Guidance on Expert Knowledge Elicitation in Food and Feed Safety Risk Assessment

Risk assessment of Phlyctinus callosus for the EU

Following a request from the European Commission, the EFSA Panel on Plant Health performed a quantitative risk assessment for the EU of Phlyctinus callosus (Coleoptera: Curculionidae), a polyphagous pest occurring in Australia, New Zealand and South Africa. The current risk assessment focused on potential pathways for entry, the climatic conditions allowing establishment, the expected spread capacity and the impact considering a time horizon of 10 years (2023-2032). The Panel identified the import of apples, cut flowers and table grapes as the most relevant entry pathways. Over the next 10 years, an annual median estimate of approximately 49.5 (90% certainty range, CR, ranging from 4.0 to 881.2) potential P. callosus founder populations are expected. When the probability of establishment is considered and climatic indicators are used to define the areas in the EU where establishment is possible, the model estimated a median of 1 founder population every 1.3 years (90% CR: 1 every 30.8 years to 23.3 per year) in the scenario where the areas are defined by the union of all the climatic indicators and 1 founder population every 11.9 years (90% CR: 1 every 256.6 years to 2.5 per year) in the scenario where establishment is possible only in the areas defined by the climatic indicator of minimum soil temperature. The estimated number of founder populations per year is mostly driven by the probability of establishment in the rural areas, infestation rate in table grapes and the probability of transfer to a suitable host in the rural area. The risk of entry for cut flowers and apples is substantially lower than the risk from the table grapes. If such founder populations were to establish, P. callosus is estimated to spread by natural dispersal and common agricultural practices at a rate of 15.5 m/year (90% CR 5.1-46.8 m/year) after a lag phase of 4.0 years (90% CR 1.3-8.7 years). The impact, expressed as percentage loss of the production directly attributable to P. callosus in the areas where establishment is possible and assuming farmers do not apply specific control measures was estimated at 0.5% (90% CR 0.01%-2.8%) for cut flowers/foliage, 5.2% (90% CR 2.2%-11.7%) for apples and 2% (90% CR 1.3%-5.2%) for table grapes. Options for risk reduction are discussed, but their effectiveness is not quantified.

The use of high expansion foam for stunning and killing pigs and poultry

The EFSA Panel on Animal Health and Welfare (AHAW) was asked to deliver a scientific opinion on the use of high-expansion foam for stunning and killing pigs and poultry. A dossier was provided by the applicant as the basis for an assessment of the extent to which the method is able to provide a level of animal welfare at least equivalent to that ensured by the currently allowed methods for pigs and poultry. According to legislation, to be approved in the EU, new stunning methods must ensure (1) the absence of pain, distress or suffering until the onset of unconsciousness, and (2) that the animal remains unconscious until death. An ad hoc Working Group set up by EFSA performed the assessment as follows: (1) The data provided were checked against the criteria laid down in the EFSA Guidance (EFSA, 2018), and was found to partially fulfil those criteria; (2) extensive literature search; (3) data extraction for quantitative assessment; (4) qualitative exercise based on non-formal expert elicitation. The assessment led to conclude that it is more likely than not (certainty > 50%-100%) that high-expansion foam for stunning and killing pigs and poultry, named NEFS in container (Nitrogen Expansion Foam Stunning in container), provides a level of welfare at least equivalent to one or more of the currently allowed methods listed in Annex I of Council Regulation (EC) No 1099/2009. The overall assessment of EFSA is valid only under the technical conditions described in this Opinion for laying hens, broiler chickens of all age and pigs weighing 15-41 kg in situations other than slaughter. The overall assessment of EFSA is that NEFS can be suitable for depopulation using containers for pig and poultry farms respecting the technical conditions and the categories and types of animals defined in this Scientific Opinion.

Risk assessment of Retithrips syriacus for the EU

Following a request from the European Commission, the EFSA Panel on Plant Health performed a quantitative risk assessment for the EU of Retithrips syriacus (Mayet) (Thysanoptera: Thripidae), a polyphagous thrips, regarded as a tropical/subtropical pest occurring in several countries of Africa, South America, Asia and in the EU in Cyprus. The current risk assessment focused on potential pathways for entry, the climatic conditions allowing establishment, the expected spread capacity and the impact considering a time horizon of 10 years (2023-2032). The Panel identified the import of cut roses, persimmons, table grapes, as well as plants for planting of the genera Acalypha and Terminalia from third countries and those of Persea americana (avocado) from Israel as the most relevant entry pathways to consider. Over the next 10 years, an annual median estimate of 95 (90% Certainty Range, CR, ranging from 13 to 1832) potential R. syriacus founder populations per year are expected to successfully transfer to a suitable host in the EU NUTS2 regions where the climatic conditions are predicted as suitable for establishment; this value drops to a median of 4.6 founder populations per year (90% CR: 1 every 1.9 years - 85.6 per year) after considering the actual probability of establishment of a potential founder population. The estimated number of founder population per year is mostly driven by the import of cut roses and plants for planting. If such founder populations were to establish, R. syriacus is estimated to spread at a median rate of 0.05 km/year (90% CR 0.02-2.30 km/year) after a median lag phase of 1.1 years (90% CR 0.3-3.3 years). The overall impact on yield (expressed as % of the total agricultural production) directly attributable to R. syriacus when considering: (i) the main R. syriacus hosts in the EU, (ii) the areas of the EU where establishment is possible, (iii) the current agricultural practices and (iv) the evidence of impact from the countries where the pest is established for a long time, was estimated at 0.065% as the median value of the uncertainty distribution (90% CR 0.001%-0.571%). Options for risk reduction are discussed, but the effectiveness was not quantified.

Pest risk assessment of African Leucinodes species for the European Union

Following a request from the European Commission, the EFSA Panel on Plant Health performed a quantitative risk assessment for the EU of African Leucinodes species (Lepidoptera: Crambidae), which are fruit and shoot borers, especially of eggplant type fruit. The assessment focused on (i) potential pathways for entry, (ii) distribution of infested imports within EU, (iii) climatic conditions favouring establishment, (iv) spread and (v) impact. Options for risk reduction are discussed, but their effectiveness was not quantified. Leucinodes spp. are widely distributed across sub-Saharan Africa but are little studied and they could be much more widespread in Africa than reported. Much African literature erroneously reports them as Leucinodes orbonalis which is restricted to Asia. The import of eggplant type fruit from sub-Saharan Africa consists of special fruit types and caters mostly to niche markets in the EU. The main pathway for entry is fruit of Solanum aethiopicum and exotic varieties of eggplant (S. melongena). CLIMEX modelling was used with two possible thresholds of ecoclimatic index (EI) to assess establishment potential. Climates favouring establishment occur mostly in southern Europe, where, based on human population, 14% of the imported produce is distributed across NUTS2 regions where EI ≥ 30; or where 23% of the produce is distributed where EI ≥ 15. Over the next 5 years, an annual median estimate of ~ 8600 fruits, originating from Africa, and infested with African Leucinodes spp. are expected to enter EU NUTS2 regions where EI ≥ 15 (90% CR ~ 570-52,700); this drops to ~ 5200 (90% CR ~ 350-32,100) in NUTS2 regions where EI ≥ 30. Escape of adult moths occurs mostly from consumer waste; considering uncertainties in pathway transfer, such as adult emergence, mate finding and survival of progeny, the annual median probability of a mated female establishing a founder population in NUTS regions where EI ≥ 15 was estimated to be 0.0078 (90% CR 0.00023-0.12125). This equates to a median estimate of one founder population ~ every 128 years (90% CR approximately one every 8-4280 years). Using an EI ≥ 30, the median number of founder populations establishing in the EU annually is 0.0048 (90% CR 0.0001-0.0739), equating to a median estimate of one founder population approximately every 210 years (90% CR approximately one every 14-7020 years). Under climate change for the period 2040-2059, the percent of infested produce going to suitable areas would be increased to 33% for EI ≥ 15 and to 21% for EI ≥ 30. Accordingly, the waiting time until the next founder population would be reduced to median estimates of 89 years for EI ≥ 15 (90% CR ~ 6-2980 years) and 139 years for EI ≥ 30 (90% CR 9-4655 years). If a founder population were to establish, it is estimated to spread at a rate of 0.65-7.0 km per year after a lag phase of 5-92 years. Leucinodes spp. are estimated to reduce eggplant yield by a median value of 4.5% (90% CR 0.67%-13%) if growers take no specific action, or 0.54% (90% CR between 0.13% and 1.9%) if they do take targeted action, matching previous estimates made during a risk assessment of L. orbonalis from Asia.

