Search

Insomnia commonly occurs in schizophrenia, and insomnia is associated with suicide risk. Clozapine has anti-suicidal properties and beneficial effects on sleep. We performed a meta-analysis of insomnia in randomized controlled trials (RCTs) of patients with schizophrenia treated with clozapine. We hypothesized that compared to clozapine there is an increased odds of insomnia in patients treated with other antipsychotics. We systematically searched PubMed, PsycINFO, and Web of Science databases. We included RCTs, in English, with data on insomnia in patients with schizophrenia treated with clozapine versus other antipsychotics. Data were pooled using a random effects model. Eight RCTs (1952 patients: 922 on clozapine and 1030 on other antipsychotics) met inclusion criteria. Patients treated with other antipsychotics versus clozapine had a significant increased odds of insomnia (22.3 % versus 12.4 %, OR = 2.20, 95 % CI = 1.64–2.94, p < 0.01). Olanzapine, quetiapine, risperidone, and ziprasidone were each associated with significant increased odds of insomnia compared to clozapine. In meta-regression analyses, clozapine dose, publication year, sex, trial duration, and study quality score were unrelated to the association; however, there was a significant association with age. The observed ORs for insomnia from RCTs were almost perfectly correlated with reported ORs from pharmacovigilance data. Clozapine is associated with significantly less insomnia compared to other antipsychotics. Findings provide additional evidence for improvement in sleep as a potential pathway underlying clozapine's anti-suicidal properties. A greater mechanistic understanding of this association is needed. [ABSTRACT FROM AUTHOR]

• An estimated 1.9 million tuberculosis cases are attributable to undernutrition. • A comprehensive systematic review containing 63 published articles was conducted. • Undernutrition was associated with prolonged time to sputum culture conversion. • Undernutrition increased the risk of unsuccessful treatment outcomes and mortality. • Nutritional support may be beneficial for people with multidrug-resistant tuberculosis. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis (MDR-TB). We searched for publications in the Medline, Embase, Scopus, and Web of Science databases. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Hazard ratio (HR) for sputum culture conversion and odds ratio (OR) for end-of-treatment outcomes, with 95% CI, were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger's tests. Of the 2358 records screened, 63 studies comprising a total of 31,583 people with MDR-TB were included. Undernutrition was significantly associated with a longer time to sputum culture conversion (HR 0.7, 95% CI 0.6-0.9, I2 = 67·1%), and a higher rate of mortality (OR 2.8, 95% CI 2.1-3.6, I2 = 21%) and unsuccessful treatment outcomes (OR 1.8, 95% CI 1.5-2.1, I2 = 70%). There was no significant publication bias in the included studies. Undernutrition was significantly associated with unsuccessful treatment outcomes, including mortality and longer time to sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardized TB drugs. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the effectiveness of mindfulness-based interventions for ruminative thinking.Methods: Cochrane Library, Web of Science, Embase, EBSCO, PubMed and Science Direct databases were searched to include randomized controlled trials of mindfulness-based interventions for rumination that met the criteria. The Rumination scale was used as the primary outcome indicator, and the secondary outcome indicator included the Mindfulness scale. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Stata 16.0 software was used to perform meta-analysis, subgroup analysis, sensitivity analysis, meta-regression analysis and publication bias detection of the extracted data.Results: A total of 61 studies with 4229 patients were included. Meta-analysis results revealed a significant intervention effect on ruminative thinking (SMD = -0.534, 95 % CI = [-0.675, -0.394], z = -7.449, P < 0.001). However, there was no significant difference between mindfulness-based interventions and CBT (SMD = 0.009, 95%CI = [-0.239, 0.258], z = 0.073, P = 0.941). Meta-analysis showed that mindfulness-based interventions significantly enhanced the level of mindfulness (SMD = 0.495, 95 % CI = [0.343, 0.647], z = 6.388, P < 0.001), while it was not significant compared to CBT (SMD = 0.158, 95%CI = [-0.087, 0.403], z = 1.266, P = 0.205). The two subgroups with >65 % (SMD = -0.534, 95%CI = [-0.681, -0.386], z = -7.081, P < 0.001) and 80 % (SMD = -0.462, 95%CI = [-0.590, -0.334], z = -7.071, P < 0.001) of females showed significant improvement in ruminative thinking. There were significant intervention effects for depression, students, cancer, healthy adults, and clinical patients. Significant intervention effects were demonstrated for various participant ages and intervention periods.Conclusion: This study confirmed the feasibility of mindfulness-based interventions in improving ruminative thinking and enhancing the level of mindfulness. However, the effectiveness of mindfulness-based interventions was not significant compared to CBT. The two subgroups with a higher proportion of females showed a more significant improvement in ruminative thinking, whereas there were no significant differences in participant characteristics, age, and the duration of intervention. [ABSTRACT FROM AUTHOR]

This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations. A systematic search was performed in PubMed, Scopus, and Web of Science databases for articles reporting data from primary longitudinal clinical studies on composite longevity published 2011–2021. Prospective or retrospective studies with restorations in permanent dentition, with follow-up periods of at least 5 years were included. In total, 33 articles were included with different study designs, practice settings, datasets, countries of origin, and sample sizes. Annual failure rates of restorations ranged from 0.08% to 6.3%. Survival rates varied between 23% and 97.7%, success rates varied between 43.4% and 98.7%. Secondary caries, fractures, and esthetic compromise were main reasons for failures. Risk factors for reduced restoration durability included patient-level factors (e.g., caries risk, parafunctional habits, number of check-ups per year, socioeconomic status), dentist factors (different operators, operator's experience), and tooth/restoration factors (endodontic treatment, type of tooth, number of restored surfaces). Patient gender and the composite used generally did not influence durability. A number of risk factors are involved in the longevity of composite restorations. Differences between composites play a minor role in durability, assuming that materials and techniques are properly applied by dentists. Patient factors play a major role in longevity. The decision-making process implemented by dentists relative to the diagnosis of aging or failed restorations may also affect the longevity of restorations. Clinicians should treat patients comprehensively and promote a healthy lifestyle to ensure longevity. [Display omitted] [ABSTRACT FROM AUTHOR]

Research serves to bolster clinical neurosurgery by critically assessing various disease pathologies, while identifying important challenges and opportunities. However, there is limited information on the landscape of the Ghanaian neurosurgical literature. A scoping review and bibliometric analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched from inception until December 21, 2021 for English language articles about neurosurgery in Ghana. 927 articles were identified and 66 were ultimately included in the analysis. A majority of them, 42.4%, were retrospective cohort studies, with 62.1% published after 2010. There were no randomized controlled or basic science studies. Most articles were published in the West African Journal of Medicine (24.2%) and non-infectious/non-traumatic spinal pathology was the most commonly discussed topic (22.7%); 66.7% of articles included only authors affiliated with Ghanaian institutions, and international collaborators frequently originated from the United States (15.9%). Only 22.7% of the manuscripts reported a funding source. Commonly reported challenges included limited sample sizes, delays in diagnosis and treatment, and lack of proper diagnostic tools and specialized care. This review revealed that while the Ghanaian academic neurosurgery output has been increasing over time, these have been limited to cohort studies largely assessing spine pathology. The Ghanaian neurosurgical research environment may be bolstered by an increase in research funding, the establishment of longitudinal clinical databases, training in research methodology, increased incentives for researchers, strengthening of research collaborative networks, and increased engagement of neurosurgical trainees in research. [ABSTRACT FROM AUTHOR]

Choledochal cysts (CCs) are rare cystic dilatations of the intrahepatic and/or extrahepatic bile ducts. We review the pathophysiology, diagnosis, and management of CCs. MEDLINE/PubMed and Web of Science databases were queried for "choledochal cyst", "bile duct cyst", "choledochocele", and "Caroli disease". Data were synthesized and systematically reviewed. Classified according to the Todani Classification, CCs are generally believed to arise secondary to reflux of pancreatic enzymes into the biliary tree due to anomalous pancreaticobiliary duct union. Complications of CCs include abdominal pain, jaundice, cystolithiasis, cholecystitis, pancreatitis, liver abscess, liver cirrhosis and malignant transformation (3–7.5%). Radiological and endoscopic imaging is the cornerstone of CC diagnosis and full delineation of cyst anatomy is imperative for proper management. Management is generally guided by cyst classification with complete cyst excision necessary for CCs with high potential of malignant transformation such as types I and IV. 5-year overall survival after choledochal cyst excision is 95.5%. Most CCs should undergo surgical intervention to mitigate the risk of cyst related complications such as cholangitis and malignant transformation. [ABSTRACT FROM AUTHOR]

