A qualitative study into the difficulties experienced by healthcare decision makers when reading a Cochrane diagnostic test accuracy review.

Published onlineResearch Support, Non-U.S. Gov'tBACKGROUND: Cochrane reviews are one of the best known and most trusted sources of evidence-based information in health care. While steps have been taken to make Cochrane intervention reviews accessible to a diverse readership, little is known about the accessibility of the newcomer to the Cochrane library: diagnostic test accuracy reviews (DTARs). The current qualitative study explored how healthcare decision makers, who varied in their knowledge and experience with test accuracy research and systematic reviews, read and made sense of DTARs. METHODS: A purposive sample of clinicians, researchers and policy makers (n = 21) took part in a series of think-aloud interviews, using as interview material the first three DTARs published in the Cochrane library. Thematic qualitative analysis of the transcripts was carried out to identify patterns in participants' 'reading' and interpretation of the reviews and the difficulties they encountered. RESULTS: Participants unfamiliar with the design and methodology of DTARs found the reviews largely inaccessible and experienced a range of difficulties stemming mainly from the mismatch between background knowledge and level of explanation provided in the text. Experience with systematic reviews of interventions did not guarantee better understanding and, in some cases, led to confusion and misinterpretation. These difficulties were further exacerbated by poor layout and presentation, which affected even those with relatively good knowledge of DTARs and had a negative impact not only on their understanding of the reviews but also on their motivation to engage with the text. Comparison between the readings of the three reviews showed that more accessible presentation, such as presenting the results as natural frequencies, significantly increased participants' understanding. CONCLUSIONS: The study demonstrates that authors and editors should pay more attention to the presentation as well as the content of Cochrane DTARs, especially if the reports are aimed at readers with various levels of background knowledge and experience. It also raises the question as to the anticipated target audience of the reports and suggests that different groups of healthcare decision-makers may require different modes of presentation.RG is partially supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula and by the European Regional Development Fund and the European Social Fund Convergence Program for Cornwall and the Isles of Scilly. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health in England, or the European Union

Effect of post processing on the creep performance of laser powder bed fused Inconel 718

In this study, the creep performance of laser powder bed fusion manufactured Inconel 718 specimens is studied in detail and compared with conventional hot-rolled specimens alongside as-built then heat-treated and as-built then hot-isostatic pressed specimens. Hot-rolled specimens showed the best creep resistance, while the hot-isostatic pressed specimens yielded the worst performance, inferior to the as-built condition. Creep testing of all samples showed increased secondary creep rate was consistently correlated with a reduced life. Fractography revealed intergranular fracture was the primary failure mode for all as-built samples. Preferential intergranular precipitation in the case of the hot-isostatic pressed specimens during hot-isostatic pressing extensive intergranular cracking as the primary failure mechanism. Heat-treated specimens possessed only sparse intergranular precipitates, thereby explaining an improved creep lifetime. The hot-rolled specimens, having smallest grain size, showed the least extensive cracking, particularly in locations of finest grains, explaining avoidance of intergranular fracture as a key creep mechanism, thereby explaining the ductile creep fracture surfaces in the case of the hot-rolled samples

C-Type Natriuretic Peptide (CNP) Inhibition of Interferon-γ-Mediated Gene Expression in Human Endothelial Cells In Vitro

