Meta-analytic Approach Research Articles

Effectiveness of immune checkpoint inhibitors and other treatment modalities in patients with advanced mucosal melanomas: a systematic review and individual patient data meta-analysis

Mucosal melanomas (MM) are an aggressive subtype of melanoma. Given the rarity of this disease, the conduct of clinical trials is challenging and has been limited. Current treatment options have been extrapolated from the more common cutaneous melanoma even though MM is distinct in pathogenesis, etiology and prognosis. This is the first meta-analysis to comprehensively assess the efficacy of immune checkpoint inhibitors (anti-PD1 and anti-CTLA4) and other treatment modalities (targeted therapy such as KIT inhibitors and VEGF inhibitors, as well as radiotherapy) on survival outcomes in MM to develop clinical guidelines for evidence-based management. The protocol was prospectively registered on PROSPERO (PROSPERO ID: CRD42023411195). PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google Scholar were searched from inception until 25 July 2024, for all cohort and observational studies. Eligible studies included those with five or more participants with locally advanced or metastatic MM treated with anti-PD1, anti-CTLA4, VEGF inhibitors and/or KIT inhibitors. Titles and abstracts of potential articles were screened and full texts of all potentially eligible studies were retrieved and reviewed by two independent reviewers. Individual patient data (IPD) from published Kaplan-Meier curves were reconstructed using a graphical reconstruction method and pooled as a one-stage meta-analysis. A sensitivity analysis using a two-stage meta-analysis approach was conducted. Extracted outcomes included overall survival (OS) and progression-free survival (PFS). For each treatment arm, median survival time and 12-month survival proportion were estimated. Data from double-arm trials was pooled to estimate hazard ratios (HRs), ratios of restricted mean time lost (RMTL) and restricted mean survival time (RMST). From a total of 7402 studies, 35 eligible studies comprising a total of 2833 participants were included. Combined anti-PD1 and anti-CTLA4 therapy had the highest 12-month OS and 12-month PFS at 71.8% (95% CI: 67.6%, 76.2%, n=476) and 35.1% (95% CI: 30.5%, 40.4%, n=401) respectively, followed by anti-PD1 therapy alone (OS: 64.0% (95% CI: 61.4%, 66.7%, n=1399); PFS: was 28.3% (95% CI: 25.8%, 31.2%, n=1142), anti-PD1 and VEGF inhibitor combination therapy (OS: 57.1% (95% CI: 51.0%, 63.9%)), KIT inhibitors (OS: 48.2% (95% CI: 37.6%, 61.8%); PFS: 8.3% (95% CI: 3.7%, 18.7%)) and anti-CTLA4 therapy alone (OS: 33.3% (95% CI: 28.4%, 39.1%); PFS: 9.8% (95% CI: 5.9%, 16.5%)). In the double-arm studies, combination therapy with anti-PD1 and anti-CTLA4 had similar OS and PFS with anti-PD1 alone (OS: HR 0.856 (95% CI: 0.704, 1.04); RMTL ratio 0.932 (95% CI: 0.832, 1.044, P=0.225); RMST ratio 1.102 (95% CI: 0.948, 1.281, P=0.204); PFS: HR 0.919 (95% CI: 0.788, 1.07); RMTL ratio 0.936 (95% CI: 0.866, 1.013, P=0.100); RMST ratio 1.21 (95% CI: 0.979, 1.496, P=0.078)), however, anti-PD1 therapy alone had significantly better PFS than anti-CTLA4 alone (HR 0.548 (95% CI: 0.376, 0.799); RMTL ratio 0.715 (95% CI: 0.606, 0.844, P<0.001); RMST ratio 1.659 (95% CI: 1.316, 2.092, P<0.001)). Anti-PD1 therapy with radiotherapy versus anti-PD1 alone showed no significant difference (OS: HR 0.854 (95% CI: 0.567, 1.29); RMTL ratio 0.855 (95% CI: 0.675, 1.083, P=0.193); RMST ratio 1.194 (95% CI: 0.928, 1.536, P=0.168; PFS: HR 0.994 (95% CI: 0.710, 1.39); RMTL ratio 1.006 (95% CI: 0.87, 1.162, P=0.939); RMST ratio 0.984 (95% CI: 0.658, 1.472, P=0.939)). For the systemic treatment of MM, anti-PD1 is the best monotherapy. While combining anti-PD1 with other treatment options such as anti-CTLA4, VEGF inhibitors or radiotherapy might achieve better outcomes, these improvements did not reach statistical significance when evaluated by HR, RMTL and RMST ratios. This work was supported by theNational Medical Research CouncilTransition Award (TA20nov-0020),SingHealthDuke-NUSOncology Academic Clinical Programme (08/FY2020/EX/67-A143 and 08/FY2021/EX/17-A47), the Khoo Pilot Collaborative Award (Duke-NUS-KP(Coll)/2022/0020A), theNational Medical Research CouncilClinician Scientist-Individual Research Grant-New Investigator Grant (CNIGnov-0025), the Terry Fox Grant (I1056) and the Khoo Bridge Funding Award (Duke-NUS-KBrFA/2024/0083I).

