Meta-analysis Model Research Articles

Behavioral Intentions in Sports Tourism: Meta-Analysis and Structural Equation Modeling

This paper addresses fragmentation in sports tourism research, specifically concerning factors influencing behavioral intentions, focusing on key psychological and situational variables. Through a meta-analysis of 18 studies comprising 14,495 observations, drawn from an initial screening of 967 articles listed in the Scopus database, this study investigates the effects of perceived behavioral control, subjective norms, nostalgia, satisfaction, percieved benefit, and percieved risk, on behavioral intentions among general sport tourists. Two distinct theoretical frameworks were examined to uncover the core drivers of intentions. In the first framework, the analysis revealed that perceived behavioral control (effect size = .58), subjective norms (effect size = .50), and nostalgia (effect size = .43) have a stronger influence on behavioral intentions than attitude or image. This finding suggests that the participatory and socially embedded nature of sport tourism amplifies the impact of practical and social factors. Nostalgia emerged as a particularly strong emotional motivator, as it fosters attachment to past sport experiences and enhances future engagement. Among the components of the Theory of Planned Behavior, perceived behavioral control highlights the significance of practical considerations, such as ease of access and affordability, in shaping tourists’ intentions. The second framework underscored satisfaction as the most influential predictor of behavioral intentions (effect size = .77), consistent with Expectancy-Disconfirmation Theory, where experiences that meet or exceed expectations lead to future engagement. Perceived benefit (effect size = 0.50) also played a significant role, indicating that anticipated rewards, such as enjoyment and social connections, positively affect decision-making. In contrast, perceived risk (effect size = -0.25) showed a negative effect on behavioral intentions, in line with Prospect Theory, which emphasizes how potential losses deter engagement, particularly in unfamiliar or high-risk settings. These findings have practical implications for sport tourism management. Enhancing nostalgia, facilitating easy access, and fostering social connections can significantly boost behavioral intentions. Additionally, strategies that prioritize high-quality experiences to maximize satisfaction, while emphasizing perceived benefits and minimizing perceived risks through transparent safety measures, can further encourage positive engagement. Future research should explore specific conditions, such as familiar destinations, group dynamics, and satisfaction-driven contexts, that might enhance the influence of these key factors.

Relationships between emotional labor, job burnout, and emotional intelligence: an analysis combining meta-analysis and structural equation modeling

AbstractThe present study adopted a meta-analysis design that incorporated structural equation modeling to explore the relationships between emotional labor (EL), job burnout (JB), and emotional intelligence (EI), and enable model validation. The results revealed that EL and JB were significantly and positively correlated, that EI was significantly and positively correlated with EL, and that EI was significantly and negatively correlated with JB. The SEM parameter estimation values were all positive, reaching the level of significance and meeting the basic fit criteria. The total effect size of EL on JB was 0.289, which was equal to the sum of the direct and indirect effect sizes (0.371–0.082). This result indicated that EL affected JB through EI, validating the presence of a moderating effect. Finally, the results were discussed, and practical suggestions were proposed.

Innovative multi-trial breeding and genotype screening in triticale (x Triticosecale Wittmack) for enhanced stability under drought stress.

Triticale is a man-made crop produced by crossing wheat (Triticum aestivum) and rye (Secal cereal) with the aim of increasing the adaptability and potential production of its parental line (wheat) under environmental stresses and harsh conditions. Accordingly, the objectives of this study are as follow, a: compare different stability measurement methods regarding their suitability, b: identify most stable genotypes for cultivar release, and c: provide a freely available package in R programming language (named 'Stbidx') capable of exploiting all stability methods for similar studies. Accordingly, 30 triticale genotypes were evaluated for their stability and adaptability to changing environments during four consecutive years from 2016 to 2020 in different locations in Iran (one year in Zarghan, two years in Ghorveh, one year in Sanandaj) and under two different irrigation regimes (normal irrigation and water deficit stress conditions). All 30 triticale genotypes were cultivated in a randomized complete block design (RCBD) with three replications in each environment (12 environments: 6 trials in 2 conditions). Grain yield of triticale genotypes was measured and it applied to calculate all known stability indices (univariate methods) along with the meta-analysis models were evaluated in this study. Additionally, two novel techniques (Stability ID: SID and AMMI PC Value: APCV) were introduced and successfully tested for screening stable genotypes. These methods were introduced to improve and resolve the limitation of the previous stability methods. Meanwhile, heatmap analysis, as a proper data-mining technique, has been successfully applied for the first time to find stable genotypes in different environments in this study. The results clearly indicated a higher suitability of our introduced methods over previous multi-trials screening methods. Based on our methods and considering all environments, triticale genotypes ELTTCL21 (SID = 8.00; APCV = 28.12), ELTTCL25‌ (SID = 8.14; APCV = 30.02), ELTTCL30 (SID = 8.43; APCV = 17.00), ET-90-8 (SID = 14.00; APCV = 42.05), and Sanabad (SID = 10.57; APCV = 12.44) were among stable genotypes and they can be nominated as new cultivars. Additionally, for stress condition genotypes ELTTCL30 (stress: 380.6g/m2) and ELTTCL18 (stress: 360.79g/m2) and for normal condition genotypes ET-90-4 (normal: 849.4g/m2) and ELTTCL20 (normal:845g/m2) were respectively the most proper genotypes with the highest production to be considered for each condition separately.