Cardiovascular diseases, including atherosclerosis, now account for more deaths in the Western world than from any other cause. Atherosclerosis has a chronic inflammatory component involving Th1 pro-inflammatory cytokines such as IFN-γ, which is known to induce endothelial cell inflammatory responses. On the other hand CNP, which acts via its receptors to elevate intracellular cGMP, is produced by endothelium and endocardium and is upregulated in atherosclerosis. It is believed to be protective, however its role in vascular inflammation is not well understood. The aim of this study was to investigate the effects of CNP on human endothelial cell inflammatory responses following IFN-γ stimulation. Human umbilical vein endothelial cells were treated with either IFN-γ (10 ng/mL) or CNP (100 nm), or both in combination, followed by analysis by flow cytometry for expression of MHC class I and ICAM-1. IFN-γ significantly increased expression of both molecules, which was significantly inhibited by CNP or the cGMP donor 8-Bromoguanosine 3’,5’-cyclic monophosphate (1 µm). CNP also reduced IFN-γ mediated kynurenine generation by the IFN-γ regulated enzyme indoleamine-2,3-deoxygenase (IDO). We conclude that CNP downmodulates IFN-γ induced pro-inflammatory gene expression in human endothelial cells via a cGMP-mediated pathway. Thus, CNP may have a protective role in vascular inflammation and novel therapeutic strategies for CVD based on upregulation of endothelial CNP expression could reduce chronic EC inflammation

Measurement of Parity-Violating Asymmetry in Electron-Deuteron Inelastic Scattering

The parity-violating asymmetries between a longitudinally polarized electron beam and an unpolarized deuterium target have been measured recently. The measurement covered two kinematic points in the deep-inelastic scattering region and five in the nucleon resonance region. We provide here details of the experimental setup, data analysis, and results on all asymmetry measurements including parity-violating electron asymmetries and those of inclusive pion production and beam-normal asymmetries. The parity-violating deep-inelastic asymmetries were used to extract the electron-quark weak effective couplings, and the resonance asymmetries provided the first evidence for quark-hadron duality in electroweak observables. These electron asymmetries and their interpretation were published earlier, but are presented here in more detail

The effect of thermophoresis on the discharge parameters in complex plasma experiments

Thermophoresis is a tool often applied in complex plasma experiments. One of the usual stated benefits over other experimental tools is that changes induced by thermophoresis neither directly depend on, nor directly influence, the plasma parameters. From electronic data, plasma emission profiles in the sheath, and Langmuir probe data in the plasma bulk, we conclude that this assumption does not hold. An important effect on the levitation of dust particles in argon plasma is observed as well. The reason behind the changes in plasma parameters seems to be the change in neutral atom density accompanying the increased gas temperature while running at constant pressure.Comment: 14 pages, 12 figure

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma‑induced coagulopathy in adult trauma patients with bleeding

This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2015, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.Trauma-induced coagulopathy (TIC) is a disorder of the blood clotting process that occurs soon after trauma injury. A diagnosis of TIC on admission is associated with increased mortality rates, increased burdens of transfusion, greater risks of complications and longer stays in critical care. Current diagnostic testing follows local hospital processes and normally involves conventional coagulation tests including prothrombin time ratio/international normalized ratio (PTr/INR), activated partial prothrombin time and full blood count. In some centres, thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are standard tests, but in the UK they are more commonly used in research settings

Diagnostic accuracy of single baseline measurement of Elecsys Troponin T high-sensitive assay for diagnosis of acute myocardial infarction in emergency department: systematic review and meta-analysis