Stratification risk computation of primary graft gysfunction in heart transplant recipients on a smartphone application

Abstract Introduction There are no standardized guidelines for helping graft allocation in heart transplant (HTx) and accepting transplants from marginal donors and donors after circulatory arrest make decision making even more complex and time consuming than ever. The organ allocation process should include a risk analysis for primary graft dysfunction (PGD) that represents the most dreadful complication of HTx. There are 3 score systems validated to predict PGD but none has clear superior predictive capability compared to the others and the complexity of score computation potentially discourage their clinical use. A score integrating all the variables presented in a user-friendly format should improve efficacy and safeness of the organ allocation process. Methods Severe PGD defined as need for temporary mechanical circulatory support (ECMO) in the first 24 hours following HTx was considered the end-point for risk stratification computation. As a derivation cohort we used meta-analytic approach for identifying variables that are independently associated to severe PGD. The overall prevalence of each variable was determined to define the absolute risk increase value in presence of each factor. We then created a scoring system applying multivariate logistic regression model. As a validation cohort we studied the performance of the score in a retospective series of HTx performed at our institution from 2013 to 2022. We used C statistic equivalent to the area under a receiver-operating characteristic curve for dichotomous outcomes. Values above 0.7 were considered acceptable. We eventually developed an application for smartphone for risk computation. Results On 64 papers screened, 5 studies were considered eligible for the derivation cohort definition. Cumulative number of patients considered was 10’175 with an incidence of severe PGD of 7.1% (CI 5.3 - 10.4) and a 30-day mortality of 41%. 13 variables were identified (table 1). The ROC curve predicted the use of ECMO with the specificity and the sensitivity of 0,81 and 0,92 respectively. We have included in the validation cohort 128 out of 150 transplanted patients, excluding pediatric and double organs transplants. The mean donor age was 45 +/- 12,4 years, 72 (54%) were men. The mean recipient age was 57 +/- 9,3; 92 were men; 32 recipients (25%) needed ECMO support within 24 hours post-transplant; 75% of the donors in the ECMO group were &amp;gt; 40 y.o.; 30 days mortality was 3.1% and 6,2% in the non-ECMO and ECMO group respectively. We validated the model on our cohort defying a binary outcome (ECMO yes/no). Conclusion Clinicians fill donor, recipient and surgical parameters in user-friendly smartphone application identifying patients that are most likely to need ECMO support post HTx. The decision-making process during organ allocation evolves from what was once little more than personal experience and intuition to a reliable evidence-based method based on personalized risk prediction.Table 1

DINGO: increasing the power of locus discovery in maternal and fetal genome-wide association studies of perinatal traits

Perinatal traits are influenced by fetal and maternal genomes. We investigate the performance of three strategies to detect loci in maternal and fetal genome-wide association studies (GWASs) of the same quantitative trait: (i) the traditional strategy of analysing maternal and fetal GWASs separately; (ii) a two-degree-of-freedom test which combines information from maternal and fetal GWASs; and (iii) a one-degree-of-freedom test where signals from maternal and fetal GWASs are meta-analysed together conditional on estimated sample overlap. We demonstrate that the optimal strategy depends on the extent of sample overlap, correlation between phenotypes, whether loci exhibit fetal and/or maternal effects, and whether these effects are directionally concordant. We apply our methods to summary statistics from a recent GWAS meta-analysis of birth weight. Both the two-degree-of-freedom and meta-analytic approaches increase the number of genetic loci for birth weight relative to separately analysing the scans. Our best strategy identifies an additional 62 loci compared to the most recently published meta-analysis of birth weight. We conclude that whilst the two-degree-of-freedom test may be useful for the analysis of certain perinatal phenotypes, for most phenotypes, a simple meta-analytic strategy is likely to perform best, particularly in situations where maternal and fetal GWASs only partially overlap.

Comparison of Prior Distributions for the Heterogeneity Parameter in a Rare Events Meta-Analysis of a Few Studies.

