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Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology.

Objectives The aim of this systematic review was to evaluate the association between specific genetic polymorphisms and dental implant-related biological complications in patients having a follow-up period of at least 12-months post-loading. Material and methods A sensitive search strategy was developed to identify implant-related genetic-association studies. This was performed by searching five databases. A three-stage screening (titles, abstract, full text) was carried out in duplicate and independently by two reviewers. Assessment was carried out according to the suggested scale for quality assessment of periodontal genetic-association studies and adapted to genetic analyses of implant-related studies leading to an overall final score 0-20 based on the summation of positive answers. Results The initial search resulted in 1838 articles. Sixty-seven full-text articles were assessed for eligibility and four studies met the defined inclusion criteria. IL-6 G174C, TNF-alpha -308, IL-1A-889 and IL-1B+3954 and CD14-159 C/T polymorphisms were evaluated. The quality assessment scores ranged from 6 to 11 positive answers from out of a maximum score of 20. The great heterogeneity among the studies did not allow a meta-analysis. Conclusions The published evidence on genetic predisposition and implant biologic complications is limited. The small number of identified studies evaluating the association between genetic polymorphisms and peri-implant disease presented methodological and reporting inadequacies. Thus, the potential link between genetic polymorphisms and biological complications should be further investigated and clarified through well-designed clinical studies on adequately powered and appropriately included study populations.

Objectives The LumiraDx SARS-CoV-2 Ag Test has previously been shown to accurately detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals symptomatic for coronavirus disease 2019 (COVID-19). This evaluation investigated the LumiraDx SARS-CoV-2 Ag Test as an aid in the diagnosis of SARS-CoV-2 infection in asymptomatic adults and children. Methods Asymptomatic individuals at high risk of COVID-19 infection were recruited in 5 point-of-care (POC) settings. Two paired anterior nasal swabs were collected from each participant, tested by using the LumiraDx SARS-CoV-2 Ag Test at the POC, and compared with results from reverse transcription–polymerase chain reaction (RT-PCR) assays (cobas 6800 [Roche Diagnostics] or TaqPath [Thermo Fisher Scientific]). We calculated positive percent agreement (PPA) and negative percent agreement (NPA), then stratified results on the basis of RT-PCR reference platform and cycle threshold. Results Of the 222 included study participants confirmed to be symptom-free for at least 2 weeks before testing, the PPA was 82.1% (95% confidence interval [CI], 64.4%-92.1%). The LumiraDx SARS-CoV-2 Ag Test correctly identified 95.8% (95% CI, 79.8%-99.3%) of the samples confirmed positive in fewer than 33 RT-PCR cycles and 100% (95% CI, 85.1%-100%) in fewer than 30 RT-PCR cycles while maintaining 100% NPA. Conclusions This rapid, high-sensitivity test can be used to screen asymptomatic patients for acute SARS-CoV-2 infection in clinic- and community-based settings.

Aim To explore and synthesize the literature on factors related to mammography screening adherence among women in Brazil. Design A scoping review. Methods We searched 11 databases for studies published between 2006–January 2020. All identified articles were screened, and data were extracted from eligible studies. We used the UK Government Social Research Service weight of evidence appraisal tool to appraise the quality of the included study. Results From a total of 1,384 identified articles, 22 were retained. All included studies used quantitative, non‐experimental methods and all but two studies used cross‐sectional data. Quality of evidence varied across studies. We identified 41 factors that were investigated across the set of studies. Demographic and socio‐economic factors were the most commonly investigated, with older age, urban residence, living in the southeast of Brazil, higher level of education, higher income and private health insurance most consistently associated with mammography adherence.

Introduction: Microleakage is a major concern in composite restorations, especially with margins located on dentin or cementum of the tooth. This study aimed to review the available literature investigating in vitro the efficacy of different tooth lining materials on the marginal seal of composite restorations extended below the Cemento-Enamel Junction (CEJ) of the tooth. Materials and Methods: Different combinations of the review terms were used to electronically search PubMed, Google Scholar, Cochrane Library, and Ebscohost databases for the last fifteen years. The records were initially screened for relevancy based on title and abstract. Articles that seemed to meet the criteria for inclusion were selected for full-text assessment. Studies deemed eligible were in vitro studies conducted on human teeth with cavities extending below the CEJ and restored using different tooth lining materials under the composite restorations.Every included study was evaluated using the Cochrane risk of bias assessment tool. Results: The initial search identified 619 publications. After removing duplicated records, the remaining 421 records are screened at the level of titles and abstracts to meet our inclusion criteria. 62 records were designated for full-text methodological assessment, and 15 studies were found eligible for qualitative synthesis. The sealing ability of different tooth lining materials under composite restorations was investigated in the chosen studies, with varying outcomes. Microleakage in the tooth restorations was determined by examining the extent of dye penetration under a microscope. Conclusion: Despite the reports of less dye penetration with specific tooth liners in some in-vitro studies, there is no consistent evidence supporting that such tooth liners could reduce microleakage in composite restorations of the tooth.

INTRODUCTION The Tiger Tech Warfighter Monitor (WFM) is a novel single-limb device for ECG acquisition. The WFM provides true (not derived) single limb Electrocardiogram monitoring (ECG) to provide heart rate and R-R interval monitoring between QRS complexes. Herein, we evaluate the diagnostic accuracy of the WFM heart rate, R-R interval monitoring, and heart rate variability monitoring in comparison to a 2‑lead chest ECG. METHODS Data was collected under Institutional Review Board (IRB) approval. Patients available within our institution's pre-operative holding unit were randomly selected to undergo simultaneous chest and WFM ECG monitoring. 3-5-min measurements were taken depending on the patient's availability. Data was saved to two separate mobile phones and time-stamped for synchronization. A proprietary Tiger Tech extraction algorithm was used to tag proper features on both the WFM 1-Limb ECG and Chest ECG data files. A separate algorithm was then used to compare the beat-to-beat variations between the ECGs. RESULTS Data was extracted and analyzed on 26 subjects. Linear regression of heart rate analysis revealed excellent correlations with an R2 of 0.99 (p < 0.05). Similar linear regression evaluation of R-R interval correlation demonstrated a mean R2 value of 0.95 (p < 0.05). Statistically significant correlation was achieved in all 26 included study participants. Heart rate variability also achieved excellent correlation (SDNN R2 = 0.997, RMSSD R2 = 0.995, LnRMSSD R2 = 0.992, p << 0.05). CONCLUSION Results demonstrate that the WFM achieves excellent correlation with chest ECG for heart rate, R-R internals, and heart rate variability.

Reports of COVID-19 associated pulmonary aspergillosis (CAPA) are rising, but the associated mortality and factors affecting it are not well-characterised. We performed a systematic review including 20 peer-reviewed English language studies reporting mortality in CAPA published till 18 February 2021from PubMed, Ovid SP, Web of Science, Embase and CINHAL. The pooled mortality in CAPA was 51.2% (95% CI: 43.1-61.1, I2 = 38%). The leave one out sensitivity analysis and influential case diagnostics revealed one outlier and its exclusion resulted in a mortality estimate of 54% (95% CI: 45-62). Higher odds of mortality: 2.83 (95% CI: 1.8-4.5) were seen in CAPA compared to controls. No significant difference in various subgroups according to the country of study, the continent of study, income category of country and quality of the included study was seen. None of the host risk factors, mycological test results, therapy for COVID-19 and antifungal therapy affected mortality. Thus, patients with CAPA have a high probability of mortality and early diagnosis with prompt therapy must be ensured to optimally manage these patients. However, more prospective studies with global and multi-centre coordination may help to address CAPA in a better way.

Ripe date fruits contain phenolic compounds which possess a high antioxidant activity. The current review was carried out to evaluate total phenolic content in ripe date fruits. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed during the review process. Relevant studies published from inception up to March 2019 were retrieved from three databases. Study selection was performed based on specific inclusion criteria. A total of twenty-two articles were selected and included in the present review. Data collected from these studies were organized, pooled, and analyzed using descriptive statistics. Total phenolic content means and medians have been reported for the collected ripe date fruit samples for each included study and pooled data. The results suggested that ripe date fruits contain a potent total phenolic content that can contribute mainly to their antioxidant properties.

