Luteinizing hormone supplementation in controlled ovarian stimulation: the Iran Delphi consensus

Introduction

Numerous consensus documents worldwide address luteinizing hormone (LH) supplementation in controlled ovarian stimulation, yet to the best of our knowledge, only one consensus paper has been published in the Arab region. This study presents a Delphi consensus by seven Iranian infertility experts, offering real-world clinical perspectives. The aim was to develop evidence-based opinions on LH's role alongside FSH in various aspects of assisted reproductive technology (ART), including LH levels, monitoring, r-hLH use, and suggested activity.

Methods

Employing the Delphi consensus approach, the Iran consensus unfolded in three steps. In Step 1, eight out of 10 statements gained approval, while two unclear statements were removed. In Step 2, the 20-member extended panel voted on the remaining eight statements.

Results

Only one (statement 3) lacked consensus (55% agreement), prompting a modification. The revised statement (noted as statement 3') obtained an 83% agreement.

Discussion

The clinical perspectives included in this consensus complement clinical guidelines and policies that help further improve treatment outcomes, especially for patients with FSH and LH deficiencies.

World addiction medicine reports: formation of the International Society of Addiction Medicine Global Expert Network (ISAM-GEN) and its global surveys

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.

The role of people with intellectual disability in intellectual disability research: A systematic review of Delphi studies

BACKGROUND

The way intellectual disability research is designed warrants critical examination, as the knowledge produced through these approaches informs evidence-based practices. People with lived experience should be considered experts in relation to understanding their bodies, conditions, and treatment.

METHOD

This systematic review analyses the design of Delphi studies, to determine the extent to which people with intellectual disability are involved as experts. The design of Delphi studies (involving structured feedback from experts) provides an insight into the extent that 'lived experience' is valued as a source of expert knowledge.

RESULTS

Fifty-five publications reporting on forty-nine separate Delphi studies met our inclusion criteria. Nine publications report the involvement of people with intellectual disability. However, family/informal caregivers are represented as experts in higher numbers and their voices carry greater weight.

CONCLUSION

The findings of this review include guidance for practitioners and researchers to facilitate greater participatory roles of people with intellectual disability.

National and international guidelines on the management of twin pregnancies: a comparative review

Twin gestations are associated with increased risk of pregnancy complications. However, high-quality evidence regarding the management of twin pregnancies is limited, often resulting in inconsistencies in the recommendations of various national and international professional societies. In addition, some recommendations related to the management of twin gestations are often missing from the clinical guidelines dedicated to twin pregnancies and are instead included in the practice guidelines on specific pregnancy complications (eg, preterm birth) of the same professional society. This can make it challenging for care providers to easily identify and compare recommendations for the management of twin pregnancies. This study aimed to identify, summarize, and compare the recommendations of selected professional societies from high-income countries on the management of twin pregnancies, highlighting areas of both consensus and controversy. We reviewed clinical practice guidelines of selected major professional societies that were either specific to twin pregnancies or were focused on pregnancy complications or aspects of antenatal care that may be relevant for twin pregnancies. We decided a priori to include clinical guidelines from 7 high-income countries (United States, Canada, United Kingdom, France, Germany, and Australia and New Zealand grouped together) and from 2 international societies (International Society of Ultrasound in Obstetrics and Gynecology and the International Federation of Gynecology and Obstetrics). We identified recommendations regarding the following care areas: first-trimester care, antenatal surveillance, preterm birth and other pregnancy complications (preeclampsia, fetal growth restriction, and gestational diabetes mellitus), and timing and mode of delivery. We identified 28 guidelines published by 11 professional societies from the 7 countries and 2 international societies. Thirteen of these guidelines focus on twin pregnancies, whereas the other 16 focus on specific pregnancy complications predominantly in singletons but also include some recommendations for twin pregnancies. Most of the guidelines are recent, with 15 of the 29 guidelines published over the past 3 years. We identified considerable disagreement among guidelines, primarily in 4 key areas: screening and prevention of preterm birth, using aspirin to prevent preeclampsia, defining fetal growth restriction, and the timing of delivery. In addition, there is limited guidance on several important areas, including the implications of the "vanishing twin" phenomenon, technical aspects and risks of invasive procedures, nutrition and weight gain, physical and sexual activity, the optimal growth chart to be used in twin pregnancies, the diagnosis and management of gestational diabetes mellitus, and intrapartum care.This consolidation of key recommendations across several clinical practice guidelines can assist healthcare providers in accessing and comparing recommendations on the management of twin pregnancies and identifies high-priority areas for future research based on either continued disagreement among societies or limited current evidence to guide care.

Observed practices of design engineers

While there are numerous studies documenting the skills and abilities of experienced designers and engineers, research is needed to document the specific practices or behaviors of design engineers, a subset of creative engineers who solve complex problems. To document observed practices of design engineers, twelve experienced engineers were asked to describe an expert design engineer, someone who always has the solution when others do not. Using inductive thematic analysis, nine observed practices with 30 subtopics were identified from 186 data points. The observed practices of design engineers include being collaborative, confident, creative, independent, intuitive, inquisitive, motivated, systematic, and versatile. Eight additional data points document varying observations of design engineers' interest in mentoring or management. While participants spoke with reverence about the design engineers, some observed practices could have a negative connotation, such as being egotistical, conservative to a fault, and not good at public speaking. One realization from this paper is that studies generally report admirable practices to replicate, when potentially negative practices can help engineering educators to better prepare students for industry. Lastly, this article provides engineering educators with a mapping between the observed practices of design engineers and the graduate attributes used in accrediting Canadian engineering programs.

At the Same Table: A Delphi Consensus-Based Model of Health-Promoting Eating Behaviors

Eating behaviors and patterns are one of the key behavioral indicators of health, and as such these behaviors are a focus of interest across different areas of scholarship. Yet, to date, work in this area is impeded by the lack of a collective theoretical framework to conceptualize, assess, and intervene upon eating behaviors. The aim of this study was therefore to establish a consensus-based framework for health-promoting eating behaviors using a Delphi methodology. An initial systematic search identified constructs that yielded 150 items grouped into three topic areas: (1) the content, types of food and nutrition provided; (2) eating behaviors; and (3) thoughts and feelings related to eating and foods. Over the course of three iterative rounds of rating by a panel of n = 37 experts, a consensus was reached that included eight of the original items that represented the three topic areas. The findings from this study result in a novel consensus-based framework for health-promoting eating behaviors that can form the basis for collaborative work towards the integration of physical and mental health promotion.

