Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment

Objectives: This review assessed current practice in the preparation of rapid reviews by health technology assessment (HTA) organizations, both internationally and in the Australian context, and evaluated the available peer-reviewed literature pertaining to the methodology used in the preparation of these reviews. Methods: A survey tool was developed and distributed to a total of fifty International Network of Agencies for Health Technology Assessment (INAHTA) members and other selected HTA organizations. Data on a broad range of themes related to the conduct of rapid reviews were collated, discussed narratively, and subjected to simple statistical analysis where appropriate. Systematic searches of the Cochrane Library, EMBASE, MEDLINE, and the Australian Medical Index were undertaken in March 2007 to identify literature pertaining to rapid review methodology. Comparative studies, guidelines, program evaluations, methods studies, commentaries, and surveys were considered for inclusion. Results: Twenty-three surveys were returned (46 percent), with eighteen agencies reporting on thirty-six rapid review products. Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review. The twelve studies identified by the systematic literature search did not specifically address the methodology underpinning rapid review; rather, many highlighted the complexity of the area. Authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review. Conclusions: Rather than developing a formalized methodology by which to conduct rapid reviews, agencies should work toward increasing the transparency of the methods used for each review. It is perhaps the appropriate use, not the appropriate methodology, of a rapid review that requires future consideration.Amber Watt, Alun Cameron, Lana Sturm, Timothy Lathlean, Wendy Babidge, Stephen Blamey, Karen Facey, David Hailey, Inger Norderhaug and Guy Madder

The helium and carbon isotope characteristics of the Andean Convergent Margin

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Barry, P. H., De Moor, J. M., Chiodi, A., Aguilera, F., Hudak, M. R., Bekaert, D. V., Turner, S. J., Curtice, J., Seltzer, A. M., Jessen, G. L., Osses, E., Blamey, J. M., Amenabar, M. J., Selci, M., Cascone, M., Bastianoni, A., Nakagawa, M., Filipovich, R., Bustos, E., Schrenk, M. O. , Buongiorno, J., Ramírez, C. J., Rogers, T. J., Lloyd, K. G. & Giovannelli, D. The helium and carbon isotope characteristics of the Andean Convergent Margin. Frontiers in Earth Science, 10, (2022): 897267, https://doi.org/10.3389/feart.2022.897267.Subduction zones represent the interface between Earth’s interior (crust and mantle) and exterior (atmosphere and oceans), where carbon and other volatile elements are actively cycled between Earth reservoirs by plate tectonics. Helium is a sensitive tracer of volatile sources and can be used to deconvolute mantle and crustal sources in arcs; however it is not thought to be recycled into the mantle by subduction processes. In contrast, carbon is readily recycled, mostly in the form of carbon-rich sediments, and can thus be used to understand volatile delivery via subduction. Further, carbon is chemically-reactive and isotope fractionation can be used to determine the main processes controlling volatile movements within arc systems. Here, we report helium isotope and abundance data for 42 deeply-sourced fluid and gas samples from the Central Volcanic Zone (CVZ) and Southern Volcanic Zone (SVZ) of the Andean Convergent Margin (ACM). Data are used to assess the influence of subduction parameters (e.g., crustal thickness, subduction inputs, and convergence rate) on the composition of volatiles in surface volcanic fluid and gas emissions. He isotopes from the CVZ backarc range from 0.1 to 2.6 RA (n = 23), with the highest values in the Puna and the lowest in the Sub-Andean foreland fold-and-thrust belt. Atmosphere-corrected He isotopes from the SVZ range from 0.7 to 5.0 RA (n = 19). Taken together, these data reveal a clear southeastward increase in 3He/4He, with the highest values (in the SVZ) falling below the nominal range associated with pure upper mantle helium (8 ± 1 RA), approaching the mean He isotope value for arc gases of (5.4 ± 1.9 RA). Notably, the lowest values are found in the CVZ, suggesting more significant crustal inputs (i.e., assimilation of 4He) to the helium budget. The crustal thickness in the CVZ (up to 70 km) is significantly larger than in the SVZ, where it is just ∼40 km. We suggest that crustal thickness exerts a primary control on the extent of fluid-crust interaction, as helium and other volatiles rise through the upper plate in the ACM. We also report carbon isotopes from (n = 11) sites in the CVZ, where δ13C varies between −15.3‰ and −1.2‰ [vs. Vienna Pee Dee Belemnite (VPDB)] and CO2/3He values that vary by over two orders of magnitude (6.9 × 108–1.7 × 1011). In the SVZ, carbon isotope ratios are also reported from (n = 13) sites and vary between −17.2‰ and −4.1‰. CO2/3He values vary by over four orders of magnitude (4.7 × 107–1.7 × 1012). Low δ13C and CO2/3He values are consistent with CO2 removal (e.g., calcite precipitation and gas dissolution) in shallow hydrothermal systems. Carbon isotope fractionation modeling suggests that calcite precipitation occurs at temperatures coincident with the upper temperature limit for life (122°C), suggesting that biology may play a role in C-He systematics of arc-related volcanic fluid and gas emissions.This work was principally supported by the NSF-FRES award 2121637 to PB, KL, and JM. Field work was also supported by award G-2016-7206 from the Alfred P. Sloan Foundation and the Deep Carbon Observatory to PB, KL, DG, and JM. Additional support came from The National Fund for Scientific and Technological Development of Chile (FONDECYT) Grant 11191138 (The National Research and Development Agency of Chile, ANID Chile), and COPAS COASTAL ANID FB210021 to GJ. DG was partially supported by funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program Grant Agreement No. 948972—COEVOLVE—ERC-2020-STG

