possibly leading to flawed decisions. Actions to remedy this problem, at both an individual and group level, are suggested.

Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis

SummaryBackgroundThere are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years.MethodsIn this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485.FindingsThe most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15–20, I2=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6–9, I2=99·8%). The pooled estimate for occasional use was 0·8% (0·5–1·2, I2=99·4%) for daily use and 7·5% (6·1–9·1, I2=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS.InterpretationThere is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems.FundingWorld Health Organization and the Bill & Melinda Gates Foundation.

Is open banking driving the financial industry towards a true electronic market?

Over the last two years, there has been an exponentially increasing number of articles, tweets, interviews and specialist panels about open banking and how banks, fintechs, and the whole industry can profit from this fundamental, irreversible and revolutionary change. Experts have argued with increasing urgency that the market players have to step on the gas if they want to gain a good position in this new and unknown open banking world. The bottom line is that banks can profit strongly if they do it right.

Remote Tool-Based Adjudication for Grading Diabetic Retinopathy.

PurposeTo present and evaluate a remote, tool-based system and structured grading rubric for adjudicating image-based diabetic retinopathy (DR) grades.MethodsWe compared three different procedures for adjudicating DR severity assessments among retina specialist panels, including (1) in-person adjudication based on a previously described procedure (Baseline), (2) remote, tool-based adjudication for assessing DR severity alone (TA), and (3) remote, tool-based adjudication using a feature-based rubric (TA-F). We developed a system allowing graders to review images remotely and asynchronously. For both TA and TA-F approaches, images with disagreement were reviewed by all graders in a round-robin fashion until disagreements were resolved. Five panels of three retina specialists each adjudicated a set of 499 retinal fundus images (1 panel using Baseline, 2 using TA, and 2 using TA-F adjudication). Reliability was measured as grade agreement among the panels using Cohen's quadratically weighted kappa. Efficiency was measured as the number of rounds needed to reach a consensus for tool-based adjudication.ResultsThe grades from remote, tool-based adjudication showed high agreement with the Baseline procedure, with Cohen's kappa scores of 0.948 and 0.943 for the two TA panels, and 0.921 and 0.963 for the two TA-F panels. Cases adjudicated using TA-F were resolved in fewer rounds compared with TA (P < 0.001; standard permutation test).ConclusionsRemote, tool-based adjudication presents a flexible and reliable alternative to in-person adjudication for DR diagnosis. Feature-based rubrics can help accelerate consensus for tool-based adjudication of DR without compromising label quality.Translational RelevanceThis approach can generate reference standards to validate automated methods, and resolve ambiguous diagnoses by integrating into existing telemedical workflows.

Building Enforcement Capacity for Brazilian Corporate and Securities Law

Brazil is one of the world’s largest emerging markets, with many opportunities for development. Persuading financiers to commit funds to Brazilian firms requires effective corporate and securities laws to facilitate ‘arm’s length’ contracting. Enforcement of these laws is problematic. Brazilian judges are over-worked, with a long case backlog. They lack relevant business expertise, and are often expected to anticipate ‘social and economic consequences’ in their judgments. This provides little certainty. Nevertheless, authorities and market participants have developed an array of specialist enforcement institutions, which build upward from the authority of the inefficient courts, and overlap each other. Drawing on qualitative data from interviews with participants, we document the evolution and interaction of four such institutions in Brazilian corporate and securities law: (i) The growing role of arbitration; (ii) the restructuring of the Sao Paulo Court of Justice to create specialist panels of expert commercial judges; (iii) a dedicated administrative court operated by the Brazilian securities regulator (the ‘CVM’); and (iv) a recent initiative to create a Brazilian Takeover Panel (the ‘CAF’). Together they form a mutually reinforcing system of enforcement, the sum of which is far greater than its unpromising judicial foundations.

Normes OEPP EPPO Standards

Normes OEPP EPPO Standards

Normes OEPP ‐ Diagnostic/EPPO Standards ‐ Diagnostics

Normes OEPP ‐ Diagnostic/EPPO Standards ‐ Diagnostics

Normes OEPP EPPO Standards

Normes OEPP EPPO Standards

Normes OEPP EPPO Standards Diagnostics Diagnostic

Normes OEPP EPPO Standards Diagnostics Diagnostic

Early design-stage biorefinery process selection

A methodology for early design-stage evaluation of biorefinery processes that uses multicriteria decision-making (MCDM) panels was developed with the goal of screening out less promising options. Panel members were asked to rate the relative importance of a set of evaluation criteria for biorefinery process implementation at a pulp and paper mill. Three different panels were conducted, each with this same objective. This report compares and assesses the results from the panels. Two of the MCDM panels were comprised of biorefinery specialists of similar backgrounds from government and academia, and the third panel consisted of pulp and paper industry decision makers. In general, consensus was high between all three panels, and especially between the two biorefinery specialist panels; however, certain differences were noted with the industry panel. For three out of eight criteria, these differences were attributable to a difference in the perspective of the forest industry decision makers and biorefinery specialists. For example, for the return on investment criteria, the specialist panels gave a significantly higher importance to current information from technology suppliers because it provides an important short-term perspective. In contrast, the forest industry decision makers thought that information about a particular technology should be critiqued and adjusted based on a systematic assessment of likely future process performance. Differences between the other criteria were attributed to differing interpretations of the criteria.

