Validation of mouse welfare indicators: a Delphi consultation survey

Nest-building in breeding mice: Impact of macro- and micro-environment

The housing conditions of laboratory mice must be strictly controlled in order to reduce the impact of pathophysiological changes that affect animal health and welfare, possibly resulting in increased variability within experimental results. One way to improve the activity and survival of laboratory mice is to provide nesting material. The objective of this study was to determine if nest-building quality could be used to detect changes in murine mating behaviour in a rodent facility under controlled conditions. Nesting scores of 847 cages with monogamous pairs from three different genetic backgrounds (129, B6 and BALB/c) of both sexes were correlated with 18 predefined variables. The effects on nest quality were evaluated using descriptive data analysis, correspondence analysis and ordinal logistic model fitting. The results showed a strong relationship between nest quality and nest position. Humidity, genetic background, cage change and the number and age of pups in the cage affected the nest-building scores. The most important indicators were cage change and relative humidity, both of which exerted significant negative effects on nest-building quality. Even though the criteria were well defined, the observer could still influence nest score appraisal. However, in a long-term observational study, observers could improve their assessment by training and acquiring greater experience in score assignment. Nest-building scores are easy to assess in the cage, with little discomfort to the animal. Moreover, the nest score is a valid indicator of the health and well-being of laboratory mice and can provide valuable support in the management of animal facilities.

Construction of a standardized training system for hospital infection prevention and control for new medical staff in internal medicine ICUs based on the Delphi method

In China, studies have shown nosocomial infections contribute to increased mortality rates, prolonged hospital stays, and added financial burdens for patients. Previous studies have demonstrated that effective infection control training can enhance the quality of infection control practices, particularly in intensive care unit (ICU) settings. However, there is currently no universally accepted training mode or program that adequately addresses the specific needs of ICU medical staff regarding nosocomial infection control. The objective of this study was to develop a standardized training system for preventing and controlling hospital-acquired infections among new medical staff in the internal medicine ICU. Our methodology encompassed an extensive literature review, technical interviews focusing on key events, semi-structured in-depth interviews, and two rounds of Delphi expert correspondence. We employed intentional sampling to select 16 experts for the Delphi expert consultation. Indicators were chosen based on an average importance score of >3.5 and a coefficient of variation of <0.25. The weight of each indicator was determined using the analytic hierarchy process. The efficacy of the two rounds of questionnaires was also evaluated. Our findings revealed that the questionnaires achieved a 100% effective recovery rate, with expert authority coefficients of 0.96 and 0.90. The Kendall coordination coefficients for the first-, second-, and third-level indicators in the initial round of expert consultation questionnaires were 0.440, 0.204, and 0.386 (P < 0.001), respectively. In the second round of expert consultation questionnaires, the Kendall coordination coefficients for the first, second, and third-level indicators were 0.562, 0.467, and 0.556 (P < 0.001), respectively. The final training model consisted of four first-level indicators (hospital infection prevention and control training content, training methods/forms, assessment content, and evaluation indicators), 26 second-level indicators, and 44 third-level indicators. In conclusion, the proposed standardized training system for infection prevention and control among new medical staff in the internal medicine ICU is both scientifically sound and practical, which can contribute to improved patient safety, reduced healthcare costs, and enhanced overall quality of care in internal medicine ICUs. Moreover, it can serve as a framework for future training projects.

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study

OBJECTIVE

Nonhuman primates (NHPs) are suitable for being model animals in the study of consciousness and loss of consciousness (LoC) with a similar brain structure and function to humans. However, there is no effective consciousness assessment scale for them. This study aimed to develop a behavioral assessment scale of consciousness for NHPs.

METHODS

We constructed an initial indicator framework based on the clinical consciousness disorder assessment scales and the physiological characteristics, consciousness, and arousal behavior of NHPs. A two-round online Delphi method was conducted by a multidisciplinary expert panel to construct a behavioral assessment scale of consciousness for NHPs. The indicators and descriptions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. The accepted competencies of indicators were established with mean scores in two scoring criteria (importance and feasibility) ≥4.0, agreement rate with a rating of importance or essential ≥70.0%, and a coefficient of variation ≤0.25, as well as discussions of the research group.

