Rural, tropical coastal communities are experiencing sustained, often increasing food insecurity, poverty, and global change impacts. These challenges have stimulated a rise in projects aiming to... Show moreRural, tropical coastal communities are experiencing sustained, often increasing food insecurity, poverty, and global change impacts. These challenges have stimulated a rise in projects aiming to enhance and diversify local livelihoods. The ability of these projects to achieve broad-scale benefits is limited by approaches that do not account for feedbacks among sectors and across marine and terrestrial environments. To address these limitations, we present an applied research agenda to support an integrated approach to livelihood project planning and management. This agenda explicitly examines interactions among natural resources, industries, and livelihoods and is based on three foundational activities: (1) a governance review and assessment, (2) strategic partnership formation, and (3) a diagnostic approach supported by science and shared outcomes. We add structure to the established logic in our field by broadening the sectoral and spatial scope of livelihoods projects, so they can better contribute to interrelated UN Sustainable Development Goals. Show less
Moloney, K.; Janda, M.; Frumovitz, M.; Leitao, M.; Abu-Rustum, N.R.; Rossi, E.; ... ; Obermair, A. 2021
IntroductionSentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and... Show moreIntroductionSentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance.MethodsA Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability.ResultsSeventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach alpha=0.88).ConclusionSpecific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care. Show less
Gralnek, I.M.; Stanley, A.J.; Morris, A.J.; Camus, M.; Lau, J.; Lanas, A.; ... ; Hooft, J.E. van 2021
