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Food safety evaluation, which aims to reflect food safety status, is an important part of food safety management. Traditional food evaluation methods often consider limited data, and the evaluation process is subjective, time-consuming, and difficult to popularize. We developed a new food safety evaluation system that incorporates simple qualification degrees, food consumption, project hazard degrees, sales channels, food production regions, and other information obtained from food safety sampling and inspection to reflect the food safety situation accurately, objectively, and comprehensively. This evaluation model combined the statistical method and the machine learning method. The optimal distance method was used to calculate the basic qualification degree, and then expert elicitation via a questionnaire and the factor analysis of mixed data method (FADM) was applied to modify the basic qualification degree so as to obtain the food safety index, which indicates food safety status. Then, the effectiveness of this new method was verified by calculating and analyzing of the food safety index in region X. The results show that this model can clearly distinguish food safety levels in different cities and food categories and identify food safety trends in different years. Thus, this food safety evaluation system based on the FADM quantifies the real food safety level, screens out cities and food categories with high food safety risks, and, finally, helps to optimize the allocation of regulatory resources and provide technical and theoretical support for government decision-making.

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BACKGROUND: Eating disorders (EDs) constitute a considerable burden for individuals and society, but adequate and timely professional treatment is rare. Evidence-based Digital Mental Health Interventions (DMHIs) have the potential both to reduce this treatment gap and to increase treatment effectiveness. However, their integration into routine care is lacking. Understanding practitioners' attitudes towards DMHIs for EDs is crucial for their effective use. AIMS: To investigate the consensus among German ED treatment experts on the relevance of different influencing factors for DMHI use in EDs. METHODS: This Delphi study consisted of two rounds and was conducted online with an initial sample of N = 24 ED experts (Mage=41.96, SDage=9.92, n = 22 female). Prior to the Delphi rounds, semi-structured qualitative telephone interviews were performed to explore participants' attitudes, experiences, and expectations towards DMHIs. In order to construct the Delphi survey, content analysis was applied to a subset of ten interviews. A total of 63 influencing factors were identified and grouped into three main categories: contextual conditions, design, and content of DMHIs. In both Delphi rounds, the interview participants were subsequently invited to rate each of the factors with regard to their importance on 10-point scales. Group percentages and individual ratings of the first round (n = 23) were presented in the second round (n = 21). Consensus was calculated for each item (defined as IQR ≤ 2). RESULTS: Importance ratings were high across items (M = 7.88, SD = 2.07, Mdn = 8). In the first round, 48% of the items reached consensus, with its most important (Mdn = 10) factors referring to data security, evidence base, technical requirements, usability, and specific DMHI content (psychoeducation, crisis intervention). In the second Delphi round, a consensus was reached on 73% of the items. No consensus was reached on 17 items. CONCLUSIONS: The findings on practitioners' attitudes and priorities have relevant implications for subsequent DMHI development, dissemination, and implementation strategies, indicating that the highest-rated factors should be highlighted in the process.

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This scoping review was conducted under the Joanna Briggs Institute (JBI) framework. It included primary studies published until 30 April 2023, obtained through a systematic search across PubMed, Web of Science, CINAHL, and MEDLINE databases. The review focused on primary studies that used the Delphi technique in nursing competence research, especially those related to defining core competency frameworks and developing instruments to assess professional competence. The goal was to analyze the different methodological approaches used by authors, synthesize them, and propose recommendations to enhance methodological rigor, reliability, and validity in the application of the Delphi technique. For this purpose, the following review question was established: "What is the available evidence on the use of the Delphi technique in the study of professional competence in nursing?". The extracted textual elements underwent a content analysis, resulting in dimensions established through an inductive approach. Twenty studies were included, yielding insights into diverse methodological options for conducting Delphi studies, organised around a set of dimensions: (1) preparatory procedures; (2) procedures for accessing and selecting experts; (3) acquisition of expert input; (4) data analysis and consensus; and (5) ethical and legal procedures and guarantees. The study's limitations include the inability to include certain studies due to a lack of response to requests for clarification from corresponding authors. Additionally, the primary studies' methodological quality was not assessed, which is another relevant aspect. The study's results offer valuable insights for researchers intending to utilise the Delphi technique within the context of the research referenced in the included studies. This information encompasses important methodological choices, highlighting their potential benefits and associated risks. The review was prospectively registered on the Open Science Framework (Registration No: osf.io/kp2vw).

