Original Consensus Research Articles

Expert consensus for clinical application of molecular diagnosis on hepatobiliary tumors (2024 edition)

Molecular diagnosis is of enormous significance for the clinical diagnosis and treatment of hepatobiliary tumors. The expert group first released the "Expert Consensus for Clinical Application of Molecular Diagnosis on Hepatobiliary Tumors" in 2020. The introduction of this consensus has promoted the standardized application of molecular diagnostic technology in the clinical work of hepatobiliary tumors and improved the diagnosis and treatment capabilities of clinical physicians for hepatobiliary tumors. Research on hepatobiliary tumors has gradually been carried out in recent years, with the continuous publication of new research results. Hence, the expert group updated this consensus on the basis of the latest research progress, the original consensus, with a focus on the detection of molecular markers for targeted and immunotherapy of hepatobiliary tumors, in order to provide a reference for clinical physicians in treatment decisions and maximize the benefits for patients.

Implications of the Updated Lyon Consensus 2.0 in Clinical Practice

Over the past few decades, efforts have been made to refine the characterization of gastroesophageal reflux disease (GERD) and delineate accurate diagnostic criteria. The original Lyon Consensus published in 2018 defined conclusive diagnostic criteria for GERD, and its subsequent iteration, Lyon Consensus 2.0, provides an updated assessment for actionable GERD. We aim to review the modifications made to the updated consensus, review the supporting literature for said changes, and highlight how these changes may alter clinical practice. The key revisions in the updated consensus are the recommendations to discontinue antisecretory therapy before endoscopic grading, the modifications to endoscopic criteria for proven GERD, the incorporation of wireless pH testing parameters, and the establishment of the threshold for pH-impedance monitoring on antisecretory therapy. Apart from enhancing diagnostic reliability using conclusive and inconclusive thresholds for defining GERD, Lyon Consensus 2.0 provides medical and surgical clinicians the guidance they need to provide clear management pathways for patients with GERD symptoms.

Bounded rationality consensus reaching process with prospect theory and preventing individual weight manipulation for multi-attribute group decision making

Owing to the development and popularization of social media, multi-attribute group decision-making (MAGDM) adopting social network analysis (SNA) has appealed to widespread focus for a few years. However, most existing research on SNA has not simultaneously considered the expert's weight manipulation behavior and bounded rationality during the consensus-reaching process (CRP). To overcome this limitation, an original consensus model predicated on prospect theory (PT) and preventing individual weight manipulation is proposed in this paper. First, the experts’ behavior under certain risks is characterized by using PT, where a dynamic reference point is proposed to provide a more objective description of the experts’ psychological behavior. Then, the PT is integrated into the CRP, and the three-level prospect consensus measurement and a three-stage feedback identification mechanism are investigated. Subsequently, to safeguard against individual weight manipulation and obtain the appropriate expert weights, a feedback model incorporating minimum adjustment and maximum entropy rooted in PT is developed. This model is established from the perspectives of “efficiency” and “equity.” At last, the proposed method is applied to evaluate low-carbon investment projects in a power generation enterprise to verify its effectiveness and applicability. The superiority and robustness of the proposed method are also demonstrated through comparative analysis and sensitivity analysis.

Co-design of distributed dynamic event-triggered scheme and extended dissipative consensus control for singular Markov jumping multi-agent systems under periodic Denial-of-Service jamming attacks

This paper introduces a distributed dynamic event-triggered (DDET) controller meticulously crafted to achieve resilient consensus control in singular Markov jumping multi-agent systems (SMJMAs) even in the face of periodic Denial-of-Service (DoS) jamming attacks. With a dual focus on optimizing network resource utilization and fortifying against cyber threats, we propose a distributed dynamic event-triggered scheme (DDETS) grounded in the principles of sampled data consensus. In the presence of cyber attacks, we demonstrate the transformation of the original consensus control challenge within the singular multi-agent system into a robust stability control problem, centering around a singular switching error system governed by the DoS attack signal. Acknowledging the disturbances that typify real-world scenarios, this paper establishes criteria for attaining exponential stability and stochastic admissibility within the singular Markov jumping switching error system under the extended dissipative performance index. Furthermore, we present a hybrid design for the consensus controller and DDETS, delineated through a set of solvable linear matrix inequalities (LMIs). Finally, a comprehensive array of numerical examples meticulously illustrates the compelling effectiveness and unequivocal superiority of our proposed methodology.

