One of my favorite profs at U of C. Vargas joined the College of Dentistry as an assistant professor in My program of research generally addresses the role of novel and alternative tobacco products e. Tweet with a location. And our instructors are second to none! Meet Professor Juan V. My main area of interest is issue conflict. Dawn Hodges Chattahoochee Technical College.
Kimberly Cobb, M.
Cobb Scott. Cobb attended the University of Chicago where she obtained a BS in biochemistry and an unflagging interest in hormone action. By Debra Cassens Weiss. The Cobb County Public Library System is proud to be a place of possibilities, where its citizens can dream, dare, and discover. Many of these techniques have been deployed to evaluate processes in organisms and environmental systems.
We move with purpose. Group membership and duration, by year of joining on October 1 unless stated [A postgraduate member is listed on obtaining the qualification shown - the Chemistry Department's latest review of qualifications was made in on November We are a team of energetic, innovative lawyers who have been helping small, medium, and large businesses since we were established in There generally exists no closed-form solution for such problems. With over stores, education and shows, salon furnishings, sales consultants, plus an iPhone app and business building tools… Cobb is a faculty member at Walden University and is also the founder and owner of the medical spa Allure Enhancement Center.
You can add location information to your Tweets, such as your city or precise location, from the web and via third-party applications. Drew Hwang Professor and Chair dhwang cpp. Cobb's special talent for science earned him the Blodgett Scholarship for work at the Marine The Cobb angle is probably the most widely used parameter for quantifying the severity of scoliotic curvature 1. Innovations Melanie Cobb received her undergraduate degree in biochemistry from the University of Chicago and her PhD in biological chemistry from Washington University in St.
Home; Members; The use of contract workers is a rising trend among private companies and public entities. This conference has been awarded 5. Join us as faculty, students, and local ministers share their gifts and experiences as women in Baptist life. I did a BA in Psychology at the University of Sheffield, and went on to do my PhD there, in Psychology and Genetics, looking at the mating behaviour of seven species of fruitfly.
Check out the reviews for your classes! Curriculum Vitae: Current resume Cobb June, Cobb's class at Florida State University. Cobb, Ph. His work focused on the biosynthesis of fluorinated natural products, in the bacteria Streptomyces cattleya. Fall Prof. Full text is unavailable for this digitized archive article. Cobb is often regarded as the preeminent scholar in the field of process philosophy and process theology, the school of thought associated with the philosophy of Alfred North Whitehead.
C A brief look back in history; Mr Ronald Furlong and the creation of the first biologically coated hip system. Notes on Log-Linearization Eric Sims University of Notre Dame Spring The solutions to many discrete time dynamic economic problems take the form of a system of non-linear di erence equations. Do the lyrics encourage you? He has published 13 books and many articles focusing on the interaction of the economy, politics and culture in the American South. John Boswell Cobb Jr. Major research thrusts have involved coupling Prof.
They offer services such as basement remodeling, roofing, renovation and more. Cobb, Jr. View Ryon J. Cobb, along with Jennifer, his wife of more than twenty years, serve in several ministries at The Calvary Church in Springdale Northern Cincinnati. Browse the Google Map for other locations click Visualize Data!.
Posted on November 1, by rswarr. Justin Cobb Professor , United Kingdom. The cutaneous symptoms of Cobb syndrome appear at birth, and neurological symptoms present by the age of 5 years. Daniel T. He tries hard for his students. Photo of Michael Cobb. She works on the modeling side of the lab, analyzing the impact of last millennium volcanic eruptions on precipitation and water isotope patterns in the tropics and western Pacific.
Ty Cobb, the supposedly fearsome outfielder for the Detroit Tigers from , allegedly sharpened his spikes in order to injure opposing players while sliding into a base. Cobb is a great lecturer and explains concepts really well. He is very open to help you. WellStar is a not-for-profit Georgia-based organization dedicated to providing world-class healthcare. William J. John B. Find low everyday prices and buy online for delivery or in-store pick-up. Mathematics Teacher Education and Development, 13 1 , Annika Jersild comes to the Cobb lab after completing a Masters degree in forest resources and environmental conservation at Virginia Tech.
