Thinking territory historically.

BACKGROUND: While the randomised controlled trial (RCT) is generally regarded as the design of choice for assessing the effects of health care, within the social sciences there is considerable debate about the relative suitability of RCTs and non-randomised studies (NRSs) for evaluating public policy interventions. // OBJECTIVES: To determine whether RCTs lead to the same effect size and variance as NRSs of similar policy interventions; and whether these findings can be explained by other factors associated with the interventions or their evaluation. // METHODS: Analyses of methodological studies, empirical reviews, and individual health and social services studies investigated the relationship between randomisation and effect size of policy interventions by: 1) Comparing controlled trials that are identical in all respects other than the use of randomisation by 'breaking' the randomisation in a trial to create non-randomised trials (re-sampling studies). 2) Comparing randomised and non-randomised arms of controlled trials mounted simultaneously in the field (replication studies). 3) Comparing similar controlled trials drawn from systematic reviews that include both randomised and non-randomised studies (structured narrative reviews and sensitivity analyses within meta-analyses). 4) Investigating associations between randomisation and effect size using a pool of more diverse RCTs and NRSs within broadly similar areas (meta-epidemiology). // RESULTS: Prior methodological reviews and meta-analyses of existing reviews comparing effects from RCTs and nRCTs suggested that effect sizes from RCTs and nRCTs may indeed differ in some circumstances and that these differences may well be associated with factors confounded with design. Re-sampling studies offer no evidence that the absence of randomisation directly influences the effect size of policy interventions in a systematic way. No consistent explanations were found for randomisation being associated with changes in effect sizes of policy interventions in field trials

Caffeinated energy drinks and effects in UK young people

International systematic review evidence indicates an association of caffeinated energy drink use with physical symptoms and lifestyle but is unclear about associations with mental health and behavioural outcomes. The design of studies included in the reviews and the quality of the systematic reviews themselves limits the strength of the conclusions. The lack of UK research in the reviews prompted our analysis of UK population-level data. Our analysis of UK data suggests that many children in the UK consume CEDs with higher consumption reported by older children, by boys, and by those living in northern areas or in more deprived regions. Findings also suggest associations between consumption and physical, psychological, social and educational symptoms, behaviours and wellbeing. A lack of studies that measure these variables over time meant we were unable to determine whether CED consumption is the cause of associated symptoms, behaviours and wellbeing. Future research on this topic should employ longitudinal methods to examine whether CED consumption is responsible for poorer health and wellbeing. Research should also examine the influence of geographic region and deprivation on children’s caffeinated energy drink consumption. The measurement of caffeinated energy drink consumption in the future needs to be consistent across surveys, so that a clearer picture of the frequency, timing and dosage can be established. UK-wide exploration of the context and reasons for caffeinated energy drink consumption is needed and should include examining consumption of CEDs with alcohol in older children aged 16 to 17 years

"A hard day’s night?" The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review

Objective: To systematically review studies of the effects of the Compressed Working Week on the health and work-life balance of shift workers, and to identify any differential impacts by socio-economic group. Methods: Systematic review. Following QUORUM guidelines, published or unpublished experimental and quasi-experimental studies were identified. Data were sourced from 27 electronic databases, websites, bibliographies, and expert contacts. Results: Forty observational studies were found. The majority of studies only measured self-reported outcomes and the methodological quality of the included studies was not very high. Interventions did not always improve the health of shift workers, but in the five prospective studies with a control group, there were no detrimental effects on self-reported health. However, work-life balance was generally improved. No studies reported differential impacts by socio-economic group; however, most of the studies were conducted on homogeneous populations. Conclusion: This review suggests that the Compressed Working Week can improve work-life balance, and that it may do so with a low risk of adverse health or organisational effects. However, better designed studies that measure objective health outcomes are needed