Bayesian meta-analysis is a promising approach for rare events meta-analysis. However, the inference of the overall effect in rare events meta-analysis is sensitive to the choice of prior distribution for the heterogeneity parameter. Therefore, it is crucial to assign a convincing prior specification and ensure that it is both plausible and transparent. Various priors for the heterogeneity parameter have been proposed; however, the comparative performance of alternative prior specifications in rare events meta-analysis is poorly understood. Based on a binomial-normal hierarchical model, we conducted a comprehensive simulation study to compare seven heterogeneity prior specifications for binary outcomes, using the odds ratio as the metric. We compared their performance in terms of coverage, median percentage bias, width of the 95% credible interval, and root mean square error (RMSE). We illustrate the results with two recently published rare events meta-analyses of a few studies. The results show that the half-normal prior (with a scale of 0.5), the prior proposed by Turner etal. for the general healthcare setting (without restriction to a specific type of outcome) and for the adverse event setting perform well when the degree of heterogeneity is not relatively high, yielding smaller bias and shorter interval widths with similar coverage and RMSE in most cases compared to other prior specifications. None of the priors performed better when the heterogeneity between-studies were significantly extreme.

An Interpersonal and Meta-analytic Approach to Parenting Behaviors and Adolescent Sleep.

Two dimensions of parenting behaviors-affiliative/non-affiliative and autonomy/control- are each consistently linked to adolescent sleep health. Parenting behaviors that facilitate good sleep likely involve affiliation (i.e., warmth) and some degree of parental guidance and appropriate autonomy-granting to the adolescent; however, these domains are often confounded in parenting assessments, which limits understanding and specificity of recommendations for providers and families on how to optimize adolescents' sleep. Thus, we categorized existing literature according to an interpersonal developmental framework to identify parenting behaviors most strongly linked to adolescent sleep health. Studies (k = 42) included 43,293 participants (M age = 14.84, SD age = 2.04). Structural analysis of social behavior (SASB)interpersonal coding was applied to define and operationalize parenting behaviors (independent variables). Dependent variables included measures of sleep health (i.e.,sleep regularity, duration, efficiency, latency, timing, quality, alertness/sleepiness) and sleep disturbance. The final effect size of interest for analysis was a correlation coefficient r. Optimal parenting behaviors (e.g., warm, autonomy-granting, moderately controlling) were associated with longer sleep duration, earlier bedtime, less daytime sleepiness, shorter sleep latency, and fewer sleep disturbances. Suboptimal parenting behaviors (e.g., hostile, controlling) were associated with more daytime sleepiness and more sleep disturbances. This is one of the first studies to specify that, when paired with affiliation, both moderate control and moderate autonomy-granting were associated with better adolescent sleep health. Findings indicate that the importance of parental interpersonal warmth extends into adolescence and further suggest that the interpersonal security necessary for good sleep includes appropriate use of control and autonomy-granting behaviors.

Context-Aware Embedding Techniques for Addressing Meaning Conflation Deficiency in Morphologically Rich Languages Word Embedding: A Systematic Review and Meta Analysis

This systematic literature review aims to evaluate and synthesize the effectiveness of various embedding techniques—word embeddings, contextual word embeddings, and context-aware embeddings—in addressing Meaning Conflation Deficiency (MCD). Using the PRISMA framework, this study assesses the current state of research and provides insights into the impact of these techniques on resolving meaning conflation issues. After a thorough literature search, 403 articles on the subject were found. A thorough screening and selection process resulted in the inclusion of 25 studies in the meta-analysis. The evaluation adhered to the PRISMA principles, guaranteeing a methodical and lucid process. To estimate effect sizes and evaluate heterogeneity and publication bias among the chosen papers, meta-analytic approaches were utilized such as the tau-squared (τ2) which represents a statistical parameter used in random-effects, H-squared (H2) is a statistic used to measure heterogeneity, and I-squared (I2) quantify the degree of heterogeneity. The meta-analysis demonstrated a high degree of variation in effect sizes among the studies, with a τ2 value of 8.8724. The significant degree of heterogeneity was further emphasized by the H2 score of 8.10 and the I2 value of 87.65%. A trim and fill analysis with a beta value of 5.95, a standard error of 4.767, a Z-value (or Z-score) of 1.25 which is a statistical term used to express the number of standard deviations a data point deviates from the established mean, and a p-value (probability value) of 0.2 was performed to account for publication bias which is one statistical tool that can be used to assess the importance of hypothesis test results. The results point to a sizable impact size, but the estimates are highly unclear, as evidenced by the huge standard error and non-significant p-value. The review concludes that although contextually aware embeddings have promise in treating Meaning Conflation Deficiency, there is a great deal of variability and uncertainty in the available data. The varied findings among studies are highlighted by the large τ2, I2, and H2 values, and the trim and fill analysis show that changes in publication bias do not alter the impact size’s non-significance. To generate more trustworthy insights, future research should concentrate on enhancing methodological consistency, investigating other embedding strategies, and extending analysis across various languages and contexts. Even though the results demonstrate a significant impact size in addressing MCD through sophisticated word embedding techniques, like context-aware embeddings, there is still a great deal of variability and uncertainty because of various factors, including the different languages studied, the sizes of the corpuses, and the embedding techniques used. These differences show how future research methods must be standardized to guarantee that study results can be compared to one another. The results emphasize how crucial it is to extend the linguistic scope to more morphologically rich and low-resource languages, where MCD is especially difficult. The creation of language-specific models for low-resource languages is one way to increase performance and consistency across Natural Language Processing (NLP) applications in a practical sense. By taking these actions, we can advance our understanding of MCD more thoroughly, which will ultimately improve the performance of NLP systems in a variety of language circumstances.

