Recommendations of an expert group for the cardiac assessment of non-dystrophic myotonia adult patients treated with mexiletine.

Mexiletine (NaMuscla™) is indicated for the symptomatic treatment of myotonia in adults with non-dystrophic myotonia. A cardiac assessment is required as mexiletine may have a pro-arrhythmic effect. Long-term safety data supporting the use of mexiletine in patients with non-dystrophic myotonia combined with the extensive clinical experience of an expert group resulted in creation of an algorithm for cardiac monitoring of patients treated with mexiletine. To define the treatment algorithm, several expert workshops including three neurologists, five cardiologists from different French neuromuscular reference centers and one pharmacologist from Italy were set up. These workshops aimed to define the screening and surveillance tools required to ensure the safe use of mexiletine in patients. The recommendations are based on the summary of product characteristics (SmPC), a review of the literature on the safety of mexiletine-treated patients with non-dystrophic myotonia, and the expertise of the authors. The expert group concluded that the cardiac safety profile of mexiletine in these patients appears to be similar to that in the general population. Therefore, patients with non-dystrophic myotonia treated with mexiletine should be monitored as per any patient with cardiac problems who are prescribed a class 1b anti-arrhythmic.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation.

BACKGROUND: Electronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers. METHODS: Implementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy's feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review. RESULTS: Of the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups. CONCLUSION: We present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

Prospective Human Validation of Artificial Intelligence Interventions in Cardiology: A Scoping Review.

Background: Despite the potential of artificial intelligence (AI) in enhancing cardiovascular care, its integration into clinical practice is limited by a lack of evidence on its effectiveness with respect to human experts or gold standard practices in real-world settings. Objectives: The purpose of this study was to identify AI interventions in cardiology that have been prospectively validated against human expert benchmarks or gold standard practices, assessing their effectiveness, and identifying future research areas. Methods: We systematically reviewed Scopus and MEDLINE to identify peer-reviewed publications that involved prospective human validation of AI-based interventions in cardiology from January 2015 to December 2023. Results: Of 2,351 initial records, 64 studies were included. Among these studies, 59 (92.2%) were published after 2020. A total of 11 (17.2%) randomized controlled trials were published. AI interventions in 44 articles (68.75%) reported definite clinical or operational improvements over human experts. These interventions were mostly used in imaging (n = 14, 21.9%), ejection fraction (n = 10, 15.6%), arrhythmia (n = 9, 14.1%), and coronary artery disease (n = 12, 18.8%) application areas. Convolutional neural networks were the most common predictive model (n = 44, 69%), and images were the most used data type (n = 38, 54.3%). Only 22 (34.4%) studies made their models or data accessible. Conclusions: This review identifies the potential of AI in cardiology, with models often performing equally well as human counterparts for specific and clearly scoped tasks suitable for such models. Nonetheless, the limited number of randomized controlled trials emphasizes the need for continued validation, especially in real-world settings that closely examine joint human AI decision-making.

Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review.

BACKGROUND: The environment of healthcare institutions plays a major role in the transmission of multidrug resistant organisms (MDRO) and likely in subsequent healthcare-associated infections (HAIs). Probiotic cleaning products are a novel option for environmental cleaning. They represent a sustainable and biodegradable alternative to conventional chemical disinfectants for controlling microbial bioburden, and preventing pathogen transmission in hospital environments. High-quality studies including randomized clinical trials (RCT) triggered a summary with expert recommendations until further studies allow a critical review and meta-analysis of the data. METHODS: Infection control experts from five European countries summarized available data as of June 2023. Authors presented their published RCTs, reviewed the existing literature on probiotic cleaning, summarized the results and identified knowledge gaps and subsequent research needs. RESULTS: Probiotic cleaning was similarly effective for reducing HAI-related pathogens, enveloped viruses such as SARS-CoV-2 and MDRO in environmental samples compared to conventional chemical disinfectants. More importantly, probiotic cleaning was non-inferior to disinfectants in terms of preventing HAI in a large RCT. In addition, probiotic cleaning has also been shown to reduce antimicrobial resistance genes (ARG), costs and antimicrobial consumption in other hospital trials. They are biodegradable, do not require any protection for chemical hazards, and are compliant with occupational health. A paradigm shift, however, requires a very strong evidence to justify for such a change. In the past, this evidence was limited by the heterogeneity of study design, products, protocols, and few studies on clinical outcomes used in the trials. Furthermore, the regulatory, safety, and quality aspects of probiotic cleaning products are not, yet, completely defined and require clearing by authorities. CONCLUSION: To date, probiotic cleaning is a breakthrough technology and a biological alternative for chemical disinfectant when treating hospital environment. It may also have a positive effect on MDRO transmission. However, the different compositions of probiotic products will require standardization, and more robust data should be generated to support these promising results on different compositions. This may trigger a paradigm shift in cleaning of healthcare institutions from chemical to biological control of the hospital environment.