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BACKGROUND: The advancement of endoscopic techniques has resulted in an increasing need for comprehensive competency in endoscopy nursing. However, there is currently no unified competency evaluation index system for nurse endoscopists in China. AIMS: To develop and validate of a competency evaluation index system for nurse endoscopists with different stages performing endoscopy nursing in China. DESIGN: A modified Delphi study. SETTINGS: Data were collected in a medical university affiliated hospital. PARTICIPANTS: A total of 569 participants in different fields were included at various phases of this research. METHODS: The preliminary indicators were designed after conducting a literature review, semi-structured interviews and questionnaires. Two rounds of correspondence with 30 experts using the Delphi method were conducted to evaluate the content of the index followed by reliability and validity tests. The competency evaluation index system for nurse endoscopists at different stages was developed through expert meetings based on the Delphi consultation results according to the novice-to-expert model. RESULTS: After two rounds of Delphi method consultation, we have established 4 first-level indicators ('Cognitive skill', 'Practice professional skills', 'Professional development skills' and 'Personal characteristics and inner qualities') and 21 s-level indicators, which are the detailed description of first-level indicators. According to the index weight analysis, the four first-level indicators are ranked from the largest to the smallest as practical professional skills, cognitive skills, professional development skills, personal characteristics and intrinsic qualities. Three different stages of nurse endoscopists competency evaluation forms and criteria were developed: primary stage (New skilled), intermediate stage (Capable) and advanced stage (Expert). CONCLUSIONS: The establishment of a competency evaluation index system based on the novice-to-expert model can accurately assess competency levels and help to effectively train the nurse endoscopists at different stages. Future research should focus on imbedding these competencies in nurse education.

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High altitude polycythemia(HAPC) is one of the most common chronic high-altitude diseases and a prominent public health issue in the Qinghai-Xizang Plateau region of China. Tibetan medicine has provided a safe and effective treatment approach for HAPC, but there is currently no expert consensus on Tibetan medicine diagnosis and treatment for the disease. This consensus followed the principles of evidence-based medicine and learned the procedure and methods of Technical specifications on developing expert consensus for clinical practice guideline in traditional Chinese medicine recommended by China Association of Chinese Medicine. Five clinical issues were identified through literature search, expert interviews, clinical research, and conference consensus. The PICO principle was used for evidence retrieval, screening, and synthesis, and the opinions of experts on high-altitude diseases and cardiovascular and cerebrovascular diseases from major Tibetan medical institutions in China, as well as some traditional Chinese medicine(TCM), western medicine, and evidence-based experts, were widely solicited. Recommendations and consensus suggestions were formed through one expert consensus meeting and two rounds of Delphi expert questionnaire surveys. The consensus included disease diagnosis, etiology and pathogenesis, syndrome classification, clinical treatment, outcome evaluation, prevention and care, and other contents. Therapies for HAPC included Tibetan medicine treatments based on syndrome differentiation, single formula or patent medicine, and external treatment. Each treatment had corresponding levels of evidence and recommendations. This consensus was guided by solving clinical problems, combining disease diagnosis and syndrome differentiation and highlighting the characteristics and advantages of Tibetan medicine, with a view to promoting the standardization of Tibetan medicine diagnosis, treatment, and research on HAPC and improving the level of prevention and treatment.

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PURPOSE: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the 'Definition of Surgical Success/Failure after OSA Surgery'. Regarding the 'Predictive Factors of Surgical Failure in OSA Surgery', consensus was reached on 10 out of 13 statements. In the context of the 'Diagnostic Workup in OSA Surgery', consensus was achieved on 9 out of 13 statements. Lastly, in 'Treatment in Surgical Failure Cases', consensus was reached on 12 out of 24 statements. CONCLUSION: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