Published onlineJournal ArticleMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewOBJECTIVE: To obtain summary estimates of the accuracy of a single baseline measurement of the Elecsys Troponin T high-sensitive assay (Roche Diagnostics) for the diagnosis of acute myocardial infarction in patients presenting to the emergency department. DESIGN: Systematic review and meta-analysis of diagnostic test accuracy studies. DATA SOURCES: Medline, Embase, and other relevant electronic databases were searched for papers published between January 2006 and December 2013. STUDY SELECTION: Studies were included if they evaluated the diagnostic accuracy of a single baseline measurement of Elecsys Troponin T high-sensitive assay for the diagnosis of acute myocardial infarction in patients presenting to the emergency department with suspected acute coronary syndrome. STUDY APPRAISAL AND DATA SYNTHESIS: The first author screened all titles and abstracts identified through the searches and selected all potentially relevant papers. The screening of the full texts, the data extraction, and the methodological quality assessment, using the adapted QUADAS-2 tool, were conducted independently by two reviewers with disagreements being resolved through discussion or arbitration. If appropriate, meta-analysis was conducted using the hierarchical bivariate model. RESULTS: Twenty three studies reported the performance of the evaluated assay at presentation. The results for 14 ng/L and 3-5 ng/L cut-off values were pooled separately. At 14 ng/L (20 papers), the summary sensitivity was 89.5% (95% confidence interval 86.3% to 92.1%) and the summary specificity was 77.1% (68.7% to 83.7%). At 3-5 ng/L (six papers), the summary sensitivity was 97.4% (94.9% to 98.7%) and the summary specificity was 42.4% (31.2% to 54.5%). This means that if 21 of 100 consecutive patients have the target condition (21%, the median prevalence across the studies), 2 (95% confidence interval 2 to 3) of 21 patients with acute myocardial infarction will be missed (false negatives) if 14 ng/L is used as a cut-off value and 18 (13 to 25) of 79 patients without acute myocardial infarction will test positive (false positives). If the 3-5 ng/L cut-off value is used, <1 (0 to 1) patient with acute myocardial infarction will be missed and 46 (36 to 54) patients without acute myocardial infarction will test positive. CONCLUSIONS: The results indicate that a single baseline measurement of the Elecsys Troponin T high-sensitive assay could be used to rule out acute myocardial infarction if lower cut-off values such as 3 ng/L or 5 ng/L are used. However, this method should be part of a comprehensive triage strategy and may not be appropriate for patients who present less than three hours after symptom onset. Care must also be exercised because of the higher imprecision of the evaluated assay and the greater effect of lot-to-lot reagent variation at low troponin concentrations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42013003926.This research was funded by the South West Academic Health Science Network (AHSN) and the National Institute for Health Research (NIHR) Collaboration for Leadership for Applied Health Research and Care for the South West Peninsula

The Cross-Section Measurement for the \u3csup\u3e3\u3c/sup\u3eH (e, e\u27, K\u3csup\u3e+\u3c/sup\u3e) nnΛ Reaction

The small binding energy of the hypertriton leads to predictions of the non-existence of bound hypernuclei for isotriplet three-body systems such as nnΛ. However, invariant mass spectroscopy at GSI has reported events that may be interpreted as the bound nnΛ state. The nnΛ state was sought by missing-mass spectroscopy via the (e, e′K+) reaction at Jefferson Lab’s experimental Hall A. The present experiment has higher sensitivity to the nnΛ-state investigation in terms of better precision by a factor of about three. The analysis shown in this article focuses on the derivation of the reaction cross-section for the 3H(γ*, K+)X reaction. Events that were detected in an acceptance, where a Monte Carlo simulation could reproduce the data well (⁠ƍp/p⎮ \u3c 4%), were analyzed to minimize the systematic uncertainty. No significant structures were observed with the acceptance cuts, and the upper limits of the production cross-section of the nnΛ state were obtained to be 21 and 31nbsr-1 at the 90% confidence level when theoretical predictions of (−BΛ, Γ) = (0.25, 0.8) MeV and (0.55, 4.7) MeV, respectively, were assumed. The cross-section result provides valuable information for examining the existence of nnΛ

Spectroscopic Study of a Possible Λ Resonance and a Pair of (e, e\u27K⁺) Reaction With a Tritium Target

A mass spectroscopy experiment with a pair of nearly identical high-resolution spectrometers and a tritium target was performed in Hall A at Jefferson Lab. Utilizing the (e,e′K+) reaction, enhancements, which may correspond to a possible Λnn resonance and a pair of ΣNN states, were observed with an energy resolution of about 1.21 MeV (σ), although greater statistics are needed to make definitive identifications. An experimentally measured Λnn state may provide a unique constraint in determining the Λn interaction, for which no scattering data exist. In addition, although bound A = 3 and 4 Σ hypernuclei have been predicted, only an A=4 Σ hypernucleus (4ΣHe) was found, utilizing the (K−,π−) reaction on a 4He target. The possible bound ΣNN state is likely a Σ⁰nn state, although this has to be confirmed by future experiments