bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of Double Diffusive Natural Convection in Presence of Gray Gas Radiation Within a Square Cavity Using Multiple Relaxation Time Lattice Boltzmann Method
Authors: Moufekkir F. , Moussaoui M. A. , Mezrhab A. , Fontaine J. P. , Bouzidi M.
Published: August 2013

The present work proposes a coupling between the hybrid lattice Boltzmann, the finite difference method, and the discrete ordinates method to simulate combined double diffusive convection and volumetric radiation in a square cavity filled with an emitting and absorbing gray gas. The vertical walls are kept at different temperatures and pollutant concentrations, while the horizontal walls are insulated and impermeable. A parametric study is carried out to evaluate the influence of control parameters such as the Lewis number (Le), Planck number (Pl), and reference temperature ratio (Θ0) on the flow field as well as on heat and mass transfer. The results are presented in terms of isotherms, streamlines, isoconcentrations, average Nusselt, and Sherwood numbers. They show that the volumetric radiation accelerates the flow and significantly alters the structure of the dynamic, concentration, and temperature fields, especially when the thermal forces are dominant. On the other hand, when the mass forces are dominant, the flow is slowed down. The influence of radiation is greater on the thermal field than on the dynamic and concentration fields.
Effects of operational and geometrical conditions upon photosensitivity of amorphous InZnO thin film transistors
Authors: Park Sungho , Park Sekyoung , Ahn Seung-Eon , Song Ihun , Chae Wonseok , Han Manso , Lee Jeseung , Jeon Sanghun
Published: August 2013

The photosensitivity of an amorphous oxide semiconductor thin film transistor (TFT) with an In-Zn-O (IZO) layer as the active channel passivated with SiO2 is investigated. Under illumination, the photocurrent (IPhoto) in the off regime is greatly increased rather than displaying a negative shift of the threshold voltage. In this way, the photosensitivity (IPhoto/IDark) can be maximized by adjusting a reading bias to be placed in the off regime. Furthermore, the photosensitivity is significantly influenced by operational and geometrical conditions, such as the bias voltages and the active layer thickness. In particular, for a 1500-Å-thick IZO TFT, the photosensitivity is increased by a factor of almost eight orders of magnitude. This suggests back channel conduction of excess electrons generated from the optically ionized oxygen vacancies (Vo++) where the gate voltage-induced electric field is screened.
Electromagnetic Induction with Neodymium Magnets
Authors: Wood Deborah , Sebranek John
Published: August 2013

In April 1820, Hans Christian Ørsted noticed that the needle of a nearby compass deflected briefly from magnetic north each time the electric current of the battery he was using for an unrelated experiment was turned on or off. Upon further investigation, he showed that an electric current flowing through a wire produces a magnetic field. In 1831 Michael Faraday and Joseph Henry separately expanded on Ørsted's discovery by showing that a changing magnetic field produces an electric current. Heinrich Lenz found in 1833 that an induced current has the opposite direction from the electromagnetic force that produced it. This paper describes an experiment that can help students to develop an understanding of Faraday's law and Lenz's law by studying the emf generated as a magnet drops through a set of coils having increasing numbers of turns.
Mapping Neuronal Diversity One Cell at a Time
Authors: Wichterle Hynek , Gifford David , Mazzoni Esteban
Published: August 2013

A universal method for classifying neuronal subtypes will increase our understanding of the human brain.
Current Challenges and Trends in the Discovery of Agrochemicals
Authors: Lamberth Clemens , Jeanmart Stephane , Luksch Torsten , Plant Andrew
Published: August 2013

Crop protection chemistry has come a long way from its “alchemic” beginnings in the late 19th century to a high-tech science that supports the sustainable production of food, feed, and fiber for a rapidly growing population. Cutting-edge developments in the design and synthesis of agrochemicals help to tackle today’s challenges of weed and pest resistance, higher regulatory safety margins, and higher cost of goods with the invention of selective, environmentally benign, low use rate, and cost-effective active ingredients.
A Gut Lipid Messenger Links Excess Dietary Fat to Dopamine Deficiency
Authors: Tellez Luis A. , Medina Sara , Han Wenfei , Ferreira Jozelia G. , Licona-Limón Paula , Ren Xueying , Lam TuKiet T. , Schwartz Gary J. , de Araujo Ivan E.
Published: August 2013

Food as Reward

Why does ice cream taste so good? High-fat foods activate a reward circuit in the brain involving dopamine, a neurotransmitter that regulates pleasure. Overconsumption of high-fat foods is thought to dampen this dopamine-induced reward sensation, leading to compensatory consumption of even more high-fat foods. The mechanisms by which dietary fat in the gut “talks” to the dopamine reward circuit are unclear.

Tellez
et al.