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INTRODUCTION: The rise in opioid use for managing chronic and oncologic pain has led to a significant increase in opioid-induced constipation (OIC) that impacts patient quality of life and pain management. AREAS COVERED: In this study, emerging therapies for OIC were criticized for refining advancements and novel treatment options. Key topics included the efficacy of peripherally acting mu-opioid receptor antagonists (PAMORAs) such as methylnaltrexone, naloxegol, and naldemedine, which specifically target opioid-induced gut dysfunction. Other treatment options, including intestinal secretagogues like lubiprostone and linaclotide, selective 5-HT receptor agonists such as prucalopride, and emerging adjunctive therapies like transcutaneous electrical nerve stimulation (TENS) and electroacupuncture were mentioned. Current guidelines from the American Gastroenterological Association (AGA) and the European consensus were criticized. EXPERT OPINION: Experts stress the importance of a stepwise approach to managing OIC, considering patient-specific factors and the efficacy of various treatments. While PAMORAs have demonstrated effectiveness in improving bowel function, their high cost and lack of extensive head-to-head comparisons with traditional laxatives are significant concerns. Emerging therapies and adjunctive treatments offer promising results but require further validation through rigorous studies. Future research should focus on long-term outcomes, cost-effectiveness, and comparative effectiveness to better address the complex needs of patients with OIC and refine treatment protocols.

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Background: Tibial diaphysis represents the primary location for tibial fractures, accounting for 80% of such cases, often accompanied by fibular fractures. In terms of surgical management, the recommended technique for addressing both displaced and undisplaced tibial shaft fractures in adults is intramedullary nail fixation. Additionally, there is a growing consideration for suprapatellar nailing, which involves performing the procedure with the knee in a semi-extended position, as a potentially safe and efficacious alternative. Objectives: To evaluate the clinical and functional union amongst tibial shaft fracture cases, managed by nailing in the suprapatellar approach, and to study the complications associated with it. Materials and Methods: Our study with prospective observational design was conducted for 18 months on 30 patients with tibial shaft fractures. Following comprehensive laboratory assessments and confirmation of surgical fitness, the patients underwent surgical intervention through a specialised suprapatellar approach employing expert tibial nailing. Results: The mean age of the subjects was 42.83 ± 11.47 years, and the majority were males (70.0%). Notably, there was a statistically significant reduction in Visual Analogue Scale scores and a concurrent increase in Lysholm Knee Scoring Scale scores during the follow-up period, indicating substantial enhancements in both clinical and functional outcomes. Delayed union was the complication observed in three individuals. We found that the younger the age of the subjects, the earlier the surgery after an injury, the better the functional outcome. Conclusion: Expert tibial nailing with a suprapatellar approach was successful in yielding clinical and functional union amongst the subjects with tibial shaft fractures. In addition, delayed union was the complication observed in the approach, which was evident in a few cases.

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Anticipating future biosecurity threats to prevent their occurrence is the most cost-effective strategy to manage invasive alien species. Yet, biological invasions are complex, highly uncertain processes. High uncertainty drives decision-making away from strategic preventative measures and towards operational outcomes aimed at post-invasion management. The limited success of preventative measures in curbing biological invasions reflects this short-term mindset and decision-makers should instead apply strategic foresight to imagine futures where biosecurity threats are minimised. Here, four major futures thinking tools (environmental scanning, driver-mapping, horizon scanning, and scenario planning) that describe probable, possible, plausible and preferable futures are assessed in terms of their potential to support both research and policy addressing biological invasions. Environmental scanning involves surveying existing data sources to detect signals of emerging alien species through knowledge of changes in either the likelihood or consequences of biological invasions. Several approaches are widely used for biosecurity including automated scans of digital media, consensus-based expert scoring, and prediction markets. Automated systems can be poor at detecting weak signals because of the large volume of 'noise' they generate while expert scoring relies on prior knowledge and so fails to identify unknown unknowns which is also true of prediction markets that work well for quite specific known risks. Driver-mapping uses expert consensus to identify the political, economic, societal, technological, legislative, and environmental forces shaping the future and is a critical component of strategic foresight that has rarely been applied to biological invasions. Considerable potential exists to extend this approach to develop system maps to identify where biosecurity interventions may be most effective and to explore driver complexes to determine megatrends shaping the future of biological invasions. Horizon scanning is a systematic outlook of potential threats and future developments to detect weak signals of emerging issues that exist at the margins of current thinking. Applications have been strongly focused on emerging issues related to research and technological challenges relevant to biosecurity and invasion science. However, most of these emerging issues are already well known in current-day research. Because horizon scanning is based on expert consensus, it needs to embrace a diversity of cultural, gender, and disciplinary diversity more adequately to ensure participants think intuitively and outside of their own subject boundaries. Scenario planning constructs storylines that describe alternative ways the political, economic, social, technological, legislative, and environmental situation might develop in the future. Biological invasion scenario planning has favoured structured approaches such as standardised archetypes and uncertainty matrices, but scope exists to apply more intuitive thinking by using incasting, backcasting, or causal layered analysis. Futures thinking in biological invasions has not engaged with decision-makers or other stakeholders adequately and thus outcomes have been light on policy and management priorities. To date, strategic foresight addressing biological invasions has applied each approach in isolation. Yet, an integrated approach to futures thinking that involves a diverse set of stakeholders in exploring the probable, possible, plausible, and preferable futures relating to biological invasions is crucial to the delivery of strategic biosecurity foresight at both national and global scales.

