Preferred Reporting Items For Systematic Reviews And Meta-Analyses Statement Research Articles

Salt Marsh Soil Organic Carbon is Regulated by Drivers of Microbial Activity

Abstract Soil organic carbon is the foundation for soil health and a livable climate. Organic carbon is concentrated in coastal wetland soils, but dynamics that govern carbon persistence in coastal ecosystems remain incompletely understood. Whether microbial activity results in a gain or loss of carbon depends on environmental conditions that regulate microbial community attributes. We sought to identify which drivers of microbial activity have the greatest impact on organic carbon content in salt marsh soils. To address this question, we used the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) Statement to compile data on soil and ecosystem characteristics from 50 studies of over 60 salt marshes located around the world. We conducted a meta-analysis with structural equation modeling, including mediation and moderation analyses, to identify environmental drivers of salt marsh soil organic carbon content. High salinity, pH, nitrogen, and phosphorus were associated with increased microbial biomass carbon and soil organic carbon. Correlations between microbial biomass and organic carbon were strengthened by soil salinity and nitrogen, and weakened by soil water content. These results suggest that environmental conditions that control microbial growth and activity have potential to preserve or degrade organic carbon in salt marsh soils.

Epigenetic and Coping Mechanisms of Stress in Affective Disorders: A Scoping Review

This review aims to explore the intricate relationship among epigenetic mechanisms, stress, and affective disorders, focusing on how early life experiences and coping mechanisms contribute to susceptibility to mood disorders. Epigenetic factors play a crucial role in regulating gene expression without altering the DNA (deoxyribonucleic acid) sequence, and recent research has revealed associations between epigenetic changes and maladaptive responses to stress or psychiatric disorders. A scoping review of 33 studies employing the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Statement) guidelines investigates the role of stress-induced epigenetic mechanisms and coping strategies in affective disorder occurrence, development, and progression. The analysis encompasses various stress factors, including childhood trauma, work-related stress, and dietary deficiencies, alongside epigenetic changes, such as DNA methylation and altered gene expression. Findings indicate that specific stress-related genes frequently exhibit epigenetic changes associated with affective disorders. Moreover, the review examines coping mechanisms in patients with bipolar disorder and major depressive disorder, revealing mixed associations between coping strategies and symptom severity. While active coping is correlated with better outcomes, emotion-focused coping may exacerbate depressive or manic episodes. Overall, this review underscores the complex interplay among genetic predisposition, environmental stressors, coping mechanisms, and affective disorders. Understanding these interactions is essential for developing targeted interventions and personalized treatment strategies for individuals with mood disorders. However, further research is needed to elucidate specific genomic loci involved in affective disorders and the clinical implications of coping strategies in therapeutic settings.

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review.

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

Adherence to PRISMA 2020 reporting guidelines and scope of systematic reviews published in nursing: A cross-sectional analysis.

Systematic reviews are considered the highest level of evidence that can help guide evidence-informed decisions in nursing practice, education, and even health policy. Systematic review publications have increased from a sporadic few in 1980s to more than 10,000 systematic reviews published every year and around 30,000 registered in prospective registries. A cross-sectional design and a variety of data sources were triangulated to identify the journals from which systematic reviews would be evaluated for adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines and scope. Specifically, this study used the PRISMA 2020 reporting guidelines to assess the reporting of the introduction, methods, information sources and search strategy, study selection process, quality/bias assessments, and results and discussion aspects of the included systematic reviews. Upon review of the 215 systematic reviews published in 10 top-tier journals in the field of nursing in 2019 and 2020, this study identified several opportunities to improve the reporting of systematic reviews in the context of the 2020 PRISMA statement. Areas of priority for reporting include the following key areas: (1) information sources, (2) search strategies, (3) study selection process, (4) bias reporting, (5) explicit discussion of the implications to policy, and lastly, the need for (6) prospective protocol registration. The use of the PRISMA 2020 guidelines by authors, peer reviewers, and editors can help to ensure the transparent and detailed reporting of systematic reviews published in the nursing literature. Systematic reviews are considered strong research evidence that can guide evidence-based practice and even clinical decision-making. This paper addresses some common methodological and process issues among systematic reviews that can guide clinicians and practitioners to be more critical in appraising research evidence that can shape nursing practice.

Safety and effectiveness of butorphanol in epidural labor analgesia: A protocol for a systematic review and meta-analysis.