• List of 27 specific nakshatravan trees associated with nakshatra/constellation. • Common and unique medicinal properties of 27 pharmaceutically important trees. • Comparative analysis of volatile and non-volatile compounds of 27 trees. • Potential role of specific trees on human health and benefits of therapeutic landscape in sacred grooves. • Conservation of scared/nakshatravan trees and its pharmacological values. Sacred natural sites are considered part of human beings and communities, consisting of unique medicinal plant species with specific therapeutic properties. Among the sacred trees, Nakshatravan comprises an impressive range of medicinal and aromatic plants, mainly trees, which may help as a source of readily available raw materials from temple premises for traditional medicine. Therefore, the review aims to analyze and compare the medicinal properties and volatile organic compounds (VOCs) of nakshatravan trees, which are associated with 27 nakshatras/constellations used in Vedic tradition since 2nd Century. Various scientific databases, such as Pubmed, Scopus, and Google Scholar, were used. The keywords such as constellation, nakshatravan trees, human health, sacred groves, volatile oil, essential oil, and influence on human diseases were used. The 27 nakshatravan trees belong to 20 families, of which the Moraceae family contributes five trees; Fabaceae, Papilonaceae, and Sapotaceae contribute two trees, whereas the remaining 16 family consists of 1 tree each. There are 92 different medicinal properties, and 132 Volatile Compounds (VCs) and 36 non-volatile compounds (NVCs) noted from 27 trees, which are reported from nakshatravan trees and used for the treatment and prevention of various human diseases. An innovative approach to conserving these plants diversity has been emerging as 'Star Garden' comprising imperative medicinal trees with several unique or common medicinal properties. This approach will facilitate establishing and maintaining important, unique medicinal tree species. In the present study, we have analyzed common and unique medicinal properties, volatile and non-volatile compounds of 27 nakshatravan trees, and their potential pharmacological values. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic and its accompanying containment measures can be conceptualized as traumatic events. This review systematically investigates trauma-related symptoms in the course of the COVID-19 pandemic and the association of the pandemic and its containment measures with trauma-related disorders or symptoms.Methods: The EBSCO (MEDLINE, PsycINFO, PsycARTICLES, PSYNDEX), Cochrane Library, and Web of Science databases were searched in June 2021. The Quality Assessment Tool for Quantitative Studies (EPHPP-QAT; Thomas et al., 2004) was applied. Studies conceptualizing the COVID-19 pandemic as a traumatic event and assessing typically developing children and adolescents (under 18 years), and/or caregivers (at least 18 years) were included.Results and Limitations: 22 primary studies including 27,322 participants were evaluated. Only three primary studies executed a statistical comparison with pre-pandemic or retrospective data, showing a negative impact of the COVID-19 pandemic and its associated measures on children's and caregiver's internalizing symptoms and hyperactivity. In the majority of the remaining studies, prevalence rates of various trauma sequelae in children, adolescents, and caregivers were reported to be descriptively higher in the context of the COVID-19 pandemic when compared to other pre-pandemic studies. However, due to numerous methodological differences between these studies the statement that the pandemic is associated with higher prevalence rates of trauma-associated symptoms cannot be validly answered at this point.Conclusion: Due to some methodological shortcomings of the primary studies, our results might be cautiously interpreted as a first indicator of an association between the COVID-19 pandemic and trauma sequelae. [ABSTRACT FROM AUTHOR]

Among patients who present with acute myocardial infarction (MI), 2–6% are found to have non-obstructive coronary arteries (NOCA). Patients with MINOCA are more commonly women and present at a younger age (51–59 years). The influence of sex on adverse event rates remains unclear. PubMed, MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE, EBSCO, Web of Science and CINAHL databases were searched for trials comparing gender differences in clinical outcomes among patients with MINOCA from inception through April 10, 2022. The primary endpoint of the study was composite major adverse clinical events (MACE) including all-cause mortality, non-fatal MI, stroke, and cardiovascular readmissions, and secondary endpoints were the individual components of the MACE. Seven studies with a total of 28,671 MINOCA patients were included (n = 11,249 men and n = 17,422 women) over a mean follow-up of 2 years. Women had more MACE than men (10.1% vs. 9.1%, OR 1.15, 1.04–1.23, I2 = 44.7%). Among secondary endpoints, only the incidence of stroke was higher in women (3.5% vs. 2.2%, OR 1.3, 1.01–1.68, I2 = 0%). All-cause mortality, non-fatal MI, and cardiovascular readmissions were not significantly different between the two groups. We hypothesize that small vessel disease associated with MINOCA drives MACE in women and the diminishing influence of estrogen, hypercoagulability and underprescribing could contribute to the differences sex-related outcomes. • The influence of sex on adverse events in MINOCA remains unclear. • Our meta-analysis of >28,000 MINOCA patients showed women had more MACE than men (10.1% vs. 9.1%). • The adverse events in women were driven only by higher incidence of stroke in women (3.5% vs. 2.2%, p < 0.05). • Diminishing influence of estrogen, hypercoagulability, and underprescribing in women are likely contributors to MACE. [ABSTRACT FROM AUTHOR]

The genus Scadoxus (family: Amaryllidaceae) is native to Africa and it comprises a great variety of ornamental, medicinal, and poisonous plant species. In India, it is represented by only a single species, Scadoxus multiflorus. The genus has a wide range of traditional uses. However, scientific validation of the traditional uses requires extensive pharmacognostic research along with toxicity and safety evaluation. Various scientific databases such as PubMed, Science Direct, Google Scholar, and Web of Science were utilized to search the research articles for this review. This review work is a comprehensive study of the genus Scadoxus about its taxonomy, geographical distribution, traditional uses, phytochemistry, toxicity, and pharmacological activities for the first time. [Display omitted] • This review followed the articles during the period of 1958 – 2022 (64 years) and aims to give a piece of comprehensive knowledge about the genus Scadoxus for the first time. • The African genus, Scadoxus , is rich in various bioactive compounds but its phytochemistry and pharmacological activities are still now underrated. • Most of the species are concentrated in various regions of Africa, especially in South Africa. A single member has worldwide distribution and is also found in India. • Pharmacological activities like antimicrobial, cholinesterase inhibitory, cytotoxic, antioxidant, neuroprotective, immunostimulatory, and analgesic activities are reported here. • A special concern is needed to conserve the single representative, Scadoxus multiflorus , of this genus in India. [ABSTRACT FROM AUTHOR]

• A systematic review is done on the effects of safety climate on safety performance. • Safety climate is predominantly used as a predictor. • Safety-related behavior is the most common definition of safety performance. • Methods used to link safety climate and safety performance is methodologically biased. • Literature on safety climate is dominated by studies in developed countries. Introduction: Since its inception more than four decades ago, research on safety climate has been conducted in many industries. Subsequently, a plethora of systematic literature reviews on safety climate in various work environments has focused on research trends and measurement scales. Yet, despite these reviews, the overall picture of how safety climate influences performance is still not well understood. The current study reviews existing literature on safety climate, specifically how it affects safety performance. Method: Literature searches were conducted using EBSCOhost and Web of Science databases in March 2021. We included English-language, peer-reviewed studies that reported the results of research done on safety climate and safety performance. We extracted data (contextual, theoretical, methodological and definition of safety performance) from these studies and were deductively analyzed and categorized into common themes. Results: One hundred and sixty-two safety climate studies were identified. We found that studies on safety climate–performance were conducted in 16 types of industries while 23 different theories explained the safety climate–performance relationship. The quantity and quality of variables and methods used varied considerably across the surveys. Safety climate is predominantly used as a predictor while safety-related behavior is the most common definition of safety performance among the articles we reviewed. Few papers from the current review were methodologically strong, suggesting that current evidence on the link between safety climate and safety performance still suffers from common method bias. Conclusions: Although literature has provided evidence for the positive effect on safety performance via a strong safety climate, strong and convincing methods are still lacking and the causality of an improved safety climate still needs to be demonstrated. Practical applications: The findings of the current review offer a better understanding of how employers can improve safety climate in the workplace in various settings. [ABSTRACT FROM AUTHOR]

Background: Treatment-resistant depression (TRD) results in huge healthcare costs and poor patient clinical outcomes. Most studies have adopted a "candidate mechanism" approach to investigate TRD pathogenesis, however this is made more challenging due to the complex and heterogeneous nature of this condition. High-throughput "omics" technologies can provide a more holistic view and further insight into the underlying mechanisms involved in TRD development, expanding knowledge beyond already-identified mechanisms. This systematic review assessed the information from studies that examined TRD using hypothesis-free omics techniques.Methods: PubMed, MEDLINE, Embase, APA PsycInfo, Scopus and Web of Science databases were searched on July 2022. 37 human studies met the eligibility criteria, totalling 17,518 TRD patients, 571,402 healthy controls and 62,279 non-TRD depressed patients (including antidepressant responders and untreated MDD patients).Results: Significant findings were reported that implicate the role in TRD of various molecules, including polymorphisms, genes, mRNAs and microRNAs. The pathways most commonly reported by the identified studies were involved in immune system and inflammation, neuroplasticity, calcium signalling and neurotransmitters.Limitations: Small sample sizes, variability in defining TRD, and heterogeneity in study design and methodology.Conclusions: These findings provide insight into TRD pathophysiology, proposing future research directions for novel drug targets and potential biomarkers for clinical staging and response to antidepressants (citalopram/escitalopram in particular) and electroconvulsive therapy (ECT). Further validation is warranted in large prospective studies using standardised TRD criteria. A multi-omics and systems biology strategy with a collaborative effort will likely deliver robust findings for translation into the clinic. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period and its mechanisms are not fully understood. Metabolomics, can quantitatively measure metabolites in a high-throughput method, and thus uncover the underlying pathophysiology of disease.Objectives: In this study, we reviewed metabolomics studies conducted on PPD, aiming to understand the changes of metabolites in PPD patients and analyze the potential application of metabolomics in PPD prediction and diagnosis.Methods: Relevant articles were searched in PubMed, Google scholar, and Web of Science databases from January 2011 to July 2022. The metabolites involved were systematically examined and compared. MetaboAnalyst online software was applied to analyze metabolic pathways.Results: A total of 14 papers were included in this study. There were several highly reported metabolites, such as kynurenine, kynurenic acid, and eicosapentaenoic acid. Dysregulation of metabolic pathways involved amino acids metabolism, fatty acids metabolism, and steroids metabolism.Limitations: The included studies are relatively inadequate, and further work is needed.Conclusions: This study summarized significant metabolic alterations that provided clues for the prediction, diagnosis, and pathogenesis of PPD. [ABSTRACT FROM AUTHOR]

