Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The ...aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.
Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted.
A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range IQR 31-84%), Scope and Purpose (median 64%, IQR 22-83%), Rigour of Development (median 50%, IQR 21-72%), Clarity and Presentation (median 50%, IQR 28-79%), Stakeholder Involvement (median 36%, IQR 10-74%), and Applicability (median 11%, IQR 0-46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88-0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.
We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence.
1 TRIAL REGISTRATION: REGISTRATION PROSPERO DETAILS: CRD42019127619 .
The Large Hadron Collider forward (LHCf) experiment is designed to use the LHC to verify the hadronic-interaction models used in cosmic-ray physics. Forward baryon production is one of the crucial ...points to understand the development of cosmic-ray showers. We report the neutron-energy spectra for LHC s=7 TeV proton–proton collisions with the pseudo-rapidity η ranging from 8.81 to 8.99, from 8.99 to 9.22, and from 10.76 to infinity. The measured energy spectra obtained from the two independent calorimeters of Arm1 and Arm2 show the same characteristic feature before unfolding the detector responses. We unfolded the measured spectra by using the multidimensional unfolding method based on Bayesian theory, and the unfolded spectra were compared with current hadronic-interaction models. The QGSJET II-03 model predicts a high neutron production rate at the highest pseudo-rapidity range similar to our results, and the DPMJET 3.04 model describes our results well at the lower pseudo-rapidity ranges. However, no model perfectly explains the experimental results over the entire pseudo-rapidity range. The experimental data indicate a more abundant neutron production rate relative to the photon production than any model predictions studied here.
Introduction
Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender ...psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development.
Aims
(1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis.
Methods
A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors’ expertise.
Results
A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD.
Conclusions
Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the understanding of these challenging conditions and clinical practice, in providing a better prediction of gender identity.
Antiparticles account for a small fraction of cosmic rays and are known to be produced in interactions between cosmic-ray nuclei and atoms in the interstellar medium, which is referred to as a ...'secondary source'. Positrons might also originate in objects such as pulsars and microquasars or through dark matter annihilation, which would be 'primary sources'. Previous statistically limited measurements of the ratio of positron and electron fluxes have been interpreted as evidence for a primary source for the positrons, as has an increase in the total electron+positron flux at energies between 300 and 600 GeV (ref. 8). Here we report a measurement of the positron fraction in the energy range 1.5-100 GeV. We find that the positron fraction increases sharply over much of that range, in a way that appears to be completely inconsistent with secondary sources. We therefore conclude that a primary source, be it an astrophysical object or dark matter annihilation, is necessary.
Transgender people represent a broad spectrum of individuals that transiently or persistently identify with a gender different from the one assigned at birth (APA, 2013). Transgender healthcare ...issues have become an increased matter of interest over the last years, as shown by the growth of publications on the subject and by the increase of referrals reported worldwide in all age groups. However, transgender people report encountering numerous obstacles in accessing and receiving appropriate health care with professionals being described as not properly trained on specific gender issues. Considering the diversity and complexity of the gender spectrum in the different age groups and in light of the recent changes in the formal psychiatric classification, mental health providers play a critical role in meeting the needs of gender non-conforming children, adolescents and adults, according to individualized paths. This course has the following aims: (1) learn the principles of assessment of gender incongruence in childhood, adolescence and adulthood; (2) address co-occurring psychopathology (if present); (3) identify different treatment paths according to age and individualized psychological and/or medical needs; (4) work in a multidisciplinary team in line with an integrated model.
Disclosure
No significant relationships.
The CALorimetric Electron Telescope (CALET)on the International Space Station consists of a high-energy cosmic-ray CALorimeter (CAL)and a lower-energy CALET Gamma-ray Burst Monitor (CGBM). CAL is ...sensitive to electrons up to 20 TeV, cosmic-ray nuclei from Z=1 throughZ∼40, and gamma rays over the range1 GeV–10 TeV. CGBM observes gamma rays from 7 keV to 20 MeV. The combined CAL-CGBM instrument has conducted a search for gamma-ray bursts (GRBs)since 2015 October. We report here on the results of a search for X-ray/gamma-ray counterparts to gravitational-wave events reported during the LIGO/Virgo observing run O3. No events have been detected that pass all acceptance criteria. We describe the components, performance, and triggering algorithms of the CGBM—the two Hard X-ray Monitors consisting of LaBr3(Ce)scintillators sensitive to 7 keV–1 MeV gamma rays and a Soft Gamma-ray Monitor BGO scintillator sensitive to 40 keV–20 MeV—and the high-energy CAL consisting of a charge detection module, imaging calorimeter, and the fully active total absorption calorimeter. The analysis procedure is described and upper limits to the time-averaged fluxes are presented.
Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the ...presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours.
138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R).
participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs.
Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
•Feeding and eating disorder patients show higher autism traits than healthy controls.•Rigidity and restricted interests are more represented in restricrive patients.•Different clinical presentations of autism spectrum symptoms are highlighted.
Introduction
Theory of Mind (ToM) is defined as the ability to understand mental states of other people. Recent studies explored its role in various psychopathological disorders, but evidence lacks ...on the relationship existing between specific psychopathological domains and ToM.
Objectives
We aimed to investigate the relationship between psychopathology of Anxiety Disorders (AD) and Theory of Mind.
Methods
We enrolled 35 patients admitted to the Psychiatric Unit of Careggi Hospital in Florence with diagnosis of AD. We administered them: Zung Anxiety Scale (ZSAS), Metacognition Questionnaire-30 (MCQ-30), and Reading the Mind in the Eyes (RMET). Pearson’s correlation was used to assess relationships between variables.
Results
A significant positive correlation was detected between RMET scores and ZSAS total scores (r=0.385, p=0.022), MCQ-30 Negative Beliefs about Uncontrollability and Danger subscale (MCQ-30-Neg, r=0.407, p=0.015), and MCQ-30 Cognitive Self-Consciousness subscale (MCQ-30-CSC, r=0.349, p=0.040).
Correlations between the variables in the study and Reading the mind in the eyes total scores are shown.
RMET total score
r
p
MCQ-30-Neg
0.407
0.015
MCQ-30-CSC
0.349
0.040
MCQ-30 Positive beliefs about Worry
0.073
0.667
MCQ-30 Lack of Cognitive Confidence
-0.245
0.155
MCQ-30 Need to Control Thoughts
0.311
0.069
ZSAS total scores
0.385
0.022
Conclusions
Such preliminary data suggest a relationship between Theory of Mind and AD psychopathology. In particular, some dimensions of AD psychopathology seem to predict higher Theory of Mind levels.
Disclosure
No significant relationships.
Introduction
Theory of Mind is defined as the ability to understand mental states of other people, and is notoriously impaired in patients with Autism Spectrum Disorder. A growing body of evidence ...suggests an impairment of Theory of Mind in several other psychopathological disorders. However, only few studies have assessed Theory of Mind in patients with Anxiety Disorders (AD), addressing only patients with Social Anxiety Disorder.
Objectives
We aimed to investigate the differences in Theory of Mind between patients with AD and Healthy Controls (HC).
Methods
We enrolled 35 patients admitted in the Psychiatric Unit of Careggi with diagnosis of AD and 31 HC. We administered them: Zung Anxiety Scale (ZSAS), Empathy Quotient (EQ), Reading the Mind in the Eyes (RMET), and Faux Pas test (FP). A t-test for independent samples was performed to assess between-group differences.
Results
Zung total scores proved to be significantly higher in patients (t(60)=4.375, p<0.001), while Empathy Quotient total scores (t(61)=-3.325, p=0.002), detection of faux pas in Faux Pas test (t(61)=-4.957, p<0.001), RMET total scores (t(63)=-2.269, p=0.031) were significantly higher in healthy controls.
Conclusions
Such preliminary data suggest impairment of Theory of Mind and Empathy in patients with AD as compared to HC. This could be linked to the development and maintenance of anxiety symptoms in patients with AD, making Theory of Mind a potential target in psychotherapy of AD.
Disclosure
No significant relationships.
The satellite-borne experiment PAMELA has been used to make a new measurement of the cosmic-ray antiproton flux and the antiproton-to-proton flux ratio which extends previously published measurements ...down to 60 MeV and up to 180 GeV in kinetic energy. During 850 days of data acquisition approximately 1500 antiprotons were observed. The measurements are consistent with purely secondary production of antiprotons in the Galaxy. More precise secondary production models are required for a complete interpretation of the results.
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