(p.
800
) suggest that an intestinal lipid messenger called oleoylethanolamine (OEA) may play a role—at least in mice. Mice on a high-fat diet had unusually low levels of intestinal OEA and exhibited deficient dopaminergic responses to gut stimulation with high-fat lipids. Infusion of OEA into these mice restored the dopaminergic response, and mice that had been accustomed to a high-fat diet began to eat more low-fat foods.
Electrifying the Imagination
Tesla
Inventor of the Electrical Age

by W. Bernard Carlson

Princeton University Press, Princeton, NJ, 2013. 516 pp. $29.95, £19.95. ISBN 9780691057767.
Authors: Misa Thomas J.
Published: August 2013

Carlson's scholarly biography offers a fresh perspective on Tesla, his inventions, and the economic and social contexts of his efforts.
The Road to Pollinator Health
Authors: Woteki Catherine
Published: August 2013

Agricultural production is a balancing act. On one side is sustainable production of food and biobased products for a growing population. On the other is protecting our natural resources and the environment. The global decline of the honey bee, a major domestic pollinator of many crops, exemplifies how complex the factors are that contribute to maintaining this balance. Overall bee colony decline, including loss from colony collapse disorder (CCD), poses a serious challenge to agricultural research worldwide. The causes are still not definitive, but stress from pesticides may be a factor. This spring, the European Commission temporarily restricted the use of three neonicotinoid pesticides for specific applications (pending more research). Last year, the U.S. Environmental Protection Agency (EPA) and U.S. Department of Agriculture (USDA) formed a bee health task force to take an even broader look at the pollinator crisis, with a plan to collect interagency input and develop a federal Pollinator Roadmap before the end of 2013.
Researchers Scramble to Understand Camel Connection to MERS
Authors: Kupferschmidt Kai
Published: August 2013

Antibodies found in 50 camels from Oman reinvigorate the search for the virus's origins.
In Rural Asia, Locking Up Poisons to Prevent Suicides
Authors: Hvistendahl Mara
Published: August 2013

Pesticide ingestion accounts for one-third of the world's suicides. Can a simple plastic lockbox keep toxic chemicals out of desperate people's hands?
Immunodetection of Fasciola gigantica Circulating Antigen in Sera of Infected Individuals for Laboratory Diagnosis of Human Fascioliasis
Authors: Attallah Abdelfattah M. , Bughdadi Faisal A. , El-Shazly Atef M. , Ismail Hisham
Published: August 2013

Currently, the laboratory diagnosis of human fascioliasis is based on the parasitological examination of parasite eggs in stool specimens and serological detection of specific antibodies in serum samples, which are often unreliable diagnostic approaches. Ideally, a sensitive and specific diagnostic test forFasciolainfection should be based on the detection of circulatingFasciolaantigen, which implies active infection. Here, a 27-kDa-molecular-mass antigen was identified in aFasciola giganticaadult worm antigen preparation, excretory-secretory products, and sera fromF. gigantica-infected individuals, and it was not detected in antigenic extracts of other parasites and sera from noninfected individuals. The target antigen was isolated and partially characterized as a protein. Immunoperoxidase staining located the target epitope within teguments and guts ofF. giganticaadult worms. The performance characteristics of a newly developed enzyme-linked immunosorbent assay (ELISA) based onF. giganticacirculating antigen detection in serum (FgCA-27 ELISA) were investigated using sera of 120 parasitologically diagnosedF. gigantica-infected individuals and 80 noninfected individuals. The area under the receiving operating characteristic (ROC) curve (AUC) for ELISA was significantly high (AUC = 0.961,P< 0.0001) for discriminatingFasciola-infected and noninfected individuals. The developed assay showed high degrees of sensitivity, specificity, and efficiency (>93%), and a significant correlation (r= 0.715,P< 0.0001) between antigen level and parasite egg count was shown. In conclusion, a 27-kDaFasciolaantigen was identified in sera ofF. gigantica-infected individuals. A highly sensitive and specificFasciolaantigen detection assay, FgCA-27 ELISA, was developed for laboratory diagnosis of human fascioliasis.
Diagnostic Value of Cytokines and Chemokines in Lyme Neuroborreliosis
Authors: Cerar T. , Ogrinc K. , Lotrič-Furlan S. , Kobal J. , Levičnik-Stezinar S. , Strle F. , Ružić-Sabljić E.
Published: August 2013