This first university worship of the year will be led by women involved in ministry through Baptist denominations. Paul M. We would love to see your review. The information contained on Finder is submitted by consultants, therapists and healthcare services, and these third parties declare it to be correct and compliant with their relevant regulatory bodies' standards and codes of conduct.
Last Sunday I raced the Triathlon England National Aquathlon championship — m open water swim non-wetsuit mass start , 5k run. Personal hip resurfacing stories from Professor Cobb. Highlights of your career? There is something about college teaching that draws liberal or liberal-leaning people. Full Time Faculty. Tyrus Raymond Cobb was the stuff of legend. The problem only asks for berries. Cobb, currently the Department Chair, is a social and cultural historian of the pre-modern Islamic world. Nine Lessons and Carols for Curious People has been an end of year tradition playing to sold out audiences in London for over a decade.
Marietta Eye Clinic offers a full range of eye doctor services including LASIK, laser-assisted cataract surgery, routine and medical eye care and more. Big values. Stephen Roberts and Prof. George Cobb killed in motorcycle crash Sorry this is a bit late, but I did not think of posting it here until today. Visiting Professor of Journalism. Hi Dr. He is much better than Dr. Abnormalities in brain development, once thought to be irreversible in adults, are assumed to underlie a range of autism, intellectual disability and epilepsy disorders. Cobb County anger management therapists can help with anger management classes, anger classes, feeling angry, anger control and other anger issues.
James C. Cobb is Emeritus B. He is a very funny and nice person. Urologist A Urologist, also known as a Genitourinary Surgeon, manages congenital and acquired conditions of the genitourinary system and contiguous structures including the adrenal gland.businesspodden.com/barrio-yungay-imgenes-de-poesa.php
The company's filing status is listed as Good Standing and its File Number is Share photos and videos, send messages and get updates. COBB retired recently from the Livesey professorship of coal gas and fuel industries in the University of Leeds—a chair which he had held since , shortly after its foundation Dr. This information is provided without warranties, expressed or implied, concerning its accuracy, completeness, reliability, or suitability. Faculty Office Hours. Device H1 all ceramic clinical trial — NHS. The key is doing something that you truly enjoy.
If you like to play along with Jeopardy on TV, do that. Or if you prefer reading novels or nonfiction, fine. Regular social engagement comes up repeatedly among those who maintain better memories as they age. In fact, some of the memory experts themselves struggle to navigate this very terrain. Brandt says he relies on little notes to himself to prompt his memory and he asks his patients if they do the same.
Do they use day planners, datebooks, or cellphones for notes to themselves? This is your life!
In their study, which involved 84 patients, the researchers found that low doses of the drug improved memory performance in some. They hope next to study the drug in a larger-scale, longer-term clinical trial. Another ongoing study at Hopkins takes a different approach and is also showing some success. Researchers in a large, multicenter trial, including Hopkins, are experimenting with patients inhaling insulin through their noses.
The device sends a series of small, continuous shocks into the fornix, a C-shaped bundle of fibers in the brain that carries signals from the hippocampus. The momentum to find a cure and eliminate the disease, Lyketsos says, builds each year. And scientists are working hard to develop better ways to care for affected people and support their families, friends, and caregivers.
These interventions were part of an experimental care program developed at Hopkins known as Maximizing Independence at Home, and its success in keeping people with dementia at home longer has garnered significant attention from organizations like the National Institute on Aging. In the next two to five years, he says, there will be a big boost in the dissemination of research and best practices thanks to federal funding and an organized, concerted effort by researchers.
Marcos Chin. Other Featured Articles. Thirsty Planet With climate change comes uncertainty about our water reserves. What can we do about it? Pain, Pain Go Away Pain afflicts millions of lives and costs millions of dollars. Therefore, assessing evidence of psychopharmacologic agents' safety and harms is essential.
