Search

There are many consensus measures that can be computed using Likert data. Although these measures should work with any number n of choices on the Likert scale, the measurements have been most widely studied and demonstrated for n = 5. One measure of consensus introduced by Akiyama et al. for n = 5 and theoretically generalized to all n depends on both the mean and variance and gives results that can differentiate between some group consensus behavior patterns better than other measures that rely on either just the mean or just the variance separately. However, this measure is more complicated and not easy to apply and understand. This paper addresses these two common problems by introducing a new computational method to find the measure of consensus that works for any number of Likert item choices. The novelty of the approach is that it uses computational methods in n-dimensional space. Numerical examples in three-dimensional (for n=6) and four-dimensional (for n=7) spaces are provided in this paper to assure the agreement of the computational and theoretical approach outputs. [ABSTRACT FROM AUTHOR]

In this paper, adaptive guaranteed-performance consensus control problems for multiagent systems with an adjustable convergence speed are investigated. A novel adaptive guaranteed-performance consensus protocol is proposed, where the communication weights can be adaptively regulated. By the state space decomposition method and the stability theory, sufficient conditions for guaranteed-performance consensus are obtained and the guaranteed-performance cost is determined. Moreover, the lower bound of the convergence coefficient for multiagent systems is deduced, which is linearly adjustable approximately by changing the adaptive control gain. Finally, simulation examples are introduced to demonstrate theoretical results. [ABSTRACT FROM AUTHOR]

In this paper, the consensus tracking control problem of leader-following nonlinear multiagent systems with iterative learning control is investigated. The model of each following agent consists of second-order unknown nonlinear dynamics and the external disturbance. Moreover, the input of each following agent is subject to saturation constraint. It is assumed that the information of leader is not available to any following agents, and the radial basis function neural network is introduced to approximate the nonlinear dynamics. Then, a distributed adaptive neural network iterative learning control protocol and the adaptive updating laws for the time-varying parameters are proposed, respectively. A new Lyapunov function is constructed to analyze the validity of the presented control protocol. Finally, a numerical example is provided to verify the effectiveness of theoretical results. [ABSTRACT FROM AUTHOR]

In this paper, the consensus tracking problem of leader-following nonlinear control time-delay multiagent systems with directed communication topology is addressed. An improved high-order iterative learning control scheme with time-delay is proposed, where the local information between agents is considered. The uniformly global Lipschitz condition is applied to deal with the nonlinear dynamics. Then, a sufficient condition is driven, which guarantees that all the following agents track the trajectory of leader. Also, the convergence of proposed control protocol is analyzed by the norm theory. Finally, two cases are provided to illustrate the validity of theoretical results. [ABSTRACT FROM AUTHOR]

What Is Known and Objective: The management of biological agents during pregnancy poses challenges as maternal and infant safety must be addressed. This study aims to compare the recommendations of existing guidelines on managing the use of biologics during pregnancy, lactation for patients with inflammatory bowel disease, and the influence on neonatal vaccination. Methods: The PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database and China Biomedical Database were systematically searched from the inception date to 11 May 2022, to screen all relevant guidelines. Quality assessment was performed using the guideline methodology reporting tool AGREE II. Results and Discussion: Fourteen guidelines and consensus statements with detailed recommendations were included. All guidance documents cover management comments during pregnancy, and most consider that biologics can be given safely during pregnancy but require suspension at the right time to protect the foetus. However, the roles of vedolizumab and ustekinumab are disputed. Five documents guide lactation and the use of most biologics during lactation is safe, but no guidelines recommend vedolizumab. Six papers provide recommendations for newborns' vaccination, suggesting a delay in infants' live vaccination schedule if their mothers are treated with biologics. What Is New and Conclusion: Our study concluded that future guidelines could consider incorporating newer, more robust evidence to update recommendations. The development of future guidelines needs to consider the involvement of multidisciplinary experts, adequately report on the evidence retrieval process, and provide strategies for implementation. Besides, more research is needed to explore the use of biologics during pregnancy and lactation in patients with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Blockchain is characterized by privacy, traceability, and security features as a novel framework of distributed ledger technologies. Blockchain technology enables stakeholders to conduct trusted data sharing and exchange without a trusted centralized institution. These features make blockchain applications attractive to enhance trustworthiness in very different contexts. Due to unique design concepts and outstanding performance, blockchain has become a popular research topic in industry and academia in recent years. Every participant is anonymous in a permissionless blockchain represented by cryptocurrency applications such as Bitcoin. In this situation, some special incentive mechanisms are applied to the permissionless blockchain, such as "mined" native cryptocurrency to solve the trust issues of the permissionless blockchain. In many use cases, permissionless blockchain has bottlenecks in transaction throughput performance, which restricts further application in the real world. A permissioned blockchain can reach a consensus among a group of entities that do not establish an entire trust relationship. Unlike permissionless blockchains, the participants must be identified in permissioned blockchains. By relying on the traditional crash fault-tolerant consensus protocols, permissioned blockchains can achieve high transaction throughput and low latency without sacrificing security. However, how to balance the security and consensus efficiency is still the issue that needs to be solved urgently in permissioned blockchains. As the core module of blockchain technology, the consensus algorithm plays a vital role in the performance of the blockchain system. Thus, this paper proposes a new consensus algorithm for permissioned blockchain, the Risk Assessment-based Consensus (RAC) protocol, combined with the decentralized design concept and the risk-node assessment mechanism to address the unbalance issues of performance in speed, scalability, and security. [ABSTRACT FROM AUTHOR]

In this paper, a cooperative guidance law based on consensus theory is proposed for multiple flight vehicles against a maneuvering target in a three-dimensional plane. The proposed guidance law has three orientation components: the one along the line-of-sight (LOS) ensures that all flight vehicles reach the target simultaneously, and the other two normal to the LOS in longitudinal and lateral plane guarantee the accurate interception. The target maneuverings are estimated by a finite-time convergence disturbance observer (FTDOB) and are compensated into the kinematic equation to achieve more accurate interception. Using the Lyapunov stability theorem, time-to-go of all flight vehicles' convergence is proved. Mathematical simulations verify the effectiveness of the proposed cooperative guidance law. [ABSTRACT FROM AUTHOR]