Epidural analgesia is the most effective analgesic method during labor. Butorphanol administered epidurally has been shown to be a successful analgesic method during labor. However, no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor. To assess butorphanol's safety and efficacy for epidural labor analgesia. The PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure, and Google Scholar databases will be searched from inception. Other types of literature, such as conference abstracts and references to pertinent reviews, will also be reviewed. We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor. There will be no language restrictions. The primary outcomes will include the visual analog scale score for the first stage of labor, fetal effects, and Apgar score. Two independent reviewers will evaluate the full texts, extract data, and assess the risk of bias. Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot, and heterogeneity will be evaluated using the Cochran Q test, P values, and I2 values. Meta-analysis, subgroup analysis, and sensitivity analysis will be performed using RevMan software version 5.4. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols statement, and the PRISMA statement will be used for the systematic review. This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor. To support clinical practice and development, this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Subjective caregiver burden and coping in family carers of dependent adults and older people: A systematic review and meta-analysis.

Subjective caregiver burden is highly prevalent in family caregivers. Despite several studies investigating the relationship between subjective caregiver burden and coping strategies, results remain inconsistent. The aim of our study was to systematically review current literature on the relationship between subjective caregiver burden and coping in family carers of dependent adults and older people. A secondary objective was to analyse possible sources of heterogeneity in the estimated effect. The study design was a systematic review with meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines. We searched several international databases (CINAHL, LILACS, PsycINFO and PubMed) up to February 2024. We performed several subgroup analyses to examine whether study design, methodological quality or care recipient dependency influenced results. Of the 1064 records identified in our search, a total of 80 studies met inclusion criteria. We found a significant association between greater use of dysfunctional coping and higher levels of subjective caregiver burden ( =0.400; 95% CI=0.315, 0.478); higher use of second-order active coping was significantly associated with lower caregiver burden ( =-0.213; 95% CI=-0.316, -0.105). Problem-focused coping showed no statistically significant association with levels of subjective burden; emotion-focused coping was associated with caregiver burden only after controlling for confounding variables ( =-0.258; 95% CI=-0.441, -0.055); several individual strategies of this dimension such as acceptance ( =-0.135; 95% CI=-0.238, -0.028), positive reappraisal ( =-0.178; 95% CI=-0.255, -0.099) and religious coping ( =-0.083; 95% CI=-0.162, -0.002), were associated with lower burden. We found that several dimensions of coping strategies are significantly associated with levels of subjective caregiver burden experienced by carers. These results can inform future research evaluating the effectiveness of interventions aimed at improving carers' mental health.

The candidate proteins associated with keratoconus: A meta-analysis and bioinformatic analysis.

Keratoconus (KC) is a multifactorial disorder. This study aimed to conduct a systematic meta-analysis to exclusively explore the candidate proteins associated with KC pathogenesis. Relevant literature published in the last ten years in Pubmed, Web of Science, Cochrane, and Embase databases were searched. Protein expression data were presented as the standard mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis is registered on PROSPERO, registration number CRD42022332442 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA). GO and KEGG enrichment analysis were performed, as well as the miRNAs and chemicals targeting the candidate proteins were predicted. PPI was analyzed to screen the hub proteins, and their expression was verified by RT-qPCR. A total of 21 studies were included in the meta-analysis, involving 346 normal eyes and 493 KC eyes. 18 deregulated proteins with significant SMD values were subjected to further analysis. In which, 7 proteins were up-regulated in KC compared with normal controls, including IL6 (SMD 1.54, 95%CI [0.85, 2.24]), IL1B (SMD 2.07, 95%CI [0.98, 3.16]), TNF (SMD 2.1, 95%CI [0.24, 3.96]), and MMP9 (SMD 1.96, 95%CI [0.68, 3.24]). While 11 proteins were down-regulated in KC including LOX (SMD 2.54, 95%CI [-4.51, -0.57]). GO and KEGG analysis showed that the deregulated proteins were involved in inflammation, extracellular matrix (ECM) remodeling, and apoptosis. MMP9, IL6, LOX, TNF, and IL1B were regarded as hub proteins according to the PPI analysis, and their transcription changes in stromal fibroblasts of KC were consistent with the results of the meta-analysis. Moreover, 10 miRNAs and two natural polyphenols interacting with hub proteins were identified. This study obtained 18 candidate proteins and demonstrated altered cytokine profiles, ECM remodeling, and apoptosis in KC patients through meta-analysis and bioinformatic analysis. It will provide biomarkers for further understanding of KC pathogenesis, and potential therapeutic targets for the drug treatment of KC.

