Moderate Confidence Research Articles

Fluorescence imaging in reducing anastomotic leak after left-sided colorectal resections: a systematic review and updated meta-analysis.

The objective of this systematic review and meta-analysis was to pool randomized trials of patients undergoing left-sided colorectal anastomosis, comparing the use of fluorescence perfusion imaging versus visual inspection in reducing anastomotic leaks. Databases searched included PubMed, Cochrane Library, Scopus, CINHAL (EBSCO), and Google Scholar based on the concepts: randomized, colorectal, anastomotic leak, and fluorescence imaging. The risk of bias was assessed using RoB2 and the certainty of the evidence with the GRADE Pro tool. The analysis used the log odds ratio for dichotomous data with 95% confidence intervals. Back-transformation of the log odds to odds ratio was performed for the summary of findings. All syntheses used the Random-effects model. Six randomized trials were included with 1949 patients and 204 events (leaks). Three trials included exclusively rectal cancer patients, while the other three involved benign and malignant pathologies of the sigmoid and rectum. The use of ostomy and preoperative radiation was variable. None of the studies had a high risk of bias. The pooled odds ratio for anastomotic leak reduction with Indocyanine Green (ICG) fluorescence was 0.586 (95% CI: 0.434-0.792). An absolute reduction of 4.7% in leak rates was observed, with no statistical heterogeneity (I2 = 0; p = 0.529). Due to clinical heterogeneity, the quality of evidence was rated moderate. The use of ICG is associated with reduced leak rates following left-sided colorectal anastomosis with moderate confidence. ICG may be considered a standard of care given the clinically significant benefit in decreasing anastomotic leaks.

Systematic Review and Network Meta-Analysis: Efficacy and Safety of Antipsychotics vs Antiepileptics or Lithium for Acute Mania in Children and Adolescents

To compare second-generation antipsychotics (SGAs) and mood stabilizers (MSs) in youth with a bipolar disorder type I (BD-I) manic/mixed episode. A systematic PubMed/Embase/PsycInfo literature search until December 31, 2023, for randomized trials of SGAs or MSs in patients≤18 years of age with BD-I manic/mixed episode was conducted. The study included a network meta-analysis comparing treatments regarding mania symptoms and mania response (co-primary outcomes), and secondary efficacy and tolerability outcomes. Eighteen studies (n= 2844, mean age= 11.74, female participants= 48.0%, mean study duration= 5.4 weeks) comparing 6 SGAs (aripiprazole, asenapine, olanzapine, quetiapine, risperidone, and ziprasidone) and 4 MSs (lithium, oxcarbazepine, topiramate, and valproate) were meta-analyzed. All 6 SGAs outperformed placebo in reducing manic symptomatology, including risperidone (standardized mean difference [SMD]=-1.18, 95% CI=-0.92,-1.45, Confidence in Network Meta-Analysis [CINeMA]= moderate confidence), olanzapine (SMD=-0.77, 95% CI=-0.36,-1.18, low confidence), aripiprazole (SMD=-0.67, 95% CI=-0.33,-1.01, moderate confidence), quetiapine (SMD=-0.60, 95% CI=-0.32,-0.87, high confidence), asenapine (SMD=-0.54, 95% CI=-0.19,-0.89, moderate confidence), and ziprasidone (SMD=-0.43, 95% CI=-0.17, 0.70, low confidence), whereas no mood stabilizer outperformed placebo. Concerning mania response, risperidone (RR= 2.58, 95% CI= 1.88, 3.54, low confidence), olanzapine (RR= 2.42, 95% CI= 1.33, 3.54, very low confidence), aripiprazole (RR= 2.05, 95% CI= 1.44, 2.92, low confidence), quetiapine (RR= 1.89, 95% CI= 1.45n 2.47, moderate confidence), asenapine (RR= 1.81, 95% CI= 1.28, 2.55, very low confidence) and lithium (RR= 1.35, 95% CI= 1.00, 1.83, p= .049, very low confidence) outperformed placebo, without superiority of other MSs vs placebo. Individually, risperidone was more efficacious in reducing manic symptomatology than all other comparators, except olanzapine and topiramate, yet with low/very low confidence, and was associated with increased prolactin and glucose. Pooled together, SGAs outperformed both placebo and MSs for mania symptom reduction (SMD=-0.68, 95% CI=-0.86,-0.51 and SMD=-0.61, 95% CI=-0.82,-0.40, moderate confidence), and mania response (RR= 1.85, 95% CI= 1.53, 2.24 and RR= 1.65, 95% CI= 1.33, 2.04, moderate confidence) without differences between MSs and placebo. There were no significant treatment-placebo differences for all-cause discontinuation, whereas lithium, ziprasidone, and oxcarbazepine were associated with more adverse event-related drop-outs than placebo. Most SGAs were associated with more sedation, weight gain, and metabolic issues vs placebo and MSs. SGAs were more efficacious than placebo and MSs in treating acute mania symptoms, however, their use must be carefully weighed against important side effects.