In Silico Analyses of Vertebrate G-Protein-Coupled Receptor Fusions United With or Without an Additional Transmembrane Sequence Indicate Classification into Three Groups of Linkers.

Natural G-protein-coupled receptors (GPCRs) rarely have an additional transmembrane (TM) helix, such as an artificial TM-linker that can unite two class A GPCRs in tandem as a single-polypeptide chain (sc). Here, we report that three groups of TM-linkers exist in the intervening regions of natural GPCR fusions from vertebrates: (1) the original consensus (i.e., consensus 1) and consensus 2~4 (related to GPCR itself or its receptor-interacting proteins); (2) the consensus but GPCR-unrelated ones, 1~7; and (3) the inability to apply 1/2 that show no similarity to any other proteins. In silico analyses indicated that all natural GPCR fusions from Amphibia lack a TM-linker, and reptiles have no GPCR fusions; moreover, in either the GPCR-GPCR fusion or fusion protein of (GPCR monomer) and non-GPCR proteins from vertebrates, excluding tetrapods, i.e., so-called fishes, TM-linkers differ from previously reported mammalian and are avian sequences and are classified as Groups 2 and 3. Thus, previously reported TM-linkers were arranged: Consensus 1 is [T(I/A/P)(A/S)-(L/N)(I/W/L)(I/A/V)GL(L/G)(A/T)(S/L/G)(I/L)] first identified in invertebrate sea anemone Exaiptasia diaphana (LOC110241027) and (330-SPSFLCI-L-SLL-340) identified in a tropical bird Opisthocomus hoazin protein LOC104327099 (XP_009930279.1); GPCR-related consensus 2~4 are, respectively, (371-prlilyavfc fgtatg-386) in the desert woodrat Neotoma lepida A6R68_19462 (OBS78147.1), (363-lsipfcll yiaallgnfi llfvi-385) in Gavia stellate (red-throated loon) LOC104264164 (XP_009819412.1), and (479-ti vvvymivcvi glvgnflvmy viir-504) in a snailfish GPCR (TNN80062.1); In Mammals Neotoma lepida, Aves Erythrura gouldiae, and fishes protein (respectively, OBS83645.1, RLW13346.1 and KPP79779.1), the TM-linkers are Group 2. Here, we categorized, for the first time, natural TM-linkers as rare evolutionary events among all vertebrates.

Updated ACVIM consensus statement on equine herpesvirus-1.

Equine herpesvirus-1 (EHV-1) is a highly prevalent and frequently pathogenic infection of equids. The most serious clinical consequences of infection are abortion and equine herpesvirus myeloencephalopathy (EHM). The previous consensus statement was published in 2009 and considered pathogenesis, strain variation, epidemiology, diagnostic testing, vaccination, outbreak prevention and control, and treatment. A recent survey of American College of Veterinary Internal Medicine large animal diplomates identified the need for a revision to this original consensus statement. This updated consensus statement is underpinned by 4 systematic reviews that addressed key questions concerning vaccination, pharmaceutical treatment, pathogenesis, and diagnostic testing. Evidence for successful vaccination against, or effective treatment of EHV-1 infection was limited, and improvements in experimental design and reporting of results are needed in future studies of this important disease. This consensus statement also updates the topics considered previously in 2009.

Adaptive protocol of raft in wireless network

Original distributed consensus algorithms are typically engineered with wired communication networks in mind. However, when these algorithms are applied in wireless networks, the unique characteristics of wireless communication among nodes, including high error rates, variable latency, and dynamic network topology, present novel challenges that necessitate the development of adaptive protocols. This article aims to address these challenges by designing an adaptive protocol specifically for the implementation of the Raft consensus algorithm within wireless environments. We first outline the key stages of this adaptive protocol, focusing on enhancing robustness and efficiency in the state synchronization and routing processes, which are demonstrated through extensive simulations. The proposed adaptive protocol intends to ensure consistent states across nodes in wireless networks, which promote reliable and effective distributed systems for a variety of applications in autonomous wireless networks, including Vehicle-to-everything (V2X), Internet of Things (IoT), and edge computing.

