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Background: High quality supportive care is fundamental to achieve optimal health outcomes for people affected by cancer. Use of quality indicators provides comparative information for monitoring, management, and improvement of care within and across healthcare systems. The aim of this Australian study was to develop and test a minimum viable set of cancer supportive care quality indicators that would be feasible to implement and generate usable data for policy and practice. Methods: A two-round, modified reactive Delphi process was employed firstto develop the proposed indicators. Participants with expertise in cancer control in Australia, the United Kingdom, and Canada rated their level of agreement on a 7-point Likert scale against criteria assessing the importance, feasibility, and usability of proposed indicators. Relative response frequencies were assessed against pre-specified consensus criteria and a ranking exercise, which delivered the list of proposed indicators. Draft indicators were then presented to a purposive sample of clinicial and health management staff via qualitative interviews at two acute care settings in Melbourne, Australia for feedback regarding feasibility. Desktop audits of online published health service policy and practice descriptions were also conducted at participating acute care settings to confirm health service data availability and feasibility of collection to report against proposed indicators. Results: Sixteen quality indicators associated with the delivery of quality cancer supportive care in Australian acute healthcare settings met pre-specified criteria for inclusion. Indicators deemed ‘necessary’ were mapped and ranked across five key categories: Screening, Referrals, Data Management, Communication and Training, and Culturally Safe and Accessible Care. Testing confirmed indicators were viewed as feasible by clinical and health management staff, and desktop audits could provide a fast and reasonably effective method to assess general adherence and performance. Conclusions: The development of quality indicators specific to cancer supportive care provides a strong framework for measurement and monitoring, service improvement, and practice change with the potential to improve health outcomes for people affected by cancer. Evaluation of implementation feasibility of these expert consensus generated quality indicators is recommended. [ABSTRACT FROM AUTHOR]

Background Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people’s daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future. Methods A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder. Results Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people’s physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences. Conclusion VI and comorbid MD have a major impact on people’s daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients’ perspectives. [ABSTRACT FROM AUTHOR]

Introduction: Plant-based meats (PBM) are an emerging set of food technologies that could reduce the environmental impacts of food systems by mitigating consumer demand for animal products. However, scaling up the production and consumption of plant-based meats requires overcoming multiple technological, regulatory, political, and market barriers. An evidence-based prioritization of needs and actions may help actors (e.g., investors, funders, policymakers) who wish to help scale PBM achieve desired outcomes with limited resources. Research question: What actions could most effectively help to scale up the production and/or consumption of plant-based meat in Brazil? Methods: We selected Brazil as a case study of a country with a significant animal agriculture sector and a burgeoning PBM sector. We constructed a panel of nine experts and employed the Delphi technique during two rounds of an online survey to iteratively assess the degree of consensus and disagreement around the relative priority of 14 possible actions (identified from relevant literature) that could help to scale up the production and/or consumption of PBM in Brazil. We used the Importance, Neglect, and Tractability framework. Results: The panelists collectively concluded that the top priority action for scaling up both the production and the consumption of plant-based meat in Brazil was to reduce the price of products for consumers. For most priority actions, there was greater consensus among panelists in the second round of the survey. Discussion: Our findings contribute to an improved understanding of (a) which actions may be of highest priority for investors, funders, and policymakers, (b) synergies and differences between priority actions to scale up the production versus consumption of PBM in Brazil, (c) the relative merits of focusing on scaling up PBM production versus consumption, and (d) the strengths and limitations of assessing expert opinion on alternative protein futures using the Delphi technique. [ABSTRACT FROM AUTHOR]

A three-round Delphi method was used to study the problematic situations that adolescents may encounter when using the social media, and the competencies needed to address these situations. A panel of Finnish experts (N = 22) provided an open-ended list of problematic situations and competencies in 2020–2021. These were then evaluated and ranked according to their significance. The experts provided an information-rich list of both problematic situations and competencies. Finally, 16 problematic situations and 19 competencies were ranked in order of importance by the experts. The most important problematic situations were direct and indirect cyberbullying and sexual harassment. The most important competencies were the ability to act responsibly, knowing what kinds of activity are prohibited, and knowing whom to contact on exposure to cyberbullying or harassment. The findings can be used in developing policies, recommendations, and solutions aimed at counteracting the harmful effects of social media on wellbeing during adolescence. [ABSTRACT FROM AUTHOR]

The family of Janus Kinases (JAKs) associated with the JAK–signal transducers and activators of transcription signaling pathway plays a vital role in the regulation of various cellular processes. The conformational change of JAKs is the fundamental steps for activation, affecting multiple intracellular signaling pathways. However, the transitional process from inactive to active kinase is still a mystery. This study is aimed at investigating the electrostatic properties and transitional states of JAK1 to a fully activation to a catalytically active enzyme. To achieve this goal, structures of the inhibited/activated full-length JAK1 were modelled and the energies of JAK1 with Tyrosine Kinase (TK) domain at different positions were calculated, and Dijkstra's method was applied to find the energetically smoothest path. Through a comparison of the energetically smoothest paths of kinase inactivating P733L and S703I mutations, an evaluation of the reasons why these mutations lead to negative or positive regulation of JAK1 are provided. Our energy analysis suggests that activation of JAK1 is thermodynamically spontaneous, with the inhibition resulting from an energy barrier at the initial steps of activation, specifically the release of the TK domain from the inhibited Four-point-one, Ezrin, Radixin, Moesin-PK cavity. Overall, this work provides insights into the potential pathway for TK translocation and the activation mechanism of JAK1. [ABSTRACT FROM AUTHOR]