NTP monograph on the state of the science concerning fluoride exposure and neurodevelopment and cognition: a systematic review.

Fluoride is a common exposure in our environment that comes from a variety of sources and is widely promoted for its dental and overall oral health benefits. Contributions to an individual's total exposure come primarily from fluoride in drinking water, food, beverages and dental products. A 2006 evaluation by the National Research Council (NRC) found support for an association between consumption of high levels of naturally occurring fluoride in drinking water and adverse neurological effects in humans and recommended further investigation. The evidence reviewed at that time was from dental and skeletal fluorosis-endemic regions of China. Since the NRC evaluation, the number and location of studies examining cognitive and neurobehavioral effects of fluoride in humans have grown considerably, including several recent North American prospective cohort studies evaluating prenatal fluoride exposure. In 2016, the National Toxicology Program (NTP) published a systematic review of the evidence from experimental animal studies on the effects of fluoride on learning and memory. That systematic review found a low-to-moderate level of evidence that deficits in learning and memory occur in non-human mammals exposed to fluoride. To conduct a systematic review of the human, experimental animal, and mechanistic literature to evaluate the extent and quality of the evidence linking fluoride exposure to neurodevelopmental and cognitive effects in humans. A systematic review protocol was developed and utilized following the standardized OHAT systematic review approach for conducting literature-based health assessments. This monograph presents the current state of evidence associating fluoride exposure with cognitive or neurodevelopmental health effects and incorporated predefined assessments of study quality and confidence levels. Benefits of fluoride with respect to oral health are not addressed in this monograph. The bodies of experimental animal studies and human mechanistic evidence do not provide clarity on the association between fluoride exposure and cognitive or neurodevelopmental human health effects. Human mechanistic studies were too heterogenous and limited in number to make any determination on biological plausibility. This systematic review identified studies that assessed the association between estimated fluoride exposure and cognitive or neurodevelopmental effects in both adults and children, which were evaluated separately. The most common exposure assessment measures were drinking water concentrations and estimates of total fluoride exposure, as reflected in biomarkers such as urinary fluoride. In adults, only two high-quality cross-sectional studies examining cognitive effects were available. The literature in children was more extensive and was separated into studies assessing intelligence quotient (IQ) and studies assessing other cognitive or neurodevelopmental outcomes. Eight of nine high-quality studies examining other cognitive or neurodevelopmental outcomes reported associations with estimated fluoride exposure. Seventy-two studies assessed the association between fluoride exposure and IQ in children. Nineteen of those studies were considered to be high quality; of these, 18 reported an inverse association between estimated fluoride exposure and IQ in children. The 18 studies, which include 3 prospective cohort studies and 15 cross-sectional studies, were conducted in 5 different countries. Forty-six of the 53 low-quality studies in children also found evidence of an inverse association between estimated fluoride exposure and IQ in children. Existing animal studies provide little insight into the question of whether fluoride exposure affects IQ. In addition, studies that evaluated fluoride exposure and mechanistic data in humans were too heterogenous and limited in number to make any determination on biological plausibility. The body of evidence from studies in adults is also limited and provides low confidence that fluoride exposure is associated with adverse effects on adult cognition. There is, however, a large body of evidence on associations between fluoride exposure and IQ in children. There is also some evidence that fluoride exposure is associated with other neurodevelopmental and cognitive effects in children; although, because of the heterogeneity of the outcomes, there is low confidence in the literature for these other effects. This review finds, with moderate confidence, that higher estimated fluoride exposures (e.g., as in approximations of exposure such as drinking water fluoride concentrations that exceed the World Health Organization Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride) are consistently associated with lower IQ in children. More studies are needed to fully understand the potential for lower fluoride exposure to affect children's IQ.

