How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

The evolution of the Patagonian Ice Sheet from 35 ka to the present day (PATICE)

\ua9 2020 The AuthorsWe present PATICE, a GIS database of Patagonian glacial geomorphology and recalibrated chronological data. PATICE includes 58,823 landforms and 1,669 geochronological ages, and extends from 38\ub0S to 55\ub0S in southern South America. We use these data to generate new empirical reconstructions of the Patagonian Ice Sheet (PIS) and subsequent ice masses and ice-dammed palaeolakes at 35 ka, 30 ka, 25 ka, 20 ka, 15 ka, 13 ka (synchronous with the Antarctic Cold Reversal), 10 ka, 5 ka, 0.2 ka and 2011 AD. At 35 ka, the PIS covered of 492.6 x103 km2, had a sea level equivalent of ~1,496 mm, was 350 km wide and 2090 km long, and was grounded on the Pacific continental shelf edge. Outlet glacier lobes remained topographically confined and the largest generated the suites of subglacial streamlined bedforms characteristic of ice streams. The PIS reached its maximum extent by 33 – 28 ka from 38\ub0S to 48\ub0S, and earlier, around 47 ka from 48\ub0S southwards. Net retreat from maximum positions began by 25 ka, with ice-marginal stabilisation then at 21 – 18 ka, which was then followed by rapid, irreversible deglaciation. By 15 ka, the PIS had separated into disparate ice masses, draining into large ice-dammed lakes along the eastern margin, which strongly influenced rates of recession. Glacial readvances or stabilisations occurred at least at 14 – 13 ka, 11 ka, 6 – 5 ka, 2 – 1 ka, and 0.5 – 0.2 ka. We suggest that 20th century glacial recession (% a-1) is occurring faster than at any time documented during the Holocene

Renal tract malformations: perspectives for nephrologists.

Contains fulltext : 71176.pdf (publisher's version ) (Closed access)Renal tract malformations are congenital anomalies of the kidneys and/or lower urinary tract. One challenging feature of these conditions is that they can present not only prenatally but also in childhood or adulthood. The most severe types of malformations, such as bilateral renal agenesis or dysplasia, although rare, lead to renal failure. With advances in dialysis and transplantation for young children, it is now possible to prevent the early death of at least some individuals with severe malformations. Other renal tract malformations, such as congenital pelviureteric junction obstruction and primary vesicoureteric reflux, are relatively common. Renal tract malformations are, collectively, the major cause of childhood end-stage renal disease. Their contribution to the number of adults on renal replacement therapy is less clear and has possibly been underestimated. Renal tract malformations can be familial, and specific mutations of genes involved in renal tract development can sometimes be found in affected individuals. These features provide information about the causes of malformations but also raise questions about whether to screen relatives. Whether prenatal decompression of obstructed renal tracts, or postnatal initiation of therapies such as prophylactic antibiotics or angiotensin blockade, improve long-term renal outcomes remains unclear