Meta-Analytic Methodology for Basic Research: A Practical Guide

Sensors and Devices Based on Electrochemical Skin Conductance and Bioimpedance Measurements for the Screening of Diabetic Foot Syndrome: Review and Meta-Analysis

Diabetic foot syndrome is a multifactorial disease involving different etiological factors. This syndrome is also insidious, due to frequent lack of early symptoms, and its prevalence has increased in recent years. This justifies the remarkable attention being paid to the syndrome, although the problem of effective early screening for this syndrome, possibly at a patient's home, is still unsolved. However, some options appear available in this context. First, it was demonstrated that the temperature measurement of the foot skin is an interesting approach, but it also has some limitations, and hence a more effective approach should combine data from temperature and from other sensors. For this purpose, foot skin conductance or bioimpedance measurement may be a good option. Therefore, the aim of this study was to review those studies where skin conductance/bioimpedance measurement was used for the detection of diabetic foot syndrome. In addition, we performed a meta-analysis of some of those studies, where a widely used device was exploited (SUDOSCAN®) for foot skin conductance measurement, and we found that skin conductance levels can clearly distinguish between groups of patients with and without diabetic neuropathy, the latter being one of the most relevant factors in diabetic foot syndrome.

The effect of muscle warm-up on voluntary and evoked force-time parameters: A systematic review and meta-analysis with meta-regression

BACKGROUND

While muscle contractility increases with muscle temperature, there is no consensus on the best warm-up protocol to use before resistance training or sports exercise due to the range of possible warm-up and testing combinations available. Therefore, the objective of the current study was to determine the effects of different warm-up types (active, exercise-based vs. passive) on muscle function tested using different activation methods (voluntary vs. evoked) and performance test criteria (maximum force vs. rate-dependent contractile properties), with consideration of warm-up task specificity (specific vs. non-specific), temperature measurement method (muscle vs. skin), baseline temperatures, and subject-specific variables (training status and sex).

METHODS

A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane, Embase, and ProQuest. Random-effects meta-analyses and meta-regressions were used to compute the effect sizes (ES) and 95 % confidence intervals (95 %CI) to examine the effects of warm-up type, activation method, performance criterion, subject characteristics, and study design on temperature-related performance enhancement.

RESULTS

The search yielded 1272 articles, of which 33 met the inclusion criteria (n = 921). Increasing temperature positively affected both voluntary (3.7 % ± 1.8 %/°C, ES = 0.28 (95 %CI: 0.14, 0.41)) and evoked (3.2 % ± 1.5 %/°C, ES = 0.65 (95 %CI: 0.29, 1.00)) rate-dependent contractile properties (dynamic, fast-velocity force production, and rate of force development (RFD)) but not maximum force production (voluntary: -0.2 % ± 0.9 %/°C, ES = 0.08 (95 %CI: -0.05, 0.22); evoked: -0.1 % ± 0.8 %/°C, ES = -0.20 (95 %CI: -0.50, 0.10)). Active warm-up did not induce greater enhancements in rate-dependent contractile properties (p = 0.284), maximum force production (p = 0.723), or overall function (pooled, p = 0.093) than passive warm-up. Meta-regressions did not reveal a significant effect of study design, temperature measurement method, warm-up task specificity, training status, or sex on the effect of increasing temperature (p > 0.05).

CONCLUSION

Increasing muscle temperature significantly enhances rate-dependent contractile function (RFD and muscle power) but not maximum force in both evoked and voluntary contractions. In contrast to expectation, no effects of warm-up modality (active vs. passive) or temperature measurement method (muscle vs. skin) were detected, although insufficient data prevented robust sub-group analyses.