An Alarming Poor Knowledge with Moderate Confidence Towards Asthma Management among School Teachers: The Dunning–Kruger Effect

ABSTRACT Childhood asthma is a highly prevalent chronic illness with a large burden. Schools play an essential role in helping children with asthma manage their illness. This study assessed primary school teachers’ knowledge and confidence in managing children with asthma in Jordan. A descriptive correlational design was used. A total of 131 teachers from 10 primary schools participated in the study and completed the asthma knowledge questionnaire and the confidence scale. Findings demonstrated low teacher knowledge scores (10.47/32) yet moderate levels of confidence in asthma management (59.3/100). No correlation and no significant difference in knowledge and confidence were found between teachers based on their demographics. Findings from this study are consistent with prior research regarding poor knowledge and limited confidence in asthma management among school teachers. The overrated confidence might be explained by the Dunning–Kruger effect. Findings are discussed about supportive efforts to improve teachers’ knowledge and skills of asthma management in schools.

Assessing The Effect of Digital Banking Services on Retail Banking Customers’ Satisfaction Levels in Lusaka’s Central Business District

Digital banking platforms have improved the way banks deliver their services to clients which has resulted in the gradual movement from brick and mortar to the use of digital applications such as mobile phones, iPads, laptops and ATM machines. The purpose of this study was to assess the effect of digital banking on retail banking customer service satisfaction levels in Lusaka Town. The study was guided by three objectives which were; to determine customers’ perception of the reliability of digital banking services in Lusaka Central Business District; to assess customers’ perception of the responsiveness of digital banking services in Lusaka Central Business District and, to examine customers’ perceptions of the security of digital banking services in Lusaka Central Business District. This study investigated customers' perceptions of digital banking services, focusing on reliability, responsiveness, and security, using a quantitative approach. Simple random sampling was used to collect data using a structured questionnaire with 5-point Likert scale. The researcher ensured that the respondents remained anonymous to avoid bias and that whatever information they provided would be treated with confidentiality. The researcher did not influence the responses provided by the respondents in anyway. The sample size was 150 and 140 respondents who are bank customers in Lusaka Central Business District responded. The response rate was 93.33%. The data was analysed using descriptive statistics, ANOVA, hierarchical regression, and correlation analysis. The findings reveal that customers generally perceive digital banking services positively in terms of reliability and responsiveness, with significant associations found between these factors and overall customer satisfaction. However, concerns remain regarding security, despite moderate confidence in digital banking security measures. The study underscores the importance of trust, transparency, and technological advancement in shaping customer perceptions. Recommendations for further research include exploring the impact of AI technologies, regulatory frameworks, and demographic differences on digital banking adoption and satisfaction. These findings contribute to understanding customer behaviour in digital banking and inform strategies for enhancing service delivery and customer experience in the financial sector.