The aims of the present study were to assess the concentrations of different cytokines and chemokines in blood serum and cerebrospinal fluid (CSF) samples of patients with Lyme neuroborreliosis and to identify the possible marker(s) that would enable a distinction between clinically evident and suspected Lyme neuroborreliosis, as well as between Lyme neuroborreliosis and tick-borne encephalitis (TBE). Our additional interest was to evaluate the relationship between cytokine and chemokine concentrations andBorrelia burgdorferi sensu latoisolation from CSF, as well as intrathecal synthesis of specific borrelial antibodies. We found that higher concentrations of CXCL13 and lower concentrations of interleukin 10 (IL-10) in serum were associated with higher odds for clinically evident Lyme neuroborreliosis compared to suspected Lyme neuroborreliosis, as well as to TBE. The concentrations of IL-2, IL-5, IL-6, IL-10, and CXCL13 in the CSF were higher in patients with evident Lyme neuroborreliosis than in those who were only suspected to have the disease. A comparison of CSF cytokine and chemokine levels in patients with and without intrathecal synthesis of specific borrelial antibodies revealed that CXCL13 CSF concentration is significantly associated with intrathecal synthesis of borrelial antibodies. A comparison of the cytokine and chemokine CSF concentrations in patients with clinically evident Lyme neuroborreliosis according to CSF culture results revealed that higher concentrations of gamma interferon (IFN-γ) were associated with lower odds ofBorreliaisolation. Although several differences in the blood serum and CSF concentrations of various cytokines and chemokines between the groups were found, the distinctive power of the majority of these findings is low. Further research on well-defined groups of patients is needed to appraise the potential diagnostic usefulness of these concentrations.
Septicemia Caused by Leifsonia aquatica in a Healthy Patient after Retinal Reattachment Surgery
Authors: Han Lei , Lei Jin-e , Wang Xue , Guo Li-tao , Kang Qian-yan , He Li , Xu Ji-ru
Published: August 2013

Leifsonia aquatica
is an aquatic bacterium that is typically found in environmental water habitats. Infections due to
L. aquatica
are rare and commonly catheter associated in immunocompromised patients. We report the first case of an acute septicemia caused by
L. aquatica
in a healthy immunocompetent host after cryopexy in the absence of a catheter.
Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty
Authors: Qu Xinhua , Zhai Zanjing , Wu Chuanlong , Jin Fangchun , Li Haowei , Wang Lei , Liu Guangwang , Liu Xuqiang , Wang Wengang , Li Huiwu , Zhang Xiaoyu , Zhu Zhenan , Dai Kerong
Published: August 2013

This meta-analysis evaluated preoperative aspiration culture for diagnosing prosthetic joint infection (PJI) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The pooled sensitivity and specificity were 0.72 (95% confidence interval, 0.65 to 0.78) and 0.95 (0.93 to 0.97), respectively. Subgroup analyses revealed nonsignificant worse diagnostic performance for THA than for TKA (sensitivity, 0.70 versus 0.78; specificity, 0.94 versus 0.96). Preoperative aspiration culture has moderate to high sensitivity and very high specificity for diagnosing PJI.
Role of Herpes Simplex Virus VP11/12 Tyrosine-Based Motifs in Binding and Activation of the Src Family Kinase Lck and Recruitment of p85, Grb2, and Shc
Authors: Strunk Ulrike , Saffran Holly A. , Wu Frederick W. , Smiley James R.
Published: August 2013

Previous studies have shown that the abundant herpes simplex virus 1 (HSV-1) tegument protein VP11/12, encoded by gene UL46, stimulates phosphatidylinositol 3-kinase (PI3-kinase)/Akt signaling: it binds the Src family kinase (SFK) Lck, is tyrosine phosphorylated, recruits the p85 subunit of PI3-kinase, and is essential for the activation of Akt during HSV-1 infection. The C-terminal region of VP11/12 contains tyrosine-based motifs predicted to bind the SH2 domains of SFKs (YETV and YEEI), p85 (YTHM), and Grb2 (YENV) and the phosphotyrosine-binding (PTB) domain of Shc (NPLY). We inactivated each of these motifs in the context of the intact viral genome and examined effects on binding and activation of Lck and recruitment of p85, Grb2, and Shc. Inactivating the p85, Grb2, or Shc motif reduced (p85) or eliminated (Grb2 and Shc) the interaction with the cognate signaling molecule without greatly affecting the other interactions or activation of Lck. Inactivating either SFK motif had only a minor effect on Lck binding and little or no effect on recruitment of p85, Grb2, or Shc. In contrast, inactivation of both SFK motifs severely reduced Lck binding and activation and tyrosine phosphorylation of VP11/12 and reduced (p85) or eliminated (Grb2 and Shc) binding of other signaling proteins. Overall, these data demonstrate the key redundant roles of the VP11/12 SFK-binding motifs in the recruitment and activation of SFKs and indicate that activated SFKs then lead (directly or indirectly) to phosphorylation of the additional motifs involved in recruiting p85, Grb2, and Shc. Thus, VP11/12 appears to mimic an activated growth factor receptor.
A Strain-Specific Epitope of Enterovirus 71 Identified by Cryo-Electron Microscopy of the Complex with Fab from Neutralizing Antibody
Authors: Lee Hyunwook , Cifuente Javier O. , Ashley Robert E. , Conway James F. , Makhov Alexander M. , Tano Yoshio , Shimizu Hiroyuki , Nishimura Yorihiro , Hafenstein Susan
Published: August 2013

