Critical Tool Research Articles

The modified DECAF score: A critical tool in copd patient assessment

The modified DECAF score: A critical tool in copd patient assessment

Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis.

The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68%), pyrexia (n=122,120, 13.56%), and fatigue (n=121,910, 13.54%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns.

The prevalence of gambling and problematic gambling: a systematic review and meta-analysis

Gambling behaviours have become of increased public health interest, but data on prevalence remain scarce. In this study, we aimed to estimate for adults and adolescents the prevalence of any gambling activity, the prevalence of engaging in specific gambling activities, the prevalence of any risk gambling and problematic gambling, and the prevalence of any risk and problematic gambling by gambling activity. We performed a systematic review and meta-analysis. We systematically searched for peer-reviewed literature (on MEDLINE, Embase, and PsycInfo) and grey literature to identify papers published between Jan 1, 2010, and March 4, 2024. We searched for any gambling, including engagement with individual gambling activities, and problematic gambling data among adults and adolescents. We included papers that reported the prevalence or proportion of a gambling outcome of interest. We excluded papers of non-original data or based on a biased sample. Data were extracted into a bespoke Microsoft Access database, with the Joanna Briggs Institute Critical Appraisal Tool used to identify the risk of bias for each sample. Representative population survey estimates were firstly meta-analysed into country-level prevalence estimates, using metaprop, of any gambling, any risk gambling, problematic gambling, and by gambling activity. Secondly, population-weighted regional-level and global estimates were generated for any gambling, any risk gambling, problematic gambling, and specific gambling activity. This review is registered on PROSPERO (CRD42021251835). We screened 3692 reports, with 380 representative unique samples, in 68 countries and territories. Overall, the included samples consisted of slightly more men or male individuals, with a mean age of 29·72 years, and most samples identified were from high-income countries. Of these samples, 366 were included in the meta-analysis. Globally, 46·2% (95% CI 41·7-50·8) of adults and 17·9% (14·8-21·2) of adolescents had gambled in the past 12 months. Rates of gambling were higher among men (49·1%; 45·5-52·6) than women (37·4%; 32·0-42·5). Among adults, 8·7% (6·6-11·3) were classified as engaging in any risk gambling, and 1·41% (1·06-1·84) were engaging in problematic gambling. Among adults, rates of problematic gambling were greatest among online casino or slots gambling (15·8%; 10·7-21·6). There were few data reported on any risk and problematic gambling among adolescent samples. Existing evidence suggests that gambling is prevalent globally, that a substantial proportion of the population engage in problematic gambling, and that rates of problematic gambling are greatest among those gambling on online formats. Given the growth of the online gambling industry and the association between gambling and a range of public health harms, governments need to give greater attention to the strict regulation and monitoring of gambling globally. Australian National Health and Medical Research Council.

Digital education about delirium for health care professional students: a mixed methods systematic review

BackgroundCompetence in delirium care begins with pre-registration education for health care professionals. Although a common complication for hospitalised patients, delirium is avoidable and reversible. Delirium requires early recognition in person-centred care. Students need to learn how to identify and effectively care for ‘at risk’ patients.AimTo identify and examine literature on how pre-registration health care professional students are prepared to recognise, assess, and deliver interventions to prevent delirium in practice, using digital/web based educational interventions.MethodMixed methods systematic review with narrative synthesis. A protocol was registered with PROSPERO. The review questions and search strategy were guided by the Population, Phenomena of Interest, Context (PICo) framework. The PRISMA framework guided the screening, data extraction and analysis. Database searches (MEDLINE, Web of Science, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO & Scopus) were undertaken in April 2023 for publications from 2012 to 2023. Covidence software [30] was used to extract and manage the data. Quality appraisal was guided by the Crowe Critical Appraisal Tool (CCAT) [31].FindingsTen papers were included: mixed methods (2), qualitative (1) and quantitative (7). Medical students were the most studied group (n = 5), followed by student nurses (n = 4) and mixed nursing and medical students (n = 1). Length of learning experience varied from 12 min virtual reality (VR) to a two-week ‘geriatrics’ elective. Learning was enhanced by player autonomy, engagement, safety, applicability, choices, multiple perspectives and moral reasoning opportunities.DiscussionDigital programmes should be visually appealing, interactive with opportunities for practice and timely appropriate feedback.

Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana.

To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair. This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years. A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was -5.0 (1-tailed 95% confidence interval, -10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years. Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana.

A sum of its parts: A systematic review evaluating biopsychosocial and behavioral determinants of perinatal depression.

Depression is one of the most common yet underdiagnosed perinatal complications and our understanding of its pathophysiology remains limited. Though perinatal depression is considered to have a multifactorial etiology, integrative approaches to investigation are minimal. This review takes an integrative approach to systematically evaluate determinants (e.g., biological, behavioral, environmental, social) and interactions among determinants of perinatal depression and the quality of methods applied. Four databases (i.e., PubMed, CINAHL, APA PsycInfo, Web of Science) were systematically searched to identify studies examining determinants of perinatal depression in adult perinatal persons (≥ 18 years). Articles were excluded if the outcomes were not focused on perinatal persons and depression or depression symptoms, depression was examined in a specific subpopulation evidenced to have psychological consequences due to situational stressors (e.g., fetal/infant loss, neonatal intensive care unit admission), or was considered grey literature. The Critical Appraisal Skills Programme and AXIS tools were used to guide and standardize quality appraisal assessments and determine the level of risk of bias. Of the 454 articles identified, 25 articles were included for final review. A total of 14 categories of determinants were investigated: biological (5), behavioral (4), social and environmental (5). Though only 32% of studies simultaneously considered determinants under more than one domain, a pattern of interactions with the tryptophan pathway emerged. Concerns for risk of bias were noted or were unclear for three types of bias: 13 (52%) selection bias, 3 (12%) recall bias, and 24 (96%) measurement bias. Future research is needed to explore interactions among determinants and the tryptophan pathway; to strengthen the methods applied to this area of inquiry; and to generate evidence for best practices in reporting, selecting, and applying methods for measuring determinants and perinatal depression.

Shared decision-making in the management of pulmonary nodules: a systematic review of quantitative and qualitative studies

ObjectiveThe objective of this systematic review was to explore the evidence regarding shared decision-making (SDM) in the management of pulmonary nodules.DesignSystematic review of quantitative and qualitative studies.Data sourceStudies published in...

Is it premature to formulate recommendations for policy and practice, based on culture and health research? A robust critique of the CultureForHealth (2022) report.

Arts and health practice and research has expanded rapidly since the turn of the millennium. A World Health Organization scoping review of a large body of evidence claims positive health benefits from arts participation and makes recommendations for policy and implementation of arts for health initiatives. A more recent scoping review (CultureForHealth) also claims that current evidence is sufficient to form recommendations for policy and practice. However, scoping reviews of arts and health research-without critical appraisal of included studies-do not provide a sound basis for recommendations on the wider implantation of healthcare interventions. We performed a detailed assessment of 18 Randomised Controlled Trials (RCTs) on arts-based interventions included in Section 1 of the CultureForHealth report using the Joanna Briggs Institute Critical Appraisal Tool for RCTs (2023). The 18 RCTs included demonstrated considerable risks of bias regarding internal and statistical conclusion validity. Moreover, the trials are substantially heterogeneous with respect to settings, health-issues, interventions, and outcomes, which limits their external validity, reliability, and generalisability. The absence of a critical appraisal of studies included in the CultureForHealth report leads to an overinterpretation and overstatement of the health outcomes of arts-based interventions. As such, the CultureForHealth review is not a suitable foundation for policy recommendations, nor for formulating guidance on implementation of arts-based interventions for health.

Functional ultrasound imaging and neuronal activity: how accurate is the spatiotemporal match?

Over the last decade, functional ultrasound (fUS) has risen as a critical tool in functional neuroimaging, leveraging hemodynamic changes to infer neural activity indirectly. Recent studies have established a strong correlation between neural spike rates (SR) and functional ultrasound signals. However, understanding their spatial distribution and variability across different brain areas is required to thoroughly interpret fUS signals. In this regard, we conducted simultaneous fUS imaging and Neuropixels recordings during stimulus-evoked activity in awake mice within three regions the visual pathway. Our findings indicate that the temporal dynamics of fUS and SR signals are linearly correlated, though the correlation coefficients vary among visual regions. Conversely, the spatial correlation between the two signals remains consistent across all regions with a spread of approximately 300 micrometers. Finally, we introduce a model that integrates the spatial and temporal components of the fUS signal, allowing for a more accurate interpretation of fUS images.

