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While it is known that speakers tend to use more reduced forms for more predictable words or phrases, it is unclear whether the same happens at the referential level: the influence of referent predictability on pronoun production remains a contentious issue, with divergent findings reported in the literature. To address this inconsistency, we carried out a Bayesian meta-analysis of the current literature on the relationship between referent predictability and pronoun production. Our meta-analysis covers twenty primary peer-reviewed studies, encompassing twenty-six experiments across eight languages. We find stronger evidence for a small positive effect of referent predictability on pronoun usage, as opposed to the alternative hypothesis of no effect or a negative effect. As the first comprehensive synthesis of available evidence on this topic, our study offers insights into pronoun production and identifies promising avenues for future research: focus on typologically diverse languages, on conditions where a variety of referring expressions are expected or where the effect of predictability is more likely to appear, and others. Finally, we also advocate for the use of meta-analysis as a tool for theoretical linguistics.
To compare the clinical efficacy and prognosis of Ozaki procedure and Ross procedure in the treatment of paediatric aortic valve disease.
Methods:
According to the predetermined inclusion and exclusion criteria, relevant clinical studies were comprehensively searched in three databases, and relevant data were extracted for analysis and comparison.
Results:
This meta-analysis included four retrospective cohort studies with a total of 243 patients (117 undergoing Ozaki procedure and 126 undergoing Ross procedure). There were no significant difference in the in-hospital all-cause mortality [odds ratio = 1.38; 95% confidence interval: 0.38, 5.07, p = 0.63] and all-cause mortality during the follow-up period [odds ratio = 1.85; 95% confidence interval: 0.54, 6.32, p = 0.32] between Ozaki procedure and Ross procedure. The reoperation on the aortic valve [odds ratio = 10.48; 95% confidence interval: 2.22, 49.40, p = 0.003] was higher in the Ozaki procedure than in the Ross procedure. There were no patients who underwent pulmonary valve reoperation after Ozaki procedure [odds ratio = 0.21; 95% confidence interval: 0.03, 1.23, p = 0.08]. The cumulative reoperation rate after Ozaki procedure [odds ratio = 2.29; 95% confidence interval: 0.93, 5.66, p = 0.07] was higher than that of Ross procedure, but the difference was not statistically significant. The cardiopulmonary bypass time after Ozaki procedure [odds ratio = −32.09; 95% confidence interval:−45.05, −19.14, p < 0.00001] was shorter than that of Ross procedure. The incidence of postoperative complications [odds ratio = 0.24; 95% confidence interval: 0.04, 1.62, p = 0.14], aortic cross-clamping time [odds ratio = −20.39; 95% confidence interval: −43.68, 2.90, p = 0.09], ventilator assistance time [odds ratio = 1.71; 95% confidence interval: −42.70, 46.13, p = 0.94], and ICU time [odds ratio = −0.38; 95% confidence interval: −0.93, 0.16, p = 0.17] in Ozaki procedure was not statistically significant compared to Ross procedure.
Conclusions:
In the treatment of children with aortic valve disease, there is no statistically significant difference between the Ozaki procedure and the Ross procedure in terms of freedom from reoperation and all-cause mortality.
This chapter focuses on the foundations of study design and statistical analysis in psychological research. It explores strategies for ensuring internal validity, such as randomization, control groups, and large sample sizes. Additionally, it addresses the complexity of human behavior by exploring multivariate experiments and the use of artificial intelligence and machine learning in neuroscience. The chapter also discusses the replication crisis and the emergence of open science practices, encouraging students to think critically about isolated scientific findings and offering tools for identifying credible research. Lastly, it critiques null hypothesis significance testing and p-values while providing an overview of key statistical topics like correlation coefficients, standardized mean differences, and regression.
