Variations In Design Research Articles

Evaluating the Efficacy and Safety of Hepatitis E Vaccination in Reproductive-Age Women: A Systematic Review and Meta-Analysis.

Hepatitis E virus (HEV) infection presents a significant health risk in endemic regions, especially for pregnant women, who face higher risks of severe complications, including maternal and fetal mortality. The recombinant HEV vaccine, HEV239, has demonstrated high efficacy in the general population, yet data on its safety and efficacy in women of a childbearing age remain limited. This systematic review and meta-analysis aim to evaluate the safety and effectiveness of HEV239 in this specific population, with a focus on pregnancy-related outcomes. A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported outcomes on HEV239's safety or efficacy in women of childbearing age, with data being extracted and analyzed for immunogenicity, HEV incidence, and maternal adverse events. The risk of bias was assessed using the Cochrane and Newcastle Ottawa Scales, and a random-effects meta-analysis was performed. Three studies, enrolling over 23,000 participants, were included in the current systematic review, with two meeting the criteria for meta-analysis. HEV239 demonstrated high efficacy in preventing hepatitis E infection, with no significant increase in adverse pregnancy outcomes such as stillbirth or elective termination. However, there was an elevated risk of miscarriage (odds ratio [OR], 1.60; 95% confidence interval [CI], 0.99-2.57). The analysis revealed high heterogeneity for miscarriage outcomes (I2 = 67%), reflecting variability in study designs and populations. HEV239 is effective in preventing HEV infection among women of childbearing age, although caution is advised when administering the vaccine near conception due to potential miscarriage risks. Future studies should focus on understanding the biological mechanisms and timing-specific safety to guide vaccination recommendations.

Evaluation of the initial rollout of the physical activity referral standards policy in Scotland: a qualitative study

ObjectivesPhysical activity referral schemes (PARS) allow healthcare professionals to refer patients for physical activity support. Evidence of effectiveness is equivocal. Public Health Scotland has developed ‘physical activity referral standards’ that...

Pelvic floor muscle training after childbirth: A systematic review

Introduction: the training of pelvic floor muscles is a recommended strategy to improve the quality of life in postpartum women, addressing common issues such as urinary incontinence and pelvic organ prolapse. This systematic review evaluated the effectiveness of various interventions, including supervised programs, biofeedback, electrical stimulation, and core stabilization exercises.Methods: thirteen studies were identified through searches in PubMed, Cochrane, and Google Scholar. Results: the results indicated that supervised interventions, especially those supported by technologies like mobile applications and feedback devices, show significant improvements in muscle strength, symptom reduction, and quality of life, outperforming unsupervised methods. However, some studies did not find significant differences in aspects such as pain relief or prolapse recovery, highlighting the importance of personalizing protocols. Additionally, variability in study designs and methodologies limits the generalization of the findings. Conclusions: supervised pelvic floor training, complemented by innovative technologies, is an effective tool for postpartum rehabilitation. However, it is necessary to standardize protocols and evaluate long-term effects to optimize future interventions.

To protect and serve: a review of initiatives to support of police officers to better meet the needs of older adult