Problem identification Although frailty is an important parameter in treatment planning and in predicting prognosis and overall survival among patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation, frailty assessment tools are not standardized in clinical care settings. The purpose of this article is to provide an overview of the literature on frailty assessment tools in these patient populations. Literature search A systematic search of CINAHL®, Embase®, MEDLINE®, PubMed®, and Web of Science was performed using keywords and controlled vocabulary for the concepts "bone marrow transplants," "hematologic neoplasms," and "frailty." Data evaluation Extracted data included study type, diagnosis, transplantation status, frailty tools used, and outcome measures. Synthesis A systematic search resulted in 24 studies that met the inclusion criteria. There were significant differences in how various groups define and assess frailty. Implications for practice Addressing the lack of standardized frailty assessments will assist healthcare providers to routinely integrate frailty measures in clinical assessments to identify those at risk for poor outcomes, improving personalized care.

Objective Children with some chronic health conditions experience family functioning difficulties. However, research examining family functioning in youth with functional gastrointestinal disorders (FGIDs) has produced mixed results. Therefore, the current review critically synthesized the literature on family functioning among youth with FGIDs. Methods A systematic search using pediatric, family functioning, and FGID search terms was conducted in PubMed, PsycInfo, and ProQuest. Out of the 586 articles initially identified, 17 studies met inclusion criteria. Studies were included if they presented original research in English, assessed family functioning, and the study sample consisted of children (0–18 years) diagnosed with a FGID. Quality assessment ratings were conducted for each included study based on a previously developed scientific merit 3-point rating system. Results The majority of studies (n = 13) examined family functioning between youth with FGIDs and comparison groups. The remaining studies explored associations between family functioning and study variables (e.g., child psychosocial functioning and sociodemographic factors) and examined family functioning clusters among children with FGIDs. In general, children with FGIDs demonstrated poorer family functioning compared to healthy counterparts. Findings also suggested that child psychosocial functioning, disease characteristics, and sociodemographic factors were related to family functioning among youth with FGIDs. The average quality of studies was moderate (M = 2.3). Conclusions Maintaining healthy family functioning appears to be challenging for some families of children with FGIDs. Future research should explore the directionality of the relationship between family functioning and child physical and psychosocial outcomes to advance the understanding and treatment of pediatric FGIDs.

Objectives The objective of the study was to assess inconsistencies between individual protocols and associated full-text publications in the development of core outcome sets (COSs). Study Design and Setting Protocols and subsequent full-text publications were retrieved by searching the following electronic databases: PubMed, Embase, Web of Science, and the Core Outcome Measures in Effectiveness Trials database from inception to October 1, 2019. We summarized changes in the general and methodological characteristics by comparing the protocols with the full-text publications and reported change as information frequency and proportion. Results A total of 24 protocols and 32 corresponding full-text publications that encompassed 14 study topics were identified from databases. In the identified initial list of outcomes, five COSs (20.8%) changed the included study type, none of which explained the reasons for these changes. In addition, eight COSs showed inconsistencies between the protocols and full-text publications in the searched databases, of which, only two studies explained the reasons for these changes. Compared with the protocols, three COSs changed the number of Delphi rounds, eight COSs changed the participants (stakeholder groups), and three COSs changed the consensus definition of the Delphi survey. Only two COSs explained the reason for changing the number of Delphi rounds, and none of the studies explained why the participants changed. For the face-to-face consensus meeting, we found that nine COSs changed the participants and none explained the reasons for these changes. Conclusion Our study found many inconsistencies between protocols and the full-text publications concerning COS development. These inconsistencies related to the included study types, databases searched, Delphi surveys, and face-to-face consensus meetings. As it is necessary to publish protocols before developing COSs, transparency regarding any changes to the methods is needed.

Objective The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions. Material and methods A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness. Results and conclusions Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.

IntroductionThere is little systematic tracking or detailed analysis of investments in research and development for blast injury to support decision-making around research future funding.MethodsThis study examined global investments into blast injury-related research from public and philanthropic funders across 2000–2019. Research databases were searched using keywords, and open data were extracted from funder websites. Data collected included study title, abstract, award amount, funder and year. Individual awards were categorised to compare amounts invested into different blast injuries, the scientific approaches taken and analysis of research investment into blast traumatic brain injury (TBI).ResultsA total of 806 awards were identified into blast injury-related research globally, equating to US$902.1 million (m, £565.9m GBP). There was a general increase in year-on-year investment between 2003 and 2009 followed by a consistent decline in annual funding since 2010. Pre-clinical research received $671.3 m (74.4%) of investment. Brain-related injury research received $427.7 m (47.4%), orthopaedic injury $138.6 m (15.4%), eye injury $63.7 m (7.0%) and ear injury $60.5m (6.7%). Blast TBI research received a total investment of $384.3 m, representing 42.6% of all blast injury-related research. The U.S. Department of Defense funded $719.3 m (80%).ConclusionsInvestment data suggest that blast TBI research has received greater funding than other blast injury health areas. The funding pattern observed can be seen as reactive, driven by the response to the War on Terror, the rising profile of blast TBI and congressionally mandated research.

We aimed to provide an overview on research path in nuclear medicine climbing the steps of the Evidence-Based Medicine (EBM) pyramid using review of 14 subjectively selected papers out of 111 published in the Annals of Nuclear Medicine during January-December 2019. Following the structure of the EBM hierarchy, we chose at least one study for each step of the pyramid from the basis (pre-clinical research, expert opinion, case report and case series), to the middle (case-control and cohort studies, randomised controlled trials), towards the top (meta-analyses and systematic reviews). Additionally, we collected information on the promoter of each included study: investigator-initiated trials (IITs) vs industry-sponsored trials (ISTs). We found that pre-clinical studies are primarily focused on the development of novel molecular targets in cancer, with promising results. At the same time, clinical investigations deal with cardiological, neurological, infectious and oncological applications using both SPECT and PET modalities. Additionally, radionuclide therapy gained interest and is experiencing comprehensive clinical implementation. Our overview confirms the current central role of IITs as compared with ISTs. Challenges and future directions in Nuclear Medicine research are discussed.

Introduction Several studies have assessed the histological co-existence of endometrial carcinoma (EC) and adenomyosis. However, the significance of this association is still unclear. Objective To assess the prevalence of adenomyosis in women with EC for a better understanding of the association between the two diseases. Materials and methods A systematic review and meta-analysis was performed by searching electronics databases from their inception to March 2020, for all studies that allowed extraction of data about prevalence of adenomyosis in EC patients. Adenomyosis prevalence was calculated for each included study and as pooled estimate, with 95% confidence interval (CI). Results Eight retrospective cohort studies assessing 5573 EC patients were included in our analysis. Of total, 1322 were patients with adenomyosis, and 4251 were patients without adenomyosis. Pooled prevalence of adenomyosis in EC patients was 22.6% (95% CI 12.7–37.1%). Conclusion Adenomyosis prevalence in EC patients was not different from that reported for other gynecological conditions. The supposed association between the two diseases appears unsupported.

Background Thrombocytopenia is frequent in intensive care unit (ICU) patients and may be associated with adverse outcomes. We aimed to assess the incidence, risk factors, and outcomes associated with thrombocytopenia in adult ICU patients. Methods We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included study reports on adult ICU patients with thrombocytopenia and assessed patient-important outcomes, including mortality and health-related quality-of-life. Results We included a total of 70 studies comprising a total of 215 098 patients; 57 were cohort studies. The incidence of thrombocytopenia varied from 8 to 56 per 100 admissions (very low quality of evidence). We identified several risk factors including age, sepsis, and higher disease severity (low quality of evidence). Thrombocytopenia was associated with bleeding, use of life support, length of stay in the ICU, and increased mortality (low/very low quality of evidence). Data on platelet transfusion before invasive procedures and transfusion thresholds were limited. No studies assessed the benefits and harms of thromboprophylaxis in ICU patients with thrombocytopenia. Conclusions Thrombocytopenia is common and associated with increased morbidity and mortality in adult ICU patients. Several risk factors for thrombocytopenia exists, but the evidence-base on management strategies, including transfusion thresholds and thromboprophylaxis in ICU patients is very limited.