Science is invariably based on some sort of data collection and further treatment of the data gathered. Data can come from pure observations, from structured observations (‘natural experiments’) or from experiments. The central importance of models in science is mentioned. It is discussed how the choice of statistics reflects the philosophy of science adopted by the scientist. Different research programmes use different statistics, in particular, depending on when and how they deal with variation. The relationship between falsificationism and the rejection of null hypotheses as a workaround for the Duhem-Quine thesis is discussed, as well as the role of significance thresholds and their associated problems. It is argued that predicted results are more reliable than chance findings. The pros and cons of having alternative hypotheses are discussed, and a short introduction to Bayesian statistics as an alternative to frequentist approaches is given. Systematic reviews and metaanalyses of data from several studies are introduced, and an example is given on how different types of evidence from many studies are combined to form the current consensus of rational opinion regarding a particular hypothesis.
This meta-analysis investigates the contributions of viewing audiovisual input on second language (L2) learning. We calculated 75 effect sizes from 56 experiments (n = 1954) and assessed the effects of audiovisual input on language learning using a within-group (pre-post) meta-analytic approach. Fifteen moderator variables were included in the analysis. Results showed that a) there was a small effect of audiovisual input on L2 learning (g = .89); b) no differences were found between the effects of viewing audiovisual input on different areas of L2 learning (vocabulary, grammar, pronunciation, speaking, listening proficiency); and c) video category had a significant impact on L2 learning with entertainment-focused videos (e.g., TV series, movies, and mixed videos) yielding lower effects than educational videos (e.g., TED Talks, documentaries, and language-focused).
1. Meta-analyses are a reliable method for a quantitative research synthesis. They are, however, prone to specific biases that can be introduced in the process. Such a bias could exist if primary literature produces similar results if coming from the same authors. Authorship network bias is the non-independence of effect sizes introduced by the overlap of authors of primary studies. If not accounted for, it can severely impact the quality of meta-analysis and the conclusions drawn from it.
2. To account for such non-independence, multilevel models with author clusters as an additional hierarchy level were recently suggested. We propose a new method for the detection of non-independent effect sizes based on authorship networks and for their correction.
3. An analysis of simulated data demonstrates the effectiveness of the here-suggested new method. We further applied our new method to nine exemplary meta-analyses.
4. Our new method for detection and effective correction can be easily integrated in existing meta-analysis workflows, using the functionality already offered by R’s metafor package.
5. Our goal is to enhance the reliability of meta-analyses by highlighting potential authorship network bias and offering a method to address this often-overlooked bias.
'Transfiction' refers to the phenomenon of language mediators portrayed as characters in literature. Research investigating this phenomenon has developed through a long series of case studies. While providing in-depth analyses of different instances of transfiction, case studies have produced findings that are anchored to specific texts, consequently precluding theoretical observations at a higher level of abstraction. Thus, this Element constructs a concentrated profile of transfiction. It asks about the state of the art of this research area and its potential to inform other subfields of translation studies. By adopting a meta-analytical research style, the Element retraces the development of transfiction studies, identifying patterns and lacunae. It then goes on to thread transfiction together with previously disconnected research strands, such as translator studies, suggesting new research questions and methodologies. Ultimately, Charting Transfiction provides a reference point for future research in this area, as well as other subfields of translation studies.
The co-occurrence of psychotic disorders and borderline personality disorder (BPD) complicates clinical management, with overlapping symptoms exacerbating morbidity and impairing therapeutic outcomes. This systematic review and meta-analysis aimed to estimate the prevalence of psychotic disorders and BPD co-occurrence, including with first-episode psychosis (FEP) and to describe associated sociodemographic and clinical characteristics.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases were systematically searched from inception to June 2025. Eighteen studies met the inclusion criteria. Data extraction and quality appraisal (Effective Public Health Practice Project tool) were conducted independently by two reviewers. Random-effects meta-analyses estimated pooled prevalence rates.