Pest risk assessment of Leucinodes orbonalis for the European Union

Following a request from the European Commission, the EFSA Panel on Plant Health performed a quantitative risk assessment of Leucinodes orbonalis (Lepidoptera: Crambidae), the eggplant fruit and shoot borer, for the EU. The assessment focused on potential pathways for entry, climatic conditions favouring establishment, spread and impact. Options for risk reduction are discussed but effectiveness was not quantified. L. orbonalis is a key pest of eggplant (aubergine/brinjal) in the Indian subcontinent and occurs throughout most of southern Asia with records mostly from India and Bangladesh. The main pathway of entry is fruit of solanaceous plants, primarily exotic varieties of eggplant, Solanum melongena and turkey berry, S. torvum. The trade in both commodities from Asia is small but nevertheless dwarfs the trade in other Solanum fruits from Asia (S. aethiopicum, S. anguivi, S. virginianum, S. aculeatissimum, S. undatum). Other Solanum fruits were therefore not further assessed as potential pathways. The trade in eggplant from Asia consists of special fruit types and caters mostly to niche markets in the EU, while most eggplant consumed in Europe is produced in southern European and northern African countries, where L. orbonalis does not occur. Using expert knowledge elicitation (EKE) and pathway modelling, the Panel estimated that approximately 3-670 infested fruit (90% certainty range, CR) of S. melongena or fruit bunches of S. torvum enter into regions of the EU that are suitable for L. orbonalis establishment each year. Based on CLIMEX modelling, and using two possible thresholds of ecoclimatic index (EI) to indicate uncertainty in establishment potential, climates favouring establishment occur mostly in southern Europe, where, based on human population, approximately 14% of the imported produce is distributed across NUTS2 regions where EI ≥ 30; or 23% of the produce is distributed where EI ≥ 15. Escape of adult moths occurs mostly from consumer waste. By analysing results of different scenarios for the proportion of S. melongena and S. torvum in the trade, and considering uncertainties in the climatic suitability of southern Europe, adult moth emergence in areas suitable for establishment is expected to vary between 84 individuals per year and one individual per 40 years (based on 90% CR in different scenarios). In the baseline scenario, 25% of the solanaceous fruit from Asia is S. torvum, 75% is S. melongena and EI ≥ 30 is required for establishment. After accounting for the chances of mating, host finding and establishment, the probability of a mated female establishing a founder population in the EU is less than 1 in 100,000 to about 1 event per 622 years (90% CR in baseline scenario). The waiting time until the first establishment is then 622 to more than 100,000 years (CR). If such a founder population were established, the moth is estimated to spread at a rate of 0.65-7.0 km per year after a lag phase of 5-92 years. The impact of the insect on the production of eggplant is estimated to be 0.67%-13% (CR) if growers take no specific action against the insect and 0.13%-1.9% if they do take targeted actions. Tomato (S. lycopersicum) and potato (S. tuberosum) are hosts of L. orbonalis, but the insect does not develop to maturity in tomato fruit, and it does not feed on potato tubers under field conditions; hence, damage to potato can only occur due to feeding on shoots. Tomato and potato are not preferred hosts; nevertheless, impact can occur if populations of L. orbonalis are high and preferred hosts are not available. The Panel did not assess this damage due to insufficient information.

Serological and Molecular Detection of Toxoplasma gondii in Domestic Pigs Intended for Human Consumption and Potential Occupational Hazard to Pig Farmers in India

Toxoplasma gondii, an important food-borne zoonotic parasite, poses a worldwide public health hazard. Domestic pigs are considered one of the main intermediate hosts in the zoonotic transmission of T. gondii. To date, seroepidemiological information on T. gondii in domestic pigs in India is very scarce, and there are no reports of occupational hazards to pig farmers in this country. Here, we aimed at estimating the occurrence of T. gondii (antibodies and parasite DNA) in slaughtered pigs and pig farmers in Central India. Seroprevalence was determined in 410 serum samples from slaughtered pigs and 103 sera from pig farmers using an in-house prepared antigen-based modified agglutination test (MAT), enzyme-linked immunosorbent assay (ELISA), and indirect-fluorescent antibody test (IFAT). Anti-T. gondii IgG antibodies were detected in 200 pigs (up to 48.8%, confidence interval [95% CI]: 40.4-52.2) and 44 pig farmers (up to 42.7%, 95% CI: 35.6-47.3) using MAT, ELISA, and IFAT. Inter-rater agreement showed an excellent agreement (kappa κ = 0.9) among the different serological tests suggesting similar detection potential of these tests. Recently acquired infections in all seropositive subjects were determined using IgG avidity testing and polymerase chain reaction (PCR). IgG avidity showed that 20 (10.3%) of slaughtered pigs and 8 (19.5%) pig farmers had a recently acquired infection. PCR for B1 and 529 repeats was performed in the heart tissues of slaughtered pigs and the blood cells of pig farmers. T. gondii DNA was detected in 14 (7.2%) slaughtered pigs and 5 (12.2%) pig farmers. Univariate analysis revealed that adult animals (>1 year), cats and rodents on the farm, and outdoor access are common factors (p ≤ 0.05) associated with T. gondii infection in pigs. Our results indicate that T. gondii is widely distributed in slaughtered pigs and pig farmers at risk of infection, highlighting a potential zoonotic transmission and health risk to consumers.

Bayesian design and analysis of two-arm cluster randomized trials using assurance

We consider the design of a two-arm superiority cluster randomized controlled trial (RCT) with a continuous outcome. We detail Bayesian inference for the analysis of the trial using a linear mixed-effects model. The treatment is compared to control using the posterior distribution for the treatment effect. We develop the form of the assurance to choose the sample size based on this analysis, and its evaluation using a two loop Monte Carlo sampling scheme. We assess the proposed approach, considering the effect of different forms of prior distribution, and the number of Monte Carlo samples needed in both loops for accurate determination of the assurance and sample size. Based on this assessment, we provide general advice on each of these choices. We apply the approach to the choice of sample size for a cluster RCT into poststroke incontinence, and compare the resulting sample size to that from assurance based on a Wald test for the treatment effect. The Bayesian approach to design and analysis developed in this article can offer advantages in terms of an increase in the robustness of the chosen sample size to parameter mis-specification and reduced sample sizes if prior information indicates the treatment effect is likely to be larger than the minimal clinically important difference.

Assessment of the probability of introduction of Thaumatotibia leucotreta into the European Union with import of cut roses

Following a request from the European Commission, the EFSA Panel on Plant Health performed a quantitative pest risk assessment to assess whether the import of cut roses provides a pathway for the introduction of Thaumatotibia leucotreta (Lepidoptera: Tortricidae) into the EU. The assessment was limited to the entry and establishment steps. A pathway model was used to assess how many T. leucotreta individuals would survive and emerge as adults from commercial or household wastes in an EU NUTS2 region climatically suitable in a specific season. This pathway model for entry consisted of three components: a cut roses distribution model, a T. leucotreta developmental model and a waste model. Four scenarios of timing from initial disposal of the cut roses until waste treatment (3, 7, 14 and 28 days) were considered. The estimated median number of adults escaping per year from imported cut roses in all the climatically suitable NUTS2 regions of the EU varied from 49,867 (90% uncertainty between 5,298 and 234,393) up to 143,689 (90% uncertainty between 21,126 and 401,458) for the 3- and 28-day scenarios. Assuming that, on average, a successful mating will happen for every 435 escaping moths, the estimated median number of T. leucotreta mated females per year from imported cut roses in all the climatically suitable NUTS2 regions of the EU would vary from 115 (90% uncertainty between 12 and 538) up to 330 (90% uncertainty between 49 and 923) for the 3- and 28-day scenarios. Due to the extreme polyphagia of T. leucotreta, host availability will not be a limiting factor for establishment. Climatic suitability assessment, using a physiologically based demographic modelling approach, identified the coastline extending from the northwest of the Iberian Peninsula through the Mediterranean as area suitable for establishment of T. leucotreta. This assessment indicates that cut roses provide a pathway for the introduction of T. leucotreta into the EU.

Expert opinions on informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease: a Delphi consensus study

Background

The present study introduces informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease (IBD) through a three-round Expert Delphi Consensus Opinions method.

Methods

According to our previous scoping review, important items in the area of informational and supportive needs and sources of obtaining information were elucidated. After omitting duplicates, 56 items in informational needs, 36 items in supportive needs, and 36 items in sources of obtaining information were retrieved. Both open- and close-ended questions were designed for each category in the form of three questionnaires. The questionnaires were sent to selected experts from different specialties. Experts responded to the questions in the first round. Based on the feedback, questions were modified and sent back to the experts in the second round. This procedure was repeated up to the third round.

Results

In the first round, five items from informational needs, one item from supportive needs, and seven items from sources of obtaining information were identified as unimportant and omitted. Moreover, two extra items were proposed by the experts, which were added to the informational needs category. In the second round, seven, three, and seven items from informational needs, supportive needs, and sources of obtaining information were omitted due to the items being unimportant. In the third round, all the included items gained scores equal to or greater than the average and were identified as important. Kendall coordination coefficient W was calculated to be 0.344 for information needs, 0.330 for supportive needs, and 0.325 for sources of obtaining information, indicating a fair level of agreement between experts.

Conclusions

Out of 128 items in the first round, the omission of 30 items and the addition of two items generated a 100-item questionnaire for three sections of informational needs, supportive needs, and sources of obtaining information with a high level of convergence between experts' viewpoints.