In Finland, agriculture is practiced in variable growing conditions that are further challenged by climate change and under external pressure caused by international competition, changing consumer preferences and demands, and the renewal of the European Union Common Agriculture Policy and Paris Agreement climate targets. Futures studies in agriculture have focused on scenario building with expert panels, though usually without farmers' involvement. This study focuses on farmers' views of shaping the future of Finnish agriculture. It builds on the disaggregative Delphi method and combines interviews and a representative survey of Finnish farmers. The study is based on a bottom-up process in which a farmer panel of 20 farms defined their views of the future in a semi-structured thematic interview. The views were turned into statements in a structured survey sent to the second panel, which comprised all Finnish farmers who had received agricultural subsidies in 2016, with 4401 respondents. The results were analyzed using quantitative factor analysis, which produced five future images for Finnish agriculture. The images were shown to the original farmer panel for reflection. They considered the probability of each future image and their own role in it. Technology solves as a future image was most favored by farmers, followed by Ecological and specializing small-scale production image. Business-as-usual was the least likely future images according to the interviewed farmers. This paper describes the process and discusses both methodological benefits and pitfalls, as well as farmers' future views of the forthcoming decades. [ABSTRACT FROM AUTHOR]

Background: We aimed to develop a consensus on the need for and priorities of exercise to treat preexisting sarcopenia with hemiplegic stroke. Methods: A modified three-round Delphi study was conducted. The panelists responded to the questionnaire on a 7-point Likert scale. Responses were returned with descriptive statistics in the next round. Consensus was defined as >75% agreement (score of 5–7) with a median > 5. The percentage of strong agreement (score of 6–7) and Kendall's coefficient of concordance were calculated to demonstrate a more refined interpretation of the consensus. Results: Fifteen panelists contributed to all rounds. The need for exercise was demonstrated. The consensus was reached on 53 of 58 items in the first round and all items in the second and final rounds. The percentage of strong agreement was high for all but eight items. Conclusions: This study is the first Delphi study to investigate the need for and priorities of exercise for treating preexisting sarcopenia in stroke hemiplegia. We present a standard recommendation including 57 priorities and a strong recommendation including 49 priorities. The eight items that were excluded reflected factors that are less important to hemiplegic patients with poor balance, cognitive decline, or mental vulnerability. [ABSTRACT FROM AUTHOR]

This research aims to understand the relevant pre-conditions and barriers for territorial innovation behind the Research and Innovation Strategies for Smart Specialisation (RIS3) of a lagging European Union (EU) region. For that purpose, a Delphi was conducted to a panel of experts responsible for the design of the RIS3 of the Centro region of Portugal. Consensus was reached on the role of determinant factors for territorial innovation, but the operationalization and effectiveness of the RIS3 remained debatable. Policy recommendations focus on the need to increase the inclusiveness of different actors and knowledge in RIS3 and overcome some of its barriers. [ABSTRACT FROM AUTHOR]

Simple Summary: Including therapy dogs in adolescent mental health is increasingly popular; however, there is poor guidance to assist providers in developing high-quality interventions. This study recruited global experts in the field to agree on a set of minimum standards for health, safety, and welfare. A panel of 40 experts agreed that 32 items out of a possible 49 were important or essential to the minimum standards, including risk assessments, veterinary screening and preventative healthcare for dogs, and training in infection control and first aid for providers. Welfare measures included training providers to assess, document, and respond to dog (and human) wellbeing. Strict measures, including fecal testing, prohibiting raw food diets, and one-hour work schedules, were not included in the minimum standards, despite their common use in hospital/acute settings. Recommendations for providers are made. As interest in animal-assisted therapy (AAT) and canine-assisted psychotherapy (CAP) grows, there are increasing calls for the management of related health, safety, and welfare concerns for canines, providers, and clients. Existing health and safety guidelines lack empirical support and are, at times, contradictory. Welfare is increasingly prioritized; however, tools to monitor and manage welfare are underutilized and under-reported. The aim of this study was to provide expert consensus on the minimum health, safety, and welfare standards required to develop and deliver a CAP group program to adolescents experiencing common mental health disorders. Diverse AAT experts were recruited globally. Using Delphi methodology, over two rounds, 40 panelists reached a consensus agreement to include 32 items from a possible 49 into the minimum standards. Health and safety measures included risk assessment, veterinary screening, preventative medicine, training in infection control, and first aid. Welfare measures included training in welfare assessment, documentation of welfare, and flexible, individualized responses to promote wellbeing. Intestinal screening for parasites and the prohibition of raw food were not supported. Flexible and individualized assessment and management of canine welfare were supported over fixed and time-limited work schedules. Clinical practice implications are discussed, and recommendations are made. [ABSTRACT FROM AUTHOR]

The concept of immersion has been widely used for the design and evaluation of user experiences. Augmented, virtual and mixed-reality environments have further sparked the discussion of immersive user experiences and underlying requirements. However, a clear definition and agreement on design criteria of immersive experiences remains debated, creating challenges to advancing our understanding of immersive experiences and how these can be designed. Based on a multidisciplinary Delphi approach, this study provides a uniform definition of immersive experiences and identifies key criteria for the design and staging thereof. Thematic analysis revealed five key themes – transition into/out of the environment, in-experience user control, environment design, user context relatedness, and user openness and motivation, that emphasise the coherency in the user-environment interaction in the immersive experience. The study proposes an immersive experience framework as a guideline for industry practitioners, outlining key design criteria for four distinct facilitators of immersive experiences – systems, spatial, empathic/social, and narrative/sequential immersion. Further research is proposed using the immersive experience framework to investigate the hierarchy of user senses to optimise experiences that blend physical and digital environments and to study triggered, desired and undesired effects on user attitude and behaviour. [ABSTRACT FROM AUTHOR]