PurposePolice officers increasingly respond to incidents involving aging-related issues, where older adults are vulnerable and require tailored approaches. This scoping review aims to map initiatives aimed at enhancing interactions between older adults and police and evaluates outcomes. Findings inform the development of a geriatrics-focused police training curriculum to support age-friendly policing. A literature search across major databases and grey literature yielded 20 relevant publications. Three main initiatives were identified: geriatrics-oriented training programs, specialized geriatric police units and geriatrics-oriented policing guidelines. These insights highlight effective strategies for improving police responses to aging-related challenges and guide future research and policy in this domain.Design/methodology/approachThe study employed a scoping review methodology guided by the Joanna Briggs Institute Manual and PRISMA-ScR checklist. A comprehensive search strategy was developed and executed across multiple databases and grey literature sources. Screening and selection of relevant studies were conducted in duplicate, with data extraction focusing on key elements such as study objectives, design, interventions and outcomes. Thematic analysis was employed to synthesize findings from included studies, highlighting three principal initiatives: geriatrics-oriented training programs, specialized geriatric police units and geriatrics-oriented policing guidelines. This approach aimed to map existing evidence, inform the development of a geriatrics-focused training curriculum and identify best practices for age-friendly policing.FindingsThe scoping review identified 28 studies meeting inclusion criteria. Findings highlighted varied approaches to enhancing police interactions with older adults, emphasizing training as pivotal. Effective strategies included specialized units, tailored training programs and guidelines integrating geriatrics principles. Key outcomes encompassed improved officer knowledge, communication skills and attitudes toward older adults, fostering enhanced service delivery and community relations. Evidence underscored the importance of ongoing education and collaborative partnerships in optimizing policing responses to aging populations, advocating for sustainable, age-friendly policing practices.Research limitations/implicationsThe review’s limitations stem from primarily English-language studies, potentially overlooking non-English literature. Variability in study designs and outcomes poses challenges to synthesizing findings comprehensively. Limited generalizability may result due to geographic and cultural differences in policing practices. Future research could benefit from longitudinal studies assessing long-term impacts and broader inclusion of diverse policing contexts and perspectives, enhancing applicability and depth of understanding in optimizing police interactions with older adults.Practical implicationsPractical implications include informing policy makers and law enforcement agencies about effective strategies to enhance interactions with older adults, emphasizing communication skills and de-escalation techniques. Training programs should integrate age-sensitive approaches to improve officers’ awareness and response to older adults’ needs and vulnerabilities. Implementing community engagement initiatives can foster trust and cooperation, contributing to safer and more supportive environments for older adults in policing interactions. These efforts can ultimately promote enhanced well-being and reduced conflicts between law enforcement and older adults.Social implicationsSocial implications highlight the need for broader societal awareness and education regarding the challenges faced by older adults in interactions with law enforcement. Addressing ageism and promoting respectful treatment can enhance community trust and reduce misunderstandings. Improved interactions between older adults and law enforcement can foster a more inclusive and supportive society, ensuring that older adults feel valued and protected. This can contribute to overall social cohesion and a more equitable experience for older adults in their interactions with law enforcement agencies.Originality/valueThe originality of this study lies in its focus on the intersection of age-related issues and law enforcement interactions, a relatively underexplored area in both gerontology and criminal justice research. By examining the perceptions and experiences of older adults and law enforcement officers, it provides valuable insights into mitigating ageism and improving interactions. The study’s findings contribute to enhancing understanding of how to promote respectful and effective communication between these groups, thereby offering practical implications for policy and training initiatives aimed at fostering better relationships and outcomes for older adults in law enforcement encounters.

Nutritional interventions in depression: The role of vitamin D and omega-3 fatty acids in neuropsychiatric health.

Depression is a pervasive mental health disorder with complex etiologies involving neurotransmitter imbalances, inflammation, and hormonal dysregulation. Emerging evidence highlights the significance of nutritional interventions in improving depressive symptoms. This review explores the mechanisms of action and clinical applications of Vitamin D and Omega-3 fatty acids in managing depression, providing insights into their potential therapeutic roles. A comprehensive search was conducted across databases, including PubMed, Scopus, Web of Science, and PsycINFO. Keywords such as "depression," "Vitamin D," "Omega-3 fatty acids," "nutritional psychiatry," and "mental health" were employed. Articles were selected based on relevance, methodology, and contribution to the understanding of nutritional interventions in depression. Observational studies, randomized controlled trials, and meta-analyses were prioritized, while non-peer-reviewed sources were excluded. Vitamin D modulates neurotransmitter activity, reduces neuroinflammation, and influences neuroplasticity, enhancing cognitive function and mood regulation. Omega-3 fatty acids, particularly EPA and DHA, exhibit anti-inflammatory properties, optimize serotonergic transmission, and stabilize neuronal membranes. Clinical evidence suggests that supplementation with these nutrients can significantly reduce depressive symptoms, particularly in patients with comorbid nutritional deficiencies. However, variability in study designs and dosages limits the generalizability of findings. Integrating Vitamin D and Omega-3 supplementation into mental health care holds promise as an adjunctive strategy for treating depression. However, limitations in existing studies, including heterogeneity in study design and dosage, warrant further investigation.