Academic Cheating, Achievement Orientations, and Culture Values: A Meta-Analysis

This preregistered meta-analysis investigated whether cultural values moderate the relations between students’ achievement orientations and their tendency to cheat. We identified 80 studies on the associations between performance/learning orientations and academic cheating in 27 countries with 40,867 participants. Performance orientation positively correlates with academic cheating ( r = .09, 95% CI = 0.04 to 0.13), and learning orientation negatively correlates with academic cheating ( r = −.16, 95% CI = −0.20 to –0.13). Univariate meta-analysis, hierarchical meta-regression, and meta-analytic structural equation modeling (MASEM) revealed that cultural values at the country level significantly moderate the relations between achievement orientations and cheating. These findings suggested that cultural values play a significant role in influencing the relations between achievement orientations and academic cheating, and, thus, cheating prevention programs must consider culture to achieve optimal effects. Based on these findings, we propose a new model that integrates cultural values into the existing model of academic cheating decision-making.

Envisioning doctoral education as research hubs in Latin America (2011–2021): waves of evolution

ABSTRACT This study analyses 70 scholarly articles on doctoral education in Latin America from 2011 to 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. The research identifies key trends, themes, and defining characteristics within the literature. We propose a three-wave evolution model for doctoral education in Latin America based on the findings. The results show the consolidation of doctoral education in several countries, the ‘second wave’, with themes such as quality assurance policy, program development, learning, curriculum, and advising. The study also highlights the emergence of research hubs as a ‘third wave’, in which doctoral programs attract individuals from different backgrounds and locations who mobilise knowledge and ideas within and across regions. Our three-wave model of evolution for doctoral education offers a way to articulate research and policy around doctoral education in Latin America, a critical step towards significant research hubs and pertinent programs.

Prevalence of Undernutrition and Its Contributing Factors Among Cancer Patients in Africa - A Systematic Review and Meta-Analysis of Observational Studies.

Cancer poses a significant burden in Africa, where limited resources and infrastructure compound the challenges of managing the disease. Undernutrition, a critical concern among cancer patients, can profoundly affect treatment outcomes and overall prognosis. Despite its importance, the prevalence of undernutrition among African cancer patients remains poorly understood. Five major databases were searched for observational studies that reported the prevalence of undernutrition, from inception till February 2024. Study selection, data extraction, and quality assessment were conducted by at least two independent reviewers. The NIH criteria for observational studies were used for quality assessment. A random-effects meta-analysis model was used to estimate the overall undernutrition prevalence, with subgroup analyses conducted based on country and population characteristics. Twenty-four studies involving 4,283 participants met the inclusion criteria, most studies included children (41%), followed by adults (37%), and women (19%). The overall undernutrition prevalence among African cancer patients was estimated at 32.8% (95% CI, 25.1%, 41.67%) with substantial heterogeneity observed (I² = 95.4%, P < 0.0001). Subgroup analyses revealed significant variations in prevalence across countries and population groups. Undernutrition is a serious issue among African cancer patients and requires an urgent response with targeted interventions. Tailored nutritional support strategies, considering demographic and regional contexts, are essential for improving patient outcomes.