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A critical review of the current state-of-the-science for the physiologically based pharmacokinetic (PBPK) modeling of metal nanoparticles and their application to human health risk assessment for inhalation exposures was conducted. A systematic literature search was used to identify four model groups (defined as a primary publication along with multiple supplementary publications) subject to review. Using a recent guideline document from the Organization for Economic Cooperation and Development (OECD) for PBPK model evaluation, these model groups were critically peer-reviewed by an independent panel of experts to identify those to be considered for modeling and simulation application. Based upon the expert panel input, model confidence scores for the four model groups ranged from 30 to 41 (out of a maximum score of 50). The three highest-scoring model groups were then applied to compare predictions to a different metal nanoparticle (i.e. not specifically used to parameterize the original models) using a recently published data set for tissue burdens in rats, as well as predicting human tissue burdens expected for corresponding occupational exposures. Overall, the rat models performed reasonably well in predicting the lung but tended to overestimate systemic tissue burdens. Data needs for improving the state-of-the-science, including quantitative particle characterization in tissues, nanoparticle-corona data, long-term exposure data, interspecies extrapolation methods, and human biomonitoring/toxicokinetic data are discussed.

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The promotion of oral health in nursing care is essential for preventing oral diseases and maintaining health in elderly vulnerable populations. There is a need for standardized guidelines and education. The aim of this study was to collect data on the attitudes and hopes of caregivers regarding the implementation of the German Expert Nursing Standard "Promotion of Oral Health in Nursing" (GENS-POHN) and to evaluate their oral healthcare knowledge before implementation. A cross-sectional study was conducted in five different care settings in Germany. A self-administered questionnaire was used to collect data on the attitudes and hopes of nursing assistants regarding the GENS-POHN. Oral healthcare knowledge was evaluated before implementation. Most participants had a positive attitude towards the GENS-POHN and hoped that its implementation would lead to greater safety and competence in daily oral healthcare tasks. Few participants currently use screening or assessment instruments for oral care. There is a need for further education and training, as well as the development and implementation of standardized guidelines and tools for screening and assessment, in oral care. The GENS-POHN as an expert standard could be made accessible to an international audience by translating it into other respective national languages, thereby enhancing its usability for a wider range of users.

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BACKGROUND: In recent years, as the availability of precision therapies expands, there is increasing reliance on genomic profiling assays to help identify the most appropriate treatment options for patients with advanced cancers. We retrospectively investigated the results of comprehensive genomic profiling tests from the time insurance coverage began until recently and examined the status of genetic analysis. METHODS: We retrospectively reviewed the analysis results of 300 patients with advanced solid tumors who consented to comprehensive genomic profiling tests from October 2019 to December 2022. RESULTS: Of the 300 patients who underwent comprehensive genomic profiling tests, analysis results for 274 patients were obtained, and were reviewed by the Clinical Genome Expert Panel. Six specimens (2%) were discontinued due to patient deaths and deteriorations in general condition. The three most frequently occurring actionable genomic alterations observed were TP53 (47.4%), KRAS (28.1%) and CDKN2A (20.4%). The most common druggable variant was CDKN2A, which was noted in 52 (19%) of 274 patients. The next most common were PIK3CA, BRAF, KRAS and PTEN. The cancer types that showed a greater median number of actionable alterations comprised thyroid cancer, pancreatic cancer and colorectal cancer. CONCLUSIONS: In conclusion, comprehensive genomic profiling tests have the potential to be valuable in identifying genomic abnormalities. Even if there is no effective treatment at present, it may lead to a treatment in the future. Comprehensive genomic profiling tests should be considered for any cancer.