AOP-based framework for predicting the joint action mode of di-(2-ethylhexyl) phthalate and bisphenol A co-exposure on autism spectrum disorder

Autism spectrum disorder (ASD), also known as autism, is a common, highly hereditary and heterogeneous neurodevelopmental disorder. The global prevalence of ASD among children continues to rise significantly, which is partially attributed to environmental pollution. It has been reported that pre- or post-natal exposure to di-(2-ethylhexyl) phthalate (DEHP) or bisphenol A (BPA), two prevalent environmental endocrine disruptors, increases the risk of ASD in offspring. Yet, the joint action mode linking DEHP and BPA with ASD is incompletely understood. This study aims to unravel the joint action mode of DEHP and BPA co-exposure on the development of ASD. An adverse outcome pathway (AOP) framework was employed to integrate data from multiple public database and construct chemical-gene-phenotype-disease networks (CGPDN) for DEHP- and BPA-related ASD. Topological analysis and comprehensive literature exploration of the CGPDN were performed to build the AOP. By analysis of shared key events (KEs) or phenotypes within the AOP or the CGPDN, we uncovered two AOPs, decreased N-methyl-D-aspartate receptor (NMDAR) and estrogen antagonism that were likely linked to ASD, both with moderate confidence. Our analysis further predicted that the joint action mode of DEHP and BPA related ASD was possibly an additive or synergistic action. Thus, we propose that the co-exposure to BPA and DEHP perhaps additively or synergistically increases the risk of ASD.

Emergence of Confidence with Principles of Curiosity and Information Processing

Researchers in cognitive neuroscience, developmental cognitive neuroscience, educational psychology, educational technology, education theory, and other related fields collaborate in the emerging field of educational neuroscience, also known as neuroeducation. This interdisciplinary approach aims to explore the connections between psychological processes and education. By integrating basic discoveries in cognitive neuroscience with educational technology, researchers in neuroeducation strive to enhance curricula to foster curiosity and boost confidence levels in learners. The ultimate objective of neuroeducation is to generate both theoretical insights and practical applications that offer a fresh perspective on learning across various disciplines. The development of confidence is closely related to the principles of curiosity and information processing. When people are interested in a topic, they are more likely to seek out information and engage in learning experiences that can lead to deeper understanding. This information process allows people to analyze and understand the information they encounter, which in turn can increase their confidence in their knowledge and abilities. By embracing curiosity and honing their information-processing skills, people can develop a strong self-confidence that empowers them to take new challenges and pursue their goals with determination. This review study on curiosity have uncovered a fascinating insight into its mechanisms. Researchers found that curiosity aligns with a confidence function resembling an inverted U-shape, peaking when individuals have moderate confidence in their knowledge. Moreover, heightened curiosity drives individuals to actively seek out new information, showcasing the profound impact of curiosity on knowledge acquisition. This revelation holds immense promise for understanding human behavior and learning processes. This study focuses on boosting confidence in individuals through the application of curiosity and information knowledge processing techniques to elevate the standards of education and training across both traditional and modern methodologies. The integration of these principles is poised to revolutionize the learning experience, fostering a more dynamic and effective approach to knowledge acquisition and skill development. This innovative strategy holds immense potential to empower learners, educators, and trainers alike, paving the way for a more enriched and impactful educational landscape.

Interobserver agreement during clinical magnetic resonance imaging of the equine foot

