Diagnosing Overtraining Syndrome: A Scoping Review

Context: Overtraining syndrome (OTS) is a condition characterized by a long-term performance decrement, which occurs after a persisting imbalance between training-related and nontraining-related load and recovery. Because of the lack of a gold standard diagnostic test, OTS remains a diagnosis of exclusion. Objective: To systematically review and map biomarkers and tools reported in the literature as potentially diagnostic for OTS. Data Sources: PubMed, Web of Science, and SPORTDiscus were searched from database inception to February 4, 2021, and results screened for eligibility. Backward and forward citation tracking on eligible records were used to complement results of database searching. Study Selection: Studies including athletes with a likely OTS diagnosis, as defined by the European College of Sport Science and the American College of Sports Medicine, and reporting at least 1 biomarker or tool potentially diagnostic for OTS were deemed eligible. Study Design: Scoping review following the guidelines of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR). Level of Evidence: Level 4. Data Extraction: Athletes’ population, criteria used to diagnose OTS, potentially diagnostic biomarkers and tools, as well as miscellaneous study characteristics were extracted. Results: The search yielded 5561 results, of which 39 met the eligibility criteria. Three diagnostic scores, namely the EROS-CLINICAL, EROS-SIMPLIFIED, and EROS-COMPLETE scores (EROS = Endocrine and Metabolic Responses on Overtraining Syndrome study), were identified. Additionally, basal hormone, neurotransmitter and other metabolite levels, hormonal responses to stimuli, psychological questionnaires, exercise tests, heart rate variability, electroencephalography, immunological and redox parameters, muscle structure, and body composition were reported as potentially diagnostic for OTS. Conclusion: Specific hormones, neurotransmitters, and metabolites, as well as psychological, electrocardiographic, electroencephalographic, and immunological patterns were identified as potentially diagnostic for OTS, reflecting its multisystemic nature. As exemplified by the EROS scores, combinations of these variables may be required to diagnose OTS. These scores must now be validated in larger samples and within female athletes.

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A protocol for a scoping review of equity measurement in mental health care for children and youth

Systematic Reviews ◽

10.1186/s13643-020-01495-3 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

William Gardner ◽

Stuart G. Nicholls ◽

Graham J. Reid ◽

Brian Hutton ◽

Candyce Hamel ◽

...

Keyword(s):

Mental Health ◽

Scoping Review ◽

Full Text ◽

Data Extraction ◽

Open Science ◽

Children And Youth ◽

Eligibility Criteria ◽

Study Selection ◽

Study Characteristics ◽

Two Stages

Abstract Background Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? Methods The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. Discussion The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. Systematic review registration Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/.

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How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis

BMJ Open ◽

10.1136/bmjopen-2021-054368 ◽

2021 ◽

Vol 11 (7) ◽

pp. e054368

Author(s):

Gail Davison ◽

Martina Ann Kelly ◽

Richard Conn ◽

Andrew Thompson ◽

Tim Dornan

Keyword(s):

Scoping Review ◽

Healthcare Professionals ◽

Medical Information ◽

Data Extraction ◽

Contextual Information ◽

Evidence Base ◽

Eligibility Criteria ◽

Study Characteristics ◽

Trusting Relationships ◽

Methodological Principles

ObjectiveExplore children’s and adolescents’ (CADs’) lived experiences of healthcare professionals (HCPs).DesignScoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences.Data sourcesFive key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications.Eligibility criteriaResearch articles containing direct first-person quotations by CADs (aged 0–18 years inclusive) describing how they experienced HCPs.Data extraction and synthesisTabulation of study characteristics, contextual information, and verbatim extraction of all ‘relevant’ (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children’s experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children’s hospital.Results669 quotations from 99 studies described CADs’ experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs’ wider needs and preferences.ConclusionThese findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.