Challenges in Implementing Comprehensive Precision Medicine Screening for Ovarian Cancer

Precision medicine has revolutionised targeted cancer treatments; however, its implementation in ovarian cancer remains challenging. Diverse tumour biology and extensive heterogeneity in ovarian cancer can limit the translatability of genetic profiling and contribute to a lack of biomarkers of treatment response. This review addresses the barriers in precision medicine for ovarian cancer, including obtaining adequate and representative tissue samples for analysis, developing functional and standardised screening methods, and navigating data infrastructure and management. Ethical concerns related to patient consent, data privacy and health equity are also explored. We highlight the socio-economic complexities for precision medicine and propose strategies to overcome these challenges with an emphasis on accessibility and education amongst patients and health professionals and the development of regulatory frameworks to support clinical integration. Interdisciplinary collaboration is essential to drive progress in precision medicine to improve disease management and ovarian cancer patient outcomes.

Utilizing PRAME Expression and a Meta-Analytic Framework for iSALT to Explore Atypical Late-Onset Nevi of the Elderly and Their Relationship With Lentiginous and Nested Nevoid Melanomas

BACKGROUND

In contrast to early-onset dysplastic nevi, late-onset atypical nevi of the elderly are more often precursors to distinctive nevoid melanomas. PReferentially expressed Antigen in MElanoma (PRAME) immunohistochemistry was applied to delineate the nevoid aspect of late-onset oncogenic nevoid pathway. Inducible Skin-Associated Lymphoid Tissue, regulatory T-cell mesenchymal hubs, has emerged as a translational tool and was used to define nevoid oncogenesis within a dynamic meta-analytic pathway.

METHODS

PRAME immunohistochemistry was applied after designating a histopathologic diagnosis. Late-onset atypical nested lentiginous nevus, lentiginous nested melanoma, and hypercellular nested nevoid melanoma were the diagnostic categories. A positive PRAME for melanoma was set at 75% percentage labeling.A wide-ranging published evidence-based database was incorporated to develop a meta-analytic framework for oncogenic nevogenesis. This combined inducible Skin-Associated Lymphoid Tissue incorporating the pleiotropic functions of regulatory T cells regulating immunity and gene regulatory epigenetics as principal modulators.

RESULTS

Concordant-negative PRAME expression was present in 64 of 81 (79%) atypical nested lentiginous nevi, concordant-positive PRAME expression occurred in 54 of 75 (72%) nevoid lentiginous and nested melanomas, and 18 of 23 (78%) nevoid hypercellular nested melanomas.

CONCLUSIONS

PRAME expression confirmed the existence of a late-onset oncogenic nevoid pathway that can be defined by histopathology. Subsequent meta-analysis data linked to the meta-analytic framework revealed that PRAME is an epigenetic surrogate antigen expressed because of repression of retinoic acid receptor signaling, preventing ligand-induced retinoic acid cellular differentiation, growth arrest, and apoptosis, and promoting melanoma growth and survival for melanomas. PRAME is only a single antigen within a highly complex dynamic framework that governs nevoid oncogenesis. Significantly, the retinoic acid/retinoic acid receptor complex has been shown to modulate the immunosuppressive arm of regulatory T cells underpinning immune tolerance and is pertinent to the broad framework but is not linked to PRAME expression in this arm.

The state of nitrogen in rivers and streams across sub-Saharan Africa

The nutrient status of rivers and streams is less researched in sub-Saharan Africa than in many other inhabited regions of the world. Given the expected population growth, intensification of agriculture, increased pressure on natural ecosystems and projected climate change in sub-Saharan Africa, it is crucial to quantify and understand drivers behind spatiotemporal patterns of nitrogen concentrations and loads in rivers and streams. Such knowledge can support sustainable management of water resources with the goal to provide clean water, create and maintain healthy ecosystems and prevent excessive pollution of water resources with nitrogen compounds, as is found in large parts of North America, Europe and Asia. This review provides a synthesis of the current available data from peer-reviewed literature (n = 243) on particulate and dissolved nitrogen in rivers and streams in sub-Saharan Africa, looking into seasonal and land cover-related differences. The review shows that data on nitrogen concentrations in rivers and streams is available for 32 out of the 48 countries (67 %) in sub-Saharan Africa, highlighting large data gaps given the size of the region. Differences in nitrogen concentrations between land cover types are reported, with highest median total nitrogen (3.9 mg N L-1) and nitrate (1.2 mg N L-1) concentrations observed at sites characterised by settlement and industry. In contrast, natural land cover types, like forest, have higher median (N:P) ratios (> 14.6) than cropland and urban areas (< 12.0). The analysis of paired samples from dry and wet seasons reveals varying effects of seasonality on the concentration of different nitrogen compounds between land cover types. However, the processes driving these spatiotemporal differences are still poorly understood. These findings highlight the need for a targeted research agenda for Africa to advance our understanding of the role of rivers and streams in nitrogen cycling in different ecosystems and their interaction with anthropogenic and natural drivers of change.