Dental students' Myers-Briggs Type Indicator personality profile in the past 50 years: Systematic review and meta-analysis.

Dental students' personalities are strongly correlated with their didactic and clinical performances. With the significant changes in the social environment in the past decades, students' personalities may also change dramatically. Additionally, with the increasing number of international students admitted into US dental programs, educators must pay attention to the potential personality differences between domestic and international students. A systematic review focusing on the Myers-Briggs Type Indicator personality types of dental students was conducted with 11 literature databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The quality assessment of each included article was conducted following the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analyses were conducted for each personality type within the United States in the past 50 years, and in each country in the past 20 years. Eighteen articles (17 reports) were included after the eligibility assessment. The longitudinal trends within the United States showed the predominant two personality types have changed from Extraversion, Sensing, Feeling, and Judging (ESFJ) and Extraversion, Sensing, Thinking, and Judging (ESTJ) to ESTJ and Introversion, Sensing, Thinking, and Judging (ISTJ) during the past 50 years. When comparing different countries, the United States, China, Korea, and Iran have the same two dominant personality types (ESTJ and ISTJ) but not the Philippines (Extraversion, Intuition, Feeling, and Perceiving and Introversion, Intuition, Feeling, and Perceiving). However, there are large variations in the prevalence of other personality types. There have been constant changes in the predominant personalities of dental students over the years. Additionally, understanding the diversity of personality types within the United States as well as among different countries could serve as the foundation for further improvements in teaching strategies and student support services.

Factors in the Effective Use of Hearing Aids among Subjects with Age-Related Hearing Loss: A Systematic Review.

Objectives: Investigate factors contributing to the effective management of age-related hearing loss (ARHL) rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022374811). Articles were identified through systematic searches in the Scopus, PubMed, Web of Science, and Cochrane databases in May 2024. Only articles published between January 2005 and May 2024 were included. Studies were assessed for eligibility by two independent researchers and evaluated using the Crowe Critical Appraisal Tool v1.4 (CCAT). Results: Of the 278 articles identified, 54 were included. Three factors explain effective HA use. First, hearing aid signal processing, with directional microphones and noise reduction, improves user comfort and understanding regarding noise. Second, there is hearing aid fitting, with the NAL prescription rules as the gold standard, and bilateral, high-level HA performance for spatial localization and noise comprehension. Third, there is a patient-centered approach, using patient-related outcome measures (PROMs), questionnaires, counseling, and regular follow-up to involve patients in their therapeutic rehabilitation. Conclusions: Reaching a consensus on acoustic parameters is challenging due to variability in audiological results. Involving patients in their rehabilitation, addressing their needs and expectations, and offering individualized care are crucial.