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Measurement of unnecessary psychiatric readmissions in the context of care transition interventions: a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-045364 ◽

2021 ◽

Vol 11 (2) ◽

pp. e045364

Author(s):

Bo Kim ◽

Christopher Weatherly ◽

Courtney Benjamin Wolk ◽

Enola K Proctor

Keyword(s):

Scoping Review ◽

Data Extraction ◽

Mental Healthcare ◽

Care Transition ◽

Time Interval ◽

Eligibility Criteria ◽

Transition Processes ◽

Healthcare Transition ◽

Population Type ◽

Scoping Reviews

ObjectiveThe objective of this study was to examine how published studies of inpatient to outpatient mental healthcare transition processes have approached measuring unnecessary psychiatric readmissions.DesignScoping review using Levac et al’s enhancement to Arksey and O’Malley’s framework for conducting scoping reviews.Data sourcesMedline (Ovid), Embase (Ovid), PsycINFO, CINAHL, Cochrane and ISI Web of Science article databases were searched from 1 January 2009 through 28 February 2019.Eligibility criteria for selecting studiesWe included studies that (1) are about care transition processes associated with unnecessary psychiatric readmissions and (2) specify use of at least one readmission time interval (ie, the time period since previous discharge from inpatient care, within which a hospitalisation can be considered a readmission).Data extraction and synthesisWe assessed review findings through tabular and content analyses of the data extracted from included articles.ResultsOur database search yielded 3478 unique articles, 67 of which were included in our scoping review. The included articles varied widely in their reported readmission time intervals used. They provided limited details regarding which readmissions they considered unnecessary and which risks they accounted for in their measurement. There were no perceptible trends in associations between the variation in these findings and the included studies’ characteristics (eg, target population, type of care transition intervention).ConclusionsThe limited specification with which studies report their approach to unnecessary psychiatric readmissions measurement is a noteworthy gap identified by this scoping review, and one that can hinder both the replicability of conducted studies and adaptations of study methods by future investigations. Recommendations stemming from this review include (1) establishing a framework for reporting the measurement approach, (2) devising enhanced guidelines regarding which approaches to use in which circumstances and (3) examining how sensitive research findings are to the choice of the approach.

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Evidence for the effects of viewing visual artworks on stress outcomes: a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-043549 ◽

2021 ◽

Vol 11 (6) ◽

pp. e043549

Author(s):

Mikaela Law ◽

Nikita Karulkar ◽

Elizabeth Broadbent

Keyword(s):

Heart Rate ◽

Scoping Review ◽

English Language ◽

Data Extraction ◽

Controlled Trial ◽

Included Study ◽

Individual Characteristics ◽

Eligibility Criteria ◽

Scoping Reviews ◽

Randomised Controlled

ObjectiveTo review the existing evidence on the effects of viewing visual artworks on stress outcomes and outline any gaps in the research.DesignA scoping review was conducted based on the Joanna Briggs Institute methodology for scoping reviews and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two independent reviewers performed the screening and data extraction.Data sourcesMedline, Embase, APA PsycINFO, Cochrane CENTRAL, Scopus, Google Scholar, Google, ProQuest Theses and Dissertations Database, APA PsycExtra and Opengrey.eu were searched in May 2020.Eligibility criteriaStudies were included if they investigated the effects of viewing at least one visual artwork on at least one stress outcome measure. Studies involving active engagement with art, review papers or qualitative studies were excluded. There were no limits in terms of year of publication, contexts or population types; however, only studies published in the English language were considered.Data extraction and synthesisInformation extracted from manuscripts included: study methodologies, population and setting characteristics, details of the artwork interventions and key findings.Results14 primary studies were identified, with heterogeneous study designs, methodologies and artwork interventions. Many studies lacked important methodological details and only four studies were randomised controlled trials. 13 of the 14 studies on self-reported stress reported reductions after viewing artworks, and all of the four studies that examined systolic blood pressure reported reductions. Fewer studies examined heart rate, heart rate variability, cortisol, respiration or other physiological outcomes.ConclusionsThere is promising evidence for effects of viewing artwork on reducing stress. Moderating factors may include setting, individual characteristics, artwork content and viewing instructions. More robust research, using more standardised methods and randomised controlled trial designs, is needed.Registration detailsA protocol for this review is registered with the Open Science Framework (osf.io/gq5d8).

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Public health implications of SARS-CoV-2 variants of concern: a rapid scoping review

BMJ Open ◽

10.1136/bmjopen-2021-055781 ◽

2021 ◽

Vol 11 (12) ◽

pp. e055781

Author(s):

Mari Somerville ◽

Janet A Curran ◽

Justine Dol ◽

Leah Boulos ◽

Lynora Saxinger ◽

...

