Medicine and Health Sciences Commons^™

How An Athlete’S Injuries Affect Their Caregiver, John-Luke Taylor, Susan Macdermott

Fall 2024 OTD Capstone Symposium

The purpose of this proposal was to explore the experiences that caregivers face when their child recovers from a sports injury and needs physical rehab.

Parent Perceptions Of Modified Toy Cars Influence On Play For Children With Disabilities: A Case Study, Taylor Brown, Angela Labrie Blackwell, Erik Pérez, Karen Aranha

Fall 2024 OTD Capstone Symposium

Play is a crucial childhood occupation because it facilitates the growth of various developmental skills. Children with disabilities (CWD) often exhibit intrinsic factors that can prevent them from participating in meaningful childhood occupations, such as play. Mobility play is a specific type of play that refers to any means for the child to explore and move around their environment, which can be accessed through the use of commercially available toys, including motorized toy cars. However, these commercially available toys are not always accessible to this population due to their unique presentation that hinders performance and participation in the desired and …

The Benefit Of Creative Arts-Based Interventions For Children With Autism Spectrum Disorder, Marissa Patrick, Zeida Gutierrez

Fall 2024 OTD Capstone Symposium

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that significantly affects emotional regulation, social communication, and executive functioning. Addressing emotional regulation in children with ASD is essential for enhancing mental health, quality of life, and functional independence in occupations such as social participation. Despite evidence supporting the use of creative arts-based interventions to improve mental health, limited research exists on their specific application for emotional regulation in this population.

This project aimed to implement and evaluate a creative arts-based intervention program designed to improve emotional regulation skills in children with ASD within occupational therapy (OT) practice. Conducted over five weeks …

Occupation-Based Programming For An Addiction Recovery Program, Mckenna Howard, Susan Macdermott Otd, Otr/L

Fall 2024 OTD Capstone Symposium

Addiction can impact engagement in many different occupations and occupational therapists can assist in returning to engagement in meaningful occupations. This capstone project focused on creating occupation-based programming for an addiction recovery program. This program aims to enhance engagement, skills, and confidence in daily occupations to promote overall well-being during recovery.

The Efficacy Of Occupation-Based Caregiver Education On Primitive Reflex Integration In Children With Asd, Alexis Cinotti, Cynthia Haynes

Fall 2024 OTD Capstone Symposium

This capstone research improved the delivery of care regarding caregiver education in children with autism spectrum disorder and retained primitive reflexes. The purpose of this project was to generate resources for occupational therapy practitioners that provide caregiver education on primitive reflex integration interventions that directly correlate with specific ADL’s their child has difficulty with and how to incorporate these exercises in the home environment. Occupational therapy practitioners lack educational resources for caregivers of children diagnosed with ASD to explain the importance and impact of primitive reflex integration on participation in meaningful ADL’s and promote adherence to home exercise programs, implementing …

Understanding The Perceptions Of Technology In Homes For Aging In Place, Jinelle Abugan, Amy Lyons-Brown Ms, Otd, Otr/L, Molly Wuebker Otd, Otr/L, Actcp

Fall 2024 OTD Capstone Symposium

The purpose of this study is to understand the thoughts and experiences of technology in homes and the use of technology-based home modifications to help individuals with participation and performance in daily activities. The education of perceptions of culture in homes will be supported by faculty, OTs, professional designers, about the need to explore culture in technology for home modifications aging in place.

Exercise As A Therapeutic Intervention And Its Effects On The Quality Of Life Of Those Diagnosed With Amyotrophic Lateral Sclerosis, Theresa Stettner, Helen Carey, Cynthia Haynes

Fall 2024 OTD Capstone Symposium

The standard of care for those with ALS includes range of motion, limb relaxation, trunk balance, and gait training (Braga et al., 2018). This study examines perceived quality of life in ALS clients before and after an in-person exercise program and home exercise program to evaluate the benefits of exercise as exercise does not exacerbate symptoms of ALS (Meng et al., 2020). Daily occupation performance requires functional ability which may be preserved through exercise (Kalron et al., 2021).