Stroke represents the second highest disease burden worldwide. It is well documented that rapid stroke identification and treatment are associated with improved outcomes. In particular, prehospital stroke detection (PSD) devices have emerged as possible tools to facilitate more rapid and accurate stroke triage. Bibliometric analyses offer a powerful tool to characterize the entire field from an interdisciplinary perspective. This bibliometric analysis aims to analyze current themes and identify future trends within the PSD space. The Web of Science collection database was surveyed for PSD literature. Search terms focused on stroke diagnostic techniques, clinical indicators for ischemia/hemorrhage, and prehospital timing. Subsequently, VOSviewer was used for visual mapping analyses. A total of 237 documents were identified between 1995 and 2021 from 1190 different authors. Publication volume has increased greatly in recent years. Publications were spread across 156 journals with the largest journal, Stroke , contributing just 7 studies over 26 years. Keywords analysis showed that stroke, near-infrared spectroscopy, and electroencephalography were the most common keywords. Novel PSD devices are promising tools for the early detection and characterization of stroke. This study identifies recent increased attention to PSD technology, a trend that will likely continue in the coming years. Devices using near-infrared spectroscopy, ultrasonography, microwave, and electroencephalography represent the central areas of future PSD research. The multidisciplinary, and therefore fractured, nature of the PSD space requires those interested in the field to maintain active search habits across multiple journals to remain up to date on PSD innovations. [ABSTRACT FROM AUTHOR]

The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy (postendarterectomy PA [PEPA]). Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Scopus, and Web of Science databases from date of inception to June 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective review was conducted of patients who underwent neurosurgical evaluation of suspected PEPA at our institution. Of the 321 articles in the original literature search, 62 were selected. A total of 143 patients (93 men, 27 women; mean age, 70.7 years) diagnosed with PEPA were included. Mean time from carotid endarterectomy to PA diagnosis was 41.8 months. Primary repair data were available for 135 patients, including 19 with primary closures, 112 with patch or graft repairs, and 4 with eversion procedures. Fifty-five patients with PA (39%) presented with infection. Staphylococcal species were the most common causative organism. Of infected PAs, 89.1% were treated with open procedures. Overall complication rates of PAs treated via open, endovascular, and hybrid methods were 31%, 15.4%, and 0%, respectively. Open ligation (42.9%) and aneurysmectomy with grafting (36.4%) resulted in the highest rates of complications. Despite higher complication rates after open repair strategies, use of these techniques remains a viable option in situations requiring removal of infected patches or evacuation of large extravascular collections. Endovascular treatment options are associated with low numbers of complications and can be considered for primary PEPA treatment when infection is not present. [ABSTRACT FROM AUTHOR]

During pancreatic resections assessing tumour boundaries and identifying the ideal resection margins can be challenging due to the associated pancreatic gland inflammation and texture. This is particularly true in the context of minimally invasive surgery, where there is a very limited or absent tactile feedback. Indocyanine green (ICG) fluorescence imaging can assist surgeons by simply providing valuable real-time intraoperative information at low cost with minimal side effects. This meta-analysis summarises the available evidence on the use of near-infrared fluorescence imaging with ICG for the intraoperative visualization of pancreatic tumours (PROSPERO ID: CRD42021247203). MEDLINE, Embase, and Web Of Science electronic databases were searched to identify manuscripts where ICG was intravenously administered prior to or during pancreatic surgery and reporting the prevalence of pancreatic lesions visualised through fluorescence imaging. Six studies with 7 series' reporting data on 64 pancreatic lesions were included in the analysis. MINOR scores ranged from 6 to 10, with a median of 8. The most frequent indications were pancreatic adenocarcinoma and neuroendocrine tumours. In most cases (67.2%) ICG was administered during surgery. ICG fluorescence identified 48/64 lesions (75%) with 81.3% accuracy, 0.788 (95%CI 0.361–0.961) sensitivity, 1 (95%CI 0.072–1) specificity and positive predictive value of 0.982 (95%CI 0.532–1). In line with the literature, ICG fluorescence identified 5/6 (83.3%) of pancreatic lesions during robotic pancreatic resections performed at our Institution. This meta-analysis is the first summarising the results of ICG immunofluorescence in detecting pancreatic tumours during surgery, showing good accuracy. Additional research is needed to define optimal ICG administration strategies and fluorescence intensity cut-offs. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to analyze the influence of a maternal and/or offspring high-fat diet (HFD) on the morphology of the offspring adipocytes and amount of food and energy consumption. The search was conducted through Pubmed, EMBASE, and Web of Science databases up to October 31st, 2021. The outcomes were extracted and pooled as a standardized mean difference with random effect models. 5,004 articles were found in the databases. Of these, only 31 were selected for this systematic review and 21 were included in the meta-analysis. A large discrepancy in the percentage of fat composing the HFD (from 14% to 62% fat content) was observed. Considering the increase of adipose tissue by hyperplasia (cell number increase) and hypertrophy (cell size increase) in HFD models, the meta-analysis showed that excessive consumption of a maternal HFD influences the development of visceral white adipose tissue in offspring, related to adipocyte hypertrophy, regardless of their HFD or control diet consumption. Upon following a long-term HFD, hyperplasia was confirmed in the offspring. When analyzing the secondary outcome in terms of the amount of food and energy consumed, there was an increase of caloric intake in the offspring fed with HFD whose mothers consumed HFD. Furthermore, the adipocyte hypertrophy in different regions of the adipose tissue is related to the sex of the pups. Thus, the adipose tissue obesity phenotypes in offspring are programmed by maternal consumption of a high-fat diet, independent of postnatal diet. • Maternal high-fat diet intake affects the adipogenic capacity of offspring. • Maternal-HFD programs hypertrophy of adipocytes independent of postnatal diet. • Hyperplasia of adipose tissue is related to the high-fat diet consumption. • Alterations in area and number of adipocytes are sex-specific in offspring. [ABSTRACT FROM AUTHOR]

Introduction: One of the most common adverse events reported by gynecological cancer survivors with spontaneous or iatrogenic menopause is vulvo-vaginal atrophy (VVA). An increasing number of women have this kind of discomfort related to the menopause induced by different cancer therapies. In this regard, fractional CO2 laser may be a valid therapeutic choice for these patients.Methods: We performed a literature search of PubMed, EMBASE, SCOPUS and Web of Science databases with search terms of laser CO2 treatment of vulvovaginal atrophy and gynecologic cancer survivors and reviewed major US Society Guidelines to create this narrative review of this topic. Breast, ovarian endometrial and cervical cancers were included.Results: Nine studies were included. Fractional CO2 laser improves clinical symptoms and sexual function, in terms of VHI (vaginal health index) and FSFI (female sexual function index). Non severe adverse event occurred.Conclusion: According to the best evidence available, fractional CO2 laser treatment for VVA is an effective and safe therapeutic option for gynecological cancer survivors, improving sexual life and quality of life (QoL). [ABSTRACT FROM AUTHOR]

To systematically review existing literature on the neurosurgical management and outcomes of brain metastasis from pancreatic cancer in comparison with our institutional experience of this patient cohort. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed using PubMed, Ovid Embase, Scopus, and Web of Science databases from date of database inception to March 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective analysis was conducted of patients who underwent neurosurgical evaluation and treatment for intracranial metastatic lesions from pancreatic origin at a single institution. The original literature search yielded 292 articles, of which 17 studies comprising 23 patients with brain metastases of pancreatic origin were ultimately selected. Median overall survival from primary diagnosis of pancreatic cancer was 22 months (interquartile range: 3–84) and 3 months (interquartile range: 1–36) after diagnosis of brain metastasis. In our institutional cohort, 4 patients were identified with a median overall survival of 30.5 months (interquartile range: 2–108). Our institutional cohort experienced a prolonged median overall survival (3 months vs. 30.5 months, P = 0.03) compared with the literature. Brain metastasis from pancreatic cancer is rare and associated with a fatal outcome. However, based on the data presented in this review, patient-specific and treatment-related factors could signal better prognosis. Further studies are needed to elucidate multimodal therapy and survival to suggest a more personalized decision-making process. [ABSTRACT FROM AUTHOR]