Keyword(s):

Public Health ◽

Systematic Reviews ◽

Scoping Review ◽

Data Extraction ◽

Control Measures ◽

Eligibility Criteria ◽

Health Measures ◽

Infection Control Measures ◽

Scoping Reviews ◽

The Impact

ObjectivesThe four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC.DesignA rapid scoping review.Data sourcesOn 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos’ L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication.Eligibility criteriaStudies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included.Data extraction and synthesisTitles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.ResultsOf the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC.ConclusionsThe increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.

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Artificial Intelligence for Skin Cancer Detection: A Scoping Review (Preprint)

10.2196/preprints.22934 ◽

2020 ◽

Author(s):

Abdulrahman Takiddin ◽

Jens Schneider ◽

Yin Yang ◽

Alaa Abd-Alrazaq ◽

Mowafa Househ

Keyword(s):

Artificial Intelligence ◽

Skin Cancer ◽

Scoping Review ◽

Performance Metrics ◽

Data Extraction ◽

Characteristic Curve ◽

Evaluation Metrics ◽

Cancer Type ◽

Computer Algorithms ◽

Scoping Reviews

BACKGROUND Skin cancer is the most common cancer type affecting humans. Traditional skin cancer diagnosis methods are costly, require a professional physician, and take time. Hence, to aid in diagnosing skin cancer, Artificial Intelligence (AI) tools are being used, including shallow and deep machine learning-based techniques that are trained to detect and classify skin cancer using computer algorithms and deep neural networks. OBJECTIVE The aim of this study is to identify and group the different types of AI-based technologies used to detect and classify skin cancer. The study also examines the reliability of the selected papers by studying the correlation between the dataset size and number of diagnostic classes with the performance metrics used to evaluate the models. METHODS We conducted a systematic search for articles using IEEE Xplore, ACM DL, and Ovid MEDLINE databases following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The study included in this scoping review had to fulfill several selection criteria; to be specifically about skin cancer, detecting or classifying skin cancer, and using AI technologies. Study selection and data extraction were conducted by two reviewers independently. Extracted data were synthesized narratively, where studies were grouped based on the diagnostic AI techniques and their evaluation metrics. RESULTS We retrieved 906 papers from the 3 databases, but 53 studies were eligible for this review. While shallow techniques were used in 14 studies, deep techniques were utilized in 39 studies. The studies used accuracy (n=43/53), the area under receiver operating characteristic curve (n=5/53), sensitivity (n=3/53), and F1-score (n=2/53) to assess the proposed models. Studies that use smaller datasets and fewer diagnostic classes tend to have higher reported accuracy scores. CONCLUSIONS The adaptation of AI in the medical field facilitates the diagnosis process of skin cancer. However, the reliability of most AI tools is questionable since small datasets or low numbers of diagnostic classes are used. In addition, a direct comparison between methods is hindered by a varied use of different evaluation metrics and image types.

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Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Healthcare ◽

10.3390/healthcare9050609 ◽

2021 ◽

Vol 9 (5) ◽

pp. 609

Author(s):

Uchenna Benedine Okafor ◽

Daniel Ter Goon

Keyword(s):

Physical Activity ◽

Pregnant Women ◽

Scoping Review ◽

Post Partum ◽

Healthcare Providers ◽

Original Research ◽

Eligibility Criteria ◽

Physical Activity Advice ◽

Scoping Reviews ◽

Physical Activity And Exercise

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010–2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.

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Instruments for measuring nursing research competence: a protocol for a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-042325 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042325

Author(s):

Qirong Chen ◽

Chongmei Huang ◽

Aimee R Castro ◽

Siyuan Tang

Keyword(s):