The multiagent system has the advantages of simple structure, strong function, and cost saving, which has received wide attention from different fields. Consensus is the most basic problem in multiagent systems. In this paper, firstly, the problem of partial component consensus in the first-order linear discrete-time multiagent systems with the directed network topology is discussed. Via designing an appropriate pinning control protocol, the corresponding error system is analyzed by using the matrix theory and the partial stability theory. Secondly, a sufficient condition is given to realize partial component consensus in multiagent systems. Finally, the numerical simulations are given to illustrate the theoretical results. [ABSTRACT FROM AUTHOR]

In this paper, the weighted couple-group consensus of continuous-time heterogeneous multiagent systems with input and communication time delay is investigated. A novel weighted couple-group consensus protocol based on cooperation and competition interaction is designed, which can relax the in-degree balance condition. By using graph theory, general Nyquist criterion and Gerschgorin disc theorem, the time delay upper limit that the system may allow is obtained. The conclusions indicate that there is no relationship between weighted couple-group consensus and communication time delay. When the agents input time delay, the coupling weight between the agents, and the systems control parameters are satisfied, the multiagent system can converge to any given weighted coupling group consistent state. The experimental simulation results verify the correctness of the conclusion. [ABSTRACT FROM AUTHOR]

This paper investigates couple-group consensus problems for multiagent first-order and second-order systems. Several consensus protocols are proposed based on the time-dependent distributed event-triggered control. For the case of no communication delays, the time-dependent event-triggered strategies are applied to couple-group consensus problems. Based on the matrix theory, algebraic conditions for couple-group consensus are established. For the system with communication delays, based on event-triggered strategies, a Lyapunov-Krasovskii functional is constructed to prove the input-to-state stability of the systems. Moreover, Zeno behavior is excluded. Finally, numeral examples are given to illustrate the effectiveness of these results. [ABSTRACT FROM AUTHOR]

This paper proposes a novel approach to design fully distributed consensus controllers for heterogeneous linear Multiagent Systems subjected to randomly switching directed topologies and model uncertainties. The appealing features of this approach are as follows. First, it uses the mildest assumption for the randomly switching topologies that the union of switched graphs has a spanning tree. Second, the consensus is achieved under a class of state multiplicative uncertainties. Moreover, the proposed consensus controllers are low-rank and have nonconservative coupling strengths. Finally, a numerical example is presented to illustrate the effectiveness of the proposed theoretical approach. [ABSTRACT FROM AUTHOR]

Abstract: Decision situations in which several individual are involved are known as group decision‐making (GDM) problems. In such problems, each member of the group, recognizing the existence of a common problem, tries to come to a collective decision. A high level of consensus among experts is needed before reaching a solution. It is customary to construct consensus measures by using similarity functions to quantify the closeness of experts preferences. The use of a metric that describes the distance between experts preferences allows the definition of similarity functions. Different distance functions have been proposed in order to implement consensus measures. This paper examines how the use of different aggregation operators affects the level of consensus achieved by experts through different distance functions, once the number of experts has been established in the GDM problem. In this situation, the experimental study performed establishes that the speed of the consensus process is significantly affected by the use of diverse aggregation operators and distance functions. Several decision support rules that can be useful in controlling the convergence speed of the consensus process are also derived. [ABSTRACT FROM AUTHOR]

Background. Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients. Objective. To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study. Methods. A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0. Results. Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining Interaction, tailored Diet, Acupressure, mindfulness Meditation, and physical Exercise. Conclusion. The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms. [ABSTRACT FROM AUTHOR]

Takotsubo syndrome (TTS) is a recently identified cardiac disease, which is far from being completely known. The aims of this narrative review are to provide a better understanding of the pathophysiological features of TTS and to update clinical findings in order to improve the management of subjects affected by this syndrome (according to the most recent consensus papers issued by the international scientific societies). We based our search on the material obtained via PubMed up to April 2019. The terms used were "Takotsubo Syndrome and Takotsubo cardiomyopathy" in combination with "heart failure, pathophysiology, complications, diagnosis, and treatment." TTS is a reversible form of ventricular dysfunction usually characterized by akinesia of the apex in the absence of obstructive coronary artery disease. In its initial phase, TTS may be indistinguishable from AMI and is usually triggered by a sudden emotional/physical stressor which abruptly increases catecholamine levels. However, the mechanisms by which catecholamines or other unidentified molecules can cause myocardial dysfunction is unknown. In-hospital stay may be hampered by various life-threatening complications, while data on long-term survival remain scarce and unclear. Furthermore, TTS may sometimes recur. We believe that TTS is clearly a much more complex condition than previously thought. Much remains to be discovered about its pathophysiologic mechanisms, the role of the link between the heart and brain and that of triggering factors and gender, and the reasons why this syndrome displays different phenotypes and sometimes recurs. Undoubtedly, preliminary evidence from pathophysiological studies (mainly genetic studies) has shown promising advances. However, prospective randomized clinical trials are still needed in order to identify and to tailor the best medical treatments for TTS patients. [ABSTRACT FROM AUTHOR]

In this paper we study the impact of active participation, or deliberately seeking out other agents with an aim of convincing them, on the dynamics of consensus formation. For this purpose, we propose an adaptive network model in which two processes shape opinion dynamics at interwoven time-scales as follows: (i) agents adapt their opinions subject to influence from social network neighbours who hold opinions within a tolerance interval δ and (ii) agents rewire network connections with an aim of maximizing their own influence on overall system opinion. We study this system both in an endogenous setting, in which all agents are subject to influence and also attempt to maximize influence, and in a setting of exogenous control, in which external agents not subject to influence adaptively attempt to maximize their influence. In both settings we find three regimes of stationary opinion configurations: (i) for low δ a regime of two evenly balanced radicalized opinion clusters at the extremes of the opinion space, (ii) for intermediate δ a 'winner-takes-most' regime of two unevenly sized radicalized opinion clusters, and (iii) for large δ a regime in which very low spread compromise consensus states can be reached. Comparing to adaptive processes of random and deliberately spread-reducing rewiring, we demonstrate that in regime (iii) competitive influence maximization can achieve near-minimal opinion spread within near-optimal times. Further, we also show that competitive influence maximizing rewiring can reduce the impact of small influential minorities on consensus states. [ABSTRACT FROM AUTHOR]