HPB SO43 - Meta-analysis of completion pancreatectomy for local recurrence of pancreatic cancer after the index pancreatectomy

Abstract Background Poor prognosis post-resection of pancreatic cancer is owed to a high rates of cancer recurrence (approximately 80%) despite complete surgical resection being achieved. The role of surgical re-resection in patients with recurrent pancreatic cancer is unclear. Several studies have reported survival benefit of repeat pancreatectomy for selected patients with local recurrence in the remnant pancreas after the index pancreatectomy. We aimed to conduct a comprehensive systematic review and meta-analysis of best available evidence to evaluate survival outcomes of completion pancreatectomy for locally recurrent pancreatic cancer following index pancreatectomy. Method A systematic search of electronic data sources and bibliographic reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data. Results Fifteen retrospective studies were included reporting a total of 250 patients who underwent completion pancreatectomy for locally recurrent pancreatic cancer following their index pancreatectomy. Completion pancreatectomy was associated with 1-year survival of 70.6% (95% CI 65.0%-76.2%), 2-year survival of 38.8% (95% CI 28.6%-49.0%), 3-year survival of 20.2% (95% CI 13.8%-26.7%), and 5-year survival of 9.2% (95% CI 5.5%-12.8%). The between-study heterogeneity was insignificant in all outcome syntheses. Conclusion Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favourable tumour size and location. Our findings may encourage conduction of better-quality studies in this context to provide stronger evidence.

Characterisation and calibration of multiversal methods

AbstractMultiverse Analysis is a heuristic for robust multiple models estimation where data fit many connected specifications of the same abstract model, instead of a singular or a small selection of specifications. Differently from the canonical application of multimodels, in Multiverse Analysis the probabilities of the specifications to be included in the analysis are never assumed independent of each other. Grounded in this consideration, this study provides a compact statistical characterisation of the process of elicitation of the specifications in Multiverse Analysis and conceptually adjacent methods, connecting previous insights from meta-analytical Statistics, model averaging, Network Theory, Information Theory, and Causal Inference. The calibration of the multiversal estimates is treated with references to the adoption of Bayesian Model Averaging vs. alternatives. In the applications, it is checked the theory that Bayesian Model Averaging reduces both error and uncertainty for well-specified multiversal models but amplifies errors when a collider variable is included in the multiversal model. In well-specified models, alternatives do not perform better than Uniform weighting of the estimates, so the adoption of a gold standard remains ambiguous. Normative implications for misinterpretation of Multiverse Analysis and future directions of research are discussed.

Abstract 4145889: Association between Pulmonary Artery Elastance and all cause mortality in patients with Heart Failure: A Meta-Analysis

Background: Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patients Methods: A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis. Results: Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 - 1.19, p &lt; 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders. Conclusion: This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.

A Meta-Analytic Structural Equation Modelling (MASEM) Approach Toward Scrutinizing the Influence of Brand Equity Antecedents on Brand Advocacy

Brand equity antecedents are essential in the creation and development of brand advocacy strategies and implementation tactics that transform conventional customers into active brand advocates. Yet, the association incorporating these two concepts is less studied. This research aims to bridge such a gap by combining these two approaches to explore the most influential antecedents of brand equity for incentivizing brand advocacy within technological platforms. The proposed model was assessed using Meta-Analytic Structural Equation Modeling (MASEM). The study featured 68 empirical studies with 183 correlations derived from 15 hypothetical ‎relationships and a combined sample of 24,585 respondents. The findings authenticate the significance of all the relationships among BE antecedents proposed in this study. Moreover, the findings reveal that brand awareness can be linked with brand advocacy via the intervention and mediating role of brand image. Additionally, the outcomes of the study highlight that brand image has a greater overall influence than brand loyalty on brand advocacy.

Meta-analytic structural equation modeling for exploring workplace friendship, well-being, and organizational commitment.

Workplace friendships, which are informal relationships in the workplace, foster mutual trust, assistance, and emotional support and create a sense of belonging among coworkers. Employees with positive perceptions of their job responsibilities, psychological needs, and work environment experience happiness, satisfaction, and an overall sense of well-being. A heightened sense of well-being in the workplace positively affects employee satisfaction with job tasks and the work environment, reinforcing employees' sense of belonging and organizational commitment. The study proposed and validated a theoretical model, with meta-analytic structural equation modeling employed to conduct quantitative, empirical research on workplace friendships, well-being, and organizational commitment in Taiwan and to analyze correlations between relevant variables. The theoretical model was further validated through structural equation modeling, which yielded favorable goodness of fit in terms of various indicators. The mediating effect of well-being was verified through bootstrapping analysis. Within a 95% confidence interval, the total effect size of workplace friendships on organizational commitment was 0.549, which is the sum of its direct effect (0.255) and indirect effect (0.294). This finding indicates that well-being plays a mediating role in the association between workplace friendships and organizational commitment. The proposed theoretical model in this study is supported. Finally, the research results are discussed, and practical suggestions are provided.