Impact of gestational diabetes mellitus on women's sexual function: a systematic review and meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap.

METHODS

This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis.

RESULTS

The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD - 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD - 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD - 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD - 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function.

CONCLUSION

Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

Osteoclast indices in osteogenesis imperfecta: systematic review and meta-analysis

Osteogenesis imperfecta (OI) is a rare bone fragility disorder caused by mutations in genes encoding collagen type I or that affect its processing. Alterations in osteoclasts were suggested to contribute to OI pathophysiology. We aimed to systematically identify studies reporting measures of osteoclast formation and function in patients and mouse models of OI, to quantify OI-induced changes. The systematic search of Medline, Ovid, and Web of Science identified 798 unique studies. After screening, we included 23 studies for meta-analysis, reporting osteoclast parameters in 310 patients with OI of 9 different types and 16 studies reporting osteoclast parameters in 406 animals of 11 different OI mouse models. The standardized mean difference with 95% confidence interval (CI) was used as the effect size, and random-effects meta-analysis was performed. In patients with OI, collagen degradation markers were significantly higher compared with age-matched controls, with an effect size of 1.23 (CI: 0.36, 2.10]. Collagen degradation markers were the most elevated in the 3- to 7-year-old age group and in patients with more severe forms of OI. Bone histomorphometry demonstrated the trends for higher osteoclast numbers (1.16; CI: -0.22, 2.55) and osteoclast surface (0.43; CI: -0.63, 1.49), and significantly higher eroded surface (3.24; CI: 0.51, 5.96) compared with age-matched controls. In OI mice, meta-analysis demonstrated significant increases in collagen degradation markers (1.59; CI: 1.07, 2.11), in osteoclast numbers (0.94; CI: 0.50, 1.39), osteoclast surface (0.73; CI: 0.22, 1.23), and eroded surface (1.31; CI: 0.54, 2.08). The largest differences were in OI mice with the mutations in Col1a1 and Col1a2 genes. There were no differences between males and females in clinical or animal studies. Quantitative estimates of changes in osteoclast indices and their variance for patients with OI are important for planning future studies. We confirmed that similar changes are observed in mice with OI, supporting their translational utility.

Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review

Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. This systematic review sourced records from CINAHL, EMBASE, ERIC, JBI and MEDLINE from 1970 to March 2022. The search identified 589 records, 13 of which met eligibility criteria after the screening process, in which 10 of these records were conference abstracts. Education curricula focused on inhalational agent choice (69%), lowering the fresh gas flow during maintenance anaesthesia (69%), encouraging alternatives such as total intravenous anaesthesia (23%) and/or switching off the gas on transfer (8%). The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.

Akkermansia muciniphila for the Prevention of Type 2 Diabetes and Obesity: A Meta-Analysis of Animal Studies

BACKGROUND

More than half of the states in the U.S. report that over 30% of adults are obese. Obesity increases the risk of many chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease, and can even reduce one's lifespan. Similarly, the prevalence of type 2 diabetes follows a comparable trend. As a result, researchers are striving to find solutions to reduce obesity rates, with a particular focus on gut health, which has been previously linked to both obesity and type 2 diabetes. Recent studies suggest that Akkermansia muciniphila (Akk) may have a positive probiotic effect on preventing the onset of type 2 diabetes and obesity.

METHODS

We conducted a quantitative meta-analysis of 15 qualified animal studies investigating the effects of Akk administration as a probiotic.