Determining the sample size for a cluster-randomised trial using knowledge elicitation: Bayesian hierarchical modelling of the intracluster correlation coefficient

BACKGROUND

The intracluster correlation coefficient is a key input parameter for sample size determination in cluster-randomised trials. Sample size is very sensitive to small differences in the intracluster correlation coefficient, so it is vital to have a robust intracluster correlation coefficient estimate. This is often problematic because either a relevant intracluster correlation coefficient estimate is not available or the available estimate is imprecise due to being based on small-scale studies with low numbers of clusters. Misspecification may lead to an underpowered or inefficiently large and potentially unethical trial.

METHODS

We apply a Bayesian approach to produce an intracluster correlation coefficient estimate and hence propose sample size for a planned cluster-randomised trial of the effectiveness of a systematic voiding programme for post-stroke incontinence. A Bayesian hierarchical model is used to combine intracluster correlation coefficient estimates from other relevant trials making use of the wealth of intracluster correlation coefficient information available in published research. We employ knowledge elicitation process to assess the relevance of each intracluster correlation coefficient estimate to the planned trial setting. The team of expert reviewers assigned relevance weights to each study, and each outcome within the study, hence informing parameters of Bayesian modelling. To measure the performance of experts, agreement and reliability methods were applied.

RESULTS

The 34 intracluster correlation coefficient estimates extracted from 16 previously published trials were combined in the Bayesian hierarchical model using aggregated relevance weights elicited from the experts. The intracluster correlation coefficients available from external sources were used to construct a posterior distribution of the targeted intracluster correlation coefficient which was summarised as a posterior median with a 95% credible interval informing researchers about the range of plausible sample size values. The estimated intracluster correlation coefficient determined a sample size of between 450 (25 clusters) and 480 (20 clusters), compared to 500-600 from a classical approach. The use of quantiles, and other parameters, from the estimated posterior distribution is illustrated and the impact on sample size described.

CONCLUSION

Accounting for uncertainty in an unknown intracluster correlation coefficient, trials can be designed with a more robust sample size. The approach presented provides the possibility of incorporating intracluster correlation coefficients from various cluster-randomised trial settings which can differ from the planned study, with the difference being accounted for in the modelling. By using expert knowledge to elicit relevance weights and synthesising the externally available intracluster correlation coefficient estimates, information is used more efficiently than in a classical approach, where the intracluster correlation coefficient estimates tend to be less robust and overly conservative. The intracluster correlation coefficient estimate constructed is likely to produce a smaller sample size on average than the conventional strategy of choosing a conservative intracluster correlation coefficient estimate. This may therefore result in substantial time and resources savings.

SARS-CoV-2 in animals: susceptibility of animal species, risk for animal and public health, monitoring, prevention and control

The epidemiological situation of SARS-CoV-2 in humans and animals is continually evolving. To date, animal species known to transmit SARS-CoV-2 are American mink, raccoon dog, cat, ferret, hamster, house mouse, Egyptian fruit bat, deer mouse and white-tailed deer. Among farmed animals, American mink have the highest likelihood to become infected from humans or animals and further transmit SARS-CoV-2. In the EU, 44 outbreaks were reported in 2021 in mink farms in seven MSs, while only six in 2022 in two MSs, thus representing a decreasing trend. The introduction of SARS-CoV-2 into mink farms is usually via infected humans; this can be controlled by systematically testing people entering farms and adequate biosecurity. The current most appropriate monitoring approach for mink is the outbreak confirmation based on suspicion, testing dead or clinically sick animals in case of increased mortality or positive farm personnel and the genomic surveillance of virus variants. The genomic analysis of SARS-CoV-2 showed mink-specific clusters with a potential to spill back into the human population. Among companion animals, cats, ferrets and hamsters are those at highest risk of SARS-CoV-2 infection, which most likely originates from an infected human, and which has no or very low impact on virus circulation in the human population. Among wild animals (including zoo animals), mostly carnivores, great apes and white-tailed deer have been reported to be naturally infected by SARS-CoV-2. In the EU, no cases of infected wildlife have been reported so far. Proper disposal of human waste is advised to reduce the risks of spill-over of SARS-CoV-2 to wildlife. Furthermore, contact with wildlife, especially if sick or dead, should be minimised. No specific monitoring for wildlife is recommended apart from testing hunter-harvested animals with clinical signs or found-dead. Bats should be monitored as a natural host of many coronaviruses.

Perceived feasibility of sward management options in permanent grassland of Alpine regions and expected effects on delivery of ecosystem services

Agriculture in Alpine regions plays an important role for multiple ecosystem services (ES) supplied from permanent grassland (PG). This paper investigates the feasibility of sward renewal, overseeding, and rising plate meters on PG for the Swiss Alpine region and analyses their expected effects on ES supply. Sward renewal and overseeding are management options implemented in response to a decline of grassland yields and nutritive value or sward damage. Rising plate meters focus on increased grass utilisation for improving profitability of grassland farms in a sustainable manner. The aim was to improve the understanding which of these three PG management practices could be promoted to deliver a wide range of agricultural and non-agricultural ESs in the Swiss Alpine region. Through interviews with 75 farmers (including organic and intensive/extensive non-organic farmers) and a Delphi-methodology on a panel of experts (N = 10 experts with different expertise), we found that sward renewal is perceived to have negative effects on biodiversity, carbon storage, flood control, prevention of soil erosion, and prevention of loss of organic matter in Alpine regions. Therefore, sward renewal should not be promoted, although about half of the farmers interviewed had already carried out the practice on plots following severe sward damage in Alpine regions. Overseeding is perceived to have positive effects on biodiversity, prevention of soil erosion, and grass production. Thus, the high level of overseeding that is currently practiced in the Swiss Alpine region is probably sustainable. Rising plate meters do not play a significant role in PG management in the Alpine region because calibration in PG with diverse grassland botanical composition in the Alpine region is too difficult.

Using Expert Elicitation for ranking hazards, promoters and animal-based measures for on-farm welfare assessment of indoor reared beef cattle: an Italian experience

On-farm welfare assessment gives the opportunity to monitor and improve the quality of the animal life on the farm. In order to build the first Italian public standard for the welfare of indoor reared beef cattle, a list of 25 potential hazards and 22 potential promoters of beef cattle welfare was judged by a group of national experts by taking into account their negative or positive impacts on the welfare-state of the target population. In addition, the experts were asked to rank a list of 11 animal-based measures for identifying the most appropriate and important for measuring negative welfare outcomes in beef cattle. Based on experts' ratings, an "impact score" (IS_overall) was calculated for the proposed measures. Management hazards and promoters were ranked to have a greater impact on beef cattle welfare than housing factors. Keeping cattle in large (≥ 40 animals) and heterogeneous groups obtained the highest IS_overall among the proposed hazards (IS_overall = 5.54), followed by the presence of animals without free access to drinking water (IS_overall = 4.39) and the use of high-concentrate corn silage diets (concentrate > 80% and fiber < 6%) (IS_overall = 4.39). On the other hand, housing animals in small (≤ 20 animals) and homogeneous groups (IS_overall = 5.41), checking them at least twice a day (IS_overall = 4.62) and rearing cattle in loose housing systems with access to an outdoor area/pasture (IS_overall = 4.27) were ranked among the top 3 promoters. Concerning animal-based measures, experts scored lameness, severe respiratory diseases, body condition scoring and mortality rate to be measures most important for assessing serious welfare impairment.

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.

More vaquita porpoises survive than expected

In 2018, it was estimated that fewer than 20 of Mexico’s endemic vaquita porpoise Phocoena sinus remained, and the species was declining by 47% yr-1. Entanglement in gillnets is the sole threat to the species, and since the last population size estimate, gillnetting has increased in the small area where most vaquitas remain—a 12 × 24 km area in the Gulf of California near San Felipe, Mexico. We conducted research efforts in 2019 and 2021 in that area to estimate the minimum numbers of adults and calves and look for any signs that vaquitas are unhealthy. Through expert elicitation, we estimated between 7 and 15 unique individuals were seen in 2019 and 5-13 were seen in 2021. Calves were seen in both years, and all vaquitas appeared healthy. Population projections from the last full survey indicated that more vaquitas have survived than expected. We suggest that these surviving adult vaquitas may have learned to avoid entanglement in gillnets. These vaquitas and their calves provide hope that the species can survive. However, given the high levels of illegal gillnetting and the theft of equipment which hindered our monitoring efforts, and with only around 10 individuals remaining, survival can only be assured if vaquita habitat is made gillnet-free.