The Continuing Problem of Expert Evidence in Medical Litigation - A Surgical Perspective with Reference to Daubert

The tension that exists between the medical and legal professions regarding expert evidence is longstanding. In this article, we will examine some of the issues regarding expert evidence particularly as it relates to matters involving surgeons. Many of the current aspects of the Australian uniform evidence law in relation to expert testimony were based on the Federal Rules of Evidence promulgated in the United States in 1975. We will discuss some of the problems of expert evidence in surgical matters, particularly in New South Wales, and offer some thoughts on how the so-called Daubert trilogy could form a basis on which to re-examine the concept of an "expert". Our analysis offers suggestions for further improvements to the process of adducing expert evidence in claims involving surgical matters.

Behavioral and neural underpinnings of empathic characteristics in a Humanitude-care expert

Background

Humanitude approaches have shown positive effects in elderly care. However, the behavioral and neural underpinnings of empathic characteristics in Humanitude-care experts remain unknown.

Methods

We investigated the empathic characteristics of a Humanitude-care expert (YG) and those of age-, sex-, and race-matched controls (n = 13). In a behavioral study, we measured subjective valence and arousal ratings and facial electromyography (EMG) of the corrugator supercilii and zygomatic major muscles while participants passively observed dynamic facial expressions associated with anger and happiness and their randomized mosaic patterns. In a functional magnetic resonance imaging (MRI) study, we measured brain activity while participants passively observed the same dynamic facial expressions and mosaics. In a structural MRI study, we acquired structural MRI data and analyzed gray matter volume.

Results

Our behavioral data showed that YG experienced higher subjective arousal and showed stronger facial EMG activity congruent with stimulus facial expressions compared with controls. The functional MRI data demonstrated that YG showed stronger activity in the ventral premotor cortex (PMv; covering the precentral gyrus and inferior frontal gyrus) and posterior middle temporal gyrus in the right hemisphere in response to dynamic facial expressions versus dynamic mosaics compared with controls. The structural MRI data revealed higher regional gray matter volume in the right PMv in YG than in controls.

Conclusion

These results suggest that Humanitude-care experts have behavioral and neural characteristics associated with empathic social interactions.

From Novice To Expert: An Assessment To Measure Strategies Students Implement While Learning To Read Primary Scientific Literature

Primary Scientific Literature (PSL) has been used in undergraduate classrooms as a way to engage students with the research process and to increase science literacy. Most curricula lack any formal training for undergraduates to critically read PSL even though most undergraduate science courses require students to engage with PSL at some level. In addition, there are limited studies exploring the process by which expertise in reading PSL develops in undergraduates. In this study, we adapted behaviors that expert and novice PSL readers exhibit into a quantitative assessment tool, the PSL Reading Strategies Assessment, to evaluate undergraduates' development of reading strategies when learning to read PSL. Factor analysis and reliability measures were implemented to determine the structure of our assessment tool. Our results show the PSL Reading Strategies Assessment is sensitive enough to measure differences among student populations, suggesting that it can be used as a diagnostic tool to guide instructors and researchers as they change curricula, implement new teaching strategies, and strive to develop students' science literacy. Moreover, our data show that developing expert-like reading strategies in students learning to read PSL is not easy. Simply reading a PDF does little to promote the development of reading strategies in students learning to read PSL.

Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions

Brain metastases occur commonly in patients with advanced solid malignancies. Yet, less is known about brain metastases than cancer-related entities of similar incidence. Advances in oncologic care have heightened the importance of intracranial management. Here, in this consensus review supported by the Society for Neuro-Oncology (SNO), we review the landscape of brain metastases with particular attention to management approaches and ongoing efforts with potential to shape future paradigms of care. Each coauthor carried an area of expertise within the field of brain metastases and initially composed, edited, or reviewed their specific subsection of interest. After each subsection was accordingly written, multiple drafts of the manuscript were circulated to the entire list of authors for group discussion and feedback. The hope is that the these consensus guidelines will accelerate progress in the understanding and management of patients with brain metastases, and highlight key areas in need of further exploration that will lead to dedicated trials and other research investigations designed to advance the field.

Robotic-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer training curriculum-a worldwide Delphi consensus study

BACKGROUND

Structured training protocols can safely improve skills prior initiating complex surgical procedures such as robotic-assisted minimally invasive esophagectomy (RAMIE). As no consensus on a training curriculum for RAMIE has been established so far it is our aim to define a protocol for RAMIE with the Delphi consensus methodology.

METHODS

Fourteen worldwide RAMIE experts were defined and were enrolled in this Delphi consensus project. An expert panel was created and three Delphi rounds were performed starting December 2019. Items required for RAMIE included, but were not limited to, virtual reality simulation, wet-lab training, proctoring, and continued monitoring and education. After rating performed by the experts, consensus was defined when a Cronbach alpha of ≥0.80 was reached. If ≥80% of the committee reached a consensus an item was seen as fundamental.

RESULTS

All Delphi rounds were completed by 12-14 (86-100%) participants. After three rounds analyzing our 49-item questionnaire, 40 items reached consensus for a training curriculum of RAMIE.

CONCLUSION

The core principles for RAMIE training were defined. This curriculum may lead to a wider adoption of RAMIE and a reduction in time to reach proficiency.

Effects of Passion, Experience, and Cultural Politics on Classical Musicians' Practice During the COVID-19 Pandemic

The widespread cancelation of cultural events during the early 2020 stages of the COVID-19 pandemic led professional performing musicians across the world to experience an increasing economic fragility that threatened their health and wellbeing. Within this “new normal,” developing countries have been at a higher risk due to their vulnerable health systems and cultural policies. Even in such difficult times, the music profession requires musicians to keep up their practicing routines, even if they have no professional commitments. This is because high level technical and expressive skills are crucial to sustaining a music career at a high performance level. However, it could be expected that not all musicians might have had the same engagement with music practice during lockdowns. In this study, we studied the experiences of 309 professional classical musicians based in European and Latin American countries with different levels of performing experience to examine their passionate (or lack thereof) engagement with music practice. Through the mixed methods combination of multigroup invariance and narrative analyses, we identified distinct profiles of musicians who displayed more harmonious or more obsessive passion orientations before and at the peak of the pandemic. We observed that musicians with higher levels of harmonious passion in particular were more capable of sustaining their practice at the peak of the pandemic and that these musicians were mostly located in Latin America—a paradox, considering that cultural politics supporting the careers of professional performing musicians and entrepreneurial education in Latin America are lacking to a great extent, especially in comparison with the European context. We explain this in terms of the “forced” self-management embraced by musicians in Latin American countries who want to engage with music practice both before and during the COVID-19 pandemic even if the music profession does not generate enough revenue for them.

EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach

Background

Technology-based innovations that are created collaboratively by local technology specialists and health experts can optimize the addressing of priority needs for disease prevention and control. An EpiHack is a distinct, collaborative approach to developing solutions that combines the science of epidemiology with the format of a hackathon. Since 2013, a total of 12 EpiHacks have collectively brought together over 500 technology and health professionals from 29 countries.

Objective

We aimed to define the EpiHack process and summarize the impacts of the technology-based innovations that have been created through this approach.

Methods

The key components and timeline of an EpiHack were described in detail. The focus areas, outputs, and impacts of the twelve EpiHacks that were conducted between 2013 and 2021 were summarized.

Results

EpiHack solutions have served to improve surveillance for influenza, dengue, and mass gatherings, as well as laboratory sample tracking and One Health surveillance, in rural and urban communities. Several EpiHack tools were scaled during the COVID-19 pandemic to support local governments in conducting active surveillance. All tools were designed to be open source to allow for easy replication and adaptation by other governments or parties.

Conclusions

EpiHacks provide an efficient, flexible, and replicable new approach to generating relevant and timely innovations that are locally developed and owned, are scalable, and are sustainable.

Shared Representations in Athletes: Segmenting Action Sequences From Taekwondo Reveals Implicit Agreement

How do athletes represent actions from their sport? How are these representations structured and which knowledge is shared among experts in the same discipline? To address these questions, the event segmentation task was used. Experts in Taekwondo and novices indicated how they would subjectively split videos of Taekwondo form sequences into meaningful units. In previous research, this procedure was shown to unveil the structure of internal action representations and to be affected by sensorimotor knowledge. Without specific instructions on the grain size of segmentation, experts tended to integrate over longer episodes which resulted in a lower number of single units. Moreover, in accordance with studies in figure-skating and basketball, we expected higher agreement among experts on where to place segmentation marks, i.e., boundaries. In line with this hypothesis, significantly more overlap of boundaries was found within the expert group as compared to the control group. This was observed even though the interindividual differences in the selected grain size were huge and expertise had no systematic influence here. The absence of obvious goals or objects to structure Taekwondo forms underlines the importance of shared expert knowledge. Further, experts might have benefited from sensorimotor skills which allowed to simulate the observed actions more precisely. Both aspects may explain stronger agreement among experts even in unfamiliar Taekwondo forms. These interpretations are descriptively supported by the participants’ statements about features which guided segmentation and by an overlap of the group’s agreed boundaries with those of an experienced referee. The study shows that action segmentation can be used to provide insights into structure and content of action representations specific to experts. The mechanisms underlying shared knowledge among Taekwondoists and among experts in general are discussed on the background of current theoretic frameworks.

Introduction: Scientific Authority and the Politics of Science and History in Central, Eastern, and Southeastern Europe*

What sounds like a laborious set up for a shallow joke actually hits the core of the problem this issue covers: What do the leading archaeologist of the former German Democratic Republic in re-unifying Germany, Bulgarian scientists in the late 1960s and some recent discussions about representations of Polish ancient history have in common? They all operate along fractures in the crust of scientific authority, they mark moments in time when classical figures of knowledge reach or breach authoritative status. They serve to study how authoritative speech bridged and manifested these relations and help identify areas where scientific authority is contested. This volume transcends this topological rhetoric with a praxeological take on scientific authority. Concentrating on authority figures, it brings specific margins and contestations into sight. The papers in this volume study cases from former socialist countries of Central, Eastern, and Southeastern Europe, and thus examples that present us with the complexity of agonal relations within state socialism and post-socialist transformations that complicate matters of scientific authority in many ways, yet also offer illustrative examples of shifting constellations of (scientific) authority.

The perceptions of newly qualified nurses on the guidance by preceptors towards becoming experts in nursing

Background

The new role as professional nurse can be a difficult transition for the new qualified nurses. During this time, factors such as not being well prepared, working without supervision and a lack of guidance can be the result of a difficult transition.

Objectives

The purpose of this study is to assess the perceptions of newly qualified nurses on the guidance given by their preceptors towards becoming experts in practice at a Level II regional hospital in the Western Cape.

Method

A non-experimental quantitative descriptive design was followed. Collection of data was done by means of a questionnaire, designed by the researcher, using a cross-sectional research method. Non-probability sampling produced a sample of 162 nurses comprising registered nurses (48.2%), enrolled nurses (32.7%), and enrolled nursing auxiliaries (19.1%). Statistical analysis was performed using the Statistical Analysis System (SAS), version 9.3.

Results

The results of the research study indicated that respondents had more positive experiences than negative ones. The respondents indicated that for the role and characteristics of the preceptor, expectations were met for knowledgeability, professionalism and contribution to team work. Furthermore, the results indicated that the respondents would recommend preceptorship.

Conclusion

Preceptorship is one of the major interventions available to support newly qualified nurses by easing the transition from student to practicing nurse and reducing the theory-practice gap. The findings emphasised the importance of ongoing support programmes for nurses after obtaining a new qualification or/and being a new nurse.

Surrogate based continuous noninvasive blood pressure measurement

Arterial blood pressure is one of the most often measured vital parameters in clinical practice. State-of-the-art noninvasive ABP measurement technologies have noticeable limitations and are mainly based on uncomfortable techniques of complete or partial arterial occlusion by cuffs. Most commonplace devices provide only intermittent measurements, and continuous systems are bulky and difficult to apply correctly for nonprofessionals. Continuous cuffless ABP measurements are still an unmet clinical need and a topic of ongoing research, with only few commercially available devices. This paper discusses surrogate-based noninvasive blood pressure measurement techniques. It covers measurement methods of continuously and noninvasively inferring BP from surrogate signals without applying external pressures, except for reference or initialization purposes. The BP is estimated by processing signal features, so called surrogates, which are modulated by variations of BP. Discussed techniques include well-known approaches such as pulse transit time and pulse arrival time techniques, pulse wave analysis or combinations thereof. Despite a long research history, these methods have not found widespread use in clinical and ambulatory practice, in part due to technical limitations and the lack of a standardized regulatory framework. This work summarizes findings from an invited workshop of experts in the fields covering clinical expertise, engineering aspects, commercialization and standardization issues. The goal is to provide an application driven outlook, starting with clinical needs, and extending to technical actuality. It provides an outline of recommended research directions and includes a detailed overview of clinical use case scenarios for these technologies, opportunities, and limitations.

Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

OBJECTIVES

To compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.

METHODS

A retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.

RESULTS

In total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.