Introduction The Carba NP test is a biochemical chromogenic assay developed to detect carbapenemase activity. Variable performance has been reported according to the type of carbapenemase and bacterial species involved. We aimed to describe the benefit of the Carba NP test and its commercial version, the RAPIDEC® CARBA NP, to detect carbapenemase-producing Pseudomonas aeruginosa. Methods PubMed and ScienceDirect databases were searched. The following data was collected from each included study: research protocol, molecular profile of the tested strains, and sensitivity and specificity of the test used to detect carbapenemase-producing P. aeruginosa. Results Thirty-four studies were included. The most frequently tested strains were metallo-beta-lactamase producers. The pooled sensitivity to detect carbapenemase-producing P. aeruginosa with the original Carba NP test, the Clinical and Laboratory Standards Institute (CLSI) Carba NP test, and the RAPIDEC® CARBA NP was 92%, 95%, and 96%, respectively. The pooled specificity was 99% with the original and the CLSI Carba NP tests, and 92% with the RAPIDEC® CARBA NP. Several studies evaluated modified versions of the Carba NP test to detect carbapenemase-producing P. aeruginosa, with reported sensitivity and specificity exceeding 90% in most cases. Conclusion The Carba NP test allows for fast screening and easy handling as well as optimal performance to detect carbapenemase-producing P. aeruginosa. These findings should be confirmed by further studies including a larger cohort of isolates and various types of carbapenemases, mainly non-metallo-beta-lactamases.

The limited, low-level evidence available on refeeding syndrome (RFS) is likely a result of there being no universally accepted definition of RFS. Cautious feeding is typically recommended to prevent RFS-related adverse outcomes; however, these recommendations are outdated. This systematic review aimed to summarize the RFS literature, describe feeding methods used, and determine whether higher or lower energy rates at commencement of feeding were associated with RFS or RFS-related adverse outcomes. Databases were searched for interventional and observational studies examining feeding and RFS-related adverse events in adult patients. Data extracted included study design, participant descriptions, energy intake, and incidence of RFS-related adverse outcomes. Studies were compared based on assertive (>20 kcal/kg/d) or conservative (≤20 kcal/kg/d) feeding initiation rates. Of 2803 abstracts, 24 studies were included (1 randomized control trial, 23 observational studies). Fifteen studies were classified as assertive. Feeding methods varied greatly, making interpretations difficult. Incidence of hypophosphatemia varied widely and was reported at rates of up to 74% for assertive studies and 72% for conservative studies. Similarly, diagnosed RFS was reported at rates of up to 20% for both types of studies. Time to achieve goal feeding rate appeared to have no influence on incidence of RFS-related adverse outcomes. No consensus was found regarding the best method of feeding, energy initiation, or the time to achieve goal feeding rate that minimizes risk of RFS. There is currently limited evidence to suggest that higher-energy feeding initiation rates have detrimental impacts on those at risk of RFS; however, further research is necessary.

ملخص البحث کتاب تفاعلى فى الإقتصاد المنزلى بتقنية الواقع المعزز لبناء الوعى الوقائى والتمکين من إدارة الذات لمواجهـة تداعيات جائحـة فيروس کورونا المستجد ( (Covied- 19 استهدف البحث الحالى التعرف على فاعلية کتاب تفاعلى بالاقتصاد المنزلى بتقنيه الواقع المعزز فى بناء الوعى الوقائى والتمکين من إدارة الذات لمواجهه تداعيات جائحه فيروس کورونا المستجد ((Covied- 19، تکونت عينة البحث التجريبية من (35) طالبة بالمرحلة الإعدادية ،واستخدم البحث المنهج الوصفى التحليلى و المنهج شبة التجريبى باستخدام المجموعة الواحدة ،واستخدام القياس القبلى و البعدى لذات المجموعة ، واشتملت أدوات القياس على اختبار الوعى الوقائى (المعرفة العلمية ، الإتجاة الإيجابى ، الممارسة الفعالة ) و مقياس إدارة الذات ( إدارة المعرفة الشخصية ، إدارة الضغوط النفسية، إدارة التغيير الإيجابى )، وتمثلت مادة المعالجة التجريبية فى کتاب تفاعلى للإقتصاد المنزلى بتقنية الواقع المعزز تضمن موضوعات دراسية تستهدف مواجهه تداعيات جائحة فيروس کورونا المستجد ، وأوضحت نتائج البحث وجود فرق دال إحصائيا بين متوسطي درجات الطلاب في التطبيق القبلي والبعدي لإختبار الوعى الوقائى لصالح التطبيق البعدي ،ووجودفرق دال إحصائيا بين متوسطي درجات الطلاب في التطبيق القبلي والبعدي لمقياس إدارة الذات لصالح التطبيق البعدي، کما تم التحقق من وجود علاقة إرتباطية موجبة بين درجات الطلاب مجموعة البحث فى التطبيق البعدى لإختبار الوعى الوقائى و مقياس إدارة الذات ، واستنادا لما تم التوصل اليه البحث من نتائج تم التوصية بأن تطلق کل مدرسة "منصة الکترونية " تبث من خلالها التدابير الوقائية لمواجهة جائحه فيروس کورونا المستجد ، وتستهدف بث الطمأنينة والدعم النفسى للطلاب ، وتقديم أنشطة علمية إثرائية بتفاعلات الطلاب لإستثمار أوقاتهم لبناء الوعى الوقائى والتمکين من ادارة الذات لمواجهة تداعيات جائحه فيروس کورونا المستجد . Abstract An interactive Home Economics Book with Augmented Reality Technology to build Preventive Awareness and Empower Self-Management To face the Repercussions of the Emerging Corona Virus (Covied-19) The current research aims to identify the effectiveness of an interactive book on home economics with augmented reality technology in building preventive awareness and empowering self-management to face the repercussions of the emerging corona virus pandemic ((Covied-19), the experimental research sample consisted of (35) middle school students, and the research used the analytical descriptive method. And the semi-experimental approach using one group, and the use of pre and post measurement for the same group. The measurement tools included the preventive awareness test (scientific knowledge, positive attitude, effective practice) and the self-management measure (personal knowledge management, stress management, positive change management), and the experimental treatment material was represented in an interactive home economics book with augmented reality technology that included study topics It aims to confront the repercussions of the emerging corona virus pandemic, and the results of the research showed the existence of a statistically significant difference between the mean scores of the students in the pre and post application of the preventive awareness test in favor of the post application, and the existence of a statistically significant difference between the mean scores of the students in the pre and post application of the self-management scale in favor of the post application, as well as A positive correlation was verified between the students' grades and the research group in the post application of the preventive awareness test and the Self-Management Scale. Based on the results of the research, it was recommended that each school launch an "electronic platform" through which it broadcasts preventive measures to confront the emerging corona virus pandemic, and aims to broadcast reassurance and psychological support to students, and provide enriching scientific activities with student interactions to invest their time to build preventive awareness and empowerment Self-management to face the repercussions of the emerging corona virus pandemic. Key words: interactive book with augmented reality technology, home economics, preventive awareness, self-management, (COVID-19).

While conventional nutrition research has yielded biomarkers such as doubly labeled water for energy metabolism and 24-h urinary nitrogen for protein intake, a critical need exists for additional, equally robust biomarkers that allow for objective assessment of specific food intake and dietary exposure. Recent advances in high-throughput MS combined with improved metabolomics techniques and bioinformatic tools provide new opportunities for dietary biomarker development. In September 2018, the NIH organized a 2-d workshop to engage nutrition and omics researchers and explore the potential of multiomics approaches in nutritional biomarker research. The current Perspective summarizes key gaps and challenges identified, as well as the recommendations from the workshop that could serve as a guide for scientists interested in dietary biomarkers research. Topics addressed included study designs for biomarker development, analytical and bioinformatic considerations, and integration of dietary biomarkers with other omics techniques. Several clear needs were identified, including larger controlled feeding studies, testing a variety of foods and dietary patterns across diverse populations, improved reporting standards to support study replication, more chemical standards covering a broader range of food constituents and human metabolites, standardized approaches for biomarker validation, comprehensive and accessible food composition databases, a common ontology for dietary biomarker literature, and methodologic work on statistical procedures for intake biomarker discovery. Multidisciplinary research teams with appropriate expertise are critical to moving forward the field of dietary biomarkers and producing robust, reproducible biomarkers that can be used in public health and clinical research.