Discrepancy Between Hyaluronic Acid Levels And Mri-Based Measurements Of Hepatic Fat And Fibrosis, Daniel Aaron Borman, Rachel Chevalier, Jonathan Wagner, Michele T. Pritchard, Sherwin S. Chan, Nathan S. Artz, Johnston Fite, Yoon Cho, Valentina Shakhnovich, Veronica Williams, Voytek Slowik

Posters

Introduction Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in children in the United States and, when left untreated, can progress to liver fibrosis. Clinicians currently utilize imaging and biopsy to assess fibrosis in this patient population as there is no validated serum biomarker available for detecting fibrosis. Previous research suggests that serum hyaluronic acid levels are predictive of hepatic fibrosis in children with MASLD. Methods Retrospective data were obtained from the Children’s Mercy Hospital Liver Lab study. Pediatric subjects with both hyaluronic acid (HA) samples and MRI evaluation within a month were identified and included for …

Process Evaluation Of A Randomised Controlled Trial Intervention Designed To Improve Rehabilitation Services For Aboriginal Australians After Brain Injury: The Healing Right Way Trial, Judith M. Katzenellenbogen, Jane White, Melanie Robinson, Sandra C. Thompson, Amy Epstein, Mandy Stanley, Jane Klobas, Emma Haynes, Elizabeth A. Armstrong, Juli Coffin, Rachel Skoss

Research outputs 2022 to 2026

Background: Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a stepped-wedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staff and 2.Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service …

Differences In Igg Afucosylation Between Groups With And Without Carotid Atherosclerosis, Cuihong Tian, Xingang Li, Hongxia Zhang, Jieyi He, Yan Zhou, Manshu Song, Peixuan Yang, Xuerui Tan

Research outputs 2022 to 2026

Background: A previous study demonstrated that N-glycosylation profiles of IgG are associated with subclinical atherosclerosis in a British population. However, the generalisability of this finding to other ethnic groups remains to be investigated, and it has yet to account for additional traditional atherosclerotic risk factors. The present study, thus, aims to explore IgG N-glycosylation profiles in Han Chinese with atherosclerosis, and their potential role in atherosclerosis, while controlling for traditional atherosclerotic risk factors. Methods: Data of this case-control study were obtained from an established umbrella Health Examination Cohort Study (registration number: ChiCTR2100048740). The investigation was conducted at the Health Care …

The Effects Of Short-Term, Progressive Exercise Training On Disease Activity In Smouldering Multiple Myeloma And Monoclonal Gammopathy Of Undetermined Significance: A Single-Arm Pilot Study, A. Emery, S. Moore, J. Crowe, J. Murray, O. Peacock, D. Thompson, F. Betts, S. Rapps, L. Ross, D. Rothschild-Rodriguez, A. A. Echarri, R. Davies, R. Lewis, D. X. Augustine, A. Whiteway, Z. Afzal, J. L. J. Heaney, M. T. Drayson, J. E. Turner, John P. Campbell

Research outputs 2022 to 2026

Background: High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly …

Co-Design Of A Personalised Digital Intervention To Improve Vegetable Intake In Adults Living In Australian Rural Communities, Katherine M. Livingstone, Jonathan C. Rawstorn, Laura Alston, Stephanie R. Partridge, Amber Bastian, Kate Dullaghan, Sarah A. Mcnaughton, Gilly A. Hendrie, Lauren C. Blekkenhorst, Ralph Maddison, Yuxin Zhang, Scott Barnett, John C. Mathers, Stephanie L. Godrich

Research outputs 2022 to 2026

Background: Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Methods: Active participants in the co-design process were adults ≥ 18 years living in three rural Australian …

Joint Association Of Tyg Index And High Sensitivity C-Reactive Protein With Cardiovascular Disease: A National Cohort Study, Cancan Cui, Lin Liu, Yitian Qi, Ning Han, Haikun Xu, Zhijia Wang, Xinyun Shang, Tianjiao Han, Yining Zha, Xin Wei, Zhiyuan Wu

Research outputs 2022 to 2026

Background: Both the triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and systemic inflammation are predictors of cardiovascular diseases; however, little is known about the coexposures and relative contributions of TyG index and inflammation to cardiovascular diseases. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted longitudinal analyses to evaluate the joint and mutual associations of the TyG index and high-sensitivity C-reactive protein (hsCRP) with cardiovascular events in middle-aged and older Chinese population. Methods: This study comprised 8 658 participants aged at least 45 years from the CHARLS 2011 who are …