RESULTS

Consensus was achieved after the second round of consultations, which was completed by 28 experts who specialized in rehabilitation, neuroscience, psychology, neurosurgery, and neurology. A new behavioral assessment scale of consciousness for NHPs, including 37 items organized hierarchically within seven dimensions including visual function, auditory function, motor function, orofacial movements, arousal, brainstem reflexes, and respiration, was developed in this study.

CONCLUSIONS

This study has successfully developed a behavioral assessment scale for measuring the conscious state of NHPs or NHP models with LoC. This tool is expected to facilitate future research into the underlying mechanisms of consciousness by providing a detailed and comprehensive means of measurement.

Review of Rat (Rattus norvegicus), Mouse (Mus musculus), Guinea pig (Cavia porcellus), and Rabbit (Oryctolagus cuniculus) Indicators for Welfare Assessment

The monitoring and assessment of animals is important for their health and welfare. The appropriate selection of multiple, validated, and feasible welfare assessment indicators is required to effectively identify compromises or improvements to animal welfare. Animal welfare indicators can be animal or resource based. Indicators can be collated to form assessment tools (e.g., grimace scales) or animal welfare assessment models (e.g., 5 Domains) and frameworks (e.g., 5 Freedoms). The literature contains a wide variety of indicators, with both types needed for effective animal welfare assessment; however, there is yet to be an ideal constellation of indicators for animal-based welfare assessment in small mammals such as guinea pigs (Cavia Porcellus), mice (Mus musculus), rabbits (Oryctolagus cuniculus), and rats (Rattus norvegicus). A systematic review of grey and peer-reviewed literature was performed to determine the types of animal-based welfare indicators available to identify and assess animal health and welfare in these small mammals maintained across a wide variety of conditions. The available indicators were categorised and scored against a selection of criteria, including potential ease of use and costs. This review and analysis aim to provide the basis for further research into animal welfare indicators for these species. Future applications of this work may include improvements to animal welfare assessments or schemes, guiding better management, and implementing future strategies to enable better animal welfare.

Construction of a competency framework of dental hygienists: A Delphi study

AIM

To explore the basic and core competencies of dental hygienists, construct a systematic and scientific competency framework for dental hygienists taking into account China's national conditions and provide a theoretical basis for the future training in China and other countries that have not yet established the competencies of dental hygienists.

BACKGROUND

The establishment of dental hygienists role is essential for the public to improve the dental health level. Currently, more than 50 countries around the world have established the role of dental hygienists and defined the core competencies needed by dental hygienists. However, studies on developing a standardized and unified consensus of competencies of dental hygienists are lacking in China.

METHODS

Based on the literature review and theoretical research, this study explored the theoretical basis and fundamental principle of constructing the competency framework for dental hygienists. Moreover, a correspondence questionnaire on dental hygienists' competency framework was initially constructed to clarify the specific content of each competency. Finally, the Delphi method was adopted to establish the indicators of the dental hygienists' competency framework according to the principle of expert selection and inclusion criteria.

RESULTS

The three rounds of Delphi consultation experts were from nursing, stomatology and management and other fields. Three rounds of Delphi results showed that the expert authority, enthusiasm and coordination coefficients were high. Thereafter, a competency framework of dental hygienists with 4 primary indicators, 15 secondary indicators and 50 tertiary indicators was constructed, which included theoretical knowledge, professional skills, professional abilities and occupational qualities.

CONCLUSION

Literature and theoretical research methods along with Delphi expert consultation were used to construct the competency framework of dental hygienists based on the onion model. The competency framework of dental hygienists was scientific, reasonable and practical, which is consistent with the current health situation in China and has distinct Chinese characteristics. Some of our findings, offer ideas for other developing countries that have not yet set up the role of dental hygienists or are in an initial stage.

Developing guidelines for pet rat housing through expert consultation

BACKGROUND

Pet care guidelines play an important role in ensuring that owners are well informed about good husbandry practices, allowing them to provide the best care for their animals. However, the development of such guidelines is difficult when there is little appropriate empirical evidence on which to base guidelines, as in the case of pet rats. The consultation of multiple experts can help to surmount this challenge.

METHODS

We developed a set of guidelines for pet rat housing by consulting with a group of experts, including veterinarians, veterinary nurses, animal welfare scientists and experienced pet rat owners. The consultation involved two rounds of online surveys (n = 13) and one online discussion (n = 8).