RESULTS

The statistical analyses showed that Akk administration significantly reduced body weight gain by 10.4% and fasting blood glucose by 21.2%, while also significantly improving glucose tolerance by 22.1% and increasing blood insulin levels by 26.9%. However, our analysis revealed substantial heterogeneity between the control and experimental groups across all subgroups.

CONCLUSIONS

Overall, Akk appears to be effective at reducing the onset of type 2 diabetes and diet-induced obesity. Long-term studies with larger sample sizes are needed to confirm these beneficial effects, as the current animal studies were of short duration (less than 20 weeks).

Mitochondrial DNA Haplogroup K Is Protective Against Autism Spectrum Disorder Risk in Populations of European Ancestry

OBJECTIVE

Accumulative evidence indicates a critical role of mitochondrial function in autism spectrum disorders (ASD), implying that ASD risk may be linked to mitochondrial dysfunction due to DNA (mtDNA) variations. Although a few studies have explored the association between mtDNA variations and ASD, the role of mtDNA in ASD is still unclear. Here, we aimed to investigate whether mitochondrial DNA haplogroups are associated with the risk of ASD.

METHOD

Two European cohorts and an Ashkenazi Jewish (AJ) cohort were analyzed, including 2,062 ASD patients in comparison with 4,632 healthy controls. DNA samples were genotyped using Illumina HumanHap550/610 and Illumina 1M arrays, inclusive of mitochondrial markers. Mitochondrial DNA (mtDNA) haplogroups were identified from genotyping data using HaploGrep2. A mitochondrial genome imputation pipeline was established to detect mtDNA variants. We conducted a case-control study to investigate potential associations of mtDNA haplogroups and variants with the susceptibility to ASD.

RESULTS

We observed that the ancient adaptive mtDNA haplogroup K was significantly associated with decreased risk of ASD by the investigation of 2 European cohorts including a total of 2,006 cases and 4,435 controls (odds ratio = 0.64, P=1.79 × 10-5), and we replicated this association in an Ashkenazi Jewish (AJ) cohort including 56 cases and 197 controls (odds ratio = 0.35, P = 9.46 × 10-3). Moreover, we demonstrate that the mtDNA variants rs28358571, rs28358584, and rs28358280 are significantly associated with ASD risk. Further expression quantitative trait loci (eQTLs) analysis indicated that the rs28358584 and rs28358280 genotypes are associated with expression levels of nearby genes in brain tissues, suggesting those mtDNA variants may confer risk for ASD via regulation of expression levels of genes encoded by the mitochondrial genome.

CONCLUSION

This study helps to shed light on the contribution of mitochondria in ASD and provides new insights into the genetic mechanism underlying ASD, suggesting the potential involvement of mtDNA-encoded proteins in the development of ASD.

PLAIN LANGUAGE SUMMARY

Increasing evidence indicates that mitochondrial dysfunction may be linked to autism spectrum disorder (ASD). This study investigated potential associations of mitochondrial DNA (mtDNA) variants in 2 European and Ashkenazi Jewish cohorts including 2,062 individuals with ASD and 4,632 healthy controls. Researchers found that the ancient mtDNA haplogroup K was linked to a reduced risk of ASD in both European and Ashkenazi Jewish populations. Additionally, specific mtDNA variants were associated with ASD risk and were shown to influence the expression of nearby genes in the brain. These findings highlight the potential involvement of mtDNA in ASD development, offering new insights into the genetic mechanisms underlying the disorder.