CONCLUSIONS

The amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

Considerations surrounding remote medicolegal assessments: a systematic search and narrative synthesis of the range of motion literature

Remote telehealth practices were forced to advance 10 years in a few short weeks in March 2020 due to the onset of a global pandemic. In the sphere of non‐clinical medicine, a dramatic element of uncertainty entered the psyche of doctors and lawyers in relation to the validity of remote or virtual independent medical examination (vIME). This paper considers the key issues surrounding the virtual assessment of clients for medicolegal purposes. Our main hypothesis was that, within certain defined parameters, the vIME technique can deliver reliable and accurate assessments. To explore this, a systematic literature search focusing on advanced device‐based range of motion measurement was conducted, along with an historical snapshot of observation‐based range of motion measurement considering application to remotely performed IME. While some specialists are of the view that observational measurement may be applied reliably to some joints when conducted by experienced orthopaedic surgeons, evidence for this is scant. The results, instead, support the notion of using task substitution, that is specialists appropriately assisted in conducting vIMEs by musculoskeletal trained allied health practitioners, regardless of the measurement tool, for permanent impairment assessments. Moreover, self‐performed examinations by injured individuals using advanced technology are not reliable in this setting. Our final contention is that remote examinations with limited clinical assessment have utility for legal matters, such as the assessment of causation of injury, treatment advice or approvals and fitness for pre‐employment tasks or safe variations, with objective clinical adjunct support such as Picture Archiving and Communication System‐based modern radiology systems.

Experience Affects EEG Event-Related Synchronization in Dancers and Non-dancers While Listening to Preferred Music

EEGs were analyzed to investigate the effect of experiences in listening to preferred music in dancers and non-dancers. Participants passively listened to instrumental music of their preferred genre for 2 min (Argentine tango for dancers, classical, or jazz for non-dancers), alternate genres, and silence. Both groups showed increased activity for their preferred music compared to non-preferred music in the gamma, beta, and alpha frequency bands. The results suggest all participants' conscious recognition of and affective responses to their familiar music (gamma), appreciation of the tempo embedded in their preferred music and emotional arousal (beta), and enhanced attention mechanism for cognitive operations such as memory retrieval (alpha). The observed alpha activity is considered in the framework of the alpha functional inhibition hypothesis, in that years of experience listening to their favorite type of music may have honed the cerebral responses to achieve efficient cortical processes. Analyses of the electroencephalogram (EEG) activity over 100s-long music pieces revealed a difference between dancers and non-dancers in the magnitude of an initial alpha event-related desynchronization (ERD) and the later development of an alpha event-related synchronization (ERS) for their preferred music. Dancers exhibited augmented alpha ERD, as well as augmented and uninterrupted alpha ERS over the remaining 80s. This augmentation in dancers is hypothesized to be derived from creative cognition or motor imagery operations developed through their dance experiences.

Impact of integrated graphical display on expert and novice diagnostic performance in critical care

OBJECTIVE

To determine the impact of a graphical information display on diagnosing circulatory shock.

MATERIALS AND METHODS

This was an experimental study comparing integrated and conventional information displays. Participants were intensivists or critical care fellows (experts) and first-year medical residents (novices).

RESULTS

The integrated display was associated with higher performance (87% vs 82%; P < .001), less time (2.9 vs 3.5 min; P = .008), and more accurate etiology (67% vs 54%; P = .048) compared to the conventional display. When stratified by experience, novice physicians using the integrated display had higher performance (86% vs 69%; P < .001), less time (2.9 vs 3.7 min; P = .03), and more accurate etiology (65% vs 42%; P = .02); expert physicians using the integrated display had nonsignificantly improved performance (87% vs 82%; P = .09), time (2.9 vs 3.3; P = .28), and etiology (69% vs 67%; P = .81).

DISCUSSION

The integrated display appeared to support efficient information processing, which resulted in more rapid and accurate circulatory shock diagnosis. Evidence more strongly supported a difference for novices, suggesting that graphical displays may help reduce expert-novice performance gaps.

Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards

Background

Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed.

Objective

The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users (“why”), content and data (“what”), and analyses and displays (“how” they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards.

Methods

We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question.

Results

A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are “close to home”; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues.

Conclusions

COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified.

A Systematic Review and Meta-analysis of the Use of High-Fidelity Simulation in Obstetric Ultrasound

SUMMARY STATEMENT

There is little global consensus on how to train, assess, and evaluate skills in obstetric ultrasound. The outcomes of curricula, where present, are often based on the number of clinical cases completed, rather than objective outcomes. The central question in this review is whether simulation enhances training and prepares trainees for clinical practice. A systematic review was conducted of the currently available literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies considering the use of simulators in training or assessment of sonographers were eligible for inclusion. We conclude that simulation is best used for acquisition of technical skills and image optimization. Best outcomes are observed when simulation augments traditional learning, with a strong focus on specific, objective, and measurable skills. Integrating simulation into training curricula could allow trainees to contribute to clinical service while learning. How skills learned in a simulated environment translate to the clinic is poorly addressed by the literature.

[Integration and differentiation in forensic expertise solving interdisciplinary tasks]

The purpose of the study is to consider the issues of integration and differentiation in forensic examination, to establish their significance in the formation of new types (genera) of forensic examination, in particular traceological and forensic medical examinations, to determine the possibilities of a comprehensive examination at the interdisciplinary level and the role of language in the production of complex examinations.

Surgeon level of expertise reported in Journal of Hand Surgery (American Volume) and (European Volume) publications

The purpose of the study was to evaluate the trend in documentation of surgeon level of expertise among the Journal of Hand Surgery (American Volume) and the Journal of Hand Surgery (European Volume) publications. A review of Journal of Hand Surgery (American Volume) and Journal of Hand Surgery (European Volume) databases for level of expertise between January 2015 and October 2019 was performed. Of 1042 articles identified, all 115 (20%) reporting level of expertise were published in Journal of Hand Surgery (European Volume). Since 2015, there has been an increase in reported level of expertise in Journal of Hand Surgery (European Volume) (2015: 8 (7%); 2016: 15 (13%); 2017: 22 (19%); 2018: 28 (24%); 2019: 42 (37%)). In the same period, no publications have reported level of expertise in Journal of Hand Surgery (American Volume). Documenting level of expertise may provide readers with additional information for incorporation of novel techniques into their practices. It may identify procedures that require a baseline level of expertise for effective performance. Further evaluation of level of expertise criteria may improve the reliability of the numeric scale, while widespread adoption of this scale will allow future outcome analysis by level of expertise.