Risks related to a possible reduction of the waiting period for dogs after rabies antibody titration to 30 days compared with 90 days of the current EU legislative regime

EFSA received a mandate from the European Commission to assess the risks related to a possible reduction of the waiting period after rabies antibody titration test to 30 days compared with 90 days of the current EU legislation, for dogs moving from certain non-EU countries to the EU. This Scientific Report assessed the probability of introduction of rabies into the EU through commercial and non-commercial movements of vaccinated dogs with a positive titration test (≥ 0.5 IU/mL) if the waiting period decreases from 90 to 30 days. Assuming that all the legal requirements are complied with, the risk of transmission of rabies through the movement of a vaccinated dog is related to the risk of introducing an animal incubating rabies that was infected before the day of vaccination or shortly after vaccination but before the development of immunity (21 days post-vaccination). Using published data on the incubation period for experimental and field cases in dogs and considering the rabies incidence data in certain countries, the aggregated probability for the annual introduction of rabies through dogs was assessed. Considering the uncertainty related to the duration of the incubation period, the number of imported dogs, and the disease incidence in some countries it was concluded with a 95% certainty that the maximum number of rabies-infected imported dogs complying with the regulations in a 20-year period could increase from 5 to 20 when decreasing the waiting period from 90 to 30 days. Nevertheless, the potential impact of even a small increase in probability means the risk is increased for a region like the EU where rabies has long been a focus for eradication, to protect human and animal health.

Robinson A. Co-designing and building an expert-elicited non-parametric Bayesian network model: demonstrating a methodology using a Bonamia Ostreae spread risk case study

The development and use of probabilistic models, particularly Bayesian networks (BN), to support risk-based decision making is well established. Striking an efficient balance between satisfying model complexity and ease of development requires continuous compromise. Codesign, wherein the structural content of the model is developed hand-in-hand with the experts who will be accountable for the parameter estimates, shows promise, as do so-called nonparametric Bayesian networks (NPBNs), which provide a light-touch approach to capturing complex relationships among nodes. We describe and demonstrate the process of codesigning, building, quantifying, and validating an NPBN model for emerging risks and the consequences of potential management decisions using structured expert judgment (SEJ). We develop a case study of the local spread of a marine pathogen, namely, Bonamia ostreae. The BN was developed through a series of semistructured workshops that incorporated extensive feedback from many experts. The model was then quantified with a combination of field and expert-elicited data. The IDEA protocol for SEJ was used in its hybrid (remote and face-to-face) form to elicit information about more than 100 parameters. This article focuses on the modeling and quantification process, the methodological challenges, and the way these were addressed.

The design of a matrix linking work situations to chemical health risk at the workplace

In France, laws require each company to draw up an inventory of the risks that may threaten employees' health in order to prioritize the preventive actions to be implemented. Focusing on chemical risk, databases on hazards or exposures are widely available but they lack information regarding chemical risks resulting from combining the hazards of chemicals with their conditions of use, thus generating exposures. Our objective is to build a matrix of French work situations associated with their chemical risk. Eighty-eight work situations were collected from reports written by professionals from the French public health insurance service. Each work situation is defined by descriptive parameters of the task, the exposure, and the hazard. According to an expert elicitation method (Delphi, n = 21 experts), each work situation was assessed and a chemical risk score defined, taking into account all the descriptive exposure and hazard parameters. Chemical risk scores were expressed as a range of values from 0 to 100, with the size of the range chosen by the experts themselves according to their uncertainty. The experts' assessments were merged to assign one risk score for each work situation, variability, and confidence. The results showed that 50% of the work situations had a risk score between 40 and 60. The average variability and confidence were around 15% and 82%, respectively. This work situation matrix constructed from French data can be used by occupational safety and health managers that have similar work situations in their company (Western European industrial sector). In this context, it may be useful to easily determine the level of risks for similar tasks and prioritize those that are most risky. Moreover, it could be used to compare and define the differences between a risk assessment performed by "expertise" and another defined by a software.

Challenges in estimation, uncertainty quantification and elicitation for pandemic modelling

The estimation of parameters and model structure for informing infectious disease response has become a focal point of the recent pandemic. However, it has also highlighted a plethora of challenges remaining in the fast and robust extraction of information using data and models to help inform policy. In this paper, we identify and discuss four broad challenges in the estimation paradigm relating to infectious disease modelling, namely the Uncertainty Quantification framework, data challenges in estimation, model-based inference and prediction, and expert judgement. We also postulate priorities in estimation methodology to facilitate preparation for future pandemics.

Tolerable upper intake level for dietary sugars

Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50-75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (> 15-50% probability) and very low for hypertension (0-15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.

Reference Case Methods for Expert Elicitation in Health Care Decision Making

BACKGROUND

The evidence used to inform health care decision making (HCDM) is typically uncertain. In these situations, the experience of experts is essential to help decision makers reach a decision. Structured expert elicitation (referred to as elicitation) is a quantitative process to capture experts' beliefs. There is heterogeneity in the existing elicitation methodology used in HCDM, and it is not clear if existing guidelines are appropriate for use in this context. In this article, we seek to establish reference case methods for elicitation to inform HCDM.

METHODS

We collated the methods available for elicitation using reviews and critique. In addition, we conducted controlled experiments to test the accuracy of alternative methods. We determined the suitability of the methods choices for use in HCDM according to a predefined set of principles for elicitation in HCDM, which we have also generated. We determined reference case methods for elicitation in HCDM for health technology assessment (HTA).

RESULTS

In almost all methods choices available for elicitation, we found a lack of empirical evidence supporting recommendations. Despite this, it is possible to define reference case methods for HTA. The reference methods include a focus on gathering experts with substantive knowledge of the quantities being elicited as opposed to those trained in probability and statistics, eliciting quantities that the expert might observe directly, and individual elicitation of beliefs, rather than solely consensus methods. It is likely that there are additional considerations for decision makers in health care outside of HTA.

CONCLUSIONS

The reference case developed here allows the use of different methods, depending on the decision-making setting. Further applied examples of elicitation methods would be useful. Experimental evidence comparing methods should be generated.

Precise Yet Uncertain: Broadening Understandings of Uncertainty and Policy in the BPA Controversy

Bisphenol A (BPA) is one of the most studied and most controversial chemicals used by the food packaging industry, because of its endocrine disruptive properties. Part of the controversy is due to the uncertainty that surrounds the effects of BPA on the endocrine system. Uncertainty includes data gaps, methodological hurdles, incompatibilities between toxicology and endocrinology-based approaches, and so on. In this article, we analyze how uncertainty has been conceptualized and treated. We focus on the European Food Safety Authority assessments of BPA, and study how exposure and hazard assessments have evolved over time, how uncertainty has been analyzed, and how the agency responded to controversies. Results show that in the attempt to reduce knowledge gaps, assessments have become progressively larger, including more references, evidence, and effects. There is a tendency toward greater precisions and specification of results, and toward protocolization of all processes included in the assessment (from literature review, to uncertainty assessments, and public consultation). Yet, the uncertainty has not diminished following the increase in evidence. We argue that the strategy used to reduce uncertainty within risk assessment, namely including more variables, studies, data, and methods, amplifies the uncertainty linked to indeterminacy (as more results increase the fragmentation of the knowledge base due to the open-ended nature of complex issues) and ambiguity (as complexity gives way to multiple nonequivalent interpretations of results). For this reason, it is important to consider different types of uncertainty and how these uncertainties interact with each other.

Uncertainty Quantification with Experts: Present Status and Research Needs

Expert elicitation is deployed when data are absent or uninformative and critical decisions must be made. In designing an expert elicitation, most practitioners seek to achieve best practice while balancing practical constraints. The choices made influence the required time and effort investment, the quality of the elicited data, experts' engagement, the defensibility of results, and the acceptability of resulting decisions. This piece outlines some of the common choices practitioners encounter when designing and conducting an elicitation. We discuss the evidence supporting these decisions and identify research gaps. This will hopefully allow practitioners to better navigate the literature, and will inspire the expert judgment research community to conduct well powered, replicable experiments that properly address the research gaps identified.

Statement on the active substance acetamiprid

Acetamiprid is a pesticide active substance with insecticidal action currently under the third renewal (AIR3) of the Commission implementing regulation (EU) No 844/2012. Following concerns that this substance may pose high risks to humans and the environment, the French authorities asked the Commission to restrict its uses under Article 69 of Regulation (EC) No 1107/2009. To support this request, competent Authorities from France cited a series of literature papers investigating its hazards and/or exposure to humans and the environment. Consequently, the EFSA PPR Panel was mandated to advise on the likelihood that body of evidence would constitute proof of serious risks to humans or the environment. Therefore, the EFSA PPR Panel evaluated the likelihood of these studies indicating new or higher hazards and exposure to humans and the environment compared to previous EU assessments.A stepwise methodology was designed, including: (i) the initial screening; (ii) the data extraction and critical appraisal based on the principles of OHAT/NTP; (iii) the weight of evidence, including consideration of the previous EU assessments; (iv) the uncertainty analysis, followed, whenever relevant, by an expert knowledge elicitation process. For human health, no conclusive evidence of higher hazards compared to previous assessment was found for genotoxicity, developmental toxicity, neurotoxicity including developmental neurotoxicity and immunotoxicity. However, due to the lack of adequate assessment of the current data set, the PPR Panel recommends conducting an assessment of endocrine disrupting properties for acetamiprid in line with EFSA/ECHA guidance document for the identification of endocrine disruptors. For environment, no conclusive, robust evidence of higher hazards compared to the previous assessment was found for birds, aquatic organisms, bees and soil organisms. However, the potential of high inter-species sensitivity of birds and bees towards acetamiprid requires further consideration.