Indian Dental Malpractice Claims and Lawsuits: A Medico-Legal Analysis.

Background and Aim: The law of the land assumes that a dentist will always use credible skill, care, and caution in the care of patients. Failing to do something that one is supposed to do (act of omission) or doing something that one is not supposed to do (act of commission) falls under the purview of medical jurisprudence. Each patient is legally entitled to get quality medical care from a physician; failure to such trust is an actionable offense and grievances can be challenged in consumer redressal forums. This analytical study was aimed to study the reasons for dental negligence cases that sought judicial assistance in consumer courts in terms of monetary benefits and also to study the delay in settlements. Materials and Methods: Archival data of final court-pronounced judgment cases on dental negligence between 2018 and 2022 (i.e., 5 years) were gathered from customer forum websites (https://confonet.nic.in, http://indiankanoon.org/doc, and www.casemine.com). A total of 56 proven dental allegation cases were retrieved. In each verdict case, the allegation against dentist by the plaintiff was recorded, and the response to the complaint by the defendant was studied and analyzed. The year of filing the case and date of judgment, basis of compensation awarded, delay in judgment and role of expert evidence appointed by the court assessed. Results: Misdemeanor by serious negligence: 3, slight negligence: 8, negligent injuries: 35, felony of injuries by serious negligence: 10. Conclusion: Because dentistry involves making decisions in unclear scenarios that affect patient care, there is an inherent danger of malpractice litigation. Awareness of medico-legal issues and professional indemnity insurance coverage for the dentist to safeguard himself from negligence, continuous medico-legal training and documentation of records, and adherence to clinical standards for procedures should be emphasized as prior motives to enhance the standard of care, and a basic awareness of how Indian courts resolve disputes would help dentists plan their professional indemnity insurance and operate their profession properly.

When a Battered Victim Kills Their Abuser: The Impact of Child and Expert Testimony on Mock Jurors' Decision-Making.

The present study investigated the effects of child and expert witness testimony on mock jurors' decision-making and perceptions of a case in which a female defendant claimed self-defense as the reason for killing her husband during a domestic dispute. A 3 (expert witness: Battered Woman Syndrome [BWS] vs. Social Agency [SA] vs. No Expert) × 3 (child witness: Age 5 vs. Age 8 vs. no child) between-subject design was used to examine the effects of two different forms of expert testimony and their interaction with the presence of a child witness. Jury-eligible participants (N = 370) were recruited from Amazon Mechanical Turk and a Psychology Undergraduate Student Pool. The mock jurors who were exposed to the BWS expert perceived the defendant as more guilty when an 8-year-old testified compared to when no child testified at all. Furthermore, when the jurors were exposed to the BWS expert, they imposed a harsher sentence on the defendant when an 8-year-old child testified compared to a 5-year-old child or no child testifying. Although the jurors perceived the defendant in the BWS condition as more fearful compared to no expert and the SA condition, this knowledge did not seem to translate into a lighter verdict or sentencing decision. This study aims to provide guidelines for future researchers and legal professionals considering the issue of expert testimony and child witnesses in intimate partner homicides.

Liver Injury in People With HIV on Antituberculosis and/or Antiretroviral Therapy-Assessing Causality Using the Updated Roussel Uclaf Causality Assessment Method.