Efficacy and Safety of Advanced Therapies in Moderately-to-Severely Active Ulcerative Colitis: a Systematic Review and Network Meta-analysis.

This study aimed to compare the efficacy and safety of biologics and small molecules for treatment of adults with moderately-to-severely active ulcerative colitis (UC). A systematic literature review was conducted to identify randomised controlled trials evaluating approved and emerging targeted therapies for patients with UC. A Bayesian network meta-analysis (NMA) approach was applied. Outcomes assessed included clinical response and remission, endoscopic mucosal healing, and safety. Thirty studies were included in the NMA following a feasibility assessment comparing approved induction dosing regimens and 22 studies comparing approved maintenance dosing regimens. In the biologic/Janus kinase inhibitor (JAKi)-naïve population, induction studies showed similar clinical response and remission rates across most interventions, with upadacitinib demonstrating significant improvements versus most other interventions. For maintenance studies, mirikizumab demonstrated significant improvements in clinical response and remission versus most other interventions. In the biologic/JAKi-experienced population, no significant differences were observed between most interventions in induction studies, except for significantly improved clinical response and remission for mirikizumab versus adalimumab, and upadacitinib demonstrated significant improvement versus all other interventions. Few differences between active treatments were observed in maintenance studies. In both populations, all active interventions had similar efficacy in terms of endoscopic mucosal healing in both induction and maintenance studies. Regardless of prior treatment exposure, similar rates of serious adverse events were seen across all active interventions in the induction period. Among the available interventions, owing to its favourable efficacy and safety profile, mirikizumab has a relevant role in the long-term treatment of UC.

Relative importance of competing marketing strategies on different customer metrics: a meta-analytic review of customer equity drivers

Purpose This meta-analytic study aims to generalize the impacts of three customer equity drivers (CEDs), including value equity (VE), brand equity (BE) and relationship equity (RE), on different customer metrics (e.g. loyalty, word of mouth [WoM] and satisfaction); examine the relative importance of CEDs on customer metrics; and explore boundary conditions, considering geographic and methodological characteristics. Design/methodology/approach This study used a meta-analytic approach, collected and coded 85 articles published between 2001 and 2022. After some exclusions, the authors used 272 observations (average of individuals’ sample M = 1,015, min = 10, max = 8,924). Findings The generalized effects of VE, BE, and RE on the selected customer metrics are positive. However, the importance of each CED differs for WoM and social equity. Between VE and BE, BE correlates more with WoM. RE correlates more with social equity than VE and BE That is, RE is effective in both WoM and social equity. In addition, the impacts of the CEDs on customer loyalty vary across multiple geographic and methodological characteristics. For example, the impacts of VE and RE on loyalty are stronger in more individualistic, more masculine, long-term orientation or more restraint cultures. Research limitations/implications While the authors examined VE, BE and RE as the most important marketing strategies, there might be other types of CEDs, such as interactions with others (e.g. employees and customers). Interactions with others at any touchpoints along the customer journey are important experiences (Lemon and Verhoef, 2016). Second, the authors limited the customer metrics to customer loyalty, WoM, customer satisfaction, customer trust and social equity. Practical implications The magnitudes of VE, BE and RE differ across the three customer metrics. Compared with VE, BE symbolizes customers’ identity, status and extended self, which motivates WoM. Compared with VE and BE, RE convinces customers of companies’ actions in social equity such as corporate social responsibilities. Originality/value The meta-analysis resolves the issue of inconsistent impacts of CEDs across studies. Moreover, including CEDs in a model provides insight into these strategies’ relative importance when considering different marketing objectives. Finally, this study enriches understanding of the boundary conditions on the CEDs–loyalty link.