Precision public health – A critical review of the opportunities and obstacles

The term ‘precision public health’ (PPH) refers to a new approach in public health which involves the use of novel data sources and/or computer science-driven methods of data analysis to predict risk or outcomes, in order to improve how interventions are targeted or tailored, with the aim of making them more individualised and therefore more effective and cost-effective than methods currently in use. These data may include, for example, information from social media or devices, genomic or clinical data, and information from healthcare services. In this critical review, which was conducted between March and October 2019, we outline key assumptions underpinning the PPH approach and identify potential challenges in its application. We adopted a pragmatic, non-systematic review methodology to examine: (i) the general principles underlying PPH; (ii) the validity of claims made about PPH in empirical studies and commentaries; and (iii) the potential opportunities and challenges of adopting a PPH approach through examining two case studies: health checks and community-based interventions. Non-empirical studies (commentaries and think-pieces) were included in this review because PPH represents an emerging approach and many of the ideas around the potential of PPH are only described in such studies Commentary studies emphasise that precision can be achieved in targeting interventions towards narrow social profiles of people through the incorporation of data reflecting micro-level day-to-day insights into the lives of individuals. Structured analysis of commentary studies shows that (i) the PPH field may be highly influenced by commentary and non-systematic review pieces that lack transparent methods but make claims about the potential of PPH; (ii) commentators on PPH often attempt to provide evidence for claims but the link between the evidence and the claim is often unsubstantiated when critically examined; and (iii) many of the assumptions underlying PPH are not supported by empirical evidence suggesting that there needs to be a measured approach to adopting PPH approaches. Claims around the effectiveness of PPH and around PPH being an advance on current public health approaches tended not to be supported by empirical evidence. As a relatively new concept therefore, there is limited direct empirical evidence showing PPH to be effective, and the theoretical arguments in its favour are often not well supported by evidence. The more ambitious claims made for PPH in the literature often rest on questionable readings of the evidence – for example, citing the possibility of identifying subgroups of the population through better targeting as though this automatically promises greater effectiveness among interventions targeting those subgroups. In practice, it seems that PPH is less a radically new paradigm and more a range of incremental improvements to public health interventions. Hypothetical case studies outlining the potential of a PPH approach applied to health checks and community-based interventions indicate several ways in which new data or tools could be productively used to inform the design and implementation of public health interventions. Current evidence suggests the impact of these is likely to be fairly modest, although further focused research (e.g. exploring the utility of strategies for targeting or involving communities using PPH) may merit further exploration and evaluation. Defining PPH is contentious and our findings reflect the difficulty in assessing and operationalising the broad ambition of using emerging data and technologies to better understand profiles, predict risk and outcomes, and act upon this evidence. Future work in this area should seek to introduce more focus around the concept of PPH, including being clearer about the goals and breaking down the concept into a series of components that can each be evaluated. The bulk of the work presented here took place between March and October 2019. There is scope for further analysis to understand the potential of PPH in the future, as the number of studies adopting a PPH approach grows. This larger pool of studies may also lend itself to more systematic approaches to reviewing the evidence, particularly if there is an interest in evaluating a particular component or principle of PPH. In addition, the evidence examined in this report predates the COVID-19 global pandemic, and many of the measures taken to mitigate the spread of the pandemic may provide a further source of evidence and data to understand the potential role of PPH in public health decision-making

What helps to support people affected by Adverse Childhood Experiences? A review of evidence

Adverse Childhood Experiences (ACEs) include physical, sexual or emotional abuse; neglect; domestic violence in the home; homelessness or living in care; parental mental health problems or substance abuse; and parents who are absent through imprisonment, separation or death. We sought to understand how people affected by ACEs can best be supported by conducting a review of evidence. The review involved three components: a qualitative synthesis of UK views studies; a systematic review of reviews which measured the effectiveness of interventions to support people affected by ACEs; and a stakeholder workshop with young people with lived experience of ACEs. The review was commissioned by the Department of Health and Social Care

Potential value of systematic reviews of qualitative evidence in informing user-centred health and social care: findings from a descriptive overview

Objective Systematic reviews of quantitative evidence are well-established in health and social care. Systematic reviews of qualitative evidence are increasingly available, but volume, topics covered, methods used and reporting quality are largely unknown. We provide a descriptive overview of systematic reviews of qualitative evidence assessing health and social care interventions included on the Database of Abstracts of Reviews of Effects (DARE). Study design and setting We searched DARE for reviews published between 1st January 2009 and 31st December 2014. We extracted data on review content and methods, summarised narratively and explored patterns over time. Results We identified 145 systematic reviews conducted worldwide (64 in the UK). Interventions varied, but largely covered treatment or service delivery in community and hospital settings. There were no discernible patterns over time. Critical appraisal of primary studies was conducted routinely. Most reviews were poorly reported. Conclusion Potential exists to use systematic reviews of qualitative evidence when driving forward user-centred health and social care. We identify where more research is needed and propose ways to improve review methodology and reporting

Using automation to produce a ‘living map’ of the COVID-19 research literature

The COVID-19 pandemic has disrupted life worldwide and presented unique challenges in the health evidencesynthesis space. The urgent nature of the pandemic required extreme rapidity for keeping track of research, andthis presented a unique opportunity for long-proposed automation systems to be deployed and evaluated. Wecompared the use of novel automation technologies with conventional manual screening; and Microsoft AcademicGraph (MAG) with the MEDLINE and Embase databases locating the emerging research evidence. We foundthat a new workflow involving machine learning to identify relevant research in MAG achieved a much higherrecall with lower manual effort than using conventional approaches