PURPOSE: We compared performance of the Roussel Uclaf Causality Assessment Method (RUCAM) with multidisciplinary expert panel review in identifying a drug-induced liver injury (DILI) due to antituberculosis therapy (ATT) and/or antiretroviral therapy (ART). METHODS: Cases were drawn from a prospective registry of hospitalised adults with suspected DILI due to ATT and/or ART in Cape Town, South Africa. Participants had to fulfil American Thoracic Society criteria for ATT interruption (alanine transaminase [ALT] ≥5 times upper limit of normal [ULN]/ALT ≥3 times [ULN] and symptomatic). Causality assessment by expert panel review served as reference standard. The panel ranked potentially implicated drugs as certain, probable, possible or unlikely causes guided by World Health Organization Uppsala Monitoring Centre criteria. The RUCAM was performed for each potentially implicated drug. We calculated sensitivity and specificity of the RUCAM in identifying a probable/certain drug cause for liver injury. RESULTS: We included 48 participants. All were people with HIV (PWH). Twenty-seven were on concomitant ART and ATT, with a median of six potentially hepatotoxic drugs per case. Sensitivity and specificity of the RUCAM in identifying a probable/certain drug cause of liver injury compared with expert panel review was 7% and 100% respectively. Implicated drugs (times ranked probable/certain by panel) were isoniazid (18/0), pyrazinamide (17/0), rifampicin (15/1), efavirenz (6/4) and lopinavir/ritonavir (1/0). CONCLUSIONS: PWH with liver injury received multiple potentially implicated drugs, which may increase liver injury risk and complicate causality assessment. Compared with expert panel review, the RUCAM had low sensitivity in detecting probable or certain drug causes of liver injury.

Updating a diesel engine exhaust job-exposure matrix with published measurement data.

A job-exposure matrix (JEM) is a tool that can estimate diesel engine exhaust (DEE) exposures. JEMs based on expert judgment or measurement data are limited by the information available at the time of development. Over time, more information about hazardous exposures is understood through additional measurements and peer-reviewed publications. This study presents a systematic approach to updating an existing DEE JEM using published data to better reflect current scientific knowledge. The literature was searched for occupational exposure studies that measured DEE as elemental carbon (EC) between January 2010 and May 2022. Four-digit North American Industry Classification System (NAICS) 2002 and National Occupational Classification-Statistics (NOC-S) 2006 codes were assigned to each identified subgroup within the studies. EC exposures were categorized as low (0-10 µg/m3), moderate (10-20 µg/m3), or high (>20 µg/m3). Weighted arithmetic means were calculated for each industry-occupation intersection (IOI) identified in the literature. These means were used to adjust, or retain, the existing exposure level within the JEM cells using a decision tree based on the number of studies, workplace locations, and pooled sample size of the weighted mean. Concordance was measured between the updated JEM (Diesel Exhaust in Canada JEM (DEC-JEM)), the previous (existing) JEM, and the Canadian Job-Exposure Matrix (CANJEM). Thirty-seven studies were identified from the published literature reporting on 53 unique IOIs (20 NAICS and 34 NOC-S codes), including occupations in the mining, construction, and transportation industries. Exposure levels for 66% of identified IOIs increased, most in construction and mining. After the decision tree's results were expanded to the full DEC-JEM, the exposure level of 486 IOIs (12.5% of DEC-JEM) and 286,710 workers (15.8% of DEE-exposed workers) increased. There was a significant correlation between qualitative exposure levels in the updated DEC-JEM and CANJEM (Kendall's τ = 0.364, p < 0.001). This study describes a systematic approach to updating an existing JEM to incorporate new scientific knowledge. The updated DEC-JEM better reflects existing exposure knowledge in several industries, particularly construction. Future analyses include investigating its use as an exposure assessment tool in disease surveillance.

Evaluating models of expert judgment to inform assessment of ecosystem viability and collapse.

Expert judgment underpins assessment of threatened ecosystems. However, experts are often narrowly defined, and variability in their judgments may be substantial. Models built from structured elicitation with large diverse expert panels can contribute to more consistent and transparent decision-making. We conducted a structured elicitation under a broad definition of expertise to examine variation in judgments of ecosystem viability and collapse in a critically endangered ecosystem. We explored whether variation in judgments among 83 experts was related to affiliation and management expertise and assessed performance of an average model based on common ecosystem indicators. There were systematic differences among individuals, much of which were not explained by affiliation or expertise. However, of the individuals affiliated with government, those in conservation and environmental departments were more likely to determine a patch was viable than those in agriculture and rural land management. Classification errors from an average model, in which all individuals were weighted equally, were highest among government agriculture experts (27%) and lowest among government conservation experts (12%). Differences were mostly cases in which the average model predicted a patch was viable but the individual thought it was not. These differences arose primarily for areas that were grazed or cleared of mature trees. These areas are often the target of restoration, but they are also valuable for agriculture. These results highlight the potential for conflicting advice and disagreement about policies and actions for conserving and restoring threatened ecosystems. Although adoption of an average model can improve consistency of ecosystem assessment, it can fail to capture and convey diverse opinions held by experts. Structured elicitation and models of ecosystem viability play an important role in providing data-driven evidence of where differences arise among experts to support engagement and discussion among stakeholders and decision makers and to improve the management of threatened ecosystems.