Phosphene and motor transcranial magnetic stimulation thresholds are correlated: A meta-analytic investigation

Transcranial magnetic stimulation (TMS) is commonly delivered at an intensity defined by the resting motor threshold (rMT), which is thought to represent cortical excitability, even if the TMS target area falls outside of the motor cortex. This approach rests on the assumption that cortical excitability, as measured through the motor cortex, represents a 'global' measure of excitability. Another common approach to measure cortical excitability relies on the phosphene threshold (PT), measured through the visual cortex of the brain. However, it remains unclear whether either estimate can serve as a singular measure to infer cortical excitability across different brain regions. If PT and rMT can indeed be used to infer cortical excitability across brain regions, they should be correlated. To test this, we systematically identified previous studies that measured PT and rMT to calculate an overall correlation between the two estimates. Our results, based on 16 effect sizes from eight studies, indicated that PT and rMT are correlated (ρ = 0.4), and thus one measure could potentially serve as a measure to infer cortical excitability across brain regions. Three exploratory meta-analyses revealed that the strength of the correlation is affected by different methodologies, and that PT intensities are higher than rMT. Evidence for a PT-rMT correlation remained robust across all analyses. Further research is necessary for an in-depth understanding of how cortical excitability is reflected through TMS.

Integration of Antioxidant Activity Assays Data of Stevia Leaf Extracts: A Systematic Review and Meta-Analysis

Stevia rebaudiana Bertoni, a no-calorie natural sweetener, contains a plethora of polyphenols that exert antioxidant properties with potential medicinal significance. Due to the variety of functional groups, polyphenols exhibit varying solubility depending on the nature of the extraction solvents (water, organic, or their mixtures, defined further on as hydroalcoholic extracts). In the present study, we performed a systematic review, following PRISMA guidelines, and meta-analysis, synthesizing all available data from 45 articles encompassing 250 different studies. Our results showed that the total phenolic content (TPC) of hydroalcoholic and aqueous extracts presents higher values (64.77 and 63.73 mg GAE/g) compared to organic extracts (33.39). Total flavonoid content (TFC) was also higher in aqueous and hydroalcoholic extracts; meta-regression analysis revealed that outcomes in different measuring units (mg QE/g, mg CE/g, and mg RUE/g) do not present statistically significant differences and can be synthesized in meta-analysis. Using meta-regression analysis, we showed that outcomes from the chemical-based ABTS, FRAP, and ORAC antioxidant assays for the same extract type can be combined in meta-analysis because they do not differ statistically significantly. Meta-analysis of ABTS, FRAP, and ORAC assays outcomes revealed that the antioxidant activity profile of various extract types follows that of their phenolic and flavonoid content. Using regression meta-analysis, we also presented that outcomes from SOD, CAT, and POX enzymatic antioxidant assays are independent of the assay type (p-value = 0.905) and can be combined. Our study constitutes the first effort to quantitatively and statistically synthesize the research results of individual studies using all methods measuring the antioxidant activity of stevia leaf extracts. Our results, in light of evidence-based practice, uncover the need for a broadly accepted, unified, methodological strategy to perform antioxidant tests, and offer documentation that the use of ethanol:water 1:1 mixtures or pure water can more efficiently extract stevia antioxidant compounds.

Cardiac indices of driver fatigue across in-lab and on-road studies

Driver fatigue is a major contributor to road accidents. Therefore, driver assistance systems (DAS) that would monitor drivers' states may contribute to road safety. Such monitoring can potentially be achieved with input from ECG indices (e.g., heart rate). We reviewed the empirical literature on responses of cardiac measures to driver fatigue and on detecting fatigue with cardiac indices and classification algorithms. We used meta-analytical methods to explore the pooled effect sizes of different cardiac indices of fatigue, their heterogeneity, and the consistency of their responses across studies. Our large pool of studies (N = 39) allowed us to stratify the results across on-road and simulator studies. We found that despite the large heterogeneity of the effect sizes between the studies, many indices had significant pooled effect sizes across the studies, and more frequently across the on-road studies. We also found that most indices showed consistent responses across both on-road and simulator studies. Regarding the detection accuracy, we found that even on-road classification could have been as accurate as 70% with only 2-min of data. However, we could only find two on-road studies that employed fatigue classification algorithms. Overall, our findings are encouraging with respect to the prospect of using cardiac measures for detecting driver fatigue. Yet, to fully explore this possibility, there is a need for additional on-road studies that would employ a similar set of cardiac indices and detection algorithms, a unified definition of fatigue, and additional levels of fatigue than the two fatigue vs alert states.