Vitamin D Supplementation in Critically Ill-Narrative Review.

Studies have shown a high prevalence of vitamin D deficiency in critically ill patients, and these patients are at higher risk for pneumonia and have increased incidence of sepsis and mortality. In this study, we reviewed available literature from randomized controlled trials (RCTs) on vitamin D supplementation in critically ill patients and summarized the evidence in this narrative review. Randomized controlled trials that included vitamin D supplementation as an intervention were eligible for inclusion. No limits were set regarding vitamin D dosage or route of administration, as well as for primary and secondary outcomes. A search was conducted in MEDLINE via PubMed for eligible RCTs. References from systematic reviews (SRs) and meta-analyses (MAs) were screened, and Clinicaltrials.gov was searched for ongoing studies. A total of 21 RCTs involving 3166 patients were analyzed. There was a large heterogeneity in terms of patients' characteristics and inclusion criteria. Only six studies included patients with vitamin D levels < 50 nmol/L. Regarding clinically important outcomes, most of the studies did not show differences between the intervention and control group in terms of mortality, intensive care unit (ICU) or hospital length of stay (LoS). There is great variability in trial designs regarding the selection of patients, dosage, dosing intervals and routes of administration of vitamin D supplements. Better study designs are mandatory for future clinical research, with measuring and reporting basal vitamin D levels before randomization. Since variability in supplementation regimes limits the possibility of data synthesis, standardized protocols for vitamin D supplementation should be used in clinical trial settings.

Heart rate variability in biophilic design: A systematic literature review

The use of Virtual Reality as a representation of biophilic design has been commonly used for design evaluations on human perception and performance before the actual construction. Biophilic design is known for the relaxing effects on human physiological responses; particularly cardiac activity indexed by Heart Rate Variability (HRV), representing human’s relaxation or stress conditions. How virtual biophilic design affects HRV, and what research protocols are most effective in assessing these physiological effects remains unclear. This literature review clarify research protocols and outline the trends of HRV in virtual biophilic design and to propose guidelines for improving the accuracy and reliability of HRV measurements. Most of the reviewed studies found an equal trend of the increased parasympathetic activity correlating with a reduced anxiety, during exposure to specific virtual biophilic designs. Studies with insignificant HRV effects may be due to the inadequate measurement protocol. The clearer effects on HRV may be observed by limiting virtual exposure to 15 minutes, avoiding virtual sickness, maintaining consistent subject positions, incorporating paced breathing in all conditions during HRV recordings, and evaluating short-term HRV measures for a minimum of 5 minutes. Virtual biophilic exposure holds promise for pre-construction design assessment, depending on appropriate methodologies.

An Access-Focused Patient-Centric Value Assessment Framework for Medication Formulary Decision-Making in Immune-Mediated Inflammatory Diseases.