RESULTS

The resulting guidelines cover a broad range of features within pet rat housing, including injury prevention, details of suitable refuges and substrates, and suitable cage sizing. The guidelines may evolve as more information about pet rats comes to light but may nonetheless provide a useful starting point for any future guidelines.

CONCLUSIONS

At present, these guidelines may not only be useful for pet rat owners and those advising pet rat owners, such as veterinarians, but may also be useful in the design of housing, including for laboratory rodents.

Waking inactivity as a welfare indicator in laboratory mice: investigating postures, facial expressions and depression-like states

Animal welfare assessment relies on valid and practical indicators of affect. In mice, the most widely used research vertebrates, lying still with eyes open, inactive-but-awake (IBA) in the home cage, has potential to be one such indicator. IBA is elevated in barren, conventional housing compared with well-resourced, enriched housing, and predicts immobility in Forced Swim Tests, a common measure of 'helplessness' in depression research. In Experiment 1, using females from three strains (C57BL/6, Balb/c and DBA/2), we first replicated past findings, confirming higher levels of IBA in conventional cages and a positive relationship between IBA and helplessness. We then extended this research to three other signs of depression: changes in weight and sleep, and reduced hippocampal volume. Here, IBA positively covaried with body mass index, with sleep in DBA/2s and conventionally housed BALB/cs, and negatively covaried with hippocampal volume in conventionally housed C57BL/6s. In Experiment 2, we sought to refine the phenotype of IBA to improve its accuracy as a welfare indicator. Here, scoring IBA performed in hunched postures appeared to improve its accuracy as an indicator in Balb/c mice. Additional research is now needed to further refine the phenotype of IBA and to confirm whether it reflects states consistent with depression, or instead other underlying poor welfare conditions.

Waking inactivity as a welfare indicator in laboratory mice: investigating postures, facial expressions and depression-like states

Animal welfare assessment relies on valid and practical indicators of affect. In mice, the most widely used research vertebrates, lying still with eyes open, inactive-but-awake (IBA) in the home cage, has potential to be one such indicator. IBA is elevated in barren, conventional housing compared with well-resourced, enriched housing, and predicts immobility in Forced Swim Tests, a common measure of 'helplessness' in depression research. In Experiment 1, using females from three strains (C57BL/6, Balb/c and DBA/2), we first replicated past findings, confirming higher levels of IBA in conventional cages and a positive relationship between IBA and helplessness. We then extended this research to three other signs of depression: changes in weight and sleep, and reduced hippocampal volume. Here, IBA positively covaried with body mass index, with sleep in DBA/2s and conventionally housed BALB/cs, and negatively covaried with hippocampal volume in conventionally housed C57BL/6s. In Experiment 2, we sought to refine the phenotype of IBA to improve its accuracy as a welfare indicator. Here, scoring IBA performed in hunched postures appeared to improve its accuracy as an indicator in Balb/c mice. Additional research is now needed to further refine the phenotype of IBA and to confirm whether it reflects states consistent with depression, or instead other underlying poor welfare conditions.

Identification of potential welfare and survival indicators for stranded cetaceans through international, interdisciplinary expert opinion

Management of live cetacean strandings generally focuses on refloating animals, yet there is a lack of scientific data to inform decision-making. Valid indicators that are practical to measure are needed to assess welfare status and survival likelihood for stranded cetaceans. The Delphi method was applied to gather international and interdisciplinary expert opinion to provide face validity to potential indicators of stranded cetacean welfare and survival likelihood. Two online questionnaires were conducted. In the first questionnaire these experts identified potential indicators of stranded cetacean welfare and survival likelihood. These indicators were subsequently scored by the same experts in questionnaire two, based on their value for assessing welfare/survival likelihood and being practical to measure. Indicators considered valuable and practical for assessing welfare and survival likelihood at strandings included animal-based indices of body and skin condition, signs of physical trauma, respiration rate and various behaviours. Resource-/management-based indicators related mainly to human intervention and should be correlated with animal-based indices to provide relevant evaluations. Importantly, inextricable links between welfare and survival for stranded cetaceans are emphasized, with 90% of indicators being similar for both. Investigations into these indicators should be conducted to develop a practical, science-based assessment framework to inform decision-making during stranding events.

Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: A Delphi study

Introduction

As the frequency of infectious diseases rises, it’s more important than ever to pay attention to the competency level of front-line nurses as the primary force in front-line rescue, which has an impact on the quality of anti-epidemic response. This paper aims to construct the competency evaluation index system for front-line nurses during the outbreak of major infectious diseases.

Materials and methods

This study combined literature review, critical incident technique interviews, and semi-structured in-depth interviews, as well as two rounds of Delphi expert correspondence, to construct a competence evaluation index system for front-line nurses during the outbreak of major infectious diseases. The study used purposive sampling to select 26 experts from 11 provinces and cities across China to conduct two rounds of Delphi expert consultation, and the indicators were selected based on the mean importance score > 3.5 and the coefficient of variation < 0.25, and the weights of the indicators were calculated by the Analytic Hierarchy Process. The effective recovery rates of the two rounds of correspondence questionnaires were 93.1% and 96%.

Results

The effective recovery rates of the two rounds of correspondence questionnaires were 93.1% and 96%, the authority coefficients of experts were 0.96 and 0.98, the Kendall’s coordination coefficients of the first, second, and third level indexes were 0.281, 0.132, and 0.285 (P < 0.001), 0.259, 0.158, and 0.415 (P < 0.001). The final index system includes 4 primary indicators (Knowledge System of Infectious Diseases, Nursing Skills for Infectious Diseases, Related Professional Abilities for Infectious Diseases, and Comprehensive Quality), 10 secondary indicators, and 64 tertiary indicators.

Conclusion

The competency evaluation index system of front-line nurses during the outbreak of major infectious diseases is scientific, reasonable, and practical, which can provide a scientific basis for nursing managers to accurately understand, describe, analyze, and evaluate the competence level of nursing staff and scientifically implement the allocation of human resources in the future, as well as serve as a content framework for subsequent training programs.

Fundamental Concepts, Knowledge Gaps and Key Concerns Relating to Welfare and Survival of Stranded Cetaceans

Wildlife management can influence animal welfare and survival, although both are often not explicitly integrated into decision making. This study explores fundamental concepts and key concerns relating to the welfare and survival of stranded cetaceans. Using the Delphi method, the opinions of an international, interdisciplinary expert panel were gathered, regarding the characterisation of stranded cetacean welfare and survival likelihood, knowledge gaps and key concerns. Experts suggest that stranded cetacean welfare should be characterised based on interrelated aspects of animals’ biological function, behaviour, and mental state and the impacts of human interventions. The characterisation of survival likelihood should reflect aspects of stranded animals’ biological functioning and behaviour as well as a 6-month post-re-floating survival marker. Post-release monitoring was the major knowledge gap for survival. Welfare knowledge gaps related to diagnosing internal injuries, interpreting behavioural and physiological parameters, and euthanasia decision making. Twelve concerns were highlighted for both welfare and survival likelihood, including difficulty breathing and organ compression, skin damage and physical traumas, separation from conspecifics, and suffering and stress due to stranding and human intervention. These findings indicate inextricable links between perceptions of welfare state and the likely survival of stranded cetaceans and demonstrate a need to integrate welfare science alongside conservation biology to achieve effective, ethical management at strandings.

Lipoic acid prevents mirtazapine-induced weight gain in mice without impairs its antidepressant-like action in a neuroendocrine model of depression

Mirtazapine (MIRT) is a multi-target antidepressant used in treatment of severe depression with promising efficacy, but also with important side effects, mainly sedation and weight gain. Thus, the present study aimed to test the effects of the neuroprotective antioxidant lipoic acid (ALA) in the reversal of weight and metabolic changes induced by MIRT in corticosterone-induced depression model in mice, as well as proposed mechanisms for their association antidepressant and pro-cognitive effects. To do these male Swiss mice received Tween 80 (control), corticosterone (CORT 20 mg / kg), MIRT (3 mg / kg) and ALA (100 or 200 mg / kg), alone or associated for 21 days. After this, the animals were subjected to behavioral tests for affective and cognitive domains. Daily weight changes, blood cholesterol fractions and corticosterone were measured. Also, hippocampus (HC) protein expression of the serotonin transporter (SERT), synaptophysin, protein kinase B-Akt (total and phosphorylated) and the cytokines IL-4 and IL-6 were investigated. CORT induced a marked depression-like behavior, memory deficits, metabolic changes (total cholesterol and LDL) and increased serum corticosterone. Also, CORT increased SERT expression in the HC. MIRT alone or combined with ALA sustained its antidepressant-like effect, as well as reversed CORT-induced impairment in spatial recognition memory. Additionally, the association MIRT+ALA200 reversed the weight gain induced by the former antidepressant, as well as reduced serum corticosterone levels and SERT expression in the HC. ALA alone induced significant weight loss and reduced total cholesterol and HDL fraction. Our findings provide promising evidence about the ALA potential to prevent metabolic and weight changes associated to MIRT, without impair its antidepressant and pro-cognition actions. Therefore, ALA+MIRT combination could represent a new therapeutic strategy for treating depression with less side effects.