WITHDRAWN: Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.

Consensus clustering methodology to improve molecular stratification of non-small cell lung cancer

Recent advances in machine learning research, combined with the reduced sequencing costs enabled by modern next-generation sequencing, paved the way to the implementation of precision medicine through routine multi-omics molecular profiling of tumours. Thus, there is an emerging need of reliable models exploiting such data to retrieve clinically useful information. Here, we introduce an original consensus clustering approach, overcoming the intrinsic instability of common clustering methods based on molecular data. This approach is applied to the case of non-small cell lung cancer (NSCLC), integrating data of an ongoing clinical study (PROMOLE) with those made available by The Cancer Genome Atlas, to define a molecular-based stratification of the patients beyond, but still preserving, histological subtyping. The resulting subgroups are biologically characterized by well-defined mutational and gene-expression profiles and are significantly related to disease-free survival (DFS). Interestingly, it was observed that (1) cluster B, characterized by a short DFS, is enriched in KEAP1 and SKP2 mutations, that makes it an ideal candidate for further studies with inhibitors, and (2) over- and under-representation of inflammation and immune systems pathways in squamous-cell carcinomas subgroups could be potentially exploited to stratify patients treated with immunotherapy.

Physician-defined severe toxicities occurring during and after cancer treatment: Modified consensus definitions and clinical applicability in the evaluation of cancer treatment.

Overall survival after cancer is increasing for the majority of cancer types, but survivors can be burdened lifelong by treatment-related severe toxicities. Integration of long-term toxicities in treatment evaluation is not least important for children and young adults with cancers with high survival probability. We present modified consensus definitions of 21 previously published physician-defined Severe Toxicities (STs), each reflecting the most serious long-term treatment-related toxicities and representing an unacceptable price for cure. Applying the Severe Toxicity (ST) concept to real-world data required careful adjustments of the original consensus definitions, translating them into standardized endpoints for evaluating treatment-related outcomes to ensure that (1) the STs can be classified uniformly and prospectively across different cohorts, and (2) the ST definitions allow for valid statistical analyses. The current paper presents the resulting modified consensus definitions of the 21 STs proposed to be included in outcome reporting of cancer treatment.

Adaptive Output Consensus of Heterogeneous Nonlinear Multiagent Systems: A Distributed Dynamic Compensator Approach

Distributed dynamic compensators play a key role in the output consensus problem of heterogeneous nonlinear multi-agent systems. The existing distributed dynamic compensators require the compensators' information to be exchanged through communication networks, and to satisfy additional stability conditions in the controller design. This note proposes a distributed dynamic compensator to address the adaptive output consensus problem of heterogeneous nonlinear multi-agent systems with unknown parameters. The distributed dynamic compensator only requires the output information to be exchanged through communication networks. In addition, the distributed dynamic compensator converts the original consensus problem into asymptotic tracking problem of nonlinear systems, without requiring extra stability conditions in the literature. Then, well-established and standard control approaches are used to design tracking controllers and solve the standard tracking problems. The current work adopts the standard adaptive backstepping approach as an example to design an adaptive tracking controllers. It is further proved that all signals in the closed-loop system are globally uniformly bounded, and the proposed scheme enables the outputs of all agents to track the leader's signal asymptotically. A simulation is presented to illustrate the effectiveness of the design methodology.

Prediction and validation of novel SigB regulon members in Bacillus subtilis and regulon structure comparison to Bacillales members