Patterns of abnormal activations in severe mental disorders a transdiagnostic data-driven meta-analysis of task-based fMRI studies.

Studies suggest severe mental disorders (SMDs), such as schizophrenia, major depressive disorder and bipolar disorder, are associated with common alterations in brain activity, albeit with a graded level of impairment. However, discrepancies between study findings likely to results from both small sample sizes and the use of different functional magnetic resonance imaging (fMRI) tasks. To address these issues, data-driven meta-analytic approach designed to identify homogeneous brain co-activity patterns across tasks was conducted to better characterize the common and distinct alterations between these disorders. A hierarchical clustering analysis was conducted to identify groups of studies reporting similar neuroimaging results, independent of task type and psychiatric diagnosis. A traditional meta-analysis (activation likelihood estimation) was then performed within each of these groups of studies to extract their aberrant activation maps. A total of 762 fMRI study contrasts were targeted, comprising 13 991 patients with SMDs. Hierarchical clustering analysis identified 5 groups of studies (meta-analytic groupings; MAGs) being characterized by distinct aberrant activation patterns across SMDs: (1) emotion processing; (2) cognitive processing; (3) motor processes, (4) reward processing, and (5) visual processing. While MAG1 was mostly commonly impaired, MAG2 was more impaired in schizophrenia, while MAG3 and MAG5 revealed no differences between disorder. MAG4 showed the strongest between-diagnoses differences, particularly in the striatum, posterior cingulate cortex, and ventromedial prefrontal cortex. SMDs are characterized mostly by common deficits in brain networks, although differences between disorders are also present. This study highlights the importance of studying SMDs simultaneously rather than independently.

Assessing the Impact of Enterprise Architecture on Digital Transformation Success: A Global Perspective

This research paper aims to analyze the significant contributions of enterprise architecture (EA) in leveraging digital transformation (DT) success at an international level. The paper adopts a meta-analytical approach, examining the patterns of EA’s strategic alignment and operational impact. EA plays a crucial role in managing digital ecosystem complexity, which is a key factor in successful DT. The methodology also focuses on the systematic review and meta-analysis of the relationships between EA and other advanced technological systems such as AI, IoT, and Blockchain to reveal how these technologies improve EA’s flexibility and strategic approaches. The paper emphasizes the importance of organizational culture, technological incorporation, and regional economic factors as critical determinants of EA practices in DT activities. It underscores the necessity for customized EA approaches to DT success within different cultural and economic contexts and their impact on sustainable management. This practical insight is a crucial contribution of the paper, providing a strategic roadmap for organizations aiming to optimize their digital transformation strategies through enhanced EA practices.

Relation of CMV and brain atrophy to trajectories of immunosenescence in diverse populations.

Immunosenescence (ISC), the aging of the immune system, has largely been studied in populations of European descent. Here, circulating immune cell cytometric data from African-American, Hispanic, and non-Hispanic White participants were generated. Known and novel age effects were identified using either a meta-analysis approach or a parallel genetic approach. Most results are consistent across the three populations, but some cell populations display evidence of heterogeneity, such as a PD-L1 + CD56 + NK cell subset. The study estimated "Immunological Age" (IA) during physiologic aging. While we found no relation of IA to Multiple Sclerosis, IA is associated with entorhinal cortex atrophy, a presymptomatic feature of Alzheimer's disease, linking neurodegeneration and peripheral immunity. ISC trajectories were also inferred, highlighting age, CMV status, and genetic ancestry as key influences. Our assessment offers reference ISC trajectories for personalization of assessments of immune function over the life course in diverse populations.