The healthcare system in the United States (US) is complex and often fragmented across national and regional health plans which exhibit substantial variability in benefit design and formulary policies for accessing medications. We propose an access-focused value assessment framework for formulary decision-making for medications to manage immune-mediated inflammatory diseases (IMIDs), where patients are at the center of this framework. Formulary decision-making for IMID medications can be a challenging, even daunting, task with continuously evolving and enhanced treat-to-target goals. Given the complexity of the US healthcare system, patients and their caregivers need assurance from formulary decision-makers that rapid, predictable, and sustained access to both well-established treatments and innovative therapies will be a priority, with a particular emphasis on continuity of effective care. This access-focused patient-centric (APAC) value assessment approach encompasses three "value components"-higher therapeutic goals, better health-related quality of life, and improved work productivity-the monetization of which can be derived using data from clinical trials when real-world data are yet to become available. Measures and assessment approaches are outlined to serve as a pragmatic tool for decision-makers in the US to ensure timely delivery and sustained access of clinically indicated therapies aimed to improve patient outcomes, enhance equity, and increase efficiency.

Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Early gestational diabetes mellitus (eGDM) refers to elevated blood glucose levels not meeting the criteria for overt diabetes before 20 weeks gestation. Observational studies link eGDM to adverse outcomes, but randomized controlled trial (RCT) evidence on early intervention benefits remains inconclusive. To address this, we performed a systematic review and meta-analysis (SRM) of RCTs on this subject. We searched electronic databases to identify RCTs comparing early treatment versus observation for eGDM. The primary neonatal outcomes analyzed were large-for-gestational-age (LGA) and macrosomia. The primary maternal outcome was pregnancy-related hypertension. Secondary neonatal outcomes included neonatal respiratory distress (NRD), neonatal intensive-care unit (NICU) admission, small-for-gestational-age (SGA), cord-blood C-peptide ≥90th percentile, and neonatal hypoglycemia. Secondary maternal outcomes were cesarean section (CS), emergency CS, labor induction, preeclampsia, and preterm birth. Seven RCTs involving 4,427 pregnancies were analyzed. The studies differed in their timing and methods of inclusion. Six studies used a combination of lifestyle and pharmaceutical interventions, while one relied solely on lifestyle modifications. Early treatment did not reduce LGA [OR 0.84 (95%CI: 0.53-1.32); P=0.44], macrosomia [OR 0.68 (95%CI: 0.43-1.06); P=0.09], or pregnancy-related hypertension [OR 1.04 (95%CI: 0.68-1.57); P=0.87]. Among the secondary outcomes, only NRD was significantly reduced in the treatment arm [OR 0.52 (95%CI: 0.34-0.80); P=0.003]. However, sensitivity analysis, omitting the lifestyle-only study, demonstrated a lower risk of macrosomia with early intervention [OR 0.55 (95%CI: 0.34-0.91); P=0.02]. The SRM demonstrates early intervention does not improve most pregnancy outcomes, except NRD. Sensitivity analysis, excluding the lifestyle-only study, additionally revealed a reduction in macrosomia. The findings must be interpreted cautiously due to the variability in study designs. Replication in well-designed multicenter trials is required before clinical application.

Prognostic role of quantitative pupillometry in traumatic brain injury: a scoping review.

Traumatic brain injury (TBI) is a major cause of global mortality and disability, leading to primary and secondary brain injuries that can result in severe neurological, cognitive, and psychological impairments. Accurate and early prognosis of TBI outcomes is critical, particularly in assessing the risk of neurological decline, intracranial pressure (ICP) changes, and mortality. This systematic review aims to evaluate the prognostic value of quantitative pupillometry, particularly the Neurological Pupil Index (NPi), in predicting long-term outcomes in TBI patients. A systematic review was conducted following PRISMA guidelines, with the protocol registered on PROSPERO (CRD42023489079). Databases including PubMed, Scopus, and Embase were searched. Studies were included based on predefined inclusion criteria, focusing on the prognostic accuracy of automated pupillometry in TBI patients. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool, and evidence quality was evaluated using the Best-Evidence Synthesis approach. Thirteen studies met the inclusion criteria, with sample sizes ranging from 36 to 2258 participants. The studies demonstrated a consistent association between lower NPi values and increased mortality, poorer functional outcomes, elevated ICP, and the need for emergency interventions. Despite variability in study design and sample sizes, strong evidence supported the use of NPi as a reliable prognostic tool in TBI management. Automated infrared pupillometry, particularly through NPi measurement, offers important prognostic value in TBI patients. Incorporating NPi into routine clinical practice could improve the accuracy of prognosis and enhance patient management. Future research should focus on standardizing measurement protocols and validating these findings in larger, more diverse cohorts.