This bibliometric analysis aims to identify the most impactful articles on hemangioblastoma (HB) and evaluate the trajectory of academic literature in the field. The authors performed a title search using the Web of Science database, with ("hemangioblastoma" OR "haemangioblastoma") as a search query. The top 100 cited articles from the years 1900–2020 were sorted by the descending order of the total citation count. The following variables were assessed for each article: title, first author name and institution, publication year, country of origin, citation count, citations per year, and journal impact factor. The query yielded 1918 articles related to the topic of HB that were published between the years 1900 and 2020 in 42 unique journals. The most prolific decade of publication was the 2000s (35%), followed by the 1990s (33%) and the 1980s (11%). The average citation count was 88.3 (range, 47–426), and the mean number of citations per year was 3.74 (range, 0.660–17.8). This is the first bibliometric analysis to evaluate the most influential HB publications. Though a majority of HBs are sporadic, these results suggest a research focus on von Hippel-Lindau–associated tumors. Despite established evidence for the potential to control HB growth with vascular endothelial growth factor inhibition, there are no known clinical trials underway for this investigation. There is a need for consistent treatment guidelines for asymptomatic HBs, as resection can prevent the development of neurological deficits. An improved understanding of the etiology of these neoplasms could promote the development of novel diagnostic and treatment methods. [ABSTRACT FROM AUTHOR]

Introduction: Lightning strikes have high morbidity and mortality rates. Thousands of fatalities are estimated to be caused by lightning worldwide, with the number of injuries being 10 times greater. However, evidence of lightning injuries is restricted to case reports and series and nonsystematic reviews. In this clinical review, we systematically select, score, and present evidence regarding lightning injuries.Material and Methods: We performed a systematic search for reviews and guidelines in the PubMed, Embase (OvidSP), MEDLINE (OvidSP), and Web of Science databases. All publications were scored according to the Levels of Evidence 2 Table of the Oxford center for Evidence-Based Medicine. The reviews were also scored using the scale for the quality assessment of narrative review articles (SANRA) and guidelines from the Appraisal of Guidelines for Research & Evaluation (AGREE II).Results: The search yielded 536 articles. Eventually, 56 articles were included, which consisted of 50 reviews, five guidelines and one overview. The available reviews and guidelines were graded as low to moderate evidence. Most damage from lightning injuries is cardiovascular and neurological, although an individual can experience complications with any of their vital functions. At the scene, initial treatment and resuscitation should focus on those who appear to be dead, which is called the reverse triage system. We proposed an evidence-based treatment protocol for lightning strike patients.Conclusion: It is vital that every lightning strike patient is treated according to standard trauma guidelines, with a specific focus on the possible sequelae of lighting injuries. All emergency healthcare professionals should acknowledge the risks and particularities of treating lighting strike injuries to optimize the care and outcomes of these patients. Our evidence-based treatment protocol should help prehospital and in-hospital emergency healthcare practitioners to prevent therapeutic mismanagement among these patients. [ABSTRACT FROM AUTHOR]

Bladder cuff excision (BCE) is essential to maintaining oncologic control during radical nephroureterctomy (RNUx) for upper tract urothelial carcinoma (UTUC). While intravesical, extravesical, and endoscopic methods are widely utilized, their efficacy in comparison to each other remains controversial. In this systematic review and metanalysis, we aimed to compare oncologic outcomes between different methods of BCE. We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies comparing oncologic outcomes of RNUx for UTUC based on different methods of bladder cuff management. Our primary outcomes were intravesical recurrence rate (IVR), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS). Meta-analysis was performed comparing hazard ratios and recurrence rates between different BCE techniques A total of 46 studies were included for analysis, 39 studies from initial database search and addtional 7 from reviewing references in included studies. Techniques for BCE were categorized as open intravesical, open extravesical, endoscopic, or laparoscopic extravesical. When compared to both laparoscopic and open extravesical BCE, open intravesical BCE showed superior IVRFS (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.14-1.51) but no difference in IVR or RFS. Subgroup analysis demonstrated that this effect was primarily driven by open extravesical BCE, which showed significantly worse IVRFS (HR 2.48, 95% CI 1.20-1.59). In contrast, no significant difference in IVR, IVRFS, or RFS was found between endoscopic BCE or laparoscopic extravesical BCE compared to open intravesical BCE. Similarly, there was no significant difference between extravesical BCE and endoscopic BCE. Extravesical BCE is associated with worse IVRFS compared to open intravesical BCE. Endoscopic and open intravesical BCE show equivalent rates of IVR, IVRFS, and RFS. [ABSTRACT FROM AUTHOR]

Background: Previous epidemiological studies revealed inconsistent associations between sugar-sweetened beverage (SSB) consumption and cognitive disorders, but there have been no meta-analyses of the pooled results. Thus, a meta-analysis was performed to determine the association between SSB consumption and cognitive disorders.Methods: A systematic search of the literature prior to May 20, 2022 was performed using the PubMed and Web of Science databases. Random effects models were used to calculate and combine odds ratios (ORs) depending on the degree of heterogeneity.Results: 13 studies met the inclusion criteria. A total of 242,014 participants (2752 in three cross-sectional studies and 239,262 in ten cohort studies) were included. A random effects meta-analysis, according to the comprehensive analysis of SSB consumption, was associated with a greater prevalence of cognitive disorders (OR = 1.17, 95 % CI = 1.05-1.29; I2 = 90.1 %). Subgroup analyses of study design, type of SSB, or cognitive disorders outcome was performed. In subgroup analyses, we found that SSB intake was associated with a higher prevalence of cognitive disorders in cohort studies, middle-aged and elderly population, and participants with sugar-sweetened soft drinks. However, no significant association was found in other subgroups.Conclusion: Our results indicate that SSB intake is positively associated with the prevalence of cognitive disorders. Therefore, attention should be paid to reducing SSB intake as an early intervention for cognitive disorders. [ABSTRACT FROM AUTHOR]

Cannabis is the most frequently consumed drug around the world. Its use has been associated with increased suicide behaviors; nonetheless, the association of cannabis smoking and suicide behaviors in adolescents has not yet been established. The aim of this systematic review and meta-analysis was to evaluate the risk of suicide attempt, suicidal ideation or suicide planning in individuals of 11–21 years of age who smoke cannabis. We performed an online searched using PubMed, EBSCO and Science Direct databases, up to July 2021. We calculated odds ratio with 95% confidence intervals to evaluate the association between suicide attempt, suicidal ideation or suicide planning and cannabis smoking in individuals of 11–21 years of age. Twenty studies reported suicide attempts in 34,859 young individuals, suicidal ideation in 26, 937 individuals, and suicide planning in 9054 young individuals. We found an increased risk of suicide attempt in cannabis smokers than in non-cannabis users (OR: 2.33; 95% CI: 1.78–3.05; Z p value; <0.0001; I2 = 97.12%), as well as a significant association between cannabis smoking and suicidal ideation (OR: 2.04; 95%CI: 1.64–2.53; Z p value: <0.001; I2: 94.88) and suicide planning (OR: 1.674; 95% CI: 1.554–1.804; Z p value: 0.000; I2: 92.609). Subgroup analyses showed that American teens have an increased risk of suicidal ideation; the meta-regression analysis revealed that age was negatively associated with the risk of suicide attempt. This meta-analysis shows that cannabis smoking increased the risk of suicide attempt, suicidal ideation and suicide planning in young individuals of 11–21 years of age. The high risk of suicide behaviors could vary depending on the population studied; therefore, more studies are necessary to corroborate the risk of presenting suicide behaviors in individuals of 11–21 years of age who smoke cannabis. [ABSTRACT FROM AUTHOR]

Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean. A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures, and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. We identified 882 articles published in 271 journals. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9, and the average number of citations per document was 11.2. The author with the highest number of publications was Teixeira MJ (41 articles), and the University of Sao Paulo had the highest number of articles on this topic. WORLD NEUROSURGERY was the journal with the most publications (120 articles), and the study by Carney et al (2017) was the most cited (1175 citations). The country of corresponding authors with the most publications and the greatest number of total citations was Brazil. Surgery, and Management were the most used keywords plus; however, in the most recent articles Simulation and Guidelines were used. In the past decade, there has been an increase in articles on neurosurgery in Latin America and the Caribbean. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine. [ABSTRACT FROM AUTHOR]

Different outcomes of canine in vitro oocyte maturation depend on the phases of the donor's estrus cycle. This study aimed to examine this topic using a meta-analysis approach. From 1765 identified records in three major scientific databases, 145 were selected after the screening, 27 were evaluated for eligibility, and, finally, by removing 3 studies with high heterogeneity, 11 studies were used for the meta-analysis. The anestrus (ANE) phase was the reference for evaluating the luteal (LUT) and follicular (FOL) phases. The effect size data were selected as dichotomous types, and publication bias and heterogeneity were used for the quality assessments. The results showed a higher risk ratio (RR) of meiosis resumption in oocytes from the germinal vesicle stage in the LUT and FOL phases (∼30% more than ANE oocytes). The RR of being oocytes at the germinal vesicle breakdown (GVBD) stage was similar in all three phases. When compared to ANE, the RR of oocytes reaching the metaphase I (MI) stage from GVBD were higher in the FOL and LUT phases (30% and 14%, respectively). Moreover, the rate of oocytes reaching metaphase II (MII) was higher in the FOL and LUT phases (85% and 30%, respectively) than in the ANE phase. Being at an active phase (FOL or LUT phases) increased the rates of transition from the GVBD to MI stages (18%) and the MI to MII stages (48%) as compared with the ANE phase. It was assumed that oocytes in the LUT phase can reach GVBD and MI, whereas oocytes in the FOL phase are more capable of reaching MII than oocytes in anestrus. • Odds of reaching MII stage is the highest for canine oocytes from the follicular phase. • Odds of being at MI stage is higher in canine oocytes from the luteal phase than anestrus. • Trend of changes showed a non-uniform heterogeneity and publication bias at different stages of canine oocytes. [ABSTRACT FROM AUTHOR]