Scoring and validation of a simple model for predicting diabetic retinopathy in patients with type 2 diabetes based on a meta-analysis approach of 21 cohorts

Aim To develop and validate a model for predicting diabetic retinopathy (DR) in patients with type 2 diabetes. Methods All risk factors with statistical significance in the DR prediction model were scored by their weights. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve, Kaplan–Meier curve, calibration curve and decision curve analysis. The prediction model was externally validated using a validation cohort from a Chinese hospital. Results In this meta-analysis, 21 cohorts involving 184,737 patients with type 2 diabetes were examined. Sex, smoking, diabetes mellitus (DM) duration, albuminuria, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and TG were identified to be statistically significant. Thus, they were all included in the model and scored according to their weights (maximum score: 35.0). The model was validated using an external cohort with median follow-up time of 32 months. At a critical value of 16.0, the AUC value, sensitivity and specificity of the validation cohort are 0.772 ((95% confidence interval (95%CI): 0.740–0.803), p < .01), 0.715 and 0.775, respectively. The calibration curve lied close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated that the model had notably higher net benefits. The external validation results proved the reliability of the risk prediction model. Conclusions The simple DR prediction model developed has good overall calibration and discrimination performance. It can be used as a simple tool to detect patients at high risk of DR.

Comparison of resting-state brain activity between insomnia and generalized anxiety disorder: A coordinate-based meta-analysis.

Patients with insomnia disorder (ID) usually experience a greater burden of comorbid anxiety symptoms. However, the neural mechanism under the mutual relationship between ID and anxiety remains largely unclear. The meta-analysis aimed to explore the concordance and distinction of regional brain functional activity in patients with ID and those with generalized anxiety disorder (GAD) using coordinate-based activation likelihood estimation approach. Studies using resting-state regional homogeneity, amplitude of low-frequency fluctuations (ALFF), or fractional ALFF in patients with ID or GAD were included by searching multiple databases up to May 24, 2024. Using meta-analytic approach, 21 studies of ID vs. healthy controls (HC) and 16 studies of GAD vs. HC were included to illuminate the common and distinct patterns between the two disorders. Results showed that ID and GAD shared increased brain activities in the left posterior cingulate cortex and left precuneus, as well as decreased brain activity in the left medial prefrontal cortex. Additionally, compared with ID, GAD showed greater increased activities in the left superior frontal gyrus. Our study reveals both common and different activation patterns between ID and GAD, which may provide novel insights for understanding the neural basis of the two disorders and enlighten the possibility of the development of more targeted treatment strategies for ID and GAD.

The Prevalence of Toxoplasma gondii in Saudi Arabia (1994-2023): A Systematic Review and Meta-Analysis.

Toxoplasmosis is one of the most common parasites affecting humans in diverse populations caused by T. gondii. This study aims to systematically review and analyze the prevalence of T. gondii infection among various population categories in Saudi Arabia. Our search was done in five databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science to find the relevant studies from inception to November 2023. The pooled prevalence of toxoplasmosis among the total population living in Saudi Arabia was estimated using a random-effect meta-analysis approach, and Comprehensive Meta-Analysis software was utilized for this analysis. Our study included 30 case-control and retrospective studies published from 1994 to 2023 involving 20,699 patients from different regions in the Kingdom of Saudi Arabia. Various cities were included, such as Al-Ahsa, Najran, Riyadh, Arar, Mecca, al Khobar, Mushait, Tabuk, jazan, Hail City, Almadinah Almunawwarah, AL-Ahsa, and Abha; 27 reported outcomes related to IgG seroprevalence, revealing an overall toxoplasmosis prevalence of 27.5% in Saudi Arabia. Fifteen studies that measured IgM seroprevalence found an overall toxoplasmosis prevalence of 2.2%. Specifically for pregnant women, IgG seroprevalence was 28%. Among different age categories, the highest toxoplasmosis prevalence was observed in the group aged 31-45years, reaching 32.5%, while the lowest prevalence was in the 10-20years category at 19.3%. Regarding gravidity, the grand multi-gravida group exhibited the highest prevalence at 32.9%, with an upper limit of 47.8%. Furthermore, individuals who consumed freshwater demonstrated a higher incidence than those drinking bottled water, with respective prevalence rates of 33.5% and 29.4%. In conclusion, the prevalence of toxoplasmosis in Saudi Arabia is lower than the global average, with significant variations across different age groups, water sources, and dietary habits. Targeted educational programs and public health interventions are essential to raise awareness and reduce the risk of T. gondii infection. Future research should focus on improving study quality and exploring the broader implications of toxoplasmosis on public health in Saudi Arabia.

