Management from a multidisciplinary perspective of phlebitis related to peripheral venous catheter insertion: An international Delphi study.

AIM: To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines. BACKGROUND: PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous. DESIGN: Delphi method. METHODS: Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them. RESULTS: Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work). CONCLUSION: The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities. RELEVANCE TO CLINICAL PRACTICE: Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice. REPORTING METHOD: Delphi studies (CREDES). PATIENT OR PUBLIC CONTRIBUTION: Experts contribution.

[The expert panel for Script Concordance Tests: A truly adequate reference?] / Le panel d'experts pour les tests de concordance de script : une référence réellement adéquate ?

The Script Concordance Tests (SCTs) are an examination modality introduced by decree in the French National Ranking Exam for medical students in 2024. Their objective is to evaluate clinical reasoning in situations of uncertainty. In practice, SCTs assess the impact of new information on the probability of a hypothesis formulated a priori based on an authentic clinical scenario. This approach resembles probabilistic (or Bayesian) reasoning. Due to the uncertainty associated with the explored clinical situation, SCTs do not compare the student's response to an expected one in a theoretical knowledge reference. Instead, the distribution of responses from a panel of experienced physicians is used to establish the question's scoring scale. Literature data suggest that physicians, even experienced ones, like most humans, often exhibit biased intuitive probabilistic reasoning. These biases raise questions about the relevance of using expert panel responses as scoring scales for SCTs.

Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers.

BACKGROUND: We describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022. METHODS: Experts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022. RESULTS: The five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma. CONCLUSIONS: In general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.

'Drowned in a Sea of Inhumanity': Natural Childbirth, Postnatal Depression and the National Childbirth Trust, 1956-80s.

During the 1970s, the National Childbirth Trust (NCT) began to provide information and support to women experiencing postnatal mental illness, building on its promotion of natural childbirth and emphasis on the emotional wellbeing of women around birth, which had occupied the organisation since its establishment in 1956. This article argues that, alongside emotional, social and medical factors, the NCT attributed postnatal depression to the shift to hospital deliveries, involving high levels of intervention and frustrating women's choice and agency. While sharing ambitions to improve care in childbirth and giving women a voice in describing their experiences, it is suggested that the NCT's relationship with the feminist health movement remained ambiguous. The article also explores the NCT's collaboration with a variety of experts and advisors, some of whom emphasised the risk of postnatal depression to the bonding process and infant's development, potentially exacerbating the mental distress of new mothers.

Definition and analysis of gray matter atrophy subtypes in mild cognitive impairment based on data-driven methods.

Introduction: Mild cognitive impairment (MCI) is an important stage in Alzheimer's disease (AD) research, focusing on early pathogenic factors and mechanisms. Examining MCI patient subtypes and identifying their cognitive and neuropathological patterns as the disease progresses can enhance our understanding of the heterogeneous disease progression in the early stages of AD. However, few studies have thoroughly analyzed the subtypes of MCI, such as the cortical atrophy, and disease development characteristics of each subtype. Methods: In this study, 396 individuals with MCI, 228 cognitive normal (CN) participants, and 192 AD patients were selected from ADNI database, and a semi-supervised mixture expert algorithm (MOE) with multiple classification boundaries was constructed to define AD subtypes. Moreover, the subtypes of MCI were obtained by using the multivariate linear boundary mapping of support vector machine (SVM). Then, the gray matter atrophy regions and severity of each MCI subtype were analyzed and the features of each subtype in demography, pathology, cognition, and disease progression were explored combining the longitudinal data collected for 2 years and analyzed important factors that cause conversion of MCI were analyzed. Results: Three MCI subtypes were defined by MOE algorithm, and the three subtypes exhibited their own features in cortical atrophy. Nearly one-third of patients diagnosed with MCI have almost no significant difference in cerebral cortex from the normal aging population, and their conversion rate to AD are the lowest. The subtype characterized by severe atrophy in temporal lobe and frontal lobe have a faster decline rate in many cognitive manifestations than the subtype featured with diffuse atrophy in the whole cortex. APOE ε4 is an important factor that cause the conversion of MCI to AD. Conclusion: It was proved through the data-driven method that MCI collected by ADNI baseline presented different subtype features. The characteristics and disease development trajectories among subtypes can help to improve the prediction of clinical progress in the future and also provide necessary clues to solve the classification accuracy of MCI.

'Follow the science': Popular trust in scientific experts during the coronavirus pandemic.

