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In order to investigate the effect of concurrent phoning and auditory environmental monitoring, the performance of visually impaired people was observed on a dual task that consisted of two simulation tasks. Subjects wore either a bone conducting headset, or closed or open (air conduction) earphones. Reaction times and the correctness of responses on both tasks were studied. Contrary to our expectations, correct responding on the simulated environmental monitoring task was severely delayed (irrespective of earphone). In contrast, responding on the cellphone simulation task was as fast under dual as under single task conditions. This research suggests that regardless of the type of earphone used, blind or visually impaired people should be warned against use of a cellphone when they have to simultaneously monitor the environment and respond quickly to it. By showing that concurrency of two auditory tasks may impede performance, this research extends on previous research that showed interference of conversing on visual tasks. (Contains 4 figures and 2 notes.)

GRADE ("Grading of Recommendations Assessment, Development and Evaluation") provides a transparent framework to evaluate scientific evidence and to develop healthcare recommendations. The GRADE method has been further developed, its application has been significantly broadened and over 100 organizations have endorsed GRADE. In this article, we give an overview of the most important methodological developments and discuss the basic principles. The transparent approach to make it easier for users of evidence to assess the judgments behind recommendations is not only applicable to the EBM domains but also to other disciplines. The methods developments show that GRADE is still evolving, and is constantly being further developed based on the latest methodological insights and users perspective. GRADE is not an instrument to determine the "true" certainty of the evidence. The value of applying GRADE is that judgments about the quality of evidence and the considerations behind recommendations are structured, transparent and explicit.

Clinicians, patients, policy makers, funders, programme managers, regulators, and science communities invest considerable amounts of time and energy in influencing or making decisions at various levels, using systematic reviews, health technology assessments, guideline recommendations, coverage decisions, selection of essential medicines and diagnostics, quality assurance and improvement schemes, and policy and evidence briefs. The criteria and methods that these actors use in their work differ (eg, the role economic analysis has in decision making), but these methods frequently overlap and exist together. Under the aegis of WHO, we have brought together representatives of different areas to reconcile how the evidence that influences decisions is used across multiple health system decision levels. We describe the overlap and differences in decision-making criteria between different actors in the health sector to provide bridging opportunities through a unifying broad framework that we call theory of everything. Although decision-making activities respond to system needs, processes are often poorly coordinated, both globally and on a country level. A decision made in isolation from other decisions on the same topic could cause misleading, unnecessary, or conflicted inputs to the health system and, therefore, confusion and resource waste., Competing Interests: Declaration of interests HJS is cochair of the GRADE Working Group and reports honoraria from WHO. MF reports support from HTAnalyze Consultoria e Treinamento outside the submitted work. EP and LN are employed by the European Commission. All other authors declared no competing interests., (Copyright © 2022 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)