Enterovirus 71 (EV71) is a picornavirus that causes outbreaks of hand, foot, and mouth disease (HFMD), primarily in the Asia-Pacific area. Unlike coxsackievirus A16, which also causes HFMD, EV71 induces severe neuropathology leading to high fatalities, especially among children under the age of 6 years. Currently, no established vaccines or treatments are available against EV71 infection. The monoclonal antibody MA28-7 neutralizes only specific strains of EV71 that have a conserved glycine at amino acid VP1-145, a surface-exposed residue that maps to the 5-fold vertex and that has been implicated in receptor binding. The cryo-electron microscopy structure of a complex between EV71 and the Fab fragment of MA28-7 shows that only one Fab fragment occupies each 5-fold vertex. A positively charged patch, which has also been implicated in receptor binding, lies within the Fab footprint. We identify the strain-specific epitope of EV71 and discuss the possible neutralization mechanisms of the antibody.
The effect of cooling prior to and during exercise on exercise performance and capacity in the heat: a meta-analysis
Authors: Tyler Christopher James , Sunderland Caroline , Cheung Stephen S
Published: August 2013

Exercise is impaired in hot, compared with moderate, conditions. The development of hyperthermia is strongly linked to the impairment and as a result various strategies have been investigated to combat this condition. This meta-analysis focused on the most popular strategy: cooling. Precooling has received the most attention but recently cooling applied during the bout of exercise has been investigated and both were reviewed. We conducted a literature search and retrieved 28 articles which investigated the effect of cooling administered either prior to (n=23) or during (n=5) an exercise test in hot (wet bulb globe temperature >26°C) conditions. Mean and weighted effect size (Cohen's d) were calculated. Overall, precooling has a moderate (d=0.73) effect on subsequent performance but the magnitude of the effect is dependent on the nature of the test. Sprint performance is impaired (d=−0.26) but intermittent performance and prolonged exercise are both improved following cooling (d=0.47 and d=1.91, respectively). Cooling during exercise has a positive effect on performance and capacity (d=0.76). Improvements were observed in studies with and without cooling-induced physiological alterations, and the literature supports the suggestion of a dose–response relationship among cooling, thermal strain and improvements in performance and capacity. In summary, precooling can improve subsequent intermittent and prolonged exercise performance and capacity in a hot environment but sprint performance is impaired. Cooling during exercise also has a positive effect on exercise performance and capacity in a hot environment.
Cerebral blood flow velocity changes during upright positioning in bed after acute stroke: an observational study
Authors: Aries Marcel J , Elting Jan Willem , Stewart Roy , De Keyser Jacques , Kremer Berry , Vroomen Patrick
Published: August 2013

Objectives

National guidelines recommend mobilisation in bed as early as possible after acute stroke. Little is known about the influence of upright positioning on real-time cerebral flow variables in patients with stroke. We aimed to assess whether cerebral blood flow velocity (CBFV) changes significantly after upright positioning in bed in the acute stroke phase.

Design

Observational study.

Participants

47 patients with acute ischaemic stroke measured in the subacute phase after symptom onset and 20 healthy controls.

Primary and secondary outcome measures

We recorded postural changes in bilateral transcranial Doppler (primary outcome) and simultaneously recorded near-infrared spectroscopy, end-tidal CO2, non-invasive blood pressure data and changes in neurological status (secondary outcomes).

Methods

Postures included the supine, half sitting (45°), sitting (70°) and Trendelenburg (−15°) positions. Using multilevel analyses, we compared postural changes between hemispheres, outcome groups (using modified Rankin Scale) as well as between patients and healthy controls.

Results

The mean patient age was 62±15 years and median National Institute of Health Stroke Scale score on admission was 7 (IQR 5–14). Mean proportional CBFV changes on sitting were not significantly different between healthy controls and affected hemispheres in patients with stroke. No significant differences were found between affected and unaffected stroke hemispheres and between patients with unfavourable and favourable outcomes. During upright positioning, no neurological worsening or improvement was observed in any of the patients.

Conclusions

No indications were found that upright positioning in bed in mild to moderately affected patients with stroke compromises flow and (frontal)oxygenation significantly during the subacute phase of stroke. Supine or Trendelenburg positioning does not seem to augment real-time flow variables.
071 Improving CPGs Implementation by Integrative Programs: Example of the Elective Caesarean Section
Authors: Musset S , Martinowsky M , Danscoine A , Bataillon R , Laurence M
Published: August 2013

Background

In France, one in five women gives birth by caesarean section and in almost half of cases, caesarean section is planned. Elective caesarean is a subject of controversy (some indications, maternal request) and its practice is marked by highly disparities in the country.

Objective

To improve the relevant practice of elective caesarean.

Methods

In a short time, an integrative process was developed with systematic reviews, working group of multidisciplinary health professionals and patients, focus group, implementation network.

Results

For serving the identified needs, we updated guidelines, developed information for/with the patients, and produced implementation tools adapted to the different medical indications. Clinical situations which may lead to a planned caesarean section are varied and complex. For each of them, we redefined the indications of caesarean section or vaginal delivery. For elective caesarean, women should be informed as soon as possible, with provided developed tools, to enable an informed discussion with the caregiver and to improve the maternal experience. The decision elements to report in the medical record were defined and a set of tools with the approach ‘patient journey’ developed: clinical pathways, evaluation criteria of relevance or grids, examples of improvement actions and indicators. In February 2013, more than 183 establishment of health were engaged in the programme.