Impacts Of Double Biopsy And Double Vitrification On The Clinical Outcomes Following Euploid Blastocyst Transfer: A Systematic Review And Meta-Analysis, Kate Bickendorf, Fang Qi, Kelli Peirce, Rui Wang, Jay Natalwala, Vincent Chapple, Yanhe Liu

Research outputs 2022 to 2026

STUDY QUESTION: Compared to the 'single biopsy + single vitrification' approach, do 'double biopsy + double vitrification' or 'single biopsy + double vitrification' arrangements compromise subsequent clinical outcomes following euploidy blastocyst transfer? SUMMARY ANSWER: Both 'double biopsy + double vitrification' and 'single biopsy + double vitrification' led to reduced live birth/ongoing pregnancy rates and clinical pregnancy rates. WHAT IS KNOWN ALREADY?: It is not uncommon to receive inconclusive results following blastocyst biopsy and preimplantation genetic testing for aneuploidy (PGT-A). Often these blastocysts are warmed for re-test after a second biopsy, experiencing 'double biopsy + double vitrification'. Furthermore, to achieve better …

Enrollment Of Females In Randomized Trials For Glucagon-Like Peptide 1 Receptor Agonists: A Systematic Review, Frederick Berro Rivera, Mc John Caro Ybañez, John Vincent Magalong, Mario Prado, Eloise Arias Aguirre, Ana Patricia Ting Cañares, Janos Marc Rubia, Allyn Ralph Hiyas, Polyn Luz S. Pine, Kyla Lara-Breitinger, Francisco Lopez-Jimenez, Martha Gulati

Ateneo School of Medicine and Public Health Publications

Background

Randomized controlled trials (RCTs) of glucagon-like peptide 1 receptor agonists (GLP-1RAs) form the basis for therapeutic recommendations for both males and females. Historically, females have been significantly underrepresented in RCTs.

Objectives

The authors sought to determine the trends of representation of females in GLP-1RA RCTs from 2007 to 2024.

Methods

We reviewed eligible studies and extracted important variables. The proportion of females among the total participants was obtained per study. This was compared over time (year) of publication and over mean age of participants. This proportion was also compared between specific types of GLP-1RA received, diabetes status, indication of …

A New Label Free Spiral Sensor Using Impedance Spectroscopy To Characterize Hepatocellular Carcinoma In Tissue And Serum Samples, Reda Abdelbaset, Sherif M. Shawky, Mohammed A.A. Abdullah, Omar E. Morsy, Yahia A. Yahia, Yehya H. Ghallab, Marwa Matboli, Yehea Ismail

Faculty Journal Articles

Hepatocellular carcinoma (HCC) stands as the most prevalent form of primary liver cancer, predominantly affecting patients with chronic liver diseases such as hepatitis B or C-induced cirrhosis. Diagnosis typically involves blood tests (assessing liver functions and HCC biomarkers), imaging procedures such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), and liver biopsies requiring the removal of liver tissue for laboratory analysis. However, these diagnostic methods either entail lengthy lab processes, require expensive imaging equipment, or involve invasive techniques like liver biopsies. Hence, there exists a crucial need for rapid, cost-effective, and noninvasive techniques to characterize HCC, whether in serum …

The Role Of Trauma-Related Shame In Ptsd And Dissociation, Alexis Stokes

Bakerman Student Research Awards

Dissociation commonly occurs in response to traumatic events, and a dissociative subtype of PTSD is now recognized in the DSM-5. However, researchers have not established a clear consensus as to what factors separate individuals with general PTSD and PTSD with dissociative symptoms (PTSD-D). Negative affect—specifically shame—has been increasingly examined in psychotraumatology research. There is ample evidence that shame predicts and maintains symptom severity in PTSD patients, as well as that it can induce and maintain dissociative symptoms. The clear connection of shame to PTSD and dissociation suggests that it may be an important factor for conceptualizing PTSD-D; however, there is …

Kinetics Of Naturally Induced Binding And Neutralising Anti-Sars-Cov-2 Antibody Levels And Potencies Among Sars-Cov-2 Infected Kenyans With Diverse Grades Of Covid-19 Severity: An Observational Study, John Kimotho, Yiakon Sein, Shahin Sayed, Reena Shah, Mansoor Saleh, Ann Karanu, Viviane Oluoch, Jasmit Shah, Julius Mutiso, Zaitun Nneka, Alfred Mburu, Peter Betti, Francis M. Ndungu

Pathology, East Africa

Background: Given the low levels of coronavirus disease 2019 (COVID-19) vaccine coverage in sub-Saharan Africa (sSA), despite high levels of natural severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposures, strategies for extending the breadth and longevity of naturally acquired immunity are warranted. Designing such strategies will require a good understanding of naturally acquired immunity.