Green finance has emerged as a strategy that encompasses not only instruments for mitigating greenhouse gas emissions and adapting to climate change, but also financial products and services that address a broader range of environmental concerns, including industrial pollution control, waste management, sanitation and hygiene, and ecological protection. The study employs an integrative approach comprising a bibliometric and manual review of sample studies to understand the subject of knowledge in green finance and its transition from theory to practice, indicating the current state of research and its evolution tendencies. The current study analyzes the publications that highlight the various dynamics of green finance by conducting a bibliometric analysis on a sample of 222 relevant papers retrieved from the Web of Science and Scopus databases. The study discusses the theoretical underpinnings of the constructs/themes uncovered through the results and identifies current research trends, hotspots, and prospective research opportunities. Finally, we identify key topics in the field of green finance and suggest a four-part conceptual framework (goal, procedure, place, and perspective) based on the results of the thematic map. This framework serves as a guide for future research. • Conducts integrative review to analyze green finance literature transitioning from theory to practice. • Analyses 222 sample studies retrieved from the Web of Science and Scopus databases. • Provides key topics and suggest a four-part conceptual framework. • Identifies current research trends, hotspots, and prospective research opportunities. [ABSTRACT FROM AUTHOR]

• The paper reviews the antidiabetic potentials of Aloe species. • Aloe vera is the most common species with antidiabetic properties. • Different methods were used to determine their potentials. • Further study is needed to isolate antidiabetic agents from the genus. Of all medicinal plants used to treat ailments, the genus Aloe represents one of the commonest. They manage various pathological conditions, including inflammation, infection, cancer and diabetes mellitus. There are specific reports on the hypoglycemic and antidiabetic potential of different species of Aloe. Still, there is a shortage of comprehensive reports which present all Aloe species with antidiabetic properties. This study aims to integrate available information on all Aloe spp. with antidiabetic potentials. Scientific databases such as PubMed, EBSCOhost, Science Direct, Scopus, and Google Scholar, were utilized to search and collect literature for this review. This review revealed that the most common Aloe sp. with antidiabetic potentials is A. vera. It also showed that few studies were carried out in vitro while most were performed in vivo. We can conclude that Aloe spp. is a potent source of antidiabetic agents. Further studies should be conducted to isolate the antidiabetic compounds from the plant. [ABSTRACT FROM AUTHOR]

• We assessed and included 123 eligible studies across 13 countries in Africa. • An inventory of 55 Aloe species was generated as remedies against 9 disease categories. • Aloe vera was the most popular Aloe species with ethnoveterinary applications. • Aloe greatheadii had the most diverse applications and used against 8 disease categories. • Cattle and poultry were the most dominant animals treated with Aloe species. The high diversity and occurrence of Aloe species in African landscapes often translates to their frequent utilisation for meeting the medicinal needs for human health and well-being. In addition, their value in ethnoveterinary medicine has been intermittently indicated amongst ethnic groups in Africa. This review entails a critical analysis on the ethnoveterinary uses and applications of the genus Aloe in Africa. We explored different scientific databases (Google Scholar, PubMed, Sabinet and Science Direct) to extract information from 123 eligible studies that included research articles (86.2%), dissertations/theses (9.8%), books (2.4%) and reports (1.6%). We generated an inventory of 55 Aloe species with ethnoveterinary applications across 13 African countries. Tanzania (16), South Africa (15), Kenya (14) and Ethiopia (14) had the highest number of Aloe species used for ethnoveterinary purpose. On the basis of the number of citations, A. vera (31), Aloe spp. (29), A. ferox (16) and A. secundiflora (11) were identified as the most common Aloe species with ethnoveterinary applications in Africa. The identified Aloe species were indicated as remedies against nine (9) major disease categories from the analysed literature. In terms of versatility, A. greatheadii had the most diverse applications as they were indicated as remedies for the management of eight (8) disease categories. Likewise, A. ferox, A. marlothii, Aloe spp., A. secundiflora and A. vera had multi-purpose value in ethnoveterinary medicine as they were used against seven (7) diseases/health conditions. The leaves (65.4%) and whole plant (4.7%) of Aloe species were the major plant parts used to prepare the Aloe -based herbal remedies that often targeted cattle (29.3%) and poultry/chickens (28.2%). The remedies were prepared using different methods which mainly entailed infusion (17.7%), juicing (14.2%), crushing (13.8%) and decoction (12.7%). Overall, the current review established the increasing vital role of Aloe species in treatment of animal diseases and general well-being in Africa. However, the apparent gaps (e.g., absence of plant part, diseases, animal-type, preparation and administration methods) existing in some of the assessed literature mean that deliberate efforts remain essential during ethnoveterinary surveys, to ensure the reliability and trustworthiness of the generated data. This will contribute towards the establishment of a holistic inventory/database of Aloe species with ethnoveterinary applications. Subsequent in vitro and in vivo efficacy testing of priority and valuable Aloe species with applications in ethnoveterinary medicine remain pertinent. [ABSTRACT FROM AUTHOR]

• Mallotus oppositifolius is an important medicinal herb in Africa. • It possesses valuable and diverse pharmacological activities. • More than 30 phytochemicals have been isolated and identified from this species. • Phloroglucinols and mallotoxin appear to be the most promising bioactive compounds. • Here the first comprehensive review of M. oppositifolius is presented. Mallotus oppositifolius (Geiseler) Müll.Arg. (Euphorbiaceae) is an important and multipurpose medicinal herb found in different African countries. Its various parts possess several pharmacological activities. However, to date, there is no literature review collating the traditional uses, phytochemistry and biological activities of M. oppositifolius. Therefore, the present review aims to provide a current, relevant and comprehensive summary of the botany, ethnomedicinal uses, phytochemistry, and biological activities of M. oppositifolius. To this end, a review of all published literature was conducted using various online scientific databases. Traditionally, M. oppositifolius is used to treat epilepsy, convulsions, haemorrhages, dysentery, stomach pain, waist pain, chest pain, eye infections, anemia, paralysis, ringworms, skin infections, spasms, kidney infection, inflammation, malaria, fever, headaches, " aseram ", swelling, and tumours. Phytochemical analysis revealed that M. oppositifolius contains several phytochemical classes consisting of sterols, alkaloids, saponins, flavonoids, tannins, and glycosides. The in vivo and in vitro studies conducted on isolated compounds or crude extracts reported several biological activities, viz. antimicrobial, anthelmintic, antidiarrheal, antidiabetic, antioxidant, antiperoxidative, antiproliferative, anti-inflammatory, antinociceptive, antidepressant, anxiolytic, anticonvulsant, cardioprotective and KCNQ1 activities. The leaves of M. oppositifolius are the most commonly used part of the plant and thus the most researched in pharmacological studies. This review reveals that M. oppositifolius has several traditional uses, of which some, such as treatment of epilepsy, convulsion, pain, dysentery, diarrhea, inflammation, malaria and infectious diseases have been tested in pharmacological studies. Its vulnerability to destructive harvesting and overexploitation supports the need to identify the therapeutic applications of the bioactive compounds in clinical trials in order to conserve the plant. [ABSTRACT FROM AUTHOR]

• The pharmacological importance of the west African aloe species was appraised. • Aloe species have therapeutic benefits such as antioxidants, antidiabetic and anticancer. • The west African aloe species are underutilized but can be harnessed as medicines. • Modern technologies are needed to decipher their detailed chemical entities. The genus Aloe belongs to the family Xanthorrhoeaceae with over 560 species ranging from small shrub-like plants to large trees. Despite their pharmacological applications against ailments such as arthritis, cancer, type 2 diabetes mellitus, digestive disorders, cancer, microbial infections, and skin diseases, only Aloe vera, Aloe ferox, Aloe perryi , and Aloe arborecens have received superior research attention over the years with some members of the genus such as Aloe buettneri, Aloe macrocarpa , and Aloe schweinfurthii being either neglected or underutilized. Here, we reviewed the ethnobotanical, phytochemistry, toxicological and pharmacological importance of the three indigenous and underutilized West African Aloe species- A. buettneri, A. macrocarpa , and A. schweinfurthii. Scientific databases such as Google Scholar, PubMed, JSTOR, Science Direct, and Scopus were used in retrieving the data presented in this study. The information gathered revealed that, the three species are generally underutilized with some ethnopharmacological uses against dysmenorrhea, skin diseases, female infertility, chronic gonorrhea, facilitation of childbirth, hemorrhoids, and impotency in men, being documented. Majorly, their leaves and gel are rich in alkaloids, phenolics, sterols, saponins, glycosides, anthraquinones, and anthraquinoic derivatives and the species exhibited a broad spectrum of biological activities including antidiabetic, aphrodisiac, anti-ulcer, anti-inflammatory, antimicrobial, antioxidant, analgesia, antipyretic, antileishmanial, and antimalarial. Despite their numerous therapeutic applications, Aloe species generally potentiate toxicological concerns at high doses, necessitating further research to standardize and establish their optimum therapeutic doses including those of the West African species. Furthermore, while the medicinal uses of Aloe species have been well documented in Africa, there is still paucity of information on the pharmacological and phytochemistry of the West African species. Therefore, further advanced and in-depth investigations are imperative to isolate and characterize their active compounds, as well as to understand the molecular mechanism of action of the species against human ailments with the hope of developing commercially valuable products of high economic importance. [ABSTRACT FROM AUTHOR]

Brain-derived neurotrophic factor (BDNF) is a growth factor that plays many critical functions in the central nervous system (CNS) and may be involved in the development of a range of psychopathologies, including depression, dementia, and neurodegenerative disorders. In the present study, we performed the first systematic review with a meta-analysis to quantitatively compare the peripheral blood BDNF levels between patients with obsessive-compulsive disorder (OCD) and healthy controls (HCs). A systematic search was conducted using PubMed and Web of Science databases to identify the relevant articles. Nine studies encompassing 474 adults with OCD and 436 HCs were included in this meta-analysis. A random-effects meta-analysis showed that patients with OCD had significantly decreased peripheral blood levels of Brain-derived neurotrophic factor (BDNF) when compared with the HCs (Hedges' g = −0.722, 95% confidence interval [CI] = −1.152 to −0.292, P = 0.001). Subgroup analyses revealed decreased BDNF levels in plasma of patients (Hedges' g = −1.137, 95% CI = −1.463 to −0.810, P = 0.000) and drug-free patients (Hedges' g = −1.269, 95% CI = −1.974 to −0.564, P = 0.000) as compared to patients on active drug therapy and HCs. Meta-regression analyses showed that age, sex, sample size, Y-BOS total score, and publication year had no moderating effects on the outcome. Although the relationship between our findings and the pathophysiology of OCD and the role BDNF plays in the development of the disease remains to be determined, the outcomes suggest that BDNF may serve as a potential biomarker of OCD. • Brain-derived neurotrophic factor as a potential biomarker for obsessive-compulsive disorder. • Patients with OCD have significantly lower BDNF levels than healthy controls. • BDNF levels in drug-free patients were significantly lower than controls. • No significant difference in BDNF levels in drug-treated patients vs controls. • Meta-regression analysis showed that variables had no moderating effects. [ABSTRACT FROM AUTHOR]

Background: Long-term neuropsychiatric sequelae of autoimmune encephalitis (AE) remain understudied, particularly in pediatric-onset AE. We aimed to synthesize the published data on ongoing psychiatric symptoms in pediatric-onset AE.Methods: The Pubmed, PyscINFO, Web of Science databases were searched from their inception years to August 23, 2021, and 29 studies were identified and analyzed. We also performed a quantitative synthesis of available patient data from the 29 studies combined with a cohort of anti-NMDA receptor (NMDAR) AE from our institution to examine the associations between acute treatment course and long-term psychiatric outcome.Results: At long-term follow up, 52.4% of the cases with pediatric-onset AE had any persistent symptom and 36.0% had at least one psychiatric symptom. Pooled data found that 36.3% of pediatric-onset anti-NMDAR AE had ongoing psychiatric symptoms. Using a univariate logistic regression analysis, we found that abnormal initial EEG, use of certain immunotherapies, and persistent cognitive impairments were associated with ongoing psychiatric symptoms.Limitations: Limitations of the existing literature included a significant paucity of outcomes measured using consistent, objective methods. Limitations of the systematic review included the wide variability among the studies reviewed, which rendered a meta-analysis impossible and beyond the scope of the paper.Conclusion: Chronic psychiatric and behavioral problems remain present in one-third of children months to years after onset of AE. Larger scaled prospective observational studies with a consistent standardized battery of testing are needed to examine impact of specific clinical features and immunotherapies on long-term mental health outcomes. [ABSTRACT FROM AUTHOR]

Great efforts have been made to support the innovation and development of commercially available aquaculture to realize improved inputs and culture systems, enhancing productivity. In general, culture production systems are not a new phenomenon that attracts managers to conduct evaluation assessments. Broader aspects of the innovation and development of production systems can be analyzed using cost–benefit analysis. However, no systematic review of the literature has been conducted. Hence, this study contains a review of the applicability of cost–benefit analysis to culture systems for improving aquaculture production. The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review the current research based on the Web of Science database, and a total of 86 journal articles were systematically analyzed. Based on the publication patterns, the results suggest that the interest in research in this area has increased in recent years. Subsequently, the review highlights the importance of considering social cost–benefit analysis that balances economic benefits and environmental pollution for long-term prospects. In this regard, there are still insufficient studies in this field of research. Accordingly, this study discusses four common topics related to the application of cost–benefit analysis to the development of production systems, namely, 1) integrated multi-trophic aquaculture, 2) seabass production systems, 3) stocking density effects, and 4) aquaponics and integrated floating cage aquageoponics systems. Finally, the following recommendations are presented as a reference for future studies: 1) The environmental effect has not been considered extensively in the application of cost–benefit analysis to aquaculture production systems. In addition to socioeconomic effects, future studies should consider appropriate measurement tools and data transformation techniques when they internalize environmental effects in assessments; 2) depending on the specific research objectives, future studies should consider appropriate tools, such as production economic methods and cost–benefit analysis, which could provide economic implications for different decision-making processes in production systems. • Studies about cost–benefit analysis to aquaculture production systems were reviewed. • Majority of the projects were evaluated with traditional cost-benefit analysis. • Analyze the clusters of proposed projects about production systems improvement. • Cost-benefit analysis with socio-economic and environmental impacts is suggested. [ABSTRACT FROM AUTHOR]

This work focuses on how different aspects of design, testing, and field implementation of fiber-reinforced polymer (FRP) in concrete have gained attention from the scientific research community. FRP composites have gained significant recognition after being implemented in civil engineering applications over the past three decades. This paper conducts a comprehensive survey of the existing literature on FRP in concrete from different engineering aspects. Since its advent, FRP research has resulted in numerous peer-reviewed papers available in various scientific databases such as Elsevier, ASCE, Springer Nature, ACI, and MDPI. Researchers investigated the use of FRP in concrete from different aspects, including material systems, element types, and applications, accounting for 35.8%, 50.3%, and 13.9% of the research publications, respectively. This paper aims to present an overview and summarize the use of FRP based on highly cited literature and to support FRP's continued growth and development in concrete applications. Consequently, this paper is expected to offer advantages to stakeholders involved with FRP use, such as owners, engineers, and professionals, by emphasizing the number of available research publications, which can increase confidence in adopting FRP. It offers scholars and researchers the opportunity to become acquainted with the use of FRP in the application of concrete. • Interest in fiber-reinforced (FRP) in concrete is growing within the scientific research community. • Research on FRP in concrete focuses on material systems (35.8%), element types (50.3%), and applications (13.9%). • The paper provides an overview of FRP use in concrete, citing influential works and promoting its ongoing growth. • The study identifies research gaps, helping academicians and scientists understand the challenges in incorporating FRP into concrete. [ABSTRACT FROM AUTHOR]

As a unique iron-dependent non-apoptotic cell death, Ferroptosis is involved in the pathogenesis and development of many human diseases and has become a research hotspot in recent years. However, the regulatory role of ferroptosis in the gut-liver-brain axis has not been elucidated. This paper summarizes the regulatory role of ferroptosis and provides theoretical basis for related research. We searched PubMed, CNKI and Wed of Science databases on ferroptosis mediated gut-liver-brain axis diseases, summarized the regulatory role of ferroptosis on organ axis, and explained the adverse effects of related regulatory effects on various diseases. According to our summary, the main way in which ferroptosis mediates the gut-liver-brain axis is oxidative stress, and the key cross-talk of ferroptosis affecting signaling pathway network is Nrf2/HO-1. However, there were no specific marker between different organ axes mediate by ferroptosis. Our study illustrates the main ways and key cross-talk of ferroptosis mediating the gut-liver-brain axis, providing a basis for future research. [Display omitted] • Clarifing the regulation and physiopathology of ferroptosis on gut-liver-brain axis. • Clarifing ferroptosis mediating the gut-liver-brain axis is oxidative stress. • Integrating signaling pathways of gut-liver-brain axis mediating ferroptosis. • The key cross-talk of ferroptosis affecting signaling pathway network is Nrf2/HO-1. • There was no differential marker in different ferroptosis-mediated organ axis. [ABSTRACT FROM AUTHOR]

The literature on patent analysis is quite extensive, containing a wide variety of studies. The idea has been widely discussed in the literature in recent years as innovation and globalization have increased in frequency in studies. The literature does not contain any research that integrates content analysis with bibliometric mapping analysis, despite the fact that a number of studies have been conducted on the subject. Hence, within the parameters of this study, a bibliometric mapping analysis of 1006 papers covering "patent analysis" and indexed in the Web of Science database, as well as a content analysis of the 50 most cited papers, was conducted. Therefore, this paper aims to determine the common words, keywords, journals published, authors, and universities of affiliation of 1006 studies, focusing on the 50 most cited studies. The study shows that "technology" is most frequently used as a word in summary and keywords. The reason for this can be explained by the fact that technology has the greatest impact on patenting. This study provides authors working in this area with a guide that identifies journals, institutions, authors, and works with high efficiency in patent analysis. [ABSTRACT FROM AUTHOR]

Children can experience significant distress during hospitalisation, as a result of the treatment process and due to psychosocial factors impacting their adjustment to the hospital environment. Such factors can contribute to negative outcomes for the child. Despite this, limited research focus has been placed on understanding the psychosocial factors that contribute to a child's distress to inform support strategies that can improve the experience of hospitalisation across paediatric conditions. The objectives of this review were to synthesise the qualitative and quantitative literature on psychosocial factors associated with hospital adjustment and to identify risk and protective factors that influence the adjustment process. The literature search (1980 to February 2024: CINAHL / Embase / Medline / PsychINFO and Web of Science databases) identified thirty-four studies. Poor hospital adjustment, anxiety, depression and homesickness, were reported by the majority of hospitalised children. Several demographic and psychosocial factors were identified in the quantitative synthesis to contribute to poor adjustment. Child age, temperament, attachment style, past negative hospital experiences, homesickness and fear cognitions, were all associated with adjustment to the hospital environment. Homesickness was identified as a particularly understudied and important construct. Theoretical and methodological considerations are discussed, and recommendations made for future research that can further support inpatient children and their families. • Hospitalisation experiences can be a major stressor, impacting on health. • Homesickness is a common and major concern for hospitalised children. • There is limited research on homesickness and factors that influence adjustment following paediatric admissions. • This review synthesises the literature and makes recommendations for the field. [ABSTRACT FROM AUTHOR]

Digital transformation has recently introduced itself as a groundbreaking phenomenon with profound impacts on societies, industries, businesses, and even individuals. Accordingly, several studies have attempted to give a literature review or analysis of digital transformation research during the last few years. However, most of them are domain-specific studies based on small data samples or subjective review methods, so we lack a general and robust understanding of the landscape of this field of research across different disciplines and domains. Taking a step toward filling this gap, the current study aims to shape an overall and reliable picture of the research realm on digital transformation. To the aim, a computational method namely topic modeling was applied to two big texts, one of which includes all digital transformation-related publications that were indexed in well-known Scopus and Web of Science databases (8639 documents), and the other one only contains studies that were published by high-quality JCR journals (1264 documents). As a result, 20 and 13 topics were respectively introduced as the underlying themes of the global trends and core knowledge in digital transformation research along with their temporal evolutionary paths throughout the recent years. Also, by comparing these two groups of topics, it was known that there are nine developing trends in this field of research that require more attention and advancements to establish themselves as the core knowledge of the field. Complementing the contributions of previous domain-specific or subjective reviews on digital transformation, this study tries to favor a better understanding of this scholarship through multidisciplinary and multidimensional analyses of digital transformation-related publications by using the topic modeling approach. [ABSTRACT FROM AUTHOR]

• We systematically appraised circulating biomarkers of radiation response. • Most studies are retrospective and focus on oesophageal squamous cell carcinoma. • Circulating tumour DNA, circulating tumour cells and miRNA predict radiation response. • There is a need to standardise biomarker studies focussed on radiotherapy for oesophageal cancer. The availability of circulating biomarkers that are predictive of treatment response or prognostic of overall outcome could enable the personalised and adaptive use of radiotherapy (RT) in patients with oesophageal adenocarcinoma (OAC) and squamous cell carcinoma (OSCC). A systematic review was carried out following Preferred Reporting Items for Systematic Reviews guidance. Medline, EMBASE, PubMed, Cochrane Library, CINAHL, Scopus and the Web of Science databases were searched for studies published between January 2005-February 2023 relating to circulating biomarkers evaluated in the context of neoadjuvant or definitive RT delivered for OAC/OSCC. Study quality was assessed using predefined criteria. A total of 3012 studies were screened and 57 subsequently included, across which 61 biomarkers were reported. A majority (43/57,75.4%) of studies were of Asian origin and retrospective (40/57, 70.2%), with most (52/57, 91.2%) biomarkers reported in the context of patients with OSCC. There was marked inter-study heterogeneity in patient populations, treatment characteristics, biomarker measurement and the cut points used to define biomarker positivity. Nevertheless, there is evidence for the prognostic and predictive value of circulating tumour DNA and numerous miRNAs in OAC and OSCC, as well as for the prognostic and predictive value of circulating levels of CYFRA21.1 in OSCC. There is consistent evidence for the potential predictive and prognostic value of a small number of biomarkers in OSCC and OAC, though these data are insufficient for translation to current clinical practice. Well-designed prospective studies are now required to validate their role in stratified and personalised RT treatment approaches. [ABSTRACT FROM AUTHOR]

Contamination of surface waters is a major health threat for all living creatures. Some types of blue-green algae that naturally occur in fresh water, are able to produce various toxins, like Microcystins (MCs). Microcystin-leucine arginine (MC-LR) produced by Microcystis aeruginosa is the most toxic and abundant isoforms of MCs, and it causes hepatotoxicity. The present article reviews preclinical experiments examined different treatments, including herbal derivatives, dietary supplements and drugs against MC-LR hepatotoxicity. We searched scientific databases Web of Science, Embase, Medline (PubMed), Scopus, and Google Scholar using relevant keywords to find suitable studies until November 2023. MC-LR through Organic anion transporting polypeptide superfamily transporters (OATPs) penetrates and accumulates in hepatocytes, and it inhibits protein phosphatases (PP1 and PP2A). Consequently, MC-LR disturbs many signaling pathways and induces oxidative stress thus damages cellular macromolecules. Some protective agents, especially plants rich in flavonoids, and natural supplements, as well as chemoprotectants were shown to diminish MC-LR hepatotoxicity. The reviewed agents through blocking the OATP transporters (nontoxic nostocyclopeptide-M1, captopril, and naringin), then inhibition of MC-LR uptake (naringin, rifampin, cyclosporin-A, silymarin and captopril), and finally at restoration of PPAse activity (silybin, quercetin, morin, naringin, rifampin, captopril, azo dyes) exert hepatoprotective effect against MC-LR. [Display omitted] • Contamination of surface waters is a major health threat for all living creatures. • MC-LR produced by Microcystis aeruginosa is more toxic and abundant compared to other isoforms. • Hepatotoxicity is the most important consequences of exposure to MC-LR. • MC-LR through OATP transporters penetrates in hepatocytes, and inhibits protein phosphatases (PP1 and PP2A). • This review discusses different treatments against MC-LR hepatotoxicity. [ABSTRACT FROM AUTHOR]

Corneal blindness is commonly treated through corneal replacement with allogeneic corneal donors, which may face shortage. Regarding this issue, xenogeneic alternatives are explored. Fish scale-derived scaffolds (FSSs) are among the alternatives due to the lower risk of infection and abundant sources of raw materials. Unfortunately, the information about mechanical, optical, chemical, and biological performances of FSSs for corneal replacements is still scattered, as well as about the fabrication techniques. This study aims to gather scattered pieces of information about the mentioned performances and fabrication techniques of FSSs for corneal replacements. Sorted from four scientific databases and using the PRISMA checklist, eleven relevant articles are collected. FSSs are commonly fabricated using decellularization and decalcification processes, generating FSSs with parallel multilayers or crossed fibers with topographic microchannels. In the collected studies, similar mechanical properties of FSSs to native tissues are discovered, as well as good transparency, light remittance, but poorer refractive indexes than native tissues. Biological evaluations mostly discuss histology, cell proliferations, and immune responses on FSSs, while only a few studies examine the vascularization. No studies completed comprehensive evaluations on the four properties. The current progress of FSS developments demonstrates the potential of FSS use for corneal replacements. [Display omitted] [ABSTRACT FROM AUTHOR]

In today's world, it is vital to have strong cybersecurity measures in place. To combat the ever-evolving threats, adopting advanced models like cybersecurity mesh is necessary to enhance our protection. Cybersecurity mesh is an architecture scalable, flexible, composable, robust and resilient and allows the interoperability and coordination between intelligent systems to provide security services. Designing a cybersecurity mesh faces three major challenges: scalability, distributed or federated systems, and technology integration. For the design, it is necessary to apply security tools that support scalability because millions and millions of data are stored, processed, and analysed. Federated systems are needed to improve interoperability in a decentralized cybersecurity mesh. However, it can be tough to integrate different security tools and communication protocols. Cryptographic algorithms and AI models like federated learning, swarming intelligence and blockchain technologies are useful for security services. It is essential to study the integration of existing methods to determine the best technology for the job. We conduct a comprehensive analysis of intelligent systems, including federated learning, blockchain technology, and swarming intelligence, with a particular focus on how they have been and can be used to enhance cybersecurity. We examine the latest trends in these technologies, explore their connections, and weigh the pros and cons of each approach. To conduct this review, we utilized the Web of Science and Scopus databases and followed the PRISMA guidelines. [ABSTRACT FROM AUTHOR]

Telemedicine is being applied in assisted reproduction technology (ART) to provide remote consultations, monitoring and support for patients. This study aimed to evaluate the potential advantages of telemedicine in ART treatment in the form of virtual consultations. Studies in which patients were using telemedicine during ART treatment were identified from four scientific databases (PudMed, EMBASE, Scopus, Web of Science). The success of fertility treatments was compared between telemedicine and in-office care, and patient satisfaction with ART through telemedicine was assessed. Eleven studies, comprising 4697 patients, were identified. Quality assessment (Joanna Briggs Institute Critical Appraisal and revised Cochrane risk-of-bias tools) revealed an acceptable risk of bias for both randomized controlled trials and observational studies. Using a fixed-effects model, telemedicine was comparable to in-person care regarding the pregnancy rate achieved (odds ratio 1.02, 95% confidence intervals 0.83–1.26, P = 0.83). A Q-test suggested that all the included studies were homogeneous. Patients who received telemedicine during fertility treatment reported a high level of satisfaction (91%, 95% confidence intervals 80–96%). Egger's test confirmed that no publication bias was found. Telemedicine could serve as a complementary tool during fertility treatment to facilitate patients' satisfaction and overcome some practical problems without compromising treatment outcomes. Future studies should continue exploring the potential applications of telemedicine in assisted reproduction. [ABSTRACT FROM AUTHOR]

– This study embarks on a comprehensive journey through the factors influencing Environmental, Social, and Governance (ESG) performance by employing a two-fold approach: a bibliometric analysis and a systematic literature review. Scopus, a prominent scientific database, was utilized to examine publications spanning the years 2014–2023. The article selection process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Biblioshiny, R Studio software, version 4.2.0, was used for bibliometric analysis. – Bibliometric analysis identified the most influential articles, journals, countries, authors, and themes in the field. The systematic literature review established seven key themes as the fundamental factors influencing ESG performance. Moreover, future research directions were suggested and discussed in this article. – The findings offer valuable guidance to the academic community, industry practitioners, and policymakers for real-world applications. [ABSTRACT FROM AUTHOR]

The effects of sodium selenite or selenium yeast on the meat quality of broilers were searched in the literature published in the Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), PubMed, Web of Science, and Science Direct databases from January 1, 2010 to December 31, 2022. Meta-analysis was performed with Stata software (StataCorp. 2011), and the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a random effects model. Twenty of the identified 846 literature sources, which included 791 broilers, were screened. The meat quality indices considered were shear force, drip loss, cooking loss, water holding capacity (WHC), pH, and color. The source of heterogeneity was studied using sensitivity and subgroup analyses, and publication bias was evaluated using funnel plots. The results showed that the supplementation of selenium in the broiler diet significantly reduced the shear force (SMD = −0.67, 95% CI [−1.12, −0.22], P < 0.05) and drip loss (SMD = −0.84, 95% CI [−1.39, −0.30], P < 0.05) and increased the pH (SMD = 0.38, 95% CI [0.01, 0.75], P < 0.05) of broiler breast muscle; however, it had no significant effects on other indices. Funnel plots revealed a slight publication bias in the shear force and pH of breast muscle but none in the drip loss of breast muscle. The sensitivity analysis showed that the results were stable and reliable. In conclusion, selenium supplementation in broiler feed can improve some indices of broiler meat quality, and its inclusion in broiler diets is recommended, in conjunction with other minerals, which is of great significance to improve the quality, preservation time and economic benefits of chicken products. [ABSTRACT FROM AUTHOR]

With no cure for Alzheimer disease (AD), current efforts involve therapeutics that prevent further cognitive impairment. Deep brain stimulation (DBS) has been studied for its potential to mitigate AD symptoms. This systematic review investigates the efficacy of current and previous targets for their ability to slow cognitive decline in treating AD. A systematic review of the literature was performed through a search of the PubMed, Scopus, and Web of Science databases. Human studies between 1994 and 2023 were included. Sample size, cognitive outcomes, and complications were recorded for each study. Fourteen human studies were included: 7 studies with 6 distinct cohorts (n = 56) targeted the fornix, 6 studies with 3 distinct cohorts (n = 17) targeted the nucleus basalis of Meynert (NBM), and 1 study (n = 3) investigated DBS of the ventral striatum (VS). The Alzheimer's Disease Assessment Scale–Cognitive Subscale, Mini-Mental State Examination, and Clinical Dementia Rating Scale Sum of Boxes were used as the primary outcomes. In 5 of 6 cohorts where DBS targeted the fornix, cognitive decline was slowed based on the Alzheimer's Disease Assessment Scale–Cognitive Subscale or Mini-Mental State Examination scores. In 2 of 3 NBM cohorts, a similar reduction was reported. When DBS targeted the VS, the patients' Clinical Dementia Rating Scale Sum of Boxes scores indicated a slowed decline. This review summarizes current evidence and addresses variability in study designs regarding the therapeutic benefit of DBS of the fornix, NBM, and VS. Because of varying study parameters, varying outcome measures, varying study durations, and limited cohort sizes, definitive conclusions regarding the utility of DBS for AD cannot be made. Further investigation is needed to determine the safety and efficacy of DBS for AD. [ABSTRACT FROM AUTHOR]

Exoscopes were recently developed as an alternative to the operative microscope (OM) and endoscope for intraoperative visualization during neurosurgery. Prior reviews studying mixed cranial and spinal surgical cohorts reported advantages with exoscope use, including improved ergonomics and teaching. In recent years, there has been an increase in exoscope research, with no updated systematic review focused exclusively on the benefits and limitations of exoscope use in spine surgery. Thus, we sought to systematically synthesize the literature related to exoscope-assisted spine surgery. A literature search was conducted using the PubMed, Embase, Scopus, Cochrane, and Web of Science databases to identify relevant studies reported between 2010 and September 2023. Data, such as the exoscope model used, procedure types performed, and user observations, were then collected. A total of 31 studies met our inclusion criteria, including 481 patients with spine pathologies who underwent a surgical procedure using 1 of 9 exoscope models. The lumbar region was the most frequently operated area (n = 234; 48.6%), and discectomies comprised the most overall procedures (n = 273; 56.8%). All patients benefited clinically. The reported advantages of exoscopes compared with OMs or endoscopes were improved focal distance, surgeon posture, trainee education, compactness, and assistant participation. Other aspects such as stereopsis, illumination, and cost had various observations. Exoscopes have advantages compared with OMs or endoscopes during spine surgery. The user learning curve is minimal, and no negative patient outcomes have been reported. However, some aspects of exoscope use necessitate longer term prospective research before exoscopes can be considered a standard tool in the armamentarium of intraoperative visualization strategies. [ABSTRACT FROM AUTHOR]

• State of the art of the use of robots in greenhouses. • Overview of the terminology, context, applications, and scope. • Analysis of developments, socioeconomic and legal aspects, and different tasks. • Illustrative examples of different areas and greenhouse types. • Examples of self-designed and commercial robots. One of the main initiatives to increase the profit, production, and quality of greenhouse horticulture, as well as its sustainability, is the use of robots. This paper focusses on the state-of-the-art of the use of robots in greenhouses since the 1980 s on the basis of the PRISMA methodology. It is really a scoping review because the main objective is to map the literature on the application of robotics in greenhouses to identify key features, terminology, context, applications, and scope related to this topic, without critically evaluating individual developments. The authors propose a terminology and a set of criteria to classify the technologies related to greenhouse robotization. Research methodology has been to extract information from scientific databases (mainly Scopus, ScienceDirect, Google Scholar, Web of Science, and IEEE Xplore) using a combination of filters and keywords related to this topic. Specifically, 330 publications have been identified up to 2023, including 257 in this study. Statistical analyses have been applied to assess the risk of bias and compare the results, showing significant statistical differences. Finally, based on these analyses, conclusions are presented from technical, socioeconomic, and application perspectives, as well as identifying the main R + D + I challenges and opportunities for the development of robots for greenhouse agriculture tasks. [ABSTRACT FROM AUTHOR]

Nearly six million people residing in the United States do not have access to safely managed sanitation. Housed populations may lack access to centralized wastewater treatment systems or functioning onsite wastewater treatment systems, which subsequently places them at higher risk for adverse health outcomes associated with unsafe sanitation. We sought to understand the various social barriers that impact access to safe sanitation in the United States. We included peer-reviewed studies published between January 2000 and March 2023. The publication search was conducted using Scopus, ProQuest Social Science Database, and HeinOnline. We extracted data on social barriers and physical factors associated with access to sanitation. Twenty publications met the inclusion criteria, and data relating to 11 social barriers and two physical factors were extracted. The social barriers to safe sanitation access mentioned most frequently were found to be socioeconomic status and race-based discrimination. Studies discussed sanitation in communities in five states. Barriers pertained to lack of access to centralized wastewater treatment system, inadequate repair or replacement of septic systems, and lack of safely managed onsite sanitation systems. We discuss the intersectionality of the barriers, the underlying policy and history that leads to them, and make recommendations to address inequitable access to safe sanitation. Legislation and policy must be critically reviewed at national, state, and local levels to limit or eliminate ability for utilities to be extended on the basis of a community's income and property values or racial makeup. Policy recommendations also include additional community engagement, onsite sanitation system monitoring, and knowledge dissemination and education of septic system users. More geographically diverse research and research on sanitation in specific communities such as those of migrant farmworkers, undocumented persons, and tenants are recommended. [ABSTRACT FROM AUTHOR]