Conclusions

We provided a set of implementation tools to improve the relevance of planned caesarean section. The continuous feedback by the different actors will allow enriching electronic version tools and sharing knowledge in the field, thus enabling a continuous improvement process.
080 Implantable Miniature Telescope – Implementing Guidelines When Evidence Is Uncertain
Authors: Gupta A , Garg P , Patel D
Published: August 2013

Background

Age-related macular degeneration (AMD) is the third leading cause of blindness in industrialised countries. The heavy burden of the disease, the expected increase in the number of cases, and a lack of effective treatment options highlight the need to examine new therapies. The implantable miniature telescope (IMT) is a potential new treatment for AMD. However, few high-quality studies are currently available to assess its effectiveness. Despite limited evidence, the US Food and Drug Administration (FDA) and Medicare granted regulatory approval, potentially increasing patient demand.

Context

In the context of limited available evidence, but potential patient demand driven by lack of alternatives, a large, US-based integrated healthcare system rapidly developed evidence-based guidance and implementation strategies for IMT.

Description of Best Practice

A systematic review was conducted to assess IMT effectiveness. A centralised, collaborative panel of experts was convened based upon clinical expertise, interest in providing IMT surgery, and potential operational volume. Evidence-based recommendations informed rapid development of an implementation strategy over six months. The strategy involved 1) centralised patient review and selection; 2) consent forms that describe benefit vs. harms; and 3) surgical training standards. Rapid development and distribution of the implementation strategy ensured that IMT would be provided in a timely and appropriate clinical context. The centralised process facilitated development of a patient database to track outcomes and inform future research.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Rapid, collaborative, and evidence-based development of clinical guidance and implementation strategies is an effective model for spreading best practices in an environment of uncertain or low-quality evidence.
082 Effect of Wording and Presentation of Electronic Alerts on Behavior of Providers Caring for Out-of-Control Diabetics
Authors: Stone E , Hsu H
Published: August 2013

Background

Guideline implementation through electronic point-of-care alerting has been shown to be effective. The best displays of these alerts have not been well studied.

Objectives

To assess the effect of wording and presentation of electronic alerts on insulin ordering by providers caring for out-of-control diabetics on 2 or more oral hypoglycemic agents.

Methods

An electronic message to the provider caring for an out-of-control diabetic was displayed. Prior to randomisation, a generic message was presented to all providers. Health centres were then randomised to 1 of 4 specific messages recommending insulin. Messages differed by wording (active/passive voice) and presentation (black text/red and black text). A 2-arm RCT was then performed where health centres were randomised to a complete absence of any alert or to one of the specific messages.

Results

The generic alert triggered 56,878 times. Providers prescribed insulin 5.11 % of the time. During the 4-arm RCT, the alerts triggered 11,744, 11,826, 11,742, and 11,554 times and insulin was prescribed 5.17%, 5.01%, 5.11% and 5.20% respectively. There were no statistically significant differences amongst the 4 rates (p = 0.67) nor was there a statistically significant difference between insulin ordering with the generic message compared to insulin ordering with the more specific messages (p = 0.62). For the 2-arm RCT, insulin ordering remained at 5% for the specific messages and was 0% where there was no alert (P<0.05)

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Extra effort to craft wording and develop eye-catching electronic alerts may not be worthwhile. Guideline adherence was improved by an electronic alert.
P012 The EHR
Authors: Chan Wiley
Published: August 2013

Guidelines must adhere to a rigorous, transparent, evidence-based methodology and contain explicit, actionable recommendations to ensure acceptance and facilitate implementation by clinicians and health care delivery systems. In addition to these core requirements, guidelines must be implemented in clinical practice to deliver better health outcomes for our patients. Use of Electronic Health Records (EHRs) is an effective way to embed guidance at the point of care and impact clinical care. Most EHR tools are aimed at clinicians and health care delivery system staff. However, interactive EHR tools aimed at patients that enhance patient engagement in their health care have great potential. Examples of the various types of EHR tools used in Kaiser Permanente will be presented. The characteristics of the various EHR tools available that are associated with their rate of use and their impact will be explored. The concept of EHR content implementation lifecycle will be presented. Each stage in this lifecycle is important: Requirements Definition, Design, Develop/Build, Deploy/Champion; Measure/Evaluate; Maintain/Revise. As an example of Requirements Definition, careful planning and management are necessary to ensure that EHR tools are focused on key points in the clinical pathways to address root causes of performance gaps, and support clinical workflows.

The EHR is a powerful tool to embed guidance and affect clinical care. But effective use of EHR tools also requires strong support from organisational leadership, centralised coordinated governance, and collaboration with end-users. EHR tools must be integrated into the larger health care delivery system’s infrastructure, to be effective in supporting and impacting clinical care.
090 N of One Guidelines - A New Method to Manage Multimorbidity?
Authors: Scherer M , Muche-Borowski C , Schäfer I , Hansen H , Wagner H , Dubben H , Blozik E , Lühmann D , Szecsenyi J
Published: August 2013

Background

Adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects for persons with several comorbidities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. As yet no satisfactory approaches exist to address multimorbidity (MM) in clinical guidelines since this patient group is too heterogeneous as to be met by guideline recommendations.