AbstractBackgroundAgreement between experienced observers for assessment of pathology and assessment confidence are poorly documented for magnetic resonance imaging (MRI) of the equine foot.ObjectivesTo report interobserver agreement for pathology assessment and observer confidence for key anatomical structures of the equine foot during MRI.Study designExploratory clinical study.MethodsTen experienced observers (diploma or associate level) assessed 15 equine foot MRI studies acquired from clinical databases of 3 MRI systems. Observers graded pathology in seven key anatomical structures (Grade 1: no pathology, Grade 2: mild pathology, Grade 3: moderate pathology, Grade 4: severe pathology) and provided a grade for their confidence for each pathology assessment (Grade 1: high confidence, Grade 2: moderate confidence, Grade 3: limited confidence, Grade 4: no confidence). Interobserver agreement for the presence/absence of pathology and agreement for individual grades of pathology were assessed with Fleiss' kappa (k). Overall interobserver agreement for pathology was determined using Fleiss' kappa and Kendall's coefficient of concordance (KCC). The distribution of grading was also visualised with bubble charts.ResultsInterobserver agreement for the presence/absence of pathology of individual anatomical structures was poor‐to‐fair, except for the navicular bone which had moderate agreement (k = 0.52). Relative agreement for pathology grading (accounting for the ranking of grades) ranged from KCC = 0.19 for the distal interphalangeal joint to KCC = 0.70 for the navicular bone. Agreement was generally greatest at the extremes of pathology. Observer confidence in pathology assessment was generally moderate to high.Main limitationsDistribution of pathology varied between anatomical structures due to random selection of clinical MRI studies. Observers had most experience with low‐field MRI.ConclusionsEven with experienced observers, there can be notable variation in the perceived severity of foot pathology on MRI for individual cases, which could be important in a clinical context.

Surveying Thai Secondary School Teachers’ Self-Reported Confidence and Demand for Digital Technology

This study investigates the confidence levels of Thai secondary teachers in using digital technology and their demand for professional development (PD) programs. A questionnaire was designed, covering four key areas: digital literacy, practical application of digital technology, problem-solving skills, and adaptability. The results revealed that teachers generally demonstrated either moderate or strong confidence in their digital skills, alongside a notably high demand for PD programs. Interestingly, these findings remained consistent across various demographic variables, such as age, teaching experience, gender, and educational background. Consequently, the study suggests an immediate need for in-service training programs for Thai teachers. However, it’s important to note potential limitations, including the sampling method used and concerns about the questionnaire’s validity and reliability.

Barriers and enablers to the implementation and sustainability of short-stay arthroplasty programs for elective primary total hip and knee replacement: A systematic review with qualitative evidence synthesis.

We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF). Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual. Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes. We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.

Longitudinal changes in serum immunoglobulin G testing in patients with fibrotic avian hypersensitivity pneumonitis

BackgroundEvaluation of the antigen responsible for fibrotic hypersensitivity pneumonitis (HP) is challenging. Serum immunoglobulin (Ig) G testing against HP-associated antigens is performed. Although single-serum IgG testing has been investigated, multiple-serum IgG testing has not yet been studied.MethodsThis study included patients who underwent histopathological examination and positive inhalation challenge test as well as those with moderate or high HP guideline confidence level. Serum IgG testing against pigeon serum was conducted twice using two methods: enzyme linked-immunosorbent assay (ELISA) and ImmunoCAP. The association between changes in serum IgG antibody titers and changes in forced vital capacity (FVC) and other parameters was investigated.ResultsIn this study, 28 patients (mean age, 64.5 years; mean FVC, 85.3%) with fibrotic avian HP were selected, of whom 20 and 8 underwent surgical lung biopsy and transbronchial lung cryobiopsy, respectively. Of the 28 patients, 19 had been keeping birds for more than 6 months. A correlation was observed between the annual changes in serum IgG antibody titers by ELISA and changes in relative FVC (r = − 0.6221, p < 0.001). Furthermore, there was a correlation between the annual changes in serum IgG antibody titers by ImmunoCAP and changes in relative FVC (r = − 0.4302, p = 0.022). Multiple regression analysis revealed that the change in serum IgG antibody titers by both ELISA and ImmunoCAP also influenced the relative FVC change (p = 0.012 and p = 0.015, respectively). Moreover, 13 patients were given additional treatments between the first and second blood test; however, the additional treatment group was not significantly different in relative FVC change compared to the group with no additional treatment (p = 0.982).ConclusionsIn patients with fibrotic avian HP, the annual changes in serum IgG testing were correlated with FVC changes, highlighting the importance of serum IgG testing over time.

Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities

A competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs' clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known. To identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions. This cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023. Microassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle. The primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence. Among 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range: 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association. In this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.