Randomised controlled trials RCTs and observational studies may provide complementary information about harms of psychopharmacologic medications from both experimental and real-world settings. It is considered that RCTs provide a better control of confounding variables, while observational studies provide evidence from larger samples, longer follow-ups, in more representative samples, which may be more reflective of real-life clinical scenarios. However, this may not always hold true. Moreover, in observational studies, safety data are poorly or inconsistently reported, precluding reliable quantitative synthesis in meta-analyses.
Beyond individual studies, meta-analyses, which represent the highest level of 'evidence', can be misleading, redundant and of low methodological quality. Overlapping meta-analyses sometimes even reach different conclusions on the same topic. Meta-analyses should be assessed systematically. Descriptive reviews of reviews can be poorly informative. Conversely, 'umbrella reviews' can use a quantitative approach to grade evidence. In this editorial, we present the main factors involved in the assessment of psychopharmacologic agents' harms from individual studies, meta-analyses and umbrella reviews.
Background: One of the claimed main advantages of individual participant data meta-analysis IPDMA is that it allows assessment of subgroup effects based on individual-level participant characteristics, and eventually stratified medicine. We included papers if they described an IPDMA based on randomized clinical trials that investigated a therapeutic intervention on human subjects and in which the meta-analysis was preceded by a systematic literature search.
We extracted data items related to subgroup analysis and subgroup differences subgroup-treatment interaction p View details for PubMedID For the same clinical question, the largest effect estimate from any analysis was 1. The effect estimates of both approaches differed 1. Nevertheless, some of the differences in effect estimates or statistical significance may become important in clinical decision-making and the multiple estimates require utmost attention of possible selective reporting bias.
Identifying modifiable factors through environmental research may improve mental health outcomes. However, several challenges need to be addressed to optimize the chances of success. By analyzing the Netherlands Mental Health Survey and Incidence Study-2 data, we provide a data-driven illustration of how closely connected the exposures and the mental health outcomes are and how model and variable specifications produce "vibration of effects" variation of results under multiple different model specifications.
Interdependence of exposures is the rule rather than the exception. Therefore, exposure-wide systematic approaches are needed to separate genuine strong signals from selective reporting and dissect sources of heterogeneity. Pre-registration of protocols and analytical plans is still uncommon in environmental research. Different studies often present very different models, including different variables, despite examining the same outcome, even if consistent sets of variables and definitions are available. For datasets that are already collected and often already analyzed , the exploratory nature of the work should be disclosed.
Exploratory analysis should be separated from prospective confirmatory research with truly pre-specified analysis plans. In the era of big-data, where very low P values for trivial effects are detected, several safeguards may be considered to improve inferences, eg, lowering P-value thresholds, prioritizing effect sizes over significance, analyzing pre-specified falsification endpoints, and embracing alternative approaches like false discovery rates and Bayesian methods. Any claims for causality should be cautious and preferably avoided, until intervention effects have been validated.
We hope the propositions for amendments presented here may help with meeting these pressing challenges. Given this background, we aimed to assess whether implausibly large treatment effects for gabapentin and for a similar gabapentinoid, pregabalin may have been published. Background: Many effects of statins on non-cardiovascular disease non-CVD outcomes have been reported. Purpose: To evaluate the quantity, validity, and credibility of evidence regarding associations between statins and non-CVD outcomes and the effects of statins on these outcomes.
Data Extraction: Two investigators extracted data from meta-analyses and individual studies. For observational studies, no convincing class I evidence, 2 highly suggestive class II associations decreased cancer mortality in patients with cancer and decreased exacerbation in patients with chronic obstructive pulmonary disease , 21 suggestive class III associations, and 42 weak class IV associations were identified.
One outcome from the RCTs decreased all-cause mortality in patients with chronic kidney disease attained a sufficient amount of evidence with no hints of bias. For adverse events, observational studies showed suggestive evidence that statins increase the risk for diabetes and myopathy. Among the RCTs, no statistically significant effects were found on myopathy, myalgia, or rhabdomyolysis.
Limitations: Studies with relevant data and outcomes not included in the meta-analyses may have been missed. Credibility assessments relied on several assumptions and arbitrary thresholds. Conclusion: The absence of convincing evidence of an association between statins and non-CVD outcomes supports leaving the current recommendations unchanged. Primary Funding Source: None. To support evidence-informed education, health professions education HPE stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice.