ENTREPRENEURSHIP COMPETENCY MODEL FOR POLITICS AND LAW MAJORS: A SYSTEMATIC LITERATURE REVIEW

In terms of the clarification of the entrepreneurship competency, many entrepreneurship competency models have been built up focusing on what the specific competencies should be included and cultivated. Regarding the heterogeneity in the entrepreneurship competency models in different levels of teaching institutions and for different majors, an in-depth systematic literature review (SLR) of the entrepreneurship competency model from the year 2013 to 2023 was conducted with the purpose to identify the entrepreneurship competencies and construct a conceptual entrepreneurship competency model conform to the characteristics of vocational colleges of political science and law. Pre-defined review protocol with keywords searching strategy and the inclusion/exclusion criteria for the review are clearly established during the review of the databases. After carefully selection process，thirteen out of 893 articles that met the inclusion-exclusion measures were selected for this SLR. Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement (PRISMA) are demonstrated in the literature review reporting.This review serves the aim of presenting state of the study results, based on which a conceptual entrepreneurship competency model including aspects of knowledge, skill, thinking ability, personality and humanistic quality is identified and proposed for the politics and law majors.

Etiological Factors Affecting Female Sexuality: A Systematic Review

Introduction: Evidence suggests that masturbation, genital stimulation, body awareness and movement, pelvic floor exercises, depression, anxiety, positive and negative feelings, personality type, emotional and overall well-being and emotional intelligence have been studied in association with female orgasm through the years. Additionally, healthcare providers of sexual health and most women lack information regarding sexual satisfaction and reaching orgasm. Few studies have addressed this issue. Aim: To systematically study the effect of social, behavioral, and psychological factors on female orgasm. Methods: An extensive search was conducted in PubMed, CINAHL, Google Scholar and Scopus, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA) guidelines, for relevant articles published between June 2002 and June 2022. Studies in languages other than English were excluded. The following Medical Subject Headings (MeSH) terms were used: female, orgasm, psychological, behavioral, social, sexual. Inclusion criteria concerned studies that sampled adult healthy women, used quantitative methodology and explored factors influencing sexual satisfaction. Results: Out of 531 studies, forty-five were further screened. A total of twenty-one studies were reviewed, most of which were conducted in the USA, Portugal and the United Kingdom. They were followed by Switzerland, Iran, Brazil, Sweden, Canada, Hungary and the Netherlands. Four major themes influencing female sexual satisfaction emerged from the synthesis: psychological disorders, psychological background, genital stimulation, body awareness and movement. Conclusions: The female orgasm was influenced by a number of factors, some of which adversely affected it.

Trauma outcomes at higher-level trauma centres compared with lower-level trauma centres: a systematic review and meta-analysis

The introduction of trauma systems has helped reduce mortality in severely injured patients. This fall in mortality, however, appears to be concentrated in higher-level trauma centres (TCs) in comparison to lower-level TCs, but the evidence is inconsistent. Therefore, we undertook a systematic review with the aim of comparing outcomes in lower-level TCs (i.e. level III and IV trauma centres) with higher-level TCs (i.e. level I and II centres). This systematic review was performed in accordance with the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). The review was registered on PROSPERO (CRD42019111933). Mortality data were combined using the Mantel-Haenszel random-effects method for meta-analysis, using Review Manager (RevMan v5.3.5). We found 28 eligible articles from an initial total of 10,816 identified abstracts. Our meta-analysis revealed no evidence of a difference in mortality risk in severely injured patients between lower-level and higher-level TCs (RR 1.55; 95% CI 0.97 to 2.50; p=0.07), but there was considerable heterogeneity (I2=92%) in the dataset. The risk of death in lower-level TCs in patients with neurological trauma, however, was statistically lower than in higher-level TCs (RR 0.80; 95% CI 0.73 to 0.86; I2=78%; p<00001). There was a higher risk of death in patients with neurological trauma managed at higher-level TCs and this is likely to be due to the higher severity of injury (intracranial and extracranial) sustained by patients at higher-level TCs. However, the high level of heterogeneity in the risk estimates of evaluated studies reduces the certainty of our interpretations.