Effects of Pacing When Using Material Handling Manipulators

Common manipulator-assisted materials handling tasks were performed in a laboratory simulation at self-selected and faster (paced) speeds. The effects of pacing on peak hand forces, torso kinematics, spine moments and forces, and muscle antagonism were determined, along with any influences of several task variables on these effects. The faster trials were performed 20% more rapidly than the self-paced trials. It was found that (a) achieving this level of performance required 10% higher hand forces and 5%-10% higher torso moments, (b) consistent torso postures and motions were used for both speed conditions, and (c) the faster trials resulted in 10% higher spine forces and 15% higher levels of lumbar muscle antagonism. On whole, these results suggest a higher risk of musculoskeletal injury associated with performance of object transfers at faster than self-selected speeds with and without a manipulator. Further analysis provided evidence that the use of manipulators involves higher levels of motor coordination than do manual tasks. Several implications regarding the use of material handling manipulators in paced operations are discussed. Results from this investigation can be used in the design, evaluation, and selection of material handling manipulators.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67067/2/10.1518_001872099779591240.pd

Transplantation of Photoreceptor Precursors Isolated via a Cell Surface Biomarker Panel From Embryonic Stem Cell-Derived Self-Forming Retina.

Loss of photoreceptors due to retinal degeneration is a major cause of untreatable blindness. Cell replacement therapy, using pluripotent stem cell-derived photoreceptor cells, may be a feasible future treatment. Achieving safe and effective cell replacement is critically dependent on the stringent selection and purification of optimal cells for transplantation. Previously, we demonstrated effective transplantation of post-mitotic photoreceptor precursor cells labelled by fluorescent reporter genes. As genetically labelled cells are not desirable for therapy, here we developed a surface biomarker cell selection strategy for application to complex pluripotent stem cell differentiation cultures. We show that a five cell surface biomarker panel CD73(+)CD24(+)CD133(+)CD47(+)CD15(-) facilitates the isolation of photoreceptor precursors from three-dimensional self-forming retina differentiated from mouse embryonic stem cells. Importantly, stem cell-derived cells isolated using the biomarker panel successfully integrate and mature into new rod photoreceptors in the adult mouse retinae after subretinal transplantation. Conversely, unsorted or negatively selected cells do not give rise to newly integrated rods after transplantation. The biomarker panel also removes detrimental proliferating cells prior to transplantation. Notably, we demonstrate how expression of the biomarker panel is conserved in the human retina and propose that a similar selection strategy will facilitate isolation of human transplantation-competent cells for therapeutic application. Stem Cells 2015;33:2469-2482

Cost-effectiveness of Microsoft Academic Graph with machine learning for automated study identification in a living map of coronavirus disease 2019 (COVID-19) research

BACKGROUND: Conventionally, searching for eligible articles to include in systematic reviews and maps of research has relied primarily on information specialists conducting Boolean searches of multiple databases and manually processing the results, including deduplication between these multiple sources. Searching one, comprehensive source, rather than multiple databases, could save time and resources. Microsoft Academic Graph (MAG) is potentially such a source, containing a network graph structure which provides metadata that can be exploited in machine learning processes. Research is needed to establish the relative advantage of using MAG as a single source, compared with conventional searches of multiple databases. This study sought to establish whether: (a) MAG is sufficiently comprehensive to maintain our living map of coronavirus disease 2019 (COVID-19) research; and (b) eligible records can be identified with an acceptably high level of specificity. METHODS: We conducted a pragmatic, eight-arm cost-effectiveness analysis (simulation study) to assess the costs, recall and precision of our semi-automated MAG-enabled workflow versus conventional searches of MEDLINE and Embase (with and without machine learning classifiers, active learning and/or fixed screening targets) for maintaining a living map of COVID-19 research. Resource use data (time use) were collected from information specialists and other researchers involved in map production. RESULTS: MAG-enabled workflows dominated MEDLINE-Embase workflows in both the base case and sensitivity analyses. At one month (base case analysis) our MAG-enabled workflow with machine learning, active learning and fixed screening targets identified n=469 more new, eligible articles for inclusion in our living map – and cost £3,179 GBP ($5,691 AUD) less – than conventional MEDLINE-Embase searches without any automation or fixed screening targets. CONCLUSIONS: MAG-enabled continuous surveillance workflows have potential to revolutionise study identification methods for living maps, specialised registers, databases of research studies and/or collections of systematic reviews, by increasing their recall and coverage, whilst reducing production costs