Scoping Review ◽

Data Extraction ◽

Target Population ◽

Measurement Properties ◽

Nursing Research ◽

Measurement Instruments ◽

Health Measurement ◽

Research Competence ◽

Scoping Reviews

IntroductionNursing research competence of nursing personnel has received much attention in recent years, as nursing has developed as both an independent academic discipline and an evidence-based practiing profession. Instruments for appraising nursing research competence are important, as they can be used to assess nursing research competence of the target population, showing changes of this variable over time and measuring the effectiveness of interventions for improving nursing research competence. There is a need to map the current state of the science of the instruments for nursing research competence, and to identify well validated and reliable instruments. This paper describes a protocol for a scoping review to identify, evaluate, compare and summarise the instruments designed to measure nursing research competence.Methods and analysisThe scoping review will be conducted following Arksey and O’Malley’s methodological framework and Levac et al’s additional recommendations for applying this framework. The scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The protocol is registered through the Open Science Framework (https://osf.io/ksh43/). Eight English databases and two Chinese databases will be searched between 1 December 2020 and 31 December 2020 to retrieve manuscripts which include instrument(s) of nursing research competence. The literature screening and data extraction will be conducted by two researchers, independently. A third researcher will be involved when consensus is needed. The COnsensus-based Standards for the selection of health Measurement INstruments methodology will be used to evaluate the methodological quality of the included studies on measurement properties of the instruments, as well as the quality of all the instruments identified.Ethics and disseminationEthical approval is not needed. We will disseminate the findings through a conference focusing on nursing research competence and publication of the results in a peer-reviewed journal.

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Gender disparity between authors in leading medical journals during the COVID-19 pandemic: a cross-sectional review

BMJ Open ◽

10.1136/bmjopen-2021-051224 ◽

2021 ◽

Vol 11 (7) ◽

pp. e051224

Author(s):

Vaidehi Misra ◽

Frozan Safi ◽

Kathryn A Brewerton ◽

Wei Wu ◽

Robin Mason ◽

...

Keyword(s):

Data Extraction ◽

Gender Disparity ◽

High Impact ◽

Original Research ◽

Eligibility Criteria ◽

Cross Sectional ◽

Medical Journals ◽

The Usa ◽

Study Characteristics ◽

Data Elements

ObjectivesEvaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.DesignCross-sectional review.Data sourcesMedline database.Eligibility criteriaArticles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.Data extractionKey data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors’ likely gender; this was quantified using adjusted ORs (aORs).ResultsWe included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; p<0.001). Men were more likely to author articles reporting original research and those with corresponding authors based outside the USA and Europe.ConclusionsWomen were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women’s authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.PROSPERO registration numberCRD42020186702.

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Algorithms for Prediction of Clinical Deterioration on the General Wards: A Scoping Review

Journal of Hospital Medicine ◽

10.12788/jhm.3630 ◽

2021 ◽

Author(s):

Roel V Peelen ◽

Yassin Eddahchouri ◽

Mats Koeneman ◽

Tom H van de Belt ◽

Harry van Goor ◽

...

Keyword(s):

Scoping Review ◽

Data Extraction ◽

Vital Signs ◽

Population Data ◽

Primary Objective ◽

General Ward ◽

Clinical Deterioration ◽

Predictive Algorithms ◽

Study Characteristics ◽

Input Variables

OBJECTIVE: The primary objective of this scoping review was to identify and describe state-of-the-art models that use vital sign monitoring to predict clinical deterioration on the general ward. The secondary objective was to identify facilitators, barriers, and effects of implementing these models. DATA SOURCES: PubMed, Embase, and CINAHL databases until November 2020. STUDY SELECTION: We selected studies that compared vital signs–based automated real-time predictive algorithms to current track-and-trace protocols in regard to the outcome of clinical deterioration in a general ward population. DATA EXTRACTION: Study characteristics, predictive characteristics and barriers, facilitators, and effects. RESULTS: We identified 1,741 publications, 21 of which were included in our review. Two of the these were clinical trials, 2 were prospective observational studies, and the remaining 17 were retrospective studies. All of the studies focused on hospitalized adult patients. The reported area under the receiver operating characteristic curves ranged between 0.65 and 0.95 for the outcome of clinical deterioration. Positive predictive value and sensitivity ranged between 0.223 and 0.773 and 7.2% to 84.0%, respectively. Input variables differed widely, and predicted endpoints were inconsistently defined. We identified 57 facilitators and 48 barriers to the implementation of these models. We found 68 reported effects, 57 of which were positive. CONCLUSION: Predictive algorithms can detect clinical deterioration on the general ward earlier and more accurately than conventional protocols, which in one recent study led to lower mortality. Consensus is needed on input variables, predictive time horizons, and definitions of endpoints to better facilitate comparative research.

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