Lung sonography can improve the specificity of determination of left-sided double-lumen tracheal tube position in both novices and experts: a randomised prospective study

Objective

Lung sonography can be helpful to determine the position of a left-sided double-lumen tube (DLT). However, clinical experience is required for correct assessment. We investigated whether lung sonography can improve the diagnostic efficacy of determining the DLT position in novices and experts.

Methods

In this randomised prospective clinical study, 88 patients were allocated to two groups using auscultation or lung sonography for initial assessment of the DLT position. In each group, two repeated assessments were performed; the first was performed by a novice, and the second was performed by an expert. The final DLT position was confirmed by fibre-optic bronchoscopy. The primary outcome was the diagnostic efficacy (including overall accuracy, sensitivity, and specificity) in confirming the DLT position.

Results

In both the novices and experts, the specificity of determining the DLT position was significantly higher with lung sonography than auscultation (60.0% vs. 21.7% and 66.7% vs. 37.5%, respectively). Additionally, the predictability of an incorrect position was similar between the novices and experts using lung sonography (area under the curve of 0.665 and 0.690, respectively).

Conclusions

Lung sonography can improve the diagnostic efficacy of detecting an incorrect DLT position in both novices and experts.

Kinetics of stone tool production among novice and expert tool makers

OBJECTIVES

As is the case among many complex motor tasks that require prolonged practice before achieving expertise, aspects of the biomechanics of knapping vary according to the relative experience/skill level of the practitioner. In archaeological experiments focused on the production of Plio-Pleistocene stone tools, these skill-mediated biomechanical differences have bearings on experimental design, the interpretation of results, and lithic assemblage analysis. A robust body of work exists on variation in kinematic patterns across skill levels but less is known about potential kinetic differences. The current study was undertaken to better understand kinetic patterns observed across skill levels during "Oldowan," freehand stone tool production.

MATERIALS AND METHODS

Manual pressure data were collected from 23 novice and 9 expert stone tool makers during the production of simple stone flakes using direct hard hammer percussion.

RESULTS

Results show that expert tool makers experienced significantly lower cumulative pressure magnitudes and pressure-time integral magnitudes compared with novices. In expert knappers, digits I and II experienced similarly high pressures (both peak pressure and pressure-time integrals) and low variability in pressure relative to digits III-V. Novices, in contrast, tended to hold hammerstones such that pressure patterns were similar across digits II-V, and they showed low variability on digit I only.

DISCUSSION

The similar and consistent emphasis of the thumb by both skill groups indicates the importance of this digit in stabilizing the hammerstone. The emphasis placed on digit II is exclusive to expert knappers, and so this digit may offer osteological signals diagnostic of habitual expert tool production.

Experiences and mentoring needs of novice nurse educators at a public nursing college in the Eastern Cape

Background

When novice nurse educators enter academia, they are expected to demonstrate and implement knowledge in the clinical and classroom environment. However, when one enters academia without proper guidance and support, these expectations create lack of role models. Although mentorship has proved to make the transition easier, there is a lack of mentoring in most nursing schools and/or departments at higher education institutions in South Africa because of scarcity of mentoring programmes for novice nurse educators.

Aim

The aim of this study was to explore and describe the experiences and mentoring needs of novice (newly qualified) nurse educators at a public nursing college in the Eastern Cape, to make recommendations for the mentoring of novice nurse educators.

Setting

Urban and rural public nursing college campuses and sub-campuses in the Eastern Cape.

Methods

Qualitative research approach and exploratory, descriptive, contextual and phenomenological designs were used. Sampling was purposive, data were collected by using semi-structured individual interviews and analysed using Tesch’s method.

Results

Five themes emerged from this study. Findings indicated that novice nurse educators experienced lack of theoretical and clinical mentoring and lack of orientation and resources. Participants also provided recommendations to optimise the experience and performance of novice nurse educators.

Conclusion

Lack of mentoring causes difficult transition by novice nurse educators from the nursing role into the nurse educator role. The implementation of the recommendations on mentoring of novice nurse educators would optimise the experience and performance of the novice nurse educators, thus enhance their smooth transition into academia.

[Forensic medical examination in the context of expanding the possibility of competitiveness realization in criminal proceedings]

The involvement of special knowledge in criminal proceedings has always created the problem of assessing the reliability of conclusions formulated on the basis of their application. At the beginning of the 20th century, one of the ways to solve this problem was the expansion of competition between the parties. For a long time, in criminal proceedings, competition has not been actively developed due to the particular historical development of society and the state. In the same period, it became a separate medical profession and the formation of a domestic forensic medical examination took place. With the adoption in 2001 of the current Code of Criminal Procedure, competition as a principle returned to the domestic criminal proceedings (Article 15 of the Code of Criminal Procedure of Russian Federation. Competition of the parties). In the practice of forensic medical examination, little has changed, since, on the one hand, the involvement of an expert's opponent in the process was difficult to implement, and on the other hand, his participation in criminal proceedings for several reasons had little effect on the outcome of case. At the same time, forensic medical examination remained an unshakable pillar in cases of crimes against health and life (and in other categories of cases whose corpus delicti provides for harm to health). The situation began to change rapidly from April 2017 after the coming into force of a number of federal laws that significantly simplified the organization of opposing an expert in criminal proceedings and created the conditions for a more critical assessment of an expert opinion. The purpose of the work is to analyze the consequences of federal laws for forensic expert practice.

A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.

Outcome Bias in Clinical Negligence Medico-legal Cases

Independent medical experts provide reports in clinical negligence claims brought against doctors and other health care professionals. They are asked to provide an opinion on whether the doctor has breached their duty of care to the patient, commonly described as the "Bolam Principle". By the time a patient litigates against a health care professional, the clinical sequence and outcome are known. Experts provide their opinions with the benefit of this knowledge. To determine whether knowledge of the outcome affects the expert's opinion, 42 independent general practice experts were asked to indicate whether a general practitioner had breached their duty of care in six clinical case scenarios. 21 were told the clinical outcome. Experts who knew the outcome were less likely to support the general practitioner's course of action, although this did not reach statistical significance. General practitioners demonstrated considerable "dove" or "hawk" variability when giving opinions on the same scenario.