Development and application of a health-based framework for informing regulatory action in relation to exposure of microplastic particles in California drinking water

Microplastics have been documented in drinking water, but their effects on human health from ingestion, or the concentrations at which those effects begin to manifest, are not established. Here, we report on the outcome of a virtual expert workshop conducted between October 2020 and October 2021 in which a comprehensive review of mammalian hazard studies was conducted. A key objective of this assessment was to evaluate the feasibility and confidence in deriving a human health-based threshold value to inform development of the State of California's monitoring and management strategy for microplastics in drinking water. A tiered approach was adopted to evaluate the quality and reliability of studies identified from a review of the peer-reviewed scientific literature. A total of 41 in vitro and 31 in vivo studies using mammals were identified and subjected to a Tier 1 screening and prioritization exercise, which was based on an evaluation of how each of the studies addressed various quality criteria. Prioritized studies were identified largely based on their application and reporting of dose-response relationships. Given that methods for extrapolating between in vitro and in vivo systems are currently lacking, only oral exposure in vivo studies were identified as fit-for-purpose within the context of this workshop. Twelve mammalian toxicity studies were prioritized and subjected to a Tier 2 qualitative evaluation by external experts. Of the 12 studies, 7 report adverse effects on male and female reproductive systems, while 5 reported effects on various other physiological endpoints. It is notable that the majority of studies (83%) subjected to Tier 2 evaluation report results from exposure to a single polymer type (polystyrene spheres), representing a size range of 0.040 to 20 µm. No single study met all desired quality criteria, but collectively toxicological effects with respect to biomarkers of inflammation and oxidative stress represented a consistent trend. While it was possible to derive a conservative screening level to inform monitoring activities, it was not possible to extrapolate a human-health-based threshold value for microplastics, which is largely due to concerns regarding the relative quality and reliability of current data, but also due to the inability to extrapolate data from studies using monodisperse plastic particles, such as polystyrene spheres to an environmentally relevant exposure of microplastics. Nevertheless, a conservative screening level value was used to estimate a volume of drinking water (1000 L) that could be used to support monitoring activities and improve our overall understanding of exposure in California's drinking water. In order to increase confidence in our ability to derive a human-health-based threshold value in the future, several research recommendations are provided, with an emphasis towards strengthening how toxicity studies should be conducted in the future and an improved understanding of human exposure to microplastics, insights critically important to better inform future risk assessments.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s43591-022-00030-6.

Statement on the active substance flupyradifurone

Flupyradifurone is a novel butenolide insecticide, first approved as an active substance for use in plant protection products by Commission Implementing Regulation (EU) 2015/2084. Following concerns that this substance may pose high risks to humans and the environment, the French authorities, in November 2020, asked the Commission to restrict its uses under Article 69 of Regulation (EC) No 1107/2009. To support this request, competent Authorities from France cited a series of literature papers investigating its hazards and/or exposure to humans and the environment. In addition, in June 2020, the Dutch Authorities notified the Commission, under Article 56 of Regulation (EC) No 1107/2009, of new information on flupyradifurone on the wild bee species Megachile rotundata. This notification is also referred to in the French notification on flupyradifurone. Consequently, the EFSA PPR Panel was mandated to quantify the likelihood of this body of evidence constituting proof of serious risks to humans or the environment. Therefore, the EFSA PPR Panel evaluated the likelihood of these studies indicating new or higher hazards and exposure to humans and the environment compared to previous EU assessments. A stepwise methodology was designed, including: (i) the initial screening; (ii) data extraction and critical appraisal based on the principles of OHAT/NTP; (iii) weight of evidence, including consideration of the previous EU assessments; (iv) uncertainty analysis, followed, whenever relevant, by an expert knowledge elicitation process. For the human health, only one study was considered relevant for the genotoxic potential of flupyradifurone in vitro. These data did not provide sufficient information to overrule the EU assessment, as in vivo studies already addressed the genotoxic potential of flupyradifurone. Environment: All available data investigated hazards in bee species. For honey bees, the likelihood of the new data indicating higher hazards than the previous EU assessment was considered low or moderate, with some uncertainties. However, among solitary bee species - which were not addressed in the previous EU assessment - there was evidence that Megachile rotundata may be disproportionately sensitive to flupyradifurone. This sensitivity, which may partially be explained by the low bodyweight of this species, was mechanistically linked to inadequate bodily metabolisation processes.

Application of Methods to Assess Animal Welfare and Suffering Caused by Infectious Diseases in Cattle and Swine Populations

Simple Summary

Infectious disease control in livestock is often motivated by food safety concerns and economic impact. However, most diseases also affect animal welfare. We established an approach to quantify the welfare effect of infectious diseases in cattle (three diseases) and pigs (two diseases). A “suffering score” was established based on the aggregation of severity, duration, and frequency of clinical entities of the diseases. The resulting suffering scores were then used to compare the welfare impact of the different diseases and for comparison to other common welfare hazards. For example, the approach suggested that bovine viral diarrhoea and paratuberculosis are more severe for cattle than infectious bovine rhinotracheitis. In pigs, porcine reproductive and respiratory syndrome has a much bigger welfare impact than Aujeszky’s disease, assuming all diseases remain endemic.

Abstract

Control of infectious diseases in livestock has often been motivated by food safety concerns and the economic impact on livestock production. However, diseases may also affect animal welfare. We present an approach to quantify the effect of five infectious diseases on animal welfare in cattle (three diseases) and pigs (two diseases). We grouped clinical manifestations that often occur together into lists of clinical entities for each disease based on literature reviews, and subsequently estimated “suffering scores” based on an aggregation of duration, frequency, and severity. The duration and severity were based on literature reviews and expert knowledge elicitation, while frequency was based mainly on estimates from the literature. The resulting suffering scores were compared to scores from common welfare hazards found under Danish conditions. Most notably, the suffering scores for cattle diseases were ranked as: bovine viral diarrhoea and infection with Mycobacterium avium subsp. paratuberculosis > infectious bovine rhinotracheitis, and for pigs as: porcine respiratory and reproductive syndrome > Aujeszky’s disease. The approach has limitations due to the limited data available in literature and uncertainties associated with expert knowledge, but it can provide decision makers with a tool to quantify the impact of infections on animal welfare given these uncertainties.

Mergers and Acquisitions Risk Modeling

In the context of the dynamics of the modern external environment, the importance of risk management in general and the risks inherent in the processes of mergers and acquisitions has sharply increased. This is becoming one of the primary challenges in business, the solution of which will contribute to economic growth and development. In this article, based on a broad review of literature, the key risks of mergers and acquisitions are identified and classified, the level of their significance is assessed, the relevant management tools are selected for each risk and a computer program is developed that implements the selection of tools for each specific merger and acquisition transaction. A comprehensive automated methodology for the selection of risk management tools in the implementation of mergers and acquisitions can become an effective risk management tool for companies participating in such transactions. This will allow to identify and track risks in a timely manner, assess their significance, and, among other things, contribute to the adoption of effective management decisions regarding risk management.

A Simplified Population-Level Landscape Model Identifying Ecological Risk Drivers of Pesticide Applications, Part One: Case Study for Large Herbivorous Mammals

Environmental risk assessment is a key process for the authorization of pesticides, and is subjected to continuous challenges and updates. Current approaches are based on standard scenarios and independent substance-crop assessments. This arrangement does not address the complexity of agricultural ecosystems with mammals feeding on different crops. This work presents a simplified model for regulatory use addressing landscape variability, co-exposure to several pesticides, and predicting the effect on population abundance. The focus is on terrestrial vertebrates and the aim is the identification of the key risk drivers impacting on mid-term population dynamics. The model is parameterized for EU assessments according to the European Food Safety Authority (EFSA) Guidance Document, but can be adapted to other regulatory schemes. The conceptual approach includes two modules: (a) the species population dynamics, and (b) the population impact of pesticide exposure. Population dynamics is modelled through daily survival and seasonal reproductions rates; which are modified in case of pesticide exposure. All variables, parameters, and functions can be modified. The model has been calibrated with ecological data for wild rabbits and brown hares and tested for two herbicides, glyphosate and bromoxynil, using validated toxicity data extracted from EFSA assessments. Results demonstrate that the information available for a regulatory assessment, according to current EU information requirements, is sufficient for predicting the impact and possible consequences at population dynamic levels. The model confirms that agroecological parameters play a key role when assessing the effect of pesticide exposure on population abundance. The integration of laboratory toxicity studies with this simplified landscape model allows for the identification of conditions leading to population vulnerability or resilience. An Annex includes a detailed assessment of the model characteristics according to the EFSA scheme on Good Modelling Practice.