Results
The pooled prevalence of BPD in people with psychotic disorders was 22.7% (95% CI: 14.2–34.3%), while 14.3% (95% CI: 5.5–32.1%) of individuals with BPD had a comorbid psychotic disorder. In FEP samples, 40.0% (95% CI: 21.9–61.3%) met the criteria for BPD. People with both conditions, often young women, showed greater emotional dysregulation, suicidality, psychotic symptoms, and social dysfunction. Trauma, dissociation and substance use emerged as frequent vulnerability factors. However, most studies were cross-sectional, with small samples and high heterogeneity (I2 > 80%), limiting generalizability.
Conclusion
This co-occurrence constitutes a distinct clinical subgroup with complex needs. Categorical diagnostic approaches may fail to capture the dimensional nature of overlapping affective and psychotic symptoms. Integrative and personalized care pathways, especially in early intervention settings, are warranted. This review was registered in PROSPERO (CRD42024577525).
This systematic review and meta-analyses provide the first synthesis of the literature on trait mindfulness and psychotic-like experiences (PLEs). Theoretical models suggest a protective function of mindfulness and it is important to understand any potential role of mindfulness in the prevention and treatment of PLEs. We examined the following: (1) What is the relationship between trait mindfulness and PLEs in nonclinical populations?; and (2) What is the effect of mindfulness-based interventions (MBIs) on PLEs in nonclinical populations? Five databases were searched, and effect sizes were extracted for each study. Seventeen papers were included in the review. Eleven papers explored the relationship between mindfulness and PLEs, and the meta-regression found a small negative association between PLEs and mindfulness (k = 8; pooled correlation r = −0.25; 95% confidence interval [CI]: −0.37, −0.13, p < .001). Eight studies investigated the effect of MBIs on PLEs and the summary effect was not significant in the meta-analysis (k = 5; pooled standard mean difference = .09; 95% CI: −0.61, 0.79, p = 0.80). Overall, the findings suggest that higher levels of mindfulness are associated with reduced PLEs, with no evidence for the effectiveness of MBIs in reducing PLEs. Findings should be interpreted cautiously given the small number of studies and high heterogeneity in the meta-analyses. Future studies are needed to determine whether MBIs might prevent the transition to psychosis or an at-risk mental state and might usefully measure a broader range of clinically relevant outcomes.
A meta-analysis of diagnostic test accuracy (DTA) studies typically synthesizes study-specific test sensitivity ($Se$) and specificity ($Sp$) to quantify the accuracy of an index test of interest. The bivariate linear mixed effects model with logit transformation of $Se$ and $Sp$ (BLMM-Logit) is commonly used to make statistical inferences, but may lead to misleading results due to the need for Haldane–Anscombe correction and an approximate estimation of variance within the study. Alternative models based on the arcsine square root and Freeman–Tukey double arcsine transformation have been proposed to address these issues; however, they still rely on approximate variance estimation, which is suitable only for large sample sizes. The bivariate generalized linear mixed effects model (BGLMM) is another option, but it faces convergence issues with small meta-analyses or sparse primary studies. To address these limitations, we proposed an exact within-study variance calculation method that does not require Haldane–Anscombe correction and is applicable regardless of the transformation used or the number of studies and participants. We evaluated this method against existing approaches using real-life and simulated DTA meta-analyses. The methods were comparable for large meta-analyses. However, BLMM-Logit demonstrated substantial negative bias in estimating variances between studies and consistently underestimated summary $Se$ and $Sp$ in all simulation scenarios. In contrast, the proposed exact methods (Exact-Logit, Exact-ASR, and Exact-FTDA) and BGLMM had minimal bias and better performance metrics, particularly for meta-analyses with sparse primary studies. Thus, the proposed exact methods should be preferred for DTA meta-analyses with small or sparse studies.
The COVID-19 pandemic presented significant challenges to infectious disease management and mental health services (MHS). Service demand and delivery changed due to fear of infection, economic hardships, and the psychological effects of protective measures. This systematic review with meta-analysis aims to quantify these impacts on different mental health service settings.
