Rebuttal to Dr. Radner`s letter: Different use of Radner Reading Charts and no methodological bias influencing the results

n.a.

Accuracy of Image-Based Automated Diagnosis in the Identification and Classification of Acute Burn Injuries. A Systematic Review

Although they are a common type of injury worldwide, burns are challenging to diagnose, not least by untrained point-of-care clinicians. Given their visual nature, developments in artificial intelligence (AI) have sparked growing interest in the automated diagnosis of burns. This review aims to appraise the state of evidence thus far, with a focus on the identification and severity classification of acute burns. Three publicly available electronic databases were searched to identify peer-reviewed studies on the automated diagnosis of acute burns, published in English since 2005. From the 20 identified, three were excluded on the grounds that they concerned animals, older burns or lacked peer review. The remaining 17 studies, from nine different countries, were classified into three AI generations, considering the type of algorithms developed and the images used. Whereas the algorithms for burn identification have not gained much in accuracy across generations, those for severity classification improved substantially (from 66.2% to 96.4%), not least in the latest generation (n = 8). Those eight studies were further assessed for methodological bias and results applicability, using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. This highlighted the feasibility nature of the studies and their detrimental dependence on online databases of poorly documented images, at the expense of a substantial risk for patient selection and limited applicability in the clinical setting. In moving past the pilot stage, future development work would benefit from greater input from clinicians, who could contribute essential point-of-care knowledge and perspectives.

Corporate governance and corporate social responsibility: mapping the most critical drivers in the board academic literature

Purpose This study aims to provide the intellectual structure of the academic literature on board characteristics and corporate social responsibility disclosure (CSRD) and corporate social responsibility performance (CSRP). To do that, the authors analyse the main theories, data sources and methodologies used by researchers, providing information on methodological bias and research gaps. Beyond that, this study offers a novel picture of the most critical drivers of CSRP/CSRD and offer constructive suggestions to guide future research. Design/methodology/approach A content analysis was performed on 242 articles extracted from the Web of Science database from 1992 to 2019. Findings Results indicate that board characteristics have a significant and increasing impact on corporate social responsibility (CSR) literature. The results also revealed that the board practices play a crucial role in managing CSRP/CSRD-related issues. The study also identifies the effect of the critical board characteristics on CSRP, CSRD quantity and CSRD quality. Furthermore, the study findings provide an overarching picture of the patterns and trends of the systematic nexus between board characteristics and CSRP/CSRD quality and quantity. Practical implications The study findings help provide an overarching picture of the systematic nexus patterns and trends between board characteristics and CSRP/CSRD quality and quantity. These results draw potential future avenues to bridge the void in the current board–CSR literature by presenting fruitful and indispensable directions for future research (governance mechanisms, new methodologies, variables, countries, etc.). It also suggests multidimensional and in-depth insights for reforming the board of directors’ guidelines. Originality/value To the best of the authors’ knowledge, minimal attention has been paid to systematising the literature on board and CSR.

OSA Upper Airways Surgery: A Targeted Approach

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

Aproximación a la composición demográfica de los sepulcros megalíticos de la submeseta norte española. Un enfoque desde la osteoarqueología = Overview of the Demographic Composition of the Spanish Northern Sub-Plateau Megalithic Monuments: An Approach from Osteoarchaeology