Sesenta y nueve millones de personas tienen una lesión cerebral traumática (TBI) cada año, y la TBI es la causa más común de hemorragia subaracnoidea (HSA). La HAS traumática (TSAH) se ha descrito como un factor pronóstico adverso que conduce a un deterioro neurológico progresivo y a un aumento de la morbilidad y la mortalidad. Sin embargo, un número limitado de estudios evalúa las tendencias recientes en el diagnóstico y manejo de la HSA en el contexto del trauma. El objetivo de esta revisión de alcance fue comprender el alcance y el tipo de evidencia sobre los criterios de diagnóstico y manejo de TSAH. Esta revisión de alcance se realizó siguiendo la metodología del Instituto Joanna Briggs para revisiones de alcance. La revisión incluyó adultos con HSA secundaria a trauma, donde TSAH aislada (iTSAH) se refiere a la presencia de SAH en ausencia de cualquier otra patología intracraneal radiográfica traumática, y TSAH se refiere a la presencia de SAH con la posibilidad o presencia de una lesión radiográfica traumática adicional. patología intracraneal. Los datos extraídos de cada estudio incluyeron el objetivo del estudio, el país, la metodología, las características de la población, las medidas de resultado, un resumen de los hallazgos y las directivas futuras. Treinta estudios cumplieron los criterios de inclusión. Los estudios se agruparon en cinco categorías por tema: TSAH asociado con TBI leve (mTBI), n = 13) y TBI grave (n = 3); manejo clínico y diagnóstico (n = 9); imágenes (n = 3); y TSAH aneurismático (n = 1). De los 30 estudios, dos procedían de un país de ingresos bajos y medios (LMIC), excluyendo China, casi un país de ingresos altos. Los pacientes con TSAH asociado con mTBI tienen un riesgo muy bajo de deterioro clínico e intervención quirúrgica y deben ser tratados de forma conservadora al considerar la admisión en la unidad de cuidados intensivos. Los sistemas de puntuación de tomografía computarizada de Helsinki y Estocolmo, además de la Escala Americana de Lesiones, el nivel de creatinina, el árbol de decisión de la edad, pueden ser herramientas valiosas para predecir el resultado y la muerte. Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low-and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.

Background: Among the various intraocular lens (IOL) power calculation formulas available in clinical settings, which one can yield more accurate results is still inconclusive. We performed a meta-analysis to compare the accuracy of the IOL power calculation formulas used for pediatric cataract patients.Methods: Observational cohort studies published through April 2021 were systematically searched in PubMed, Web of Science, and EMBASE databases. For each included study, the mean differences of the mean prediction error and mean absolute prediction error (APE) were analyzed and compared using the random-effects model.Results: Twelve studies involving 1,647 eyes were enrolled in the meta-analysis, and five formulas were compared: Holladay 1, Holladay 2, Hoffer Q, SRK/T, and SRK II. Holladay 1 exhibited the smallest APE (0.97; 95% confidence interval [CI]: 0.92–1.03). For the patients with an axial length (AL) less than 22 mm, SRK/T showed a significantly smaller APE than SRK II (mean difference [MD]: −0.37; 95% CI: −0.63 to −0.12). For the patients younger than 24 months, SRK/T had a significantly smaller APE than Hoffer Q (MD: −0.28; 95% CI: −0.51 to −0.06). For the patients aged 24–60 months, SRK/T presented a significantly smaller APE than Holladay 2 (MD: −0.60; 95% CI: −0.93 to −0.26).Conclusion: Due to the rapid growth and high variability of pediatric eyes, the formulas for IOL calculation should be considered according to clinical parameters such as age and AL. The evidence obtained supported the accuracy and reliability of SRK/T under certain conditions.Systematic Review Registration: PROSPERO, identifier: INPLASY202190077.

Background Reporting of systematic reviews (SRs) using PRISMA increases transparency and reproducibility; adherence in the dermatology literature has not been assessed. Objectives To assess selected, primarily methodological items from the PRISMA reporting guideline among SRs published in dermatology journals. Methods We reviewed SRs published from 2013 to 2017 in the five highest-impact dermatology journals according to the Science Citation Index. We descriptively assessed reporting of selected PRISMA items, the proportion of PRISMA items fully and partially reported, and whether SRs described using a preregistered protocol. We used univariate and multivariate linear regression to evaluate associations between exposures (year, protocol registration, funding source, type of included study, disease and journal), and outcomes (proportion of PRISMA items fully reported, and fully and partially reported, for each SR). Results We identified 136 SRs. All had more than one inadequately reported PRISMA item. Protocol registration (73%) and risk of bias (38%) were most often unreported. Reporting improved over time in our primary multivariate analysis [fully reported vs. partially and not reported, β = 2·48; 95% confidence interval (CI) 0·73-4·27] and secondary analysis (fully and partially reported vs. not reported, β = 1·28, 95% CI 0·06-2·50). Only 15% (20 of 136) of SRs stated that their protocols were registered; this was associated with PRISMA adherence to the evaluated PRISMA items in our primary multivariate analysis (β = 10·05, 95% CI 2·89-17·2) and secondary analysis (β = 8·87, 95% CI 3·84-13·9). Conclusions SR reporting in dermatology journals is often inadequate but improving over time; protocol registration is associated with better reporting. What's already known about this topic? No studies to date have examined the adherence of dermatology systematic reviews (SRs) to reporting guidelines, such as PRISMA. In other medical fields, reporting is variable with some improvement in adherence to reporting standards over time. What does this study add? Among SRs published in five dermatology journals from 2013 to 2017, all (n = 136) had at least one inadequately reported PRISMA item, while 93% (127 of 136) had at least one fully nonreported item. Reporting improved over time and SRs that stated use of a preregistered protocol were associated with better reporting. Several items remain commonly underreported in dermatology SRs. Authors, reviewers, journal editors and editorial committees should encourage preregistration of SR protocols and improved SR reporting.

Background Preferences for health states for Duchenne muscular dystrophy (DMD) are necessary to assess costs and benefits of novel therapies. Because DMD progression begins in childhood, the impact of DMD on health-related quality-of-life (HRQoL) affects preferences of both DMD patients and their families. The objective of this review was to synthesize published evidence for health state utility from the DMD patient and caregiver perspectives. Methods A systematic review was performed using MEDLINE and Embase, according to best practices. Data were extracted from studies reporting DMD patient or caregiver utilities; these included study and patient characteristics, health states considered, and utility estimates. Quality appraisal of studies was performed. Results From 888 abstracts, eight publications describing five studies were identified. DMD utility estimates were from preference-based measures presented stratified by ambulatory status, ventilation, and age. Patient (or patient–proxy) utility estimates ranged from 0.75 (early ambulatory DMD) to 0.05 (day-and-night ventilation). Caregiver utilities ranged from 0.87 (for caregivers of adults with DMD) to 0.71 (for caregivers of predominantly childhood patients). Both patient and caregiver utilities trended lower with higher disease severity. Variability in utilities was observed based on instrument, respondent type, and country. Utility estimates for health states within non-ambulatory DMD are under reported; nor were utilities for DMD-related health states such as scoliosis or preserved upper limb function identified. Conclusion Published health state utilities document the substantial HRQoL impacts of DMD, particularly with disease progression. Additional research in patient utilities for additional health states, particularly in non-ambulatory DMD patients, is warranted.

We conducted a Cochrane systematic review on the effectiveness of supplemental intravenous crystalloid administration in preventing postoperative nausea and vomiting. We included randomised controlled trials of patients undergoing surgery under general anaesthesia and given supplemental peri-operative intravenous crystalloid. Our primary outcomes were the risk of postoperative nausea and the risk of postoperative vomiting. We assessed the risk of bias for each included study and applied the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework for the certainty of evidence. We included 41 studies. We found that the intervention probably reduces the overall risk of postoperative nausea, the risk ratio (95%CI) being 0.62 (0.51-0.75) (I2 =57%, p&nbsp

OBJECTIVE To investigate the effectiveness of active video games (AVGs) on obesity-related outcomes and physical activity levels in children and adolescents. DESIGN Systematic review with meta-analysis. METHODS Literature search was performed in five electronic databases and the main clinical trials registries. Randomized controlled trials investigating the effect of AVGs compared with no/minimal intervention on obesity-related outcomes (body mass index [BMI], body weight, body fat, and waist circumference) and physical activity levels of children and adolescents were eligible. Two independent reviewers extracted the data of each included study. PEDro scale was used to assess risk of bias and GRADE approach to evaluate overall quality of evidence. Pooled estimates were obtained using random effect models. RESULTS Twelve studies were considered eligible for this review. Included studies mostly reported outcome data at short-term (less or equal than three months) and intermediate-term follow-up (more than 3 months, but