Análisis de los modelos de opiniones de expertos para informar la evaluación de la viabilidad y el colapso ambiental Resumen La evaluación de los ecosistemas amenazados se basa en la opinión de los expertos. Sin embargo, la definición de experto suele ser limitada y la variabilidad de sus juicios puede ser considerable. Los modelos elaborados a partir de consultas estructuradas con grupos de expertos amplios y diversos pueden contribuir a una toma de decisiones más coherente y transparente. Realizamos una consulta estructurada con una definición amplia de experto para analizar la variación en los juicios sobre la viabilidad y el colapso de un ecosistema en peligro crítico. Exploramos si la variación en los juicios entre 83 expertos estaba relacionada con la afiliación y la experiencia en gestión y evaluamos el rendimiento de un modelo medio basado en indicadores comunes del ecosistema. Observamos diferencias sistemáticas entre los expertos, gran parte de las cuales no se explicaban por la afiliación o la experiencia. Sin embargo, entre los expertos vinculados a la administración pública, los de los departamentos de conservación y medio ambiente tenían más probabilidades de determinar que una parcela era viable que los de agricultura y gestión de tierras rurales. Los errores de clasificación de un modelo medio con todos los individuos ponderados por igual, fueron mayores entre los expertos gubernamentales en agricultura (27%) y menores entre los expertos gubernamentales en conservación (12%). En la mayoría de los casos, las diferencias se debían a que el modelo medio predecía que una parcela era viable, pero el individuo pensaba que no lo era. Estas diferencias surgieron sobre todo en zonas que habían sido pastoreadas o con una tala total de árboles maduros. Estas zonas suelen ser objeto de restauración, pero también son valiosas para la agricultura. Estos resultados ponen de manifiesto la posibilidad de que se produzcan consejos contradictorios y desacuerdos sobre las políticas y acciones de conservación y restauración de los ecosistemas pastoreados y forestales. Si bien la adopción de un modelo medio puede mejorar la coherencia de la evaluación de los ecosistemas, también puede fallar a la hora de captar y transmitir las diversas opiniones de los expertos. Las consultas estructuradas y los modelos de viabilidad de los ecosistemas desempeñan un papel importante a la hora de aportar pruebas basadas en datos de dónde surgen las diferencias entre los expertos para apoyar el compromiso y el debate entre las partes interesadas y los responsables de la toma de decisiones, así como para mejorar la gestión de los ecosistemas amenazados.

Knowledge graph based reasoning in medical image analysis: A scoping review.

Automated computer-aided diagnosis (CAD) is becoming more significant in the field of medicine due to advancements in computer hardware performance and the progress of artificial intelligence. The knowledge graph is a structure for visually representing knowledge facts. In the last decade, a large body of work based on knowledge graphs has effectively improved the organization and interpretability of large-scale complex knowledge. Introducing knowledge graph inference into CAD is a research direction with significant potential. In this review, we briefly review the basic principles and application methods of knowledge graphs firstly. Then, we systematically organize and analyze the research and application of knowledge graphs in medical imaging-assisted diagnosis. We also summarize the shortcomings of the current research, such as medical data barriers and deficiencies, low utilization of multimodal information, and weak interpretability. Finally, we propose future research directions with possibilities and potentials to address the shortcomings of current approaches.

Exploring teacher discourse patterns: Comparative insights from novice and expert teachers in junior high school EFL contexts.