Objectives

to develop a set of case-based (N = 1) guidelines for common disease combinations identified through epidemiological research and expert (GP) consultations.

Methods

We followed a new 5-step, mixed methods approach comprising: (1) review of epidemiological data on MM patterns; (2) interdisciplinary focus groups developed case vignettes according to both internal evidence and the results of step 1; (3) development of case-based recommendations according to case vignettes (N of one guidelines); (4) informal consensus of recommendations; (5) formal consensus.

Results

Step one revealed three different approaches for the selection criteria of case vignettes: first, cases addressing MM disease patterns from epidemiological studies (MM clusters); second, cases addressing triads of the 6 most prevalent chronic conditions; third, cases according to a problem-oriented prioritisation of focus group participants. All in all 10 N-of-one guidelines according to 10 cases could be developed according to the new 5-step-process.

Discussion

We present a new approach in order to capture the complex and heterogeneous problems of MM through evidence-based and case-based recommendations. This set of N-of-one-guidelines may serve as a framework of evidence-based recommendations for MM patients as the base for the development of meta-tools for both guideline developers and clinicians.
P043 Five major areas of research of GRADE system
Authors: Chen Y , Yao L , Wang Q , Wu Q , Wang X , Yang K
Published: August 2013

Background

Over the past 10 years, more and more guideline developers and systematic review authors adopt the GRADE method. Also, many researchers and groups become interested in discussing, studying and developing it.

Methods

We searched and analysed all GRADE papers published in academic journals from 2004 to 2012, abstracts in Cochrane colloquium from 2000 to 2012 and G-I-N Conferences from 2003 to 2012, attended GRADE workshops and meeting in GIN and Cochrane colloquium.

Results

We found the following five major areas of research of GRADE system: 1. Comparison and Trend Analysis between GRADE and other different rating systems 2. Reasons analysis for downgrading and upgrading the quality of evidence and agreement test for different raters in systematic reviews 3. How to from evidence to recommendations in guidelines 4. Exploration of the application of GRADE in clinical stage (e.g. whether the guideline covers prevention, screening, assessment, treatment, rehabilitation or monitoring); Exploration of the application of GRADE in different areas such as public health, health policy and system. 5. The establishment and development of GRADE centre such as the Chinese GRADE centre and Spanish GRADE centre and how to promote the implementation of GRADE.

Conclusion

As a new paradigm, the GRADE approach provides a comprehensive, explicit, and transparent methodology for grading the quality of evidence and strength of recommendations about the management of patients, however, GRADE is not a perfect system and still need to develop itself and been disseminated widely.
P014 Guideline Implementation in a 21st Century Health System
Authors: Mittman Brian
Published: August 2013

The nature of healthcare delivery has changed dramatically during the 20+ years since clinical practice guidelines first became a central focus of efforts to improve healthcare quality and outcomes. Continued development of new clinical and service delivery technologies, dramatic shifts in fiscal and regulatory environments, and continued changes in delivery system structure and organisation are among the key drivers of evolution in healthcare delivery practices. This presentation highlights key features of this evolution and derives important implications for clinical practice guideline implementation. Key implications include the need to (1) embed guidelines in broader efforts to reorganise and redesign care delivery, including team-based multidisciplinary care, (2) expand efforts to integrate guideline recommendations in health information technology applications targeting consumers and other stakeholders, in addition to clinicians, and (3) better coordinate and integrate guidelines within clinical policies, quality and performance monitoring schemes and technical assistance and quality improvement initiatives. Additional trends in healthcare technologies and delivery practices have implications for guideline development processes and guideline attributes, in addition to guideline implementation. These include growing interest in personalised medicine and patient-centred care, the emergence of “big data” and associated opportunities to develop new forms of evidence-based guidance for clinical decisions, and continued developments in clinical research methods such as observational designs for comparative effectiveness research, “N of 1” trials and others. The presentation will touch briefly on these developments as well, and discuss their implications for the future of clinical practice guidelines as a foundation for evidence-based clinical decision making and quality improvement.
P070 Toolbox for the Complete Process of Guideline Development, Revision, Implementation and Evaluation
Authors: Hilbink M , Ouwens M , Kool T
Published: August 2013

Background

Problems in the process of guideline development, revision, implementation and evaluation are commonly perceived.

Objectives

To support and improve the process of guideline development, revision, implementation and evaluation.

Methods

After reaching consensus about topics for which there was a huge need for support, we composed thirteen working groups consisting of 4–5 representatives of various Dutch institutions involved in guideline development and implementation. Each group developed a support tool on a specific topic. 150 experts commented the draft version of the tools. Subsequently, the tools were used in more than 40 guideline projects to evaluate their practical value. The final versions of the tools have been disseminated by internet and will be adopted by the National Dutch Quality Insitute.