This paper reports an ethnobotanical study that focused on the traditional medicinal plants used by local communities to treat human diseases. Ethnobotanical study of medicinal plants was carried out from June 25 to September 5, 2015, in Berbere district of Oromia region, Ethiopia. The study focused on documentation of medicinal plants used to treat various human diseases in the study area. Ethnobotanical data were collected using semistructured interviews, group discussion, guided field walks, and observations with participants. Preference ranking, paired comparison, direct matrix ranking, and informant consensus factors (ICF) were used to analyze the importance of some plant species. A total of 70 medicinal plants, distributed in 56 genera and 46 families, were collected and identified. Plant family with the highest medicinal plants in the study area used for various diseases treatment was Euphorbiaceae (11.4%). The result of growth form analysis showed that shrubs constituted the highest proportion of medicinal plants (48.6%). Roots, 43 (44.8%), were the most frequently utilized plant parts for preparation of traditional herbal medicines. Crushing was a widely used mode of preparation of traditional remedies where oral administration (37.5%) was the dominant route. The highest informants consensus factor (ICF) values were linked to gonorrhea and syphilis disease (0.95); the lowest was linked with external parasites and wound (0.69). Local people in the study area possess traditional knowledge of medicinal plants to treat various human ailments; however, agricultural expansion and disinterest of young generation became the major threat to medicinal plants. It is, therefore, necessary to preserve this indigenous knowledge on traditional medicines by proper documentation, identification of plant species used, and herbal preparation. To save medicinal plants from further loss, involving local communities in cultivation of the most utilized medicinal plants is recommended. [ABSTRACT FROM AUTHOR]

We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co-ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi-agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice-based domestic violence training. [ABSTRACT FROM AUTHOR]

Background. Hypertension is a major global health concern, and lifestyle modifications have been recommended as first-line treatment for hypertension in many guidelines. However, different guidelines may recommend different types of lifestyle adjustment, and it is unclear which ones are most effective. In this review, we compared hypertension guidelines to identify any differences and/or consensus in content, efficacy, and timing of initiation of lifestyle modifications. Methods. We conducted a search of databases to identify hypertension guidelines available in English. We extracted and compared information about lifestyle modifications recommended by the guidelines. Results. Five hypertension guidelines from America, Europe, the UK, Canada, and the International Society of Hypertension are included. They all recommend diet adaptation, sodium reduction, alcohol restriction, physical exercise, and weight reduction. Other lifestyle interventions emphasized by some guidelines, such as potassium supplementation, smoking cessation, and stress management, are not recommended by all the five guidelines. Among lifestyle changes, the dietary approaches to stop hypertension (DASH) diet may be considered the most effective treatment for reducing blood pressure. These guidelines recommend that for patients with high-normal blood pressure or grade 1 hypertension without high risk factors, lifestyle medicine should be used first for 3–6 months, if blood pressure is still not controlled, then start medication. For those patients who need drug treatment, lifestyle changes can also enhance the effects of antihypertensive therapy. Conclusion. Lifestyle modifications are crucial in the treatment of hypertension and should be recommended to most hypertensive patients. Among these lifestyle interventions, diet adaptation containing low sodium and alcohol restriction may be the most effective in reducing blood pressure. Physical exercise and weight reduction are also recommended. In some cases, lifestyle modifications should be tried first. They may also enhance the effects of antihypertensive drugs in other patients. [ABSTRACT FROM AUTHOR]

In the present study, the diversity of medicinal plants and associated traditional medicinal knowledge of the rural community in the Ameya district in Ethiopia was assessed and documented. A survey was conducted through semistructured interviews, guided field walks, focus group discussions, and field observations. The snowball and purposeful sampling techniques were employed to select general and knowledgeable informants, respectively. Accordingly, a total of 210 respondents, 156 (74.3%) males and 54 (25.7%) females, were participated in this study. The informants were selected from seven kebeles (the lowest administrative units) following the recommendations of the local community for the availability of traditional medicinal plant use practice. Descriptive statistics, preference ranking, fidelity level, informant consensus factor, and direct matrix ranking were used to analyze and present the data. A total of 78 medicinal plants represented in 70 genera and 40 families were identified. Croton macrostachyus and Dodonaea viscosa were the most preferred species used to treat wounds, whereas Cucumis ficifolius and Phragmanthera macrosolen were the most popular species applied to treat stomachache. Leaves (38%) and roots (20%) were the most predominantly used plant parts for remedial preparation to treat 42 human ailments. The informant consensus factor (ICF) value ranged between 0.45 and 0.81, with the respiratory diseases category scoring the highest ICF value. The fidelity level (FL) value for the medicinal plants ranged from 24 to 95%. Considerable proportions (55.5%) of the medicinal plants were collected from wild habitats. Higher ICF (0.81) and FL (>90%) scores indicate the presence of rich traditional knowledge in the community. This knowledge can be used to select medicinal plants (such as Croton macrostachyus, Cucumis ficifolius, Dodonaea viscosa, and Phragmanthera macrosolen) for further pharmacological and phytochemical studies. [ABSTRACT FROM AUTHOR]

Robust H∞ consensus control problems of linear swarm systems with parameter uncertainties and time-varying delays are investigated. In this literature, a linear consensus protocol for high-order discrete-time swarm systems is proposed. Firstly, the robust H∞ consensus control problem of discrete-time swarm systems is transformed into a robust H∞ control problem of a set of independent uncertain systems. Secondly, sufficient linear matrix inequality conditions for robust H∞ consensus analysis of discrete-time swarm systems are given by the stability theory, and a H∞ performance level γ is determined meanwhile. Thirdly, the convergence result is derived as a final consensus value of swarm systems. Finally, numerical examples are presented to demonstrate theoretical results. [ABSTRACT FROM AUTHOR]

