Prognostic Models for Chronic Low Back Pain Outcomes in Primary Care Are at High Risk of Bias and Lack Validation-High-Quality Studies Are Needed: A Systematic Review.

OBJECTIVE: To provide an updated overview of available prognostic models for people with chronic low back pain (LBP) in primary care. DESIGN: Prognosis systematic review LITERATURE SEARCH: We searched for relevant studies on MEDLINE, Embase, Web of Science, and CINAHL databases (up to July 13, 2022), and performed citation tracking in Web of Science. STUDY SELECTION CRITERIA: We included observational (cohort or nested case-control) studies and randomized controlled trials that developed or validated prognostic models for adults with chronic LBP in primary care. The outcomes of interest were physical functioning, pain intensity, and health-related quality of life at any follow-up time-point. DATA SYNTHESIS: Data were extracted using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and the Prediction model Risk of Bias Assessment Tool (PROBAST) tool was used to evaluate the risk of bias of the models. Due to the number of studies retrieved and the heterogeneity, we reported the results descriptively. RESULTS: Ten studies (out of 5593 hits screened) with 34 models met our inclusion criteria, of which six are development studies and four are external validation studies. Five studies reported the area under the curve of the models (ranging from 0.48 to 0.84), whereas no study reported calibration indices. The most promising model is the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form. CONCLUSIONS: Given the high risk of bias and lack of external validation, we cannot recommend that clinicians use prognostic models for patients with chronic LBP in primary care settings. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 15 February 2024. doi:10.2519/jospt.2024.12081.

Bias in the measurement of the outcome is associated with effect sizes in randomized clinical trials on exercise therapy for chronic low back pain: a meta-epidemiological study.

OBJECTIVES: To explore the relationships between the risk of bias and treatment effect estimates for exercise therapy interventions on pain intensity and physical functioning outcomes in randomized controlled trials (RCTs) involving patients with chronic low back pain. STUDY DESIGN AND SETTING: A cross-sectional meta-epidemiological study of the 230 RCTs (31,674 participants) in the 2021 'Exercise therapy for chronic low back pain' Cochrane Review were included. Study design characteristics, sample size, prospective trial registration, flowchart information, interventions, and comparisons were extracted. Independent pairs of reviewers assessed the risk of bias using the Cochrane Risk of Bias 2 tool. RESULTS: The metaregression included 220 (pain intensity) and 203 (physical functioning) effect sizes. Unadjusted and adjusted metaregression models showed no significant associations between the bias domains and pain intensity effect sizes. Only domain 'bias in the measurement of the outcome' was significantly associated with physical functioning (standardized mean difference: -0.40, 95% confidence interval: -0.77 to -0.02) when adjusted for flowchart reported (yes/no), prospective trial registration, sample size, and comparator type. CONCLUSION: The risk of bias in the measurement of the outcome could lead to slight overestimates of the effect size for physical functioning. Clinicians should consider this when they read and assess RCT results in this field. We encourage metaresearchers to replicate our findings using a consistent approach for evaluating the risk of bias (i.e., the RoB 2 tool) in other musculoskeletal conditions and interventions to investigate their generalizability.

Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis.

OBJECTIVE: We aimed to estimate the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched the MEDLINE, Cochrane CENTRAL, Embase, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022. STUDY SELECTION CRITERIA: RCTs evaluating SMT compared to guideline-recommended and nonrecommended interventions, sham SMT, and no intervention for adults with neck pain were eligible for our systematic review. Prespecified outcomes included pain, range of motion, disability, health-related quality of life. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogenous RCTs at short-term and long-term outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool. We used the Grading of Recommendations, Assessment, Development, and Evaluations approach to judge the certainty of evidence. RESULTS: We included 28 RCTs. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short term (standardized mean difference [SMD], 0.66; 95% confidence interval [CI]: 0.35, 0.97) and long term (SMD, 0.73; 95% CI: 0.31, 1.16), and for reducing disability at short-term (SMD, 0.95; 95% CI: 0.48, 1.42) and long term (SMD, 0.65; 95% CI: 0.23, 1.06). Transient side effects only were found (eg, muscle soreness). CONCLUSION: There was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. J Orthop Sports Phys Ther 2023;53(9):510-528. Epub: 10 August 2023. doi:10.2519/jospt.2023.11708.

Physiotherapy Screening for Referral of a Patient with Peripheral Arterial Disease Masquerading as Sciatica: A Case Report.