This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Forty-two Guides published in Medical Teacher between and were analyzed. Accessibility to each Guide's full-text and supplemental materials was variable. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice. The available evidence on the benefits and harms of novel drugs and therapeutic biologics at the time of approval is reported in publicly available documents provided by the US Food and Drug Administration FDA.
We aimed to create a comprehensive database providing the relevant information required to systematically analyze and assess this early evidence in meta-epidemiological research. We designed a modular and flexible database of systematically collected data. We identified all novel cancer drugs and therapeutic biologics approved by the FDA between and , recorded regulatory characteristics, acquired the corresponding FDA approval documents, identified all clinical trials reported therein, and extracted trial design characteristics and treatment effects.
Herein, we describe the rationale and design of the data collection process, particularly the organization of the data capture, the identification and eligibility assessment of clinical trials, and the data extraction activities. The database provides information on the clinical trial evidence available at the time of approval of novel cancer treatments. The modular nature and structure of the database and the data collection processes allow updates, expansions, and adaption for a continuous meta-epidemiological analysis of novel drugs.
The database allows us to systematically evaluate benefits and harms of novel drugs and therapeutic biologics. It provides a useful basis for meta-epidemiological research on the comparative effects of innovative cancer treatments and continuous evaluations of regulatory developments. Furthermore, when the intervention was a drug or biologic, we searched also the original RCT articles, when their funding information was unavailable in the meta-analysis. We then qualitatively summarized the sources of funding. For binary outcomes, separate summary odds ratios were calculated for trials with and without industry funding.
The development of depression may involve a complex interplay of environmental and genetic risk factors. PubMed and PsycInfo databases were searched from inception through August 3, , to identify meta-analyses and Mendelian randomization MR studies of environmental risk factors associated with depression.
Seventy meta-analytic reviews met the eligibility criteria and provided meta-analyses for associations from primary studies. Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear.
We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. A large majority of human nutrition research uses nonrandomized observational designs, but this has led to little reliable progress.
This is mostly due to many epistemologic problems, the most important of which are as follows: difficulty detecting small or even tiny effect sizes reliably for nutritional risk factors and nutrition-related interventions; difficulty properly accounting for massive confounding among many nutrients, clinical outcomes, and other variables; difficulty measuring diet accurately; and suboptimal research reporting. Tiny effect sizes and massive confounding are largely unfixable problems that narrowly confine the scenarios in which nonrandomized observational research is useful.
Although nonrandomized studies and randomized trials have different priorities assessment of long-term causality compared with assessment of treatment effects , the odds for obtaining reliable information with the former are limited. Randomized study designs should therefore largely replace nonrandomized studies in human nutrition research going forward. To achieve this, many of the limitations that have traditionally plagued most randomized trials in nutrition, such as small sample size, short length of follow-up, high cost, and selective reporting, among others, must be overcome.
Pivotal megatrials with tens of thousands of participants and lifelong follow-up are possible in nutrition science with proper streamlining of operational costs. Fixable problems that have undermined observational research, such as dietary measurement error and selective reporting, need to be addressed in randomized trials. For focused questions in which dietary adherence is important to maximize, trials with direct observation of participants in experimental in-house settings may offer clean answers on short-term metabolic outcomes.
Johns Hopkins University Press Seasonal Catalog Fall/Winter by Susan Ventura - Issuu
Other study designs of randomized trials to consider in nutrition include registry-based designs and "N-of-1" designs. Mendelian randomization designs may also offer some more reliable leads for testing interventions in trials. Collectively, an improved randomized agenda may clarify many things in nutrition science that might never be answered credibly with nonrandomized observational designs. To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer.
Umbrella review. Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs meta-analyses and original studies. Physical activity was associated with lower risk of seven cancer sites colon, breast, endometrial, lung, oesophageal, pancreas and meningioma.