Purpose. Paclitaxel and carboplatin are novel anticancer drugs that have emerged in recent years, while there is still a lack of clinical consensus on these two drugs. The study conducted a meta-analysis and systematic review to analyze the efficacy and safety of paclitaxel and carboplatin for platinum-sensitive ovarian cancer. Methods. A systematic search was carried out in three databases of the Cochrane Library, Embase, and PubMed from the inception of each database to March 2021, and defined the progression-free survival and overall survival as the primary outcomes. Data analysis was performed using STATA 15.1. Results. Altogether, five randomized controlled trials (RCTs) were included in the meta-analysis, involving 2,740 patients, including 1317 in the CD (carboplatin doxorubicin) group and 1423 in the CP (carboplatin plus paclitaxel) group. It was found that pooled OS demonstrated no significant differences between the CD group and CP group (HR = 1.02, 95% CI = 0.89–1.18, P = 0.340), and the differences were not statistically significant in progression-free survival (HR = 0.84, 95% CI = 0.71–0.99, P = 0.140), thrombocytopenia (OR = 0.23, 95% CI = 0.09−0.58, P = 0.775), and grade II alopecia between the two groups (OR = 9.41, 95% CI = 6.57–13.47, P = 0.215). Conclusion. Current evidence suggests that paclitaxel and carboplatin do not produce more satisfactory results with respect to overall survival and reduction of side effects in treating platinum-sensitive ovarian cancer, and further studies are needed. [ABSTRACT FROM AUTHOR]

In nature, many phenomena can be explained by coordinated behavior of agents with fractional-order dynamics. In this paper, the consensus problem of fractional-order multiagent systems with double-integrator is studied, where the fractional-order satisfies 0<α<2. Based on the fractional-order stability theory, Mittag-Leffler function, and Laplace transform, a necessary and sufficient condition is obtained under the assumption that the directed graph for the communication network contains a directed spanning tree. Finally, an example with simulation is presented to illustrate the theoretical results. [ABSTRACT FROM AUTHOR]

The article presents the discussion on preschool children with type 1 diabetes (T1D) having access to modern diabetes care can safely achieve a HbA1c. Topics include continuous glucose monitoring (CGM) being the recommended tool for glycemic monitoring in preschoolers with T1D; and onset diabetes being associated with a high lifetime risk of diabetes complications, necessitating optimal glycemic control from onset.

Since the 2018 ISPAD guidelines on this topic, follow‐up of large cohorts from around the globe have continued informing the current incidence and prevalence of co‐morbidities and complications in young adults with youth‐onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth‐onset T2D, the initial and subsequent management of youth‐onset T2D, and management of co‐morbidities and complications. We include key updates from the observational phase of the multi‐center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head‐to‐head comparison of youth onset vs adult‐onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co‐morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth‐onset T2D, social determinants of health, and settings of care given COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Social isolation and loneliness are significant concerns in community dwelling older adults due to associated poorer health outcomes, inadequate crises responsiveness and increased societal burdens of care and cost. Generating Engagement in Networks Involvement (GENIE) is an online evidence‐based, client‐centred social network tool piloted by community‐aged care services in Sydney, Australia. GENIE facilitates access to community resources, activities and people to extend or re‐establish a client's social connections. This study aimed to identify GENIE's potential to maintain and promote social connections in older adults from the perspective of allied health professionals who could deliver GENIE. This qualitative exploratory study involved 33 participants on an emerging placement across two organisations who piloted GENIE. Data included consensus and priority statements produced from six nominal group technique‐facilitated discussions, and an inductive thematic analysis of student documentation and all consensus statements. The main findings indicated that participants prioritised GENIE's clinical advantages, implementation barriers and recommendations for future implementation. The inductive thematic analysis revealed the two themes of practice applications, and client and professional experiences when using GENIE. As a time‐efficient and personalised intervention, the research team concluded that GENIE could empower service providers to address the overarching needs of clients through rapidly connecting older adults to resources of their interests within the overburdened Australian‐aged care system. [ABSTRACT FROM AUTHOR]

Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well‐resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community‐based child and family health (CFH) service models for rural and other under‐resourced settings. A modified Delphi study was undertaken with a 12‐person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access. [ABSTRACT FROM AUTHOR]

Social support is commonly associated with women's postpartum health. Yet such support can also have unintended effects and trigger negative reactions. This study provides a qualitative examination of the positive and negative social interactions described by Arab postpartum women. Participants were Arab women recruited at Mother and Child Healthcare Clinics (MCHC). Inclusion criteria were married women over the age of 18 with a healthy newborn who described both positive and negative social experiences. Exclusion criteria were signs of postpartum depression. Data were gathered using semi‐structured in‐depth interviews that were audio‐recorded and transcribed verbatim. Themes and categories were extracted based on interpretative phenomenological analysis. The impact of lived experiences on the well‐being of postpartum women was explored. Data analysis revealed three main themes: (1) Support from the family and community: positive impact on the mother; (2) Negative social interactions as invasion of mother's personal space; (3) Impact of negative social interactions on mother's relationship with her family. A deeper understanding of the social environment of these women and the factors that affect their well‐being during the critical postpartum period can help MCHC staff offer culturally appropriate support and relevant interventions. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to systematically evaluate quality of shared decision‐making (SDM) in colorectal cancer (CRC) screening clinical practice guidelines (CPGs) and consensus statements (CSs). Methods: Search for CRC screening guidances was from 2010 to November 2021 in EMBASE, Web of Science, MEDLINE, Scopus and CDSR, and the World Wide Web. Three independent reviewers and an arbitrator rated the quality of each guidance using a SDM quality assessment tool (maximum score: 31). Reviewer agreement was 0.88. Results: SDM appeared in 41/83 (49.4%) CPGs and 9/19 (47.4%) CSs. None met all the quality criteria, and 51.0% (52/102) failed to meet any quality items. Overall compliance was low (mean 1.63, IQR 0–2). Quality was better in guidances published after 2015 (mean 1, IQR 0–3 vs. mean 0.5, IQR 0–1.5; p = 0.048) and when the term SDM was specifically reported (mean 4.5, IQR 2.5–4.5 vs. mean 0.5, IQR 0–1.5; p < 0.001). CPGs underpinned by systematic reviews showed better SDM quality than consensus (mean 1, IQR 0–3 vs. mean 0, IQR 0–2, p = 0.040). Conclusion: SDM quality was suboptimal and mentioned in less than half of the guidances, and recommendations were scarce. Guideline developers should incorporate evidence‐based SDM recommendations in guidances to underpin the translation of evidence into practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to reach a consensus on a set of proposals to optimise the disease management of Multiple myeloma (MM) within the Spanish National Health System (SNHS) and to apply the Social Return on Investment (SROI) method to estimate their social impact. Methods: A Multidisciplinary Working Team (MWT) including MM main stakeholders was organised. A survey was administered to gather information from patients regarding the impact of MM on different life domains. A forecast‐type SROI analysis, with a 1‐year timeframe, was applied. Results: Fifteen proposals were selected, to optimise MM management, including actions for early diagnosis, psychological support, improvement of information for patients and quick access to palliative care, among others. The implementation of these proposals would benefit patients, their informal caregivers and the SNHS. The investment required would amount to 10.32 million euros with a social return of 43.31 million euros: 4.2 euros for each euro invested. According to the sensitivity analysis, this ratio could range from 3.38 to 5.20 euros from the worst to the best‐case scenario. Conclusions: The current management of MM could be optimised by implementing a set of proposals that would most likely result in an overall positive social return. [ABSTRACT FROM AUTHOR]

