Current practices and challenges in adaptation of clinical guidelines : A qualitative study based on semistructured interviews

Funding YS is funded by China Scholarship Council (No 201707040103).Altres ajuts: CSC/201707040103Objective This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. Design A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. Setting Nine guideline development organisations from seven countries. Participants Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. Results We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. Conclusions Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines

Measurements of the Electroweak Diboson Production Cross Sections in Proton-Proton Collisions at s\sqrt{s} =5.02 TeV Using Leptonic Decays

The first measurements of diboson production cross sections in proton-proton interactions at a center-of-mass energy of 5.02 TeV are reported. They are based on data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 302 pb$^{-1}$. Events with two, three, or four charged light leptons (electrons or muons) in the final state are analyzed. The WW, WZ, and ZZ total cross sections are measured as σWW=37.0$^{+5.5}$$_{-5.2}$(stat)$^{+2.7}$$_{-2.6}$(syst)  pb , σWZ=6.4$^{+2.5}$$_{-2.1}$(stat)$^{+0.5}$$_{-0.3}$(syst) pb, and σZZ=5.3$^{+2.5}$$_{-2.1}$(stat)$^{+0.5}$$_{-0.4}$(syst)  pb

Development of a new risk score for invasive cancer in branch-duct intraductal papillary mucinous neoplasms according to morphological characterization by EUS

Background and Objective: The management of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is determined by a number of guidelines. The current weight of risk factors by EUS predicting invasive cancer is unknown. The aim of this study is to develop a risk score for early prediction of invasive cancer according to morphological characterization by EUS in a surgical cohort. Materials and Methods: This is an observational, multicenter retrospective study. All consecutive patients with a histologically proven BD-IPMN who underwent previous EUS between 2005 and 2017 were included. Morphological features by EUS were evaluated. A score using a logistic regression model was performed to assess the risk of invasive cancer. Results: Of 335 patients who underwent pancreatic surgery, 131 (median age: 66 years, 50.4%-male) were included. By multivariable analysis, lymph nodes (odds ratio [OR]: 17.7 [confidence interval (CI) 95%: 2.8-112.6], P = 0.002, 4 points), main pancreatic duct =10 mm (OR: 8.6 [CI 95%: 1.9-39.5], P = 0.006, 2 points), abrupt change of pancreatic duct (OR: 5.5 [CI 95%: 1.4-22.2], P = 0.016, 1.5 points), and solid component (OR: 4.2 [CI 95%: 1.3-13.6], P = 0.017, 1 point) were independent factors associated with invasive cancer and included in the model. The following categories of the score (0-8.5 points)-A (0-1), B (1.5-3), C (3.5-5), and D (5.5-8.5 points)-presented a positive predictive value of 8.5%, 38.9%, 62.5%, and 100%, respectively. The area under the curve was 0.857 (P < 0.001), with an overall sensitivity and specificity of 84% and 70% in the internal validation of the score. Conclusion: This EUS predictive score for invasive cancer in BD-IPMN has a high accuracy and could be an additional tool to consider in patient management

Titanium dioxide photocatalysis for pharmaceutical wastewater treatment

Heterogeneous photocatalysis using the semiconductor titanium dioxide (TiO2) has proven to be a promising treatment technology for water purification. The effectiveness of this oxidation technology for the destruction of pharmaceuticals has also been demonstrated in numerous studies. This review highlights recent research on TiO2 photocatalytic treatment applied to the removal of selected pharmaceuticals. The discussions are tailored based on the therapeutic drug classes as the kinetics and mechanistic aspects are compound dependent. These classes of pharmaceuticals were chosen because of their environmental prevalence and potential adverse effects. Optimal operational conditions and degradation pathways vary with different pharmaceutical compounds. The main conclusion is that the use of TiO2 photocatalysis can be considered a state-of-the-art pharmaceutical wastewater treatment methodology. Further studies are, however, required to optimize the operating conditions for maximum degradation of multiple pharmaceuticals in wastewater under realistic conditions and on an industrial scale

VHE gamma-ray detection of FSRQ QSO B1420+326 and modeling of its enhanced broadband state in 2020

Publisher Copyright: © ESO 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Context. QSO B1420+326 is a blazar classified as a flat-spectrum radio quasar (FSRQ). At the beginning of the year 2020, it was found to be in an enhanced flux state and an extensive multiwavelength campaign allowed us to trace the evolution of the flare. Aims. We search for very high-energy (VHE) gamma-ray emission from QSO B1420+326 during this flaring state. We aim to characterize and model the broadband emission of the source over different phases of the flare. Methods. The source was observed with a number of instruments in radio, near-infrared, optical (including polarimetry and spectroscopy), ultraviolet, X-ray, and gamma-ray bands. We use dedicated optical spectroscopy results to estimate the accretion disk and the dust torus luminosity. We performed spectral energy distribution modeling in the framework of combined synchrotron-self-Compton and external Compton scenario in which the electron energy distribution is partially determined from acceleration and cooling processes. Results. During the enhanced state, the flux of both SED components of QSO B1420+326 drastically increased and the peaks were shifted to higher energies. Follow-up observations with the MAGIC telescopes led to the detection of VHE gamma-ray emission from this source, making it one of only a handful of FSRQs known in this energy range. Modeling allows us to constrain the evolution of the magnetic field and electron energy distribution in the emission region. The gamma-ray flare was accompanied by a rotation of the optical polarization vector during a low -polarization state. Also, a new superluminal radio knot contemporaneously appeared in the radio image of the jet. The optical spectroscopy shows a prominent FeII bump with flux evolving together with the continuum emission and a MgII line with varying equivalent width.Peer reviewe

VHE gamma-ray detection of FSRQ QSO B1420+326 and modeling of its enhanced broadband state in 2020

Abstract Context.: QSO B1420+326 is a blazar classified as a flat-spectrum radio quasar (FSRQ). At the beginning of the year 2020, it was found to be in an enhanced flux state and an extensive multiwavelength campaign allowed us to trace the evolution of the flare. Aims.: We search for very high-energy (VHE) gamma-ray emission from QSO B1420+326 during this flaring state. We aim to characterize and model the broadband emission of the source over different phases of the flare. Methods: The source was observed with a number of instruments in radio, near-infrared, optical (including polarimetry and spectroscopy), ultraviolet, X-ray, and gamma-ray bands. We use dedicated optical spectroscopy results to estimate the accretion disk and the dust torus luminosity. We performed spectral energy distribution modeling in the framework of combined synchrotron-self-Compton and external Compton scenario in which the electron energy distribution is partially determined from acceleration and cooling processes. Results: During the enhanced state, the flux of both SED components of QSO B1420+326 drastically increased and the peaks were shifted to higher energies. Follow-up observations with the MAGIC telescopes led to the detection of VHE gamma-ray emission from this source, making it one of only a handful of FSRQs known in this energy range. Modeling allows us to constrain the evolution of the magnetic field and electron energy distribution in the emission region. The gamma-ray flare was accompanied by a rotation of the optical polarization vector during a low -polarization state. Also, a new superluminal radio knot contemporaneously appeared in the radio image of the jet. The optical spectroscopy shows a prominent FeII bump with flux evolving together with the continuum emission and a MgII line with varying equivalent width