Many causes potentially underline pain in the lower extremities, presenting a real challenge for primary care clinicians in the recognition of the source of the patient's complaints. Peripheral arterial disease (PAD) is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. PAD of the lower extremities may masquerade as lumbosacral radiculopathy (LSR)-a common source of leg pain. Physiotherapists should be able to screen for PAD in people presenting with pain in the lower extremities. Failure to correctly screen for PAD could put the patient at risk of severe disability and possible permanent sequelae. This case report outlines the relevant concepts relating to the pathophysiology, screening, and differential diagnosis of PAD, and then further describes the relevant findings from the history and physical examination from the physiotherapist's perspective in a patient with an unusual symptom presentation. Although the patient was referred by a physician with a diagnosis of LSR, our case highlights the pivotal role of skilled physiotherapists in triaging a severe lower-limb PAD in need of referral. Therefore, this case report aims to increase clinicians' awareness of the clinical features of a complex case of PAD.

Relationships between task awareness, comprehension strategies, and literacy outcomes.

Reading is typically guided by a task or goal (e.g., studying for a test, writing a paper). A reader's task awareness arises from their mental representation of the task and plays an important role in guiding reading processes, ultimately influencing comprehension outcomes and task success. As such, a better understanding of how task awareness arises and how it affects comprehension is needed. The present study tested the Task Awareness Mediation Hypothesis. This hypothesis assumes that the strategies that support reading comprehension (e.g., paraphrasing, bridging, and elaborative strategies) also support a reader's task awareness while engaged in a literacy task. Further, it assumes that the reader's level of task awareness partially mediates the relationship between these comprehension strategies and a comprehension outcome. At two different time points in a semester, college students completed an assessment of their propensity to engage in comprehension strategies and a complex academic literacy task that provided a measure of comprehension outcomes and an assessment of task awareness. Indirect effects analyses provided evidence for the Task Awareness Mediation Hypothesis showing that the propensity to engage in paraphrasing and elaboration was positively predictive of task awareness, and that task awareness mediated the relationships between these comprehension strategies and performance on the complex academic literacy task. These results indicate that task awareness has complex relationships with comprehension strategies and performance on academic literacy tasks and warrants further consideration as a possible malleable factor to improve student success.

The Reporting of Somatic Sensory Training Interventions in Individuals After a Stroke Is Suboptimal: A Systematic Review and Meta-research Study.

OBJECTIVE: The purpose of this systematic review is to assess adherence to the "template for intervention description and replication" checklist among all published randomized controlled trials of sensory retraining strategies for patients with a history of stroke. METHODS: Medline, the Cochrane Register of Controlled Trials, and the Physiotherapy Evidence Database were investigated, without time restrictions, until September 1, 2021. In addition, a search for additional studies was carried out using the included studies' reference list. Only randomized controlled trials of adults with a history of stroke who aimed to improve sensation, via any type of intervention, were included. The template for intervention description and replication checklist was used to assess the completeness of reporting on each intervention. RESULTS: A total of 61 trials were included. None of the included studies declared to have used the template for intervention description and replication checklist to report interventions. Overall, the median percentage of adherence to the 12 items of the template for intervention description and replication was 33% (interquartile range, 25%-50%). Only five of the single items were adequately described in more than 50% of the studies. None of the randomized controlled trials reported the entirety of the core intervention components, as described in items 3 to 9. CONCLUSIONS: This systematic review demonstrates that interventions in sensory retraining strategy trials are described below desirable standards. Without this information, clinicians and researchers cannot reliably replicate interventions.

Exploring Thresholds in the Foundational Skills for Reading and Comprehension Outcomes in the Context of Postsecondary Readers.

There is a range of reasons why college students may be underprepared to read, but one possibility is that some college students are below a threshold of proficiency in the component skills of reading. The presence of thresholds means that when students fall below that threshold, their proficiency in that component skill of reading is not sufficient for there to be a relationship with comprehension performance. The present study assessed (a) whether there were thresholds in proficiencies in foundational skills, (b) whether students falling below the thresholds were disproportionately in developmental literary programs (i.e., institutionally designated as underprepared), and (c) the implications of being below the thresholds on engaging in strategic processing during reading. College students were administered assessments of foundational literacy skills, text comprehension, and strategic processing of texts. The sample included students who were enrolled in developmental literacy programs and students who were not. Thresholds were found in the foundational skills associated with word-, sentence-, and discourse-level processing. Participants below these thresholds were represented disproportionately by students determined to be underprepared for college and assigned to developmental literacy programs. Finally, students falling below the thresholds demonstrated lower reading strategy scores than students above the threshold.