BackgroundSigma factor B (SigB) is the central regulator of the general stress response in Bacillus subtilis and regulates a group of genes in response to various stressors, known as the SigB regulon members. Genes that are directly regulated by SigB contain a promotor binding motif (PBM) with a previously identified consensus sequence.ResultsIn this study, refined SigB PBMs were derived and different spacer compositions and lengths (N12-N17) were taken into account. These were used to identify putative SigB-regulated genes in the B. subtilis genome, revealing 255 genes: 99 had been described in the literature and 156 genes were newly identified, increasing the number of SigB putative regulon members (with and without a SigB PBM) to > 500 in B. subtilis. The 255 genes were assigned to five categories (I-V) based on their similarity to the original SigB consensus sequences. The functionalities of selected representatives per category were assessed using promoter-reporter fusions in wt and ΔsigB mutants upon exposure to heat, ethanol, and salt stress. The activity of the PrsbV (I) positive control was induced upon exposure to all three stressors. PytoQ (II) showed SigB-dependent activity only upon exposure to ethanol, whereas PpucI (II) with a N17 spacer and PylaL (III) with a N16 spacer showed mild induction regardless of heat/ethanol/salt stress. PywzA (III) and PyaaI (IV) displayed ethanol-specific SigB-dependent activities despite a lower-level conserved − 10 binding motif. PgtaB (V) was SigB-induced under ethanol and salt stress while lacking a conserved − 10 binding region. The activities of PygaO and PykaA (III) did not show evident changes under the conditions tested despite having a SigB PBM that highly resembled the consensus. The identified extended SigB regulon candidates in B. subtilis are mainly involved in coping with stress but are also engaged in other cellular processes. Orthologs of SigB regulon candidates with SigB PBMs were identified in other Bacillales genomes, but not all showed a SigB PBM. Additionally, genes involved in the integration of stress signals to activate SigB were predicted in these genomes, indicating that SigB signaling and regulon genes are species-specific.ConclusionThe entire SigB regulatory network is sophisticated and not yet fully understood even for the well-characterized organism B. subtilis 168. Knowledge and information gained in this study can be used in further SigB studies to uncover a complete picture of the role of SigB in B. subtilis and other species.

Risk of sarcopenia in older adults with type 2 diabetes mellitus: evaluation of the SARC-F and SARC-CalF as screening tools

Objective: To evaluate the diagnostic power of SARC-F and SARC-CalF as screening tools for sarcopenia risk in older adults with type 2 diabetes mellitus. Methodology: This cross-sectional study of 128 patients was conducted at the endocrinology outpatient clinic of a hospital in Recife, Brazil between July 2022 and February 2023. Sarcopenia was diagnosed according to original and updated European Consensus criteria for older adults. Muscle mass was assessed with electrical bioimpedance, muscle strength was assessed with a handgrip test, and physical performance was assessed with gait speed. Sarcopenia risk was assessed using the SARC-F and SARC-CalF instruments. The sensitivity, specificity, positive and negative predictive values, receiver operating characteristic curve, and area under the curve were analyzed to determine the best diagnostic performance. Results: According to the original and updated versions of the European Consensus criteria, the prevalence of sarcopenia was 25.00% and 10.90%, respectively. Sarcopenia risk was 17.20% according to the SARC-F and 23.40% according to the SARC-CalF. The sensitivity and specificity of the SARC-F ranged from 12.55% to 36.11% and 71.87% to 92.39%, respectively, while those of the SARC-CalF ranged from 47.22% to 85.71% and 82.46% to 88.89%, respectively. The area under the curve for the SARC-F and SARC-CalF varied between 0.51 and 0.71 and 0.67 and 0.86, respectively.Conclusions: The SARC-CalF had better diagnostic performance for all analyzed diagnostic criteria. Adding calf circumference to the SARC-F was an effective screening method for sarcopenia risk in the study population.

New International Guidelines and Consensus on the Use of Lung Ultrasound.

Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.

Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure.

ABSTRACTObjectivesTo evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.MethodsA modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two‐dimensional (2D) video recordings (four recordings also included three‐dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.ResultsOf 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan‐shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.ConclusionConsensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

BackgroundPatients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures.MethodsWe analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien–Dindo (C–D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition.ResultsOf the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs. n-MetSG 10.5 ± 10.2 days, p = 0.046). MetSG has a significantly higher rate of morbidity (353 (35.%) vs. 385 (29.4%), p = 0.005). The mortality rate in patients with MetS (98/1010, 10%) was similar to that in patients without it (129/1308, 10%). Considering patients with MetS who developed SIRS and those who had frailty or both, the occurrence of these conditions was associated with a higher rate of morbidity and mortality.ConclusionImpact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.

