An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools

Abstract Background Fibromyalgia (FM) is a chronic, debilitating pain disorder. Dissatisfaction with conventional medicine can lead people with FM to turn to complementary and alternative medicine (CAM). Two previous overviews of systematic reviews of CAM for FM have been published, but they did not assessed for risk of bias in the review process. Methods Five databases Medline, Embase, AMED (via OVID), Web of Science and Central were searched from their inception to December 2015. Reference lists were hand-searched. We had two aims: the first was to provide an up-to-date and rigorously conducted synthesis of systematic reviews of CAM literature on FM; the second was to evaluate the quality of the available systematic review evidence using two different tools: AMSTAR (Shea et al. BMC Med Res Methodol 15; 7:10, 2007) and a more recently developed tool ROBIS (Whiting et al. J Clin Epidemiol 69:225-34, 2016) specifically designed to assess risk of bias in systematic reviews. Any review that assessed one of eight CAM therapies for participants diagnosed with FM was considered. The individual studies had to be randomised controlled trials where the intervention was compared to placebo, treatment as usual or waitlist controls to be included. The primary outcome measure was pain, and the secondary outcome measure was adverse events. Results We identified 15 reviews that met inclusion criteria. There was low-quality evidence that acupuncture improves pain compared to no treatment or standard treatment, but good evidence that it is no better than sham acupuncture. The evidence for homoeopathy, spinal manipulation and herbal medicine was limited. Conclusions Overall, five reviews scored 6 or above using the AMSTAR scale and the inter-rater agreement was good (83.6%), whereas seven reviews achieved a low risk of bias rating using ROBIS and the inter-rater agreement was fair (60.0%). No firm conclusions were drawn for efficacy of either spinal manipulation or homoeopathy for FM. There is limited evidence for topical Capsicum, but further research is required. There is some evidence to support the effectiveness of acupuncture for FM, but further high-quality trials are needed to investigate its benefits, harms and mechanisms of action, compared with no or standard treatment. Systematic review registration PROSPERO CRD42016035846

Remote and blended teacher education : a rapid review

Initial and continuing teacher education are increasingly making use of remote and blended modes of education. Conducted in the summer of 2020 during the COVID-19 pandemic, this rapid review brings together literature and evidence to inform planning for remote and blended teacher education during restrictions in face-to-face teaching activity. The review consists of three main parts: first, a descriptive framework of modes of remote and blended teacher education; second, an exploratory review of the affordances and limitations of remote and blended approaches connecting the literature on effective teacher education with reviews of remote and blended approaches; third, a rapid review of evidence on the efficacy of remote and blended approaches, including of a small number of studies comparing these to face-to-face equivalents. We conclude that remote and blended teacher education is likely to become an increasingly important part of the teacher education landscape and there are plausible theoretical reasons suggesting that it can be effective with suitable design. However, we find too few studies presenting robust evidence to enable firm conclusions to be drawn on the relative effectiveness of modes and approaches. The review provides a foundation for further research and practice in this area

Bridging the conservation and development trade‐off? A working landscape critique of a conservancy in the Maasai Mara

The recent call to halt biodiversity loss by protecting half the planet has been hotly contested because of the extent to which people might be excluded from these landscapes. It is clear that incorporating landscapes that implicitly work for indigenous people is vital to achieving any sustainable targets. We examine an attempt to balance the trade‐offs between conservation and development in Enonkishu Conservancy in the Maasai Mara, using a working landscape approach. Mobile livestock production strategies are theoretically consistent with wildlife‐based activities and can present a win‐win solution for both conservation and development. We explore the success and failings of Enonkishu's evolving attempts to achieve this: addressing the criticism of the conservation sector that it fails to learn from its mistakes. We found that Enonkishu has had considerable positive conservation outcomes, preventing the continued encroachment of farmland and maintaining and improving rangeland health relative to the surrounding area, while maintaining diverse and large populations of wildlife and livestock. The learning from certain ventures that failed, particularly on livestock, has created institutions and governance that, while still evolving, are more robust and relevant for conservancy members, by being fluid and inclusive. Practical implication: Diverse revenue streams (beyond tourism, including a residential estate, livestock venture and philanthropy) enabled Enonkishu to withstand the pressures of COVID‐19. Livestock is crucial for defining the vision of the conservancy, and the institutions and governance that underpin it

The gamma response to colour hue in humans: evidence from MEG

It has recently been demonstrated through invasive electrophysiology that visual stimulation with extended patches of uniform colour generates pronounced gamma oscillations in the visual cortex of both macaques and humans. In this study we sought to discover if this oscillatory response to colour can be measured non-invasively in humans using magnetoencephalography. We were able to demonstrate increased gamma (40–70 Hz) power in response to full-screen stimulation with four different colour hues and found that the gamma response is particularly strong for long wavelength (i.e. red) stimulation, as was found in previous studies. However, we also found that gamma power in response to colour was generally weaker than the response to an identically sized luminance-defined grating. We also observed two additional responses in the gamma frequency: a lower frequency response around 25–35 Hz that showed fewer clear differences between conditions than the gamma response, and a higher frequency response around 70–100 Hz that was present for red stimulation but not for other colours. In a second experiment we sought to test whether differences in the gamma response between colour hues could be explained by their chromatic separation from the preceding display. We presented stimuli that alternated between each of the three pairings of the three primary colours (red, green, blue) at two levels of chromatic separation defined in the CIELUV colour space. We observed that the gamma response was significantly greater to high relative to low chromatic separation, but that at each level of separation the response was greater for both red-blue and red-green than for blue-green stimulation. Our findings suggest that the stronger gamma response to red stimulation cannot be wholly explained by the chromatic separation of the stimuli

Improving Interpretation of Cardiac Phenotypes and Enhancing Discovery With Expanded Knowledge in the Gene Ontology.