Only colon a protective association with recreational physical activity and breast cancer a protective association with overall physical activity were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature eg, not reaching P values View details for PubMedID To provide an overview of the evidence on prevalence and outcomes of incidental imaging findings.
Umbrella review of systematic reviews. Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities "incidentalomas". An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms.
Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas 13 provided both. Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging MRI , chest computed tomography for incidentalomas of thorax, abdomen, spine, or heart , and computed tomography colonoscopy for extra-colonic incidentalomas.
There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis.
Our results can underpin the creation of guidelines to assist these decisions. Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive interventions for psychosis, comparing different treatments in a network meta-analysis.
Two reviewers independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time points and the secondary outcome was treatment acceptability dropout due to any cause. The network meta-analysis showed no evidence of significantly superior efficacy of any one intervention over the others at 6 and 12 months insufficient data were available after 12 months. Similarly, there was no evidence for intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for different clustering of interventions and biases did not materially affect the interpretation of the results.
A brief history of Stephen Hawking's Brief History of Time
In summary, this study indicates that, to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further experimental research is needed. Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. It is not known whether interview method is associated with probability of major depression classification. AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 PHQ-9 diagnostic accuracy were analysed and binomial generalised linear mixed models were fit. A total of 17 participants with major depression from 57 primary studies were analysed. The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. All other authors declare no competing interests.
No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. The aim of this study was to evaluate how often the European Medicines Agency EMA has authorized drugs based on nonrandomized studies and whether there is an association between treatment effects and EMA preference for further testing in randomized clinical trials RCTs.
We reviewed all initial marketing authorizations in the EMA database on human medicines between and and included authorizations granted without randomized data. Of drugs, 51 were authorized based on nonrandomized data. These 51 drugs were licensed for 71 indications. In the 51 drug-indication pairs with no preference for further RCT testing, effect estimates were large [odds ratio OR : Larger effect sizes were associated with greater likelihood of approval based on nonrandomized data alone.
We did not find a clear treatment effect threshold for drug approval without RCT evidence. To evaluate limitations of common statistical modeling approaches in deriving clinical prediction models and explore alternative strategies. A previously published model predicted the likelihood of having a mutation in germline DNA mismatch repair genes at the time of diagnosis of colorectal cancer. This model was based on a cohort where 38 mutations were found among participants, with validation in an independent cohort with 35 mutations.
The modeling strategy included stepwise selection of predictors from a pool of over 37 candidate predictors and dichotomization of continuous predictors. We simulated this strategy in small subsets of a large contemporary cohort 2, mutations among 19, participants and made comparisons to other modeling approaches. All models were evaluated according to bias and discriminative ability concordance index, c in independent data. A small validation sample hampered stable assessment of performance. Prediction models perform poorly if based on small numbers of events and developed with common but suboptimal statistical approaches.
Alternative modeling strategies to best exploit available predictive information need wider implementation, with collaborative research to increase sample sizes. P values represent a widely used, but pervasively misunderstood and fiercely contested method of scientific inference. Display items, such as figures and tables, often containing the main results, are an important source of P values. We conducted a survey comparing the overall use of P values and the occurrence of significant P values in display items of a sample of articles in the three top multidisciplinary journals Nature, Science, PNAS in and, respectively, in We also examined the reporting of multiplicity corrections and its potential influence on the proportion of statistically significant P values.
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Our findings demonstrated substantial and growing reliance on P values in display items, with increases of 2. Use of Bayesian methods was scant 2. Overall, wider appreciation of the need for multiplicity corrections is a welcome evolution, but the rapid growth of reliance on P values and implausibly high rates of reported statistical significance are worrisome. Network meta-analysis NMA is a common approach to summarizing relative treatment effects from randomized trials with different treatment comparisons. Most NMAs are based on published aggregate data AD and have limited possibilities for investigating the extent of network consistency and between-study heterogeneity.
We discuss several one-stage random-effects NMA models that account for within-trial imbalances, treatment effect modifiers, missing response data and longitudinal responses. We illustrate all models in a case study of 18 antidepressant trials with a continuous endpoint the Hamilton Depression Score. Furthermore, it can help to improve network consistency and explain between-study heterogeneity by adjusting for participant-level effect modifiers and adopting more advanced models for dealing with missing response data.