Exploring the Prevalence and Characteristics of Obstructive Sleep Apnea Among Idiopathic Pulmonary Fibrosis Patients: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to scrutinize the prevalence, characteristics, and outcomes of obstructive sleep apnea (OSA) in individuals with ideopathic pulmonary fibrosis (IPF). We carried out this systematic review and meta-analysis in accordance with the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Two independent researchers systematically searched major databases, including MEDLINE/PubMed, EMBASE, and the Cochrane Library, from January 1, 2000, until December 31, 2023. We included all studies involving adult patients (age >18 years) with IPF that assessed the prevalence and characteristics of OSA in IPF patients. A total of seven studiesinvolving a pooled sample of 411 patientswere included in this meta-analysis. The pooled prevalence of OSA among individuals with IPF was found to be 70% (95% CI: 59 to 82%). Individuals with OSA exhibited a significantly higher mean body mass index (BMI) compared to their counterparts. While individuals with both IPF and OSA exhibited higher scores on the Epworth Sleepiness Scale (ESS) compared to those with IPF alone, the OSA group also showed lower oxygen saturation during sleep in comparison to non-OSA patients. In summary, OSA is a prevalent coexisting condition among individuals with IPF. This presence could worsen the nighttime oxygen saturation. Consequently, there is a need for more extensive studies involving more uniform participant groups.

Obstetric fistula repair failure and its associated factors among women who underwent repair in sub-Saharan Africa. A systematic review and meta-analysis.

Obstetric fistula repair failure can result in increased depression, social isolation, financial burden for the woman, and fistula care programs. However, there is limited, comprehensive evidence on obstetric fistula repair failure in Sub-Saharan African countries. This systematic review and meta-analysis aimed to determine the pooled prevalence of obstetric fistula repair failure and associated factors among women who underwent surgical repair in Sub-Saharan African countries. To identify potential articles, a systematic search was done utilizing online databases (PubMed, Hinari, and Google Scholar). The Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA) guideline was used to report the review's findings. I2 test statistics were employed to examine study heterogeneity. A random-effects model was used to assess the pooled prevalence of obstetric fistula repair failure, and the association was determined using the log odds ratio. Publication bias was investigated using the funnel plot and Egger's statistical test at the 5% level of significance. Meta-regression and subgroup analysis were done to identify potential sources of heterogeneity. The data were analyzed using STATA version 17 statistical software. A total of 24 articles with 9866 study participants from 13 Sub-Saharan African countries were included in this meta-analysis. The pooled prevalence of obstetric fistula repair failure in sub-Saharan Africa was 24.92% [95% CI: 20.34-29.50%]. The sub-group analysis by country revealed that the highest prevalence was in Angola (58%, 95% CI: 53.20-62.80%) and the lowest in Rwanda (13.9, 95% CI: 9.79-18.01%). Total urethral damage [OR  =  3.50, 95% CI: 2.09, 4.91], large fistula [OR = 3.09, 95% CI: (2.00, 4.10)], duration of labor [OR = 0.45, 95% CI: 0.27, 0.76], and previous fistula repair [OR = 2.70, 95% CI: 1.94, 3.45] were factors associated with obstetric fistula repair failure. Women who received surgical treatment for obstetric fistulas in Sub-Saharan African countries experienced more repair failures than the WHO standards. Obstetric fistula repair failure was affected by urethral damage, fistula size, duration of labor, types of fistula, and history of previous repairs. Therefore, we suggest policy measures specific to each country to provide special attention to the prevention of all risk factors, including poor nutrition, multiparty, obstructed labor, and maternal age, which can result in conditions like large fistulas, urethral damage, and repeat repair, in order to reduce obstetric fistula repair failure.

Probiotics for functional constipation in children: an overview of overlapping systematic reviews.

This overview of systematic reviews (SRs) and meta-analysis (MAs) aimed to systematically collate, appraise and synthesize evidence of probiotics for functional constipation (FC) in children. SRs/MAs of probiotics for FC in children were systematic identified by searching Cochrane Library, PubMed, Embase, and Web of science. Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were unitized by two reviewers independently to assess the methodological quality, reporting quality, and quality of evidence, respectively. Seven SRs/MAs met the eligibility criteria and were included in this study. According to AMSTAR-2, a very low methodological quality assessment was given to the included SRs/MAs due to the limitations of items 2, 4 and 7. For the PRISMA statement, the overall quality of reporting was unsatisfactory due to the lack of reporting on protocol, risk of bias across studies, synthesis of results, and additional analysis. According to GRADE, the quality of evidence for outcomes was rated as very low to moderate. Probiotics may be beneficial in improving FC in children. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs/MAs are needed to provide robust evidence for definitive conclusions.