Panoramic view of the effects of active breaks in an educational context

In education, optimising academic achievement (AA) and promoting attention and concentration are essential elements. The main goal of this systematic review (SR) is to analyse and synthetise the scientific evidence to examine the impact that the different interventions with active breaks (AB) have on the AA, attention, and concentration of the students in educational contexts. To do this, the PRISMA protocol is followed (REG INPLASY: INPLASY202390082). The documents that comply with the inclusion criteria for this research are 29 scientific articles extracted from the databases Web of Science (WOS), SCOPUS and ERIC. The specific goals of this study are detailed through 13 research questions related to the characteristics of the works and their results, e.g. thematic and geographic diversity, variability in the research designs, inclusion of several educational levels and academic contents, as well as the presence of common intervention modalities and heterogeneous durations. The panoramic view suggested by the results presents AB as an interdisciplinary topic of international interest mainly focused on basic education, with measure instruments that are diverse and have variable duration, which might influence the comparability between studies. Even though some studies back up the positive effects of AB, the heterogeneity of approaches and results highlights the need of future research in order to unify criteria and allow a better understanding of the effects of AB and their applicability in several educational contexts.

Characteristics of the Outdoor Environment Affording Physical Activity, Motor Competence, and Social Interactions in Children Aged 3-7 Years: A Systematic Review.

This review used the PRISMA framework and study quality was assessed using the mixed-methods appraisal tool (MMAT). Keyword searches were conducted in seven databases. Studies were eligible if children were aged 3-7 years in ECE; physical activity, social interactions and/or motor competence were measured; location and/or social context were measured. Results were synthesised using an effect direct plot, a table of associations, and narrative synthesis. Twenty-three studies from eight countries met the inclusion criteria. Intervention and controlled cross-sectional studies (n = 9) favoured high-quality outdoor environments rich in affordances, portable play equipment, and natural features to increase children's physical activity, social interactions, and cooperative play. Cross-sectional and descriptive studies (n = 14) positively associated open grassy space, portable and fixed equipment, wheeled toys, and paths with physical activity (p < 0.05). Based on limited evidence, playground size and active games in small groups were associated with greater MC. The findings highlight the benefit of creating diverse affordance rich outdoor environments in early childhood settings to promote physical and social development. Limitations include variability in study designs and protocols for conducting systematic observations, thus emphasising the need for standardised approaches to future research.

The Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) Guidelines.

Preclinical studies for wound healing disorders are an essential step in translating discoveries into therapies. Also, they are an integral component of initial safety screening and gaining mechanistic insights using an in vivo approach. Given the complexity of the wound healing process, existing guidelines for animal testing do not capture key information due to the inevitable variability in experimental design. Variations in study interpretation are increased by complexities associated with wound aetiology, wounding procedure, multiple treatment conditions, wound assessment, and analysis, as well as lack of acknowledgement of limitation of the model used. Yet, no standards exist to guide reporting crucial experimental information required to interpret results in translational studies of wound healing. Consistency in reporting allows transparency, comparative, and meta-analysis studies and avoids repetition and redundancy. Therefore, there is a critical and unmet need to standardise reporting for preclinical wound studies. To aid in reporting experimental conditions, The Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) Guidelines have now been created by the authors working with the Wound Care Collaborative Community (WCCC) GAPS group to provide a checklist and reporting template for the most frequently used preclinical models in support of development for human clinical trials for wound healing disorders. It is anticipated that the WRAHPS Guidelines will standardise comprehensive methods for reporting in scientific manuscripts and the wound healing field overall. This article is not intended to address regulatory requirements but is intended to provide general guidelines on important scientific considerations for such studies.