The effects of domain knowledge and event structure on event processing.

Research suggests that domain knowledge facilitates memory for domain-specific information through two mechanisms: differentiation, which involves the ability to identify meaningful, fine-grained details within a sequence, and unitization, which involves binding individual components from a sequence into functional wholes. This study investigated the extent to which individuals engaged in differentiation and unitization when parsing continuous events into discrete, meaningful units (i.e., event segmentation) and recalling them. Participants watched and segmented basketball videos. They then rewatched the videos and provided descriptions afterward. Videos were coded for the presence of higher order goals (A2 actions) and the individual sub-actions that comprised them (A1 actions). Results suggested that event segmentation behavior for participants with less knowledge was more aligned with changes in basic actions (A1 actions) than for participants with greater knowledge. When describing events, participants with greater knowledge were more likely than participants with less knowledge to use statements that reflected unitization.

Exercise for Depressive Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To evaluate the efficacy of physical exercise in improving depressive symptoms in Parkinson disease (PD). DATA SOURCE AND STUDY SELECTION: We conducted a systematic review of randomized controlled trials (RCTs) following a prespecified protocol guidance (PROSPERO CRD42021243142). Two independent authors searched for studies in MEDLINE, Cochrane Register of Controlled Trials, Physiotherapy Evidence Database, Embase, PsycINFO, and Sports Discus from database inception to June 2022. DATA EXTRACTION: Two independent authors extracted the data and evaluated the risk of bias using the revised Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DATA SYNTHESIS: A total of 36 RCTs met the inclusion criteria, 14 of which were pooled in the quantitative synthesis. Depression symptomatology significantly decreased in the exercise group compared with usual care (standardized mean difference [SMD], -0.49; 95% confidence interval [CI], -0.74 to -0.24; very low quality of evidence; 14 RCTs; 961 participants). Physical exercise also improved patients' quality of life (SMD, -0.51; 95% CI, -0.81 to -0.21; 7 RCTs; 485 participants). As for acceptability, we did not find any difference between exercise and usual care (relative risk, 1.01; 95% CI, 0.97 to 1.05; 12 RCTs; 1048 participants). We judged all the studies except 2 to be at high risk of bias. CONCLUSIONS: Results from our systematic review identify physical activity as a viable option to reduce depressive symptoms in PD. Future clinical practice guidelines should consider physical exercise in their recommendations for depression symptomatology reduction in people with PD.

Adherence to the PRISMA statement and its association with risk of bias in systematic reviews published in rehabilitation journals: A meta-research study.

BACKGROUND: Systematic reviews (SRs) and meta-analyses are essential resources for the clinicians. They allow to evaluate the strengths and the weaknesses of the evidence to support clinical decision-making if they are adequately reported. Little is known in the rehabilitation field about the completeness of reporting of SRs and its relationship with the risk of bias (ROB). OBJECTIVES: Primary: 1) To evaluate the completeness of reporting of systematic reviews (SRs) published in rehabilitation journals by evaluating their adherence to the PRISMA 2009 checklist, 2) To investigate the relationship between ROB and completeness of reporting. Secondary: To study the association between completeness of reporting and journals and study characteristics. METHODS: A random sample of 200 SRs published between 2011 and 2020 in 68 rehabilitation journals was indexed under the "rehabilitation" category in the InCites database. Two independent reviewers evaluated adherence to the PRISMA checklist and assessed ROB using the ROBIS tool. Overall adherence and adherence to each PRISMA item and section were calculated. Regression analyses investigated the association between completeness of reporting, ROB, and other characteristics (impact factor, publication options, publication year, and study protocol registration). RESULTS: The mean overall PRISMA adherence across the 200 studies considered was 61.4%. Regression analyses show that having a high overall ROB is a significant predictor of lower adherence (B=-7.1%; 95%CI -12.1, -2.0). Studies published in fourth quartile journals displayed a lower overall adherence (B= -7.2%; 95%CI -13.2, -1.3) than those published in first quartile journals; the overall adherence increased (B= 11.9%; 95%CI 5.9, 18.0) if the SR protocol was registered. No association between adherence, publication options, and publication year was found. CONCLUSION: Reporting completeness in rehabilitation SRs is suboptimal and is associated with ROB, impact factor, and study registration. Authors of SRs should improve adherence to the PRISMA guideline, and journal editors should implement strategies to optimize the completeness of reporting.

