Assessing unConventional Evidence (ACE) tool: development and content of a tool to assess the strengths and limitations of 'unconventional' source materials

BACKGROUND

When deciding whether to implement an intervention, decision-makers typically have questions on feasibility and acceptability and on factors affecting implementation. Descriptions of programme implementation and of policies and systems are rich sources of information for these questions. However, this information is often not based on empirical data collected using explicit methods. To use the information in unconventional source materials in syntheses or other decision support products, we need methods of assessing their strengths and limitations. This paper describes the development and content of the Assessing unConventional Evidence (ACE) tool, a new tool to assess the strengths and limitations of these sources.

METHODS

We developed the ACE tool in four stages: first, we examined existing tools to identify potentially relevant assessment criteria. Second, we drew on these criteria and team discussions to create a first draft of the tool. Third, we obtained feedback on the draft from potential users and methodologists, and through piloting the tool in evidence syntheses. Finally, we used this feedback to iteratively refine the assessment criteria and to improve our guidance for undertaking the assessment.

RESULTS

The tool is made up of 11 criteria including the purpose and context of the source; the completeness of the information presented; and the extent to which evidence is provided to support the findings made. Users are asked to indicate whether each of the criteria have been addressed. On the basis of their judgements for each criterion, users then make an overall assessment of the limitations of the source, ranging from no or very minor concerns to serious concerns. These assessments can then facilitate appropriate use of the evidence in decision support products.

CONCLUSIONS

Through focussing on unconventional source materials, the ACE tool fills an important gap in the range of tools for assessing the strengths and limitations of policy-relevant evidence and supporting evidence-informed decision-making.

Effects of source materials on desorption kinetics of carcinogenic PAHs from contaminated soils

Research investigating the desorptive behaviour of PAHs from contaminated soils often overlooked the effects of source materials, especially coal tar and coal tar pitch and materials alike. In this study, a refined experimental approach was adopted to establish a simple-to-complex continuum of systems that allow the investigation of desorption kinetics of benzo(a)pyrene (BaP) and 3 other carcinogenic PAHs (cPAHs) over an incubation period of 48 d. By comparing the modelled desorption parameters, elucidation of the effects of PAH source materials on their desorptive behaviour was achieved. Desorption of cPAHs from coal tar and pitch was enhanced when they were added to soils, with rapidly desorbing fraction (F_rap) of BaP increased from 0.68% for pitch to 1.10% and 2.66% for pitch treated soils, and from 2.57% for coal tar to 6.24% for coal tar treated soil G and 8.76% for coal tar treated sand (1 d). At 1 d, desorption of target cPAHs from solvent and source material spiked soils generally followed the order of solvent > coal tar > pitch. Increases in F_rap of cPAHs were observed in coal tar-treated soils after 48 d soil incubation (0.33%-1.16% for soil M, p ≥ 0.05, 6.24%-9.21% for soil G, p < 0.05) and was attributed to the continuous migration of coal tar as a non-aqueous phase liquid (NAPL) into soil pore structures. Slow desorption was dominated by source materials, whereas the extents and rates of rapid desorption (F_rap and k_rap) were more controlled by the quantity of soil organic matter (SOM), rather than quality of SOM (as in solvent-spiked soils). The results of this study challenged the role of PAH source materials as 'sinks' and led to the proposed roles of coal tar and pitch and source materials alike as 'reservoirs' with a risk-driven perspective.

Standardizing CAR-T therapy: Getting it scaled up

CAR-T therapy, grafting the specificity of a monoclonal antibody onto a T cell to target certain cancer cells, has been recognized as a promising therapeutic approach for cancer control as evidenced by the two CAR-T products proved by FDA in 2017. However, the unique heterogeneity of CAR-T therapy has restricted its production in a limited number of institutions and made it a boutique oncotherapy. By reviewing outstanding issues surrounding the commercial scale production of CAR-T therapy, we conclude that achieving mass production of CAR-T therapy without sacrificing its personalized nature is a worldwild challenge for making CAR-T a key element in the next generation of precision medicine, which can be achieved by standardizing 7 prominent factors that collectively determine the scale of CAR-T manufacturing.