Comparison of still image quality between traditional 35 mm digital and GoPro cameras in a surgical setting

Intraoperative photography is used to obtain images for both education and research purposes, but poses challenges due concerns regarding aseptic technique. Waterproof digital cameras have sterilisable cases that can be used by the surgeon for intraoperative photography. We compared the quality of still intraoperative images obtained by a non-scrubbed observer using a 35 mm single lens reflex (SLR) camera to images obtained by the surgeon using a GoPro camera in a sterilised case. Image quality was scored using a 4 point Likert scale by 3 groups of end users with differing experience: faculty surgeons, surgical residents, and 3rd year veterinary students. Mean ± SEM overall image quality scores were higher for the traditional 35 mm digital SLR camera when compared to the GoPro (3.25 ± 0.08 vs. 2.0 ± 0.08, p < .0001), as were scores for each image characteristic (brightness, colour, sharpness, and contrast). Image quality scores for each camera also differed significantly between user groups, with expert users (faculty and residents) giving lower quality scores when compared to scores from novices (students). Findings suggest that GoPro cameras provide lower intraoperative image quality than digital SLR cameras, although lower quality images may be more accepted by novices than by experienced users.

Oxytocin Facilitates Social Learning by Promoting Conformity to Trusted Individuals

There is considerable interest in the role of the neuropeptide oxytocin in promoting social cohesion both in terms of promoting specific social bonds and also more generally for increasing our willingness to trust others and/or to conform to their opinions. These latter findings may also be important in the context of a modulatory role for oxytocin in improving the efficacy of behavioral therapy in psychiatric disorders. However, the original landmark studies claiming an important role for oxytocin in enhancing trust in others, primarily using economic game strategies, have been questioned by subsequent meta-analytic approaches or failure to reproduce findings in different contexts. On the other hand, a growing number of studies have consistently reported that oxytocin promotes conformity to the views of groups of in-group individuals. Most recently we have found that oxytocin can increase acceptance of social advice given by individual experts without influencing their perceived trustworthiness per se, but that increased conformity in this context is associated with how much an expert is initially trusted and liked. Oxytocin can also enhance the impact of information given by experts by facilitating expectancy and placebo effects. Here we therefore propose that a key role for oxytocin is not in facilitating social trust per se but in conforming to, and learning from, trusted individuals who are either in-group members and/or perceived experts. The implications of this for social learning and use of oxytocin as an adjunct to behavioral therapy in psychiatric disorders are discussed. Interpersonal trust within social groups is of key importance for social interactions, bonds, cooperation and learning and trust between different groups can also help ensure a stable and peaceful co-existence as well as mutually beneficial co-operation and trade. Trust is generally considered to be critical for co-operation and reciprocity in social and economic interactions but importantly trust also involves risk of potential injury if misplaced or broken and we have a natural aversion to taking such risks (Hardin, 2002; Ostrom and Walker, 2003). Indeed, an important factor influencing our trust behavior is that we are strongly motivated to avoid others betraying our trust (Bohnet and Zeckhauser, 2004; Bohnet et al., 2008). Trust can potentially be influenced by our assessment of the level of risk that trusting others might have and also by increased sensitivity to physical and/or other cues for detecting trustworthiness. It is therefore of great importance to identify both behavioral and physiological factors which can act to enhance trust, particularly in situations where individuals have impaired trust and therefore find it hard to interact socially with others and learn from them and/or to benefit optimally from cognitive and behavioral therapeutic strategies.

Connectivity Analysis Using Functional Brain Networks to Evaluate Cognitive Activity during 3D Modelling

Modelling 3D objects in CAD software requires special skills which require a novice user to undergo a series of training exercises to obtain. To minimize the training time for a novice user, the user-dependent factors must be studied. we have presented a comparative analysis of novice/expert information flow patterns. We have used Normalized Transfer Entropy (NTE) and Electroencephalogram (EEG) to investigate the differences. The experiment was divided into three cognitive states i.e., rest, drawing, and manipulation. We applied classification algorithms on NTE matrices and graph theory measures to see the effectiveness of NTE. The results revealed that the experts show approximately the same cognitive activation in drawing and manipulation states, whereas for novices the brain activation is more in manipulation state than drawing state. The hemisphere- and lobe-wise analysis showed that expert users have developed an ability to control the information flow in various brain regions. On the other hand, novice users have shown a continuous increase in information flow activity in almost all regions when doing drawing and manipulation tasks. A classification accuracy of more than 90% was achieved with a simple K-nearest neighbors (k-NN) to classify novice and expert users. The results showed that the proposed technique can be used to develop adaptive 3D modelling systems.

Protocol for a systematic evaluation of pediatric pharmacy development and pediatric pharmacy experts' research area in China

BACKGROUND

The pediatric pharmacy research status of children's hospitals in China is still unknown. Our previous findings suggest the regional differences in academic level in tertiary (grade III level A) children's hospitals in China.

METHODS

This systemic evaluation described in this protocol will be conducted to follow the Cochrane Handbook. We will perform a systemic literature search of relevant databases including Chinese databases (CNKI, Wanfang Data, VIP Paper Check System) and English databases (Medline, EMbase, Cochrane Library) from inception to December 31, 2018. The search strategy will be enacted according to the guidance offered from the Cochrane Handbook. Two rounds of searches will be conducted to prevent the omission of relevant literature. A pre-set grading standard will be used to give calculation weight (W) to evaluate the quality of each article. Data synthesis will be performed using STATA software (version 13.1, Statacorp, College Station, Texas). Pediatric pharmacy development index (PPDI) of each hospital will be used to evaluate the pediatric pharmacy development in each tertiary children's hospitals. The cumulative calculation weight (∑W) and annual calculation weight (∑yearW) will be used to evaluate the academic level of pharmaceutical departments in different tertiary children's hospitals. Subgroup analysis will be performed to compare the number of different types of articles published between different hospitals base on different research areas such as policy research, basic research, and clinical research.

RESULTS

In this article, we will evaluate pediatric pharmacy development and the research area of pediatric pharmacy experts in China. Based on the results from this research, we will analyze the professional backgrounds of pediatric pharmacy experts from 23 tertiary children's hospitals in China. According to the contents and research directions of literature published by the pediatric pharmacy experts in these 23 hospitals, we will determine the professional field of pediatric pharmacy experts and establish an expert database. In the process of formulating the related national or local policies in the future, the expert database will be selected accurately to reach the expert consensus.

CONCLUSION

Our study will provide a comprehensive picture of pediatric pharmacy development in China. The pediatrics pharmacy expert's database constructed by this study will be used to build consensus on pediatric pharmacology in the future.

