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Mapping reviews (MRs) are crucial for identifying research gaps and enhancing evidence utilization. Despite their increasing use in health and social sciences, inconsistencies persist in both their conceptualization and reporting. This study aims to clarify the conceptual framework and gather reporting items from existing guidance and methodological studies. A comprehensive search was conducted across nine databases and 11 institutional websites, including documents up to January 2024. A total of 68 documents were included, addressing 24 MR terms and 55 definitions, with 39 documents discussing distinctions and overlaps among these terms. From the documents included, 28 reporting items were identified, covering all the steps of the process. Seven documents mentioned reporting on the title, four on the abstract, and 14 on the background. Ten methods-related items appeared in 56 documents, with the median number of documents supporting each item being 34 (interquartile range [IQR]: 27, 39). Four results-related items were mentioned in 18 documents (median: 14.5, IQR: 11.5, 16), and four discussion-related items appeared in 25 documents (median: 5.5, IQR: 3, 13). There was very little guidance about reporting conclusions, acknowledgments, author contributions, declarations of interest, and funding sources. This study proposes a draft 28-item reporting checklist for MRs and has identified terminologies and concepts used to describe MRs. These findings will first be used to inform a Delphi consensus process to develop reporting guidelines for MRs. Additionally, the checklist and definitions could be used to guide researchers in reporting high-quality MRs.
Oral supplementation with probiotics, prebiotics, and synbiotics is a novel potential complementary therapy for addressing overweight and obesity through gut microbiota modulation. This systematic review provides a comprehensive summary of the existing evidence to guide future research. Literature searches were conducted in four databases to identify human trials published until May 2024 that examined the impact of probiotic, prebiotic, or synbiotic interventions on faecal microbiota composition changes in overweight and obese participants from Latin American and Caribbean populations (LACPs). Of the 13,090 identified records, five randomised controlled trials (RCTs) from Brazil, Mexico, and Chile met the inclusion criteria for this review. The included RCTs evaluated different forms of therapies over short-term interventions (6 or 8 weeks), with sample sizes ranging from 21 to 39 participants across the studies. Variations in the reported outcomes were observed due to differences in supplement formulation, dosage, population characteristics, and methodological heterogeneity. The findings indicate that the available data are inadequate to establish definitive conclusions regarding the impact of biotic treatments on gut microbiota profiles in LACP. Further research with larger sample sizes and precise microbiota analysis is required to elucidate the implications of dietary interventions on gut microbiota in obesity and related disorders.
Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs.
Design:
A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention.
Setting:
Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site.
Participants:
Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association.
Methods:
The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation.
Results:
Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33–0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55–0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged.
Conclusions:
This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.
Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients’ knowledge and expectations regarding antibiotics.
Design:
Stratified Block Randomized Control Trial.
Setting:
Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey.
Participants:
Urgent care patients.
Methods:
We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm.
Results:
Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores.
Conclusions:
Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials.
Differential item functioning (DIF), referring to between-group variation in item characteristics above and beyond the group-level disparity in the latent variable of interest, has long been regarded as an important item-level diagnostic. The presence of DIF impairs the fit of the single-group item response model being used, and calls for either model modification or item deletion in practice, depending on the mode of analysis. Methods for testing DIF with continuous covariates, rather than categorical grouping variables, have been developed; however, they are restrictive in parametric forms, and thus are not sufficiently flexible to describe complex interaction among latent variables and covariates. In the current study, we formulate the probability of endorsing each test item as a general bivariate function of a unidimensional latent trait and a single covariate, which is then approximated by a two-dimensional smoothing spline. The accuracy and precision of the proposed procedure is evaluated via Monte Carlo simulations. If anchor items are available, we proposed an extended model that simultaneously estimates item characteristic functions (ICFs) for anchor items, ICFs conditional on the covariate for non-anchor items, and the latent variable density conditional on the covariate—all using regression splines. A permutation DIF test is developed, and its performance is compared to the conventional parametric approach in a simulation study. We also illustrate the proposed semiparametric DIF testing procedure with an empirical example.
East Asian population history has only recently been the focus of intense investigations using ancient genomics techniques, yet these studies have already contributed much to our growing understanding of past East Asian populations, and cultural and linguistic dispersals. This Element aims to provide a comprehensive overview of our current understanding of the population history of East Asia through ancient genomics. It begins with an introduction to ancient DNA and recent insights into archaic populations of East Asia. It then presents an in-depth summary of current knowledge by region, covering the whole of East Asia from the first appearance of modern humans, through large-scale population studies of the Neolithic and Metal Ages, and into historical times. These recent results reflect past population movements and admixtures, as well as linguistic origins and prehistoric cultural networks that have shaped the region's history. This title is also available as Open Access on Cambridge Core.