Methods
Comprehensive searches were conducted in PubMed, Embase, and PsycINFO, focusing on studies published from the initial outbreak of COVID-19, starting in November 2019. Studies were included comparing the utilization of mental health inpatient, emergency department (ED), and outpatient services (including telemedicine and medication prescriptions) before and during the COVID-19 pandemic. A random-effects model was employed to estimate pooled effects, with study quality assessed using a modified Newcastle-Ottawa Scale.
Results
Among 128 studies, significant decreases in utilization were observed during the initial phase of the pandemic for inpatient services (RR: 0.75, 95% CI: 0.67 to 0.85) and ED visits (RR: 0.87, 95% CI: 0.69 to 1.10). Outpatient services showed a similar decline (RR: 0.78, 95% CI: 0.66 to 0.92), while no significant change was found in psychotropic medication prescriptions (RR: 0.90, CI: 0.77 to 1.05). In contrast, telemedicine utilization increased significantly (RR: 7.57, 95% CI: 3.63 to 15.77).
Conclusions
The findings reveal substantial shifts in mental health service utilization during the pandemic, with the largest reductions in inpatient services and significant increases in telemedicine use. These results emphasize the need for flexible healthcare models. Further research is essential to evaluate the consequences of reduced MHS utilization.
Bipolar disorder (BD) is associated with impairments in facial emotion recognition (FER), affecting social functioning and quality of life. Understanding FER deficits in BD is crucial for tailoring interventions and improving treatment outcomes. This systematic review and meta-analysis aims to evaluate FER differences among individuals with BD, unaffected first-degree relatives (FDRs), and healthy controls (HCs), exploring predictors related to patient and study characteristics.
Methods
We systematically searched PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO databases from inception to March 28, 2024. Random-effects meta-analyses were conducted to explore differences in accuracy and reaction time during FER identification and discrimination tasks.
Results
A total of 100 studies were included, comprising 4920 individuals with BD (females = 56%, mean age = 34.1 ± 9.1), 676 FDRs (females = 55%, mean age = 36.1 ± 12), and 4909 HCs (females = 53.2%, mean age = 32.5 ± 9.5). Compared to HCs, adults with BD exhibited significantly lower accuracy (SMD = −0.47; 95% CIs = −0.56, −0.38) and higher reaction time (SMD = 0.57; 95%CIs = 0.33, 0.81) during facial emotion identification tasks. During facial emotion discrimination tasks, adults with BD had significantly lower accuracy than HCs (SMD = −0.59; 95%CIs = −0.78, −0.4), but similar speed. No significant differences were observed between BD and FDRs. Meta-regressions identified several predictors of FER performance, including manic symptom severity, stimulus duration, and presence of practice before task.
Conclusions
FER deficits appear to be a core feature of BD and require specialized, systematic assessment. Identifying these deficits may help guide interventions aimed at improving affective cognition and social outcomes in individuals with BD.
To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.
Methods
We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.
Results
We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of −1.40, 95% confidence interval: −2.15 to −0.66, P < 0.001, low–quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.
Conclusions
Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.
Systematic reviews are often characterized as being inherently replicable, but several studies have challenged this claim. The objective of the study was to investigate the variation in results following independent replication of literature searches and meta-analyses of systematic reviews. We included 10 systematic reviews of the effects of health interventions published in November 2020. Two information specialists repeated the original database search strategies. Two experienced review authors screened full-text articles, extracted data, and calculated the results for the first reported meta-analysis. All replicators were initially blinded to the results of the original review. A meta-analysis was considered not ‘fully replicable’ if the original and replicated summary estimate or confidence interval width differed by more than 10%, and meaningfully different if there was a difference in the direction or statistical significance. The difference between the number of records retrieved by the original reviewers and the information specialists exceeded 10% in 25/43 (58%) searches for the first replicator and 21/43 (49%) searches for the second. Eight meta-analyses (80%, 95% CI: 49–96) were initially classified as not fully replicable. After screening and data discrepancies were addressed, the number of meta-analyses classified as not fully replicable decreased to five (50%, 95% CI: 24–76). Differences were classified as meaningful in one blinded replication (10%, 95% CI: 1–40) and none of the unblinded replications (0%, 95% CI: 0–28). The results of systematic review processes were not always consistent when their reported methods were repeated. However, these inconsistencies seldom affected summary estimates from meta-analyses in a meaningful way.