Needs for mobile and internet-based psychological intervention in patients with self-injury and suicide-related behaviors: a qualitative systematic review

BackgroundIn recent years, mobile psychological interventions have proven effective in reducing self-injury and suicide-related behaviors. Therefore, it is essential to continually enhance the user experience and address patients' needs to facilitate the development of mobile mental health interventions. Identifying patients with mobile mental health needs can be challenging for mental health professionals. To address this, we conducted a systematic review of qualitative research to synthesize the needs of patients engaged in self-injury and suicide-related behaviors for mobile and internet-based psychological interventions.MethodsThis study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement (ENTREQ). We explored 11 databases and synthesized the results using thematic analysis.ResultsSixteen qualitative and mixed-method studies were included. The study found that the needs of patients with self-injury and suicide-related behaviors for mobile psychological intervention included therapy, technology, culture, privacy, communication, emotional support, personalization, and self-management. Consistent with the Technology Acceptance Model (TAM), the needs of patients with self-injury and suicide-related behaviors are influenced by the perceived ease of use and perceived usefulness of the mobile intervention. However, the findings also highlight the importance and unmet needs of peer support, communication, self-management, and empowerment in using mobile psychological interventions for patients with self-injury and suicide-related behaviors.ConclusionsStudies in this area have shown that the needs of patients with self-harm and suicide-related behaviors cover multiple stages, including basic therapeutic and technical needs and advanced emotional needs. This complexity makes it challenging to address the needs of patients engaged in self-injury and suicide-related behaviors through digital interventions. In the future, mental health professionals should be encouraged to participate in multidisciplinary collaborations to expand the use of digital interventions, enhancing remote self-management for patients and providing new strategies for the ongoing care of psychiatric patients.We registered the review protocol on PROSPERO (CRD42022324958).

Anterolateral augmentation procedures during anterior cruciate ligament reconstructions in skeletally immature patients: Scoping review of surgical techniques and outcomes.

Graft failure rates after anterior cruciate ligament reconstruction (ACLR) in children and adolescents are higher compared to adults. Anterolateral augmentation procedures have recently generated increased focus regarding their ability to reduce graft failure rates. Concerns in skeletally immatures are potential growth disturbances and overconstraint after anterolateral augmentation. The aim of this scoping review is to provide an overview of all current anterolateral augmentation procedures in skeletally immature patients and to discuss surgical techniques, clinical and biomechanical outcomes. This scoping review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement extension for scoping reviews. On 22December 2022, an information specialist performed a systematic literature search in Cochrane, PubMed (Medline) and EMBASE databases. Inclusion criteria were anterolateral augmentation procedures, including lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), in combination with ACLR in skeletally immatures. Twenty studies were included after screening 1.485 abstracts. Seventeen studies describe LET techniques, four studies ALLR techniques and one study both techniques. Biomechanical data is scarce and shows conflicting results. Two studies compared ACLR with LET to ACLR in skeletally immatures with promising results in favour of the combined procedure. There were no differences in outcomes between LET and ALLR. Several LET and ALLR techniques have been described for skeletally immature patients and the first clinical data on LET and ALLR is available, which showed promising results. Further research is necessary to evaluate the risk of growth disturbances and overconstraint in skeletally immatures. Level IV.

Clinical and radiological outcomes and analysis of failures of modular revisions stems at long-term follow-up: a systematic review and meta-analysis.