Construction of an index system of core competence assessment for infectious disease specialist nurse in China: a Delphi study

Aim and objective

This study was to establish an index system for the evaluation of Chinese infectious disease specialist nurses’ core competence.

Background

The index system for the evaluation of infectious disease specialist nurses’ core competence has not been established.

Design

A two-round Delphi survey was conducted to seek opinions from experts about the index system for the evaluation of infectious disease specialist nurses’ core competence.

Methods

The study adopted several research methods, including literature retrieval, theoretical analysis and qualitative research. Based on the above method, the draft of core competence evaluation index system of infectious disease specialist nurses was constructed. A Delphi survey was used for the study of 30 infectious disease experts from 8 provinces and cities around China. A modified recommendation for the Conducting and Reporting of Delphi studies (CREDES) was also used to guide this study. A STROBE checklist was used.

Results

The Core Competence Evaluation Index System of Infectious Disease Nurses is composed of 6 primary indicators, namely, Nursing Abilities for Infectious Diseases, Infection Prevention and Control Abilities, Responsiveness to Infectious Diseases, Professional Development Abilities, Communication and Management Abilities, and Professionalism and Humanistic Accomplishment, 16 secondary indicators and 47 tertiary indicators. The authority coefficient, judgment coefficient and familiarity degree of Delphi experts were 0.923, 0.933 and 0.913 respectively.

Conclusions

The evaluation index system of core competence of diseases specialist nurses is scientific and reliable. It can be reference for future training and assessment of Chinese infectious disease specialist nurses.

Relevance to clinical practice

Infectious disease specialist nurses are the main force for infectious disease nursing. Their core competence is related to the quality of infectious disease nursing and treatment. The core competence of the nurses is important for identification of training strategies and can be regarded as reference for nurse assessment and promotion. The construction of the index system is based on the consensus of infectious disease experts, which is not only helpful to standardize the training strategies and selection standards of infectious disease specialist nurses in the future, but also meet the society’s needs in clinical infectious disease nursing.

Identification of Animal-Based Welfare Indicators in Captive Reptiles: A Delphi Consultation Survey

There is an increasing focus on evidence-based welfare assessment by animal care staff in zoos, along with a strong interest in animal welfare by the zoo-visiting public, to the extent that this can influence their choice of institutions to visit. Regulatory oversight of animal welfare standards continues to strengthen across many jurisdictions. Zoos are increasingly formalizing their practices with the development and refinement of evidence-based welfare assessment tools. There has been a drive for welfare assessment tools to comprise both resource-based and animal-based measures. However, animal-based indicators are not always well characterized, in terms of their nature and whether they infer a positive or negative affective state. This is especially so for reptiles, which are often considered behaviorally inexpressive and are under-researched. In this study, a Delphi consultation approach was used to gather expert opinion on the suitability of potential animal-based indicators of welfare for inclusion in a welfare assessment tool across four families of reptiles: Agamidae, Chelidae, Pythonidae, and Testudinidae. Two rounds of online surveys were conducted eliciting responses from a global group of professionals who work with reptiles. In the first survey, respondents were provided with an author-derived list of potential animal-based indicators for consideration of their validity and practicality as welfare indicators. The indicators were refined for the second survey including only those indicators that were considered valid or practical on the first survey (≥4 on a 5-point Likert scale), and that achieved ≥70% consensus amongst experts. In the second survey, respondents were asked to re-evaluate the reliability and practicality of the indicators and to rank them on these facets. Eight to ten assessment indicators for each family of reptiles were identified from Survey 2. These indicators were often health related, for example, presence of oculo-nasal discharge or wounds. However, some true behavioral indicators were identified, such as showing species-specific interest and alertness. These indicators should now be incorporated into taxon-tailored welfare assessment tools for trial and validation in captive reptile populations. This study provides a next step towards developing reptile-specific animal welfare assessment tools for these often-overlooked animals.

