Applicability of trials in rheumatoid arthritis and osteoarthritis: A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people

Objectives: To evaluate whether elderly people and women are adequately represented in randomized controlled trials (RCT) in rheumatoid arthritis (RA) and osteoarthritis (OA). Methods: Four systematic searches in MEDLINE yielded RCT in RA and OA on any intervention published in 2016 and 2017 and population-based studies (PBS) in RA and OA published between 2013 and 2017. Random effects meta-analyses estimated the pooled proportion of elderly people (defined as being ≥ 65 years old), the mean age, its standard deviation (SD), and the proportion of women stratified by disease (RA and OA) and study type (RCT and PBS). Stratified estimates were subsequently compared. Results: 265 RCT comprising 51,240 participants and 53 PBS comprising 523,630 participants were included. In both RA and OA, RCT included lower proportions of elderly people than PBS: RA –0.18 (95% confidence interval –0.22 to –0.13); OA –0.20 (–0.30 to –0.09); had lower mean ages: RA –5.2 years (–6.8 to –3.5); OA –4.7 years (–7.5 to –2.0); and smaller SD: RA –1.9 years (–2.6 to –1.3); OA –2.7 years (–4.2 to –1.2); (all comparisons: p ≤ 0.001). Proportions of women were comparable in RCT compared to PBS in both RA and OA. Conclusions: While women are adequately represented in RA and OA trials, the elderly are underrepresented, probably limiting applicability of current evidence to this growing subgroup. It is urgent to improve the inclusion of elderly people in clinical trials and study age as a determinant for outcome

The risk associated with spinal manipulation:an overview of reviews

BACKGROUND: Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS: We searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated. RESULTS: We identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe. CONCLUSIONS: It is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015030068. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0458-y) contains supplementary material, which is available to authorized users

Processed meat intake and chronic disease morbidity and mortality:An overview of systematic reviews and meta-analyses

Despite the nutritional value of meat, a large volume of reviews and meta-analyses suggests that processed meat intake is associated with an increased risk of chronic diseases. However, assessments of the quality of these published reviews internal validity are generally lacking. We systematically reviewed and assessed the quality alongside summarizing the results of previously published systematic reviews and meta-analyses that examined the association between processed meat intake and cancers, type II diabetes (T2D), and cardiovascular diseases (CVD). Reviews and meta-analyses published until May 2018 were identified through a systematic literature search in the databases MEDLINE and EMBASE, and reference lists of included reviews. The quality of the systematic reviews and meta-analyses was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). All eligible reviews had to comply with two quality requirements: providing sufficient information on quality assessment of the primary studies and a comprehensive search. The results were summarized for T2D, CVD, and each of the different cancer types. The certainty in the estimates of the individual outcomes was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. In total, 22 systematic reviews were eligible and thus included in this review. More than 100 reviews were excluded because quality assessment of the primary studies had not been performed. The AMSTAR score of the included reviews ranged from 5 to 8 indicating moderate quality. Overall, the quality assessments of primary studies of the reviews are generally lacking; the scientific quality of the systematic reviews reporting positive associations between processed meat intake and risk of various cancers, T2D and CVD is moderate, and the results from case-control studies suggest more often a positive association than the results from cohort studies. The overall certainty in the evidence was very low across all individual outcomes, due to serious risk of bias and imprecision

Captive pandas are at risk from environmental toxins

Ex situ conservation efforts are the last resort for many critically endangered species, and captive breeding centers are thought to provide a safe environment for producing individuals for eventual re-introduction to the wild. The giant panda (Ailuropoda melanoleuca) is one of the world's most endangered animals and is a widely recognized symbol for conservation. Here, we report that captive pandas in China experience environmental and dietary exposures to high concentrations of persistent organic pollutants (polychlorinated dibenzo-p-dioxins, dibenzofurans, and biphenyls) and heavy metals (arsenic, cadmium, chromium, and lead). In the short term, those animals exhibiting elevated levels of such toxins should be relocated to breeding centers in less contaminated areas. Ensuring the long-term survival of both captive and wild pandas depends in part on reducing atmospheric emissions of toxic pollutants throughout China

"I can't get no satisfaction":measuring student satisfaction in the age of a consumerist higher education