The coronavirus pandemic increased the role played by scientific advisers in counselling governments and citizens on issues around public health. This raises questions about how citizens evaluate scientists, and in particular the grounds on which they trust them. Previous studies have identified various factors associated with trust in scientists, although few have systematically explored a range of judgements and their relative effects. This study takes advantage of scientific advisers' heightened public profile during the pandemic to explore how people's trust in scientists is shaped by perceptions of their features and traits, along with evaluations of their behaviour and role within the decision-making process. The study also considers people's trust in politicians, thereby enabling us to identify whether trust in scientists reflects similar or distinctive considerations to trust in partisan actors. Data are derived from specially designed conjoint experiments and surveys of nationally representative samples in Britain and the United States.

Digital competence among pre-service teachers: A global perspective on curriculum change as viewed by experts from 33 countries.

In the intensely developing information society, the education of pre-service teachers presents an organisational, methodological, and conceptual challenge. Recent years have necessitated reflection on the content and modalities of the formation of digital competence in pre-service teachers. This article - considers which components the digital competences of the new generations of teachers should contain and how this area can be effectively developed within academic education. The article is the result of interviews conducted with 35 experts (recognized scholars in the field of media pedagogy) from North and South America, Africa, Australia and Oceania, Asia, and Europe. Qualitative interviews using the Delphi methodology were conducted between June and September 2022. Using grounded theory principles, it was noted that there is a need to modify pre-service teachers' curricula in the following areas: creating, retrieving and managing digital content; integrating ICT into subject content; developing soft skills; enhancing interactivity in the classroom; social aspects of ICT; distance learning; new socio-technical processes; advanced digital competencies; predictive learning; analysing the impact of ICT on human life; data protection; e-risks; low digital competencies; understanding media messaging; and supporting people with disabilities.

Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus.

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.

EMPT: a sparsity Transformer for EEG-based motor imagery recognition.

Introduction: Transformer network is widely emphasized and studied relying on its excellent performance. The self-attention mechanism finds a good solution for feature coding among multiple channels of electroencephalography (EEG) signals. However, using the self-attention mechanism to construct models on EEG data suffers from the problem of the large amount of data required and the complexity of the algorithm. Methods: We propose a Transformer neural network combined with the addition of Mixture of Experts (MoE) layer and ProbSparse Self-attention mechanism for decoding the time-frequency-spatial domain features from motor imagery (MI) EEG of spinal cord injury patients. The model is named as EEG MoE-Prob-Transformer (EMPT). The common spatial pattern and the modified s-transform method are employed for achieving the time-frequency-spatial features, which are used as feature embeddings to input the improved transformer neural network for feature reconstruction, and then rely on the expert model in the MoE layer for sparsity mapping, and finally output the results through the fully connected layer. Results: EMPT achieves an accuracy of 95.24% on the MI EEG dataset for patients with spinal cord injury. EMPT has also achieved excellent results in comparative experiments with other state-of-the-art methods. Discussion: The MoE layer and ProbSparse Self-attention inside the EMPT are subjected to visualisation experiments. The experiments prove that sparsity can be introduced to the Transformer neural network by introducing MoE and kullback-leibler divergence attention pooling mechanism, thereby enhancing its applicability on EEG datasets. A novel deep learning approach is presented for decoding EEG data based on MI.

Epistemic Trust in Scientific Experts: A Moral Dimension.

In this paper, I develop and defend a moralized conception of epistemic trust in science against a particular kind of non-moral account defended by John (2015, 2018). I suggest that non-epistemic value considerations, non-epistemic norms of communication and affective trust properly characterize the relationship of epistemic trust between scientific experts and non-experts. I argue that it is through a moralized account of epistemic trust in science that we can make sense of the deep-seated moral undertones that are often at play when non-experts (dis)trust science.

Visible scientists in digital communication environments: An analysis of their role performance as public experts on Twitter/X during the Covid-19 pandemic.

In response to significant societal challenges, there is a growing demand for scientists to actively engage in public discussions. The recent Covid-19 pandemic led to the sudden visibility of certain scientists, necessitating them to extend their roles beyond research and actively communicate with the general public. Online platforms allow for direct engagement but increase the challenge by interconnecting different public arenas. Our case study examined the role performance of visible virologists on Twitter/X in six different time periods during the pandemic in Germany (N = 1003). Findings indicate that they often express calls to action, and voice their own views, but seldom address uncertainty. Differences over time were found in their use of different types of statements, scientific jargon and emotional language. They also utilised the opportunities of direct communication, performing roles like watchdogs or advocates, highlighting the importance for scientists to reflect on their roles as communicators.

Use of digital health tools in inflammatory bowel disease. / Uso de herramientas digitales en salud en enfermedad inflamatoria intestinal.