Population viability analysis (PVA) is useful in management of imperiled species. Applications range from research design, threat assessment, and development of management frameworks. Given the importance of PVAs, it is essential that they be rigorous and adhere to widely accepted guidelines; however, the quality of published PVAs is rarely assessed. We evaluated the quality of 160 PVAs of 144 species of birds and mammals published in peer-reviewed journals from 1990 to 2017. We hypothesized that PVA quality would be lower with generic programs than with custom-built programs; be higher for those developed for imperiled species; change over time; and be higher for those published in journals with high impact factors (IFs). Each included study was evaluated based on answers to an evaluation framework containing 32 questions reflecting whether and to what extent the PVA study adhered to published PVA guidelines or contained important PVA components. All measures of PVA quality were generally lower for studies based on generic programs. Conservation status of the species did not affect any measure of PVA quality, but PVAs published in high IF journals were of higher quality. Quality generally declined over time, suggesting the quantitative literacy of PVA practitioners has not increased over time or that PVAs developed by unskilled users are being published in peer-reviewed journals. Only 18.1% of studies were of high quality (score75%), which is troubling because poor-quality PVAs could misinform conservation decisions. We call for increased scrutiny of PVAs by journal editors and reviewers. Our evaluation framework can be used for this purpose. Because poor-quality PVAs continue to be published, we recommend caution while using PVA results in conservation decision making without thoroughly assessing the PVA quality.Una Evaluación Crítica del Análisis de Viabilidad Poblacional Resumen El análisis de viabilidad poblacional (AVP) es útil para el manejo de especies en peligro. La gama de aplicaciones incluye el diseño de la investigación, la valoración de amenazas y el desarrollo de marcos de trabajo para el manejo. Ya que los AVP son de suma importancia, es esencial que sean rigorosos y se adhieran a las directrices aceptadas por la mayoría; sin embargo, rara vez se examina. la calidad de los AVP publicados Evaluamos la calidad de 160 AVP para 144 especies de aves y mamíferos publicados en revistas con revisión por pares desde 1990 hasta 2017. Nuestra hipotesis consistió en que la calidad del AVP sería más baja con programas genéricos que con programas hechos a la medida; sería más alta para los programas desarrollados para especies en peligro; la calidad cambiaría con el tiempo; y la calidad sería más alta para los AVP publicados en revistas con un alto factor de impacto (VI). Cada estudio que incluimos fue evaluado con base en las respuestas a un marco de trabajo de evaluación que contenía 32 preguntas, las cuales reflejaban si y cuánto se adherían los AVP a las directrices publicadas para los AVP o si contenía componentes importantes de AVP. Todas las medidas de la calidad de los AVP fueron generalmente más bajas para los estudios basados en programas genéricos. El estado de conservación de las especies no afectó ninguna de las medidas de la calidad de los AVP, pero aquellos publicados en revistas con un VI alto tuvieron una mayor calidad. La calidad, en general, declinó con el tiempo, lo que sugiere que el alfabetismo cuantitativo de quienes practican los AVP no ha incrementado con el tiempo o que se están publicando AVP desarrollados por usuarios con poca práctica en revistas con revisión por pares. Sólo el 18.1% de los estudios fue de calidad alta (puntaje75%), lo cual es preocupante porque los AVP de baja calidad podrían mal informar las decisiones de conservación. Pedimos un incremento en el escrutinio de los AVP por parte de los editores y revisores. Nuestro marco de trabajo de evaluación puede usarse para este propósito. Ya que todavía se publican AVP con baja calidad, recomendamos que se tomen precauciones cuando se usen los resultados de un AVP en la toma de decisiones de conservación sin evaluar minuciosamente la calidad de dicho estudio.种群生存力分析 (population viability analysis, PVA) 是濒危物种管理的有效工具, 其应用范围包括研究设计、威胁评估及管理框架开发等。鉴于 PVA 分析的重要性, 它们应当确保严谨、遵守普遍接受的准则, 然而, 已发表的 PVA 分析的质量却很少得到评估。本研究评估了 1990 至 2017 年间在同行评议期刊上发表的针对144种鸟类及哺乳动物的 160 项 PVA 分析的质量。我们假设自行设定程序的 PVA 质量应比使用通用程序的更高;针对濒危物种的 PVA 质量更高; PVA 质量随时间变化;发表在高影响因子期刊上的 PVA 质量更高。我们基于包含三十二个问题的评估框架评估了每项纳入分析的研究, 这些问题反映了 PVA 研究是否及在多大程度上遵守了已发布的 PVA 指南或包含了重要的 PVA 组成部分。结果表明, 使用通用程序的研究的 PVA 质量在所有指标上都较低, 物种的濒危情况没有影响 PVA 质量, 而发表在高影响因子的期刊上的 PVA 质量更高。此外, PVA 质量普遍随时间推移而下降, 这表明 PVA 实践者的定量推理能力没有与时俱进, 或是同行评议期刊上发表了非熟练使用者开发的 PVA 研究。我们认为只有 18.1 %的研究属于高质量研究 (评分75%), 这个结果十分令人担忧, 因为低质量的 PVA 分析可能会误导保护决策。因此, 我们呼吁期刊编辑和审稿人加强对 PVA 分析的审查, 而我们的评估框架就可以用于该目的。由于低质量的 PVA 还在持续发表, 我们建议在保护决策中应谨慎使用未经彻底评估质量的 PVA 结果。 【翻译: 胡怡思; 审校: 聂永刚】.

In response to global interest in the development of a universal influenza vaccine, the Bill & Melinda Gates Foundation, PATH, and the Global Funders Consortium for Universal Influenza Vaccine Development convened a meeting of experts (London, UK, May 2018) to assess the role of a standardized controlled human influenza virus infection model (CHIVIM) towards the development of novel influenza vaccine candidates. This report (in two parts) summarizes those discussions and offers consensus recommendations. Part 1 covers challenge virus selection, regulatory and ethical considerations, and issues concerning standardization, access, and capacity. This article (Part 2) summarizes the discussion and recommendations concerning CHIVIM methods. The panelists identified an overall need for increased standardization of CHIVIM trials, in order to produce comparable results that can support universal vaccine licensure. Areas of discussion included study participant selection and screening, route of exposure and dose, devices for administering challenge, rescue therapy, protection of participants and institutions, clinical outcome measures, and other considerations. The panelists agreed upon specific recommendations to improve the standardization and usefulness of the model for vaccine development. Experts agreed that a research network of institutions working with a standardized CHIVIM could contribute important data to support more rapid development and licensure of novel vaccines capable of providing long-lasting protection against seasonal and pandemic influenza strains.

Objectives: Total hip arthroplasty (THA) is highly successful but national registries indicate that average age has lowered and that younger patients are at higher risk of revision. Long-term follow-up of THA was historically recommended to identify aseptically failing THA, minimising the risks associated with extensive changes, but follow-up services are now in decline. A systematic review was conducted to search for evidence of the clinical or cost-effectiveness of hip arthroplasty surveillance. Methods: The study was registered with PROSPERO International Prospective Register of Systematic Reviews and conducted according to PRISMA guidelines; databases included MEDLINE and Embase, and all studies were quality assessed. Original studies (2005 to 2017) reporting follow-up of adults with THA in situ >5 years were included. Researchers extracted quantitative and qualitative data from each study. Results: For eligibility, 4,137 studies were screened: 114 studies were included in the final analysis, representing 22 countries worldwide. Data extracted included study endpoint, patient detail, loss to follow-up, revisions, scores and radiographic analysis. Six themes were derived from inductive content analysis of text: support for long-term follow-up, subgroups requiring follow-up, effect of materials/techniques on THA survival, effect of design, indicators for revision, review process. Main findings-follow-up was specifically recommended to monitor change (eg asymptomatic loosening), when outcomes of joint construct are unknown, and for specific patient subgroups. Outcome scores alone are not enough, and radiographic review should be included. Conclusion: There were no studies directly evaluating the clinical effectiveness of the long-term follow-up of THA but expert opinions from a range of international authors advocated its use for defined subgroups to provide patient-centred care. In the absence of higher level evidence, these opinions, in conjunction with emerging outputs from the national joint registries, should be used to inform services for long-term follow-up of THA.