Hippocrates to Nightingale: Converging or Diverging Concepts in Patient Management and Decision Making

Although medicine and nursing are complementary and equally important, paradoxically the relationship can appear adversarial at times. Physicians and nurses work concurrently and conjointly in hospitals where patients are admitted for round-the-clock nursing care to help cure or attenuate diseases. Roles are further obscured for advanced practice nurses and physicians when they perform the same function, such as in the practice of anesthesia. Regarding physician-nurse relationships, the following questions become apparent:Why do these professions compete over the right to take care of patients? Where and when did this conflict originate? Answers are complicated and multifactorial. This commentary briefly reviews the history of the establishment of medicine and nursing, discusses gender roles, and summarizes differences in education and training between the two disciplines.

Evaluation of the quality of transesophageal echocardiography images and verification of proficiency

Various metrics have been used in curriculum-based transesophageal echocardiography (TEE) training programs to evaluate acquisition of proficiency. However, the quality of task completion, that is the final image quality, was subjectively evaluated in these studies. Ideally, the endpoint metric should be an objective comparison of the trainee-acquired image with a reference ideal image. Therefore, we developed a simulator-based methodology of preclinical verification of proficiency (VOP) in trainees by tracking objective evaluation of the final acquired images. We utilized geometric data from the simulator probes to compare image acquisition of anesthesia residents who participated in our structured longitudinal simulator-based TEE educational program vs ideal image planes determined from a panel of experts. Thirty-three participants completed the study (15 experts, 7 postgraduate year (PGY)-1 and 11 PGY-4). The results of our study demonstrated a significant difference in image capture success rates between learners and experts (χ² = 14.716, df = 2, P < 0.001) with the difference between learners (PGY-1 and PGY-4) not being statistically significant (χ² = 0, df = 1, P = 1.000). Therefore, our results suggest that novices (i.e. PGY-1 residents) are capable of attaining a level of proficiency comparable to those with modest training (i.e. PGY-4 residents) after completion of a simulation-based training curriculum. However, professionals with years of clinical training (i.e. attending physicians) exhibit a superior mastery of such skills. It is hence feasible to develop a simulator-based VOP program in performance of TEE for junior anesthesia residents.

Creative Processes in the Shaping of a Musical Interpretation: A Study of Nine Professional Musicians

Various studies have been conducted to understand the role of mental representation when musicians practice or perform music (Lehman and Ericsson, 1997; Sloboda, 2005) and the work steps required for a musician to prepare a concert (Chaffin et al., 2003). More recent studies examine creativity in the shaping of a musical interpretation (Lisboa et al., 2011; Payne, 2016; Barros et al., 2017; Wise et al., 2017). However, none of these studies answers the following questions: Why do expert musicians working from the same score create different musical interpretations? During individual practice sessions, what happens that allows each musician to produce significantly different interpretive results? To answer these questions, we instructed nine expert musicians to record their individual practice sessions, verbalize their actions and thoughts, and answer a self-reflection questionnaire. A third-party observer also described what happened during the practice sessions. We conducted interviews in order to gather additional information about the contents of the individual practice sessions; the musicians' usual work habits; and their beliefs, values, and ideas regarding the role of the musician in the creative process. Based on the methodology of Analyse par théorisation ancrée¹ (Paillé, 1994), we were able to take into account a diverse data set and identify aspects of the creative process that were specific to each individual as well as elements that all musicians shared. We found that the context in which the creative process takes place—the musician (e.g., his or her values and knowledge); the musical work (e.g., style, technical aspects, etc.); and the external constraints (e.g., deadlines, public expectations, etc.)—impacted the strategies used. The participants used reflection, extramusical supports, emotions, body reactions, intuition, and other tools to generate new musical ideas and evaluate the accuracy of their musical interpretations. We identified elements related to those already discussed in the literature, including the creative process as an alternation between divergent and convergent thinking (Guilford, 1950), creative associations (Lubart, 2015), and artistic appropriation (Héroux and Fortier, 2014; Héroux, 2016).

Moving from Novice to Expertise and Its Implications for Instruction

Objective: To address the stages of expertise development, what differentiates a novice from an expert, and how the development and differences impact how we teach our classes or design the curriculum. This paper will also address the downside of expertise and discuss the importance of teaching expertise relative to domain expertise. Summary: Experts develop through years of experience and by progressing from novice, advance beginner, proficient, competent, and finally expert. These stages are contingent on progressive problem solving, which means individuals must engage in increasingly complex problems, strategically aligned with the learner's stage of development. Thus, several characteristics differentiate experts from novices. Experts know more, their knowledge is better organized and integrated, they have better strategies for accessing knowledge and using it, and they are self-regulated and have different motivations.

Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors

RATIONALE, AIMS, AND OBJECTIVES

Clinical reasoning is an essential aspect of clinical practice, however is largely ignored in the current rehabilitation sciences evidence base. Literature related to clinical reasoning and clinical expertise has evolved concurrently although rehabilitation reasoning frameworks remain relatively generic. The purpose of this study was to explicate the clinical reasoning process of Bobath instructors of a widely used neuro-rehabilitation approach, the Bobath concept.

METHODS

A qualitative interpretive description approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews. Purposive sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA). Interview transcripts were transcribed verbatim providing the raw data. Data analysis was progressive, iterative, and inductive.

RESULTS

Twenty-two IBITA instructors from 7 different countries participated. Ranging in clinical experience from 12 to 40 years, and instructor experience from 1 to 35 years. Three themes were developed, (a) a Bobath clinical framework, (b) person-centered, and (c) a Bobath reasoning approach, highlighting the role of practical wisdom, phronesis in the clinical reasoning process. In particular the role of visuospatial-kinesthetic perception, an element of technical expertise, was illuminated as an integral aspect of clinical reasoning in this expert group.

CONCLUSIONS

This study provides an interpretive understanding of the clinical reasoning process used by IBITA instructors illustrating an inactive embodied view of clinical reasoning, specifically the role of phronesis, requiring further investigation in nonexpert Bobath therapists, as well as in novice and experienced therapists in other specialty areas.

The Neural System of Postdecision Evaluation in Rostral Frontal Cortex during Problem-solving Tasks

Little attention has been paid to the postdecision processing in fMRI studies with task paradigms in which there was no explicit feedback. Although late-onset BOLD responses were previously observed in the lateral frontopolar cortex after the familiar-novel decision on visually presented words, the nature of neural activations that caused the late-onset BOLD responses remained elusive. We here found, in human experts conducting complicated problem-solving tasks in their expertise domain, that the rostral frontal cortex, including the lateral frontopolar cortex, along with the anterior inferior parietal lobule, was activated only during the postdecision period, although there was no feedback. That is, these areas showed late-onset BOLD responses, and fitting of the BOLD responses with different models indicates that they were caused by neural activations that occurred after the decision. However, there was no response after performing a sensory-motor control task, and the magnitude of postdecision activations was correlated with the degree of uncertainty about the preceding decision, which suggests that the postdecision neural activations were associated with the preceding decision procedure. Furthermore, the same set of areas was more strongly activated when the subject explicitly rethought the preceding problem. These results suggest that the rostral frontal cortex, together with anterior inferior parietal lobule, comprises a network for uncertainty monitoring and exploration of alternative resolutions in postdecision evaluation. The present results thus introduce a new aspect of the functional gradient along the rostrocaudal axis in the frontal cortex.