Leveraging a multidimensional linguistic analysis of constructed responses produced by college readers.

The goal of this study was to assess the relationships between computational approaches to analyzing constructed responses made during reading and individual differences in the foundational skills of reading in college readers. We also explored if these relationships were consistent across texts and samples collected at different institutions and texts. The study made use of archival data that involved college participants who produced typed constructed responses under thinking aloud instructions reading history and science texts. They also took assessments of vocabulary knowledge and proficiency in comprehension. The protocols were analyzed to assess two different ways to determine their cohesion. One approach involved assessing how readers established connections with themselves (i.e., to other constructed responses they produced). The other approach involved assessing connections between the constructed responses and the texts that were read. Additionally, the comparisons were made by assessing both lexical (i.e., word matching) and semantic (i.e., high dimensional semantic spaces) comparisons. The result showed that both approaches for analyzing cohesion and making the comparisons were correlated with vocabulary knowledge and comprehension proficiency. The implications of the results for theory and practice are discussed.

Identifying peripheral arterial diseases or flow limitations of the lower limb: Important aspects for cardiovascular screening for referral in physiotherapy.

Many conditions could potentially cause pain in the lower limbs. One of these is peripheral arterial disease (PAD). PAD is often a real challenge to be recognized for clinicians due to symptoms that commonly mimic musculoskeletal conditions. PAD is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. Its prevalence is around 7 percent in subjects between 55 and 59, reaching almost 25% in individuals between 95 and 99 years old. The most dominant symptom of PAD is lower limb pain. Also, PAD can produce other symptoms such as discoloration, altered skin temperature, and, when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue, focal areas of ischemia. In our view, physical therapists should be capable of triaging for PAD in a direct access setting. Therefore, in this Professional Issue, we present the main characteristics of PAD and the physiotherapy role in its management. A supplementary step-by-step guide will provide further resources for testing PAD.

Completeness of Reporting Is Suboptimal in Randomized Controlled Trials Published in Rehabilitation Journals, With Trials With Low Risk of Bias Displaying Better Reporting: A Meta-research Study.

OBJECTIVE: Primary: To evaluate the completeness of reporting of randomized controlled trials (RCTs) published in rehabilitation journals through the evaluation of the adherence to the Consolidated Standards of Reporting Trials (CONSORT) checklist and investigate the relationship between reporting and risk of bias (ROB). Secondary: To study the association between completeness of reporting and the characteristics of studies and journals. DATA SOURCES: A random sample of 200 RCTs published between 2011 and 2020 in 68 rehabilitation journals indexed under the "rehabilitation" category in the InCites Journal Citation Report. STUDY SELECTION: One reviewer evaluated the completeness of reporting operationalized as the adherence to the CONSORT checklist. Two independent reviewers evaluated the ROB using the Cochrane risk-of-bias 2.0 tool. DATA EXTRACTION: Overall adherence and adherence to each CONSORT section were calculated. Regression analyses investigated the association between completeness of reporting, ROB, and other characteristics (quartile range, publication modalities, study protocol registration). DATA SYNTHESIS: The mean overall CONSORT adherence across studies was 65%. Studies with high ROB have less adherence than those with low ROB (-5.5%; CI, -10.9 to 0.0). There was a 10.2% (% CI, 6.2-14.3) increase in adherence if the RCT protocol was registered. Studies published in first quartile journals displayed an overall adherence of 11.7% (% CI 17.1-6.4) higher than those published in the fourth quartile. CONCLUSIONS: Reporting completeness is still suboptimal and is associated with ROB, journal impact ranking, and registration of the study protocol. Trial authors should improve adherence to the CONSORT guideline, and journal editors should adopt new strategies to improve the reporting.

The scope and severity of white-nose syndrome on hibernating bats in North America.