Increasingly hip replacements at young age exposes the patient to an increased risk of failure of the implant over the years. In case of failure, revision specific stems were designed to overcome bone loss. Modularity of these devices is an important resource for the surgeon as they allow the new implant to be better adapted to the patient's anatomy. The purpose of this systematic review is to provide data about the outcome at long-term follow-up (>8 years) of hip modular revision femoral stems. This systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. PubMed and Google Scholar databases were systematically and independently searched, according to the inclusion and exclusion criteria. Two reviewers performed the data extraction independently. In case of disagreement, the senior authors were sought to resolve the divergences. Quality of the involved studies was evaluated with National Institute for Health and Care Excellence (NICE) guidelines (eight-item list) and the Newcastle-Ottawa scale (NOS). Primary and secondary outcomes were evaluated. The statistical analysis of this meta-analysis was performed by using Excel Microsoft and the software STATA. The primary outcome was the re-revision rate of modular revision stems at long-term follow-up. It ranged from 1.4% to 45.6%: random effect pooled estimate was 5.5% [95% confidence interval (CI): 4% to 7%], with a I2 of 12.3% (P=0.332). Mean Harris Hip Score (HHS) was 83 [min: 79; max: 87.6; standard deviation (SD): 3.55]. Secondary evaluated outcomes were: subsidence >5 mm, rate of periprosthetic infection or fractures (intra- and post-operative) and dislocations. The mean value for the NICE tool was 5.5 (SD: 1.13) and 7.3 (SD: 0.79) for the NOS tool. The survival rate was >90% at long-term follow-up (min: 60%; max: 97%). The modular femoral revision stems have demonstrated good long-term reliability and efficacy. This meta-analysis demonstrates that the re-revision rate after 8 years of follow-up is low and 90% of the implants did not fail.

Application of artificial intelligence in the assessment of thyroid eye disease (TED) - a scoping review.

There is emerging evidence which suggests the utility of artificial intelligence (AI) in the diagnostic assessment and pre-treatment evaluation of thyroid eye disease (TED). This scoping review aims to (1) identify the extent of the available evidence (2) provide an in-depth analysis of AI research methodology of the studies included in the review (3) Identify knowledge gaps pertaining to research in this area. This review was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). We quantify the diagnostic accuracy of AI models in the field of TED assessment and appraise the quality of these studies using the modified QUADAS-2 tool. A total of 13 studies were included in this review. The most common AI models used in these studies are convolutional neural networks (CNN). The majority of the studies compared algorithm performance against healthcare professionals. The overall risk of bias and applicability using the modified Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool led to most of the studies being classified as low risk, although higher deficiency was noted in the risk of bias in flow and timing. While the results of the review showed high diagnostic accuracy of the AI models in identifying features of TED relevant to disease assessment, deficiencies in study design causing study bias and compromising study applicability were noted. Moving forward, limitations and challenges inherent to machine learning should be addressed with improved standardized guidance around study design, reporting, and legislative framework.

The Effects of Acetazolamide on Cerebral Hemodynamics in Adult Patients with an Acute Brain Injury: A Systematic Review.

Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the regulation of cerebral blood flow (CBF). The aim of this review was to understand the effects of acetazolamide on CBF, intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) after an acute brain injury (ABI). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), we performed a comprehensive, computer-based, literature research on the PubMed platform to identify studies that have reported the effects on CBF, ICP, or PbtO2 of acetazolamide administered either for therapeutic or diagnostic purposes in patients with subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, and hypoxic-ischemic encephalopathy. From the initial search, 3430 records were identified and, through data selection, 11 of them were included for the qualitative analysis. No data on the effect of acetazolamide on ICP or PbtO2 were found. Cerebral vasomotor reactivity (VMR-i.e., the changing in vascular tone due to a vasoactive substance) to acetazolamide tends to change during the evolution of ABI, with the nadir occurring during the subacute stage. Moreover, VMR reduction was correlated with clinical outcome. This systematic review showed that the available studies on the effects of acetazolamide on brain hemodynamics in patients with ABI are scarce. Further research is required to better understand the potential role of this drug in ABI patients.

A Systematic Review and Meta-Analysis to Evaluate Hydroxyurea at Escalated Dose Versus Fixed Low-Dose Hydroxyurea in Adults with Sickle Cell Disease