Purpose To determine the effect of knee flexion angle during graft fixation on outcomes and complications following medial patellofemoral ligament (MPFL) reconstruction. Methods Three databases (PubMed, EMBASE, and MEDLINE) were searched from database inception to January 2018. After screening based on inclusion and exclusion criteria, patient demographics, fixation technique, graft selection, outcomes, and complications were extracted from the included studies. The studies were grouped based on flexion angle used during graft fixation: low (0°-30°) and high (45°-90°) flexion angle group. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. Descriptive statistics are presented. Results Seventeen studies (of 3,399) were included and were either cohort (n = 1) or case series (n = 17) study designs. A total of 556 patients with a mean age of 23.6 years (range, 10-60 years) underwent MPFL reconstructions, with 458 patients in the 0° to 30° fixation group and 98 in the 45° to 90° fixation group. The mean Kujala score improved from 45 to 72.9 (365 patients) preoperatively to 83 to 94.5 (460 patients) postoperatively for the 0° to 30° fixation group and from 53.3 to 72 preoperatively to 92.2 to 95.2 postoperatively for the 45° to 90° fixation group (98 patients). Conclusions The knee flexion angle during MPFL graft fixation ranges from 20° to 90°. Graft fixation at low and high knee flexion angles during MPFL reconstruction showed excellent patient-reported outcomes and low patellar redislocation rates overall, with no clear differences between the 2 groups based on the currently available data. Level of Evidence Level IV, systematic review of Level III-IV studies.

Fetal growth has been demonstrated to be an important predictor of perinatal and postnatal health. Although the effects of maternal exposure to air pollution during pregnancy on fetal growth have been investigated using ultrasound in many previous studies, the results were inconsistent and disputable. We aimed to qualitatively and quantitatively investigate the associations of air pollution exposure during different periods of pregnancy with fetal growth and anthropometric measurements at birth. We searched for all studies investigating the associations of air pollution exposure during pregnancy with fetal growth and birth anthropometric measurements in English and Chinese databases published before July 31, 2017. A random-effects model was employed in the meta-analysis to estimate the pooled effects of each 10 μg/m3 increment in air pollutant exposure. The ACROBAT-NRSI tool was applied to assess the quality of each included study, and the GRADE tool was employed to assess the overall quality of the meta-analysis. Maternal PM2.5 exposure (10 μg/m3) during the entire pregnancy was negatively associated with head circumference at birth (β = − 0.30 cm, 95% CI − 0.49, − 0.10), and NO2 exposure during the entire pregnancy was significantly linked to shorter length at birth (β = − 0.03 cm, 95% CI − 0.05, − 0.02). Maternal exposure to higher NO2 and PM2.5 during pregnancy may impair neonatal head circumference and length development, respectively. More studies are needed to confirm the effects of NO2 and PM2.5 and to identify the sources and major toxic components of PMs.

Background RCTs in surgery are challenging owing to well established methodological issues. Well designed pilot and feasibility studies (PFS) may help overcome such issues to inform successful main trial design and conduct. This study aimed to analyse protocols of UK-funded studies to explore current use of PFS in surgery and identify areas for practice improvement. Methods PFS of surgical interventions funded by UK National Institute for Health Research programmes from 2005 to 2015 were identified, and original study protocols and associated publications sourced. Data extracted included study design characteristics, reasons for performing the work including perceived uncertainties around conducting a definitive main trial, and whether the studies had been published. Results Thirty-five surgical studies were identified, of which 29 were randomized, and over half (15 of 29) included additional methodological components (such as qualitative work examining recruitment, and participant surveys studying current interventions). Most studies focused on uncertainties around recruitment (32 of 35), with far fewer tackling uncertainties specific to surgery, such as intervention stability, implementation or delivery (10 of 35). Only half (19 of 35) had made their results available publicly, to date. Conclusion The full potential of pretrial work to inform and optimize definitive surgical studies is not being realized.

Background Intranasal corticosteroid (INCS) sprays are indicated for use in the treatment of seasonal and perennial allergic rhinitis and include aqueous and nonaqueous formulations. Secondary symptoms of rhinitis include postnasal drip, facial pain/pressure, headache, cough, and ear fullness. The effectiveness of INCS on these specific symptoms, as well as the comparative effectiveness of aqueous and nonaqueous formulations, is poorly defined. Objective To evaluate the effectiveness of aqueous versus nonaqueous INCS formulations on less common sinonasal symptoms. Methods A systematic review was conducted of English-language, randomized controlled trials, with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard. Studies that did not provide quantitative data on relief of postnasal drip, facial pain/pressure, headache, cough, and ear fullness were excluded. An itemized assessment of the risk of bias was conducted for each included study. Results Of the 118 studies identified, 9 met the criteria for qualitative analysis. An effect on postnasal drip was reported in 5 studies, facial pain/pressure in 2 studies, and cough in 2 studies. A reduction in a specific symptom was reported in about half of these studies, with heterogenous outcome measures. Only 1 study reported the effect of a nonaqueous formulation on a specific symptom. No studies reported an effect on aural fullness. Conclusions Limited data are available regarding the effectiveness of aqueous or nonaqueous INCS on secondary symptoms in adult patients with rhinitis. Further study is needed using homogenous outcome measures and direct comparison of INCS formulations.

Women living with HIV (WLWH) face unique barriers and require specialized, integrated care that focuses on women's specific needs. We conducted a scoping review to examine factors important for a women-centred HIV care (WCHC) approach. We included published peer-reviewed articles which featured WCHC services as their central focus; included study populations of girls and WLWH aged 14 years of age or older; and contributed to the understanding of WCHC for WLWH. Seven databases were reviewed and yielded 15,332 references, of which 21 fit our inclusion criteria for the scoping review. Research findings were categorized into characteristics of the study, recommendations, and target audiences. Findings revealed WCHC as care which includes the involvement of WLWH in decisions; person-centred integrated care; integrated services including mental health; sexual and reproductive health services; trauma-informed and safe space practices; healthcare provider training; and women's care self-management. In general, current systems of care do not meet the unique needs of WLWH.

Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by nondermatophyte molds and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blind, controlled trials for US Food and Drug Administration approval. The primary efficacy measure is complete cure (complete mycologic and clinical cure). The secondary measures are clinical cure (usually ≤10% involvement of target nail) and mycologic cure (negative microscopy and culture). Some lasers are US Food and Drug Administration approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis. Methods: A systematic review of the literature was performed in July of 2020 to evaluate the efficacy rates demonstrated by randomized controlled trials of laser monotherapy for dermatophyte onychomycosis of the great toenail. Results: Randomized controlled trials assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates by means of nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycologic cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were 13.0%–16.7% and 25.9%, respectively. There was no study that reported the complete cure rate; however, one did report treatment success (mycologic cure [negative microscopy and culture] and ≤10% clinical involvement) in nails as 16.7%. Conclusions: The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycologic, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver, and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed.

We present an updated overview of the literature comparing normothermic with hypothermic machine perfusion in porcine kidneys. We conducted a systematic literature review in Embase, Medline Epub (Ovid), Cochrane Central, Web of Science, and Google Scholar on studies comparing normothermic (NMP) to hypothermic machine perfusion (HMP) in porcine kidneys. A meta‐analysis was judged inappropriate because of heterogeneity in study design and perfusion methods. The quality of evidence of each included study was assessed. We included 8 studies. One out of 5 studies reported a significant difference in peak renal blood flow in favor of NMP. Oxygen consumption was significantly higher in NMP kidneys in 2 out of 5 studies. Peak creatinine clearance in NMP was significantly higher than that in HMP in 1 out of 6 studies. Two out of 4 studies reported a higher degree of epithelial vacuolation in kidneys receiving NMP over HMP. None of the studies found a significant difference between NMP and HMP in peak serum creatinine or graft survival after autotransplantation. The results need to be interpreted with caution in view of the diversity in perfusion protocols, the low quality of evidence, and the limited sample sizes.