Effective teacher discourse is critical in improving English as a foreign language (EFL) education, particularly in junior high schools in China, where students are at a crucial stage in their language development. As junior high school students are at a pivotal developmental stage, this research investigates the discourse patterns employed by novice and expert teachers to assess their impact on students' engagement and language acquisition. Despite the extensive research on teacher discourse in higher education, a significant gap remains regarding its application in compulsory primary education settings. This study aims to fill this gap by examining the current classroom discourse patterns of EFL teachers in junior high schools to identify the distinctions between novice and expert teachers and explore the factors contributing to these differences. This mixed-methods study includes qualitative and quantitative analyses. Verbatim transcriptions of six classes were used to create a corpus exceeding 20,000 words. The data were analysed using cross-tabulation in Excel and Chi-square tests in SPSS 22.0, complemented by semi-structured interviews with selected teachers. The theoretical framework is grounded in Long's（1996）interaction hypothesis, which underlines the significance of communication in facilitating language proficiency through meaningful interaction, and the analysis follows Sinclair and Coulthard's（1975）discourse patterns. The initiation-response-feedback (IRF) and initiation-response-0 (IR0) emerged as predominant patterns among both novice and expert teachers. Novice teachers predominantly relied on the basic IRF pattern, while expert teachers exhibited greater flexibility and more frequent use of variant patterns, such as IRFR, I[RnFn] and [InRn]F. Such adaptability among expert teachers creates a more interactive and engaging learning environment, thereby enhancing student participation and language acquisition. The study also identifies a novel variant structure, IRnF, used more frequently by expert teachers, underlining the benefits of group work in fostering teamwork and independent thinking. Expert teachers demonstrated a greater propensity to adapt their discourse strategies to foster a more production-oriented learning environment, which was the main factor driving the teachers' differing discourse patterns. This study significantly contributes to the analysis of teacher discourse in the junior high school EFL context, providing empirical evidence and practical insights that bridge the gap between theory and practice. By elucidating the distinct discourse practices of novice and expert teachers, this study offers valuable recommendations for teacher professional development and highlights the importance of employing varied and interactive discourse structures to improve EFL teaching effectiveness. The study also provides valuable insights for educators striving to improve their instructional practices and the language acquisition in EFL classrooms.

From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion.

BACKGROUND AND PURPOSE: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. METHODS: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. RESULTS: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. DISCUSSION AND CONCLUSION: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.

[Improvement of oral health of older people in hospitals: a scoping review]. / Verbesserung der Mundgesundheit älterer Menschen in Krankenhäusern: ein Scoping-Review.

BACKGROUND: The current evidence regarding interventions to improve oral health in older hospital patients is unclear. OBJECTIVE: This scoping review assesses the scope and nature of research activities and identifies gaps in the existing literature. METHODS: The inclusion criteria for this study included adults over the age of 65 years who were treated as inpatient outside of intensive care units and covered all interventions aimed at promoting oral health or hygiene. RESULTS: The systematic search yielded 12 final studies, focusing on oral healthcare interventions in various settings, primarily in high-income countries. The studies employed diverse designs including randomized controlled trials and prospective studies, with interventions mainly provided by multidisciplinary teams. The interventions aimed to improve oral health or prevent pneumonia. Overall, the studies highlighted a potential effectiveness of multidisciplinary approaches in improving oral health and preventing pneumonia in geriatric populations. CONCLUSION: This scoping review shows a limited and heterogeneous evidence base for oral health interventions for older patients in hospitals. The need for patient involvement is evident; however, there is often a lack of high-quality studies to draw robust conclusions.

Eliciting diverse perspectives to prioritize community actions for biodiversity conservation.

Communities have a strong role in protecting biodiversity. In addition to participation in restoration, a range of actions in the public or private sphere may support biodiversity. Despite this, there is a lack of clarity about what actions should be prioritized for behavior change campaigns. We developed and applied a method to prioritize community actions for biodiversity conservation that incorporates an expert-based assessment of impact and a community-informed measure of the likelihood of uptake. In stage 1, experts (n = 143) completed a survey that quantified the relative impact of actions based on best-worst scaling of perceived impact. In stage 2, surveyed community members (n = 3200) ranked the likelihood of adopting actions based on the ease or difficulty of performing each action, and the opportunity for change based on the proportion of respondents not yet engaging in each behavior. Experts gave the following actions the highest ranking for impact: voting for the environment (first), participating in restoration in ecological priority areas (second), and purchasing and protecting remnant bushland (third). When considering the disciplinary background and institutional background of experts, voting and participating in restoration activities remained in the upper ranked options. However, there was some divergence between these groups. For example, reducing beef consumption was ranked third by university-based experts but ranked 28th by experts based in state government. Overall, community members ranked the following behaviors as most likely to be adopted: following quarantine laws (first), reducing plastic use (second), and managing pets (third). Top likelihood ranking of actions was minimally affected by community characteristics (nature relatedness, gender, location). Integrating these findings, the action ranked most favorably for impact, likelihood, and opportunity was participating in restoration. Choosing actions for behavior change campaigns requires consideration of the entire social-ecological system-from social factors that enable or constrain adoption to the ecological impact of actions across relevant social and ecological contexts.