Determinants of preterm prelabor rupture of fetal membrane among pregnant women in Ethiopia: A systematic review and meta-analysis.

Ethiopia is one of the countries where persistently high neonatal and maternal mortalities are reported. Preterm prelabor rupture of membrane (PPROM) plays an important contribution to these high mortalities. However, there is a paucity of comprehensive evidence about the epidemiology of PPROM in Ethiopia. Therefore, this systematic review was conducted to assess the pooled prevalence and determinants of PPROM among pregnant women in Ethiopia. A systematic review and meta-analysis were conducted following the PRISMA guideline. Relevant literatures were searched on African Journals Online (AJOL), PubMed, Scopus, Epistemonikos, CINAHL, Cochrane Library and gray literature. All statistical analyses were performed using STATA 17 software. The random effect meta-analysis model was employed to summarize the pooled estimates. Heterogeneity between included studies was evaluated using I2 statistic. Egger's regression test and Begg's correlation test were employed to assess publication bias, in conjunction with funnel plot. Besides, the non-parametric trim-and-fill analysis, sensitivity analysis, subgroup analysis and meta-regression were also performed. A total of 13 original studies with 24,386 participants were considered in this systematic review. The pooled prevalence of PPROM was 6.58% (95% CI: 5.36, 7.79). Urinary tract infection (OR: 3.44; 95% CI: 1.81, 6.53), abnormal vaginal discharge (OR: 4.78; 95% CI: 2.85, 8.01), vaginal bleeding (OR: 2.04; 95% CI: 1.03, 4.06), history of PROM (OR: 4.64; 95% CI: 2.71, 7.95), history of abortion (OR: 3.06; 95% CI: 1.71, 5.46), malnutrition (OR: 5.24; 95% CI: 2.63, 10.44), anemia (OR: 3.97; 95% CI: 2.01, 7.85) and gestational diabetes (OR: 5.08; 95% CI: 1.93, 13.36) were significantly associated with PPROM. This meta-analysis found a high prevalence of PPROM in Ethiopia. Urinary tract infection, abnormal vaginal discharge, vaginal bleeding, history of PROM, history of abortion, malnutrition, anemia and gestational diabetes were risk factors for PPROM. Prevention and control of antenatal infections and malnutrition are highly recommended to reduce the magnitude of PPROM in Ethiopia. Additionally, healthcare providers should emphasize the identified risk factors. CRD42024536647.

Generalized Fused Lasso for Treatment Pooling in Network Meta-Analysis.

This work develops a generalized fused lasso (GFL) approach to fitting contrast-based network meta-analysis (NMA) models. The GFL method penalizes all pairwise differences between treatment effects, resulting in the pooling of treatments that are not sufficiently different. This approach offers an intriguing avenue for potentially mitigating biases in treatment rankings and reducing sparsity in networks. To fit contrast-based NMA models within the GFL framework, we formulate the models as generalized least squares problems, where the precision matrix depends on the standard error in the data, the estimated between-study heterogeneity and the correlation between contrasts in multi-arm studies. By utilizing a Cholesky decomposition of the precision matrix, we linearly transform the data vector and design matrix to frame NMA within the GFL framework. We demonstrate how to construct the GFL penalty such that every pairwise difference is penalized similarly. The model is straightforward to implement in R via the "genlasso" package, and runs instantaneously, contrary to other regularization approaches that are Bayesian. A two-step GFL-NMA approach is recommended to obtain measures of uncertainty associated with the (pooled) relative treatment effects. Two simulation studies confirm the GFL approach's ability to pool treatments that have the same (or similar) effects while also revealing when incorrect pooling may occur, and its potential benefits against alternative methods. The novel GFL-NMA method is successfully applied to a real-world dataset on diabetes where the standard NMA model was not favored compared to the best-fitting GFL-NMA model with AICc selection of the tuning parameter ( .