Methods: We measured whole-spike immunoglobulin G (IgG) and spike-receptor binding domain (RBD) total immunoglobulins (Igs) on 585 plasma samples collected longitudinally over five successive time points within six months of COVID-19 diagnosis in 309 COVID-19 patients. We measured antibody-neutralising potency against the wild-type (Wuhan) SARS-CoV-2 …

The Internist's Post V.1 N.10, The University Of Texas Rio Grande Valley. School Of Medicine, Eunbee Cho, Osiris Fernandez, Hector D. Preciado, Sobia Memon, Diana Acosta Pozo, Corey Haines, Roque Mifuji Lira, Martha Solis, Cesar Gutierrez

School of Medicine Publications

No abstract provided.

Inattentional Deafness And Musical Training: Effects Of Perceptual Load On Tonal And Verbal Auditory Suppression, Annelise Coffey

All-Inclusive List of Electronic Theses and Dissertations

Inattentional deafness (ID) is a cognitive phenomenon of which we have relatively little understanding. The current study attempted to address this by considering current cognitive theories of thought and examined how musical training affects incidence rates of inattentional deafness. This study utilized a cognitive task and auditory stimuli previously designed to elicit inattentional deafness and measured musical training by administering the Goldsmith’s Musical Sophistication Index. Participants were instructed to engage in a high-load cognitive task, providing a condition in which inattentional deafness is likely to occur. During the task, a brief pure tone was presented simultaneously with the visual task …

Ecological And Pathological Applications Of The Heat Shock Response, Taylor Rae Stanley

Theses and Dissertations

The heat shock response (HSR) is a cytoprotective stress response pathway that regulates cellular proteostasis. The HSR is an evolutionarily conserved pathway that is essential for normal cellular functioning. Here, we explore the broad ecological and pathological impacts of the HSR. In an ecological context, we perform gene level analysis of the transcriptomes of two closely related sunfish. We found that the more invasive bluegill sunfish has gene expansions in two HSR gene families, the HSP70 family and the HSP90 family compared to the redear sunfish. These gene expansions were also observed in several other teleost fish species and were …

Labrad : Vol 49, Issue 2 - December 2024, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• EDITORIAL
• ARTICLES
• Anti-Glomerular Basement Membrane (GBM) Disease: Pathogenesis, Presentation, and Diagnostic Insights
• Advanced Total Laboratory Automation (TLA) Workflow: A Comprehensive Approach towards High-Throughput Analyzers in Clinical Chemistry
• Precision Under Pressure: Challenges in Therapeutic Drug Monitoring for Immunosuppressants
• Frozen Section: Diagnostic Accuracy, Pitfalls and Use of Digital Pathology
• Working Environment Perspective of a Learner
• AI Training: A Must-Have Skill for Tomorrow’s Radiologists
• Challenges in Blood Supply: Importance of Voluntary Donations
• Leadership Skills and Emotional Intelligence For Professional Capacity Building in Histopathology – A Broad Perspective
• Factor VIII and XI Deficiency; A Finding That Could Have Been Missed-A Case Report
• Accelerated Phase …

Exploring Diet Quality, Food Insecurity, And Health Status Among Utah Residents, Palak Gupta, Lendel Narine

Journal of Human Sciences and Extension

A lower-quality diet is a significant contributor to preventable mortality worldwide. This study investigated the intricate relationships between diet quality, food insecurity, and health status among residents in Utah. Using a cross-sectional survey design with a sample size of 1,522 participants, data were collected through an online survey focusing on household characteristics, diet quality, health status, and food security. The primary exposure, household food insecurity, was assessed using a validated 6-item scale, while diet quality was measured through a modified Rapid Eating Assessment for Participants– Shortened Version (REAP-S). The findings revealed an association between very low food security and poor …

Personal Protective Equipment For Minoritized U.S. Agricultural Farmworkers: Community-Based Efforts During The Pandemic & Implications For Extension, Helen Trejo