Metachromatic leukodystrophy (MLD) is a rare autosomal recessive lysosomal storage disorder resulting from arylsulfatase A enzyme deficiency, leading to toxic sulfatide accumulation. As a result affected individuals exhibit progressive neurodegeneration. Treatments such as hematopoietic stem cell transplantation (HSCT) and gene therapy are effective when administered pre-symptomatically. Newborn screening (NBS) for MLD has recently been shown to be technically feasible and is indicated because of available treatment options. However, there is a lack of guidance on how to monitor and manage identified cases. This study aims to establish consensus among international experts in MLD and patient advocates on clinical management for NBS-identified MLD cases. A real-time Delphi procedure using eDELPHI software with 22 experts in MLD was performed. Questions, based on a literature review and workshops, were answered during a seven-week period. Three levels of consensus were defined: A) 100%, B) 75–99%, and C) 50–74% or >75% but >25% neutral votes. Recommendations were categorized by agreement level, from strongly recommended to suggested. Patient advocates participated in discussions and were involved in the final consensus. The study presents 57 statements guiding clinical management of NBS-identified MLD patients. Key recommendations include timely communication by MLD experts with identified families, treating early-onset MLD with gene therapy and late-onset MLD with HSCT, as well as pre-treatment monitoring schemes. Specific knowledge gaps were identified, urging prioritized research for future evidence-based guidelines. Consensus-based recommendations for NBS in MLD will enhance harmonized management and facilitate integration in national screening programs. Structured data collection and monitoring of screening programs are crucial for evidence generation and future guideline development. Involving patient representatives in the development of recommendations seems essential for NBS programs. • Newborn screening for metachromatic leukodystrophy aligns with established newborn screening criteria. • Prediction of symptom onset should be based on family history, genotype and blood ARSA enzyme activity. • Recommendations for pre-symptomatic treatment depend on the predicted MLD subtype. • Consensus-based recommendations for NBS in MLD will enhance harmonized management and facilitate integration in national screening programs. [ABSTRACT FROM AUTHOR]

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In this article, I explore the so-called "decree cultures" of selected Greek sanctuaries by studying the chronological distribution of inscribed public decrees at Delos, Delphi and the Amphiareion at Oropos. The employment of quantitative methods will allow for the careful analysis of the chronological distribution of decrees displayed within the sacred space and to compare them to public documents erected in civic spaces. Interesting questions to consider are whether local decree habits were consistent with or departed from broader practices in Greek sanctuaries, and what kind of forces and intentions lay behind the setting up of decrees in sanctuaries in the first place. [ABSTRACT FROM AUTHOR]

This study aims to describe a local community expert's perspective on the identification of and access to children's health assets and to gather proposals to promote children's health and well-being within their community. The health asset approach is essential for health promotion, and there is evidence of its benefits to individuals' or communities' health when this approach is observed. Children's health assets are gaining increasing interest, but the literature that captures the perception of professionals working with children is scarce. Qualitative research designed with Delphi methodology was carried out with the participation of 25 professionals working in a neighbourhood with children and families. The participants stated that this neighbourhood was a good environment for the healthy and happy growth of children but pointed out that there were inequities. They emphasised the importance of economic and physical security and feeling loved. The absolute best aspects of the neighbourhood according to these experts were its support networks, mutual help, educational and health services, and green spaces, and the most deficient aspects were the possibility of a hopeful future and emotional support within the family unit. Poverty and/or the scarcity of economic resources were identified as the main barriers to accessing health assets. Special difficulties in access to health for migrant and Roma children were also identified. The panel of experts made concrete action proposals. It was recommended to support resources and services that already exist in their community. The experts prioritised work with families, education, working in conjunction with vulnerable groups, community participation, and networking. [ABSTRACT FROM AUTHOR]

Young people with physical disability experience challenges to being physically active. To attain the health benefits of physical activity (PA) and sustain engagement, it is essential that participation is meaningful and enjoyable. This study aims to describe current participation in PA by adolescents with physical disability in Ireland, and to establish consensus on their priorities for enhancing physical activity participation. A parallel convergent mixed methods study will be undertaken, comprising a national cross-sectional quantitative assessment of PA participation (“Participation Snapshot”) and Delphi consensus study (“Delphi”). Adolescents (n=100) aged 13–17 years with a physical disability will be invited to take part. The Participation Snapshot primary outcome is the Children’s Assessment of Participation and Enjoyment (CAPE). Contextual factors including underlying medical diagnosis, demographics, mobility (Functional Mobility Scale), hand function (Manual Ability Classification System) and health related quality of life (Child Health Utility 9D) will also be collected. The Delphi will comprise two to four survey rounds, until consensus is reached. Round 1 consists of a bespoke survey, designed and piloted with a public and patient involvement (PPI) panel, with open-ended questions and Likert scales inviting contributions from adolescents on their prior experience and ideas to enhance participation. Responses will be analysed using inductive thematic analysis to construct items and themes, which will then be deductively mapped to the “F-words” and the family of Participation-Related Constructs frameworks. These items will be presented back to participants in subsequent rounds for selection and ranking, until consensus is achieved on the “top 10 priorities” for enhancing PA participation. The project team and PPI panel will then co-design dissemination material and identify targets for dissemination to relevant stakeholder or policy groups. The findings will provide a basis for developing interventions aiming to enhance future PA participation for adolescents with physical disability.

Abstract Background The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages. Methods This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two‐round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator. Results The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p

Abstract In emerging markets, investment costs tend to be associated with uncertainty, especially if the investment is policy driven. Globally, nations have agreed to reduce greenhouse gas emissions to keep the temperature increase below 1.5°C by 2100. Australia faces challenges in achieving its Paris Agreement Nationally Determined Contributions and Agenda 2030 commitments, mostly given the extraction profile of its economy. Introducing renewable carbon from forest residues in the niche markets could increase the competitiveness of the forest industry not only in terms of reduced energy costs but also in terms of ‘greening’ the primary product. Growing interest in the bioenergy market, linked with large volumes of available biomass feedstocks including forest residues, presents opportunities in Australia. Yet, ambiguity about costs and concerns about biomass supply throttle the investment potential. This paper aims to estimate a range of forest residue costs along the supply chain for the Australian market by projecting the biomass supply costs from a mature bioenergy market onto it using a benchmarking process reinforced by expert opinion. A three‐round Delphi method in which experts indicated direction and range of costs along the forest biomass supply chain revealed that roadside costs of forest residues (other than stumps), and biomass transportation costs, are lower than or equal to and equal to or higher than, the EU costs respectively. Experts ranked investment and supply‐side support as priority areas for the development of forest bioenergy in Australia. The expert estimations of forest residue cost ranges along the supply chain offer the first layer for framing a national policy for forest bioenergy within the broader bioeconomy.