One could be excused for failing to recognise today’s universities as the inheritors of the global higher education system that arose more than 70 years ago from the ashes of the Second World War. A wave of post-war optimism ushered in a global movement with a utopian vision in which arbitrary divisions such as class, gender and race would be transcended in the pursuit of academic enlightenment (Scott, 1995). Universities were to be one of the key drivers of this change. But, contemporary academia is a distinctly different beast. The enlightenment values of the liberal education model, once the dominant philosophy in universities across the world, are gradually being supplanted by a consumerist ideology (Furedi, 2011): Yesterday’s ‘Cathedrals of learning’ are being replaced by today’s ‘Supermarkets of facts’

A Comprehensive Analysis of Error Sources in Electronic Fully Digital Impedance Bridges

open12sìFully digital impedance bridges are emerging as measuring instruments for primary electrical impedance metrology and the realization of impedance units and scales. This article presents a comprehensive analysis of electronic fully digital impedance bridges for both generating (based on digital-to-analog converters) and digitizing (based on analog-to-digital converters) bridges. The sources of measurement error are analyzed in detail and expressed by explicit mathematical formulas ready to be applied to the specific bridge and measurement case of interest. The same can be employed also as a basis to optimize the design and the operating parameters of digital bridges and evaluate the measurement uncertainty. A practical application of the analysis to the digital bridges developed and measurements performed in the framework of an international research project is presented.openOrtolano, Massimo; Marzano, Martina; D'Elia, Vincenzo; Mai Tran, Ngoc Thanh; Rybski, Ryszard; Kaczmarek, Janusz; Koziol, Miroslaw; Musiol, Krzysztof; Christensen, Andreas Elmholdt; Callegaro, Luca; Kucera, Jan; Power, OliverOrtolano, Massimo; Marzano, Martina; D'Elia, Vincenzo; Mai Tran, Ngoc Thanh; Rybski, Ryszard; Kaczmarek, Janusz; Koziol, Miroslaw; Musiol, Krzysztof; Christensen, Andreas Elmholdt; Callegaro, Luca; Kucera, Jan; Power, Olive

Practical Precision Electrical Impedance Measurement for the 21st Century – EMPIR Project 17RPT04 VersICal

The core objective of EMPIR project 17RPT04 VersICaL is to improve the European measurement infrastructure for electrical impedance, with particular emphasis on the capabilities of developing NMIs and calibration centres. The project will seek to exploit the results of existing research on digital impedance bridges (DIBs) by designing, constructing and validating simple, affordable versions suitable to realise the impedance scale in the range 1 nF to 10 μF and 1 mH to 10 H with relative uncertainties in the range 10-5 to 10-6. The first results of the research project, including the bridge designs and details of a polyphase digitally synthesized multichannel source capable of providing voltage outputs of precise ratio and phase are presented

Navigating the path of progress: The OMERACT 2023 emerging leaders program

Objectives: The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Emerging Leaders Program (ELP) aims to cultivate a cohort of skilled leaders within the OMERACT community empowering them with expertise and knowledge to help shape and steer the organization into the future. This publication highlights the significance of the ELP in driving leadership excellence, its impact on OMERACT's evolution, and the outcomes and learnings from the OMERACT 2023 ELP. Methods: Insights from the 2018 ELP report informed 2023 program improvements. Engagement was measured by attendance and WhatsApp interactions. Positive program aspects, areas for improvement and ideas for enhancing future ELPs were captured via anonymous survey and participant focus groups. Results: Engagement with the ELP was high with 9 participants, 96 % attendance at all workshops, 154 WhatsApp interactions. All program components were highly rated, with the highest being the ‘Psychological Safety’ and ‘Methodology/Process/Politics’ workshops. Future enhancements included creating further networking, connection and support activities, practical leadership and methodological skill development opportunities, and a new stream focussing on organisational advancement. Conclusions: The 2023 OMERACT ELP was well received and successfully addressed areas previously identified as requiring improvement. New educational enhancements were valued, and the importance of fostering psychological safety at all levels was highlighted. The ELP fortifies OMERACT by nurturing a diverse array of skilled leaders who embody OMERACTs core values. Continuing to refine and evolve the ELP over time will help OMERACT sustain its global influence in patient-centered outcome research