OBJECTIVE: To analyse the characteristics and use of digital health tools (DHT) in inflammatory bowel disease (IBD). METHODS: We performed a qualitative study based on a narrative literature review, a questionnaire and on the opinion of 3 expert gastroenterologists. Several searches were carried out until September 2022 through Medline to identify articles on the use of DHT in IBD by healthcare professionals. A structured questionnaire was designed to be answered by health professionals involved in the care of patients with IBD. The experts generated a set of recommendations. RESULTS: There are multiple DHT for IBD with different characteristics and contents. We received 29 questionnaires. Almost 50% of the participants were 41-50 years old, the majority were women (83%) and 90% were gastroenterologists. A total of 96% reported the use of several DHT, but 20% used them occasionally or infrequently. Web pages were found the most used (62%). DHT are mostly used to get information (80%), followed by clinical practice issues (70%) and educational purposes (62%). G-Educainflamatoria website is the best known and most used HDS (96% and 64%, respectively). The main barriers to the use of DHT in IBD were the lack of time (55%), doubts about the benefit of DHT (50%) and the excess of information (40%). CONCLUSIONS: Healthcare professionals involved in the care of patients with to IBD frequently use DHT, although actions are needed to optimize their use and to guarantee their efficient and safe use.

Mixture-of-experts and semantic-guided network for brain tumor segmentation with missing MRI modalities.

Accurate brain tumor segmentation with multi-modal MRI images is crucial, but missing modalities in clinical practice often reduce accuracy. The aim of this study is to propose a mixture-of-experts and semantic-guided network to tackle the issue of missing modalities in brain tumor segmentation. We introduce a transformer-based encoder with novel mixture-of-experts blocks. In each block, four modality experts aim for modality-specific feature learning. Learnable modality embeddings are employed to alleviate the negative effect of missing modalities. We also introduce a decoder guided by semantic information, designed to pay higher attention to various tumor regions. Finally, we conduct extensive comparison experiments with other models as well as ablation experiments to validate the performance of the proposed model on the BraTS2018 dataset. The proposed model can accurately segment brain tumor sub-regions even with missing modalities. It achieves an average Dice score of 0.81 for the whole tumor, 0.66 for the tumor core, and 0.52 for the enhanced tumor across the 15 modality combinations, achieving top or near-top results in most cases, while also exhibiting a lower computational cost. Our mixture-of-experts and sematic-guided network achieves accurate and reliable brain tumor segmentation results with missing modalities, indicating its significant potential for clinical applications. Our source code is already available at https://github.com/MaggieLSY/MESG-Net .

[Educational trajectory of forensic medical expert in the system of continuous medical education]. / Obrazovatel'naya traektoriya sudebno-meditsinskogo eksperta v sisteme nepreryvnogo meditsinskogo obrazovaniya.

The objective of the study is to determine the possibility and the right to choose the directions of self-education and self-development by forensic medical experts within the framework of personal and professional development program in the educational trajectory formation. The materials of special and encyclopaedic literature including pedagogical and sociological sciences, as well as legal framework regulating the processes of continuing medical education have been studied. The choice of educational trajectory of forensic physician depending on personal benchmarks, self-education building and participation in educational activities has been defined.

Conceptualizing Self-Harm through the Experiences of Psychogeriatric Experts.

INTRODUCTION: Fewer studies thus far have focused on self-harm and its specific forms among older adults. Moreover, the limited available literature applies varying terminology. The categorization of self-harm used in younger populations may not be as appropriate for this population. This means that less is known about this phenomenon in older adults. The current study aimed to reduce this gap. METHODS: Nine Flemish psychogeriatric experts participated in a semi-structured interview. Transcripts were thematically analyzed. RESULTS: Themes emerging from the interviews suggest that self-harm in older adults may also include distinct elements, such as the omission of certain behaviours and engagement in indirect self-harm to cause bodily harm. According to the experts, self-harm may be engaged in to cope with emotions, express life fatigue, hasten death, and communicate a cry for help. DISCUSSION: Self-harm is prevalent in older adults, and some characteristics may be specific to self-harm in an older age group. These findings may enable clinicians to be more alert to self-harm in older adults and consequently prevent serious suicidal behaviour. More research is needed to further uncover this phenomenon.

Autism Knowledge Assessments: A Closer Examination of Validity by Autism Experts.