Abstract INTRODUCTION Practical social media recommendations are needed to facilitate greater engagement in dementia prevention research. Alongside relevant experts, our aim was to develop a set of consensus recommendations that reflect the values and priorities of prospective participants to guide social media use. METHODS We conducted a three‐round, modified Delphi consisting of three online surveys and three conferences calls. The diverse, international Delphi panel comprised 16 experts with lived (n = 10) and professional (n = 6) experiences. Consensus was defined a priori as ≥ 70% agreement. RESULTS Twenty‐six items achieved consensus. Two items reached consensus in round 1: ethical considerations of closed social media groups (88%) and of social media users sharing prevention content with connections who are not on social media (79%). Nine items reached consensus in round 2, related to misinformation (79%), stigma (93%), and other key aspects of social media communication. After revisions, 15 items reached consensus in the final round. These items included: identifying when researchers ought to engage, managing closed social media groups, rankings of short form content, prioritizing lay summaries and multimedia resources, and rankings of preferred language. One item about the language of prevention for audiences living with dementia did not reach consensus. Final consensus items formed the new set of recommendations, which we organized into seven social media use cases. These use cases include setting up a social media page or community, handling online misinformation, actively challenging stigma, handling difficult online interactions, introducing new research to the public, help with study recruitment, and the language of prevention when writing posts. DISCUSSION These consensus recommendations can help dementia prevention researchers harness social media use for the purposes of public engagement and uphold the norms and values specific to the dementia research and broader communities. Highlights We created social media recommendations with research and community experts. Recommendations cover key ethical considerations for dementia prevention research. Areas include misinformation, stigma, information updates, and preferred language. Full consensus recommendations are organized into seven social media use cases.

Abstract Introduction Integration of exercise into standard oncology care requires a highly skilled workforce of exercise professionals; however, competency requirements have not kept pace with advancements in the field. Therefore, the aim of this study was to obtain consensus on core competencies required for an exercise professional to be qualified to work with adults undergoing active cancer treatment. Materials and Methods A three‐round modified electronic Delphi process was used. In Round 1, an international group of 64 exercise oncology stakeholders (i.e., exercise oncology professionals (n = 29), clinical referrers (n = 21), and people with lived experience (n = 14)) responded to open‐ended prompts eliciting perspectives regarding competencies needed for an exercise oncology professional to work with adults receiving active cancer treatment. Subsequently, only exercise oncology professionals participated, ranking the importance of competencies. In Round 2, professionals received summary feedback, ranked new competencies generated from open‐ended responses, and reranked competencies not reaching consensus. In the final round, professionals finalized consensus ranking and rated frequency and mastery level for each. Results Consensus was reached on 103 core competencies required for exercise professionals to be qualified to deliver care to adults undergoing active cancer treatment. The core competencies represent 10 content areas and reflect the needs of clinical referrers and people with lived experience of receiving cancer treatment. Conclusions The core competencies identified reflect significant advancements in the field of exercise oncology. Results will underpin the development of education, certification, and employment requirements for exercise oncology professionals, providing a critical step toward achieving routine integration of exercise into standard oncology care.

Abstract Despite presenting several advantages in relation to the mortar coating performed by hand labor traditionally carried out in Brazil, there is little knowledge available about mortar pumping systems. Thus, selecting a mortar pump system is not a trivial procedure, and there are no significative studies published in the specialized literature to fully understand the decision criteria applying to this equipment selection. Therefore, the present study aimed to identify the relevant criteria and quantify their importance in the selection of this equipment, by developing a framework combining both mortar pump specialists expertise and fuzzy analytic hierarchy process method to aid this decision making process. Results showed that acquisition cost and quality are the most relevant criteria, representing togheter around 2/3 of the decision weight, while technical and operational aspects account for aproximatelly 1/10 of relevance in the equipment selection.

As potent financial instruments channeling capital into climate and environmental projects, green bonds' issuance is frustrated by myriad obstacles. Therefore, this study aims to explore the critical barriers to green bond issuance in Vietnam. This study elucidates the salient barriers by utilizing an integrated multi-criteria decision-making methodology synthesizing the Fuzzy set theory-based Delphi, Decision-Making Trial and Evaluation Laboratory (DEMATEL), and DEMATEL-based Analytic Network Process (DANP). An extensive literature review of green bonds delineates five key dimensions related to impediments: Policy, Market, Financial, Capacity, and Awareness, with 38 discrete indicators representing potential obstacles. Firstly, employing a Fuzzy Delphi survey of 16 experts, 32 indicators are distilled for further analysis. Then, Fuzzy DEMATEL modeling evaluates the interrelationships and interactions among barriers. Finally, DANP is applied to obtain the relative importance of key barriers. Results unveil the five most formidable barriers as a weak regulatory framework and infrastructure (PO1), Limited availability of green bond issuance guidelines and templates (PO2), Insufficient incentives or tax benefits for green bond issuers (PO3), Limited coordination and alignment with international green bond standards (PO5), Lack of investor confidence in the quality and credibility of green projects (AW4), and Capacity constraints among issuers, particularly in smaller organisations or government agencies (CA1). The research contributes to the broader literature on green finance and offers valuable insights for promoting sustainable finance practices in Vietnam and other developing economies.