BACKGROUND: A systems biology approach to cardiac physiology requires a comprehensive representation of how coordinated processes operate in the heart, as well as the ability to interpret relevant transcriptomic and proteomic experiments. The Gene Ontology (GO) Consortium provides structured, controlled vocabularies of biological terms that can be used to summarize and analyze functional knowledge for gene products. METHODS AND RESULTS: In this study, we created a computational resource to facilitate genetic studies of cardiac physiology by integrating literature curation with attention to an improved and expanded ontological representation of heart processes in the Gene Ontology. As a result, the Gene Ontology now contains terms that comprehensively describe the roles of proteins in cardiac muscle cell action potential, electrical coupling, and the transmission of the electrical impulse from the sinoatrial node to the ventricles. Evaluating the effectiveness of this approach to inform data analysis demonstrated that Gene Ontology annotations, analyzed within an expanded ontological context of heart processes, can help to identify candidate genes associated with arrhythmic disease risk loci. CONCLUSIONS: We determined that a combination of curation and ontology development for heart-specific genes and processes supports the identification and downstream analysis of genes responsible for the spread of the cardiac action potential through the heart. Annotating these genes and processes in a structured format facilitates data analysis and supports effective retrieval of gene-centric information about cardiac defects. Circ Genom Precis Med 2018 Feb; 11(2):e001813

Childbearing and Economic Work: The Health Balance of Women in Accra, Ghana

Objectives: This study aims to investigate (1) whether the health of working women with young children differs from that of working women without young children, and (2) which social factors mediate the relationship between economic and maternal role performance and health among mothers with young children. Methods: The analyses uses panel data from 697 women present in both waves of the Women's Health Study for Accra (WHSA-I and WHSA-II); a community based study of women aged 18 years and older in the Accra Metropolitan Area of Ghana conducted in 2003 and 2008-2009. Change in physical and mental health between the survey waves is compared between women with a biological child alive at WHSA-II and born since WHSA-I and women without a living biological child at WHSA-II born in the interval. To account for attrition between the two survey waves selection models were used with unconditional change score models being used as the outcome model. Results: We found in our sample of working women that those who had a child born between WHSA-I and WHSA-II who was still alive at WHSA-II did not experience a change in mental or physical health different from other women. Among working women with young children, educational status, relationship to the household head and household demography were associated with change in mental health at the 5 % level, whilst migration status and household demography was associated with change in physical health scores. Conclusion: The results suggest there are no health penalties of combining work and childbearing among women with young children in Accra, Ghana

Accuracy of UK Rapid Test Consortium (UK-RTC) “AbC-19 Rapid Test” for detection of previous SARS-CoV-2 infection in key workers: test accuracy study

Abstract: Objective: To assess the accuracy of the AbC-19 Rapid Test lateral flow immunoassay for the detection of previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: Test accuracy study. Setting: Laboratory based evaluation. Participants: 2847 key workers (healthcare staff, fire and rescue officers, and police officers) in England in June 2020 (268 with a previous polymerase chain reaction (PCR) positive result (median 63 days previously), 2579 with unknown previous infection status); and 1995 pre-pandemic blood donors. Main outcome measures: AbC-19 sensitivity and specificity, estimated using known negative (pre-pandemic) and known positive (PCR confirmed) samples as reference standards and secondly using the Roche Elecsys anti-nucleoprotein assay, a highly sensitive laboratory immunoassay, as a reference standard in samples from key workers. Results: Test result bands were often weak, with positive/negative discordance by three trained laboratory staff for 3.9% of devices. Using consensus readings, for known positive and negative samples sensitivity was 92.5% (95% confidence interval 88.8% to 95.1%) and specificity was 97.9% (97.2% to 98.4%). Using an immunoassay reference standard, sensitivity was 94.2% (90.7% to 96.5%) among PCR confirmed cases but 84.7% (80.6% to 88.1%) among other people with antibodies. This is consistent with AbC-19 being more sensitive when antibody concentrations are higher, as people with PCR confirmation tended to have more severe disease whereas only 62% (218/354) of seropositive participants had had symptoms. If 1 million key workers were tested with AbC-19 and 10% had actually been previously infected, 84 700 true positive and 18 900 false positive results would be projected. The probability that a positive result was correct would be 81.7% (76.8% to 85.8%). Conclusions: AbC-19 sensitivity was lower among unselected populations than among PCR confirmed cases of SARS-CoV-2, highlighting the scope for overestimation of assay performance in studies involving only PCR confirmed cases, owing to “spectrum bias.” Assuming that 10% of the tested population have had SARS-CoV-2 infection, around one in five key workers testing positive with AbC-19 would be false positives. Study registration: ISRCTN 56609224

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348