Impact of allulose on blood glucose in type 2 diabetes: A meta-analysis of clinical trials

ObjectiveThis meta-analysis aims to evaluate the impact of allulose on blood glucose levels in patients with type 2 diabetes mellitus (T2DM). Primary outcomes include postprandial blood glucose, while secondary outcomes are time in range (TIR), time above range (TAR), fasting plasma glucose (FPG), and insulin area under the curve (AUC). MethodsA systematic search was conducted across PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library until May 20, 2024. Randomized controlled trials assessing the effect of allulose on glycemic parameters in T2DM patients were included. Data were synthesized using a random-effects meta-analysis model, and the quality of studies was assessed using the Cochrane Risk of Bias tool. ResultsSix studies involving 126 participants were included. Allulose significantly reduced glucose AUC (SMD: −0.6662, 95 % CI [-1.1360, −0.1964], p = 0.0054) with moderate heterogeneity (I2 = 58.3 %). Insulin AUC showed a non-significant reduction (SMD: −0.3648, 95 % CI [-0.7783, 0.0488], p = 0.0839). FPG demonstrated a non-significant reduction (MD: −5.8925, 95 % CI [-20.4892, 8.7043], p = 0.4288), while TAR significantly decreased (MD: −8.8204, 95 % CI [-14.4101, −3.2307], p = 0.0020). No significant changes were observed in TIR (MD: 7.1211, 95 % CI [-1.6028, 15.8450], p = 0.1096). ConclusionAllulose demonstrated a significant reduction in postprandial glucose levels and TAR, supporting its role as a dietary intervention for glycemic control in T2DM patients. The findings are robust, though further research is needed to confirm its long-term effects on insulin sensitivity and metabolic health.

Watch That Attitude! Examining the Role of Attitude in the Technology Acceptance Model through Meta-Analytic Structural Equation Modelling

The Technology Acceptance Model (TAM), proposed by Fred Davis in 1986, is a foundational framework for understanding technology adoption, emphasizing Perceived Ease of Use (PEOU) and Perceived Usefulness (PU) as key determinants of Intention to Use (ITU). While Attitude Toward Using (ATU) was initially central to TAM, it was later omitted in iterations like TAM2 and UTAUT. This paper revisits the role of ATU within TAM, employing One-Step Meta-Analytic Structural Equation Modelling (OSMASEM) to analyze educational technology acceptance. The findings reveal that ATU significantly mediates the relationship between PEOU, PU, and ITU, enhancing the explanatory power of TAM. By comparing models with and without ATU (TAM-O and TAM-R), the findings demonstrate that incorporating ATU provides a more comprehensive understanding of user behavior, particularly in voluntary use contexts. The study underscores the importance of attitudes in technology adoption and suggests that future TAM iterations should consider ATU to improve predictive accuracy. This research contributes to theoretical advancements in TAM and offers practical insights for enhancing technology acceptance in educational settings.

Maternal and Fetal Outcomes of Aplastic Anemia During Pregnancy and Delivery: Systematic Review and Meta-Analysis.

Little scientific evidence exists on maternal and fetal outcomes in aplastic anemia (AA) during pregnancy. The review was conducted to assess the maternal and fetal outcomes due to AA during pregnancy. Web of Science, EMBASE, PubMed, Scopus, Cochrane CENTRAL, and registries until May 5, 2024. Studies (prospective, retrospective cohort, cross-sectional, one arm, survey, follow-up studies) evaluating AA during pregnancy were searched as per PROSPERO registered protocol (CRD42024506668). Case reports, case series, expert opinion letters, and studies assessing less than or equal to 10 pregnant women were not considered. The primary outcome was the prevalence of preeclampsia in AA pregnancies. The secondary outcomes included spontaneous abortion, preterm premature rupture of membranes, premature rupture of membranes, fetal growth restriction, type of delivery, intrauterine fetal death, maternal and neonatal mortality, and pre and post-pregnancy remission status comparison. The quality of research was checked using the New Castle-Ottawa risk-of-bias tool. A meta-analysis model with a random effect distribution, coupled with meta-regression, sensitivity analysis, and publication bias assessment, was used in the statistical software R. Standard Equator network study reporting guidelines were followed. Seven (one prospective and six retrospective cohort) studies included patients with confirmed AA diagnosis in 248 pregnancies. The pooled prevalence of preeclampsia was 13% (95% CI, 8%-20%). Heterogeneity was low in the present meta-analysis (I2 = 26%). The secondary outcome evaluation showed a pooled prevalence of 5% (95% CI, 3%-11%) for spontaneous abortion, 4% (95% CI, 1%-11%) for preterm premature rupture of membranes, 10% (95% CI, 3%-28%) for premature rupture of membranes, 6% (95% CI, 3%-11%) for fetal growth restriction, 5% (95% CI, 2%-13%) for intrauterine fetal death, 12% (95% CI, 5%-26%) for post-partum hemorrhage, 74% (95% CI, 45%-91%) for intrapartum transfusion requirement, and 55% (95% CI, 27%-80%) for the cesarean delivery opting. The maternal mortality in pregnancies with AA was 4% (95% CI, 0.01-0.14), whereas neonatal mortality was 7% (95% CI, 0.03-0.18). The odds of AA complete remission were better in pre-pregnancy than post-pregnancy (OR = 0.36; 95% CI = 0.08-1.66), although the results remain insignificant. The leave-one-out sensitivity analysis did not change the pooled estimates for the primary outcome. A risk of developing preeclampsia was observed in every eighth pregnant woman with an AA diagnosis. AA remission status might worsen after undergoing pregnancy, considering the significant obstetric morbidity and mortality burden.