Assessing the scope and severity of threats is necessary for evaluating impacts on populations to inform conservation planning. Quantitative threat assessment often requires monitoring programs that provide reliable data over relevant spatial and temporal scales, yet such programs can be difficult to justify until there is an apparent stressor. Leveraging efforts of wildlife management agencies to record winter counts of hibernating bats, we collated data for 5 species from over 200 sites across 27 U.S. states and 2 Canadian provinces from 1995 to 2018 to determine the impact of white-nose syndrome (WNS), a deadly disease of hibernating bats. We estimated declines of winter counts of bat colonies at sites where the invasive fungus that causes WNS (Pseudogymnoascus destructans) had been detected to assess the threat impact of WNS. Three species undergoing species status assessment by the U.S. Fish and Wildlife Service (Myotis septentrionalis, Myotis lucifugus, and Perimyotis subflavus) declined by more than 90%, which warrants classifying the severity of the WNS threat as extreme based on criteria used by NatureServe. The scope of the WNS threat as defined by NatureServe criteria was large (36% of Myotis lucifugus range) to pervasive (79% of Myotis septentrionalis range) for these species. Declines for 2 other species (Myotis sodalis and Eptesicus fuscus) were less severe but still qualified as moderate to serious based on NatureServe criteria. Data-sharing across jurisdictions provided a comprehensive evaluation of scope and severity of the threat of WNS and indicated regional differences that can inform response efforts at international, national, and state or provincial jurisdictions. We assessed the threat impact of an emerging infectious disease by uniting monitoring efforts across jurisdictional boundaries and demonstrated the importance of coordinated monitoring programs, such as the North American Bat Monitoring Program (NABat), for data-driven conservation assessments and planning.

Alcance y Severidad del Síndrome de Nariz Blanca en los Murciélagos Hibernando en América del Norte Resumen La evaluación del alcance y la severidad de las amenazas es necesaria para los análisis de impacto sobre las poblaciones que se usan para orientar a la planeación de la conservación. La evaluación cuantitativa de amenazas con frecuencia requiere de programas de monitoreo que proporcionen datos confiables en escalas espaciales y temporales, aunque dichos programas pueden ser difíciles de justificar hasta que exista un estresante aparente. Gracias a una movilización de esfuerzos de las agencias de manejo de fauna para registrar los conteos invernales de murciélagos hibernadores, recopilamos datos para cinco especies en más de 200 sitios a lo largos de 27 estados de EUA y dos provincias canadienses entre 1995 y 2018 para determinar el impacto del síndrome de nariz blanca (SNB), una enfermedad mortal de los murciélagos hibernadores. Estimamos declinaciones en los conteos invernales de las colonias de murciélagos en sitios en donde el hongo invasivo que ocasiona el SNB (Pseudogymnoascus destructans) había sido detectado para evaluar el impacto de amenaza del SNB. Tres especies que se encuentran bajo valoración por parte del Servicio de Pesca y Vida Silvestre de los EUA (Myotis septentrionalis, Myotis lucifugus y Perimyotis subflavus) tuvieron una declinación de más del 90%, lo que justifica la clasificación de la severidad de la amenaza del SNB como extrema con base en el criterio usado por NatureServe. El alcance de la amenaza del SNB definido por el criterio de NatureServe fue desde amplio (36% de la distribución de Myotis lucifugus) hasta dominante (79% de la distribución de Myotis septentrionalis) para estas especies. Las declinaciones de otras dos especies (Myotis sodalis y Eptesicus fuscus) fueron menos severas, pero de igual manera quedaron clasificadas desde moderada hasta seria con base en los criterios de NatureServe. El intercambio de datos entre las jurisdicciones proporcionó una evaluación completa del alcance y la severidad de la amenaza del SNB e indicó las diferencias regionales que pueden guiar a los esfuerzos de respuesta realizados en las jurisdicciones internacionales, nacionales, estatales o provinciales. Evaluamos el impacto de amenaza de una enfermedad infecciosa emergente mediante la combinación de los esfuerzos de monitoreo que sobrepasan fronteras jurisdiccionales y demostramos la importancia que tienen para la planeación y la evaluación basadas en datos de la conservación los programas de monitoreo coordinados, como el Programa de Monitoreo de los Murciélagos Norteamericanos (NABat).

The effectiveness of median nerve electrical stimulation in patients with disorders of consciousness: a systematic review.

OBJECTIVE: To examine the effectiveness of median nerve electrical stimulation on consciousness level in subjects with disorders of consciousness. METHODS: Electronic databases PubMed, EMBASE, CENTRAL, and PEDro, as well as manual search and gray literature were searched from inception until May 2019. We included only randomized controlled trials. Two reviewers independently conducted the search strategy, study selection, data extraction, risk of bias assessment, and evidence judgment quality. RESULTS: Five studies met the inclusion criteria. Overall, no clear conclusion can be drawn about the intervention's effectiveness on the level of consciousness. One study reported a benefit of the intervention on the number of hospitalization days in the intensive care unit. Furthermore, another study reported a higher percentage of patients who regained consciousness six months from the event in the experimental group. CONCLUSION: Due to the limited number of studies that met the inclusion criteria and overall high risk of bias, it is impossible to draw a definitive conclusion. The results of this systematic review should be used to improve future research in this field.