PURPOSE: The goal of the current study was to conduct a substantive validity review of four autism knowledge assessments with prior psychometric support (Gillespie-Lynch in J Autism and Dev Disord 45(8):2553-2566, 2015; Harrison in J Autism and Dev Disord 47(10):3281-3295, 2017; McClain in J Autism and Dev Disord 50(3):998-1006, 2020; McMahon in Res Autism Spectr Disord 71:101499, 2020). 69 autism experts who served on the editorial board of one or more peer-reviewed autism journals evaluated the accuracy and ambiguity of autism knowledge questions. 34% of the questions were flagged as "potentially problematic" for accuracy, and 17% of the questions were flagged as "potentially problematic" for ambiguity. Autism expert feedback revealed three themes across ambiguous questions: (1) an oversimplification of mixed or still-evolving research literature, (2) an insufficient recognition of the heterogeneity of the autism spectrum, and (3) a lack of clarity in the question/answer prompt. Substantive validity of future autism knowledge assessments should be carefully evaluated via feedback from a diverse group of autism experts and/or potential respondents. Potentially problematic questions can be removed or modified to improve the validity of autism knowledge assessments.

The effect of experts on attitude change in public-facing political science: Scientific communication on term limits in the United States.

How can scientists best inform the public and change attitudes? Does the message or the messenger matter more? We test the effect of scientific expert messengers and messages in a preregistered, nationally representative survey experiment in the United States. Consistent with our hypotheses, scientists can move public attitudes in areas where knowledge is based on a non-ideological misperception to a greater extent than the same science-based message from another source. Although we focus on political science as a field and Congressional term limits in the United States as a topic area, our findings have broader implications for science communication with policymaking relevance given the persistence of misperceptions among the public across all natural and social science research fields.

Farmers' and Experts' Knowledge Coping with Sheep Health, Control and Anthelmintic Resistance of Their Gastrointestinal Nematodes.

Gastrointestinal nematodes are common in grazing sheep, but the intensity of the infection is not easily appreciated by farmers. For decades, they have relied on anthelmintic treatments to control these gastrointestinal nematodes. This has led to anthelmintic resistance and poor control of infection in most regions of the world. Using face-to-face semidirective interviews with farmers, we recorded their views on gastrointestinal nematode infection and its control. Ten organic and nine conventional meat sheep farmers from central France and 20 milk sheep farmers from the Basque region were interviewed and the data were analysed using a health model based on the importance of the disease and the barriers to implementing control. It was found that gastrointestinal nematodes were not the main health concern, and therefore farmers were not willing to invest too much time and money in their control. The conventional farmers relied on their veterinarians (the experts) to organise and select the anthelmintics, although they complained about the limited investment of their veterinarians in this matter. Organic farmers complained about their lack of knowledge about complementary and alternative medicines. Farmers rarely used faecal egg counts to build control of gastrointestinal nematodes and were unaware of the intensity of their infection. Knowledge of anthelmintic resistance was general (it exists) but farmers did not know if it existed on their farm. Resistance was often considered to have come from elsewhere, so the farmer did not feel at fault and did not take measures to prevent resistance. There is a need for all stakeholders to use faecal egg counts to assess the intensity of infection as well as the level of anthelmintic resistance to establish individual farm control programmes rather than standard blanket treatments.

Perceptions of key stakeholders on peer led strength building program for suicide prevention among young adolescents: A qualitative study from Karnataka, India.

Context: Adolescent suicides are a significant public health concern in India and understanding the intersecting perspectives becomes imperative for the prevention of various mental health concerns. Aim: Assessing perceptions of various key stakeholders, that is, mental health experts, school and college teachers, and District Mental Health Program staff about peer-led strength building programs for suicide prevention. Settings and Design: A cross-sectional qualitative design using two Focus Group Discussions (FGDs) with mental health experts and teachers and one FGD with DMHP staff was conducted. The sample comprised 45 participants from Bengaluru urban district. Materials and Methods: The data were analyzed manually by the method of direct content analysis, and themes were determined using existing literature. Results: The teachers and the DMHP highlighted the need for an intensive training program/module that is necessary to be developed in order to train the peer leaders first. The mental health experts opined that creating a network will help in easy identification of the cases and appropriate treatment could be provided without delays. Conclusions: This study indicated that suicide is a preventable public health emergency and inaccessibility to existing as well as proper support systems was perceived as a major concern. Therefore, peer-led programs are beneficial in steering and improving help seeking behavior in suicidal adolescents.

Safety competence promotion in secondary education - A case of the Finnish NouHätä! Programme.

The Nouhätä! safety education programme has been organised in secondary schools in Finland for over 25 years. However, to date, it has not been systematically evaluated. The purpose of this quantitative survey is to provide information about good practices, benefits and limitations of the NouHätä! Programme; this has been done by answering the research question what variables explain pupils' safety competence after participating in a NouHätä! safety education programme? The results show that the best learning outcomes in safety education are achieved when training is organised in collaboration with teachers and safety experts. Practical training also seems to have a significant impact on the safety competence of pupils. The results suggest that background variables like school success and the sources of safety knowledge affect the level of pupils' safety competence. The results of the study can be used to develop the programme and other safety education programmes for children and young people.