Residual displacement ground-motion model

Residual displacement (RD), indicative of permanent post-earthquake deformation resulting from nonlinear structural response, plays an important role in assessing structural integrity and seismic safety. This study introduces a ground-motion model (GMM) for predicting RDs in inelastic single-degree-of-freedom systems, utilizing a large database of recorded ground motions. The RD GMM adopts key input parameters including 5%-damped elastic pseudo-spectral acceleration (PSA) over periods from 0.01 to 4.0 s, yield strength coefficient (Cy), earthquake magnitude (M), and closest distance to the fault rupture plane (Rrup). Levels of inelasticity are accounted for by employing the yield strength reduction factor, denoted as (PSA/g)/Cy. The results indicate that while M and Rrup significantly affect RDs, site class and significant duration have relatively less influence. RD GMM coefficients and unconditional standard deviations of the model are provided for specific Cy values across a period range of 0.01–4.0 s. The analyses indicate relatively large standard deviations in the GMM due to inherent variability in residual displacement, highlighting the importance of understanding and accounting for this variability in seismic design and performance assessment. Validation against a multi-degree-of-freedom bridge residual drifts demonstrates the effectiveness of the model in predicting the distribution of residual drifts.

Health Navigator intervention to address the unmet social needs of populations living with cancer attending outpatient treatment at a major metropolitan hospital in Australia: protocol for a mixed-methods feasibility trial

IntroductionIntegrating health and social care to address unmet social needs is an emerging priority for health systems worldwide. Screening and referral interventions for unmet social needs, also known as Health...

Effectiveness of Non-Pharmacological Interventions in the Management of Pediatric Chronic Pain: A Systematic Review.

(1) Background: Chronic pain in children remains an under-researched area, especially compared to acute pain. This systematic review aims to evaluate the effectiveness of non-pharmacological interventions in the management of pediatric chronic pain and their impact on the well-being of both children and their families. Given the growing interest in integrative treatments to reduce reliance on pharmacological solutions, this review addresses the need for alternative therapeutic approaches. (2) Methods: A systematic review was conducted following the PRISMA guidelines, covering studies published between 2019 and 2024 from PubMed, Cochrane Library, Web of Science, and Scopus. Eligible studies included children aged 2 to 18 years with chronic pain who received non-pharmacological interventions. Data were extracted on intervention types, participant characteristics, and outcomes. The risk of bias was assessed using RoB2 for randomized trials and ROBINS-I for non-randomized studies. (3) Results: A total of 11 studies involving 1739 children were included, assessing interventions such as cognitive behavioral therapy, personalized psychosocial follow-up programs, hypnotherapy, music therapy, and digital tools. The results demonstrated significant reductions in pain severity, improvements in emotional and physical well-being, and high patient satisfaction. However, the generalizability of findings was limited by the small sample sizes and variability in study designs. (4) Conclusions: Non-pharmacological interventions appear effective in managing pediatric chronic pain, offering improvements in pain reduction and quality of life. Further research is needed to optimize these approaches and confirm their long-term benefits across diverse populations. These interventions represent promising alternatives or complements to pharmacological treatments in pediatric pain management.

The Financial Impact of an Employee Wellness Program Focused on Cardiovascular Disease Risk Reduction.