Atmospheric alchemy: The energy and cost dynamics of direct air carbon capture

Abstract Amid a relentless global climate crisis, the 28th Conference of the Parties (COP28) spotlighted Direct Air Carbon Capture (DACC) as a key intervention to mitigate escalating temperatures and CO2 levels. The Intergovernmental Panel on Climate Change (IPCC) underscores the urgency of this challenge, stipulating the need for robust CO2 removal strategies. It sets a daunting yet crucial target: capture 85 million metric tons of CO2 by 2030, escalating to 980 million metric tons by 2050, to achieve net-zero emissions (IEA, Executive Summary—Direct Air Capture 2022—Analysis. https://www.iea.org/reports/direct-air-capture-2022/executive-summary). Despite this imperative, the existing 19 operational DAC facilities globally face significant barriers, including prohibitive costs and stringent regulations, which impede their large-scale application (Ozkan et al.). Current status and pillars of direct air capture technologies. Iscience (2022). While COP28 stopped short of delineating a definitive roadmap for DAC, this article addresses a vital aspect of this technology: DAC processes’ substantial energy and heat requirements, which are integral to their operational efficiency and economic viability. This article illuminates pathways for future technological evolution and cost optimization through an in-depth analysis of these requirements, thereby charting a course toward a more effective and scalable DAC infrastructure. Graphical abstract Highlights With atmospheric CO2 exceeding 420 ppm, the clock is ticking on the climate crisis. DAC offers a revolutionary approach to directly remove this excess CO2, acting as a critical tool in our fight for a sustainable future. However, current DAC systems face the challenge of high energy consumption. Continuous fan operation for air intake and sorbent material regeneration, consuming nearly 2000–3000 kWh per ton of CO2 captured, are major contributors. Optimizing these processes is crucial. Advancements in sorbent efficiency, system design that minimizes parasitic energy losses, and seamless integration with renewable energy sources are key to slashing DAC’s energy demands. By reducing its carbon footprint and enhancing economic viability, these advancements can unlock the full potential of DAC to become a game-changer in combating climate change and securing a cleaner future for our planet. Discussion Given the significant energy and heat requirements of DACC processes, what technological innovations are necessary to make these systems more energy efficient and economically viable? Considering the substantial energy demands of DACC processes, what are the most promising avenues for reducing these requirements to enhance the technology's scalability and cost-effectiveness? How can current technological limitations be overcome to scale up DACC effectively? What role could renewable energy sources play in meeting the energy and heat demands of DACC facilities, and how might this integration impact the overall carbon footprint of the carbon capture process? How do the energy and heat requirements of DACC technologies influence their location and infrastructure needs, particularly in relation to energy sources and heat sinks? What technological innovations or advancements are currently being explored to optimize the energy and heat efficiency of DACC processes, and what challenges do they face in terms of implementation and scaling? Given the significant role of DACC in achieving net-zero emissions targets, how can policy and regulatory frameworks be designed to support the development and deployment of energy-efficient DACC solutions?

Rapid, easy, sensitive, low‐cost and on‐site detection of environmental DNA and RNA using CRISPR‐Cas13

Abstract Environmental DNA (eDNA) monitoring of species distribution has become a critical tool in ecology, conservation biology and fisheries for identifying the presence and distribution of diverse organisms, including important, threatened and invasive species. However, eDNA detection still has room for improvement in sensitivity, requiring time‐consuming real‐time polymerase chain reaction (qPCR) steps and costly machines. In this study, we report a CRISPR‐Cas13‐based method for rapid, easy, sensitive, low‐cost and on‐site detection of eDNA. The assay for the detection of common carp (Cyprinus carpio) and medaka (Oryzias latipes) nucleic acid employs a two‐step process, starting with recombinase polymerase amplification (RPA) and followed by cleavage using Cas13 nuclease, to effectively identify mitochondrial DNA or RNA. Our results showed that the Cas13‐based method has a higher sensitivity than the qPCR‐based method in detecting tiny amounts of eDNA. When combined with reverse transcription of environmental RNA (eRNA), our method increased detection sensitivity by approximately one order of magnitude. Cas13‐based detection could achieve on‐site detection of eDNA using a quick nucleic acid extraction solution and lateral flow strips. Cas13‐based detection of eDNA and eRNA requires minimal training efforts and can be performed in 1 h, without the need for centrifugation and qPCR machines. The portability of the Cas13‐based method, along with its accuracy and relative ease in designing primers and CRISPR RNA (crRNA), underscores its potential to broaden the application of eDNA and eRNA in various fields, including biodiversity conservation.

The Oldest Past of Christianity

Abstract The article argues that just as religion is manufactured or invented, so is tradition and history. This starting point is worked out with reference to history as a discursive construction, the past as fictioned in the present. The past does not exist independently of historical practice. History is a tool for ideological persuasion and ideological criticism in the chaotic, disputed and contested present. This understanding of historiography is brought to bear on the scholarly discourse on Christian origins, highlighting the performativity or mythic character of conventional reconstructions of the historical Jesus and the formation of early Christianity, in which sacred apologetic texts are employed as ethnographic sources. What is called for is to take leave of the “stance of the faithful,” and to reorient the study of the history of Christian origins away from a “protectionist doxa” towards a critical historiography that understands early Christian history as invented or manufactured.