Parallel feedforward compensation for output synchronization: Fully distributed control and indefinite Laplacian

This work is associated with the use of parallel feedforward compensators (PFCs) for the problem of output synchronization over heterogeneous agents and the benefits this approach can provide. Specifically, it addresses the addition of stable PFCs on agents that interact with each other using diffusive couplings. The value in the application of such PFC is twofold. Firstly, it has been an issue that output synchronization among passivity-short systems requires global information for the design of controllers in the cases when initial conditions need to be taken into account, such as average consensus and distributed optimization. We show that a stable PFC can be designed to passivate a passivity-short system while its output asymptotically vanishes as its input tends to zero. As a result, output synchronization is achieved among these systems by fully distributed controls without altering the original consensus results. Secondly, in the literature of output synchronization over signed weighted graphs, it is generally required that the graph Laplacian be positive semidefinite, i.e., $L \geq 0$ for undirected graphs or $L + L^T \geq 0$ for balanced directed graphs. We show that the PFC serves as output feedback to the communication graph to enhance the robustness against negative weight edges. As a result, output synchronization is achieved over a signed weighted and balanced graph, even if the corresponding Laplacian is not positive semidefinite.

CORAL: Development of a hybrid descriptor based QSTR model to predict the toxicity of dioxins and dioxin-like compounds with correlation intensity index and consensus modelling

In the present study, ninety-five halogenated dioxins and related chemicals (dibenzo-p-dioxins, dibenzofurans, biphenyls, and naphthalene) with endpoint pEC50 were used to develop twelve quantitative structure toxicity relationship (QSTR) models using inbuilt Monte Carlo algorithm of CORAL software. The hybrid optimal descriptor of correlation weights (DCW) using a combination of SMILES and HSG (hydrogen suppressed graph) was employed to generate QSTR models. Three target functions i.e. TF1 (WIIC=WCII=0), TF2 (WIIC= 0.3 & WCII=0) and TF3 (WIIC= 0.0 &WCII=0.3) were employed to develop robust QSTR models and the statistical outcomes of each target function were compared with each other. The correlation intensity index (CII) was found a reliable benchmark of the predictive potential for QSTR models. The numerical value of the determination coefficient of the validation set of split 1 computed by TF3 was found highest (RValid2=0.8438). The fragments responsible for the toxicity of dioxins and related chemicals were also identified in terms of the promoter of increase/decrease for pEC50. Three random splits (Split 1, Split 2 and Split 4) were selected for the extraction of the promoter of increase/decrease for pEC50. In the last, consensus modelling was performed using the intelligent consensus tool of DTC lab (https://dtclab.webs.com/software-tools). The original consensus model, which was created by combining four distinct models employing the split 4 arrangement, was more predictive for the validation set and the numerical value of the determination coefficient of the test set (validation set) was increased from 0.8133 to 0.9725. For the validation set of split 4, the mean absolute error (MAE 100%) was also lowered from 0.513 to 0.2739.

Implementation of Nationwide Evidence- and Consensus-Based Guidelines to Harmonize Neonatal Care in The Netherlands

BackgroundA Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensus-based guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent.ObjectiveThis study investigated to what extent the guidelines were implemented and which factors played a role in implementation.Study designA mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semi-structured interviews, perceived barriers and facilitators for implementation were explored.ParticipantsFellows and neonatologists working at all ten Dutch level 3–4 NICUs were eligible.ResultsOn an average, NICUs implemented 12.6 (of 19) guidelines (range 6–17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation).ConclusionThe implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.Electronic Supplementary MaterialSupplementary material is available in the online version of this article at 10.1007/s13312-022-2516-3.

Discrete space-based route planning for rotary-wing UAV formation in urban environments

The route planning problem for rotary-wing UAV formation is studied in discrete urban environments. First, a discrete-space consensus algorithm (DSCA) integrating asynchronous planning and grouping mechanism is developed to make the rotary-wing UAVs converge to the desired formation. Then the DSCA is combined with the improved rapidly-exploring random tree (IRRT) algorithm to enable the rotary-wing UAV formation to avoid the obstacles. Finally, the time information of waypoints is complemented by resolving the conflicts among multiple rotary-wing UAVs, thus reducing the rotary-wing UAVs’ time gap of reaching the destinations. The proposed method extends the original consensus theory in the discrete space and for the obstacle avoidance issue. Also, it is valid in the route planning problem for rotary-wing UAV formation considering the real urban environments.