Implications for the academic and interpersonal development of children and adolescents underpin a global political consensus to maintain in‐classroom teaching during the ongoing COVID‐19 pandemic. In support of this aim, the WHO and UNICEF have called for schools around the globe to be made safer from the risk of COVID‐19 transmission. Detailed guidance is needed on how this goal can be successfully implemented in a wide variety of educational settings in order to effectively mitigate impacts on the health of students, staff, their families, and society. This review provides a comprehensive synthesis of current scientific evidence and emerging standards in relation to the use of layered prevention strategies (involving masks, distancing, and ventilation), setting out the basis for their implementation in the school environment. In the presence of increasingly infectious SARS‐Cov‐2 variants, in‐classroom teaching can only be safely maintained through a layered strategy combining multiple protective measures. The precise measures that are needed at any point in time depend upon a number of dynamic factors, including the specific threat‐level posed by the circulating variant, the level of community infection, and the political acceptability of the resultant risk. By consistently implementing appropriate prophylaxis measures, evidence shows that the risk of infection from in‐classroom teaching can be dramatically reduced. Current studies indicate that wearing high‐quality masks and regular testing are amongst the most important measures in preventing infection transmission; whilst effective natural and mechanical ventilation systems have been shown to reduce infection risks in classrooms by over 80%. [ABSTRACT FROM AUTHOR]

Aim: To offer a clear understanding of the definition, attributes, antecedents, and consequences of undergraduate nursing students' clinical judgment in the nursing education context. Background: Clinical judgment is a concept with broad uses among healthcare professionals. Its definitions and attributes vary across contexts. There is no established understanding of clinical judgment in nursing students. Design: This concept analysis was performed using the eight steps of Walker and Avant's framework. Data Sources: A literature search was conducted using search engines and included peer‐reviewed articles related to clinical judgment in nursing students. Results: Clinical judgment in nursing students was defined as the cognitive process exhibited via a nursing action by observation, patient assessment, interpreting, and prioritizing data that lead to responding using the appropriate nursing practice with the patient. Reflection was used to evaluate nursing students' clinical judgment to revise nursing practice. Antecedents included nursing education curriculum, student's knowledge, previous clinical experience, critical thinking, and clinical reasoning. The consequences of clinical judgment were clinical judgment ability, safe nursing practice, nursing care quality, and patient safety. Conclusions: This concept analysis gives clear insights into the definition, attributes, antecedents, and consequences of undergraduate nursing student's clinical judgment. [ABSTRACT FROM AUTHOR]

Diarrhoeal diseases are one of the leading worldwide preventable causes of death among children under 5 years of age. Almost half of children do not receive optimal acute gastroenteritis (AGE) treatment in Jordan. With neither regional nor local guidelines available for AGE, consensus recommendations on the management of paediatric AGE in Jordan were developed by a panel of senior paediatricians and paediatric gastroenterologists and are endorsed by the Jordanian Paediatric Society. Recommendations are based on international guidelines and available relevant literature in relation to the AGE landscape and the healthcare system in Jordan. The prevention of diarrhoeal diseases should focus on the improvement of nutrition, hygiene, and sanitation, the introduction of routine vaccination against rotavirus, and the adoption of a standardised approach for AGE management (oral rehydration solution (ORS) use±adjunct therapies, continued feeding, and avoiding routine antibiotic use). Ondansetron, diosmectite, racecadotril, probiotics, and zinc can be considered adjunct to ORS, if needed. Local data gaps should be addressed. The clinical algorithm for the management of paediatric AGE could promote adherence to practice recommendations and by extension improve health outcomes in children. [ABSTRACT FROM AUTHOR]

Background. With the continuous in-depth research of Chinese medicine constitution (tizhi) and the continuous expansion of cross research with new disciplines, internationalization will become the future trend of Chinese medicine constitution (tizhi). Translating the terms of Chinese medicine constitution (tizhi) into English is the first step for Chinese medicine constitution (tizhi) to go international. Language memes play an important role in information transmission in social interpersonal communication activities. The continuous replication and dissemination of translation memes make language spread and popularized. Because there is no fixed translation method at present, based on the particularity of Chinese medicine constitution (tizhi), we decided to use the Delphi method to complete the term translation research. Objective. The purpose of this study is to provide a standard and unified translation method for terms of traditional Chinese medicine (TCM) constitution with Chinese characteristics through the Delphi expert consultation strategy. Methods. Forward translation and expert consensus were conducted to complete this study. We sorted out the related terms of Chinese medicine constitution (tizhi) theory and invited an expert from the World Federation of Chinese Medicine Societies (WFCMS) to complete the initial forward translation. An expert of Chinese medicine constitution (tizhi) theory joined this process. Then, we invite relevant professionals to evaluate this translation version using the Delphi method. Results. Following a 3-round Delphi survey, the translation criteria of 61 (92.42%) terms were unified, and 5 terms resulted in no consensus and reached consensus on the translation method of Chinese medicine constitution (tizhi) theory. A major problem about how to translate "中医体质学" is identified. 25 experts participated in this study, and the drop-out rate is 0% in the 3-round Delphi survey. Translation challenges include the following: (1) translation methods of "Chinese medicine constitution (tizhi) theory"; (2) experts' understanding deviation on the definitions of some terms. Conclusions. The average mode, full score ratio, standard deviation, coefficient of variation, and variation ratio of expert scores are analyzed. The diversity of regions and professional titles of experts shows that they have a high degree of authority. The scores of terms indicate the consistent of study results, so they can be used as a reference for the translation of Chinese medicine constitution (tizhi) theory. [ABSTRACT FROM AUTHOR]

Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk‐associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk‐associated alternative health care practices. A number of risk‐associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk‐free endeavours, and what those risks are. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is highly prevalent and impacts profoundly on patients' quality of life, leading to a range of supportive care needs. Methods: An updated systematic review and thematic synthesis of qualitative data using the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines, to explore prostate cancer patients' experience of, and need for, supportive care. Five databases (Medline, Embase, PsycInfo, Emcare and ASSIA) were searched; extracted data were synthesised using Corbin and Strauss's 'Three Lines of Work' framework. Results: Searches identified 2091 citations, of which 105 were included. Overarching themes emerged under the headings of illness, everyday life and biographical work. Illness work needs include consistency and continuity of information, tailored to ethnicity, age and sexual orientation. Biographical work focused on a desire to preserve identity in the context of damaging sexual side effects. Everyday life needs centred around exercise and diet support and supportive relationships with partners and peers. Work‐related issues were highlighted specifically by younger patients, whereas gay and bisexual men emphasised a lack of specialised support. Conclusion: While demonstrating some overarching needs common to most patients with prostate cancer, this review offers novel insight into the unique experiences and needs of men of different demographic backgrounds, which will enable clinicians to deliver individually tailored supportive care. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines (CPGs) and consensus statements (CSs) are being promoted to provide high‐quality healthcare guidance. This systematic review has assessed the breast cancer (BC) screening CPGs and CSs quality and reporting. Methods: A search of bibliographic databases (MEDLINE, Embase, Web of Science, Scopus and CDSR), 12 guideline databases and 51 professional society websites was performed without language restrictions from January 2017 to June 2020, following prospective registration (Prospero no.: CRD42020203807). AGREE II (% of maximum score) and RIGHT (% of total 35 items) appraised quality and reporting individually, extracting data in duplicate; reviewer agreement was 98% and 93%, respectively. Results: Forty guidances with median overall quality and reporting 51% (interquartile range [IQR] 39–63) and 48% (IQR 35–65), respectively. Twenty‐two (55%) and 20 (50%) did not reach the minimum standards (scores <50%). The guidances that deployed systematic reviews had better quality (74.2% vs. 46.9%; p = 0.001) and reporting (80.5% vs. 42.6%; p = 0.001). Guidances reporting a tool referral scored better (AGREE II: 72.8% vs. 43.1%, p = 0.002; RIGHT: 75.0% vs. 46.9%, p = 0.004). Conclusion: BC screening CPGs and CSs suffered poor quality and reporting. More than half did not reach the minimum standards. They would improve if systematic reviews were used to underpin the recommendations made. [ABSTRACT FROM AUTHOR]

The article discusess a study conducted for examining mammography volumes and performance of screen readers. It mentions that within Great Britain breast screening programme, the current recommendations are that reporters should interpret at least 5000 cases per year. It also mentions that degree of familiarity with the assessment tool is not explicitly addressed although the tool is the surrogate measure for real‐life performance.

Background. Sufficient evidence indicated the crucial role of NF-κB family played in gastric cancer (GC). The novel discovery that NF-κB could regulate cancer metabolism and immune evasion greatly increased its attraction in cancer research. However, the correlation among NF-κB, metabolism, and cancer immunity in GC still requires further improvement. Methods. TCGA, hTFtarget, and MSigDB databases were employed to identify NF-κB-related metabolic genes (NFMGs). Based on NFMGs, we used consensus clustering to divide GC patients into two subtypes. GSVA was employed to analyze the enriched pathway. ESTIMATE, CIBERSORT, ssGSEA, and MCPcounter algorithms were applied to evaluate immune infiltration in GC. The tumor immune dysfunction and exclusion (TIDE) algorithm was used to predict patients' response to immunotherapy. We also established a NFMG-related risk score by using the LASSO regression model and assessed its efficacy in TCGA and GSE62254 datasets. Results. We used 27 NFMGs to conduct an unsupervised clustering on GC samples and classified them into two clusters. Cluster 1 was characterized by high active metabolism, tumor mutant burden, and microsatellite instability, while cluster 2 was featured with high immune infiltration. Compared to cluster 2, cluster 1 had a better prognosis and higher response to immunotherapy. In addition, we constructed a 12-NFMG (ADCY3, AHCY, CHDH, GUCY1A2, ITPA, MTHFD2, NRP1, POLA1, POLR1A, POLR3A, POLR3K, and SRM) risk score. Followed analysis indicated that this risk score acted as an effectively prognostic factor in GC. Conclusion. Our data suggested that GC subtypes classified by NFMGs may effectively guide prognosis and immunotherapy. Further study of these NFMGs will deepen our understanding of NF-κB-mediated cancer metabolism and immunity. [ABSTRACT FROM AUTHOR]

People experiencing homelessness face many obstacles and barriers when it comes to getting help for their substance use. Recently, there has been an increase in substance use and opioid overdoses at public libraries, which are easily accessible public places for those struggling with homelessness. We aimed to understand this population's experience with recovery. This has led to an exploration of the intersection of experiencing homelessness and substance use‐related problems and its impact on barriers for recovery, along with facilitators to treatment and recovery. From January to June 2019, researchers interviewed 22 library patrons experiencing homelessness and actively using substances at a Southern Californian library in a major metropolitan area. Data were coded and analysed using a thematic analysis. Researchers independently coded text files for data analysis and discussed codes until consensus was reached. Library patrons who reported substance use were a mean age of 39 (range: 22–63); over half were white people (59%) and male (59%); 77% reported currently sleeping on the street; 18% lived in shelters. Themes for barriers to recovery were experiencing withdrawal, access to resources and coping with being homeless. Themes related to facilitators to treatment and recovery were Narcan access and overdose education, connectedness and trauma recovery. People experiencing homelessness are hard to reach and those using substances pose even more vulnerabilities. Many patrons attribute their circumstances to their substance use and disconnectedness to resources and supports to quit. Further research is needed on best practices for multidisciplinary care coordination for this population. [ABSTRACT FROM AUTHOR]