Random-effects meta-analysis is a widely applied methodology to synthesize research findings of studies related to a specific scientific question. Besides estimating the mean effect, an important aim of the meta-analysis is to summarize the heterogeneity, that is, the variation in the underlying effects caused by the differences in study circumstances. The prediction interval is frequently used for this purpose: a 95% prediction interval contains the true effect of a similar new study in 95% of the cases when it is constructed, or in other words, it covers 95% of the true effects distribution on average in repeated sampling. In this article, after providing a clear mathematical background, we present an extensive simulation investigating the performance of all frequentist prediction interval methods published to date. The work focuses on the distribution of the coverage probabilities and how these distributions change depending on the amount of heterogeneity and the number of involved studies. Although the single requirement that a prediction interval has to fulfill is to keep a nominal coverage probability on average, we demonstrate why the distribution of coverages should not be disregarded. We show that for meta-analyses with small number of studies, this distribution has an unideal, asymmetric shape. We argue that assessing only the mean coverage can easily lead to misunderstanding and misinterpretation. The length of the intervals and the robustness of the methods concerning the non-normality of the true effects are also investigated.
Students, due to their specific academic and psychosocial conditions, are at higher risk of suicide compared with the general population, and suicide is one of the leading causes of death among students worldwide.
Aims
To investigate the prevalence of suicidal ideation and suicide attempts among Iranian university students.
Method
A systematic search was conducted in international and national databases, including Scopus, Web of Science, PsycINFO, PubMed and Magiran, up to February 2025. Title and abstract screening was performed by a single reviewer. Two reviewers independently undertook full-text screening (study selection) and data extraction. Data were analysed using Stata 16. The heterogeneity of studies was tested with Cochran’s Q and quantified with the I2 statistic. To explore the sources of heterogeneity, we performed sensitivity analyses and meta-regression. The protocol was registered in the International Registration of Systematic Reviews (no. CRD42023471340).
Results
We included 28 studies in this research. The pooled prevalence of suicidal ideation, 12-month suicide attempts and lifetime suicide attempts among Iranian students was 17% (95% CI: 13–21%), 3% (95% CI: 2–4%) and 8% (95% CI: 6–10%), respectively, with substantial heterogeneity (I2 = 94.85, 91.16 and 93.46%, respectively).
Conclusions
This study highlights the high prevalence of suicidal ideation and suicide attempts among Iranian university students, underscoring the need for effective preventive strategies and further research.
Recent studies showing that some outcome variables do not statistically significantly differ between real-stakes and hypothetical-stakes conditions have raised methodological challenges to experimental economics’ disciplinary norm that experimental choices should be incentivized with real stakes. I show that the hypothetical bias measures estimated in these studies do not econometrically identify the hypothetical biases that matter in most modern experiments. Specifically, traditional hypothetical bias measures are fully informative in ‘elicitation experiments’ where the researcher is uninterested in treatment effects (TEs). However, in ‘intervention experiments’ where TEs are of interest, traditional hypothetical bias measures are uninformative; real stakes matter if and only if TEs differ between stakes conditions. I demonstrate that traditional hypothetical bias measures are often misleading estimates of hypothetical bias for intervention experiments, both econometrically and through re-analyses of three recent hypothetical bias experiments. The fact that a given experimental outcome does not statistically significantly differ on average between stakes conditions does not imply that all TEs on that outcome are unaffected by hypothetical stakes. Therefore, the recent hypothetical bias literature does not justify abandoning real stakes in most modern experiments. Maintaining norms that favor completely or probabilistically providing real stakes for experimental choices is useful for ensuring externally valid TEs in experimental economics.