The Adoption and Effectiveness of Automation in Health Evidence Synthesis

Background: Health systems worldwide are often informed by evidence-based guidelines which in turn rely heavily on systematic reviews. Systematic reviews are currently hindered by the increasing volume of new research and by its variable quality. Automation has potential to alleviate this problem but is not widely used in health evidence synthesis. This thesis sought to address the following: why is automation adopted (or not), and what effects does it have when it is put into use? / Methods: Roger’s Diffusion of Innovations theory, as a well-established and widely used framework, informed the study design and analysis. Adoption barriers and facilitators were explored through a thematic analysis of guideline developers’ opinions towards automation, and by mapping the adoption journey of a machine learning (ML) tool among Cochrane Information Specialists (CISs). A randomised trial of ML assistance in Risk of Bias (RoB) assessments and a cost-effectiveness analysis of a semi-automated workflow in the maintenance of a living evidence map each evaluated the effects of automation in practice. / Results: Adoption decisions are most strongly informed by the professional cultural expectations of health evidence synthesis. The stringent expectations of systematic reviewers and their users must be met before any other characteristic of an automation technology is considered by potential adopters. Ease-of-use increases in importance as a tool becomes more diffused across a population. Results of the randomised trial showed that ML-assisted RoB assessments were non-inferior to assessments completed entirely by human researcher effort. The cost-effectiveness analysis showed that a semi-automated workflow identified more relevant studies than the manual workflow and was less costly. / Conclusions: Automation can have substantial benefits when integrated into health evidence workflows. Wider adoption of automation tools will be facilitated by ensuring they are aligned with professional values of the field and limited in technical complexity

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

The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis

Abstract Background Obesity has become a world-wide epidemic and is spreading to countries with emerging economies. Previously tested interventions are often too costly to maintain in the long term. This leaves a need for improved strategies for management of the epidemic. Nudge Theory presents a new collection of methods, deemed “nudges”, which have the potential for low-cost and broad application to guide healthier lifestyle choices without the need for restrictive regulation. There has not yet been a large-scale examination of the effectiveness of nudges, despite several policy making bodies now considering their use. Methods To address this gap in knowledge, an adapted systematic review methodology was used to collect and consolidate results from current Nudge papers and to determine whether Nudge strategies are successful in changing adults’ dietary choices for healthier ones. Results It was found that nudges resulted in an average 15.3 % increase in healthier dietary or nutritional choices, as measured by a change in frequency of healthy choices or a change in overall caloric consumption. All of the included studies were from wealthy nations, with a particular emphasis on the United States with 31 of 42 included experiments. Conclusions This analysis demonstrates Nudge holds promise as a public health strategy to combat obesity. More research is needed in varied settings, however, and future studies should aim to replicate previous results in more geographically and socioeconomically diverse countries

Additional file 2: of The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis

Full text exclusions. (DOCX 18 kb

Interventions to minimize blood loss in very preterm infants-A systematic review and meta-analysis.

Blood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882

A New Approach for the Study of Lung Smooth Muscle Phenotypes and Its Application in a Murine Model of Allergic Airway Inflammation

<div><p>Phenotypes of lung smooth muscle cells in health and disease are poorly characterized. This is due, in part, to a lack of methodologies that allow for the independent and direct isolation of bronchial smooth muscle cells (BSMCs) and vascular smooth muscle cells (VSMCs) from the lung. In this paper, we describe the development of a bi-fluorescent mouse that permits purification of these two cell populations by cell sorting. By subjecting this mouse to an acute allergen based-model of airway inflammation that exhibits many features of asthma, we utilized this tool to characterize the phenotype of so-called asthmatic BSMCs. First, we examined the biophysical properties of single BSMCs from allergen sensitized mice and found increases in basal tone and cell size that were sustained <i>ex vivo</i>. We then generated for the first time, a comprehensive characterization of the global gene expression changes in BSMCs isolated from the bi-fluorescent mice with allergic airway inflammation. Using statistical methods and pathway analysis, we identified a number of differentially expressed mRNAs in BSMCs from allergen sensitized mice that code for key candidate proteins underlying changes in matrix formation, contractility, and immune responses. Ultimately, this tool will provide direction and guidance for the logical development of new markers and approaches for studying human lung smooth muscle.</p></div

Separation of BSMCs and VSMCs from the lung using the bi-fluorescent <i>αSMA-hrGFP;NG2-DsRed</i> mouse.

<p>(<b>A</b>) Expression pattern of hrGFP and DsRed in BSMCs and VSMCs in the lung of an <i>αSMA-hrGFP;NG2-DsRed</i> mouse. Both BSMCs and VSMCs are hrGFP⁺. BSMCs are DsRed⁻ whereas VSMCs are DsRed⁺. Asterisk (*) indicates the blood vessel in the lung the airway. Arrows (>) indicate the airway. Scale bar: 20 µm. (<b>B</b>) Algorithm for bronchial and vascular smooth muscle cell identification by flow cytometry. CD31⁺ endothelial cells and CD45⁺ immune cells were separated from dissociated lung preparation (left panel) followed by evaluation of hrGFP and DsRed distribution within CD31⁻CD45⁻ population (middle panel). CD31⁻CD45⁻hrGFP⁺DsRed⁻ population corresponds to BSMCs (pointed by an arrow). CD45⁻CD31⁻hrGFP⁺DsRed⁺ population is enriched in vascular smooth muscle cells (VSMCs). (<b>C</b>) Relative <i>Notch3</i> mRNA expression in isolated singly hrGFP⁺ cells and doubly hrGFP⁺DsRed⁺ cells from lung cell preparation as determined by qPCR followed by normalization to 18S. Data show mean ± SD and are representative of three independent experiments. ***p<0.001.</p

Measurement of changes in physical properties of individual BSMCs from OVA sensitized mice.

<p>BSMCs isolated from PBS-sensitized control and OVA sensitized <i>αSMA-hrGFP;NG2-DsRed</i> mice were allowed to attach to collagen I gel in culture for 72 hrs before assays. (<b>A</b>) Images of hrGFP⁺ BSMCs from PBS control and OVA sensitized mice (insert) and their traction maps on collagen I gels. (<b>B</b>) Contractile moment measurement of individual BSMCs from control and sensitized mice based on their traction maps. The line represents the mean of individual measurements of control (n = 20) and acute asthmatic (n = 22) cells. (<b>C</b>) Measurement of cell size of BSMCs from PBS sensitized control and OVA sensitized mice. The line represents the mean of individual measurements. **p<0.008.</p