Development and implementation of clinical practice guidelines: An update and synthesis of the literature with a focus in application to spinal conditions

Study Design:Review.Objectives:The objectives of this review are to (a) summarize the role of clinical practice guidelines (CPGs), (b) outline the methodology involved in formulating CPGs, (c) provide an illustration of these principles using a CPG developed for degenerative cervical myelopathy, and (d) highlight the importance of knowledge translation.Methods:A review of the literature was conducted to summarize current standards in CPG development and implementation.Results:CPGs are systematically developed statements intended to affect decisions made by health care providers, policy makers, and patients. The main objectives of CPGs are to synthesize and translate evidence into recommendations, optimize patient outcomes, standardize care, and facilitate shared decision making among physicians, patients, and their caregivers. The main steps involved in the development of CPGs include defining the clinical problem, assembling a multidisciplinary guideline development group and systematic review team, conducting a systematic review of the literature, translating the evidence to recommendations, critically appraising the CPG and updating the document when new studies arise. The final step in developing a CPG is to implement it into clinical practice; this step requires an assessment of the barriers to implementation and the formulation of effective dissemination strategies.Conclusion:CPGs are an important component in the teaching and practice of medicine and are available for a wide spectrum of diseases. CPGs, however, can only be used to influence clinical practice if the recommendations are informed by a systematic review of the literature and developed using rigorous methodology. The opportunity to transform clinical management of spinal conditions is an attractive outcome of the application of high-quality CPGs

Metabolomic Characterization of Human Rectal Adenocarcinoma with Intact Tissue Magnetic Resonance Spectroscopy

PURPOSE: This study was designed to test whether metabolic characterization of intact, unaltered human rectal adenocarcinoma specimens is possible using the high-resolution magic angle spinning proton (1H) magnetic resonance spectroscopy technique. METHODS: The study included 23 specimens from five patients referred for ultrasonographic staging of suspected rectal cancer. Multiple biopsies of macroscopically malignant rectal tumors and benign rectal mucosa were obtained from each patient for a total of 14 malignant and 9 benign samples. Unaltered tissue samples were spectroscopically analyzed. Metabolic profiles were established from the spectroscopy data and correlated with histopathologic findings. RESULTS: Metabolomic profiles represented by principle components of metabolites measured from spectra differentiated between malignant and benign samples and correlated with the volume percent of cancer (P = 0.0065 and P = 0.02, respectively) and benign epithelium (P = 0.0051 and P = 0.0255, respectively), and with volume percent of stroma, and inflammation. CONCLUSIONS: Magnetic resonance spectroscopy of rectal biopsies has the ability to metabolically characterize samples and differentiate between pathological features of interest. Future studies should determine its utility in in vivo applications for non-invasive pathologic evaluations of suspicious rectal lesions

The Texas Feral Swine Eradication and Control Pilot Program

The Agriculture Improvement Act of 2018 (the 2018 Farm Bill) established the Feral Swine Eradication and Control Pilot Program. The program funded $75M for 5 years, split evenly between the Natural Resources Conservation Service (NRCS) and the Animal and Plant Health Inspection Service (APHIS), both programs within the US Department of Agriculture. The agencies solicited joint programs from states with high densities of feral swine in two phases. In Texas, NRCS and APHIS submitted three multi-county project areas along watersheds for Phase I funding and one eradication effort along with two crop protection projects in Phase II. The eradication project was adjacent to a Phase I project area and after extensive surveillance, it was determined to be successful, the first such project in Texas. All the remaining projects were designed with a direct management effort, a self-help effort through trap loans and a damage assessment process. Landowner in-kind contributions were identified and captured to detail the effects of the program

Almost a spider: a 305-million-year-old fossil arachnid and spider origins

Spiders are an important animal group, with a long history. Details of their origins remain limited, with little knowledge of their stem group, and no insights into the sequence of character acquisition during spider evolution. We describe a new fossil arachnid, Idmonarachne brasieri gen. et sp. nov. from the Late Carboniferous (Stephanian, ca 305–299 Ma) of Montceau-les-Mines, France. It is three-dimensionally preserved within a siderite concretion, allowing both laboratory- and synchrotron-based phase-contrast computed tomography reconstruction. The latter is a first for siderite-hosted fossils and has allowed us to investigate fine anatomical details. Although distinctly spider-like in habitus, this remarkable fossil lacks a key diagnostic character of Araneae: spinnerets on the underside of the opisthosoma. It also lacks a flagelliform telson found in the recently recognized, spider-related, Devonian–Permian Uraraneida. Cladistic analysis resolves our new fossil as sister group to the spiders: the spider stem-group comprises the uraraneids and I. brasieri. While we are unable to demonstrate the presence of spigots in this fossil, the recovered phylogeny suggests the earliest character to evolve on the spider stem-group is the secretion of silk. This would have been followed by the loss of a flagelliform telson, and then the ability to spin silk using spinnerets. This last innovation defines the true spiders, significantly post-dates the origins of silk, and may be a key to the group's success. The Montceau-les-Mines locality has previously yielded a mesothele spider (with spinnerets). Evidently, Late Palaeozoic spiders lived alongside Palaeozoic arachnid grades which approached the spider condition, but did not express the full suite of crown-group autapomorphies

The Covid Sex Lives Project: Health Messaging, Hooking Up And Dating Among Men Who Have Sex With Men During The UK COVID-19 Pandemic