Normes OEPP EPPO Standards Diagnostics Diagnostic

Normes OEPP EPPO Standards Diagnostics Diagnostic

Normes OEPP/EPPO Standards Diagnostics Diagnostic

Normes OEPP/EPPO Standards Diagnostics Diagnostic

Meta‐Analysis of Trials Evaluating Parenteral Antimicrobial Therapy for Skin and Soft Tissue Infections

Many trials have been carried out to determine the effectiveness of antimicrobial agents in treating skin and soft tissue infections. The results of these studies are often utilized to make determinations about the use of these antimicrobials against other types of infections. Despite the importance of these trials in determining clinical care, we hypothesized that many of these studies failed to include a variety of infections of significant enough severity to effectively draw objective conclusions about antimicrobial efficacy. We conducted a modified PubMed search to identify studies of antimicrobial agents in treating soft tissue infections that were published from 1998 through 2008. We then evaluated these trials for specific recommended study criteria, which were based on published US Food and Drug Administration guidelines for the conduct of trials of antimicrobials for soft tissue infection. Seventeen studies were identified for inclusion in the trial. Upon review, only 30% of trials required both local and systemic signs of infection for inclusion in the trial. One trial stratified results on the basis of operative intervention, less than half reported patient comorbidities, and only 53% provided a specific definition for "cure." Our meta-analysis of current trials evaluating antimicrobial therapy for skin and soft tissue infections revealed substantial shortcomings in the design of most of these trials. These data provide evidence for the importance of designing specialist panels to objectively evaluate studies and photographs of included infections to ensure that conclusions drawn from these trials concerning clinical practice are justified.

Normes OEPP/EPPO Standards Diagnostics Diagnostic

Normes OEPP/EPPO Standards Diagnostics Diagnostic

A Specialist Patent or Intellectual Property Court for New Zealand?

Specialization in intellectual property law has, in recent years, become an important issue due to the need for an efficient system for the resolution of intellectual property and patent disputes. Specialist courts or panels within existing courts have been developed in many jurisdictions and the question posed in this article is whether New Zealand should follow suit. This article traverses the differing specialist intellectual property (IP) and patent adjudication systems in the United States, United Kingdom, Australia and Japan to assess what system would best suit New Zealand. The benefits and disadvantages of specialization generally are also discussed. The conclusion is that the time is ripe for some form of specialization in IP matters in New Zealand and that the best model for New Zealand to adopt is one similar to that of the Federal Court of Australia panel system, whereby judges opt into particular panels while still taking on cases within the court's general docket. The article proposes that this specialization in New Zealand should occur in the High Court (trial level) as the real need for specialist knowledge is at the fact‐finding stage. It is argued that a panel system would strike the appropriate balance between developing expertise on the bench, allowing for cross‐fertilization of legal developments, while also preventing stagnation and idiosyncratic interpretations of the law. Some specialization at intermediate appellate court level is also recommended.

Normes OEPP EPPO Standards Diagnostics Diagnostic

Normes OEPP EPPO Standards Diagnostics Diagnostic

Predictors of On‐call Specialist Response Times in California Emergency Departments

To assess waiting times in emergency departments (EDs) for on-call specialist response and how these might vary by facility or neighborhood characteristics. Limited availability of on-call specialists is thought to contribute to ED overcrowding. Direct observational data from a random sample of 1,798 patients visiting 30 California EDs during a six-month period provided specialist waiting times. The authors used multivariate logistic regression and survival analysis to analyze predictors of time to on-call specialists' telephone response. Eighty-six percent of on-call specialists who were paged responded by telephone within 30 minutes. Ten percent of specialists did not respond at all. After controlling for the annual percentage of nonurgent ED patients at each facility, near closure status, and hospital ownership status, for every 10,000 dollars increase in hospital zip code income, the odds of on-call specialist response within 30 minutes increased by 123% (adjusted odds ratio = 2.23; 95% confidence interval = 1.24 to 4.02; p = 0.01). Although the majority of on-call specialists met the federal recommendation of a 30-minute response, those in poor neighborhoods were less likely to do so. One in ten on-call specialists did not respond at all. State and federal policies should focus on making more funding available for on-call specialist panels in poor areas.

Predictors of On-call Specialist Response Times in California Emergency Departments

Objectives: To assess waiting times in emergency departments (EDs) for on-call specialist response and how these might vary by facility or neighborhood characteristics. Limited availability of on-call specialists is thought to contribute to ED overcrowding. Methods: Direct observational data from a random sample of 1,798 patients visiting 30 California EDs during a six-month period provided specialist waiting times. The authors used multivariate logistic regression and survival analysis to analyze predictors of time to on-call specialists' telephone response. Results: Eighty-six percent of on-call specialists who were paged responded by telephone within 30 minutes. Ten percent of specialists did not respond at all. After controlling for the annual percentage of nonurgent ED patients at each facility, near closure status, and hospital ownership status, for every $10,000 increase in hospital zip code income, the odds of on-call specialist response within 30 minutes increased by 123% (adjusted odds ratio = 2.23; 95% confidence interval = 1.24 to 4.02; p = 0.01). Conclusions: Although the majority of on-call specialists met the federal recommendation of a 30-minute response, those in poor neighborhoods were less likely to do so. One in ten on-call specialists did not respond at all. State and federal policies should focus on making more funding available for on-call specialist panels in poor areas.