Background An assessment of the validity of individual diagnostic accuracy studies in systematic reviews is necessary to guide the analysis and the interpretation of results. Such an assessment is performed for each included study and typically reported at the study level. As studies may differ in sample size and disease prevalence, with larger studies contributing more to the meta-analysis, such a study-level report does not always reflect the risk of bias in the total body of evidence. We aimed to develop improved methods of presenting the risk of bias in the available evidence on diagnostic accuracy of medical tests in systematic reviews, reflecting the relative contribution of the study to the body of evidence in the review. Methods We applied alternative methods to represent evaluations with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), weighting studies according to their relative contribution to the total sample size or their relative effective sample size. We used these methods in four existing systematic reviews of diagnostic accuracy studies, including 9, 13, 22, and 32 studies, respectively. Results The risk-of-bias summaries for each domain of the QUADAS-2 checklist changed in all four sets of studies after replacing unit weights for the studies with relative sample sizes or with the relative effective sample size. As an example, the risk of bias was high in the patient selection domain in 31% of the studies in one review, unclear in 23% and low in 46% of studies. Weighting studies according to the relative sample size changed the corresponding proportions to 4%, 4%, and 92%, respectively. The difference between the two weighting methods was small and more noticeable when the reviews included a smaller number of studies with wider range of sample size. Conclusions We present an alternative way of presenting the results of risk-of-bias assessments in systematic reviews of diagnostic accuracy studies. Weighting studies according to their relative sample size or their relative effective sample size can be used as more informative summaries of the risk of bias in the total body of available evidence. Systematic review registrations Not applicable

Emotional disorders are those that most commonly present comorbidly with medical conditions. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral emotion-based intervention, has proven efficacy and versatility. The aim of this systematic review is to know the current (research studies) and future research interest (study protocols) in using the UP for the transdiagnostic treatment of emotional symptoms or disorders (EDs) in people with a medical condition. Using the PRISMA guidelines, a literature search was conducted in Web of Science, PubMed, Medline, and Dialnet. The nine research studies included in this review indicated that the UP is effective in treating emotional symptomatology in a population with a medical condition (effect sizes ranging from d = −3.34 to d = 2.16). The three included study protocols suggest interest in the future UP application to different medical conditions, and also in distinct application formats. Our review results are encouraging, and conducting more controlled studies is advised to recommend the UP to treat and/or prevent EDs in medical conditions, especially in children and youths.

Background In traumatic bleeding, transfusion practice has shifted toward higher doses of platelets and plasma transfusion. The aim of this systematic review was to investigate whether a higher platelet‐to‐red blood cell (RBC) transfusion ratio improves mortality without worsening organ failure when compared with a lower ratio of platelet‐to‐RBC. Methods Pubmed, Medline, and Embase were screened for randomized controlled trials (RCTs) in bleeding trauma patients (age ≥16 years) receiving platelet transfusion between 1946 until October 2020. High platelet:RBC ratio was defined as being the highest ratio within an included study. Primary outcome was 24 hour mortality. Secondary outcomes were 30‐day mortality, thromboembolic events, organ failure, and correction of coagulopathy. Results In total five RCTs (n = 1757 patients) were included. A high platelet:RBC compared with a low platelet:RBC ratio significantly improved 24 hour mortality (odds ratio [OR] 0.69 [0.53–0.89]) and 30‐ day mortality (OR 0.78 [0.63–0.98]). There was no difference between platelet:RBC ratio groups in thromboembolic events and organ failure. Correction of coagulopathy was reported in five studies, in which platelet dose had no impact on trauma‐induced coagulopathy. Conclusions In traumatic bleeding, a high platelet:RBC improves mortality as compared to low platelet:RBC ratio. The high platelet:RBC ratio does not influence thromboembolic or organ failure event rates.

Objective: Reproducibility of systemic reviews (SRs) can be hindered by the presence of citation bias. Citation bias may occur when authors of SRs conduct hand-searches of included study reference lists to identify additional studies. Such a practice may lead to exaggerated SR summary effects. The purpose of this paper is to examine the prevalence of hand-searching reference lists in otolaryngology SRs.Methods: The authors searched for systematic reviews published in eight clinical otolaryngology journals using the Cochrane Library and PubMed, with the date parameter of January 1, 2008, to December 31, 2017. Two independent authors worked separately to extract data from each SR for the following elements: whether reference lists were hand-searched, other kinds of supplemental searching, PRISMA adherence, and funding source. Following extraction, the investigators met to review discrepancies and achieve consensus.Results: A total of 539 systemic reviews, 502 from clinical journals and 37 from the Cochrane library, were identified. Of those SRs, 72.4% (390/539) hand-searched reference lists, including 97.3% (36/37) of Cochrane reviews. For 228 (58.5%) of the SRs that hand-searched reference lists, no other supplemental search (e.g., search of trial registries) was conducted.Conclusions: These findings indicate that hand-searching reference lists is a common practice in otolaryngology SRs. Moreover, a majority of studies at risk of citation bias did not attempt to mitigate the bias by conducting additional supplemental searches. The implication is that summary effects in otolaryngology systematic reviews may be biased toward statistically significant findings.

Cancer treatments are expected to improve the quality of life of the patients. Thus the comparison of the quality of life before and after treatment is important to be present. Several dimensions are used in measuring the quality of life, i.e., global quality of life, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning. We applied meta-analysis to identify the comparison based on the included study material from Google Scholar. The duration in measuring the quality of life after treatment is at least two months. The treatments included in this study are chemotherapy, radiotherapy, and surgery. There are 12 suitable study materials from 1150 available articles. The models used are a random-effects model since there exists heterogeneity between studies for all variables. In general, the quality of life of patients after treatment has increased, which is indicated by the negative mean difference estimation for all variables. However, the improvement of the quality of life in the dimensions of role functioning and cognitive functioning is not significant. Meanwhile, in the other four dimensions, the improvement was significant. Thus, cancer treatments are able to improve the patient's quality of life in the long term.

Background: Angle class II malocclusion is clinically complex and common malocclusion type, which affects beauty. Conventional treatment has the disadvantages of long course of treatment, high cost, easy recurrence and limited curative effect. Clinical practice shows that micro-implant anchorage has certain advantages in the treatment of Angle II malocclusion, but lacks the evidence of evidence-based medicine. This study systematically evaluates the efficacy and safety of micro-implant anchorage in the treatment of Angle class II malocclusion. Methods: A systematic search was performed by retrieving on English databases (PubMed, Embase, Web of Science, and the Cochrane Library) and Chinese databases (CNKI, Wanfang, Weipu [VIP], CBM). Besides, manually search for Google and Baidu academic of micro-implant anchorage in the treatment of Angle class II malocclusion in randomized controlled clinical research. The retrieval time limit was from the establishment of the database to September 2020. Two researchers independently extracted and evaluated the quality of the data in the included study. A meta-analysis was performed using RevMan5.3 software. Results: In this study, the efficacy and safety of micro-implant anchorage against Angle class II malocclusion were evaluated by SNA, BNA, ANB, NLA°, Adverse reaction. Conclusions: This study will provide reliable evidence-based evidence for the clinical application of micro-implant anchorage in the treatment of Angle class II malocclusion. Ethics and dissemination: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF Registration number: DOI 10.17605/OSF.IO/UPBR8.

Objective Our primary objective was to identify the prevalence of spin — misleading reporting practices that overemphasize benefit or underemphasize harm — within the abstracts of systematic reviews and meta-analyses focused on surgical management of osteoarthritis of the knee. Methods A search string was developed to search Ovid MEDLINE and Ovid Embase for articles pertaining to surgical management, or quality of life after surgical management, of osteoarthritis of the knee. Titles and abstracts were screened according to our protocol, developed a priori, followed by full-text evaluation for spin in included articles. Study characteristics were simultaneously extracted with spin data and each included study received an AMSTAR-2 quality appraisal. All procedures were performed by two examiners in a masked, duplicate fashion. Results Of the 1419 articles returned, 96 systematic reviews qualified for inclusion. 35.4% of the included abstracts (34/96) contained at least one type of spin with a total of 36 occurrences (two abstracts contained two types of spin). Selective reporting favoring benefit (type 3; 15/36, 41.7%) was the most prevalent followed by selective reporting of harms (type 6; 7/36, 19.4%). None of the abstracts contained spin types 2, 4, or 8. We found no significant association between spin and either AMSTAR-2 rating or extracted study characteristics. Conclusion Of the included systematic reviews and meta-analyses, 35.4% contained spin in their abstract. To improve the reliability of systematic reviews and meta-analyses, researchers should act to minimize spin in future abstracts.