Sexual life experiences after myocardial infarction: A systematic review and synthesis of qualitative studies.

This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of individuals who have experienced myocardial infarction. A thorough literature review was conducted between November and December 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. This article includes 12 studies published in English since 2000 that have examined the sexual experiences of individuals who have experienced myocardial infarction. This research adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We utilized the Critical Appraisal Skills Programme tool for qualitative research to evaluate the quality of all the papers included. To synthesize the data, the deductive and interpretation technique according to Sandelowski and Barroso's approach has been used. The sexual experiences of individuals who have experienced myocardial infarction were summarized under four main themes: changes in sexual life, barriers to engaging in sexual ıntercourse, an unmet need: ınformation, and sexuality as a part of routine care. Patients' expectations from counseling services regarding sexuality after MI are oriented towards these services providing more comprehensive information and incorporating multidisciplinary approaches. This demand clearly indicates the complex and multidimensional changes in sexual life after MI and underscores the necessity for healthcare professionals to play a more active role in this area. PROSPERO CRD42023483112.

Computational Simulation of Monopile Scour under Tidal Flow Considering Suspended Energy Dissipation

Local scour around bridge foundations significantly impacts the stability and safety of marine structures. The development of scour holes adjacent to the pile foundations of sea-crossing bridges, influenced by tidal currents, involves multidimensional physical fields, multiscale coupling, and complex variations in marine loads. However, experimental models alone are inadequate for investigating the underlying mechanisms. Numerical simulation, a critical tool for studying local scour processes, faces the challenge of accurately modeling sediment transport, particularly under tidal flow conditions near pile foundations. To solve this challenge, this research considers the effect of reciprocating flow on sediment shear as well as its characteristic dissipation based on the immersed boundary method, introduces a reciprocating flow dissipation mechanism, and adds a momentum exchange term between the fluid and the sediment to derive a new controlling equation; a new tidal flow localized scour solver is ultimately constructed, termed TidalflowFOAM. The solver effectively simulates complex flow conditions under tidal currents, extending the modeling capabilities to more realistic three-dimensional bridge scour scenarios under combined wave and current conditions. Validation through cases reported in the literature and a series of controlled experiments, encompassing varying depths, flow velocities, and pile diameters, demonstrates the solver’s proficiency in capturing post-vortex data and accurately reflecting the influence of key factors on scour depth. However, the fidelity of the simulated scour hole morphology under tidal flow conditions behind the piles requires enhancement. The proposed numerical model for tidal flow conditions has high solution accuracy and can guide practical engineering applications.

Quantitative detection and survival analysis of VBNC Salmonella Typhimurium in flour using droplet digital PCR and DNA-intercalating dyes.

Salmonella, a major foodborne pathogen, poses significant risks, particularly to vulnerable groups like infants, older people, and the immunocompromised. Accurate detection is vital for public health and food safety, given its potential to cause severe and life-threatening symptoms. Our study demonstrated digital polymerase chain reaction (ddPCR) with DNA-intercalating dyes for identifying the different physiological statuses of Salmonella. Also, the application of ddPCR with DNA-intercalating dyes offers quantification of viable cells post-disinfection as an alternative method in food. Utilizing ddPCR and DNA-intercalating dyes, we enhanced the detection of VBNC Salmonella, a form often undetectable by conventional methods. This innovative approach could significantly improve the precision and efficiency of detection for viable Salmonella. By providing deeper insights into its transmission potential, our method is a critical tool in preventing outbreaks and ensuring the safety of food products. This research contributes substantially to global efforts in controlling foodborne illnesses and safeguarding public health.

