Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of...Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of widely variable quality.So,this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs,exploring factors that may influence their quality,and analyzing the change of recommendations in CPGs with evidence published.Methods.We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs.The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist.Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19(remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir)were also systematically assessed.And the statistical inference was performed to identify factors associated with the quality of CPGs.Results.We included a total of 92 COVID-19 CPGs developed by 19 countries.Overall,the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%,and the AGREE II domain score was 30.4%.The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020.Factors associated with high methodological and reporting qualities included the evidence-based development process,management of conflicts of interest,and use of established rating systems to assess the quality of evidence and strength of recommendations.The recommendations of only seven(7.6%)CPGs were informed by a systematic review of evidence,and these seven CPGs have relatively high methodological and reporting qualities,in which six of them fully meet the Institute of Medicine(IOM)criteria of guidelines.Besides,a rapid advice CPG developed by the World Health Organization(WHO)of the seven CPGs got the highest overall scores in methodological(72.8%)and reporting qualities(83.8%).Many CPGs covered the same clinical questions(it refers to the clinical questions on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavirritonavir in COVID-19 patients)and were published by different countries or organizations.Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir for patients with COVID-19 have been published,the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions,which may suggest that the CPGs do not make sufficient use of the latest evidence.Conclusions.Both the methodological and reporting qualities of COVID-19 CPGs increased over time,but there is still room for further improvement.The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs.The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic.During the pandemic,we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice.We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question,increase the transparency of the development process,and promote cooperation among guideline developers all over the world.Since the International Practice Guideline Registry Platform has been created,developers could register guidelines prospectively and internationally on this platform.展开更多
The ignition process and flame propagation with ethylene fuel in cavity-stabilized scramjet by a Multi-Channel Gliding Arc(MCGA)at Mach 2.0 were investigated.Effects of equivalence ratios on the MCGA-assisted ignition...The ignition process and flame propagation with ethylene fuel in cavity-stabilized scramjet by a Multi-Channel Gliding Arc(MCGA)at Mach 2.0 were investigated.Effects of equivalence ratios on the MCGA-assisted ignition process and flame propagation of the scramjet were recorded by two high-speed cameras from different view angles.The discharge characteristics of MCGA are also collected synchronously with the high-speed cameras.The distributions of temperature,velocity,and equivalence ratios in non-reactive flows of the cavity were simulated by Reynolds Averaged Navier-Stokes(RANS)model.The results show that MCGA can achieve reliable ignition with the Global Equivalence Ratios(GER)between 0.06 and 0.17.The ignition process is composed of flame kernel generation,flame development,and stable combustion.The time from flame kernel generation to the establishment of global flame decreases as GER decreases from 0.17 to 0.08.In the streamwise direction,the flame first develops to the Cavity Leading Edge(CLE)because of the influence of the cavity recirculation zone and then uplifts into the cavity shear layer,and finally develops to the Cavity Trailing Edge(CTE).In the spanwise direction,the flame width is less than 50%of the width of the cavity before developing to CLE and begins to develop towards the two sides of the combustor after reaching CLE,which is affected by the angular recirculation zone on both sides of CLE.The ignition processes by MCGA in the scramjet combustor are significantly affected by local distributions of equivalence ratios and velocity in the cavity.展开更多
文摘Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of widely variable quality.So,this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs,exploring factors that may influence their quality,and analyzing the change of recommendations in CPGs with evidence published.Methods.We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs.The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist.Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19(remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir)were also systematically assessed.And the statistical inference was performed to identify factors associated with the quality of CPGs.Results.We included a total of 92 COVID-19 CPGs developed by 19 countries.Overall,the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%,and the AGREE II domain score was 30.4%.The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020.Factors associated with high methodological and reporting qualities included the evidence-based development process,management of conflicts of interest,and use of established rating systems to assess the quality of evidence and strength of recommendations.The recommendations of only seven(7.6%)CPGs were informed by a systematic review of evidence,and these seven CPGs have relatively high methodological and reporting qualities,in which six of them fully meet the Institute of Medicine(IOM)criteria of guidelines.Besides,a rapid advice CPG developed by the World Health Organization(WHO)of the seven CPGs got the highest overall scores in methodological(72.8%)and reporting qualities(83.8%).Many CPGs covered the same clinical questions(it refers to the clinical questions on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavirritonavir in COVID-19 patients)and were published by different countries or organizations.Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir for patients with COVID-19 have been published,the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions,which may suggest that the CPGs do not make sufficient use of the latest evidence.Conclusions.Both the methodological and reporting qualities of COVID-19 CPGs increased over time,but there is still room for further improvement.The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs.The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic.During the pandemic,we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice.We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question,increase the transparency of the development process,and promote cooperation among guideline developers all over the world.Since the International Practice Guideline Registry Platform has been created,developers could register guidelines prospectively and internationally on this platform.
基金supported by the National Natural Science Foundation of China(Nos.12172379,11925207,and 91741205)the Foundation for Outstanding Young Scholars of National University of Defense Technology,China.
文摘The ignition process and flame propagation with ethylene fuel in cavity-stabilized scramjet by a Multi-Channel Gliding Arc(MCGA)at Mach 2.0 were investigated.Effects of equivalence ratios on the MCGA-assisted ignition process and flame propagation of the scramjet were recorded by two high-speed cameras from different view angles.The discharge characteristics of MCGA are also collected synchronously with the high-speed cameras.The distributions of temperature,velocity,and equivalence ratios in non-reactive flows of the cavity were simulated by Reynolds Averaged Navier-Stokes(RANS)model.The results show that MCGA can achieve reliable ignition with the Global Equivalence Ratios(GER)between 0.06 and 0.17.The ignition process is composed of flame kernel generation,flame development,and stable combustion.The time from flame kernel generation to the establishment of global flame decreases as GER decreases from 0.17 to 0.08.In the streamwise direction,the flame first develops to the Cavity Leading Edge(CLE)because of the influence of the cavity recirculation zone and then uplifts into the cavity shear layer,and finally develops to the Cavity Trailing Edge(CTE).In the spanwise direction,the flame width is less than 50%of the width of the cavity before developing to CLE and begins to develop towards the two sides of the combustor after reaching CLE,which is affected by the angular recirculation zone on both sides of CLE.The ignition processes by MCGA in the scramjet combustor are significantly affected by local distributions of equivalence ratios and velocity in the cavity.