Cervical Laminoplasty is Associated With Lower Health Care Costs as Compared With Cervical Fusion Procedures: A Systematic Review and Meta-analysis of Comparative Studies.

Systematic review and meta-analysis. The purpose of this study is to examine the cost of CLP versus CF stratified by approach to guide decision-making. Cervical laminoplasty (CLP) and cervical fusion (CF) are viable alternatives for surgical management of cervical spine myelopathy, with no clear consensus on clinical superiority. However, despite clinical equivalence in patient outcomes, there is limited data on the relative costs between CLP and CF. This study searched PubMed, CINAHL, MEDLINE, and Web of Science databases. Inclusion criteria were articles that examined the cost between CLP and any type of CF (stratified by anterior, posterior, or combined approach). A random-effects continuous model for meta-analysis was performed using standardized mean difference (SMD). Eleven articles were included. Patients (n = 21,033) had an average age of 56.0 ± 3.6 years and underwent either CLP (n = 4364), posterior CF (n = 3529), anterior CF (n = 13,084), or combined CF (n = 56). The mean reported cost among patients who underwent CLP (n=3742) was significantly lower compared with patients who underwent CF (n = 6329), irrespective of the approach for CF (P = 0.028; SMD = -2.965). For subgroup analysis by surgical approach, the mean reported cost among patients treated with CLP was significantly lower as compared with patients treated with posterior CF (P = 0.013; SMD = -1.861) and anterior CF (P < 0.001; SMD = -0.344). Patients who underwent CLP had a significantly lower mean hardware cost than patients who underwent posterior CF (P < 0.001; SMD = -3.275). CLP appears to be associated with statistically significant and clinically relevant lower reported costs than CF, irrespective of the approach based on meta-analysis of low or moderate-quality retrospective studies. CLP may also have lower reported costs than both posterior CF and anterior CF. IV.

Social inequalities in cancer incidence, survival and mortality: An umbrella review

Abstract Background An increasing number of systematic reviews investigating differences in cancer burden by social factors such as race, ethnicity, and socioeconomic status have been published in recent years. Our study aims to evaluate the strength and quality of evidence from systematic reviews investigating associations between social factors and cancer incidence, survival, and mortality to help policy-makers reduce existing social inequalities in the burden of cancer. Methods Our study is a pre-registered umbrella review (PROSPERO; CRD42024552884). We systematically searched Medline, Scopus, Web of Science, CINAHL, PsycINFO, the Cochrane Library, the JBI EBP database, and Epistemonikos without date restrictions for published systematic reviews with or without meta-analyses on June 17, 2024. The search identified 15,542 records, which were reduced to 7,421 after deduplication. We are currently screening studies to include systematic reviews of cohort or case-control studies that examined associations between one or more social factors (gender, race/ethnicity, education, occupation, socioeconomic status, place of residence, religion, social capital) and cancer outcomes. Study screening, data extraction, and quality appraisal will be done in duplicate using pre-piloted forms. The strength of evidence of reported associations between social factors and cancer outcomes will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Before data synthesis, we will assess the degree of overlap between primary studies in the eligible reviews by creating citation matrices and calculating corrected covered area indices. Following this, we will narratively summarize associations (for systematic reviews without meta-analyses) and pool the risk estimates for individual social factors and cancer outcomes (for reviews with meta-analyses) using random-effects meta-analysis models. We will have preliminary results ready by November 2024. Key messages • Our umbrella review aims to evaluate the strength and quality of evidence from systematic reviews which have examined social inequalities in cancer incidence, survival, and mortality. • This high-level evidence synthesis can help policy-makers better plan and target interventions to reduce the existing social inequalities in the burden of cancer.