Objective: To develop and scale algorithm‐enabled patient prioritization to improve population‐level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research design and methods: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 ± 0.20 to 1.3 ± 0.24 min per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n = 58) have associated 8.8 percentage points (pp) (95% CI = 0.6–16.9 pp) greater time‐in‐range (70–180 mg/dl) glucoses compared to 25 control patients who did not qualify at 12 months after T1D onset. Conclusions: An algorithm‐enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time‐in‐range. [ABSTRACT FROM AUTHOR]

Due to work load pressures in primary care, increasing efforts are being made internationally to implement pharmacists working alongside general practitioners. While there is wide interest in the contributions pharmacists can make within primary care, there is limited research which explores the competencies pharmacists need to safely and effectively provide care in this arena. Therefore, a modified eDelphi study was conducted between July 2019 and January 2020 among pharmacists working in General Practice in Scotland in order to (a) generate a list of competencies required to undertake pharmacotherapy tasks within General Practice using content analysis; and (b) establish consensus regarding the importance of these competencies using a rating scale ranging from 1 ("not important") to 10 ("very important"). A framework of competencies was developed, containing eight competency categories with a total of 31 individual competency items. Overall, study participants considered all eight competency categories as being important, with a mode of 10 and a median >8; agreement among participants was high, with the majority of individual competency items rated 8 or above by more than 75% of participants. There was, however, variation in responses with regards to specific tasks such as medicines reconciliation and medication compliance reviews. Findings indicate that the GP setting requires a broad set of competencies—covering areas including the use of IT systems; clinical knowledge; and communicating with patients and other healthcare professionals. This implies that further emphasis on clinical and consultation skills should be added to training programmes aimed at GP pharmacists; furthermore, ongoing support is also needed with regards to generic skills such as the use of IT systems, documentation, and general procedures and processes within primary care, some of which might need to be tailored to the specific practice context. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyze the views of patients, police‐officers and emergency mental health workers on the use of the police cell as intervention in a mental health crisis. Design and Methods: We analyzed interviews with individuals involved in police cell interventions, found first labels and categorized them in concordance with the four principles of biomedical ethics and compared them to relevant scientific literature. Findings and Practical Implications: Professionals should know that emergency mental healthcare aimed at controlling the situation is not enough to provide good care. It probably generates better outcomes for patients in the short and long term when patient experiences are taken into consideration. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections (STIs) and HIV disproportionately affect young persons; gay, bisexual and other men who have sex with men (GBMSM) and transgender women; persons of colour; and the U.S. South. Complex issues contribute to these high STI/HIV rates. Our community‐based participatory research (CBPR) partnership conducted a community‐driven needs assessment to inform an intervention addressing STI/HIV disparities and related social determinants of health (SDH) among young GBMSM and transgender women of colour in a high‐incidence STI/HIV community in North Carolina. In 2018, in‐depth interviews were conducted with 21 community members and 29 community organisation representatives to explore needs, priorities and assets. Interview data were analysed using constant comparison, an approach to grounded theory, and an empowerment theory‐based planning process was used to develop multilevel intervention strategies based on findings. Thirteen themes emerged from the interviews that were organised into five domains: health (e.g., limited health services use; need for lesbian, gay, bisexual and transgender [LGBT]‐friendly providers; prioritisation of mental health and gender transition and limited knowledge of and access to pre‐exposure prophylaxis [PrEP] for HIV); employment (e.g., employment as a priority and relying on sex work to 'make ends meet'); education (e.g., barriers to education and needs for training to improve employment opportunities); social support (e.g., few welcoming activities and groups; strong informal support networks and little interaction between GBMSM and transgender women) and discrimination (e.g., frequent experiences of discrimination and the impact of frontline staff on services use). Three strategies – community‐based peer navigation, use of social media, and anti‐discrimination trainings for organisations – were identified and integrated into a new intervention known as Impact Triad. CBPR was successfully applied to identify needs, priorities and assets and develop a multilevel intervention focused on health disparities and SDH among young GBMSM and transgender women of colour in the U.S. South. [ABSTRACT FROM AUTHOR]

Aims: To develop a framework for Patient Engagement in Patient Safety (PEPS) in hospital. Methods: The Delphi technique was embraced to involve a group of knowledgeable healthcare experts in the discussion and rating of the components of the PEPS framework. On a 5‐point Likert scale, every item was separately rated based on the three aspects, which include applicability, clarity and validity. The PEPS framework included items with 75% or more of participants scoring 4–5 on all three aspects. Items not attaining 75% agreement on the aspects were either changed or discarded, after the group discussion and underwent another round of rerating. Results: A total of 17 members participated in the consensus‐building process. Following two rounds of rating, the consensus was reached on the final framework which consisted of 28 items in four dimensions, relating to healthcare professionals, patients, community, and helth system, and three components substituted with patient empowerment, effective communication and patient‐centeredness. Conclusion: The development of PEPS framework is a stimulus to strengthen human resources for health capabilities, sustain a high level of quality patient outcomes, and improve the health system. Further studies to identify strategies are needed for the successful implementation of this framework. [ABSTRACT FROM AUTHOR]