Breast cancer prognostic classification in the molecular era: the role of histological grade

Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers. © 2010 BioMed Central Lt

A synthesis of three decades of socio-ecological change in False Bay, South Africa: setting the scene for multidisciplinary research and management

Over the past three decades, marine resource management has shifted conceptually from top-down sectoral approaches towards the more systems-oriented multi-stakeholder frameworks of integrated coastal management and ecosystem-based conservation. However, the successful implementation of such frameworks is commonly hindered by a lack of cross-disciplinary knowledge transfer, especially between natural and social sciences. This review represents a holistic synthesis of three decades of change in the oceanography, biology and human dimension of False Bay, South Africa. The productivity of marine life in this bay and its close vicinity to the steadily growing metropolis of Cape Town have led to its socio-economic significance throughout history. Considerable research has highlighted shifts driven by climate change, human population growth, serial overfishing, and coastal development. Upwelling-inducing winds have increased in the region, leading to cooling and likely to nutrient enrichment of the bay. Subsequently the distributions of key components of the marine ecosystem have shifted eastward, including kelp, rock lobsters, seabirds, pelagic fish, and several alien invasive species. Increasing sea level and exposure to storm surges contribute to coastal erosion of the sandy shorelines in the bay, causing losses in coastal infrastructure and posing risk to coastal developments. Since the 1980s, the human population of Cape Town has doubled, and with it pollution has amplified. Overfishing has led to drastic declines in the catches of numerous commercially and recreationally targeted fish, and illegal fishing is widespread. The tourism value of the bay contributes substantially to the country’s economy, and whale watching, shark-cage diving and water sports have become important sources of revenue. Compliance with fisheries and environmental regulations would benefit from a systems-oriented approach whereby coastal systems are managed holistically, embracing both social and ecological goals. In this context, we synthesize knowledge and provide recommendations for multidisciplinary research and monitoring to achieve a better balance between developmental and environmental agendas.https://www.elementascience.orgam2020Mammal Research Institut

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Partial-valued logic

PART I (Partial-valued Languages): In Chapter I we consider modes of sentence composition and ask what 'truth-functionality' is functionality in two values, when there is also a third classification for meaningful sentences, An answer to this question might, we suggest, be seen as spelling out the very idea of the third classification as lack-of-a-value rather than a third value. We go on to ask how fully to exploit partial-valued semantics and motivate the need for modes of composition which themselves actually introduce non-trivial truth-value preconditions. There are two particularly interesting connectives which provide this expressive resourcefulness. The relation between partial- and total-valued languages is then considered. In Chapter II we consider subsentential modes of composition, and extensionality in general. Hence we come to see the shape of a partial-valued semantics which admits of undefinedness in a uniform way in all categories. But we restrict special attention to a simple kind of first-order language with terms and quantifiers and a discrete and determinate identity relation. There is, finally, a section devoted to definite descriptions.PART II (Logic): In Chapter III we set up laws for sentential composition, and in Chapter IV for the simple languages mentioned above. A theory is defined to be a (consequence) relation satisfying these laws, and we investigate the connection between theories and their models. Thus we are able to answer (some) questions about the logic: familiar questions and also ones peculiar to our partial-valued framework.PART III: In Chapter V we suggest that the features of our logic make it apt for deployment in a natural-language semantics which not only accommodates but actually gives a proper systematic treatment to 'presupposition'. The emphasis is on exhibiting presuppositions (as truth-value preconditions). We attempt, furthermore, to outline an account of linguistic practice which meshes with the semantic details in an illuminating way. 'Presupposing' is taken to be constitutive of assertion making, and what is presupposed constitutive of what is asserted.</p

Diagnosis of appendicitis in adults by ultrasonography or computed tomography: A systematic review and meta-analysis

Objectives: The use of ultrasonography and computed tomography (CT) in the diagnosis of appendicitis in adult patients was compared. Methods: Systematic review and meta-analysis of current evidence in two clinical situations: unselected nonpregnant, adult patients with symptoms of appendicitis, and more selective use in only those patients who still have an equivocal diagnosis subsequent to routine clinical investigations. Results: Meta-analysis of eligible studies shows CT to have better sensitivity and specificity than ultrasound in both clinical situations. Conclusions: Application of these findings in clinical practice and/or policy would need to evaluate the better diagnostic performance of CT against its cost and availability. In addition, it is imperative that future studies be conducted in patient populations that are well-defined with respect to prior investigations. Sequelae of false-negative and false-positive diagnoses should also be evaluated