This study investigates practicing clinician and staff perspectives on potential protocol modifications for the “Nasal Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Acute Sinusitis” (NOSES) study, a pragmatic randomized controlled trial aiming at improving acute rhinosinusitis management. Focus groups with clinicians and staff at the pretrial stage recommended expanding participant age inclusion criteria, incorporating patients with COVID-19, and shortening the supportive care phase. Participants also discussed patient engagement and recruitment strategies. These practical insights contribute to optimizing the NOSES trial design and underscore the value of qualitative inquiries and healthcare stakeholder engagement in informing clinical trial design.
The depression, obstructive sleep apnea and cognitive impairment (DOC) screen assesses three post-stroke comorbidities, but additional information may be gained from the time to complete the screen. Cognitive screening completion time is rarely used as an outcome measure.
Objective:
To assess DOC screen completion time as a predictor of cognitive impairment in stroke/transient ischemic attack clinics.
Methods:
Consecutive English-speaking stroke prevention clinic patients consented to undergo screening and neuropsychological testing (n = 437). DOC screen scores and times were compared to scores on the NINDS-CSC battery using multiple linear regression (controlling for age, sex, education and stroke severity) and receiver operating characteristic (ROC) curve analysis.
Results:
Completion time for the DOC screen was 3.8 ± 1.3 minutes. After accounting for covariates, the completion time was a significant predictor of the speed of processing (p = 0.002, 95% CI: −0.016 to −0.004), verbal fluency (p < 0.001, CI: −0.012 to −0.006) and executive function (p = 0.004, CI: −0.006 to −0.001), but not memory. Completion time above 5.5 minutes was associated with a high likelihood of impairment on executive and speed of processing tasks (likelihood ratios 3.9–5.2).
Conclusions:
DOC screen completion time is easy to collect in routine care. People needing over 5.5 minutes to be screened likely have deficits in executive functioning and speed of processing – areas commonly impaired, but challenging to screen for, after stroke. DOC screen time provides a simple, feasible approach to assess these under-identified cognitive impairments.
Weeds are one of the greatest challenges to snap bean (Phaseolus vulgaris L.) production. Anecdotal observation posits certain species frequently escape the weed management system by the time of crop harvest, hereafter called residual weeds. The objectives of this work were to (1) quantify the residual weed community in snap bean grown for processing across the major growing regions in the United States and (2) investigate linkages between the density of residual weeds and their contributions to weed canopy cover. In surveys of 358 fields across the Northwest (NW), Midwest (MW), and Northeast (NE), residual weeds were observed in 95% of the fields. While a total of 109 species or species-groups were identified, one to three species dominated the residual weed community of individual fields in most cases. It was not uncommon to have >10 weeds m−2 with a weed canopy covering >5% of the field’s surface area. Some of the most abundant and problematic species or species-groups escaping control included amaranth species such as smooth pigweed (Amaranthus hybridus L.), Palmer amaranth (Amaranthus palmeri S. Watson), redroot pigweed (Amaranthus retroflexus L.), and waterhemp [Amaranthus tuberculatus (Moq.) Sauer]; common lambsquarters (Chenopodium album L.); large crabgrass [Digitaria sanguinalis (L.) Scop.]; and ivyleaf morningglory (Ipomoea hederacea Jacq.). Emerging threats include hophornbeam copperleaf (Acalypha ostryifolia Riddell) in the MW and sharppoint fluvellin [Kickxia elatine (L.) Dumort.] in the NW. Beyond crop losses due to weed interference, the weed canopy at harvest poses a risk to contaminating snap bean products with foreign material. Random forest modeling predicts the residual weed canopy is dominated by C. album, D. sanguinalis, carpetweed (Mollugo verticillata L.), I. hederacea, amaranth species, and A. ostryifolia. This is the first quantitative report on the weed community escaping control in U.S. snap bean production.