We conclude that implementation of IPD-NMA should be considered when trials are affected by substantial drop-out rate, and when treatment effects are potentially influenced by participant-level covariates. This article presents an overview of the current landscape of biomedical research, identifies problems associated with common study designs and considers potential solutions. Randomized clinical trials, observational studies, systematic reviews and meta-analyses are discussed in terms of their inherent limitations and potential ways of improving their conduct, analysis and reporting.
The current emphasis on statistical significance needs to be replaced by sound design, transparency and willingness to share data with a clear commitment towards improving the quality and utility of clinical research. Better identification of at-risk groups could benefit HIV-1 care programmes. We systematically identified HIV-1 risk factors in two nationally representative cohorts of women in the Demographic and Health Surveys. We identified and replicated the association of social, economic, environmental, and behavioral factors with HIV-1 status.
We used false discovery rate criteria to identify factors that are strongly associated with HIV-1 in univariate and multivariate models of the entire population, as well as in subgroups stratified by wealth, residence, age, and past HIV-1 testing. In the univariate analysis, we identified and variables that are associated with HIV-1 in the two surveys, respectively 79 factors were associated in both.
Factors that were associated with HIV-1 status in full-sample analyses and in subgroups include being formerly married adjusted OR , 2. Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions.
Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder. We did a systematic review and network meta-analysis. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data.
We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy response rate and acceptability treatment discontinuations due to any cause. We estimated summary odds ratios ORs using pairwise and network meta-analysis with random effects.
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials.
These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants. Pragmatic randomized controlled trials RCTs mimic usual clinical practice and they are critical to inform decision-making by patients, clinicians and policy-makers in real-world settings. Pragmatic RCTs assess effectiveness of available medicines, while explanatory RCTs assess efficacy of investigational medicines. Explanatory and pragmatic are the extremes of a continuum.
This debate article seeks to evaluate and provide recommendation on how to characterize pragmatic RCTs in light of the current landscape of RCTs. It is supported by findings from a PubMed search conducted in August , which retrieved RCTs self-labeled in their titles as "pragmatic" or "naturalistic".
We focused on 89 of these trials that assessed medicines drugs or biologics. In our opinion, such RCTs overtly deviate from usual care and pragmatism. It follows, that the use of the term 'pragmatic' to describe them, conveys a misleading message to patients and clinicians. Furthermore, many other trials among the coined as 'pragmatic' and assessing other types of intervention are plausibly not very pragmatic; however, this is impossible for a reader to tell without access to the full protocol and insider knowledge of the trial conduct. The degree of pragmatism should be evaluated by the trial investigators themselves using the PRECIS-2 tool, a tool that comprises 9 domains, each scored from 1 very explanatory to 5 very pragmatic.
To allow for a more appropriate characterization of the degree of pragmatism in clinical research, submissions of RCTs to funders, research ethics committees and to peer-reviewed journals should include a PRECIS-2 tool assessment done by the trial investigators. Clarity and accuracy on the extent to which a RCT is pragmatic will help understand how much it is relevant to real-world practice.
The term "obesity paradox" is a figure of speech, not a scientific term. The term has no precise definition and has been used to describe numerous observations that have little in common other than the finding of an association of obesity with a favorable outcome. The terminology has led to misunderstandings among researchers and the public alike. It's time for authors and editors to abandon the use of this term.
Simply labeling counterintuitive findings as the "obesity paradox" adds no value. Unexpected findings should not be viewed negatively; such findings can lead to new knowledge, better treatments, and scientific advances. The multicomponent meningococcal serogroup B vaccine 4CMenB has been licensed in more than 35 countries.
However, uncertainties remain about the lowest number of doses required to induce satisfactory, persistent immune responses. We did a systematic review and meta-analysis to provide quantitative estimates for the immunogenicity, persistence of immunogenicity, and safety of 4CMenB vaccine in children and adolescents. For proportion meta-analyses, we also included single arm trials and follow-up studies of randomised controlled trials. We requested individual patient-level data from study authors and extracted data from published reports and online trial registries.