Results

A toolbox containing 13 tools on the following topics: 1. Analysis of clinical care gaps 2. Cost-effectiveness 3. Organization and cooperation 4. Dealing with conflicts 5. International cooperation 6. Project management 7. Formulating specific recommendations 8. Attention for sex differences 9. Guidelines and shared decision making 10. Knowledge gaps 11. Implementation 12. Monitoring 13. Electronic disclosure A both Dutch and English-language version website on guideline development and implementation in the broader context, with incorporation of the tools.

Discussion

This project yielded a toolbox with tools on topics and activities that offered scope for further international development.

Implications for Guideline Developers/Users

Using these tools might improve the quality of guidelines, which in turn results in higher guideline adherence. Better guideline adherence might eventually lead to improved quality of care.
P093 Determining Pharmacist Awareness And Implementation Of The Nice Medicines Adherence Guideline
Authors: Thornton J , Tait S , Steinke D , Ashcroft D , Elliot N
Published: August 2013

Background

Up to 50% of medicines are not taken as recommended with potential for reduced benefits or treatment failure and financial implications of the unused medicines. The NICE clinical guideline on Medicines Adherence is relevant to all healthcare workers but there has been no formal assessment of its uptake among pharmacists.

Objectives

To determine awareness and application of the Medicines Adherence guideline among UK hospital pharmacists

Method

A postal self-completion questionnaire was sent to hospital pharmacies across northwest England. Descriptive statistics were used to analyse the responses and key themes identified from free-text comments.

Results

There were 45 responses. Pharmacists were aware of the guideline via communication from NICE (26%), pharmaceutical/medical press (20%) and local communication (14%). 20% of respondents reported that their hospital/department had guidance in place before publication of the guideline and 23% that their hospital issued guidance after publication. 39% already used the principles of the guideline in their practice and further independent action was not needed whereas 22% changed their practice. Although most pharmacists considered they had adequate experience and training, insufficient time and technical support were major barriers to addressing adherence issues in practice.

Discussion

Improved communication about the guideline is needed. Many pharmacists want to apply the principles of the guideline but need support to overcome barriers to effective implementation.

Implications for Guideline Developers/Users

Guideline developers could help implementation by disseminating relevant guideline information more specifically at pharmacists. Cross-referral to the Medicines Adherence guideline could be included in all other relevant NICE guidelines.
P098 The Canadian Task Force On Preventive Health Care: Process For Critical Appraisal Of Externally-Produced Guidelines
Authors: Shane A , Tonelli M , Birtwhistle R , Pottie K , Bell N , Singh H , Gorber S , L Dunfield
Published: August 2013

Background

The Canadian Task Force on Preventive Health Care (CTFPHC) was re-established in 2010, with a mandate to produce clinical practice guidelines (CPGs) for primary preventive care, based on systematic analysis of scientific evidence.

Context

In order to increase the range of topics for which the CTFPHC provides guidance, while operating with defined resources, it was necessary to explore alternative dissemination methods. In addition to developing new guidelines and updating existing guidelines, the CTFPHC has developed a process for identifying high quality guidelines produced by other organisations on topics relevant to the CTFPHC’s mandate.

Description of Best Practice

The process is comprised of 12 steps. When a CPG is identified for appraisal, a literature scan for recently produced guidelines on the same topic by other organisations is conducted. The resultant CPGs are qualitatively assessed based on 5 criteria. The CPG most appropriate for appraisal undergoes AGREEII assessment, followed by development of a summary report that includes a commentary which discusses the strengths, limitations, link between evidence review and CPG and content of the CPG.

Lessons for Guideline Developers, Adaptors, Implementers and/or Users

Through several iterations, a robust process has been developed, with 3 appraisals completed. Two essential steps were identified: systematic selection of guidelines for appraisal, and engagement of KT experts in selecting product format. Because an appraisal identifies CPGs developed using a standard and rigorous methodology, and does not imply the CTFPHC’s agreement with the recommendations, it is essential that the summary report contain information required by practitioners to ensure a benefit is gained from its dissemination.
P099 Assessment of the Diffusion and Implementation of the Clinical Practice Guidelines in Mexico
Authors: Sosa-Garcia J , Martinez-Aldana S , Puente-Rosas E , Pineda-Perez D , Hernandez-Santillan D
Published: August 2013

Background

The clinical practice guidelines (CPGs) of the National Health System of Mexico (NHSM) aim to improve the quality and to reduce the heterogeneity of medical care.

Objectives

To assess the success of the implementation of the CPGs in medical units of the NHSM.

Methods

480 health units were randomly sampled. In each one, the following items were applied: a checklist in order to verify the existence of CPGs, a questionnaire for physicians to document their knowledge, training and awareness on CPGs, and another one to those in charge of the dissemination and implementation process. Clinical records were reviewed to document the use of CPGs.

Results

The diffusion of the CPGs is conducted via internet through the Master Catalogue (MC). The MC was identified in 80% of the sample. The overall level of training on CPGs was 56% (45% -100%). 88% of doctors are aware of the existence of CPGs and 71% reported the utilisation of a CPG during the last month. 30% of the people in charge of dissemination do not have the necessary resources for the dissemination and implementation. The adherence level falls below 50%.