That's not what my app says: Perceptions of accuracy, consistency, and trust in weather apps

AbstractThe usage of weather apps for forecast information has increased dramatically over the last 10–15 years. Ensuring that consumers value and trust weather apps is important to the integrity of weather forecasting. Public perception of weather app forecast accuracy and consistency undergirds the apps' value and trustworthiness. With app forecasts being interpreted solely by the app user, misunderstanding and consequent false expectations could jeopardize the public's perception of accuracy and consistency. Furthermore, weather apps often offer excessively—and potentially unrealistically—detailed forecasts on time and spatial scales, extending far into the future without sufficient disclaimers regarding the confidence level associated with such detailed forecasts. A survey of the public found perceived app accuracy and consistency to be positively correlated with the trust in an app. Participants indicated that they take at least modest consideration of uncertainty and spatial variability when assessing specific and longer range forecasts. On average, participants had low to moderate confidence in forecasts beyond 10 days, and a significant majority did not perceive a precipitation forecast as inaccurate, even when no rain occurred at their location, as long as it rained nearby. We tested for misinterpretation using a common expression of uncertainty in weather apps, namely probability of precipitation (PoP). A majority of participants made a correct interpretation of the two PoP values given, although, depending on the percentage, some misinterpreted the values as indicating precipitation intensity, totals, or duration. Overall, these findings offer encouragement for a society heavily reliant on weather apps while also encouraging more research on weather information interpretation.

The effects of public health and social measures (PHSM) implemented during the COVID‐19 pandemic: An overview of systematic reviews

AbstractIntroductionTo systematically review the effectiveness and unintended health and socioeconomic consequences of public health and social measures (PHSM) aimed at reducing the scale and risk of transmission of coronavirus disease 2019 (COVID‐19).MethodsThis review followed guidance about overviews of reviews in the Cochrane handbook for systematic reviews of interventions and used the Epistemonikos database's COVID‐19 Living Overview of Evidence repository as a primary search source. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR 2) checklist.ResultsA total of 94 reviews were included, of which eight (9%) had “moderate” to “high” confidence ratings on the AMSTAR 2. Of 16 reviews (17%) reporting applying the GRADE framework, none found high certainty evidence for any of our outcomes of interest. Across the 94 reviews, the most frequently examined PHSM were personal protection (n = 18, 19%). Within multicomponent interventions, so‐called “lockdown” was the most frequently examined component (n = 39, 41%). The most frequently reported outcome category was non‐COVID‐19‐related health outcomes (n = 58, 62%). Only five (5%) reviews reported on socioeconomic outcomes. Findings from the eight reviews with moderate or high confidence ratings on AMSTAR 2 are narratively summarized. There is low‐certainty evidence that multicomponent interventions may reduce the transmission of COVID‐19 in different settings. For active surveillance and response measures, low‐certainty evidence suggests that routine testing of residents and staff in long‐term care facilities may reduce the number of infections, hospitalizations, and deaths among residents. We found very low‐certainty evidence about the effectiveness of personal protection measures, travel‐related control measures, and environmental measures. Unintended consequences were rarely examined by those eight reviews.ConclusionWe found predominantly low‐ to very low‐certainty evidence regarding the effectiveness and unintended consequences of PHSM in controlling the risk and scale of COVID‐19 transmission. There is a need to improve the conduct and reporting of systematic reviews.

Partners' Experiences of Chronic Pain: A Qualitative Evidence Synthesis.

This systematic review of qualitative studies synthesised evidence on the experience chronic pain from the perspective of romantic partners. Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, APA PsycInfo via Ovid, Scopus, and Web of Science databases were searched. Studies exploring the impact of chronic pain from partners' perspectives using qualitative data collection methods were eligible for inclusion. Thematic synthesis was conducted, and confidence in the review findings was assessed using GRADE CERQual criteria. A total of 198 participants were represented from 15 primary studies. Four interconnected analytical themes were developed: 'life is different', 'internal conflict between two worlds', 'togetherness vs separateness', and 'coping in the longer term'. Out of 27 review findings, 9 were assessed as high confidence, 12 as moderate confidence, 4 as low confidence, and 2 as very low confidence. Socially isolated partners, those in strained relationships, and partners who continually sacrificed their own needs were more likely to experience distressing emotions. Greater recognition of partners' needs is needed within pain management services.

