Original Consensus Research Articles

Functionalism or Fallacy: Re-locating Hans Mol’s Identity Theory

In this paper, the identity theory of religion outline by sociologist Hans Mol in the 1970s is introduced and located among the various competing theories of the mid-20 th century. Using such comparisons, particularly with enigmatic sociological figures, it is argued that the original consensus that Mol represented yet another neo-functionalist theory of religion is fallacious. Instead, it is suggested that his theoretical framework, whilst ambitious and broad, is something other than functionalism and avoids easy categorisation when viewed from a 21 st -century perspective on the history of ideas.

Can We “Future-Proof” Consensus Trees?†

Consensus methods are widely used for combining phylogenetic trees into a single estimate of the evolutionary tree for a group of species. As more taxa are added, the new source trees may begin to tell a different evolutionary story when restricted to the original set of taxa. However, if the new trees, restricted to the original set of taxa, were to agree exactly with the earlier trees, then we might hope that their consensus would either agree with or resolve the original consensus tree. In this article, we ask under what conditions consensus methods exist that are "future proof" in this sense. While we show that some methods (e.g., Adams consensus) have this property for specific types of input, we also establish a rather surprising "no-go" theorem: there is no "reasonable" consensus method that satisfies the future-proofing property in general. We then investigate a second notion of "future proofing" for consensus methods, in which trees (rather than taxa) are added, and establish some positive and negative results. We end with some questions for future work.

Peri-operative blood management.

Anaemia and allogeneic blood transfusions in surgical patients are associated with poor outcomes. Patient blood management (PBM) has been developed as an evidence-based clinical tool, by which clinicians can optimise anaemia, manage peri-operative bleeding, avoid unnecessary blood transfusion and improve patient outcome. This article aims to highlight the recent updates regarding evidence-based PBM in the perioperative period, following a thorough literature review involving original research articles, published guidelines and consensus documents discovered through an extensive PubMed and Medline search. PBM addresses three main pillars of the patient's journey through the pre-operative, intra-operative and post-operative periods. PBM encourages a restrictive approach to transfusion of blood products and promotes alternatives to blood transfusion to maximise clinical efficacy while minimising risks. Anaemia has been identified as an independent risk factor for poor outcomes. PBM highlights the importance of treating anaemia in the pre-operative period. Major elective surgery may be postponed until anaemia is corrected preoperatively. The intra-operative approach to PBM is a collaborative effort between the anaesthesia, surgery and transfusion laboratory teams. Use of tranexamic acid, meticulous haemostasis and cell salvage techniques play an important role during the intra-operative management of surgical and traumatic haemorrhage. Point-of-care coagulation tests with visco-elastographic methods and haemoglobin measurement ensure that the transfusion prescription is tailored to a patient. In the post-operative period, PBM highlights the need for patients to be optimised before discharge from the hospital. Implementation of the PBM has been shown to have individual health as well as economic benefits.

P1.02-062 Consensus of Gene Expression Phenotypes and Prognostic Risk Predictors in Primary Lung Adenocarcinoma

Transcriptional profiling of lung adenocarcinomas has identified numerous gene expression phenotype (GEP) and risk prediction (RP) signatures associated with patient outcome. However, classification agreement between signatures, underlying transcriptional programs, and independent signature validation are less studied. Published transcriptional profiles from 17 cohorts comprising 2395 lung adenocarcinomas with available patient outcome data were collected from authors’ websites or public repositories as described in the original studies. Tumors were classified according to 18 different GEPs or RPs derived from microarray analysis of lung adenocarcinoma or NSCLC cohorts, using reported original classification schemes or consensus clustering of gene signatures on a per cohort basis. To independently assess the connection between classifications by the lung cancer derived signatures and classification by expression of proliferation-related genes only, a 155-gene breast cancer proliferation signature was used to classify all tumors as low-proliferative (average expression of the 155-genes < median) or high-proliferative. Tumors were also scored according to five reported expression metagenes in lung cancer representing different biological processes; proliferation, immune response, basal/squamous, stroma/extra cellular matrix (ECM), and expression of Napsin A/ surfactants on a per cohort basis to contrast subtype classifications with biological functions. 16 out of 18 signatures were associated with patient survival in the total cohort and in multiple individual cohorts. For significant signatures, total cohort hazard ratios were ∼2 in univariate analyses (mean=1.95, range=1.4-2.6). Signatures derived in adenocarcinoma generally displayed better classification agreement than signatures derived in mixed NSCLC cohorts. Strong classification agreement between signatures was observed, especially for predicted low-risk patients by adenocarcinoma-derived signatures, despite a generally low gene overlap. Expression of proliferation-related genes correlated strongly with GEP subtype classifications and RP scores, driving the gene signature association with prognosis. A three-group consensus definition of samples across 10 GEP classifiers demonstrated aggregation of samples with specific smoking patterns, gender, and EGFR/KRAS mutations, while survival differences were only significant when patients were divided into low- or high-risk resembling a terminal respiratory (TRU) like and non-TRU division, respectively. By providing this consensus of current GEPs and RPs in lung adenocarcinoma we have connected molecular phenotypes, risk predictions, patient outcome and underlying transcriptional programs of the different classifier types. Our results provide a general insight into the nature and agreement of GEP and RP signatures in the disease, and their prognostic value.