One species-general life history (LH) principle posits that challenging childhood environments are coupled with a fast or faster LH strategy and associated behaviors, while secure and stable childhood environments foster behaviors conducive to a slow or slower LH strategy. This coupling between environments and LH strategies is based on the assumption that individuals’ internal traits and states are independent of their external surroundings. In reality, individuals respond to external environmental conditions in alignment with their intrinsic vitality, encompassing both physical and mental states. The present study investigated attachment as an internal mental state, examining its role in mediating and moderating the association between external environmental adversity and fast LH strategies. A sample of 1169 adolescents (51% girls) from 9 countries was tracked over 10 years, starting from age 8. The results confirm both mediation and moderation and, for moderation, secure attachment nullified and insecure attachment maintained the environment-LH coupling. These findings suggest that attachment could act as an internal regulator, disrupting the contingent coupling between environmental adversity and a faster pace of life, consequently decelerating human LH.
Background: Low back pain (LBP) is a common cause of disability and decreased quality of life. The Saskatchewan Spine Pathway classification (SSPc) is a method for triaging patients who are candidates for surgery. Methods: Consecutive patients who underwent lumbosacral instrumented fusion for degenerative spinal pathology from Jan 1, 2012, to Sept 20, 2018, by a single surgeon at our institution were retrospectively reviewed. Patients were stratified by SSPc into 4 groups based on pain pattern. Demographic and clinical data were collected. Outcomes were compared between cohorts both for absolute values and achieving MCID. Results: 169 consecutive patients were included in our study. After stratifying by SSPc grouping, there were 61 SSPc I patients, 45 SSPc III patients, and 63 SSPc IV patients. Patients in all groups had clinical improvement following surgery. Patients classified as SSPc III had superior outcomes in ODI, EQ-5D and EQ-VAS, and were more likely to achieve the MCID for ED-5D. Multivariate analysis demonstrated that SSPc grouping is an independent predictor of final VAS back, ODI, EQ-5D, and EQ-VAS as well as achieving the MCID for EQ-5D. Conclusions: The SSPc classification is associated with outcomes following lumbosacral fusion. In particular, patients with SSPc pattern 3 had better outcomes and improved QALY.
Background: Elevated BMI has been proposed as a risk factor for the development of meningioma. The relationship between body mass index (BMI) and disease control in high-grade meningioma has not yet been examined. A retrospective cohort study was performed to assess the relationship between high-grade meningioma recurrence and BMI. Methods: This is a retrospective cohort study of patients with Grade 2 or Grade 3 meningioma at a single tertiary care center between 2008 and 2017. We collected clinical data including age, sex, BMI, location, Simpson grade, brain invasion, and radiation treatments. Disease control was monitored on followup MRI scans. We stratified patients by BMI greater than or less than 25. Results: A total of 45 patients were included. Recurrence was observed in 15 patients (33.3%). There were 32 (71.1%) patients with BMI > 25, and 13 (28.9%) patients with normal BMI. Patients with elevated BMI had higher risk of recurrence (p=0.04). Multivariate analysis identified BMI as an independent predictor of recurrence. Conclusions: Our results suggest that overweight patients with a Grade 2 or Grade 3 meningioma are at higher risk of recurrence than patients with normal BMI. The explanation for this association unknown. Further research is suggested to confirm and better characterize this association.
Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition which can be treated with surgical evacuation. A significant percentage of CSDH patients are on antiplatelet or anticoagulation therapy at baseline which may influence risk of recurrence and postoperative thromboembolic events Methods: A search was conducted in MEDLINE (1946 to April 6, 2023), Embase (1974 to April 6, 2023), and PubMed (up to April 6, 2023) on preoperative use of antiplatelet or anticoagulation therapy and outcomes following surgical evacuation of CSDH. Results: Our literature includes 14,410 patients ifrom 42 studies, with 3218 (22%) in the antiplatelet (AP) group, 1731(12%) in the anticoagulation (AC) group, and 9537 (66%) in the no antithrombotics (NA) group. The AP group had significantly higher recurrence compared to NA (OR = 1.21, 95% CI = 1.04 to 1.40, p = 0.01). The AC group also had significantly high recurrence compared to NA (OR = 1.39. 95% CI = 1.15 to 1.68, p = 0.0007). However, being on any antithrombotic therapy is also associated with significantly higher thromboembolic events (OR 5.41, 95% CI 3.16 to 9.26, p < 0.00001). Conclusions: Patients on antithrombotic therapy have both higher recurrence and higher thromboembolic risk compared to patients not on antithrombotic therapy.