Reliability of predictive models based on the mesiodistal and buccolingual diameters of permanent canine teeth for sex estimation in forensic contexts: A systematic review and meta-analysis

This study aimed to assess the reliability of predictive models for sex estimation based on permanent canine size. A systematic literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Six electronic databases were searched as the primary source of information. As a secondary source of information, a manual search was performed to identify additional relevant studies not captured in the initial search. After assessing the methodological quality and risk of bias with the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews, the data were subjected to statistical tests for a meta-analysis of diagnostic test accuracy and Higgin’s I2 statistic to evaluate the heterogeneity between the eligible studies. The systematic search resulted in 21 studies for qualitative synthesis, and 13 of them were selected for quantitative analysis. The analysis of 25 univariate predictive models showed an estimated sensitivity of 77.2 % and specificity of 67.1 %. Meta-regression analyses were performed for dental arch, the type of diameter and dental region outcomes for these univariate predictive models. Dental arch (p = 0.029) and the dental region of measurement (p = 0.001) were significant modifiers. The analysis of 25 multivariate predictive models showed an estimated sensitivity of 82.6 % and specificity of 70.1 %. There were significant methodological limitations and substantial heterogeneity among the included studies. Based on the results, there is insufficient high-quality scientific evidence to support the safe use of predictive models based on permanent canine measurements as the exclusive method for sex estimation in forensic settings.

Seroprevalence of human brucellosis in Turkey: A comprehensive meta-analysis.

Brucellosis remains a common zoonotic disease, in developing countries, as well as in Turkey where it is endemic, underdiagnosed, and underreported. The aim of this meta-analysis was to provide a comprehensive estimate of seroprevalence with a large sample size, covering all regions of Turkey, including both grey literature and published studies. A systematic search was performed in MEDLINE (via PubMed), TürkMedline (National Health Sciences-Periodicals Database), and YÖKSİS database (Higher Education Council Information System) until May 5th, 2023. The quality of the studies was evaluated independently using Joanna Briggs Institute (JBI) critical assessment tool for prevalence studies. A random-effects model (DerSimion and Laird) was utilized to estimate the overall pooled prevalence. A sensitivity analysis was performed, excluding studies with a high risk of bias. The subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Egger test and funnel plot were used to assess publication bias. The meta-analysis included 30 studies in total published between 1999 and 2021 with 51,560 individuals. In Turkey, the pooled seroprevalence of human brucellosis was estimated to be 4.5% (95% confidence interval [CI]: 3.8%-5.3%). According to the subgroup analysis, a higher seroprevalence was found in rural areas (8.0%, 95% CI: 5.4%-10.7%), high-risk occupational groups (9.9%, 95% CI: 5.3%-14.6%), and the Central East Anatolia Region (13%, 95% CI: 3.2%-22.8%). The meta-regression analysis identified living in rural areas and certain geographic regions as significant risk factors associated with higher seroprevalence. This meta-analysis revealed a significant burden of human brucellosis in Turkey. The findings highlight the need for public health measures and targeted interventions to reduce the burden of this zoonotic disease, especially in rural areas, high-risk occupational groups, and the East Anatolia Region.

(Relative) size matters: a content analysis of front-of-packaging cue proportions and hierarchies

PurposeFront-of-packaging (FOP) is a critical branding tool that uses “cues” to communicate product attributes and establish distinct brand images. This paper aims to understand how food brands utilize cues and their relative proportions to hierarchically communicate brand image and belonging to particular subcategories.Design/methodology/approachA content analysis is used for analysing 543 food FOPs sold in Australia (breakfast cereals, chips, snack bars). Samples are collected and classified into product sub-categories defined by ingredients, consumer-audience and retail placement. A novel 10 × 10 coding grid is applied to each FOP to objectively analyse cue proportion, with statistical comparison undertaken between sub-categories.FindingsResults reveal intrinsic cues are favoured over extrinsic cues, except for those in the eatertainment sub-category. Hierarchies are evidenced that treat product and branding cues as primary, with health cues secondary. Statistically significant differences in cue proportions are consistently evident across breakfast cereals, chips and snack-bar FOPs. Clear differentiation is evidenced through cue proportions on FOP for health/nutrition focused sub-categories and eatertainment foods.Originality/value“Cue utilization theory” research is extended to an evaluation of brand encoding (not consumer decoding). Design conventions reveal how cue proportions establish a dialogue of communicating brand/product image hierarchically, the trade-offs that occur, a “meso-level” to Gestalt theory, and achieving categorization through FOP cue proportions. Deeper understanding of packaging design techniques provides inter-disciplinary insights that extend consumer behaviour, retailing and design scholarship.