Using expert knowledge to support Endangered Species Act decision-making for data-deficient species.

Many questions relevant to conservation decision-making are characterized by extreme uncertainty due to lack of empirical data and complexity of the underlying ecologic processes, leading to a rapid increase in the use of structured protocols to elicit expert knowledge. Published ecologic applications often employ a modified Delphi method, where experts provide judgments anonymously and mathematical aggregation techniques are used to combine judgments. The Sheffield elicitation framework (SHELF) differs in its behavioral approach to synthesizing individual judgments into a fully specified probability distribution for an unknown quantity. We used the SHELF protocol remotely to assess extinction risk of three subterranean aquatic species that are being considered for listing under the U.S. Endangered Species Act. We provided experts an empirical threat assessment for each known locality over a video conference and recorded judgments on the probability of population persistence over four generations with online submission forms and R-shiny apps available through the SHELF package. Despite large uncertainty for all populations, there were key differences between species' risk of extirpation based on spatial variation in dominant threats, local land use and management practices, and species' microhabitat. The resulting probability distributions provided decision makers with a full picture of uncertainty that was consistent with the probabilistic nature of risk assessments. Discussion among experts during SHELF's behavioral aggregation stage clearly documented dominant threats (e.g., development, timber harvest, animal agriculture, and cave visitation) and their interactions with local cave geology and species' habitat. Our virtual implementation of the SHELF protocol demonstrated the flexibility of the approach for conservation applications operating on budgets and time lines that can limit in-person meetings of geographically dispersed experts.

Uso del Conocimiento Experto para Respaldar la Toma de Decisiones del Acta de Especies en Peligro para Especies con Información Deficiente Resumen Muchas preguntas relevantes para la toma de decisiones de conservación se caracterizan por una incertidumbre extrema causada por la falta de información empírica y por la complejidad de los procesos ecológicos subyacentes. Esto lleva a un rápido incremento en el uso de protocolos estructurados para obtener conocimiento de los expertos en el tema. Las aplicaciones ecológicas publicadas con frecuencia emplean un método Delphi modificado, en el cual los expertos proporcionan dictámenes anónimamente y luego se usan técnicas de agregación matemática para combinar estos dictámenes. El marco de trabajo de obtención Sheffield (SHELF) difiere en su enfoque conductual para sintetizar los dictámenes individuales en una distribución de probabilidad completamente especificada para una cantidad desconocida. Usamos el protocolo SHELF remotamente para evaluar el riesgo de extinción de tres especies acuáticas subterráneas que están siendo consideradas para ser incluidas en el Acta de Especies en Peligro de los E.U.A. Les proporcionamos a los expertos una evaluación empírica de la amenaza para cada localidad conocida durante una videoconferencia y registramos los dictámenes sobre la probabilidad de la persistencia poblacional durante cuatro generaciones por medio de formularios enviados en línea y las apps R-shiny disponibles a través del paquete SHELF. A pesar de la gran incertidumbre para todas las poblaciones, hubo diferencias importantes entre el riesgo de extirpación de las especies con base en la variación espacial en las amenazas dominantes, el uso del suelo local y las prácticas de manejo, y el microhábitat de las especies. Las distribuciones resultantes de la probabilidad proporcionaron al órgano decisorio un cuadro completo de la incertidumbre que fue consistente con la naturaleza probabilística de las evaluaciones de riesgo. Las discusiones entre los expertos durante la fase de agregación conductual de SHELF documentaron claramente las amenazas dominantes (p. ej.: desarrollo, extracción de madera, agricultura animal y visitas a las cuevas) y sus interacciones con la geología de las cuevas locales y el hábitat de la especie. Nuestra implementación virtual del protocolo SHELF demostró la flexibilidad del enfoque para las aplicaciones de la conservación que operan con presupuestos y líneas de tiempo que pueden limitar las reuniones en persona de expertos dispersados geográficamente.

Influences of domain knowledge on segmentation and memory.