Inducción de perspectivas diversas para priorizar las acciones comunitarias a favor de la conservación de la biodiversidad Las comunidades juegan un papel importante en la protección de la biodiversidad. Además de participar en la restauración, existe una gama de acciones públicas y privadas que pueden ayudar a la biodiversidad. A pesar de esto, no está claro cuáles acciones deben priorizarse en las campañas de cambio conductual. Desarrollamos y aplicamos un método para priorizar las acciones comunitarias a favor de la conservación de la biodiversidad que incorpora la evaluación por experto del impacto y la medida comunitaria de la probabilidad de captación. En la fase 1, los expertos (n = 143) completaron una encuesta que cuantificó el impacto relativo de las acciones con base en una escala mejor­peor del impacto percibido. En la fase 2, los miembros de la comunidad (n = 3200) clasificaron la probabilidad del éxito de las acciones con base en la proporción de respondientes que todavía no participan en cada comportamiento. Los expertos otorgaron la clasificación más alta para el impacto a las siguientes acciones: votar por el ambiente (primero), participar en la restauración de áreas ecológicas prioritarias (segundo) y adquirir y proteger matorrales remanentes (tercero). Cuando consideramos la formación disciplinaria e institucional de los expertos, la votación y la participación en las actividades de restauración permanecieron en las opciones con clasificación más alta; sin embargo, existió una divergencia entre estos grupos. Por ejemplo, los expertos de las universidades clasificaron en tercero la reducción del consumo de carne de res, pero los expertos del gobierno estatal lo clasificaron en vigésimo octavo. En general, los miembros de la comunidad clasificaron los siguientes comportamientos como los más probables de ser adoptados: seguir las normas de cuarentena (primero), reducir el uso de plásticos (segundo) y el manejo de mascotas (tercero). Las características comunitarias (relación con la naturaleza, género, ubicación) afectaron en lo mínimo a la clasificación más alta de probabilidad de las acciones. Al integrar estos resultados, la acción mejor clasificada en cuanto a impacto, probabilidad y oportunidad fue la participación en la restauración. La selección de acciones para las campañas de cambio conductual requiere que se considere todo el sistema socio ecológico ­ desde los factores sociales que permiten o restringen la conservación hasta las acciones de impacto ecológico relevantes en los contextos sociales y ecológicos.

Delphi Technique on Nursing Competence Studies: A Scoping Review.

This scoping review was conducted under the Joanna Briggs Institute (JBI) framework. It included primary studies published until 30 April 2023, obtained through a systematic search across PubMed, Web of Science, CINAHL, and MEDLINE databases. The review focused on primary studies that used the Delphi technique in nursing competence research, especially those related to defining core competency frameworks and developing instruments to assess professional competence. The goal was to analyze the different methodological approaches used by authors, synthesize them, and propose recommendations to enhance methodological rigor, reliability, and validity in the application of the Delphi technique. For this purpose, the following review question was established: "What is the available evidence on the use of the Delphi technique in the study of professional competence in nursing?". The extracted textual elements underwent a content analysis, resulting in dimensions established through an inductive approach. Twenty studies were included, yielding insights into diverse methodological options for conducting Delphi studies, organised around a set of dimensions: (1) preparatory procedures; (2) procedures for accessing and selecting experts; (3) acquisition of expert input; (4) data analysis and consensus; and (5) ethical and legal procedures and guarantees. The study's limitations include the inability to include certain studies due to a lack of response to requests for clarification from corresponding authors. Additionally, the primary studies' methodological quality was not assessed, which is another relevant aspect. The study's results offer valuable insights for researchers intending to utilise the Delphi technique within the context of the research referenced in the included studies. This information encompasses important methodological choices, highlighting their potential benefits and associated risks. The review was prospectively registered on the Open Science Framework (Registration No: osf.io/kp2vw).