A comprehensive meta-analysis of genetic parameters for resilience and productivity indicator traits in Holstein cattle

Selection for resilience indicator (RIND) traits in Holstein cattle is becoming an important breeding objective as the worldwide population is expected to be exposed to increased environmental stressors due to both climate change and changing industry standards. However, genetic correlations between RIND and productivity indicator (PIND) traits, which are already being selected for and have the most economic value, are often unfavorable. As a result, it is necessary to fully understand these genetic relationships when incorporating novel traits into selection indices, so that informed decisions can be made to fully optimize selection for both groups of traits. In the past 2 decades, there have been many estimates of RIND traits published in the literature, albeit in small populations. To provide valuable pooled summary estimates, a random-effects meta-analysis was conducted for heritability and genetic correlation estimates for PIND and RIND traits in worldwide Holstein cattle. In total, 926 heritability estimates for 9 PIND and 27 RIND traits, along with 362 estimates of genetic correlation (PIND × RIND traits) were collected. Resilience indicator traits were grouped into the following subgroups: Metabolic Diseases, Hoof Health, Udder Health, Fertility, Heat Tolerance, Longevity, and Other. Pooled estimates of heritability for PIND traits ranged from 0.201 ± 0.05 (energy-corrected milk) to 0.377 ± 0.06 (protein content), while pooled estimates of heritability for RIND traits ranged from 0.032 ± 0.02 (incidence of lameness, incidence of milk fever) to 0.497 ± 0.05 (measures of body weight). Pooled estimates of genetic correlations ranged from -0.360 ± 0.25 (protein content vs. milk acetone concentration) to 0.535 ± 0.72 (measures of fat-to-protein ratio vs. milk acetone concentration). Additionally, out of 243 potential genetic correlations between PIND and RIND traits that could have been reported, only 40 had enough published estimates to implement the meta-analysis model. Our results confirmed that the interactions between PIND and RIND traits are complex, and all relationships should be evaluated when incorporating novel traits into selection indices. This study provides a valuable reference for breeders looking to incorporate RIND traits for Holstein cattle into selection indices.

Does the side of onset influence symptom severity in Parkinson's disease? A systematic review and meta-analysis

Parkinson's disease (PD) is a neurodegenerative movement disorder characterized by motor symptoms that initially manifest unilaterally. Whilst some studies indicate that right-side onset is associated with greater symptom severity, others report no differences between right-side and left-side onset patients. The present meta-analysis was thus designed to reconcile inconsistencies in the literature and determine whether side of onset affects PD symptom severity. Following the PRISMA guidelines 1013 studies were initially identified in database and grey literature searches; following title and abstract, and full text, screening 34 studies met the stringent inclusion criteria (n = 2210). Results of the random-effects meta-analysis indicated no difference in symptom severity between PD patients with left-side (n = 1104) and right-side (n = 1106) onset. As such, the meta-analysis suggests that the side of onset should not be used to predict symptom trajectory or to formulate prognoses for PD patients. The current meta-analysis was the first to focus on the relationship between the side of onset and symptom severity in PD. However, the studies included were limited by the common exclusion of left-handed participants. Future research would benefit from exploring other factors that may influence symptom severity and disease progression in PD, such as asymmetric loss of nigrostriatal dopaminergic neurons.

Knowledge, attitude, and practice of atrial fibrillation in high altitude areas

Background

To investigate the knowledge, attitude, and practice (KAP) of atrial fibrillation (AF) among the general population in high-altitude areas.

Methodology

A web-based cross-sectional study was conducted among the general population in high-altitude areas.