La Submeseta Norte dispone de un importante volumen de sepulcros megalíticos. Las recientes intervenciones arqueológicas, con métodos de excavación cada vez más rigurosos y un sistema de registro exhaustivo, han favorecido la identificación y correcta documentación de curiosas prácticas funerarias en las sepulturas megalíticas. Simultáneamente, la incorporación de antropólogos ha permitido conocer cómo fue el proceso de deposición, las alteraciones postdeposicionales y la reconstrucción del perfil osteobiológico de los fallecidos. El objetivo principal de este artículo es reconstruir la composición paleodemográfica en los monumentos megalíticos meseteños. Para ello, se han analizado los estudios antropológicos publicados de 12 tumbas megalíticas datadas en el IV milenio a.C., con un número total de 298 individuos. Se han estimado determinados parámetros paleodemográficos (coeficientes de mortalidad, esperanza de vida y Sex Ratio) y se han comparado con modelos estimados en poblaciones preindustriales y otras series arqueológicas prehistóricas peninsulares, como medio para identificar y evaluar posibles anomalías demográficas. Con todo, observamos patrones comunes en las 12 sepulturas en lo que respecta a los grupos de edad de los sujetos depositados en las tumbas meseteñas analizadas, así como una marcada variabilidad en lo referente al sexo. Todo ello sugiere el carácter selectivo/exclusivo en los sepulcros megalíticos de esta área geográfica y un posible sesgo metodológico por la naturaleza de la muestra.AbstractThe Northern Subplateau has a large number of megalithic tombs. Recent archaeological interventions, with increasingly rigorous excavation methods and an exhaustive recording system, have favoured the identification and correct documentation of curious funerary practices in the megalithic tombs. At the same time, the incorporation of anthropologists has allowed us to learn about the deposition process, post-depositional alterations, and the reconstruction of the osteobiological profile of the deceased. The main objective of this article is to reconstruct the palaeodemographic composition of the Plateau megalithic monuments. To this end, the published anthropological studies of 12 megalithic tombs dating from the 4th millennium BC, with a total number of 298 individuals, have been analysed. Certain palaeodemographic parameters (mortality rates, life expectancy and Sex Ratio) have been estimated and compared with models estimated in pre-industrial populations and other prehistoric archaeological series on the Iberian Peninsula, in order to identify and evaluate possible demographic anomalies. Nevertheless, we observed common patterns in the 12 burials in terms of the age groups of the subjects deposited in the tombs analysed, as well as a marked variability in terms of sex. All this suggests the selective/exclusive character of the megalithic tombs in this geographical area and a possible methodological bias due to the nature of the sample.

On the difficulty to think in ratios: a methodological bias in Stevens’ magnitude estimation procedure

In the field of new psychophysics, the magnitude estimation procedure is one of the most frequently used methods. It requires participants to assess the intensity of a stimulus in relation to a reference. In three studies, we examined whether difficulties of thinking in ratios influence participants’ intensity perceptions. In Study 1, a standard magnitude estimation procedure was compared to an adapted procedure in which the numerical response dimension was reversed so that smaller (larger) numbers indicated brighter (darker) stimuli. In Study 2, participants first had to indicate whether a stimulus was brighter or darker compared to the reference, and only afterwards they estimated the magnitude of this difference, always using ratings above the reference to indicate their perception. In Study 3, we applied the same procedure as in Study 2 to a different physical dimension (red saturation). Results from Study 1 (N = 20) showed that participants in the reversal condition used more (less) extreme ratings for brighter (darker) stimuli compared to the standard condition. Data from the unidirectional method applied in Study 2 (N = 34) suggested a linear psychophysical function for brightness perception. Similar results were found for red saturation in Study 3 (N = 36) with a less curved power function describing the association between objective red saturation and perceived redness perception. We conclude that the typical power functions that emerge when using a standard magnitude estimation procedure might be biased due to difficulties experienced by participants to think in ratios.

Network meta-analysis of infliximab biosimilars for the treatment of rheumatoid arthritis