In the context of the pandemic, government and public health measures to mitigate the spread of coronavirus have been translated into media messaging by organisations that target the health of different groups. Engaging experiences of the minority group, men who have sex with men (MSM), we provide evidence on the approaches and responses to these messages in relation to using digital platforms to connect for sexual purposes.Dating and hookup applications, or apps, are a key area where sex and romance has been negotiated over the past two decades, a trend which continued during the pandemic. MSM are an ideal group to look atthe challenges posed here as they have been early adopters of these technologies for a variety of purposes, including the obvious ones related to dating and hooking up as well as for increasing more general sociality and reducing loneliness.Due to this culture of engagement with digital media by MSM, and whatis known about their sexual cultures, digital platforms have been engaged by health educators in an attempt to improve the sexual health and wellbeing of this group. The question in the context of a pandemic therefore becomes: how are these sexual cultures affected, and how might health messaging be engaged with, or not

Bioenergetic Abnormalities Associated with Severe Left Ventricular Hypertrophy

Abstract Transmurally localized 31P-nuclear magnetic resonance spectroscopy (NMR) was used to study the effect of severe pressure overload left ventricular hypertrophy (LVH) on myocardial high energy phosphate content. Studies were performed on 8 normal dogs and 12 dogs with severe left ventricular hypertrophy produced by banding the ascending aorta at 8 wk of age. Spatially localized 31P-NMR spectroscopy provided measurements of the transmural distribution of myocardial ATP, phosphocreatine (CP), and inorganic phosphate (Pi); spectra were calibrated from measurements of ATP content in myocardial biopsies using HPLC. Blood flow was measured with microspheres. In hypertrophied hearts during basal conditions, ATP was decreased by 42%, CP by 58%, and the CP/ATP ratio by 32% in comparison with normal. Increasing myocardial blood flow with adenosine did not correct these abnormalities, indicating that they were not the result of persistent hypoperfusion. Atrial pacing at 200 and 240 beats per min caused no change in high energy phosphate content in normal hearts but resulted in further CP depletion with Pi accumulation in the inner left ventricular layers of the hypertrophied hearts. These changes were correlated with redistribution of blood flow away from the subendocardium in LVH hearts. These findings demonstrate that high energy phosphate levels and the CP/ATP ratio are significantly decreased in severe LVH. These abnormalities are proportional to the degree of hypertrophy but are not the result of persistent abnormalities of myocardial perfusion. In contrast, depletion of CP and accumulation of Pi during tachycardia in LVH are closely related to the pacing-induced perfusion abnormalities and likely reflect subendocardial ischemia. (J. Clin. Invest. 1993. 92:993-100

Uncovering hidden in vivo resonances using editing based on localized TOCSY

A novel single-shot spectral editing technique for in vivo proton NMR is proposed to recover resonances of low-concentration metabolites obscured by very strong resonances. With this new method, editing is performed by transferring transverse magnetization to J-coupled spins from selected coupling partners using a homonuclear Hartmann-Hahn polarization transfer with adiabatic pulses. The current implementation uses 1D-TOCSY with single-voxel localization based on LASER to recover the H1 proton of beta-glucose at 4.63 ppm from under water and the lactate methyl resonances from beneath a strong lipid signal. The method can be extended to further spin systems where conventional editing methods are difficult to perform

Adiabatic perturbation theory and geometry of periodically-driven systems

We give a systematic review of the adiabatic theorem and the leading non-adiabatic corrections in periodically-driven (Floquet) systems. These corrections have a two-fold origin: (i) conventional ones originating from the gradually changing Floquet Hamiltonian and (ii) corrections originating from changing the micro-motion operator. These corrections conspire to give a Hall-type linear response for non-stroboscopic (time-averaged) observables allowing one to measure the Berry curvature and the Chern number related to the Floquet Hamiltonian, thus extending these concepts to periodically-driven many-body systems. The non-zero Floquet Chern number allows one to realize a Thouless energy pump, where one can adiabatically add energy to the system in discrete units of the driving frequency. We discuss the validity of Floquet Adiabatic Perturbation Theory (FAPT) using five different models covering linear and non-linear few and many-particle systems. We argue that in interacting systems, even in the stable high-frequency regimes, FAPT breaks down at ultra slow ramp rates due to avoided crossings of photon resonances, not captured by the inverse-frequency expansion, leading to a counter-intuitive stronger heating at slower ramp rates. Nevertheless, large windows in the ramp rate are shown to exist for which the physics of interacting driven systems is well captured by FAPT.The authors would like to thank M. Aidelsburger, M. Atala, E. Dalla Torre, N. Goldman, M. Heyl, D. Huse, G. Jotzu, C. Kennedy, M. Lohse, T. Mori, L. Pollet, M. Rudner, A. Russomanno, and C. Schweizer for fruitful discussions. This work was supported by AFOSR FA9550-16-1-0334, NSF DMR-1506340, ARO W911NF1410540, and the Hungarian research grant OTKA Nos. K101244, K105149. M. K. was supported by Laboratory Directed Research and Development (LDRD) funding from Berkeley Lab, provided by the Director, Office of Science, of the U.S. Department of Energy under Contract No. DE-AC02-05CH11231. The authors are pleased to acknowledge that the computational work reported in this paper was performed on the Shared Computing Cluster which is administered by Boston University's Research Computing Services. The authors also acknowledge the Research Computing Services group for providing consulting support which has contributed to the results reported within this paper. The study of the driven non-integrable transverse-field Ising model was carried out using QuSpin [185] - an open-source state-of-the-art Python package for dynamics and exact diagonalization of quantum many body systems, available to download here. (FA9550-16-1-0334 - AFOSR; DMR-1506340 - NSF; W911NF1410540 - ARO; K101244 - Hungarian research grant OTKA; K105149 - Hungarian research grant OTKA; DE-AC02-05CH11231 - Laboratory Directed Research and Development (LDRD) funding from Berkeley Lab)https://arxiv.org/pdf/1606.02229.pd