Background: The fragility index (FI) is the minimum number of patients whose status would have to change from a nonevent to an event to turn a statistically significant result to a non-significant result. We used this to measure the robustness of trials comparing carotid endarterectomy (CEA) to carotid artery stenting (CAS). Methods: A search was conducted in MEDLINE, Embase, and PubMed on RCTs comparing CEA to CAS. The trials need to have statistically significant results and dichotomous primary endpoints to be included. Results: Our literature search identified 10 RCTs which included 9382 patients (4734 CEA, 4648 CAS). The primary end points of all included trials favoured CEA over CAS. The median FI was 9.5 (interquartile range 2.25 - 21.25). All of the studies that reported lost-to-follow-up (LTFU) had LTFU greater than its fragility index, which raises concern that the missing data could change the results of the trial from statistically significant to statistically insignificant. Conclusions: A small number of events (FI, median 9.5) were required to render the results of carotid artery stenosis RCTs comparing CEA to CAS statistically insignificant. All of the studies that reported LTFU had LTFU greater than its fragility index.
Background: Cerebrospinal fluid (CSF) leak is a common complication of minimally invasive tubular microdiscectomy (MIM). However, it is not known whether patients with CSF leak can be safely discharged home the same day. Methods: This is a retrospective cohort study of patients with incidental durotomy after MIM from January, 2009 to August, 2023. Patient demographic information, surgery information, CSF leak management, and postoperative outcomes were recorded. Results: There were 16 patients (53%) who were admitted to hospital and 14 (47%) patients discharged home the same day post CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures. The hospitalized group was kept on bed rest overnight or 24 hours. The discharge group was kept on best rest for 2 hours or mobilized immediately after surgery. The average length of admission for the hospitalized group was 2.4 ± 4.0 days. No patients in either group required readmission or revision surgery for CSF leak. Conclusions: Patients with CSF leak post minimally invasive tubular microdiscectomy can be safely discharged home the same day provided that duraplasty or primary repair was performed intraoperatively.
Background: Tethered cord syndrome, a condition in which the spinal cord stretches as a child grows, can cause various clinical symptoms. Occult TCS (OTCS) is a condition where a child displays some or many clinical symptoms of TCS, but no radiographic abnormality confirms the presence of a tethered cord (1-4). Diagnosis of OTCS in children is invasive and multi-factorial. The current diagnostic approach involves three main factors- clinical signs and symptoms, radiographic evidence, and motor evoked potentials (MEPs) tested under general anesthesia. Transcranial magnetic stimulation (TMS) is a non-invasive testing method for OTCS. It can replace MEPs, which are conducted under general anesthesia. Methods: We will conduct a case-control series of children at our center who have undergone TMS. We will characterize the children who have TCS and suspected OTCS and detail the children’s current diagnosis methods and outcomes in a technical note. We will then compare their pre-operative and post-operative data. Results: So far, we have conducted TMS on 10 children to help diagnose occult TCS. Conclusions: This approach is a novel and effective way to improve the accuracy of diagnosis in children, potentially preventing unnecessary surgery, or detecting patients who would otherwise suffer from the condition.
Both impulsivity and compulsivity have been identified as risk factors for problematic use of the internet (PUI). Yet little is known about the relationship between impulsivity, compulsivity and individual PUI symptoms, limiting a more precise understanding of mechanisms underlying PUI.
Aims
The current study is the first to use network analysis to (a) examine the unique association among impulsivity, compulsivity and PUI symptoms, and (b) identify the most influential drivers in relation to the PUI symptom community.
Method
We estimated a Gaussian graphical model consisting of five facets of impulsivity, compulsivity and individual PUI symptoms among 370 Australian adults (51.1% female, mean age = 29.8, s.d. = 11.1). Network structure and bridge expected influence were examined to elucidate differential associations among impulsivity, compulsivity and PUI symptoms, as well as identify influential nodes bridging impulsivity, compulsivity and PUI symptoms.
Results
Results revealed that four facets of impulsivity (i.e. negative urgency, positive urgency, lack of premeditation and lack of perseverance) and compulsivity were related to different PUI symptoms. Further, compulsivity and negative urgency were the most influential nodes in relation to the PUI symptom community due to their highest bridge expected influence.
Conclusions
The current findings delineate distinct relationships across impulsivity, compulsivity and PUI, which offer insights into potential mechanistic pathways and targets for future interventions in this space. To realise this potential, future studies are needed to replicate the identified network structure in different populations and determine the directionality of the relationships among impulsivity, compulsivity and PUI symptoms.