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article assesses the relative efficacy and safety of infliximab biosimilars in treatment of patients with rheumatoid arthritis (RA). Methods A frequentist, random-effects network meta-analysis was performed to evaluate evidence from randomized controlled trials that examined the use of infliximab biosimilars for treatment of patients with RA. PubMed and MEDLINE and other sources were searched for reports evaluating rates of response to treatment with the reference product (infliximab) vs an infliximab biosimilar. The primary efficacy outcome of interest was the rate of attainment of ACR20 (ie, 20% improvement in American College of Rheumatology core measures). The primary safety outcome was the rate of treatment-related serious adverse events (SAEs). Data were extracted by the primary author, and an assessment for risks of methodological bias was performed for each evaluated study. Results Five studies that enrolled a total of 2,499 patients were included. Overall comparisons using odds ratios and 95% confidence intervals (CIs) did not indicate statistically significant differences in response to treatment with biosimilar agents relative to each other or the infliximab reference product. ORs for ACR20 response for biosimilars vs infliximab were as follows: 1.475 (95% CI, 0.940-2.315) for infliximab-axxq, 1.259 (95% CI, 0.854-1.855) for infliximab-dyyb, 0.865 (95% CI, 0.5511.358) for infliximab-qbtx, and 0.832 (95% CI, 0.506-1.367) for infliximab-abda. Similar findings were observed in reported SAE rates among patients treated with the various biosimilars. Conclusion ACR20 response appears to be comparable and nonsignificantly different between infliximab biosimilars. In the absence of any meaningful differences in safety or efficacy, biosimilar cost may be the deciding factor in choosing a treatment or agent for formulary inclusion.

Die hard in Lake Bourget! The case of Planktothrix rubescens

Blooms of Planktothrix rubescens have been recorded for 15 years in Lake Bourget (France), from 1995 to 2009. Then, the presence of this filamentous and toxic cyanobacterium became anecdotic between 2010 and 2015 and it was clearly thought that such a proliferation was over. However, against all odds, blooms occurred again in 2016 and 2017 despite apparent very low phosphorus concentrations in surface waters of the lake. Aims of this study were thus to explain the reasons of this come back in order to propose scenarios likely to be helpful to stakeholders who need to know if such proliferations may occur again in the future. We show that phosphorus input, both from the main tributaries to the lake and possibly from the sediments, were likely the triggers of the new development of the cyanobacterium since a minimum autumn/winter inoculum of P. rubescens was detected the year before. Then, the bloom, that was observed deeper than previous years, was associated to a conjunction of factors already well-known to favour the development of this very competitive species (i.e. mild winter temperature, water column stability, available light at depth, surface water transparency, low predation, etc…). Although many factors and processes could account for the occurrence and bloom of the cyanobacterium, not observed, measured or taken into account here, a plausible scenario could be proposed and may be useful to deciders. One thing remains unclear: where do the cyanobacterium hides when it is not observed during the routine monitoring survey and thus from which place it could initiate its development (nearshore, in the pelagic zone, from the sediment?), unless it is simply not sampled and observed due to methodological bias.

A systematic review exploring pre-COVID-19 telehealthcare models used in the management of patients with rheumatological disease

Objective The aim was to assess the use of telehealthcare in rheumatology before coronavirus disease 2019 (COVID-19), to which future comparisons of newer interventions adapted during the crisis can be made. Methods We performed a registered systematic literature search using MEDLINE, EMBASE, CENTRAL and PubMed databases. All full-length articles comparing telehealthcare delivery models with standard care (face-to-face consultation) in the management of patients with rheumatic conditions were assessed for inclusion. Results A total of 4809 studies were identified; 108 studies were suitable for review by full text, and 13 studies were appropriate to be included in this review. Five studies (38%) included patients with RA, four studies (31%) included patients with mixed disease cohorts, two studies (15%) included patients with OA, one study (8%) included patients with JIA, and one study (8%) included patients with FM. Six studies (46%) used telephone consultation, three studies (23%) used mixed method communication, three studies (23%) used videoconferencing, and one study (8%) used website-delivered telecommunication as their method of telehealthcare delivery. Overall, seven studies (54%) identified the telehealthcare intervention to be an effective method of consultation, and six studies (46%) identified the telehealthcare intervention as non-inferior when compared with standard care. Conclusion Current evidence for telehealthcare in rheumatology is lacking, and the evidence for effectiveness is limited by methodological bias and clinical heterogeneity of telehealthcare interventions, preventing definitive inferences. Scrutinous assessment of the current telehealthcare interventions used during COVID-19 is required to accommodate recommendations and guideline reviews directed from international working groups.