Impact of COVID-19 on management of urogynaecology patients: a rapid review of the literature.

INTRODUCTION AND HYPOTHESIS: The coronavirus (COVID-19) pandemic has impacted health systems worldwide. There is a continuing need for clinicians to adapt practice to facilitate timely provision of medical care, whilst minimising horizontal transmission. Guidance and recommendations are increasingly available, and this rapid review aimed to provide a timely evidence synthesis on the current recommendations surrounding urogynaecological care. METHODS: We performed a literature review using PubMed/Medline, Embase and Cochrane and a manual search of national and international societies for management recommendations for urogynaecological patients during the COVID-19 pandemic. RESULTS: Nine guidance documents and 17 articles, including 10 reviews, were included. Virtual clinics are recommended for new and follow-up patients, to assess and initiate treatment, as well as triage patients who require face-to-face appointments. Outpatient investigations such as urodynamics and cystoscopy for benign indications can be deferred. Prolapse and continence surgery should be suspended, except in specific circumstances such as procidentia with upper tract complications and failed pessaries. There is no evidence to support a particular route of surgery, but recommendations are made to minimise COVID-19 transmission. CONCLUSIONS: Urogynaecological patients face particular challenges owing to inherent vulnerabilities of these populations. Behavioural and medical therapies should be recommended as first line options and initiated via virtual or remote clinics, which are integral to management during the COVID-19 pandemic. Expanding the availability and accessibility of technology will be increasingly required. The majority of outpatient and inpatient procedures can be deferred, but the longer-term effects of such practices are unclear

Statistical Pattern Recognition: Application to νμ→ντ\nu_{\mu}\to\nu_{\tau} Oscillation Searches Based on Kinematic Criteria

Classic statistical techniques (like the multi-dimensional likelihood and the Fisher discriminant method) together with Multi-layer Perceptron and Learning Vector Quantization Neural Networks have been systematically used in order to find the best sensitivity when searching for $\nu_\mu \to \nu_{\tau}$ oscillations. We discovered that for a general direct $\nu_\tau$ appearance search based on kinematic criteria: a) An optimal discrimination power is obtained using only three variables ($E_{visible}$, $P_{T}^{miss}$ and $\rho_{l}$) and their correlations. Increasing the number of variables (or combinations of variables) only increases the complexity of the problem, but does not result in a sensible change of the expected sensitivity. b) The multi-layer perceptron approach offers the best performance. As an example to assert numerically those points, we have considered the problem of $\nu_\tau$ appearance at the CNGS beam using a Liquid Argon TPC detector.Comment: 24 pages, 15 figure

A systematic review highlighting poor quality of evidence for content validity of quality of life instruments in female chronic pelvic pain.

OBJECTIVES: To evaluate the content validity of 19 patient-reported outcome measures (PROMs) used to measure quality of life (QoL) in women with chronic pelvic pain (CPP). STUDY DESIGN AND SETTING: We searched Embase, MEDLINE, PsycINFO databases and Google Scholar from inception to August 2020. We included records describing the development or studies assessing content validity of PROMs. Two reviewers independently assessed the methodological quality of PROMs using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Evidence was synthesized for relevance, comprehensiveness, and comprehensibility. Quality of evidence was rated using a modified Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS: PROM development was inadequate for all instruments included in this review. No high-quality evidence ratings were found for relevance, comprehensiveness, and comprehensibility. QoL was measured using generic instruments (68.42%, 13/19) rather than those specific to chronic pain (21.04%, 4/19) or pelvic pain (10.53%, 2/19). Quality of concept elicitation was inadequate for 90% of PROMs. Half of PROMs did not include patients in their development and only 40% were devised using a sample representative of the target population for which the PROM was developed. Cognitive interviews were conducted in one-fifth of PROMs and were mostly of inadequate/doubtful quality. CONCLUSION: There is poor quality of evidence for content validity of PROMs used to measure QoL in women with CPP

A meta-synthesis of qualitative literature on female chronic pelvic pain for the development of a core outcome set: a systematic review.

INTRODUCTION AND HYPOTHESIS: Qualitative research has an increasing role in the development of core outcome sets (COS) adding patient perspectives to the considerations of core outcomes. We aimed to identify priorities of women with experience of chronic pelvic pain (CPP). METHODS: The search strategy was a systematic review of qualitative studies identified from Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, MEDLINE and PsycInfo databases. Selection criteria were qualitative studies exploring the experience of women with CPP. Two independent researchers extracted data and summarized findings using thematic analysis. A CERQual assessment was performed to assess the confidence of review findings. RESULTS: We identified pertinent issues affecting women with CPP including the lack of holistic care, influence of psychosocial factors and the impact of pain on quality of life. Five meta-themes central to delivering a patient-centred approach were highlighted: acceptance of pain, quality of life, management of CPP, communication and support. Management of CPP was the most commonly reported meta-theme across seven studies and half of studies reported quality of life, management, communication and support. Quality appraisal of included studies identified only a single study that met all CASP (Critical Appraisal Skills Programme) criteria. There was high confidence in the evidence for acceptance of pain, quality of life and communication meta-themes. CONCLUSION: Meta-themes revealed by this review should be considered as a priority and reflected in outcomes reported by future studies evaluating interventions for CPP. In addition, these themes should be considered by clinicians managing women with CPP

Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument.