The Association between Gallstone Disease and Incidence of Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Gallstone Disease (GSD) is a multifactorial risk factor for various complications. This study aimed to examine the relationship between GSD and Cardiovascular Disease (CVD) incidence through a systematic review and meta-analysis approach. A thorough search was conducted across Web of Science, Scopus, MEDLINE/PubMed, Cochrane Library, and Embase databases. Only studies published between 1980 and December 2023 were included. Chi-square, I2, and forest plots were used to assess heterogeneity. Begg's and Egger's tests were used to evaluate publication bias. Statistical significance was considered at p <0.05, and all analyses were performed using Stata 17. This meta-analysis involved 21 studies and comprised 2,138,282 participants; there has been a significant association found between GSD and an increased risk of CVD (with a relative risk of 1.46, 95% confidence interval: 1.32-1.63, p <0.001). The analysis found no evidence of publication bias based on Begg's test (p =0.085) and Egger's test (p =0.231). Subgroup analysis of the studies showed a higher risk of CVD in studies with a sample size of less than 10,000 participants, conducted in 2016 or later, utilizing a cross-sectional design, in Asian countries; the analysis had a moderate quality score, with a follow-up period of equal to or less than ten years. There has been a significant association found between GSD and an increased risk of incidence of CVD. Taking proactive steps to implement targeted interventions for individuals with gallstone disease could potentially reduce the risk of cardiovascular disease within this population.

Comparison of Omega-3 polyunsaturated fatty acids bioavailability in fish oil and krill oil: Network Meta-analyses

Background and Aims: Fish oil and krill oil are primary sources of Omega-3 polyunsaturated fatty acids (PUFAs), differing in their molecular forms and bioavailability. Understanding these differences can optimize their therapeutic use. This study aims to compare the bioavailability of Omega-3 PUFAs in fish oil and krill oil using a network meta-analysis approach. By evaluating various molecular forms and dosages, the study seeks to identify the most effective Omega-3 sources and dosing regimens to maximize health benefits.Methods: The study adhered to the explanation of the PRISMA network meta-analysis 2015 (registered PROSPERO ID: CRD42024532536). The risk of bias was evaluated using the PEDro scale. This network meta-analysis incorporated data from studies published between 2003 and 2023, sourced from five databases: ClinicalTrials.gov, PubMed, Cochrane CENTRAL, the International Clinical Trials Registry Platform-World Health Organization, and Embase. Statistical analysis was conducted using advanced models in R software to ensure a rigorous evaluation of bioavailability.Results: Out of 26 high-quality studies, findings reveal superior bioavailability of krill oil compared to fish oil. Specifically, fish oil above 3000 mg, in re-esterified triacylglycerol or ethyl ester formulations (100–2900 mg), and krill oil (100–1900 mg) significantly enhanced the Omega-3 index. At lower dosages (under 2000 mg), krill oil shows superior Omega-3 absorption compared to fish oil. Using fish oil ethyl ester at doses between 2000 and 2900 mg may be the most effective for reducing Tmax. However, this finding should be interpreted with caution due to high heterogeneity and limited statistical significance. The highest AUC values were observed in krill oil phospholipid/free fatty acid formulation. Emulsion forms of fish oil are more effective in increasing Cmax than other formulations. These results were supported by robust statistical evidence (Egger's test, p > 0.05), highlighting the effectiveness of specific formulations and doses in optimizing Omega-3 absorption.Conclusion: The research highlights the importance of understanding the bioavailability of Omega-3 PUFAs from fish oil and krill oil. The findings suggest that low-dose krill oil and fish oil emulsions (under 2000 mg) are effective and potentially safer alternatives to high-dose fish oil, potentially minimizing the risk of adverse effects.

How to conduct an integrative mixed methods meta-analysis: A tutorial for the systematic review of quantitative and qualitative evidence.

This article is a guide on how to conduct mixed methods meta-analyses (sometimes called mixed methods systematic reviews, integrative meta-analyses, or integrative meta-syntheses), using an integrative approach. These aggregative methods allow researchers to synthesize qualitative and quantitative findings from a research literature in order to benefit from the strengths of both forms of analysis. The article articulates distinctions in how qualitative and quantitative methodologies work with variation to develop a coherent theoretical basis for their integration. In advancing this methodological approach to integrative mixed methods meta-analysis (IMMMA), I provide rationales for procedural decisions that support methodological integrity and address prior misconceptions that may explain why these methods have not been as commonly used as might be expected. Features of questions and subject matters that lead them to be amenable to this research approach are considered. The steps to conducting an IMMMA then are described, with illustrative examples, and in a manner open to the use of a range of qualitative and quantitative meta-analytic approaches. These steps include the development of research aims, the selection of primary research articles, the generation of units for analysis, and the development of themes and findings. The tutorial provides guidance on how to develop IMMMA findings that have methodological integrity and are based upon the appreciation of the distinctive approaches to modeling variation in quantitative and qualitative methodologies. The article concludes with guidance for report writing and developing principles for practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sulfamethoxazole degradation pathways in wastewater treatment: Bayesian network-based approach for a meta-analysis of scientific papers.