Magdalenian communities exploited mostly local and regional good-quality lithic raw materials. In south-eastern Poland, being the easternmost fringe of the Magdalenian range, Turonian grey flint had a particular importance. Outcrops of this raw material occur both at the west and at the east sides the Vistula River Gorge. The varieties from the eastern area (called here “eastern Turonian flint” or ETF) are common among inventories of the Magdalenian sites situated to west of the Vistula river. This fact points toward the frequent penetration of the ETF outcrop area by those societies. However, no Magdalenian sites were known directly from the ETF deposit area, and this gap in knowledge restricted further understanding of the character and diversity of Magdalenian activity there. Therefore, in this paper, we present the results of searching for Magdalenian sites within the ETF outcrop zone. Applied methodology included study of the archive archaeological materials, followed by detail survey and excavation of the selected site—Stare Baraki 1. This site documents a short stay or multiple stays of Magdalenian people, who were focused on Turonian flint knapping. Lithic inventory records collecting of several local flint varieties at the distance up to around 20 km from the site, followed by almost all stages of flint working. The material from Stare Baraki is the first known and currently the only trace of the Magdalenian people inside the zone of Turonian flint deposits on the right bank of the Vistula river. The study in Stare Baraki delivered new data for the reconstruction of territory exploitation strategies used in the easternmost Magdalenian.

Objective: To evaluate the evidence surrounding the association between lateral ankle sprain (LAS) history and subsequent LAS risk, as well as sex-differences in the observed associations. Data Sources: PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles reporting LAS injury history and injury incidence during a study period. Study Selection: Studies were included if they were prospective in nature, reported the number of participants with and without a history of LAS at study initiation, and reported the number of participants from each group that sustained a LAS during the study period. Data Extraction: Data included study design parameters as well as the number of participants with and without a LAS history, and the number of subsequent LAS that occurred to both groups. Risk ratios (RR) with 95% confidence intervals (CI) compared the risk of LAS within the study period between those with and without a LAS history for each included investigation. Data Synthesis: Nineteen studies with a total of 6,567 patients were included. Follow-up periods ranged from 14 weeks to 2 years. Quality assessment scores indicate moderate to high quality studies were included. A significantly higher risk of LAS within the study period was observed among those with a history of LAS in 10 out of 15 studies (RR range=1.29–6.06). Similar associations were seen in four out of six studies that included an all-male sample (RR Range=1.38–8.65), and one out of four studies with an all-female sample (RR=4.28). Conclusion: There is strong evidence to support that a previous LAS increases the risk of a subsequent LAS injury. Males but not females with a history of a LAS appear to be at a higher risk of sustaining a subsequent LAS but further data are needed to draw definitive conclusions based on the limited number of sex specific studies.

Background: Spin – the misrepresentation of a study’s results – has been identified in abstracts of studies focused on a variety of disorders from multiple fields of medicine. Objectives: This study’s primary objective was to evaluate the abstracts of systematic reviews and meta-analyses focused on the treatment of atopic dermatitis for the nine most severe forms of spin. Methods: We systematically searched Embase and MEDLINE for systematic reviews of atopic dermatitis therapies. Screening and data extraction occurred in a masked, duplicate fashion. Each included study was evaluated for the nine most severe types of spin and other study characteristics. Results: Our searches retrieved 2,456 studies, of which 113 were included for data extraction. Spin was found in 74.3% of our included studies (84/113). Spin type 6 occurred most frequently (68/113, 60.2%). Spin types 1, 2, and 9 were not identified. All industry-funded systematic reviews contained spin in their abstract. The presence of spin was not associated with any specific study characteristics, including the methodological quality of the study. Conclusions: Severe forms of spin were found in the majority of abstracts for systematic reviews of atopic dermatitis treatments. Steps should be taken to prevent spin to improve the quality of reporting in abstracts.

Background Systematic reviews often require substantial resources, partially due to the large number of records identified during searching. Although artificial intelligence may not be ready to fully replace human reviewers, it may accelerate and reduce the screening burden. Using DistillerSR (May 2020 release), we evaluated the performance of the prioritization simulation tool to determine the reduction in screening burden and time savings. Methods Using a true recall @ 95%, response sets from 10 completed systematic reviews were used to evaluate: (i) the reduction of screening burden; (ii) the accuracy of the prioritization algorithm; and (iii) the hours saved when a modified screening approach was implemented. To account for variation in the simulations, and to introduce randomness (through shuffling the references), 10 simulations were run for each review. Means, standard deviations, medians and interquartile ranges (IQR) are presented. Results Among the 10 systematic reviews, using true recall @ 95% there was a median reduction in screening burden of 47.1% (IQR: 37.5 to 58.0%). A median of 41.2% (IQR: 33.4 to 46.9%) of the excluded records needed to be screened to achieve true recall @ 95%. The median title/abstract screening hours saved using a modified screening approach at a true recall @ 95% was 29.8 h (IQR: 28.1 to 74.7 h). This was increased to a median of 36 h (IQR: 32.2 to 79.7 h) when considering the time saved not retrieving and screening full texts of the remaining 5% of records not yet identified as included at title/abstract. Among the 100 simulations (10 simulations per review), none of these 5% of records were a final included study in the systematic review. The reduction in screening burden to achieve true recall @ 95% compared to @ 100% resulted in a reduced screening burden median of 40.6% (IQR: 38.3 to 54.2%). Conclusions The prioritization tool in DistillerSR can reduce screening burden. A modified or stop screening approach once a true recall @ 95% is achieved appears to be a valid method for rapid reviews, and perhaps systematic reviews. This needs to be further evaluated in prospective reviews using the estimated recall.

Objectives For a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof. Methods PubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA. Results 16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5–58.3%), bicompartmental 33% (23.1–37.2%) and tricompartmental only 17% (8.8–24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2–31.1%), 18% (9.9–22.7%) and 23% (14.1–27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5–18.7%). Conclusion Three-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used. Trial registration number PROSPERO systematic review protocol (CRD42019140345). Keywords GonarthrosisUnicompartmentalBicompartmentalPrevalenceEpidemiology

Background Traditionally, clinical studies rely on brick-and-mortar sites to recruit participants. Newer technology-based studies have utilized non-traditional virtual methods that can potentially recruit more diverse populations and shorten recruitment timelines. This manuscript aims to quantify how sample metrics across three virtual studies compare to traditionally recruited samples, as a first step in building an empirical evidence base for the experience of participant recruitment in virtual studies. Methods We conducted a systematic search of the literature using PubMed to identify relevant studies conducted in the United States in cognitive health, diabetes, and hypertension (which we called comparator studies) to compare to three virtual studies. For each included study, we extracted participant demographic characteristics and information on recruitment methods and timing. Two investigators independently extracted this data, compared results for consistency, and contacted comparator study authors for clarifications. Characteristics for measurement included age, sex, race/ethnicity, states represented, recruitment time, and recruitment rate. Results We identified 19 comparator studies. Virtually recruited samples were slightly younger, had more female participants, and were split on enrollment of racial minorities as compared to comparator studies. Virtually recruited samples were more diverse geographically and recruited faster. Conclusions Virtual recruitment may enhance efficiency and enable more individuals to participate in clinical research. To our knowledge, this is the first rigorous and replicable study comparing participant demographic characteristics and recruitment metrics between virtual and traditional recruitment methodologies. Future research should compare a wider range of studies on other metrics such as overall cost of recruitment and quality of participants.

Objective To evaluate opioid prescribing, dispensing, and use in relation to hydrocodone-containing product (HCP) rescheduling. Methods Seven biomedical databases and grey literature sources were searched with keywords and database-specific controlled vocabulary relevant to HCP rescheduling for items published between January 2014 and July 2019. We included English-language quasi-experimental studies that assessed changes in HCP and other opioid prescribing, dispensing, utilization, and opioid-related health outcomes before and after HCP rescheduling. A data extraction sheet was created for this review. Two authors evaluated risk of bias for each included study. Two of 4 authors each independently extracted patient demographics and opioid-related outcomes from the included studies. Conflicts were resolved by a third author. Results All studies identified (n = 44) were quasi-experimental in design with 10 using an interrupted time series approach. A total of 24 studies reported a decrease in HCP prescribing by 3.1%-66.0%. Six studies reported a decrease in HCP days’ supply or doses by 14.0%-80.8%. There was increased prescribing of oxycodone-containing products by 4.5%-13.9% in 5 studies, tramadol by 2.7%-53.0% in 9 studies, codeine-containing products by 0.8%-1352.9% in 8 studies). Five studies reported a decrease in morphine equivalents by at least 10%, whereas 2 studies reported an increase in morphine equivalents. Differences in populations, sample sizes, and approaches did not allow for a meta-analysis. Details regarding approach and findings were limited in published conference abstracts (n = 16). Conclusions Hydrocodone rescheduling was associated with reductions in prescribing and use of HCPs but was also associated with increased prescribing and use of other opioids, both schedule II and nonschedule II.