A Hybrid Framework for Maritime Surveillance: Detecting Illegal Activities through Vessel Behaviors and Expert Rules Fusion.

Maritime traffic is essential for global trade but faces significant challenges, including navigation safety, environmental protection, and the prevention of illicit activities. This work presents a framework for detecting illegal activities carried out by vessels, combining navigation behavior detection models with rules based on expert knowledge. Using synthetic and real datasets based on the Automatic Identification System (AIS), we structured our framework into five levels based on the Joint Directors of Laboratories (JDL) model, efficiently integrating data from multiple sources. Activities are classified into four categories: illegal fishing, suspicious activity, anomalous activity, and normal activity. To address the issue of a lack of labels and integrate data-driven detection with expert knowledge, we employed a stack ensemble model along with active learning. The results showed that the framework was highly effective, achieving 99% accuracy in detecting illegal fishing and 92% in detecting suspicious activities. Furthermore, it drastically reduced the need for manual checks by specialists, transforming experts' tacit knowledge into explicit knowledge through the models and allowing continuous updates of maritime domain rules. This work significantly contributes to maritime surveillance, offering a scalable and efficient solution for detecting illegal activities in the maritime domain.

Construction of a Food Safety Evaluation System Based on the Factor Analysis of Mixed Data Method.

Food safety evaluation, which aims to reflect food safety status, is an important part of food safety management. Traditional food evaluation methods often consider limited data, and the evaluation process is subjective, time-consuming, and difficult to popularize. We developed a new food safety evaluation system that incorporates simple qualification degrees, food consumption, project hazard degrees, sales channels, food production regions, and other information obtained from food safety sampling and inspection to reflect the food safety situation accurately, objectively, and comprehensively. This evaluation model combined the statistical method and the machine learning method. The optimal distance method was used to calculate the basic qualification degree, and then expert elicitation via a questionnaire and the factor analysis of mixed data method (FADM) was applied to modify the basic qualification degree so as to obtain the food safety index, which indicates food safety status. Then, the effectiveness of this new method was verified by calculating and analyzing of the food safety index in region X. The results show that this model can clearly distinguish food safety levels in different cities and food categories and identify food safety trends in different years. Thus, this food safety evaluation system based on the FADM quantifies the real food safety level, screens out cities and food categories with high food safety risks, and, finally, helps to optimize the allocation of regulatory resources and provide technical and theoretical support for government decision-making.

Experts' views on the implementation of digital interventions for eating disorders: a Delphi study.

BACKGROUND: Eating disorders (EDs) constitute a considerable burden for individuals and society, but adequate and timely professional treatment is rare. Evidence-based Digital Mental Health Interventions (DMHIs) have the potential both to reduce this treatment gap and to increase treatment effectiveness. However, their integration into routine care is lacking. Understanding practitioners' attitudes towards DMHIs for EDs is crucial for their effective use. AIMS: To investigate the consensus among German ED treatment experts on the relevance of different influencing factors for DMHI use in EDs. METHODS: This Delphi study consisted of two rounds and was conducted online with an initial sample of N = 24 ED experts (Mage=41.96, SDage=9.92, n = 22 female). Prior to the Delphi rounds, semi-structured qualitative telephone interviews were performed to explore participants' attitudes, experiences, and expectations towards DMHIs. In order to construct the Delphi survey, content analysis was applied to a subset of ten interviews. A total of 63 influencing factors were identified and grouped into three main categories: contextual conditions, design, and content of DMHIs. In both Delphi rounds, the interview participants were subsequently invited to rate each of the factors with regard to their importance on 10-point scales. Group percentages and individual ratings of the first round (n = 23) were presented in the second round (n = 21). Consensus was calculated for each item (defined as IQR ≤ 2). RESULTS: Importance ratings were high across items (M = 7.88, SD = 2.07, Mdn = 8). In the first round, 48% of the items reached consensus, with its most important (Mdn = 10) factors referring to data security, evidence base, technical requirements, usability, and specific DMHI content (psychoeducation, crisis intervention). In the second Delphi round, a consensus was reached on 73% of the items. No consensus was reached on 17 items. CONCLUSIONS: The findings on practitioners' attitudes and priorities have relevant implications for subsequent DMHI development, dissemination, and implementation strategies, indicating that the highest-rated factors should be highlighted in the process.