Peripheral Neuropathies Associated With Diabetes Mellitus: A Review

The review aimed to describe various diabetes mellitus-associated peripheral neuropathies, various related diseases and clinical features. English-language literature search using a combination of words (diabetic neuropathy and diagnosis) was used to identify original studies, consensus statements, and reviews published in the last few years. The diverse neuropathies of diabetes mellitus can be seen in various research articles which are found in clinical practice. Prompt diagnosis and recognition of these with the institution of appropriate treatment measures would go a long way towards reducing morbidity and mortality outcomes. J Neurol Res. 2016;6(5-6):91-94 doi: https://doi.org/10.14740/jnr412e

HIV-associated peripheral neuropathies: a review

Objective: To review the various neurologic complications of HIV. Methods: A MEDLINE search of the English-language literature using a combination of words (HIV, neuropathy and diagnosis) was used to identify original studies, consensus statements and reviews published in the last 25 years. Results: The various HIV-associated neuropathies are described. Conclusion: It is important for clinicians to be equipped with the knowledge of the various neuropathic complications of HIV. Prompt diagnosis of these with institution of proper treatment measures would go a long way towards reducing morbidity and mortality outcomes.

Treatment of Coagulopathy Related to Hepatic Insufficiency.

To provide a concise review of the medical management of coagulopathy related to hepatic insufficiency. This review will focus on prevention and management of bleeding episodes in patients with hepatic insufficiency. The treatment and prevention of thromboembolic complications will also be addressed. Electronic search of PubMed database using relevant search terms, including hepatic coagulopathy, hemorrhage, liver diseases, blood coagulation disorders, blood transfusion, disseminated intravascular coagulation, and liver failure. Subsequent searches were done on specific issues. Articles considered include original articles, review articles, guidelines, consensus statements, and conference proceedings. A detailed review of scientific, peer-reviewed data was performed. Relevant publications were included and summarized. Available evidence is used to describe and summarize currently available tests of hemostasis, utilization of prohemostatic agents, transfusion strategies, use of prophylactic anticoagulation and treatment of thromboembolic events in patients with hepatic insufficiency. Dynamic changes to hemostasis occur in patients with hepatic insufficiency. Routine laboratory tests of hemostasis are unable to reflect these changes and should not be used exclusively to evaluate coagulopathy. Newer testing methods are available to provide data on the entire spectrum of clotting but are not validated in acute bleeding. Prohemostatic agents utilized to prevent bleeding should only be considered when the risk of bleeding outweighs the risk of thrombotic complications. Restrictive transfusion strategies may avoid exacerbation of acute bleeding. Prophylaxis against and treatment of thromboembolic events are necessary and should consider patient specific factors.

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

PurposeTo update the accelerated partial breast irradiation Consensus Statement published in 2009 and provide guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer, based on published evidence complemented by expert opinion. Methods and materialsA systematic PubMed search using the same terms as the original Consensus Statement yielded 419 articles; 44 articles were selected. The authors synthesized the published evidence and, through a series of conference calls and e-mails, reached consensus regarding the recommendations. ResultsThe new recommendations include lowering the age in the “suitability group” from 60 to 50 years and in the “cautionary group” to 40 years for patients who meet all other elements of suitability (Table 1). Patients with low-risk ductal carcinoma in situ, as per Radiation Therapy Oncology Group 9804 criteria, were categorized in the “suitable” group. The task force agreed to maintain the current criteria based on margin status. Recommendations for the use of IORT for breast cancer patients include: counseling patients regarding the higher risk of ipsilateral breast tumor recurrence with IORT compared with whole breast irradiation; the need for prospective monitoring of long-term local control and toxicity with low-energy radiograph IORT given limited follow-up; and restriction of IORT to women with invasive cancer considered “suitable.” ConclusionThese recommendations will provide updated clinical guidance regarding use of accelerated partial breast irradiation for radiation oncologists and other specialists participating in the care of breast cancer patients.

Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder

Whilst professional bodies such as the Royal College and the American College of Obstetricians and Gynecologists have well-established standards for audit of management for most gynaecology disorders, such standards for premenstrual disorders (PMDs) have yet to be developed. The International Society of Premenstrual Disorders (ISPMD) has already published three consensus papers on PMDs covering areas that include definition, classification/quantification, clinical trial design and management (American College Obstetricians and Gynecologists 2011; Brown et al. in Cochrane Database Syst Rev 2:CD001396, 2009; Dickerson et al. in Am Fam Physician 67(8):1743-1752, 2003). In this fourth consensus of ISPMD, we aim to create a set of auditable standards for the clinical management of PMDs. All members of the original ISPMD consensus group were invited to submit one or more auditable standards to be eligible in the inclusion of the consensus. Ninety-five percent of members (18/19) responded with at least one auditable standard. A total of 66 auditable standards were received, which were returned to all group members who then ranked the standards in order of priority, before the results were collated. Proposed standards related to the diagnosis of PMDs identified the importance of obtaining an accurate history, that a symptom diary should be kept for 2months prior to diagnosis and that symptom reporting demonstrates symptoms in the premenstrual phase of the menstrual cycle and relieved by menstruation. Regarding treatment, the most important standards were the use of selective serotonin reuptake inhibitors (SSRIs) as a first line treatment, an evidence-based approach to treatment and that SSRI side effects are properly explained to patients. A set of comprehensive standards to be used in the diagnosis and treatment of PMD has been established, for which PMD management can be audited against for standardised and improved care.

Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of...

Which factors influence women in the decision to breastfeed?

Identify the factors that influence women in the decision to breastfeed. Integrative review. Information was gathered from original articles, case studies, theoretical studies, consensus and systematic reviews published between 2007-2013 in Spanish, Portuguese and English and recovered in the databases MEDLINE and LILACS. The descriptors used in this study were: breastfeeding, maternal behavior, risk factors, lactation and newborn. Were included 30 articles, grouped into five categories. Factors influencing the decision of the breastfeeding woman are a convergence of breastfeeding's advantages, benefits and justifications, family, social and professional support, sociodemographic and clinical characteristics of women, personal experience and family tradition and personal choice. The decision to breastfeed by women is influenced by a convergence of factors. It is essential the role of nursing to encourage women in the decision to initiate and maintain breastfeeding her child.

Peripheral Neuropathies Associated With Diabetes Mellitus: A Review

The review aimed to describe various diabetes mellitus-associated peripheral neuropathies, various related diseases and clinical features. English-language literature search using a combination of words (diabetic neuropathy and diagnosis) was used to identify original studies, consensus statements, and reviews published in the last few years. The diverse neuropathies of diabetes mellitus can be seen in various research articles which are found in clinical practice. Prompt diagnosis and recognition of these with the institution of appropriate treatment measures would go a long way towards reducing morbidity and mortality outcomes. J Neurol Res. 2016;6(5-6):91-94 doi: https://doi.org/10.14740/jnr412e

The local control scheme for switching consensus value in multi-agent systems

A local control strategy is presented to switch the consensus value for the first-order multi-agent system. When the local proportional controller is employed in the multi-agent systems, the Laplacian matrix of the system is changed. It is proved that the changed Laplacian has the same properties as the Laplacian matrix of the original multi-agent system for the consensus. Based on this, the parameter of the local controller, which can guarantee that all the agents change the original consensus value into the desired one, is determined in terms of the matrix calculation and the stability criterion. In practice, the control system must be implemented in the discrete form. Thus, the influence of the sampling period on the stability of the discrete multi-agent system with the local controller is analysed. The simulation results show the validity of the proposed method.

SeedsGraph: an efficient assembler for next-generation sequencing data.

DNA sequencing technology has been rapidly evolving, and produces a large number of short reads with a fast rising tendency. This has led to a resurgence of research in whole genome shotgun assembly algorithms. We start the assembly algorithm by clustering the short reads in a cloud computing framework, and the clustering process groups fragments according to their original consensus long-sequence similarity. We condense each group of reads to a chain of seeds, which is a kind of substring with reads aligned, and then build a graph accordingly. Finally, we analyze the graph to find Euler paths, and assemble the reads related in the paths into contigs, and then lay out contigs with mate-pair information for scaffolds. The result shows that our algorithm is efficient and feasible for a large set of reads such as in next-generation sequencing technology.

Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1--Cardiac diseases and pulmonary hypertension.