Results

A total of 786 valid questionnaires were enrolled, with a mean age of 34.75 ± 14.16 years. The mean score of knowledge, attitude and practice were 8.22 ± 6.50 (possible range: 0-10), 28.90 ± 5.63 (possible range: 8-40), 34.34 ± 6.44 (possible range: 9-45), respectively. The multivariate analysis showed that knowledge scores (OR = 1.108, 95% CI = 1.075-1.142, p < 0.001), attitude scores (OR = 1.118, 95% CI = 1.081-1.156, p < 0.001), and never smoking (OR = 2.438, 95% CI = 1.426-4.167, p = 0.001) were independently associated with proactive practice. The structural equation modeling (SEM) showed direct effect of knowledge on practice (p = 0.014), and attitude on practice (p = 0.004), while no effect of knowledge on attitude (p = 0.190).

Conclusion

The general population in high-altitude regions had adequate knowledge, positive attitude, and proactive practice towards AF. The SEM was suitable for explaining general population' KAP regarding AF, revealing that knowledge directly and positively affected attitude and practice.

Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition

Introduction

Despite evidence from preclinical studies suggesting estrogen's neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial.

Methods

We used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants.

Results

Associations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT.

Discussion

These findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs.

Processing speed and sustained attention in bipolar disorder and major depressive disorder: A systematic review and meta-analysis

OBJECTIVES

Cognitive impairment is a core feature of bipolar disorder (BD) and major depressive disorder (MDD). Deficits in processing speed (PS) and sustained attention (SA) may be particularly impaired and may underpin a broader profile of deficits, however current knowledge of the nature of these impairments is limited by heterogeneous results in the literature. Few reviews to date have attempted to disentangle sources of heterogeneity to assess the presence and magnitude of impairments in PS and SA in BD and MDD.

METHODS

One hundred and three studies were reviewed to examine performance in tests of PS and SA in BD (n = 3452) and MDD (n = 5461) compared to healthy controls (n = 8016). Neuropsychological methodology used in the literature was summarised. Data were meta-analysed to assess impairments in PS and SA for each neuropsychological test separately. Subgroup analysis was performed across mood states to investigate sources of heterogeneity.

RESULTS

Impairments were found across most neuropsychological tests, with small to large effect sizes for BD (range: d = 0.19-0.96) and MDD (range: d = 0.29-0.86). Impairments were present in symptomatic states and euthymia in most cases. Some outcome measures were not impaired in euthymia. Heterogeneity was observed for most neuropsychological tests and remained after separating by mood state. There inadequate data to meta-analyse some outcome measures, particularly for symptomatic groups.

CONCLUSION

Impairments in PS and SA in BD and MDD can be observed across most neuropsychological tests. Future research should further investigate the nature of these impairments across mood states, controlling for clinical confounds.

XFEM for Composites, Biological, and Bioinspired Materials: A Review

The eXtended finite element method (XFEM) is a powerful tool for structural mechanics, assisting engineers and designers in understanding how a material architecture responds to stresses and consequently assisting the creation of mechanically improved structures. The XFEM method has unraveled the extraordinary relationships between material topology and fracture behavior in biological and engineered materials, enhancing peculiar fracture toughening mechanisms, such as crack deflection and arrest. Despite its extensive use, a detailed revision of case studies involving XFEM with a focus on the applications rather than the method of numerical modeling is in great need. In this review, XFEM is introduced and briefly compared to other computational fracture models such as the contour integral method, virtual crack closing technique, cohesive zone model, and phase-field model, highlighting the pros and cons of the methods (e.g., numerical convergence, commercial software implementation, pre-set of crack parameters, and calculation speed). The use of XFEM in material design is demonstrated and discussed, focusing on presenting the current research on composites and biological and bioinspired materials, but also briefly introducing its application to other fields. This review concludes with a discussion of the XFEM drawbacks and provides an overview of the future perspectives of this method in applied material science research, such as the merging of XFEM and artificial intelligence techniques.

Adverse effect of botulinum toxin-A injections on mandibular bone: A systematic review and meta-analysis

INTRODUCTION

Botulinum toxin-A (BTX) is a potent neurotoxin that is emerging in the scope of dental practice for its ability to temporarily paralyse musculature and reduce hyperfunction. This may be desirable in diseases/disorders associated with hyperactive muscles such as the muscles of mastication, most implicated in painful temporomandibular disorders (TMDs). The use of BTX extends beyond its indications with off-label use in TMD's and other conditions, while potential adverse effects remain understudied. BTX is well-established hindlimb paralysis model in animals leading to significant bone loss with underlying mechanisms remaining unclear. The objective of this study is to systematically review the literature for articles investigating changes in mandibular bone following BTX injections and meta-analyse available data on reported bone outcomes.