Introduction Hydroxyurea (HU), standard therapy for children and adults with severe sickle cell disease (SCD) in resource-rich countries, reduces the frequency of vaso-occlusive complications, increases hemoglobin, and decreases mortality. While guidelines recommend escalating HU to maximum tolerated dose (MTD), use of fixed low and moderate doses of HU are common in low resource countries. HU at MTD is superior to fixed moderate-dose HU in decreasing vaso-occlusive complications, hospitalizations, and blood transfusions in young children with SCD but has not been compared with fixed low or moderate doses in adults. We conducted a systematic review and meta-analysis to evaluate the efficacy of escalated dose HU versus fixed low-dose HU in adults with SCD. Methods This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), to evaluate if clinical and laboratory outcomes differ between SCD patients treated with HU administered with an escalated versus fixed low-dose strategy. Primary outcomes included vaso-occlusive crisis (VOC), acute chest syndrome, hospitalizations, blood transfusions, and stroke. Secondary outcomes included hemoglobin concentration, fetal hemoglobin (HbF), absolute neutrophil count (ANC), reticulocyte count, and platelet count. Literature search was conducted in PubMed, Embase, Cochrane, and Scopus and included peer-reviewed quantitative studies published from 1995 to 2020. Abstracts and full text articles were reviewed to identify articles that met inclusion criteria. Following the initial search, 2524 citations were retrieved and screened using Rayyan, a web-based software designed to conduct and coordinate systematic literature reviews. After eliminating 385 duplicates, 2139 citations remained. Seventeen full-text articles were then assessed for eligibility, of which 10 were included in the quantitative synthesis. Blinded co-authors used Rayyan to independently check the titles and abstracts based on pre-decided exclusion criteria. This was followed by a full text review of selected articles, and any conflicts were resolved by consensus. Data were systematically extracted using a standardized spreadsheet customized for the study. Average effects across studies were estimated using means for fixed-effect meta-analysis. We calculated the difference in means: MD i = m 1 i - m 2 i with standard errors. The significance of the overall effect (escalated and fixed low-dose) combined was tested using Z tests and group differences between escalated and fixed doses were compared using chi-squared tests. Analyses were conducted in Review Manager (RevMan) version 5.3. Results Ten studies were included in the quantitative synthesis - 5 evaluated the effect of HU at escalated dose and 5 evaluated fixed low-dose HU. The average daily doses of HU in the low fixed-dose and escalated dose studies were ~10 mg/kg and 22 mg/kg, respectively. Available primary and secondary outcome data for HU at escalated and fixed low-doses from eligible studies are summarized in Table 1. There was no difference in the estimate of VOC crisis rate between the escalated dose and fixed low-dose studies (p=0.73). The mean difference in hemoglobin from baseline to follow-up was greater for fixed low-dose than escalated dose studies (1.07 g/dL vs. 0.54 g/dL, p=0.01). The mean decrease in ANC from baseline to follow-up was greater for escalated dose than low fixed-dose studies (-2.28 [x10 9/L] vs. -1.00 [x10 9/L], p=0.003). No difference was seen in the mean estimate of fetal hemoglobin between escalated dose and fixed low-dose studies. Conclusions Meta-analysis of escalated and fixed low-dose HU showed no significant differences in VOC rate, although the mean difference in hemoglobin was greater for fixed low-dose studies. Comparison of effects between escalated and fixed low-dose HU on acute chest syndrome, hospitalizations, blood transfusion and stroke were not performed due to lack of data. Based on these limited findings, there appears to be clinical equipoise regarding the most appropriate HU dosing regimen to decrease vaso-occlusive complications in adults with SCD. A controlled clinical trial comparing escalated versus low fixed-dose HU in adults with SCD is necessary in low- and middle-income countries where fixed low-dose HU is commonly administered.

Digital Transformation in Public Administration: A Systematic Literature Review

Purpose:  This study aims to conduct a systematic review of the literature on the issue of digital transformation in public administration   Theoretical framework:  The impact of digital transformation on public administration and the concepts of digitization, digitalization, and digital transformation.   Design/methodology/approach:  The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was used to guide this search, based on the databases of the most important article sources (Web of Science, ScienceDirect ...)   Findings:  The results of the literature analysis on digitalization in the public sector indicate a focus on exploratory research, examining the impact of digitization and highlighting agents of change such as entrepreneurship and policy entrepreneurs. The analysis covers the major benefits of government digitalization, criteria for technology adoption, and the COVID-19 outbreak's role in accelerating digital transformation.   Research, Practical & Social implications:  The study offers valuable insights into the current state of digitalization in the public sector and can guide future strategies for policymakers and public sector managers. This study provides practical implications for the successful implementation of digital technologies, enhancing transparency, efficiency, and accountability. Moreover, the research has important social implications, as it reveals the potential for digital governance to foster citizen engagement and participation. Overall, the study's findings provide a useful framework for understanding the benefits and challenges of digital transformation in public administration.   Originality/value:  The study adds to the existing body of knowledge on digitalization in the public sector. The study's systematic approach provides a comprehensive overview of the literature, highlighting gaps in the current research and offering new avenues for future research.