Much research has shown that experts possess superior memory in their domain of expertise. This memory benefit has been proposed to be the result of various encoding mechanisms, such as chunking and differentiation. Another potential encoding mechanism that is associated with memory is event segmentation, which is the process by which people parse continuous information into meaningful, discrete units. Previous research has found evidence that segmentation, to some extent, is affected by top-down processing. To date, few studies have investigated the influence of expertise on segmentation, and questions about expertise, segmentation ability, and their impact on memory remain. The goal of the current study was to investigate the influence of expertise on segmentation and memory ability for two different domains: basketball and Overwatch. Participants with high and low knowledge for basketball and with low knowledge for Overwatch viewed and segmented videos at coarse and fine grains, then completed memory tests. Differences in segmentation ability and memory were present between experts and control novices, specifically for the basketball videos; however, experts' segmentation only predicted memory for activities for which knowledge was lacking. Overall, this research suggests that experts' superior memory is not due to their segmentation ability and contributes to a growing body of literature showing evidence supporting conceptual effects on segmentation.

Declaration of use and appropriate use of reporting guidelines in high-impact rehabilitation journals is limited: a meta-research study.

OBJECTIVES: The main aims of this metaresearch study conducted among high-impact rehabilitation journals were: 1) to evaluate if the use of reporting guidelines (RGs) was declared and 2) to categorize the declared use as appropriate or inappropriate. STUDY DESIGN AND SETTING: Cross-sectional analysis of a random sample of 200 studies published in the period 2010-2019 in five generic rehabilitation journals with the highest 5-year impact factor. Randomized controlled trials, systematic reviews, observational studies, and diagnostic studies were included. Prevalence with 95% confidence intervals (CIs) was estimated for the main outcomes. RESULTS: Among the 200 selected studies, 17.5% (95% CI: 12.2-22.8%) declared using RGs. Among these studies, 48.6% (95% CI: 32-65.1%) declared an appropriate use. There was an increasing trend over time for authors to report the use of RGs (OR: 1.31; 95% CI: 1.13-1.53). Systematic reviews (n = 54) reported more frequently the use of RGs than other study designs (35.2%). CONCLUSION: In high-impact rehabilitation journals, a small minority of article authors declared the use of RGs. In approximately half of these studies, RGs were used inappropriately. There is an urgent need to improve the use of RGs in this field of research.

A new approach to integrating patient-generated data with expert knowledge for personalized goal setting: A pilot study.

INTRODUCTION: Self-monitoring technologies produce patient-generated data that could be leveraged to personalize nutritional goal setting to improve population health; however, most computational approaches are limited when applied to individual-level personalization with sparse and irregular self-monitoring data. We applied informatics methods from expert suggestion systems to a challenging clinical problem: generating personalized nutrition goals from patient-generated diet and blood glucose data. MATERIALS AND METHODS: We applied qualitative process coding and decision tree modeling to understand how registered dietitians translate patient-generated data into recommendations for dietary self-management of diabetes (i.e., knowledge model). We encoded this process in a set of functions that take diet and blood glucose data as an input and output diet recommendations (i.e., inference engine). Dietitians assessed face validity. Using four patient datasets, we compared our inference engine's output to clinical narratives and gold standards developed by expert clinicians. RESULTS: To dietitians, the knowledge model represented how recommendations from patient data are made. Inference engine recommendations were 63 % consistent with the gold standard (range = 42 %-75 %) and 74 % consistent with narrative clinical observations (range = 63 %-83 %). DISCUSSION: Qualitative modeling and automating how dietitians reason over patient data resulted in a knowledge model representing clinical knowledge. However, our knowledge model was less consistent with gold standard than narrative clinical recommendations, raising questions about how best to evaluate approaches that integrate patient-generated data with expert knowledge. CONCLUSION: New informatics approaches that integrate data-driven methods with expert decision making for personalized goal setting, such as the knowledge base and inference engine presented here, demonstrate the potential to extend the reach of patient-generated data by synthesizing it with clinical knowledge. However, important questions remain about the strengths and weaknesses of computer algorithms developed to discern signal from patient-generated data compared to human experts.

Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study.

BACKGROUND: A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. OBJECTIVE: Our mixed methods study aimed to understand (1) users' experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. METHODS: Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users' experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. RESULTS: In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7%), white (125/238, 52.5%), cisgender men (231/238, 97.1%), and 42.0% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). CONCLUSIONS: PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration.