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Systematic reviews (SRs) and meta-analyses (MAs) require a comprehensive and reproducible strategy to assess the methodological quality of the included studies. This research-on-research study evaluated the methods used to assess research quality by SRs and MAs published in leading neurosurgical journals, and identified factors associated with the publication of a comprehensive and reproducible assessment. We systematically surveyed SRs published in the 10 leading neurosurgical journals between 01/11/2019 and 31/12/2021. PubMed was used to search the MEDLINE database, which was supplemented by individual journal searches. Included SRs were assessed using a standardised data extraction tool. Descriptive statistics were utilised to identify factors associated with methodological and reporting quality of the tool-based quality assessment. A total of 564 SRs were included in the analysis. 326 (57.80%) included MAs, 165 (29.26%) included at least one Randomized Controlled Trial (RCT) and 29 (5.14%) included only RCTs. Scales were the most commonly used tool for methodological quality assessment (32.45%), followed by domain-based tools (24.82%) and checklists (9.93%). The number of included studies was inversely associated with multiple methodological quality assessment metrics. A positive association was observed between the number of included patients and multiple methodological quality assessment metrics. We established that the methodological and reporting quality of tool-based quality assessment requires improvement. This issue is particularly pertinent for SRs limited to non-randomised studies, which account for the vast majority of neurosurgical SRs. We recommend the use of domain-based tools for methodological quality assessment as these provide a more nuanced assessment of methodological quality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The National Institute for Occupational Safety and Health (NIOSH) conducted 21 field surveys in selected industries to characterize workers' exposures to hexavalent chromium-containing airborne particulate and to evaluate existing technologies for controlling these exposures. Hexavalent chromium Cr(VI) is a respiratory irritant and chronic inhalation may cause lung cancer. Primary evaluation methods included collection of full work shift, personal breathing-zone (PBZ) air samples for Cr(VI), measurement of ventilation system parameters, and documentation of processes and work practices. This study emphasized evaluation of engineering exposure control measures, so PBZ exposures were measured on the outside of personal protective equipment, for example, respirators. Field surveys were conducted in two chromium electroplating facilities, including one where full-shift PBZ exposures to Cr(VI) ranged from 3.0 to 16 times the 1 micro g/m(3)NIOSH recommended exposure limit (REL) despite several engineering controls on the plating tanks. At a painting and coating facility that used Cr(VI)-containing products, full-shift exposures of painters and helpers (2.4 to 55 micro g/m(3)) exceeded the REL, but LEV effectiveness was limited. Other operations evaluated included welding in construction; metal cutting operations on chromium-containing materials in ship breaking; chromate-paint removal with abrasive blasting; atomized alloy-spray coating; foundry operations; printing; and the manufacture of refractory brick, colored glass, prefabricated concrete products, and treated wood products. NIOSH researchers concluded that, in many of the evaluated processes, Cr(VI) exposures at or below the current NIOSH REL are achievable. However, for some processes, it is unclear whether controlling exposures to this range is consistently achievable without respirator use. Some operations involving the application of coatings and finishes may be among those most difficult to control to this range. Most operations judged to be moderately difficult to control to this range involve joining and cutting metals with relatively high chromium content. Nonetheless, exposures in a wide variety of other processes were judged more easily controllable to the current REL or below, or were found to be minimal, including some operations meeting the general descriptions named above but with different specific operating parameters producing lower Cr(VI) exposures.

In a study of 23 small machining shops using metalworking fluids (MWFs), real-time air monitoring using an aerosol photometer was performed to investigate the temporal nature of the exposure and to examine the relationship between the instrumental measurements and traditional sampling methods. Time-weighted averages were calculated from the aerosol photometer data and the results were compared to collocated thoracic and 37-mm closed face cassette samplers. The filter samples were analyzed for total mass and the solvent extractable fraction. Depending on the averaging period used, short-term MWF concentrations exceeded 2.0 mg/m3 in 13 to 39% of the plants studied. High short-term exposures were as likely to be found in plants with average concentrations below 0.4 mg/m3 (thoracic-gravimetric) as those above. Regression analyses indicated that the aerosol photometer most closely matched the data obtained from the thoracic fraction of the total mass. In general, the aerosol photometer overestimated the levels determined using the thoracic cyclone and filter, especially when measuring concentrations of water-based fluids. Use of a calibration factor of 0.7 for straight oils or 0.5 for water-based fluids may assist in the interpretation of aerosol photometer measurements if field calibration data are not readily available. Several approaches to determining the calibration factor from field data were evaluated; more complex calibration techniques improved the accuracy of the measurements.

Sampling was conducted in 79 small machine shops to assess airborne exposures to metalworking fluids (MWFs). Measured exposures were compared with data from the literature and exposure criteria currently recommended by the National Institute for Occupational Safety and Health and the Occupational Safety and Health Administration MWF Standards Advisory Committee. Sixty-two percent of 942 personal samples collected were less than the recommended exposure limit (REL) of 0.50 mg/m3 for total particulate. However, at least 1 sample exceeded the REL in 61 of the 79 facilities studied; 100% of the samples collected in 10 shops were greater than the REL. Similar trends were found for thoracic particulate exposures where 75% of 238 samples were below the thoracic particulate REL of 0.40 mg/m3. The ratio between thoracic and total particulate for 238 paired samples was 0.55 (r2=0.73). Workers exposed to straight fluids had the highest exposures (GM=0.67 mg/m3) when compared with workers exposed to other classes of MWFs. The highest exposures were measured for grinding and hobbing (GM=0.67 and 0.60 mg/m3, respectively). Measurements using personal impactors indicated that particle size distributions of MWF aerosols had an average mass median aerodynamic diameter of 5.3 microm. Straight oils and soluble fluids tended to be associated with larger particles than were other fluid types; grinding and turning produced the largest particles, whereas hobbing resulted in the smallest. In general, exposures were similar in magnitude and particle size to those previously reported in large automotive plants. Therefore, workers in these small shops may have risks of adverse health effects similar to those demonstrated in the automotive industry.

Intra-articular fractures of the distal end of the tibia represent a wide spectrum of articular and metaphyseal damage and are relatively infrequent injuries. This article summarizes possible early and late complications involved in the treatment of pilon fractures. Diagnostic and treatment guidelines for these complications also are reviewed.

Patients with strabismus should be viewed as having a serious ocular disorder requiring early diagnosis and evaluation. They should also be encouraged to have proper therapy so that they may be returned to a more normal ocular status at the earliest possible age. The ultimate goal of the pediatric ophthalmologist is always good vision and proper alignment. Neither alone is acceptable. The pediatric practitioner should diagnose strabismus disorders at the earliest possible age so that full and proper treatment may be brought to bear, thus allowing the patient to enjoy binocular vision function throughout life.