Discussion

One limitation to the dissemination of the CPG is internet access, along with training variability among institutions. The main barrier to the use of CPGs, is the lack of resources (physical material, human and time) for the dissemination and implementation.

Implications for Guideline Developers/Users

The knowledge of CPGs is high, however there are barriers that limit their implementation.
P108 Publications Improve Wound Care Guideline Quality And Impact
Authors: Bolton L , Girolami S , Corbett L , Merkle D
Published: August 2013

Background

High quality evidence based (EB) wound care guidelines reduce costs of care and improve outcomes. They may help stem the growing burden of chronic wound care only if disseminated and used.

Context

Publications supported development, quality and dissemination of EB wound care guidelines with content-validity (CV).

Description of Best Practice

Multidisciplinary volunteer guideline developers from a global, non-profit wound care organisation with patient and wound-related specialty membership, used standardised evidence strength criteria and independently-rated CV Index as standardised recommendation strength to develop inclusive venous and pressure ulcer “Guidelines of Guidelines”. Representatives of six North American societies collaboratively published research and educational opportunities identified by this unique guideline development process.

Lessons for Guideline Developers, Adapters, Implementers, and/or Users

Publications accessible at the organisation website transparently described the guideline development process, a hallmark of guideline quality while enhancing awareness of the guidelines and EB CV recommendations worth implementing. Publications in multidisciplinary journals minimised sampling bias by inviting readership to complete online CV surveys. Publishing research and educational opportunities focused the field on EB research and education needs and fostered international cooperation, helping unify wound care across countries, settings and specialties. Medical school and university nursing and physical therapy programmes are disseminating core messages of EB CV wound care by using the guidelines, publications, patient brochures, algorithms and implementation tools to improve quality and consistency of care.

Conclusion

Publications enhanced venous and pressure ulcer guideline development quality, awareness and use while unifying wound care and highlighting needed research and education initiatives.
P119 The Rare-Best practices Project: An Overview
Authors: Taruscio D , Morciano C , Laricchiuta P , Vincenti G , Agresta L , Mincarone P , Palazzo F , Leo C , Sabina S , Guarino R , Auld J , Sejersen T
Published: August 2013

Background

RARE-Best Practices is a 4-year project (2013-2016) funded by the EU FP7.

Objective

Developing a sustainable networking platform, supporting an efficient exchange of reliable and up to date information on the management of rare diseases (RD) to improve patient health outcomes.

Methods

RARE-Best Practices will reach its goals by promoting collaboration among partners with a strong track record in RD research as well as in clinical practice guidelines (CPG) and systematic review development from academic institutions, governmental bodies, patients organisations and networks.

Results

Project expected outputs: 1) identification of challenges to be considered in deriving high quality standards for CPG on RD; 2) creation of transparent procedures and criteria for the evaluation and the collection of CPG on RD in a publicly searchable database; 3) identification of the available notations for graphic representation of processes within CPG to improve user understandability and implementation; 4) production of mechanisms to identify and prioritise RD clinical research needs to optimise the research agenda on RD; 5) development of training activities targeted to key stakeholders to disseminate process and tools for developing and evaluating CPG.

Discussion/Implication for Guidelines Developers Users

RARE-Best Practices will address the patients and health care providers demand for updated and high quality CPG on RD. It intends also to respond to the Directive 2011/24/EU which encourages EU MS to the development of European Reference Networks in the area of RD which, among other criteria and conditions, ‘should have the capacity to produce good practice guidelines’.
P132 Quality of Guidelines Developed by the World Health Organization: Preliminary Results
Authors: Burda B , Chambers A
Published: August 2013

Background

The World Health Organization (WHO) annually publishes hundreds of guidelines. Its guideline development process, however, is often criticised even after the implementation of a Guideline Review Committee (GRC) that ensure guidelines are developed using the highest methodological quality, transparent and evidence-based processes.

Objectives

To quality rate a cohort of GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

Methods

We searched the WHO website for GRC-approved guidelines published between 2008 and November 2012. Two individuals independently appraised the guidelines using AGREE II. Scores were standardised across six domains and overall quality was determined through consensus.

Results

Eighty guidelines fulfilled inclusion criteria and were appraised. Twenty-seven guidelines were recommended, 47 were recommended with modifications, and six were not recommended. Two domains of AGREE scored highly across all guidelines: scope and purpose and clarity of presentation. The rigour of development and applicability domains were variable across guidelines. The lowest scoring domains were stakeholder involvement and editorial independence.

Discussion

WHO guidelines still need improvement in the following areas: stakeholder engagement, use of systematically reviewed evidence, defining the funder’s role, consideration of barriers and resources (including costs) when implementing recommendations, and providing monitoring criteria. Most issues may be resolved through increased transparency and better reporting of the recommendation development process by more closely following the standards set forth in the WHO guideline development handbook.

Implications for Guideline Developers/Users

Guideline developers need to ensure systematic guideline development processes are followed and adequately reported in each guideline.