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Expert judgment underpins assessment of threatened ecosystems. However, experts are often narrowly defined, and variability in their judgments may be substantial. Models built from structured elicitation with large diverse expert panels can contribute to more consistent and transparent decision-making. We conducted a structured elicitation under a broad definition of expertise to examine variation in judgments of ecosystem viability and collapse in a critically endangered ecosystem. We explored whether variation in judgments among 83 experts was related to affiliation and management expertise and assessed performance of an average model based on common ecosystem indicators. There were systematic differences among individuals, much of which were not explained by affiliation or expertise. However, of the individuals affiliated with government, those in conservation and environmental departments were more likely to determine a patch was viable than those in agriculture and rural land management. Classification errors from an average model, in which all individuals were weighted equally, were highest among government agriculture experts (27%) and lowest among government conservation experts (12%). Differences were mostly cases in which the average model predicted a patch was viable but the individual thought it was not. These differences arose primarily for areas that were grazed or cleared of mature trees. These areas are often the target of restoration, but they are also valuable for agriculture. These results highlight the potential for conflicting advice and disagreement about policies and actions for conserving and restoring threatened ecosystems. Although adoption of an average model can improve consistency of ecosystem assessment, it can fail to capture and convey diverse opinions held by experts. Structured elicitation and models of ecosystem viability play an important role in providing data-driven evidence of where differences arise among experts to support engagement and discussion among stakeholders and decision makers and to improve the management of threatened ecosystems.

Análisis de los modelos de opiniones de expertos para informar la evaluación de la viabilidad y el colapso ambiental Resumen La evaluación de los ecosistemas amenazados se basa en la opinión de los expertos. Sin embargo, la definición de experto suele ser limitada y la variabilidad de sus juicios puede ser considerable. Los modelos elaborados a partir de consultas estructuradas con grupos de expertos amplios y diversos pueden contribuir a una toma de decisiones más coherente y transparente. Realizamos una consulta estructurada con una definición amplia de experto para analizar la variación en los juicios sobre la viabilidad y el colapso de un ecosistema en peligro crítico. Exploramos si la variación en los juicios entre 83 expertos estaba relacionada con la afiliación y la experiencia en gestión y evaluamos el rendimiento de un modelo medio basado en indicadores comunes del ecosistema. Observamos diferencias sistemáticas entre los expertos, gran parte de las cuales no se explicaban por la afiliación o la experiencia. Sin embargo, entre los expertos vinculados a la administración pública, los de los departamentos de conservación y medio ambiente tenían más probabilidades de determinar que una parcela era viable que los de agricultura y gestión de tierras rurales. Los errores de clasificación de un modelo medio con todos los individuos ponderados por igual, fueron mayores entre los expertos gubernamentales en agricultura (27%) y menores entre los expertos gubernamentales en conservación (12%). En la mayoría de los casos, las diferencias se debían a que el modelo medio predecía que una parcela era viable, pero el individuo pensaba que no lo era. Estas diferencias surgieron sobre todo en zonas que habían sido pastoreadas o con una tala total de árboles maduros. Estas zonas suelen ser objeto de restauración, pero también son valiosas para la agricultura. Estos resultados ponen de manifiesto la posibilidad de que se produzcan consejos contradictorios y desacuerdos sobre las políticas y acciones de conservación y restauración de los ecosistemas pastoreados y forestales. Si bien la adopción de un modelo medio puede mejorar la coherencia de la evaluación de los ecosistemas, también puede fallar a la hora de captar y transmitir las diversas opiniones de los expertos. Las consultas estructuradas y los modelos de viabilidad de los ecosistemas desempeñan un papel importante a la hora de aportar pruebas basadas en datos de dónde surgen las diferencias entre los expertos para apoyar el compromiso y el debate entre las partes interesadas y los responsables de la toma de decisiones, así como para mejorar la gestión de los ecosistemas amenazados.