Technology for preventing work-related musculoskeletal injuries in healthcare professionals: A scoping review

Background &amp; Aim: This scoping review aims to identify and summarize how technology can help prevent work-related musculoskeletal injuries in healthcare professionals. Methods &amp; Materials: We conducted a scoping review following the steps provided by the Joanna Briggs Institute. The PRISMA® - Preferred Reporting Items for Systematic Reviews and Meta-Analyses model was used to organize the information, following the recommendations described in PRISMA-ScR (PRISMA Extension for Scoping Reviews) for the article presentation. A search of PubMed, Scopus, and CINAHL databases was conducted for all articles in December 2023. Results: Of the 964 initial articles identified, 7 met the inclusion criteria. The reviewed studies highlight the effectiveness of various technological interventions in reducing musculoskeletal injuries among healthcare professionals. Wearable technologies, such as inertial measurement units, have been effective in promoting correct posture and reducing the risk of musculoskeletal disorders. However, the studies also identified significant challenges, including the generalizability of findings, the need for more robust empirical evidence, and issues related to the long-term sustainability and cost-effectiveness of these technologies. Conclusion: The conclusion of this analysis highlights the need for scalable, effective, and customized therapies and calls for more study and development in gamification, wearable technologies, and tailored mobile applications.

Sparse and inconsistent reporting of pre- and post-operative radiographic angles of total knee arthroplasty using true unrestricted kinematic alignment: An umbrella review and secondary meta-analysis.

To identify, synthesise and critically appraise findings of systematic reviews and meta-analyses on pre- and post-operative radiographic angles (lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA] and hip-knee-ankle [HKA] angle) of unrestricted kinematic alignment versus mechanical alignment in total knee arthroplasty (TKA). Two authors searched MEDLINE, EMBASE and Epistemonikos for systematic reviews, with or without meta-analyses, that reported on TKA outcomes using unrestricted kinematic alignment. The methodological quality of the included systematic reviews and meta-analyses was independently assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). The effect size with its 95% confidence interval (CI) for radiographic angles was extracted from the systematic reviews and meta-analyses. The characteristics of clinical studies included in systematic reviews were listed and tabulated. Pre- and post-operative MPTA, LDFA and HKA angles were summarised using meta-analytic random-effects models. Nineteen records were eligible for data extraction. Systematic reviews and meta-analyses included 44 clinical studies, of which 31 were on unrestricted kinematic alignment and 13 were on restricted versions of kinematic alignment. None of the included systematic reviews or meta-analyses fulfiled all seven critical AMSTAR-2 domains. Few comparative studies reported both pre- and post-operative angles (LDFA, n = 3; MPTA, n = 4; and HKA angle, n = 10). Mean pre- and post-operative LDFAs were 88.0° (range, 83-94°) and 88.0° (range, 80-96°) for the kinematic alignment group, and 88.2° (range, 83-95°) and 90.2° (range, 84-97°) for the mechanical alignment group. Mean pre- and post-operative MPTAs were 86.0° (range, 78-93°) and 87.1° (range, 78-94°) for the kinematic alignment group and 86.4° (range, 77-94°) and 89.6° (range, 84-95°) for the mechanical alignment group. Mean pre- and post-operative HKA angles were -3.3° (range, -24° to 24°) and -0.3° (range, -10° to 8°) for the kinematic alignment group and -6.9° (range, -25° to 7°) and -0.9° (range, -8° to 7°) for the mechanical alignment group. Most systematic reviews and meta-analyses that report outcomes of TKA using kinematic alignment do not distinguish between the different versions of kinematic alignment. The clinical studies included in systematic reviews are limited and inconsistent in their reporting of radiographic angles. Different alignment strategies are often grouped under the umbrella term of kinematic alignment, which contributes to conflicting reports, confusion and unresolved questions regarding the efficacy of true unrestricted kinematic alignment. Level IV.