Given the widespread presence of micropollutants in urban water systems, it is imperative to gain a comprehensive understanding of their degradation pathways. This paper focuses on sulfamethoxazole (SMX) as a model molecule due to its extensive study, aiming to elucidate its degradation pathways in biological (BIO) and oxidative (AOP) processes. Numerous reaction pathways are outlined in scientific papers. However, a significant deficiency in current methodologies has led to the development of a novel meta-analytical approach, seeking consensus among researchers by synthesizing data from studies characterized by their heterogeneity and contradictions. As an innovative alternative, probabilistic graphical models such as Bayesian networks (BNs) could illuminate the relationships and dependencies between various transformation products, providing a holistic view of the degradation process. Based on the analysis of an extensive bibliography gathering more than 45 articles for more than 140 molecules and 177 reaction pathways, this study proposes a meta-analysis methodology based on Bayesian networks.

A meta-analysis approach to evaluate the effects of early group housing on calf performance, health and behavior during the preweaning period

This study aimed to evaluate the effects of early group housing on the performance, health, and behavior of dairy calves during the pre-weaning period using systematic and meta-analysis approaches. Peer-reviewed articles written in English that compared dairy calves individually and group-housed with performance, health, or behavior outcomes were collected from Web of Science, PubMed and CabDirect databases. The resulting articles (n = 850) underwent a PRISMA 4-step appraisal process, resulting in a final sample of 51 articles containing 85 studies. The weighted or standardized mean differences between individually and group [pair or group (with > 2 calves)] housed calves were analyzed for each variable using the Der-Simonian and Laird methods. Heterogeneity between calf housing systems was evaluated by the chi-squared test and I2 statistics. A meta-regression analysis was conducted to identify categorical covariate effects for variables with high heterogeneity. Most of the studies included in this review evaluated female calves (45.8%) weaned at 8 weeks old (52.6%). Housing systems were mainly paired housing (55.3%), followed by groups of 3 to 6 calves (30.65) and groups of 7 to 15 calves (4.7%). We did not find studies with comparable outcomes for more robust health parameters (as occurrence of diseases), only blood parameters, that were not influenced by the housing system (P > 0.05). But, weight gain and feed intake parameters were higher (P < 0.05) in group-housed calves. Through the meta-regression, we found that average daily gain was positively affected (P < 0.05) by the group housing in studies with calves housed in small pen areas (<1.5 m2 per calf). Group-housed calves presented more active behaviors (feeding and playing) and less stress-related behaviors (self-grooming and interacting with the pen) than individually-housed calves. The behavioral tests most used were novel object, human approach, novel environment, and social tests. Individually-housed calves presented fewer vocalizations on these tests and spent more time interacting with humans during the human approach test than group-housed calves. Our findings provide consistent evidence that group housing improves the welfare of dairy calves; however, the effects on health parameters are still scarce and unclear.

The mediating effect of resilience between physical activity and mental health: a meta-analytic structural equation modeling approach.

While the correlation between physical activity (PA) and mental health is well known, the mediating mechanism of resilience between the two variables remains unclear. To systematically evaluate the relationship between PA and mental health, and explore the mediating role of resilience between them. A systematic search of electronic databases (PubMed, Web of Science, ProQuest, Ebsco, China Knowledge, and China Biomedical Database) was conducted to identify relevant studies, and meta-analytic procedures were used to assess the strength of the relationships between PA and mental health. Furthermore, a meta-analytic structural equation model (MASEM) was used to assess the mediating effects of resilience, ensuring the reliability of our findings. The findings of 15 studies (17,043 subjects) were subjected to meta-analysis and route analysis. The findings of the meta-analysis revealed a statistically significant positive correlation of 0.288 (95% CI, 0.166-0.402) between PA and positive indicators of mental health, as well as a statistically significant negative correlation (95% CI, -0.342 to -0.171) with negative indicators of mental health. Furthermore, the results of MASEM path analysis indicated that PA may indirectly impact both positive and negative indicators of mental health through the mediating factor of resilience. The indirect effect values were 0.108 (95% CI, 0.080-0.141) and -0.074 (95% CI, -0.100 to -0.051), respectively, accounting for 40.15% of the total effect value and 28.91%. Physical activity is positively correlated with positive indicators of mental health and negatively correlated with negative indicators of mental health. Moreover, PA can positively influence mental health through the mediating role of resilience.