To review the current veterinary and relevant human literature regarding biomarkers of cardiac disease leading to respiratory compromise. Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks. Cardiac troponins (cTn) and natriuretic peptides are routinely used in human medicine. Although biomarkers should not be accepted in lieu of gold standard diagnostics, they may be useful in directing care in the stabilization process. Biomarkers of congestive heart failure (CHF) include natriuretic peptides, cTn, and endothelin. cTnI is useful in differentiating causes of pericardial effusion, but is unlikely to be useful in differentiating CHF from other causes of respiratory distress. The most extensively studied and promising cardiac biomarker is amino-terminal probrain natriuretic peptide, although a bedside test is not currently available. Other natriuretic peptides have also proven useful, but have lower availability. Endothelin is unlikely to be clinically useful. Although critically evaluated for their use in cardiac diseases, many of the biomarkers are affected by more than one type of respiratory or systemic disease. Several cardiac biomarkers are increased in cases of pulmonary hypertension (PH), but discerning CHF alone from PH or a combination of heart disease and PH is challenging when evaluating biomarkers alone. At this time, there are no point-of-care tests for biomarkers that can reliably differentiate among causes of dyspnea of cardiac origin in dogs and cats, although there are reference laboratory tests that show promise and future development of point-of-care tests that may be useful in certain situations.

Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 2--Lower airway, thromboembolic, and inflammatory diseases.

To review the current veterinary and relevant human literature regarding biomarkers of respiratory diseases leading to dyspnea and to summarize the availability, feasibility, and practicality of using respiratory biomarkers in the veterinary setting. Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks. Numerous biomarkers have been evaluated in people for discriminating respiratory disease processes with varying degrees of success. Although biomarkers should not dictate clinical decisions in lieu of gold standard diagnostics, their use may be useful in directing care in the stabilization process. Serum immunoglobulins have shown promise as an indicator of asthma in cats. A group of biomarkers has also been evaluated in exhaled breath. Of these, hydrogen peroxide has shown the most potential as a marker of inflammation in asthma and potentially aspiration pneumonia, but methods for measurement are not standardized. D-dimers may be useful in screening for thromboembolic disease in dogs. There are a variety of markers of inflammation and oxidative stress, which are being evaluated for their ability to assess the severity and type of underlying disease process. Of these, amino terminal pro-C-type natriuretic peptide may be the most useful in determining if antibiotic therapy is warranted. Although critically evaluated for their use in respiratory disorders, many of the biomarkers which have been evaluated have been found to be affected by more than one type of respiratory or systemic disease. At this time, there are point-of-care biomarkers that have been shown to reliably differentiate between causes of dyspnea in dogs and cats. Future clinical research is warranted to understand of how various diseases affect the biomarkers and more bedside tests for their utilization.

On the origin of Neurostatus

In his commentary (Kurtzke, 2015) Dr. Kurztke recapitulates the rationale and the underlying evidence for the development of the Functional Systems (FS), the Disability Status Scale (DSS) and the Expanded Disability Status Scale (EDSS). This commentary and several of the author's previous publications on this topic (Kurtzke, 1955, 1965, 1970, 1983, 1989, 2007, 2008) underline his unique and widely appreciated contribution: Dr. Kurtzke created a scale that was a major step in comprehensively assessing neurologic impairment and disability in people with MS in the course of their disease. Although frequently criticized and challenged by other scales, the (E)DSS and its FS have persisted and hold a central role as an assessment tool in MS observational and therapeutic studies and have also – with some caveats – entered daily practice for the description and communication about the status of individual patients. Reemphasizing a statement from a previous review (Kurtzke, 2008), Dr. Kurtzke acknowledges that following his publications, the (E)DSS and FS entered the public domain and started being used in variable contexts all over the world. With increasing experience it was inevitable that investigators would also realize the scale's limitations. Many peer reviewed original publications, reviews and consensus statements (Willoughby

Constraint Consensus Methods for Finding Strictly Feasible Points of Linear Matrix Inequalities

We give algorithms for solving the strict feasibility problem for linear matrix inequalities. These algorithms are based on John Chinneck’s constraint consensus methods, in particular, the method of his original paper and the modified DBmax constraint consensus method from his paper with Ibrahim. Our algorithms start with one of these methods as “Phase 1.” Constraint consensus methods work for any differentiable constraints, but we take advantage of the structure of linear matrix inequalities. In particular, for linear matrix inequalities, the crossing points of each constraint boundary with the consensus ray can be calculated. In this way we check for strictly feasible points in “Phase 2” of our algorithms. We present four different algorithms, depending on whether the original (basic) or DBmax constraint consensus vector is used in Phase 1 and, independently, in Phase 2. We present results of numerical experiments that compare the four algorithms. The evidence suggests that one of our algorithms is the best, although none of them are guaranteed to find a strictly feasible point after a given number of iterations. We also give results of numerical experiments indicating that our best method compares favorably to a new variant of the method of alternating projections.

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2014 Update

To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and 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 to prevention and management of each disorder that incorporate these recommendations. 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 2010;21(2):146-155.

The changing role of palliative care in the ICU.

Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. Selected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.' : After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care. Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.