Abstract Introduction Sesamoiditis is a common, and often painful, musculoskeletal pathology frequently encountered by podiatrists. However, there are currently no recommendations to guide podiatrists in the assessment and management of people with sesamoiditis. The aim of this study was to develop consensus‐driven clinical recommendations on the assessment and management of people with sesamoiditis. Methods A four‐round online Delphi survey was conducted with a panel of New Zealand and Australian podiatrists. In the first round, panellists answered open‐ended questions that were used to create statements. In round two, the panellists scored the statements from 1 to 9 (1 = not at all important, 9 = absolutely essential). Consensus was defined using the RAND/University of California Los Angles Disagreement Index. Panellists were asked to reconsider statements that did not achieve consensus in round three. In the final round, content validity and acceptability of the statements for inclusion in clinical recommendations were determined using content validity ratios and the Content Validity Index (CVI). Results Eighteen panellists completed round one with 16 (89%) completing all four rounds. A total of 118 statements were generated following round one. Following rounds two and three, 78 statements were accepted by panellists as being important, with 62 statements achieving sufficient content validity for inclusion in clinical recommendations. The CVI for these 62 statements was 0.58. These recommendations provide guidance on subjective assessment (pain characteristics/symptomology, activity/sports/training history and medical history) objective assessment (establishing a diagnosis, identifying contributing biomechanical factors, footwear/orthoses, ruling out differential diagnoses) and management (temporary padding/strapping, education, footwear, foot orthoses and when to consider referral). Conclusion This consensus exercise has provided a set of consensus‐based recommendations for the assessment and management of people with sesamoiditis. In the current absence of research‐based evidence in this area, these recommendations are intended to support clinicians. The recommendations may also serve as a basis for future clinical trials evaluating the efficacy of conservative interventions for people with sesamoiditis.

ObjectivesThe objective of this study is to develop a consensus among experts on a comprehensive and scientifically sound physical activity-related injuries (PARI) public health education program specifically tailored for undergraduates.MethodsThis study designed three rounds of expert consultation by using a Delphi method. A panel of 30 experts from the fields of public health education, sports medicine, anesthesia pain, emergency medicine, and emergency nursing participated in the study.ResultsThis study successfully established a consensus among experts on the goals, content, teaching methods, and time allocation for the PARI Public Health Education Program for undergraduates. The program encompasses 10 objectives divided into 2 main categories: professional knowledge and skill goals. In terms of content, it includes 5 primary indicators, 22 secondary indicators, and 56 detailed tertiary indicators. Six teaching methods were identified as suitable. Additionally, a typical 60-min educational session was segmented into eight parts, with a proposed time arrangement for each, ensuring comprehensive coverage of all topics.ConclusionThe consensus achieved in this study on the PARI Public Health Education Program for undergraduates lays a crucial foundation for the advancement of health literacy and proactive health management within this demographic. We presented a comprehensive framework for PARI public health education, integrating diverse learning methods and content areas. This systematic approach not only enriched the resources available for undergraduate health education, especially of PARI but also had the potential to significantly impact the implementation and effectiveness of health promotion strategies.

Abstract Background To implement the ACGME Anesthesiology Milestone Project in a non-North American context, a process of indigenization is essential. In this study, we aim to explore the differences in perspective toward the anesthesiology competencies among residents and junior and senior visiting staff members and co-produce a preliminary framework for the following nation-wide survey in Taiwan. Methods The expert committee translation and Delphi technique were adopted to co-construct an indigenized draft of milestones. Descriptive analysis, chi-square testing, Pearson correlation testing, and repeated-measures analysis of variance in the general linear model were employed to calculate the F values and mean differences (MDs). Results The translation committee included three experts and the consensus panel recruited 37 participants from four hospitals in Taiwan: 9 residents, 13 junior visiting staff members (JVSs), and 15 senior visiting staff members (SVSs). The consensus on the content of the 285 milestones was achieved after 271 minor and 6 major modifications in 3 rounds of the Delphi survey. Moreover, JVSs were more concerned regarding patient care than were both residents (MD = − 0.095, P

Supply Chain Integration (SCI) has an important role in influencing supply chain overall performance. Although scholars and practitioners have identified barriers and enablers to SCI, previous studies did not delve into the partners’ different perspectives regarding integration needs, or into specific solutions to overcome the barriers. This study aims to prioritize and rank supply chain integration barriers, to propose specific and practical solutions for integration, and to assess the power of each solution in mitigating the critical barriers. The perspective of experts from the focal company and from suppliers was analyzed separately. The Delphi method was employed to generate and select solutions for SCI, and the Hesitant Fuzzy Linguistic Terms Set (HFLTS) representation was utilized to deal with uncertainty and imprecision in the experts’ judgment. HFLTS was applied to the ranking of critical barriers and to the assessment of the solutions’ power. The results showed that there are two types of solutions for integration, referred to as “specific critical solutions” and “broadband solutions”, and revealed differences in the focal company’s and in the suppliers’ perspectives regarding the priority of these solutions. The study is unique, considering the simultaneous analysis of these two perspectives, the presentation of specific solutions to achieve integration, and the provision of clear guidelines for professionals regarding implementation priorities.

This paper presents an evaluation of a cybersecurity risk management and evaluation framework for Blockchain-based Identity Management Systems (BC-IdM) in the Health Internet of Things (HIoT). In this paper, thirteen experts were interviewed using a Delphi method to evaluate the framework, which includes the factors that are used to evaluate any HIoT BC-IdM system and the cybersecurity risk management processes and activities that should be applied. In addition, the Simple Multi-Attribute Rating Technique (SMART) was used in the interviews and questionnaires with the experts to assign weights to the twenty-six identified evaluation factors to rank them based on their importance. The identified factors are divided into four main categories: security and privacy, technical, HIoT-related considerations, and external aspects. This paper shows that the security and privacy factors are the most important among other factors. Using Delphi, an agreement on the details of the framework was sought, including the cybersecurity risk management processes and activities in the main phases: framing, assessment, responding, and mentoring of risks. This article identifies the main and subcategories of the evaluation factors and explains the framework content in detail. It presents recommendations and findings concerning Blockchain-based Identity Management Systems in Health Internet of Things. The framework plays a role in standardizing BC-IdM in HIoT and contributes to the applicability and reliability of such systems by considering security, privacy, technical, HIoT-related, and external considerations.

Abstract Objective Studies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied. Results The consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.