Plant growth requires the integration of internal and external cues, perceived and transduced into a developmental programme of cell division, elongation and wall thickening. Mechanical forces contribute to this regulation, and thigmomorphogenesis typically includes reducing stem height, increasing stem diameter, and a canonical transcriptomic response. We present data on a bZIP transcription factor involved in this process in grasses. Brachypodium distachyon SECONDARY WALL INTERACTING bZIP (SWIZ) protein translocated into the nucleus following mechanostimulation. Classical touch-responsive genes were upregulated in B. distachyon roots following touch, including significant induction of the glycoside hydrolase 17 family, which may be unique to grass thigmomorphogenesis. SWIZ protein binding to an E-box variant in exons and introns was associated with immediate activation followed by repression of gene expression. SWIZ overexpression resulted in plants with reduced stem and root elongation. These data further define plant touch-responsive transcriptomics and physiology, offering insights into grass mechanotranduction dynamics.
The Sinya Beds of the Amboseli Basin in Tanzania and Kenya consist largely of carbonate rocks and Mg-rich clays that are intensely deformed where exposed in and near former meerschaum mines. The carbonate rocks consist of limestone and dolomite in Tanzania, but only dolomite has been identified in Kenya. Sepiolite and mixed-layered kerolite/stevensite (Ke/St) are subordinate constituents of the carbonate rocks. The carbonate rocks and overlying bedded sepiolite were deposited in a semiarid lake basin at the foot of the large volcano Kilimanjaro. Calcite and dolomite of the carbonate rocks have δ18O values 4–6‰ lower than calcite and dolomite of the late Pleistocene Amboseli Clays, suggesting that the Sinya Beds were deposited in the middle or early Pleistocene under a different climatic regime when meteoric water had lower δ18O values than at present.
Mg-rich clay minerals form veins and fill cavities in the Sinya Beds. The principal clay minerals are sepiolite and Ke/St, some of which contains substantial Al and Fe (Al-Ke/St). NEWMOD® modeling and other X-ray diffraction (XRD) data suggest that most of the Ke/St contains 25–50 percent kerolite layers, but minor amounts of kerolite-rich Ke/St are present in some samples. Illite with an inferred high content of Fe or Mg is a minor constituent of the samples with Al-Ke/St. The cavity-filling clays were chemically precipitated, as shown by field relationships and SEM study. The early-deposited clays of veins and cavities are principally Ke/St with minor sepiolite, and the latest clay is sepiolite (meerschaum), generally with minor Ke/St.
The δ18O values of cavity-filling Ke/St range from 22.5–25.6‰ and correlate with mineral composition, with the highest values associated with the highest content of stevensite and the lowest values with the highest content of kerolite. This relation suggests that high salinities favored stevensite and low salinities favored kerolite. δ18O values of sepiolite (meerschaum) fall in the middle of the range for Ke/St, suggesting that salinity was not the main control on sepiolite precipitation. High values of may have been a major factor in sepiolite precipitation.
Different mixtures of dilute ground water and saline, alkaline lake water in pore fluids may largely account for the differences in clay mineralogy of cavity-filling clays. Sepiolite is the dominant clay mineral in lacustrine sediments of the Amboseli Basin, and the cavity-filling sepiolite may reflect a high proportion of lake water. The low-Al Ke/St may have formed from fluids with a higher proportion of ground water. Detrital clay was very likely a factor in forming the Al-Ke/St, for which δ18O values suggest a saline environment.
It is unclear how much adolescents’ lives were disrupted throughout the COVID-19 pandemic or what risk factors predicted such disruption. To answer these questions, 1,080 adolescents in 9 nations were surveyed 5 times from March 2020 to July 2022. Rates of adolescent COVID-19 life disruption were stable and high. Adolescents who, compared to their peers, lived in nations with higher national COVID-19 death rates, lived in nations with less stringent COVID-19 mitigation strategies, had less confidence in their government’s response to COVID-19, complied at higher rates with COVID-19 control measures, experienced the death of someone they knew due to COVID-19, or experienced more internalizing, externalizing, and smoking problems reported more life disruption due to COVID-19 during part or all of the pandemic. Additionally, when, compared to their typical levels of functioning, adolescents experienced spikes in national death rates, experienced less stringent COVID-19 mitigation measures, experienced less confidence in government response to the COVID-19 pandemic, complied at higher rates with COVID-19 control measures, experienced more internalizing problems, or smoked more at various periods during the pandemic, they also experienced more COVID-19 life disruption. Collectively, these findings provide new insights that policymakers can use to prevent the disruption of adolescents’ lives in future pandemics.