Journal of Human Sciences and Extension

There are an estimated 2 million farmworkers who are essential to the food system in the United States; however, they are exposed to hazardous environmental conditions with limited access and/or use of Personal Protective Equipment (PPE). The primary purpose of this research is to evaluate community-based organizational efforts to provide farmworkers with apparel-textile basic needs, such as face masks. A primary goal is to address the research gap regarding common environmental factors that impact farmworkers, including pesticides and the pandemic, their use of available PPE, and community-based efforts to improve access to face masks as basic PPE. We consider the …

Blinding Of Transcranial Direct Current Stimulation Is Compromised In Typically Developing Children Compared To Young Adults, Sophia Bertrand, Tonya Rich, Samuel Nemanich

Occupational Therapy Faculty Research and Publications

Achieving successful blinding is a persistent challenge for clinical trials involving transcranial direct current stimulation. Studies involving populations with increased sensory sensitivity, such as children, could be at risk for increased bias from inadequate blinding due to unique sensation of stimulation relative to adults. The objectives of this study were 1) To examine differences in transcranial stimulation blinding between children and young adults and its relationship to sensory sensitivity. 2) To test the efficacy of an ActiSham protocol for participant blinding, compared to a traditional sham protocol. Typically developing right-handed children (N = 12, 5–14 yr) and young adults (N …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer's Disease Detection And Monitoring, Melissa Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah Pape, Juan Fortea, Nicholas Ashton, Chinedu Momoh, Sid O'Bryant

Brain and Mind Institute

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer's Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Engaging Fathers(To-Be): A Pilot Study On The Adaptation And Programme Experience Of Sms4baba Intervention In Kenya’S Informal Settlements, Vibian Angweny, Richard Fletcher, Paul Mwangi, Margaret Kabue, Rachel Odhiambo, Stephen Mulupi, Emmanuel Obulemire, Eunice Njoroge, Eunice Ombech, Mercy Mokaya, Moses Wesala, Joyce Marangu, Amina Abubakar

Institute for Human Development, East Africa

Background Engaging fathers(to-be) can improve maternal, newborn, and child health outcomes. However, father-focused interventions in low-resource settings are under-researched. As part of an integrated early childhood development pilot cluster randomised trial in Nairobi’s informal settlements, this study aimed to test the feasibility of a text-only intervention for fathers (SMS4baba) adapted from one developed in Australia (SMS4dads).

Methods A multi-phased mixed-methods study, which included an exploratory qualitative phase and pre-post evaluation of the adapted SMS4baba text-only intervention was conducted between 2019 and 2022. Three focusgroup discussions (FGDs) with 19 fathers were conducted at inception to inform SMS4baba content development; two post-pilot …

Dynamics Of The Blood Plasma Proteome During Hyperacute Hiv-1 Infection, Jamirah Nazziwa, Eva Freyhult, Mun-Gwan Hong, Emil Johansson, Filip Årman, Jonathan Hare, Kamini Gounder, Melinda Rezeli, Tirthankar Mohanty, Amin Hassan

Institute for Human Development, East Africa

The complex dynamics of protein expression in plasma during hyperacute HIV-1 infection and its relation to acute retroviral syndrome, viral control, and disease progression are largely unknown. Here, we quantify 1293 blood plasma proteins from 157 longitudinally linked plasma samples collected before, during, and after hyperacute HIV-1 infection of 54 participants from four sub-Saharan African countries. Six distinct longitudinal expression profiles are identified, of which four demonstrate a consistent decrease in protein levels following HIV-1 infection. Proteins involved in inflammatory responses, immune regulation, and cell motility are significantly altered during the transition from pre-infection to one month post-infection. Specifically, decreased …

Plasma Transfusion In The Intensive Care Unit, Maite M. T. Van Haeren, Senta Jorinde Raasveld, Sanne De Bruin, Merijn C. Reuland, Claudia Van Den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% …

Management Of Adult Sepsis In Resource-Limited Settings: Global Expert Consensus Statements Using A Delphi Method, Louise Thwaites, Prashant Nasa, Brett Abbenbroek, Vu Quoc Dat, Simon Finfer, Arthur Kwizera, Lowell Ling, Suzana M. Lobo, Robert Sinto, Wangari Siika

Anaesthesiology, East Africa

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.

Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include …