Abstract Background Low back pain (LBP) is the leading cause of disability worldwide and a significant component of healthcare expenditures. Clinical practice guidelines (CPGs) have been highlighted as a key resource to improve the quality of care. This study aimed to develop a clinical pathway for LBP based on CPGs in an academic health system. Methods We conducted a modified Delphi study of clinicians caring for patients with LBP who were asked to rate 21 CPG-informed seed statements through an online survey. The goal was to identify statements that achieved a minimum of 80% consensus among panelists. Results Thirty-five healthcare providers participated as panelists. The majority of participants were male (68.6%), had MD or DO (62.9%) degrees, and were clinicians (73.8%) working in neurosurgery (36.1%), orthopedics (25.7%), emergency medicine (14.3%), or physical therapy (11.4%). Initially, consensus was reached on 20 of 21 seed statements. One statement did not reach consensus in the initial round and was revised into two separate statements based on feedback from panelists. One of these statements achieved consensus in the second review round. All statements reaching consensus were incorporated into a care pathway consisting of diagnosis, evaluation, and treatment for LBP. Conclusion Healthcare providers across various disciplines supported statements interpreting current CPGs related to care for LBP. This study represents a step toward supporting guideline-concordant care for LBP. Additional research is needed to assess how such pathways impact actual clinical care.

Background Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHCs) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization's mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China's emergent mental health system. Methods A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either "somewhat agree/definitely agree", or "definitely disagree/somewhat disagree" on a five-point scale for agreement. Results 79% of statements received consensus with a mean score of 4.26 (i.e. "somewhat agree"). Agreed adaptations for mhGAP-IG.v2 included: an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians' roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide. Conclusion An adapted mhGAP-IG.v2 for depression recognises China's cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

Abstract Background The global Human Resources for Health (HRH) strategy emphasizes the need to invest in HRH to meet population needs and improve the provision of quality health care services. In South Africa, dietitians are recognized as registered professionals who provide nutrition services. In this paper, we used 2 key steps (3 and 4) of the eight step World Health Organization (WHO) Workload Indicators of Staffing Need (WISN) methodology to determine the workload components and activity standards for dietitians at South African central and tertiary public hospitals. Methods All (9) provincial nutrition managers (phase one) and 21 out of a total 22 head dietitians at central and tertiary public hospitals (phase two) participated in an online survey. In phase one, the provincial managers provided the job descriptions (JDs) of dietitians in their provinces, and the JDs were analyzed to determine the baseline workload components. In phase two, dietitians participated in a multi-stage Delphi process to reach consensus on workload components and activity standards. Consensus was deemed to be agreement of 70% or more, while the median of participants’ responses was used to obtain consensus on the activity standards. Results The JDs of dietitians were a useful baseline for the consensus exercise as there were no other suitable source documents. The response rate was 100% for all three rounds of the Delphi survey. Dietitians reached agreement (consensus ≥ 70%) on 92% of proposed workload components and activity standards. Following the removal of duplicate and certain administrative activities, a total of 15 health, 15 support and 15 additional service activities with aligned activity standards resulted from the consensus exercise. Conclusion The Delphi technique was a suitable method for reaching agreement on workload components and activity standards for dietitians at South African central and tertiary public hospitals. The findings from this study can now be used to compile a standardized list of workload components and activity standards and ultimately to determine dietetic staffing needs for the central and tertiary public hospital level of care.

Building food system resilience enables the system to buffer, adapt and transform in response to changes. Identification of key variables of resilience support actors and policymakers managing the food systems. The objective of this study was to identify the most important variables to assess food system resilience and actors with the best opportunities to take responsibility for preparing for disruptions. We operationalised the key variables of resilience in the Finnish food system and evaluated them using a Delphi expert method. We produced a framework for food system resilience, including three indispensable interacting levels of action and good practices within each supporting resilience building. In the prioritisation of key variables, diversity in production, versatile cooperation between actors based on trust, independence of external inputs, system understanding, and renewable domestic energy were considered the most important. Research and administration play a key role in producing information and implementing actions targeted especially at agriculture, where actions are expected to be the most efficient and impactful. In the whole food system, increasing transparency would help create trust and thus promote co-creation of sustainable practices. Platforms to obtain information about future risks and for co-creating solutions for building food system resilience are needed.

The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.

Introduction: The main capital of any organization is its human resources (HR). Organizations invest substantial costs in attracting, retaining, and training individuals. Therefore, it is essential to identify and implement appropriate practices to preserve and enhance HR. Aging of employees is an inevitable phenomenon that poses challenges to all organizations, irrespective of specific geographical locations, because the employees will get old and leave the organization. This research aims to identify HR management practices for aging employees in public organizations in Jahrom City, Fars Province, Iran, in the year 2022. Methods: This study utilizes meta-synthesis and Delphi methods to extract and identify management practices for aging HR. In the meta-synthesis section, the library method was used and community under study in the Delphi section included 28 academic (university professors with doctorate degrees in HR or organizational behavior) and organizational (senior managers and HR managers of public organizations in Jahrom) experts. The research tool used in the Delphi section was a questionnaire conducted in 3 rounds. Results: Through the study of the sources using meta-synthesis method, a total of 79 organizational practices were identified, categorized into 11 main dimensions. After three rounds, a consensus was reached on 60 practices, organized into 9 main dimensions, and the Delphi rounds were concluded. In the final round, no new practices were suggested or removed. Due to the minimal differences in the Kendall coefficient among the different rounds, the Delphi rounds were concluded. Conclusion: It is necessary to plan and implement all these practices in parallel and simultaneously. However, as the most crucial management measure is planning, there is a need for planning, coordination, and harmonization at the legislative, administrative, and recruitment levels. Implementing the proposed practices through organizational experts, HR managers, and the active participation of aging employees in implementing practical practices will lead to better execution. Corresponding Author: Hossein Mansoori View Orcid in Profile You can search for this author in PubMed Google Scholar Profile

Abstract The advances that have taken place in recent decades in the investigation of the ritual and topographical structure of the Sanctuary of Delphi have brought to light strong correspondences with the narrative structure of the Proem of Parmenides. These correspondences, of a ritual, topographical and narrative nature, could be a sign that Parmenides’ hymn was composed to be performed in a civic and religious festival of ancient Elea that followed the model of the Theophania of Delphi. In this paper I present the signs and evidence in favour of this thesis, which implies not only a revision of the traditional interpretations of the Proem, but also the possibility of using it as historical evidence to improve our knowledge of the religious festivals held at Delphi. According to this interpretation, the Proem would not describe a katabasis or an anabasis, but the epidemia or arrival of Apollo at Delphi from the land of the Hyperboreans. The narrator would be Apollo (and not Parmenides), and the itinerary of his journey, that of the places and stations of the Theophania procession. This reading also offers a consistent interpretation of the sculptures and inscriptions found in the Insula II of Velia. It is quite likely that the pholarchoi were priests of Apollo, whose ritual consecration took place at the festival for which Parmenides’ hymn was composed.