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BACKGROUND AND PURPOSE: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. METHODS: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. RESULTS: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. DISCUSSION AND CONCLUSION: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.

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BACKGROUND: The current evidence regarding interventions to improve oral health in older hospital patients is unclear. OBJECTIVE: This scoping review assesses the scope and nature of research activities and identifies gaps in the existing literature. METHODS: The inclusion criteria for this study included adults over the age of 65 years who were treated as inpatient outside of intensive care units and covered all interventions aimed at promoting oral health or hygiene. RESULTS: The systematic search yielded 12 final studies, focusing on oral healthcare interventions in various settings, primarily in high-income countries. The studies employed diverse designs including randomized controlled trials and prospective studies, with interventions mainly provided by multidisciplinary teams. The interventions aimed to improve oral health or prevent pneumonia. Overall, the studies highlighted a potential effectiveness of multidisciplinary approaches in improving oral health and preventing pneumonia in geriatric populations. CONCLUSION: This scoping review shows a limited and heterogeneous evidence base for oral health interventions for older patients in hospitals. The need for patient involvement is evident; however, there is often a lack of high-quality studies to draw robust conclusions.

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Automated computer-aided diagnosis (CAD) is becoming more significant in the field of medicine due to advancements in computer hardware performance and the progress of artificial intelligence. The knowledge graph is a structure for visually representing knowledge facts. In the last decade, a large body of work based on knowledge graphs has effectively improved the organization and interpretability of large-scale complex knowledge. Introducing knowledge graph inference into CAD is a research direction with significant potential. In this review, we briefly review the basic principles and application methods of knowledge graphs firstly. Then, we systematically organize and analyze the research and application of knowledge graphs in medical imaging-assisted diagnosis. We also summarize the shortcomings of the current research, such as medical data barriers and deficiencies, low utilization of multimodal information, and weak interpretability. Finally, we propose future research directions with possibilities and potentials to address the shortcomings of current approaches.

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Effective teacher discourse is critical in improving English as a foreign language (EFL) education, particularly in junior high schools in China, where students are at a crucial stage in their language development. As junior high school students are at a pivotal developmental stage, this research investigates the discourse patterns employed by novice and expert teachers to assess their impact on students' engagement and language acquisition. Despite the extensive research on teacher discourse in higher education, a significant gap remains regarding its application in compulsory primary education settings. This study aims to fill this gap by examining the current classroom discourse patterns of EFL teachers in junior high schools to identify the distinctions between novice and expert teachers and explore the factors contributing to these differences. This mixed-methods study includes qualitative and quantitative analyses. Verbatim transcriptions of six classes were used to create a corpus exceeding 20,000 words. The data were analysed using cross-tabulation in Excel and Chi-square tests in SPSS 22.0, complemented by semi-structured interviews with selected teachers. The theoretical framework is grounded in Long's（1996）interaction hypothesis, which underlines the significance of communication in facilitating language proficiency through meaningful interaction, and the analysis follows Sinclair and Coulthard's（1975）discourse patterns. The initiation-response-feedback (IRF) and initiation-response-0 (IR0) emerged as predominant patterns among both novice and expert teachers. Novice teachers predominantly relied on the basic IRF pattern, while expert teachers exhibited greater flexibility and more frequent use of variant patterns, such as IRFR, I[RnFn] and [InRn]F. Such adaptability among expert teachers creates a more interactive and engaging learning environment, thereby enhancing student participation and language acquisition. The study also identifies a novel variant structure, IRnF, used more frequently by expert teachers, underlining the benefits of group work in fostering teamwork and independent thinking. Expert teachers demonstrated a greater propensity to adapt their discourse strategies to foster a more production-oriented learning environment, which was the main factor driving the teachers' differing discourse patterns. This study significantly contributes to the analysis of teacher discourse in the junior high school EFL context, providing empirical evidence and practical insights that bridge the gap between theory and practice. By elucidating the distinct discourse practices of novice and expert teachers, this study offers valuable recommendations for teacher professional development and highlights the importance of employing varied and interactive discourse structures to improve EFL teaching effectiveness. The study also provides valuable insights for educators striving to improve their instructional practices and the language acquisition in EFL classrooms.