Fingerprint identification: advances since the 2009 National Research Council report

This paper will discuss the major developments in the area of fingerprint identification that followed the publication of the National Research Council (NRC, of the US National Academies of Sciences) report in 2009 entitled: Strengthening Forensic Science in the United States: A Path Forward. The report portrayed an image of a field of expertise used for decades without the necessary scientific research-based underpinning. The advances since the report and the needs in selected areas of fingerprinting will be detailed. It includes the measurement of the accuracy, reliability, repeatability and reproducibility of the conclusions offered by fingerprint experts. The paper will also pay attention to the development of statistical models allowing assessment of fingerprint comparisons. As a corollary of these developments, the next challenge is to reconcile a traditional practice dominated by deterministic conclusions with the probabilistic logic of any statistical model. There is a call for greater candour and fingerprint experts will need to communicate differently on the strengths and limitations of their findings. Their testimony will have to go beyond the blunt assertion of the uniqueness of fingerprints or the opinion delivered ispe dixit.

Perception of chemesthetic stimuli in groups who differ by food involvement and culinary experience

In the English language, there is generally a limited lexicon when referring to the sensations elicited by chemesthetic stimuli like capsaicin, allyl isothiocyanate, and eugenol, the orally irritating compounds found in chiles, wasabi, and cloves, respectively. Elsewhere, experts and novices have been shown to use language differently, with experts using more precise language. Here, we compare perceptual maps and word usage across three cohorts: experts with formal culinary education, naïve individuals with high Food Involvement Scale (FIS) scores, and naïve individuals with low FIS scores. We hypothesized that increased experience with foods, whether through informal experiential learning or formal culinary education, would have a significant influence on the perceptual maps generated from a sorting task conducted with chemesthetic stimuli, as well as on language use in a descriptive follow-up task to this sorting task. The low- and highFIS non-expert cohorts generated significantly similar maps, though in other respects the highFIS cohort was an intermediate between the lowFIS and expert cohorts. The highFIS and expert cohorts generated more attributes but used language more idiosyncratically than the lowFIS group. Overall, the results from the expert group with formal culinary education differed from the two naïve cohorts both in the perceptual map generated using MDS as well as the mean number of attributes generated. Present data suggest that both formal education and informal experiential learning result in lexical development, but the level and type of learning can have a significant influence on language use and the approach to a sorting task.

Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation

BACKGROUND

The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach.

METHODS

A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes.

RESULTS

Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the health system had been considered prior to implementation was strongly supported, while 'success' was perceived as an already familiar evaluation concept. Perceived challenges associated with standardised evaluation included identifying, defining and measuring key 'readiness' and 'success' indicators; impacts of systems and context changes; cost; meaningful stakeholder consultation and developing a widely applicable framework.

CONCLUSIONS

A standardised evaluation framework that includes a strong focus on 'readiness' is important to ensure successful and sustainable implementation of musculoskeletal MoCs.

Emotionally excited eyeblink-rate variability predicts an experience of transportation into the narrative world

Collective spectator communications such as oral presentations, movies, and storytelling performances are ubiquitous in human culture. This study investigated the effects of past viewing experiences and differences in expressive performance on an audience’s transportive experience into a created world of a storytelling performance. In the experiment, 60 participants (mean age = 34.12 years, SD = 13.18 years, range 18–63 years) were assigned to watch one of two videotaped performances that were played (1) in an orthodox way for frequent viewers and (2) in a modified way aimed at easier comprehension for first-time viewers. Eyeblink synchronization among participants was quantified by employing distance-based measurements of spike trains, D^spike and D^interval (Victor and Purpura, 1997). The results indicated that even non-familiar participants’ eyeblinks were synchronized as the story progressed and that the effect of the viewing experience on transportation was weak. Rather, the results of a multiple regression analysis demonstrated that the degrees of transportation could be predicted by a retrospectively reported humor experience and higher real-time variability (i.e., logarithmic transformed SD) of inter blink intervals during a performance viewing. The results are discussed from the viewpoint in which the extent of eyeblink synchronization and eyeblink-rate variability acts as an index of the inner experience of audience members.

Can taking the perspective of an expert debias human decisions? The case of risky and delayed gains

In several previously reported studies, participants increased their normative correctness after being instructed to think hypothetically, specifically taking the perspective of an expert or researcher (Beatty and Thompson, 2012; Morsanyi and Handley, 2012). The goal of this paper was to investigate how this manipulation affects risky or delayed payoffs. In two studies, participants (n = 193) were tested online (in exchange for money) using the adjusting procedure. Individuals produced certain/immediate equivalents for risky/delayed gains. Participants in the control group were solving the problem from their own perspective, while participants in the experimental group were asked to imagine "what would a reliable and honest advisor advise them to do." Study 1 showed that when taking the perspective of an expert, participants in experimental group became more risk aversive compared to participants in the control group. Additionally, their certain equivalents diverged from the expected value to a greater extent. The results obtained from the experimental group in Study 2 suggest that participants became less impulsive, which means they tried to inhibit their preferences. This favors the explanation, which suggests that the perspective shift forced individuals to override their intuitions with the social norms. Individuals expect to be blamed for impatience or risk taking thus expected an expert to advise them to be more patient and risk aversive.

Expert perceptions of the popular baby boomer image

AIM

This paper explored how gerontology experts described baby boomers, whether they challenged the popular image, and if they provided alternatives to the popularly reported baby boomer behaviours and characteristics.

METHODS

Qualitative interviews were conducted with ten experts from different areas across Australia. The interviews were semi-structured and guided by a 'sense-making' approach to explore the baby boomer construct and identify expert narratives that differed from the popularly tendered image.

RESULTS

The majority of experts were identified as baby boomers and made use of phrases associated with the popular baby boomer image, such as 'cashed up', 'reinventing retirement' and 'sea change'. Lifestyle and wealth were recognised as staple features of the popular image. To a lesser degree, the experts also recognised alternative characteristics and behaviours, including people with disabilities and those who struggle financially.

CONCLUSIONS

Experts appeared to identify with the popular baby boomer label, but not necessarily the accompanying stereotypes.