Container shipping is the backbone of the global supply chain, and its security is directly linked to the global economy. Disruptions in container transportation could have severe consequences, such as an increase in transport and insurance costs and damage to the environment and cargo. The first aim of this study is to identify, assess, and prioritize the security risks associated with maritime container transportation using the Delphi technique and to draw a risk map accordingly. The second aim is to identify the strengths, weaknesses, opportunities, and threats to using SWOT analysis from a security perspective. Maritime container transportation between Türkiye and the Far East serves as a case study for this purpose. As a conclusion of the first part of the study, the risk of cyber-attacks has one of the highest probability factors scored first, war and warlike conditions having the highest impact factor scored second, and piracy and armed robbery scored third in general. In the second part, the SWOT factors are determined and prioritized using the Analytic Hierarchy Process. Strengths scored the highest among the main SWOT factors, which indicates that it is more prominent than other factors. Weaknesses, opportunities, and threats to. The overall conclusion drawn is that security risk assessment has become essential given recent technological changes, such as the increasing risk of cyber-attacks on electronic navigational aids, and geopolitics, such as tensions in the Middle East and the South China Sea.

Abstract Background The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). Methods Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin ‘top 10’ lists of the most important research needs. Results From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. Conclusions Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

The rapidly changing and evolving technology profoundly impacts various aspects of our lives, ranging from our living arrangements and modes of transportation, to the food we consume and clothing we wear, even extending to our relationships with pets, the visions of companies, and the constitutional integrity of countries. The potential of technology to fundamentally transform our living spaces, behaviours, and habits is immense. This study investigates the relationship between working life and the Metaverse, widely regarded as one of the most significant technological advancements of our era. The Delphi technique was used as the research method in this study. Expert opinions were collected to gain insights into the key strengths and weaknesses of the Metaverse in the workplace, as well as the potential threats and opportunities it presents in working life. A total of 52 predictions were analyzed in three rounds of discussions. Although complete consensus could not be reached for six predictions concerning the weaknesses and threats posed by the impact of the Metaverse on working life, experts reached a consensus on 46 predictions.

People spend most of their time indoors, and the visual characteristics of indoor building materials affect not only the quality of the indoor environment, but also the well-being of individuals. Ceramic tiles are widely used in interior decoration of buildings due to their aesthetic appeal and ease of maintenance. However, there is currently a lack of a comprehensive framework for assessing the visual comfort of ceramic tile design. This study established an evaluation system using the Analytic Hierarchy Process (AHP) and the Delphi method to collect perceptual words, extract evaluation indices, and calculate weights. A visual comfort scale for ceramic tiles, comprising three dimensions and twelve indices, was developed. A total of 342 questionnaires were analyzed using six types of tiles, and the multidimensional visual comfort scores of the various ceramic tile samples were statistically examined. An analysis of variance was conducted to investigate the effects of tile brightness, texture, and participant gender on visual comfort. The findings indicate that tile brightness and texture significantly affect the overall visual comfort score (p < 0.001; p < 0.001), with light-toned, non-textured tiles providing higher visual comfort (3.949). Although gender did not significantly affect the overall visual comfort scores, it did influence the evaluation scores in certain dimensions. Men rated the aesthetic comfort of tiles lower than women (p = 0.035), but they rated the emotional comfort of medium-toned and non-textured tiles higher (p = 0.003; p = 0.017). In terms of theoretical significance, the establishment of this evaluation model can expand the research content and methods of ceramic tiles, which are crucial architectural decoration materials. In terms of practical significance, this study provides an evaluation method and partial evaluation information for designers, enabling them to assess and enhance the visual experience of tiles based on the specific needs of interior spaces and the characteristics of the visual subject.

In today’s competitive and environmentally conscious industries, the ability of organizations to adapt and respond is more important than ever. This study focuses on overcoming the obstacles faced by the Iranian automobile sector by highlighting the significance of incorporating green supply chain techniques. The research intends to integrate organizational operations with environmental sustainability goals by utilizing a MULTIMOORA strategy for supplier selection. The Iranian automobile sector, facing substantial environmental challenges, requires a strategy framework for selecting environmentally friendly suppliers in order to sustain competitiveness and fulfill ecological obligations. The study develops a supplier selection model based on extensive research and expert knowledge. The Delphi and MULTIMOORA techniques are employed to assess and prioritize suppliers according to green criteria, assuring conformity with environmental goals. Data are collected by conducting a comprehensive analysis of the existing literature and engaging in conversations with industry experts in order to acquire information for the construction of the model. The results emphasize the crucial significance of trust-based relationships with suppliers, rigorous compliance with quality standards in new product development, and substantial investment in employee training and development. Sector analysts view these characteristics as crucial for promoting sustainability and gaining a competitive advantage in the Iranian vehicle sector. This study provides firms with strategic instruments to effectively negotiate the intricacies of green supply chain management, with a particular focus on the need for adopting sustainable practices while selecting suppliers in the dynamic and competitive context of the Iranian automobile industry.