Developing a reference protocol for structured expert elicitation in health-care decision-making: a mixed-methods study

BACKGROUND

Many decisions in health care aim to maximise health, requiring judgements about interventions that may have higher health effects but potentially incur additional costs (cost-effectiveness framework). The evidence used to establish cost-effectiveness is typically uncertain and it is important that this uncertainty is characterised. In situations in which evidence is uncertain, the experience of experts is essential. The process by which the beliefs of experts can be formally collected in a quantitative manner is structured expert elicitation. There is heterogeneity in the existing methodology used in health-care decision-making. A number of guidelines are available for structured expert elicitation; however, it is not clear if any of these are appropriate for health-care decision-making.

OBJECTIVES

The overall aim was to establish a protocol for structured expert elicitation to inform health-care decision-making. The objectives are to (1) provide clarity on methods for collecting and using experts' judgements, (2) consider when alternative methodology may be required in particular contexts, (3) establish preferred approaches for elicitation on a range of parameters, (4) determine which elicitation methods allow experts to express uncertainty and (5) determine the usefulness of the reference protocol developed.

METHODS

A mixed-methods approach was used: systemic review, targeted searches, experimental work and narrative synthesis. A review of the existing guidelines for structured expert elicitation was conducted. This identified the approaches used in existing guidelines (the 'choices') and determined if dominant approaches exist. Targeted review searches were conducted for selection of experts, level of elicitation, fitting and aggregation, assessing accuracy of judgements and heuristics and biases. To sift through the available choices, a set of principles that underpin the use of structured expert elicitation in health-care decision-making was defined using evidence generated from the targeted searches, quantities to elicit experimental evidence and consideration of constraints in health-care decision-making. These principles, including fitness for purpose and reflecting individual expert uncertainty, were applied to the set of choices to establish a reference protocol. An applied evaluation of the developed reference protocol was also undertaken.

RESULTS

For many elements of structured expert elicitation, there was a lack of consistency across the existing guidelines. In almost all choices, there was a lack of empirical evidence supporting recommendations, and in some circumstances the principles are unable to provide sufficient justification for discounting particular choices. It is possible to define reference methods for health technology assessment. These include a focus on gathering experts with substantive skills, eliciting observable quantities and individual elicitation of beliefs. Additional considerations are required for decision-makers outside health technology assessment, for example at a local level, or for early technologies. Access to experts may be limited and in some circumstances group discussion may be needed to generate a distribution.

LIMITATIONS

The major limitation of the work conducted here lies not in the methods employed in the current work but in the evidence available from the wider literature relating to how appropriate particular methodological choices are.

CONCLUSIONS

The reference protocol is flexible in many choices. This may be a useful characteristic, as it is possible to apply this reference protocol across different settings. Further applied studies, which use the choices specified in this reference protocol, are required.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 37. See the NIHR Journals Library website for further project information. This work was also funded by the Medical Research Council (reference MR/N028511/1).

Ability of different matrices to transmit African swine fever virus

This opinion assesses the risk posed by different matrices to introduce African swine fever virus (ASFV) to non-affected regions of the EU. Matrices assessed are feed materials, enrichment/bedding materials and empty live pigs transport vehicles returning from affected areas. Although the risk from feed is considered to be lower than several other pathways (e.g. contact with infected live animals and swill feeding), it cannot be ruled out that matrices assessed in this opinion pose a risk. Evidence on survival of ASFV in different matrices from literature and a public consultation was used in an Expert Knowledge Elicitation (EKE) on the possible contamination of products and traded or imported product volumes used on pig farms. The EKE results were used in a model that provided a risk-rank for each product's contamination likelihood ('q'), its trade or import volume from affected EU or Eurasian areas (N) and the modelled number of potentially infected pig farms (N × q). The products ranking higher regardless of origin or destination were mash and pelleted compound feed, feed additives and cereals. Bedding/enrichment materials, hydrolysed proteins and blood products ranked lowest regardless of origin or destination. Empty vehicles ranked lower than compound feed but higher than non-compound feed or bedding/enrichment material. It is very likely (95-99% certainty) that compound feed and cereals rank higher than feed materials, which rank higher than bedding/enrichment material and forage. As this is an assessment based on several parameters including the contamination and delivery to a pig farm, all of which have the same impact on the final ranking, risk managers should consider how the relative rank of each product may change with an effective storage period or a virus inactivation step.

Statement on additional scientific evidence in relation to the essential composition of total diet replacement for weight control

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to revise the Opinion on the essential composition of total diet replacements for weight control (TDRs) regarding the minimum content of linoleic acid (LA) and alpha-linolenic acid (ALA) and the maximum content of magnesium (Mg). Through a comprehensive literature search, human studies were retrieved reporting on LA and ALA concentrations in adipose tissue (AT), on weight loss and gallstone formation following TDR consumption and on diarrhoea after supplemental Mg intake. The distribution of the amount of LA and ALA release from AT during weight loss when consuming TDRs was estimated using statistical simulations. Using the fifth percentile, the coverage of the adequate intake (AI) for both FA was estimated. For the risk of developing diarrhoea when consuming TDRs with an Mg content of 350 mg/day, four cross-over studies using 360-368 mg Mg/day were reviewed. The Panel concludes that (1) there is no need to add LA to TDRs, as the amount released from AT during weight loss when consuming TDRs is sufficient to cover the AI for LA; (2) a minimum of 0.8 g/day ALA is needed in TDRs in order to meet the AI for ALA; (3) the minimum fat content of TDRs of 20 g/day as derived in the Panel's previous opinion is proposed to be maintained until the availability of further evidence, given the considerable uncertainty as to the amount of fat required for reducing the risk of gallstone formation; and (4) the likelihood that Mg-induced diarrhoea occurs at a severity that may be considered of concern for overweight and obese individuals consuming TDRs is low when the total maximum Mg content in TDRs is 350 mg/day.

Expert Elicitation To Estimate the Feed Safety Impact of Criteria Included in the Canadian Food Inspection Agency Risk Assessment Model for Feed Mills

ABSTRACT

The Canadian Food Inspection Agency is developing an Establishment-based Risk Assessment (ERA) model for commercial and on-farm mills involved in the manufacture, storage, packaging, labeling, or distribution of livestock feed (ERA-Feed Mill model). This model will help inform the allocation of inspection resources on the basis of feed safety risk, including animal health and food safety risk. In a previous study, 34 risk factors, grouped into inherent, mitigation, and compliance clusters, along with assessment criteria were selected. The objective of this current study was to estimate the relative risk (RR) of the 203 assessment criteria on the basis of the impact on feed safety to design an ERA-Feed Mill model algorithm. Furthermore, the intent of this study was to assess the maximum increase or decrease of risk obtained when multiple criteria belonging to a same cluster were identified in a specific feed mill. To do so, a two-round face-to-face expert elicitation was conducted with 28 Canadian feed experts. Results showed no significant association between respondent profiles (years of experience and work sector) and estimated RR. Uniformity of answers between experts improved between rounds. Criteria having the highest increase in risk (median RR ≥ 4) included the presence of materials prohibited to be fed to ruminants in a facility that produces ruminant feed, the presence of multiple livestock species on-site, and historical noncompliances related to the inspection of the feed mill's process control and end-product control programs. Risk mitigation criteria having the highest impact on decreasing the risk were the implementation of feed safety certifications, the use of dedicated manufacturing lines (prohibited materials or medications), and having a hazard sampling plan in place for finished feed. The median RR assigned to each criterion and cluster will be used to build an algorithm of the Canadian Food Inspection Agency's ERA-Feed Mill model.

HIGHLIGHTS

Welfare Assessment: Correspondence Analysis of Welfare Score and Hematological and Biochemical Profiles of Dairy Cows in Sardinia, Italy

The need for animal welfare definition and assessment is increasing worldwide, and several studies have been conducted to help fill the knowledge gaps regarding the welfare of cattle. However, further studies are needed to provide valid synthetized measures for welfare evaluation. The aim of this study was to assess the welfare status of 16 Sardinian dairy cattle farms, based on the developed Animal Welfare and Biosecurity Evaluation checklist (AWB-EF) and the corresponding hematological, biochemical, and electrophoretic profiles of these animals. Considering the AWB-EF as gold standard, blood samples were collected from 230 Holstein breed dairy cattle, aged between 3 and 8 years, out of the periparturient period, and with no clinical signs of specific pathologies. Principal Component (PC) and correlation analyses were performed to simplify phenomena interpretation and assess positive/negative associations. Four PCs were able to explain 76% of the total variability, and six laboratory parameters were strongly associated with the AWB-EF score (Spearman's correlation coefficient ≥ 0.40, p-Value < 0.05), reflecting the real health status of the animals. Given the complexity of animal welfare as a multidimensional concept and the need to include both animal-based and non-based measures in welfare evaluation, the present work represents a sound basis for future evaluation and veterinary health planning.

A structured expert judgement elicitation approach: how can it inform sound intervention decision-making to support household food security?