Development of the Bristol Rabbit Pain Scale (BRPS): A multidimensional composite pain scale specific to rabbits (Oryctolagus cuniculus)

A species-specific composite pain scale is a prerequisite for adequate pain assessment. The aim of this study was to develop a multidimensional pain scale specific to rabbits (Oryctolagus cuniculus) called the Bristol Rabbit Pain Scale (BRPS). The scale was developed over five phases using a unique combination of methods: focus groups and behavioural observation. The first two phases aimed at identifying descriptors to describe a rabbit in pain, and then reducing their number, both using focus groups. A total of 72 pain descriptors were grouped under six categories (Demeanour, Posture, Facial expression, Attention to the painful area, Audible and Other) and 'No pain' descriptors were added. The third phase aimed to confirm, through video observation of rabbits, the categories and descriptors previously described, to reject those terms that were ambiguous, and identify any new descriptors that had not been included in the previous list of descriptors. This led to the rejection of the categories Audible and Attention to the painful area and of 34 descriptors. Seven new descriptors were identified. The last two phases constructed the final format of the BRPS by refining the categories, ranking the descriptors on an ordinal scale and testing the internal reliability of the scale using Cronbach's alpha test. This led to a composite pain scale of six categories (Demeanour, Posture, Locomotion, Ears, Eyes and Grooming) with four intensities of pain (0, 1, 2, and 3), a total score of 0-18, and a high Cronbach's alpha coefficient (alpha = 0.843). This BRPS fills an important gap in the field of rabbit medicine and has the potential to improve the assessment and management of pain in rabbits providing veterinary professionals with a novel multidimensional pain assessment tool. Further studies will investigate the clinical utility, validity and reliability of the BRPS.

The identification of effective welfare indicators for laboratory-housed macaques using a Delphi consultation process

Despite the importance for both animal welfare and scientific integrity of effective welfare assessment in non-human primates, there has been little or no consensus as what should be assessed. A Delphi consultation process was undertaken to identify the animal- and environment-based measures of welfare for laboratory-housed macaques and to determine their relative importance in on-site welfare assessments. One-hundred fifteen potential indictors were identified through a comprehensive literature search, followed by a two-round iterative electronic survey process to collect expert opinion. Stable group response and consensus about the validity, reliability, and feasibility of the proposed indicators (67.5% agreement) was achieved by the completion of Round Two. A substantially higher proportion of environment-based measures (72%: n = 44/61) were considered as valid, reliable, and feasible compared to the animal-based measures (22%: n = 12/54). The indicators that ranked most highly for assessing welfare were the presence of self-harm behaviours and the provision of social enrichment. This study provides an empirical basis upon which these indicators can be validated and then integrated into assessment tools developed for macaques and emphasises the need to include both animal- and environment-based indicators for accurate welfare monitoring.

Reliability of the Mouse Grimace Scale in C57BL/6JRj Mice

To maintain and foster the welfare of laboratory mice, tools that reliably measure the current state of the animals are applied in clinical assessment. One of these is the Mouse Grimace Scale (MGS), a coding system for facial expression analysis. Since there are concerns about the objectivity of the MGS, we further investigated its reliability. Four observers (two experienced and two inexperienced in use of the MGS) scored 188 images of 33 female and 31 male C57BL/6JRj mice. Images were generated prior to, 150 min, and two days after ketamine/xylazine anesthesia. The intraclass correlations coefficient (ICC = 0.851) indicated good agreement on total MGS scores between all observers when all three time points were included in the analysis. However, interrater reliability was higher in the early post-anesthetic period (ICC = 0.799) than at baseline (ICC = 0.556) and on day 2 after anesthesia (ICC = 0.329). The best agreement was achieved for orbital tightening, and the poorest agreement for nose and cheek bulge, depending on the observers' experience levels. In general, experienced observers produced scores of higher consistency when compared to inexperienced. Against this background, we critically discuss factors that potentially influence the reliability of MGS scoring.