Evidence for the effectiveness and cost-savings of workplace wellness programs (WWPs) is varied, likely due to the variability in program design, as not all WWPs meet the five-point criteria of a "comprehensive WWP" set by the U.S. Centers for Disease Control and Prevention. A 2019 study of changes in cardiovascular disease (CVD) risk for those enrolled in a comprehensive WWP found that nearly half of enrolled employees with moderate to high CVD risk improved their risk compared to the initial predictions. This study extends those findings by evaluating the cost-savings and return on investment (ROI) resulting from participants' CVD risk reduction from the employer's perspective. Cost-savings related to CVD risk were extrapolated using two studies that provided associated cost-savings for individuals participating in a WWP. Utilizing reference groups used in previous studies, we calculated cost-savings per 1% reduction in CVD risk using our population's specific CVD risk and our program-specific costs. The cost-savings were annualized per person within each risk category. Across all risk categories, cost-savings were USD 1224 per individual or USD 4.90 ROI for every USD 1 spent. Those at risk had a higher ROI per USD 1.00 spent (USD 35.4 and USD 19.2 for males and females, respectively) than those with minimal risk. However, even those with minimal risk showed a positive ROI (USD 0.3 and USD 5.0 for males and females, respectively). Investment in WWPs should prioritize programs that include all five elements of the standards established by the U.S Centers for Disease Control and Prevention. Well-designed and comprehensive WWPs can effectively impact employee health and lead to a positive ROI and cost-savings for employers.

AI predictive models and advancements in microdissection testicular sperm extraction for non-obstructive azoospermia: a systematic scoping review

Abstract STUDY QUESTION How accurately can artificial intelligence (AI) models predict sperm retrieval in non-obstructive azoospermia (NOA) patients undergoing micro-testicular sperm extraction (m-TESE) surgery? SUMMARY ANSWER AI predictive models hold significant promise in predicting successful sperm retrieval in NOA patients undergoing m-TESE, although limitations regarding variability of study designs, small sample sizes and a lack of validation studies restrict the overall generalizability of studies in this area. WHAT IS KNOWN ALREADY Previous studies have explored various predictors of successful sperm retrieval in m-TESE, including clinical and hormonal factors. However, no consistent predictive model has yet been established. STUDY DESIGN, SIZE, DURATION A comprehensive literature search was conducted following PRISMA-ScR guidelines, covering PubMed and Scopus databases from 2013 to May 15th, 2024. Relevant English-language studies were identified using Medical Subject Headings (MeSH) terms. We also used PubMed’s “similar articles” and “cited by” features for thorough bibliographic screening to ensure comprehensive coverage of relevant literature. PARTICIPANTS/MATERIALS, SETTING, METHODS The review included studies on patients with NOA where AI-based models were used for predicting m-TESE outcomes, by incorporating clinical data, hormonal levels, histopathological evaluations and genetic parameters. Various machine learning and deep learning techniques, including logistic regression, were employed. The Prediction Model Risk of Bias Assessment Tool (PROBAST) evaluated the bias in the studies, and their quality was assessed using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines, ensuring robust reporting standards and methodological rigour. MAIN RESULTS AND THE ROLE OF CHANCE Out of 427 screened articles, 45 met the inclusion criteria, with most using logistic regression and machine learning to predict m-TESE outcomes. AI-based models demonstrated strong potential by integrating clinical, hormonal and biological factors. However, limitations of the studies included small sample sizes, legal barriers and challenges in generalizability and validation. While some studies featured larger, multi-centre designs, many were constrained by sample size. Most studies had a low risk of bias in participant selection and outcome determination, and two-thirds were rated as low risk for predictor assessment, but the analysis methods varied. LIMITATIONS, REASONS FOR CAUTION The limitations of this review include the heterogeneity of the included research, potential publication bias and reliance on only two databases (PUBMED and SCOPUS), which may limit the scope of findings. Additionally, the absence of a meta-analysis prevents quantitative assessment of the consistency of models. Despite this, the review offers valuable insights into AI predictive models for m-TESE in NOA. WIDER IMPLICATIONS OF THE FINDINGS The review highlights the potential of advanced AI techniques in predicting successful sperm retrieval for NOA patients undergoing m-TESE. By integrating clinical, hormonal, histopathological and genetic factors, AI models can enhance decision-making and improve patient outcomes, reducing the number of unsuccessful procedures. However, to further enhance the precision and reliability of AI predictions in reproductive medicine, future studies should address current limitations by incorporating larger sample sizes and conducting prospective validation trials. This continued research and development is crucial for strengthening the applicability of AI models and ensuring broader clinical adoption. STUDY FUNDING/COMPETING INTEREST(S) The authors would like to acknowledge Mashhad University of Medical Sciences, Mashhad, Iran, for financial support (Grant ID : 4020802). The authors declare no competing interests. REGISTRATION NUMBER N/A

Evaluating the Effectiveness of Trauma Care and Emergency Preparedness Training Programs on Prehospital Primary Survey Skills: A Systematic Review.