OBJECTIVE

To examine structured expert judgement (SEJ) elicitation as a method to provide robust, defensible data for three determinants of household food security (food cost, household disposable income and physical access) for quantifying a proof-of-concept integrating decision support system for food security.

DESIGN

SEJ elicitation is a validated method for obtaining unavailable data, but its use in household food security in high-income countries is novel. Investigate Discuss Estimate Aggregate (IDEA) elicitation protocol was implemented, including quantitative and qualitative elements. Using specific questions related to three determinants, food security experts were encouraged to Investigate - estimate individual first-round responses to these questions, Discuss - with each other evidence on the reasoning and logic of their estimates, Estimate - second-round responses, following which these judgements were combined using mathematical Aggregation.

SETTING

Victoria, Australia.

PARTICIPANTS

Five experts with a range of expertise in the area of household food insecurity participated in the SEJ elicitation process.

RESULTS

The experts' ability to provide reliable estimates was tested and informed the aggregation of the collection of individual estimates into a single quantity of interest for use in decision support. The results of the quantitative elicitation show the impact of combinations of varying household income, food cost and physical access on household food security status and severity and is supported by the experts reasoning during elicitation.

CONCLUSION

This research provides insight to the application of SEJ where elicited data can inform and support intervention decision-making specific to household food security, especially where evidence is absent or of poor quality.

Cumulative dietary risk assessment of chronic acetylcholinesterase inhibition by residues of pesticides

A retrospective cumulative risk assessment of dietary exposure to pesticide residues was conducted for chronic inhibition of acetylcholinesterase. The pesticides considered in this assessment were identified and characterised in a previous scientific report on the establishment of cumulative assessment groups of pesticides for their effects on the nervous system. The exposure assessments used monitoring data collected by Member States under their official pesticide monitoring programmes in 2016, 2017 and 2018, and individual food consumption data from 10 populations of consumers from different countries and from different age groups. Exposure estimates were obtained by means of a two-dimensional probabilistic model, which was implemented in SAS ® software. The characterisation of cumulative risk was supported by an uncertainty analysis based on expert knowledge elicitation. For each of the 10 populations, it is concluded with varying degrees of certainty that cumulative exposure to pesticides contributing to the chronic inhibition of acetylcholinesterase does not exceed the threshold for regulatory consideration established by risk managers.

Multifactorial Rare Diseases: Can Uncertainty Analysis Bring Added Value to the Search for Risk Factors and Etiopathogenesis?

Uncertainty analysis is the process of identifying limitations in knowledge and evaluating their implications for scientific conclusions. Uncertainty analysis is a stable component of risk assessment and is increasingly used in decision making on complex health issues. Uncertainties should be identified in a structured way and prioritized according to their likely impact on the outcome of scientific conclusions. Uncertainty is inherent to the rare diseases (RD) area, where research and healthcare have to cope with knowledge gaps due to the rarity of the conditions; yet a systematic approach toward uncertainties is not usually undertaken. The uncertainty issue is particularly relevant to multifactorial RD, whose etiopathogenesis involves environmental factors and genetic predisposition. Three case studies are presented: the newly recognized acute multisystem inflammatory syndrome in children and adolescents associated with SARS-CoV-2 infection; the assessment of risk factors for neural tube defects; and the genotype-phenotype correlation in familial Mediterranean fever. Each case study proposes the initial identification of the main epistemic and sampling uncertainties and their impacts. Uncertainty analysis in RD may present aspects similar to those encountered when conducting risk assessment in data-poor scenarios; therefore, approaches such as expert knowledge elicitation may be considered. The RD community has a main strength in managing uncertainty, as it proactively develops stakeholder involvement, data sharing and open science. The open science approaches can be profitably integrated by structured uncertainty analysis, especially when dealing with multifactorial RD involving environmental and genetic risk factors.

Evaluation of public and animal health risks in case of a delayed post-mortem inspection in ungulates

The potential effects of a 24 or 72-h delay in post-mortem inspection (PMI) of ungulates on public health and monitoring of animal health and welfare was evaluated. The assessment used a survey of meat inspectors, expert opinion, literature search and a stochastic model for Salmonella detection sensitivity. Disease detection sensitivity at a delayed PMI is expected to reduce detection sensitivity to a variable extent, depending on the hazard and on the signs/lesions and organs involved. No reduction is expected for Trichinella detection in meat from susceptible animal species and any decrease in detection of transmissible spongiform encephalopathies (TSEs) will not exceed the current tolerance for fallen stock. A 24-h delay in PMI could result in a small reduction in sensitivity of detection for tuberculosis, echinococcosis and cysticercosis. A greater reduction is expected for the detection of pyaemia and Rift valley fever. For the detection of Salmonella, the median model estimates are a reduction of sensitivity of 66.5% (90% probability interval (PI) 0.08-99.75%) after 24-h delay and 94% (90% PI 0.83-100%) after 72-h delay of PMI. Laboratory testing for tuberculosis following a sampling delay of 24-72 h could result in no, or a moderate, decrease in detection depending on the method of confirmation used (PCR, culture, histopathology). For chemical contaminants, a delay in meat inspection of 24 or 72 h is expected to have no impact on the effectiveness of detection of persistent organic pollutants and metals. However, for certain pharmacologically active substances, there will be a reduced effectiveness to detect some of these substances due to potential degradation in the available matrices (tissues and organs) and the non-availability of specific preferred matrices of choice.

Microplastic regulation should be more precise to incentivize both innovation and environmental safety

The presence of plastic in the environment has sparked discussion amongst scientists, regulators and the general public as to how industrialization and consumerism is shaping our world. Here we discuss restrictions on the intentional use of primary microplastics: small solid polymer particles in applications ranging from agriculture to cosmetics. Microplastic hazards are uncertain, and actions are not similarly prioritized by all actors. In some instances, replacement is technically simple and easily justified, but in others substitutions may come with more uncertainty, performance questions and costs. Scientific impact assessment of primary microplastics compared to their alternatives relies on a number of factors, such as microplastic harm, existence of replacement materials and the quality, cost and hazards of alternative materials. Regulations need a precise focus and must be enforceable by these measurements. Policymakers must carefully evaluate under which contexts incentives to replace certain microplastics can stimulate innovation of new, more competitive and environmentally conscious materials.

Modelling for risk and biosecurity related to forest health

Modelling the invasion and emergence of forest pests and pathogens (PnPs) is necessary to quantify the risk levels for forest health and provide key information for policy makers. Here, we make a short review of the models used to quantify the invasion risk of exotic species and the emergence risk of native species. Regarding the invasion process, models tackle each invasion phase, e.g. pathway models to describe the risk of entry, species distribution models to describe potential establishment, and dispersal models to describe (human-assisted) spread. Concerning the emergence process, models tackle each process: spread or outbreak. Only a few spread models describe jointly dispersal, growth, and establishment capabilities of native species while some mechanistic models describe the population temporal dynamics and inference models describe the probability of outbreak. We also discuss the ways to quantify uncertainty and the role of machine learning. Overall, promising directions are to increase the models’ genericity by parameterization based on meta-analysis techniques to combine the effect of species traits and various environmental drivers. Further perspectives consist in considering the models’ interconnection, including the assessment of the economic impact and risk mitigation options, as well as the possibility of having multi-risks and the reduction in uncertainty by collecting larger fit-for-purpose datasets.

Assurance for clinical trial design with normally distributed outcomes: Eliciting uncertainty about variances

The assurance method is growing in popularity in clinical trial planning. The method involves eliciting a prior distribution for the treatment effect, and then calculating the probability that a proposed trial will produce a "successful" outcome. For normally distributed observations, uncertainty about the variance of the normal distribution also needs to be accounted for, but there is little guidance in the literature on how to elicit a distribution for a variance parameter. We present a simple elicitation method, and illustrate how the elicited distribution is incorporated within an assurance calculation. We also consider multi-stage trials, where a decision to proceed with a larger trial will follow from the outcome of a smaller trial; we illustrate the role of the elicited distribution in assessing the information provided by a proposed smaller trial. Free software is available for implementing our methods.

Health Opportunity Costs: Assessing the Implications of Uncertainty Using Elicitation Methods with Experts

Well-established methods of economic evaluation are used in many countries to inform decisions about the funding of new medical interventions. To guide such decisions, it is important to consider what health gains would be expected from the same level of investment elsewhere in the health care system. Recent research in the United Kingdom has evaluated the evidence available and the methods required to estimate the health effects of changes in health care expenditure within the National Health Service. Because of the absence of sufficiently broad-ranging data, assumptions were required in the previously mentioned work to estimate health effects in terms of a broader measure of health (quality-adjusted life-years), which is more relevant for policy. These assumptions constitute important sources of uncertainty. This work presents an application of the structured elicitation of the judgments of key individuals about these uncertain quantities. This article describes the design and conduct of the exercise, including the quantities elicited, the individual (rather than consensus) approach used, how uncertainty in knowledge was elicited (mode and bounds of an 80% credible interval), and methods to generate group estimates. It also reports on a successful application involving 28 clinical experts and 25 individuals with policy responsibilities. Although, as expected, most experts found replying to the questions challenging, they were able to express their beliefs quantitatively. Consistent across the uncertainties elicited, experts' judgments suggest that the quality-adjusted life-year (QALY) impacts of changes in expenditure from earlier work using assumptions are likely to have been underestimated and the "central" estimate of health opportunity cost from that work (£12,936 per QALY) to have been overestimated.