Study questionWhat outcomes should be reported in all studies investigating uterus-sparing interventions for treating uterine adenomyosis?Summary answerWe identified 24 specific and 26 generic core outcomes in nine domains.What is known alreadyResearch reporting adenomyosis treatment is not patient-centred and shows wide variation in outcome selection, definition, reporting and measurement of quality.Study design, size, durationAn international consensus development process was performed between March and December 2021. Participants in round one were 150 healthcare professionals, 17 researchers and 334 individuals or partners with lived experience of adenomyosis from 48 high-, middle- and low-income countries. There were 291 participants in the second round.Participants/materials, setting, methodsStakeholders included active researchers in the field, healthcare professionals involved in diagnosis and treatment, and people and their partners with lived experience of adenomyosis. The core component of the process was a 2-step modified Delphi electronic survey. The Steering Committee analysed the results and created the final core outcome set (COS) in a semi-structured meeting.Main results and the role of chanceA total of 241 outcomes was identified and distilled into a 'long list' of 71 potential outcomes. The final COS comprises 24 specific and 26 generic core outcomes across nine domains, including pain, uterine bleeding, reproductive outcomes, haematology, urinary system, life impact, delivery of care, adverse events and reporting items, all with definitions provided by the Steering Committee. Nineteen of these outcomes will apply only to certain study types. Although not included in the COS, the Steering Committee recommended that three health economic outcomes should be recorded.Limitations, reasons for cautionPatients from continents other than Europe were under-represented in this survey. A lack of translation of the survey might have limited the active participation of people in non-English speaking countries. Only 58% of participants returned to round two, but analysis did not indicate attrition bias. There is a significant lack of scientific evidence regarding which symptoms are caused by adenomyosis and when they are related to other co-existent disorders such as endometriosis. As future research provides more clarity, the appropriate review and revision of the COS will be necessary.Wider implications of the findingsImplementing this COS in future studies on the treatment of adenomyosis will improve the quality of reporting and aid evidence synthesis.Study funding/competing interest(s)No specific funding was received for this work. T.T. received a grant (grant number 2020083) from the South Eastern Norwegian Health Authority during the course of this work. T.T. receives personal fees from General Electrics and Medtronic for lectures on ultrasound. E.R.L. is the chairman of the Norwegian Endometriosis Association. M.G.M. is a consultant for Abbvie Inc and Myovant, receives research funding from AbbVie and is Chair of the Women's Health Research Collaborative. S.-W.G. is a board member of the Asian Society of Endometriosis and Adenomyosis, on the scientific advisory board of the endometriosis foundation of America, previous congress chair for the World Endometriosis Society, for none of which he received personal fees. E.S. received outside of this work grants for two multicentre trials on endometriosis from the National Institute for Health Research UK, the Rosetrees Trust, and the Barts and the London Charity, he is a member of the Medicines and Healthcare Products Regulatory Agency (MHRA), Medicines for Women's Health Expert Advisory Group, he is an ambassador for the World Endometriosis Society, and he received personal fees for lectures from Hologic, Olympus, Medtronic, Johnson & Johnson, Intuitive and Karl Storz. M.H. is member of the British Society for Gynaecological Endoscopy subcommittee. No other conflict of interest was declared.Trial registration numberN/A.

To investigate possible future transportation and land use scenarios for California as well as their likely precipitating policies and potential consequences, we convened a panel of 18 experts and used a novel variation of the Delphi method to systematically explore four specific scenarios and probe the desirability and likelihood of each. The scenario that panel members collectively thought most desirable for California (one with diverse transportation options and higher-density development) was also the one they thought least likely to materialize by 2050. This report describes the findings of the three surveys and two meetings that our method entailed and summarizes some of the discussion among panelists. We include reflections on the salient but unexpected finding that panelists viewed trust in government as both critical to effecting the scenario they considered most desirable and also lacking to such an extent that pursuing that desirable outcome could cause unintended consequences or outright failure. Accordingly, we discuss possible implications and outline policy recommendations for improving both processes and conditions that can instill in California’s government more trust, without which a future of multimodal transportation and higher-density, mixed land uses is unlikely to succeed.

There are many methods for engaging experts in interactive groups to explore, clarify, and/or decide on various issues. In an investigation of possible future transportation and land use scenarios for California, we used techniques common to several methods and developed our own variation, a “hybrid policy Delphi,” for use with a panel of 18 experts. We applied it to explore the policies that would lead to these scenarios and the consequences that would result from them. Through our process, panel members discussed and reported on the future scenarios they considered most desirable and also the scenarios they considered most likely to materialize by 2050. Panelists reported that the scenario they considered the most desirable was also least likely to occur, and that the likely trajectory of California transportation and land use policies and practices will lead to the scenario panelists considered less desirable. This report reflects on the processes behind reaching these panel conclusions, a five-stage sequence of two meetings and three online questionnaires. Our mix of discussion and questionnaires traded the benefit of anonymity (common in Delphi methods) for the benefit of exploratory discussion (used in workshops, focus groups, and the nominal group technique). In addition, our use of surveys before and after meetings allowed tracking changes in panel opinion on a central question (scenario likelihood) and discussing survey results at meetings, at the cost of greater administrative effort. We discuss the results of this effort, reflect on how well our combination of methods worked, and conclude with a discussion of limitations and future directions.

BackgroundConsensus guidance for the development and identification of high-quality Alzheimer's disease clinical trials is needed for protocol development and conduct of clinical trials.MethodsAn ad hoc consensus committee was convened in conjunction with the Alzheimer's Association to develop consensus recommendations.ResultsConsensus was readily reached for the need to provide scientific justification, registration of trials, institutional review board oversight, conflict of interest disclosure, funding source disclosure, defined trial population, recruitment resources, definition of the intervention, specification of trial duration, appropriate payment for participant engagement, risk-benefit disclosure as part of the consent process, and the requirement to disseminate and/or publish trial results even if the study is negative.ConclusionsThis consensus guidance should prove useful for the protocol development and conduct of clinical trials, and may further provide a platform for the development of education materials that may help guide appropriate clinical trial participation decisions for potential trial participants and the general public.