INTRODUCTION AND HYPOTHESIS: Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP. METHODS: We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations. RESULTS: Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the "Applicability", "Editorial Independence" and "Stakeholder Involvement" domains. CONCLUSION: Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development

Modeling power corrections to the Bjorken sum rule for the neutrino structure function F_1

Direct measurements of the the structure functions F_1^{nu p} and F_1^{nu n} at a neutrino factory would allow for an accurate extraction of alpha_s from the Q^2-dependence of the Bjorken sum rule, complementing that based on the Gross-Llewellyn-Smith sum rule for F_3. We estimate the power (1/Q^2-) corrections to the Bjorken sum rule in the instanton vacuum model. For the reduced matrix element of the flavor-nonsinglet twist-4 operator ubar_g_Gdual_gamma_gamma5_u - (u -> d) we obtain a value of 0.18 GeV^2, in good agreement with the QCD sum rule calculations of Braun and Kolesnichenko. Our result allows to reduce the theoretical error in the determination of alpha_s.Comment: 3 pages, 1 figure, uses iopart.cls. Proceedings of the 4th NuFact'02 Workshop "Neutrino Factories based on Muon Storage Rings", Imperial College, London, July 1-6, 200

Electron/pion separation with an Emulsion Cloud Chamber by using a Neural Network

We have studied the performance of a new algorithm for electron/pion separation in an Emulsion Cloud Chamber (ECC) made of lead and nuclear emulsion films. The software for separation consists of two parts: a shower reconstruction algorithm and a Neural Network that assigns to each reconstructed shower the probability to be an electron or a pion. The performance has been studied for the ECC of the OPERA experiment [1]. The $e/\pi$ separation algorithm has been optimized by using a detailed Monte Carlo simulation of the ECC and tested on real data taken at CERN (pion beams) and at DESY (electron beams). The algorithm allows to achieve a 90% electron identification efficiency with a pion misidentification smaller than 1% for energies higher than 2 GeV

Quality assessment of outcome reporting, publication characteristics and overall methodological quality in trials on synthetic mesh procedures for the treatment of pelvic organ prolapse for development of core outcome sets.

INTRODUCTION AND HYPOTHESIS: Variations in outcome measures and reporting of outcomes in trials on surgery for pelvic organ prolapse (POP) using synthetic mesh have been evaluated and reported. However, the quality of outcome reporting, methodology of trials and their publication parameters are important considerations in the process of development of Core Outcome Sets. We aimed to evaluate these characteristics in randomized controlled trials on surgery for POP using mesh. METHODS: Secondary analysis of randomized controlled trials on surgical treatments using synthetic mesh for POP previously included in a systematic review developing an inventory of reported outcomes and outcome measures. The methodological quality was investigated with the modified Jadad criteria. Outcome reporting quality was evaluated with the MOMENT criteria. Publication parameters included publishing journal, impact factor and year of publication. RESULTS: Of the 71 previously reviewed studies published from 2000 to 2017, the mean JADAD score was 3.59 and the mean MOMENT score was 4.63. Quality of outcomes (MOMENT) was related to methodological quality (JADAD) (rho = 0.662; p = 0.000) and to year of publication (rho = 0.262; p = 0.028). CONCLUSIONS: Methodological quality and outcome reporting quality appear correlated. However, publication characteristics do not have strong associations with the methodological quality of the studies. Evaluation of the quality of outcomes, methodology and publication characteristics are all an indispensable part of a staged process for the development of Core Outcome and Outcome Measure Sets

The detection of neutrino interactions in the emulsion/lead target of the OPERA experiment

The OPERA neutrino detector in the underground Gran Sasso Laboratory (LNGS) was designed to perform the first detection of neutrino oscillations in appearance mode through the study of $\nu_\mu\to\nu_\tau$ oscillations. The apparatus consists of an emulsion/lead target complemented by electronic detectors and it is placed in the high energy long-baseline CERN to LNGS beam (CNGS) 730 km away from the neutrino source. Runs with CNGS neutrinos were successfully carried out in 2007 and 2008 with the detector fully operational with its related facilities for the emulsion handling and analysis. After a brief description of the beam and of the experimental setup we report on the collection, reconstruction and analysis procedures of first samples of neutrino interaction events