Impact of Xylella fastidiosa subspecies pauca in European olives

Xylella fastidiosa is the causal agent of plant diseases that cause massive economic damage. In 2013, a strain of the bacterium was, for the first time, detected in the European territory (Italy), causing the Olive Quick Decline Syndrome. We simulate future spread of the disease based on climatic-suitability modeling and radial expansion of the invaded territory. An economic model is developed to compute impact based on discounted foregone profits and losses in investment. The model projects impact for Italy, Greece, and Spain, as these countries account for around 95% of the European olive oil production. Climatic suitability modeling indicates that, depending on the suitability threshold, 95.5 to 98.9%, 99.2 to 99.8%, and 84.6 to 99.1% of the national areas of production fall into suitable territory in Italy, Greece, and Spain, respectively. For Italy, across the considered rates of radial range expansion the potential economic impact over 50 y ranges from 1.9 billion to 5.2 billion Euros for the economic worst-case scenario, in which production ceases after orchards die off. If replanting with resistant varieties is feasible, the impact ranges from 0.6 billion to 1.6 billion Euros. Depending on whether replanting is feasible, between 0.5 billion and 1.3 billion Euros can be saved over the course of 50 y if disease spread is reduced from 5.18 to 1.1 km per year. The analysis stresses the necessity to strengthen the ongoing research on cultivar resistance traits and application of phytosanitary measures, including vector control and inoculum suppression, by removing host plants.

Update and review of control options for Campylobacter in broilers at primary production

The 2011 EFSA opinion on Campylobacter was updated using more recent scientific data. The relative risk reduction in EU human campylobacteriosis attributable to broiler meat was estimated for on-farm control options using Population Attributable Fractions (PAF) for interventions that reduce Campylobacter flock prevalence, updating the modelling approach for interventions that reduce caecal concentrations and reviewing scientific literature. According to the PAF analyses calculated for six control options, the mean relative risk reductions that could be achieved by adoption of each of these six control options individually are estimated to be substantial but the width of the confidence intervals of all control options indicates a high degree of uncertainty in the specific risk reduction potentials. The updated model resulted in lower estimates of impact than the model used in the previous opinion. A 3-log10 reduction in broiler caecal concentrations was estimated to reduce the relative EU risk of human campylobacteriosis attributable to broiler meat by 58% compared to an estimate larger than 90% in the previous opinion. Expert Knowledge Elicitation was used to rank control options, for weighting and integrating different evidence streams and assess uncertainties. Medians of the relative risk reductions of selected control options had largely overlapping probability intervals, so the rank order was uncertain: vaccination 27% (90% probability interval (PI) 4-74%); feed and water additives 24% (90% PI 4-60%); discontinued thinning 18% (90% PI 5-65%); employing few and well-trained staff 16% (90% PI 5-45%); avoiding drinkers that allow standing water 15% (90% PI 4-53%); addition of disinfectants to drinking water 14% (90% PI 3-36%); hygienic anterooms 12% (90% PI 3-50%); designated tools per broiler house 7% (90% PI 1-18%). It is not possible to quantify the effects of combined control activities because the evidence-derived estimates are inter-dependent and there is a high level of uncertainty associated with each.

Cumulative dietary risk characterisation of pesticides that have chronic effects on the thyroid

A retrospective chronic cumulative risk assessment of dietary exposure to pesticide residues, supported by an uncertainty analysis based on expert knowledge elicitation, was conducted for two effects on the thyroid, hypothyroidism and parafollicular cell (C-cell) hypertrophy, hyperplasia and neoplasia. The pesticides considered in this assessment were identified and characterised in the scientific report on the establishment of cumulative assessment groups of pesticides for their effects on the thyroid. Cumulative exposure assessments were conducted through probabilistic modelling by EFSA and the Dutch National Institute for Public Health and the Environment (RIVM) using two different software tools and reported separately. These exposure assessments used monitoring data collected by Member States under their official pesticide monitoring programmes in 2014, 2015 and 2016 and individual consumption data from 10 populations of consumers from different countries and different age groups. This report completes the characterisation of cumulative risk, taking account of the available data and the uncertainties involved. For each of the 10 populations, it is concluded with varying degrees of certainty that cumulative exposure to pesticides that have the chronic effects on the thyroid mentioned above does not exceed the threshold for regulatory consideration established by risk managers.

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

INTRODUCTION

Food insecurity is associated with increased risk for several health conditions and with poor chronic disease management. Key determinants for household food insecurity are income and food costs. Whereas short-term household incomes are likely to remain static, increased food prices would be a significant driver of food insecurity.

OBJECTIVES

To investigate food price drivers for household food security and its health consequences in the UK under scenarios of Deal and No-deal for Britain's exit from the European Union. To estimate the 5% and 95% quantiles of the projected price distributions.

DESIGN

Structured expert judgement elicitation, a well-established method for quantifying uncertainty, using experts. In July 2018, each expert estimated the median, 5% and 95% quantiles of changes in price for 10 food categories under Brexit Deal and No-deal to June 2020 assuming Brexit had taken place on 29 March 2019. These were aggregated based on the accuracy and informativeness of the experts on calibration questions.

PARTICIPANTS

Ten specialists with expertise in food procurement, retail, agriculture, economics, statistics and household food security.

RESULTS

When combined in proportions used to calculate Consumer Price Index food basket costs, median food price change for Brexit with a Deal is expected to be +6.1% (90% credible interval -3% to +17%) and with No-deal +22.5% (90% credible interval +1% to +52%).

CONCLUSIONS

The number of households experiencing food insecurity and its severity is likely to increase because of expected sizeable increases in median food prices after Brexit. Higher increases are more likely than lower rises and towards the upper limits, these would entail severe impacts. Research showing a low food budget leads to increasingly poor diet suggests that demand for health services in both the short and longer terms is likely to increase due to the effects of food insecurity on the incidence and management of diet-sensitive conditions.

A retain and refine approach to cumulative risk assessment

Mixtures of substances to which humans are exposed may lead to cumulative exposure and health effects. To study their effects, it is first necessary to identify a cumulative assessment group (CAG) of substances for risk assessment or hazard testing. Excluding substances from consideration before there is sufficient evidence may underestimate the risk. Conversely, including everything and treating the inevitable uncertainties using conservative assumptions is inefficient and may overestimate the risk, with an unknown level of protection. An efficient, transparent strategy is described to retain a large group, quantifying the uncertainty of group membership and other uncertainties. Iterative refinement of the CAG then focuses on adding information for the substances with high probability of contributing significantly to the risk. Probabilities can be estimated using expert opinion or derived from data on substance properties. An example is presented with 100 pesticides, in which the retain step identified a single substance to target refinement. Using an updated hazard characterisation for this substance reduced the mean exposure estimate from 0.43 to 0.28 μg kg-bw^-1 day^-1 and reduced the 99.99th percentile exposure from 24.9 to 5.1 μg kg-bw^-1 day^-1. Other retained substances contributed little to the risk estimates, even after accounting for uncertainty.

Health and welfare of rabbits farmed in different production systems

The AGRI committee of the European Parliament requested EFSA to assess the welfare of rabbits farmed in different production systems, including organic production, and to update its 2005 scientific opinion about the health and welfare of rabbits kept for meat production. Considering reproducing does, kits and growing rabbits, this scientific opinion focusses on six different housing systems, namely conventional cages, structurally enriched cages, elevated pens, floor pens, outdoor/partially outdoor systems and organic systems. To compare the level of welfare in the different housing systems and rabbit categories, welfare impact scores for 20 welfare consequences identified from the literature were calculated, taking their occurrence, duration and severity into account. Based on the overall welfare impact score (sum of scores for the single welfare consequences), obtained via a 2‐step expert knowledge elicitation process, the welfare of reproducing does is likely (certainty 66–90%) to be lower in conventional cages compared to the five other housing systems. In addition, it is likely to extremely likely (certainty 66–99%) that the welfare of kits is lower in outdoor systems compared to the other systems and that the welfare is higher in elevated pens than in the other systems. Finally, it is likely to extremely likely (certainty 66–99%) that the welfare of growing rabbits is lower in conventional cages compared to the other systems and that the welfare is higher in elevated pens than in the other systems. Ranking of the welfare consequences allowed an analysis of the main welfare consequences within each system and rabbit category. It was concluded that for reproducing does, as well as growing rabbits, welfare consequences related to behavioural restrictions were more prominent in conventional cages, elevated pens and enriched cages, whereas those related to health problems were more important in floor pens, outdoor and organic systems. Housing in organic rabbit farming is diverse, which can result in different welfare consequences, but the overall welfare impact scores suggest that welfare in organic systems is generally good.