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The medico-legal evaluation of occupational skin diseases is one of the core competencies of dermatology. As a neutral medical expert, the dermatologist has a different role to that of a treating physician. In Germany, the so-called Bamberg Recommendation (Bamberger Empfehlung) provides a scientifically based assessment basis to ensure equal treatment of all persons undergoing medico-legal evaluation. In addition to dermatological expertise, knowledge of insurance law and legal terminology is essential for the medical expert. Dermatologists provide legal and administrative decisions of social courts and social insurance institutions with their qualified expert opinions. In this way, dermatology makes an important contribution to social security.

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Illegal collecting of wild Venus flytraps (Dionaea muscipula) for the horticultural trade represents a persistent threat to populations of the species across their endemic range in the coastal plain of North and South Carolina (United States). Although wild collecting of Venus flytraps is not a novel threat, there has been very little research on the impacts of collecting on the species' conservation to date or why an illegal trade persists alongside a legal one. We drew on qualitative expert stakeholder elicitation to contextualize the threat of illegal collecting to the long-term conservation of Venus flytraps in relation to other anthropogenic threats. Expert elicitation included botanical and conservation researchers, cognizant state and federal agency staff, land managers, and conservation nonprofit actors. The workshop included mapping of supply chain structures and prioritization of social and environmental harms. Expert consensus determined illegal collecting is an ongoing problem for Venus flytrap conservation, but habitat destruction, degradation, and fire suppression are the most significant threats to flytrap conservation. Supply chain analysis showed that observable social and environmental harms of the trade are focused at the supply stage and that less is known about transit and demand stages. Key research gaps identified include a lack of understanding of plant laundering practices relevant to a range of desirable plant taxa; the role of commercial nurseries in illicit horticultural supply chains; motivations for engaging in Venus flytrap collecting; and the persistent demand for illegally harvested plants when cultivated, legally obtainable plants are readily available. Our findings and methodology are relevant to a range of ornamental plants affected by illegal trade for which robust social data on illegal collecting drivers are lacking.

Evaluación experta del impacto de la colecta ilegal de venus atrapamoscas y las prioridades de investigación sobre el mercado ilegal Resumen La colecta ilegal de venus atrapamoscas (Dionaea muscipula) silvestres para el mercado de horticultura representa una amenaza constante para las poblaciones de la especie a lo largo de su distribución endémica en la planicie costera de Carolina del Norte y del Sur, Estados Unidos. Aunque esta colecta no es una amenaza novedosa, a la fecha se ha investigado muy poco sobre su impacto en la conservación de la especie o por qué el mercado ilegal persiste a la par del legal. Partimos del conocimiento cualitativo de los actores expertos para contextualizar la amenaza de la colecta ilegal para la conservación a largo plazo de la venus atrapamoscas en relación con otras amenazas antropogénicas. Este conocimiento involucró a investigadores de la conservación y la botánica, personal consciente de agencias federales y estatales y actores de la conservación sin fines de lucro. El taller incluyó el mapeo de las estructuras de las cadenas de suministro y la priorización de los daños sociales y ambientales. El consenso de los expertos determinó que la colecta ilegal es un problema continuo para la conservación de la venus atrapamoscas, pero la destrucción y degradación del hábitat, así como la contención de incendios son las amenazas más significativas. El análisis de las cadenas de suministro mostró que los daños ambientales y sociales observables en el mercado se enfocan en la fase de suministro y que se sabe poco sobre las fases de tránsito y demanda. Los vacíos de investigación más importantes incluyen la falta de entendimiento de las prácticas de lavado de plantas relevantes para un rango de taxones deseables de plantas; el papel de los viveros comerciales en las cadenas de suministro de la horticultura ilícita; los motivos para participar en la colecta de venus atrapamoscas; y la demanda continua de plantas cosechadas ilegalmente cuando ya hay disponibilidad de plantas cultivadas que se obtienen legalmente. Nuestros descubrimientos y metodología son relevantes para una gama de plantas ornamentales afectadas por el mercado ilegal para las cuales hay carencia de datos sociales sólidos sobre los factores de colecta ilegal.

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