Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings : do practicing gastroenterologists agree with experts?

BACKGROUND: Appropriateness criteria for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) have been developed by experts' panels. Little is known about the acceptance of such recommendations by care providers. The aim was to explore how treatment decisions of practicing gastroenterologists differ from experts using a vignette case study and a focus group. METHODS: Seventeen clinical vignettes were drawn from clinical indications evaluated by the expert panel. A vignette case questionnaire asking for treatment options in 9-10 clinical situations was submitted to 26 practicing gastroenterologists. For each vignette case, practitioners' answers on treatments deemed appropriate were compared to panel decisions. Qualitative analysis was made based on focus group discussion to explore acceptance and divergence reasons. RESULTS: 239 clinical vignettes were completed, 98 for CD and 141 for UC. Divergence between proposed treatments and results from panels was more frequent for CD (34%) than for UC (27%). Among UC clinical vignettes, the main divergences with the panel were linked to 5-ASA failure assessment and to situations where stopping treatment was the main decision. For CD, the care provider propositions diverged with the panel in mild-to-moderate active disease, where practitioners were more prone to an accelerated step up than the panel's recommendations. CONCLUSIONS: In about one third of vignettes cases, IBD treatment propositions made by practicing gastroenterologists diverged as compared to expert recommendations. Practicing gastroenterologists may experience difficulties in applying recommendations in daily practice.

How can we agree on some product agnostic repository function fundamentals?

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Aerosol scattering and absorption during the EUCAARI-LONGREX flights of the Facility for Airborne Atmospheric Measurements (FAAM) BAe-146: can measurements and models agree?

Scattering and absorption by aerosol in anthropogenically perturbed air masses over Europe has been measured using instrumentation flown on the UK’s BAe-146-301 large Atmospheric Research Aircraft (ARA) operated by the Facility for Airborne Atmospheric Measurements (FAAM) on 14 flights during the EUCAARI-LONGREX campaign in May 2008. The geographical and temporal variations of the derived shortwave optical properties of aerosol are presented. Values of single scattering albedo of dry aerosol at 550 nm varied considerably from 0.86 to near unity, with a campaign average of 0.93 ± 0.03. Dry aerosol optical depths ranged from 0.030 ± 0.009 to 0.24 ± 0.07. An optical properties closure study comparing calculations from composition data and Mie scattering code with the measured properties is presented. Agreement to within measurement uncertainties of 30% can be achieved for both scattering and absorption,but the latter is shown to be sensitive to the refractive indices chosen for organic aerosols, and to a lesser extent black carbon, as well as being highly dependent on the accuracy of the absorption measurements. Agreement with the measured absorption can be achieved either if organic carbon is assumed to be weakly absorbing, or if the organic aerosol is purely scattering and the absorption measurement is an overestimate due to the presence of large amounts of organic carbon. Refractive indices could not be inferred conclusively due to this uncertainty, despite the enhancement in methodology compared to previous studies that derived from the use of the black carbon measurements. Hygroscopic growth curves derived from the wet nephelometer indicate moderate water uptake by the aerosol with a campaign mean f (RH) value (ratio in scattering) of 1.5 (range from 1.23 to 1.63) at 80% relative humidity. This value is qualitatively consistent with the major chemical components of the aerosol measured by the aerosol mass spectrometer, which are primarily mixed organics and nitrate and some sulphate.

Models agree on forced response pattern of precipitation and temperature extremes

Model projections of heavy precipitation and temperature extremes include large uncertainties. We demonstrate that the disagreement between individual simulations primarily arises from internal variability, whereas models agree remarkably well on the forced signal, the change in the absence of internal variability. Agreement is high on the spatial pattern of the forced heavy precipitation response showing an intensification over most land regions, in particular Eurasia and North America. The forced response of heavy precipitation is even more robust than that of annual mean precipitation. Likewise, models agree on the forced response pattern of hot extremes showing the greatest intensification over midlatitudinal land regions. Thus, confidence in the forced changes of temperature and precipitation extremes in response to a certain warming is high. Although in reality internal variability will be superimposed on that pattern, it is the forced response that determines the changes in temperature and precipitation extremes in a risk perspective.

Comparative analysis of bilateral memoranda on anti-human trafficking cooperation between Thailand and three neighboring countries : what do the origin and the destination states agree upon?

In order to prevent, suppress and punish human trafficking, bilateral agreements between origin of victim countries and destination countries are crucial, because their cooperation involves cross-border activities such as repatriation of victims, extradition of criminals and information-sharing. This article analyzes three bilateral legal instruments between The Government of The Kingdom of Thailand and her three neighboring countries, namely The Royal Government of Cambodia, The Government of Lao People's Democratic Republic and The Government of The Union of Myanmar. The analysis will examine the legal status of the victim, the victim as witness in criminal proceedings, the victim protection programs, the recovery and restitution of damages, the process of repatriating the victim, and the prosecution of the criminal.