This systematic review evaluates the impact of trauma care and emergency preparedness training programs on prehospital primary survey effectiveness. A comprehensive search strategy was employed across multiple databases, including PubMed, Cochrane Library, Embase, and the Cumulated Index to Nursing and Allied Health Literature (CINAHL), focusing on studies involving healthcare professionals such as paramedics, nurses, and emergency medical technicians (EMTs). The review included randomized controlled trials (RCTs), clinical trials, and cohort studies that assessed various training modalities like virtual reality (VR) simulations, case-based learning (CBL), and hands-on workshops. Quality assessment was performed using the Cochrane risk-of-bias (RoB) tool for randomized trials and the Newcastle-Ottawa Scale (NOS) for clinical trials, ensuring methodological rigor and consistency. The findings suggest that CBL significantly improves knowledge retention and prehospital primary survey skills, outperforming other methods such as simulation exercises, which showed mixed results. VR training increased confidence levels but did not demonstrate significant improvements in objective skills compared to traditional methods. The use of supplementary triage assistance teams (physician-nurse supplementary triage team (MDRNSTAT)) was found to be effective during high patient volume hours, though not cost-effective as a daytime strategy. While the review highlights the importance of interactive and scenario-based training programs, limitations such as variability in study designs, publication bias, and language bias were noted, suggesting that caution should be exercised in generalizing the results. Future research should focus on long-term effectiveness, the integration of emerging technologies, and larger, well-designed trials across diverse healthcare settings to strengthen the evidence base.

Prevalence of insomnia among university students in Saudi Arabia: a systematic review and meta‑analysis

Abstract Background Insomnia is a prevalent sleep disorder affecting cognitive functions critical to academic performance. University students, particularly in high-stress academic settings, are highly vulnerable. Despite its significant impact on students' health and education, there is limited research on the prevalence of insomnia among university students in Saudi Arabia. This systematic review and meta-analysis aim to assess the prevalence of insomnia among university students in Saudi Arabia, focusing on demographic variations and academic settings, to provide evidence for targeted interventions. Methods A comprehensive literature search was conducted across databases including PubMed, Scopus, and Web of Science, with additional manual searches. Inclusion criteria were cross-sectional studies addressing insomnia prevalence among Saudi university students, using standard diagnostic criteria. A total of 11 studies met the inclusion criteria, comprising data from diverse faculties, including medical and non-medical disciplines. Quality assessment was conducted using the Newcastle-Ottawa Scale. Statistical analyses were performed using a random-effects model to account for heterogeneity. Results Eleven studies, involving a total of 8297 university students, were included in the analysis. Insomnia prevalence varied widely, ranging from 19.3% to 98.7%, with a pooled prevalence of 43.3% (95% CI 28.9–58.2%). Subgroup analyses showed a prevalence of 38.6% among medical students and 38.7% among female students. The analysis revealed high heterogeneity (I2 = 99.17%), indicating significant variability in study designs, populations, and diagnostic methods. Conclusions Insomnia is highly prevalent among university students in Saudi Arabia, with significant variations across demographics and academic contexts. The findings underscore the urgent need for targeted interventions, including stress management, improved sleep hygiene education, and support systems to mitigate the impact of insomnia on academic performance and overall health. Future research should explore the longitudinal impacts of insomnia and the efficacy of tailored interventions in this population.