Background. Treatment of chronic pulmonary heart disease (CPHD), a common disease, has over recent years been studied using traditional Chinese medicine (TCM) due to many high-profile benefits. These can be evaluated by the measurement and analysis of related outcomes. Because of selective reporting bias and the heterogeneity of study outcomes, it is not possible to combine similar studies in a meta-analysis. Consequently, not only does the low quality of original studies fails to support evidence-based decision-making, but also the value of those clinical studies cannot be evaluated. To solve these problems, the development of a core outcome set for traditional Chinese medicines for the treatment of chronic pulmonary heart disease (COS-TCM-CPHD) is required. Methods. The development is conducted in five steps: (1) a library of outcomes through systematic review, the retrieval of libraries from two clinical trials registries, and semistructured interviews is established; (2) following data extraction and analysis of the library of outcomes, each outcome can be classified into seven outcome domains, including TCM disease, symptoms/signs, physical and chemical testing, quality of life, long-term prognosis, economic evaluation, and adverse events to form a preliminary list of outcomes; (3) stakeholder groups for participation are selected; (4) stakeholder groups are invited to participate in two rounds of Delphi surveys to score outcomes and provide additional outcomes; (5) a consensus meeting is organized to produce the final COS-TCM-CPHD. Discussion. The protocol is consistent with the guidelines defined by the Core Outcome Set-STAndardised Protocol (COS-STAP) statement and formulated with reference to Core Outcome Set-STAndards for development (COS-STAD). The COS-TCM-CPHD will improve the consistency of study reports and reduce publication bias, thereby improving the quality of TCM clinical trials and decision-making for evidence-based medicine. The study has been registered on the COMET website (http://www.comet-initiative.org/Studies/Details/1677). [ABSTRACT FROM AUTHOR]

Objectives. This study is aimed at developing multidimensional leisure participation assessment tool for the elderly to achieve quantitative and qualitative assessment of leisure participation and leisure exploration. Methods. This study collected preliminary items through literature review, statistical office data, and survey of the elderly's leisure activities and considered the list of leisure activities as assessment items by conducting a Delphi survey. Reliability was verified through internal consistency and test-retest reliability. The assessment tool was finally confirmed using content validity and discriminant validity. Results. A total of 81 leisure items classified into 8 categories and 22 subcategories were obtained through data collection and Delphi survey. Cronbach's α value was 0.939, and Intraclass Correlation Coefficient was 0.941. A content validity test was confirmed by validating that I-CVI was 0.78 or more and the S-CVI was 0.95. According to the result of discriminant validity, there was a difference in the number of participating leisure activities and leisure activities with participation intention by age. Conclusion. The leisure participation assessment tool for the elderly developed in this study can obtain information on the overall view of the leisure of the elderly by measuring leisure exploration, leisure participation, and interference factor affecting leisure participation. [ABSTRACT FROM AUTHOR]

Models of the consensus of the individual state in social systems have been the subject of recent research studies in the physics literature. We investigate how network structures coevolve with the individual state under the framework of social identity theory. Also, we propose an adaptive network model to achieve state consensus or local structural adjustment of individuals by evaluating the homogeneity among them. Specifically, the similarity threshold significantly affects the evolution of the network with different initial conditions, and thus there emerges obvious community structure and polarization. More importantly, there exists a critical point of phase transition, at which the network may evolve into a significant community structure and state-consistent group. [ABSTRACT FROM AUTHOR]

Background. Ischemic stroke (IS) seriously impacts the quality of life of survivors. Chinese medicine (CM) has been developed for more than 2000 years and plays a key role in the treatment of ischemic stroke. Many Chinese medicine clinical trials have been conducted; however, the heterogeneity of outcome measurements and reporting limits implications of the findings in clinical practice and health policy development. Therefore, it is important to develop a core outcome set (COS) that should be used and reported in trials for ischemic stroke treated by Chinese medicine. This protocol describes the process of developing the IS-CM-COS. Methods and Analysis. The development of the COS will involve the following four steps: (1) A list of outcomes reported in the registered and published Chinese medicine trials of ischemic stroke will be extracted by conducting a systematic literature review. (2) An additional outcome list will be collected by semistructured interview to patients with ischemic stroke. (3) A two-round Delphi survey will be performed to prioritize and condense the outcomes. (4) In the consensus meeting, a final recommended COS will be developed. Discussion. The COS could improve the reliability and consistency of outcome reporting. We hope that this IS-CM-COS will be used in the future Chinese medicine trials for the treatment of ischemic stroke and improve research quality. Trial Registration. This study was registered with the Core Outcome Measures in Effectiveness Trials Initiative (http://www.comet-initiative.org/studies/details/1282). [ABSTRACT FROM AUTHOR]

Objective: To establish the current management standards needed by nurse managers in Turkey and to share the process of establishing standards. Background: Relevant and utilizable nursing management standards are needed for effective and efficient nursing administration to achieve better outcomes in health care. Methods: A three‐round e‐Delphi method was used in this study. First, the experts were asked an open‐ended question. In the second and third rounds, data analysis measurements included item‐by‐item per cent agreement, standard deviation, average, median and interquartile range. Results: At the end of the third round, 49 standards were obtained under five main standards for nurse managers: management and organisation; leadership; human resources management; quality management; and professionalism. Conclusion: The results of this study, which represent a consensus on nursing management standards drawn from the views of experts across regions and institutions in Turkey, provide a baseline to design, manage and evaluate nursing services. Implications for Nursing Management: Nursing management standards, which are fundamental for designing, leading and evaluating nursing services, give a framework for nurse managers to provide effective and efficient administrative practices. [ABSTRACT FROM AUTHOR]

Background and Objective. The topical human milk (THM) is one of the traditional remedies for various cases of injuries, ulcers, and infections for decades. No study was found reporting the adverse effects of human milk. The current study reviews the anti-inflammatory properties of human milk when topically applied to dermal and optical diseases. Methods. The various datasets including Ovid, PubMed, Google Scholar, Science Direct, Magiran, Irandoc, SID, and IranMedex were searched from 1990 to 2018. From the 119 reviewed articles, 20 articles were selected to be included in the current article. Results. There is a consensus among the literature and ancient texts regarding the effectiveness of THM in curing the various types of skin damages, such as cord separation, atopic dermatitis, diaper dermatitis, conjunctivitis, scratches, insect bite, perineal ulcer, and nipple ulcer. However, the importance of its application has not been given much attention. Conclusion. According to the information obtained from the articles reviewed, the THM appears to be an effective, safe, and available treatment compared to conventional chemical treatments. This study suggests THM as an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of THM in similar or different injuries in different populations. [ABSTRACT FROM AUTHOR]