Pregnant and postpartum women’s experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BackgroundPregnant and postpartum women’s experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.MethodsA qualitative evidence synthesis of studies relating to women’s experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.ResultsSixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.ConclusionsThe findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis.

Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study

Background In-flight medical emergencies (IMEs) are expected to increase as air travel normalized in the post-COVID-19 era. However, few studies have examined health professions students’ preparedness to respond to such emergencies. Therefore, this study aimed to investigate medical students’ knowledge, confidence, and willingness to assist during an IME in their internship program. Methods This cross-sectional survey utilized an online, self-administered questionnaire-based survey targeted at medical students at two medical colleges in Saudi Arabia. The questionnaire comprised three parts: sociodemographic characteristics, knowledge about aviation medicine (10 items), and confidence (7 items)/willingness (4 items) to assist during an IME. Odds Ratios (OR) and 95% Confidence Intervals (95%CI) were computed to detect potential associations between the knowledge levels and the other independent variables. Responses to confidence and willingness questions were scored on a 5-point Likert scale. Results Overall, 61.4% of participants had inadequate knowledge scores for providing care during an IME, and the proportion of participants did not differ between those who had or had not attended life support courses (60.4% vs. 66.7%, p > 0.99). Only frequency of air travel ≥ two times per year was associated with higher odds of adequate knowledge score [OR = 1.89 (95%CI 1.14–3.17), p = 0.02]. In addition, 93.3% of the participants had low, 6.3% had moderate, and 0.8% had high willingness scores, while 86.3% had low, 12.2% had moderate, and 1.5% had high confidence scores. There were no differences in the proportion of participants with low, moderate, and high willingness or confidence scores by attendance in life support courses. Conclusion Even though over 8 in 10 students in our study had previously attended life support courses, the overwhelming majority lacked the knowledge, confidence, and willingness to assist. Our study underscores the importance of teaching medical students about IMEs and their unique challenges before entering their 7th-year mandatory general internship.

Population genomics provide insight into ancestral relationships and diversity of the feral horses of Theodore Roosevelt National Park.

Theodore Roosevelt National Park (TRNP) manages a herd of feral horses (Equus caballus) which was present on the landscape prior to the establishment of the park. The population presents a unique scenario in that it has experienced fairly intensive and well-documented management since the park's establishment, including herd size reductions, intentional introduction of diversity, and subsequent attempts to remove introduced lineages. This provides an interesting case study on the genetic effects of diverse evolutionary forces on an isolated feral population. To explore the effects of these forces and clarify the relationship of this feral herd with other horses, we used genome-wide markers to examine the population structure of a combined dataset containing common established breeds. Using the Illumina Equine 70k BeadChip, we sampled SNPs across the genome for 118 TRNP horses and evaluated the inbreeding coefficient f and runs of homozygosity (RoH). To identify breed relationships, we compared 23 representative TRNP samples with 792 horses from 35 different breeds using genomic population structure analyses. Mean f of TRNP horses was 0.180, while the mean f for all other breeds in the dataset was 0.116 (SD 0.079). RoH analysis indicates that the TRNP population has experienced recent inbreeding in a timeframe consistent with their management. With Bayesian clustering, PCA, and maximum likelihood phylogeny, TRNP horses show genetic differentiation from other breeds, likely due to isolation, historical population bottlenecks, and genetic drift. However, maximum likelihood phylogeny places them with moderate confidence (76.8%) among draft breeds, which is consistent with the known history of breeds used on early North Dakota ranches and stallions subsequently introduced to the park herd. These findings will help resolve speculation about the origins of the herd and inform management decisions for the TRNP herd.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.