We did meta-analyses to assess 4CMenB safety and immunogenicity against the four reference strains 30 days after a primary immunisation course three doses for children, two doses for adolescents , 30 days after the primary course plus one booster dose children only , 6 months or more after primary course, and 6 months or more after the booster dose. Plantar fascial disorder is comprised of plantar fasciitis and plantar fibromatosis. Plantar fasciitis is the most common cause of heel pain, especially for athletes involved in running and jumping sports.
Plantar fibromatosis is a rare fibrous hyperproliferation of the deep connective tissue of the foot. To identify genetic loci associated with plantar fascial disorders, a genome-wide association screen was performed using publically available data from the Research Program in Genes, Environment and Health including 21, cases of plantar fascial disorders and 80, controls.
One indel chrD and one SNP rs showed an association with plantar fascial disorders at genome-wide significance p View details for PubMedID This paper aimed to evaluate the landscape of meta-analyses in the field of occupational and environmental health and medicine.
METHODS: Using relevant search terms, all meta-analyses were searched for, but those published in were assessed for their origin, whether they included randomised trials and individual-level data and whether they had authors from the industry or consultancy firms. Only 16 considered randomised intervention trials and 13 included individual-level data. Only 1 of the meta-analyses had industry authors and none had consultancy firm authors. As an example of conflicting findings, 12 overlapping meta-analyses addressed mobile phones and brain cancer risk and they differed substantially in number of studies included, eligibility criteria and conclusions.
Authorship is still limited largely to academic and non-profit authors. With massive production of meta-analyses, redundancy needs to be anticipated and efforts should be made to safeguard quality and protect from bias. However, it is recognized that science, as well as patients, consumers and manufacturers would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Assessment of researchers is necessary for decisions of hiring, promotion, and tenure.
A burgeoning number of scientific leaders believe the current system of faculty incentives and rewards is misaligned with the needs of society and disconnected from the evidence about the causes of the reproducibility crisis and suboptimal quality of the scientific publication record.
To address this issue, particularly for the clinical and life sciences, we convened a member expert panel workshop in Washington, DC, in January Twenty-two academic leaders, funders, and scientists participated in the meeting. As background for the meeting, we completed a selective literature review of 22 key documents critiquing the current incentive system.
From each document, we extracted how the authors perceived the problems of assessing science and scientists, the unintended consequences of maintaining the status quo for assessing scientists, and details of their proposed solutions. The resulting table was used as a seed for participant discussion. This resulted in six principles for assessing scientists and associated research and policy implications. We hope the content of this paper will serve as a basis for establishing best practices and redesigning the current approaches to assessing scientists by the many players involved in that process.
The summary ROR was 0. We found no major systematic differences in harm rates in pediatric trials between MDCs and LDCs, but data on harms in children were overall very limited. However, it is recognized that science, as well as patients, consumers, and manufacturers, would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. This overview discusses whether principles of evidence-based medicine EBM hold true for BGD and how they should be operationalized in the current era. Major EBM principles include the systematic identification, description and analysis of the validity and utility of BGD, the combination of individual clinical expertise with individual patient needs and preferences, and the focus on obtaining experimental evidence, whenever possible.
BGD emphasize information of single patients with an overemphasis on N-of-1 trials to personalize treatment. However, large-scale comparative population data remain indispensable for meaningful translation of BGD personalized information. The impact of BGD on population health depends on its ability to affect large segments of the population. While several frameworks have been proposed to facilitate and standardize decision-making for use of genomic tests, there are new caveats that arise from BGD that extend beyond the limitations that were applicable for more simple genetic tests.
Non-evidence-based use of BGD may be harmful and result in major waste of health care resources. Randomized controlled trials RCTs will continue to be the strongest arbitrator for the clinical utility of genomic technologies, including BGD. Research on BGD needs to focus not only on finding robust predictive associations clinical validity , but more importantly on evaluating the balance of health benefits and potential harms clinical utility , as well as implementation challenges.