METHODS

Comprehensive search of Medline, Embase and Web of Science retrieved 934 articles. Following the screening process, 36 articles in animals and humans were included for quantitative synthesis. Articles in human individuals (6) and three different animal species (14) presented mandibular bone outcomes that were included in the meta-analysis.

RESULTS

The masseter and temporalis muscles were frequently injected across all species. In humans, we observe a decrease of about 6% in cortical thickness of mandibular regions following BTX injection with no evident changes in either volume or density of bone structures. In animals, bone loss in the condylar region is significantly high in both cortical and trabecular compartments.

DISCUSSION

Our analysis supports the concept of BTX-induced bone-loss model in animal mandibles. Further, bone loss might be confined to the cortical compartments in humans. Most studies did not address the reality of repeated injections and excessive dosing, which occur due to the reversible action of BTX. More rigorous trials are needed to draw a full picture of potential long-term adverse effects on bone.

Is the metabarcoding ripe enough to be applied to the authentication of foodstuff of animal origin? A systematic review

Food authentication using molecular techniques is of great importance to fight food fraud. Metabarcoding, based on the next-generation sequencing (NGS) technologies, allowing large-scale taxonomic identification of complex samples via massive parallel sequencing of fragments (called DNA barcodes) simultaneously, has become increasingly popular in many scientific fields. A systematic review to answer the question "Is the metabarcoding ripe enough to be applied to the authentication of foodstuff of animal origin?" is presented. The inclusion criteria were focused on the selection of scientific papers (SPs) only applying metabarcoding to foodstuff of animal origin collected on the market. The 23 included SPs were first analyzed with respect to the metabarcoding phases: library preparation (target genes, primer pairs, and fragment length), sequencing (NGS platforms), and final data analysis (bioinformatic pipelines). Given the importance of primer selection, the taxonomic coverage of the used primers was also evaluated. In addition, the SPs were scored based on the use of quality control measures (procedural blanks, positive controls, replicates, curated databases, and thresholds to filter the data). A lack of standardized protocols, especially with respect to the target barcode/s and the universal primer/s, and the infrequent application of the quality control measures, leads to answer that metabarcoding is not ripe enough for authenticating foodstuff of animal origin. However, the observed trend of the SP quality improvement over the years is encouraging. Concluding, a proper protocol standardization would allow a wider use of metabarcoding by both official and private laboratories, enabling this method to become the primary for the authentication of foodstuffs of animal origin.

The effectiveness of community friendship groups on participant social and mental health: a meta-analysis

Introduction

Social disconnectedness and isolation are risk factors for poor mental health. Community-based friendship group interventions have been designed to increase an individual's social capital and consequently their mental wellbeing. Structured and unstructured friendship groups reflect two distinct approaches to friendship group interventions.

Methods

This meta-analysis investigated whether structured or unstructured community friendship groups are more effective for mental health and social capital outcomes. A systematic search of quantitative studies was conducted across seven databases and study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Eight studies (2 unstructured and 6 structured friendship groups) were included in the review, published between 2005 and 2020.

Results

Structured friendship groups had a small significant effect on reducing participant depression symptoms. There was not enough available data to compare the effectiveness of structured and unstructured groups for mental health outcomes. There was substantial heterogeneity between studies to calculate pooled effect sizes for any social capital outcomes. Data synthesis indicated mixed reviews for social capital outcomes, likely due to the large heterogeneity and limited studies.

Discussion

This meta-analysis provides limited support for positive mental health outcomes following structured community-based friendship group interventions. There is a need for additional research as a large research gap remains, particularly for unstructured friendship groups.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260639, CRD42021260639.

The role of in vivo reflectance confocal microscopy for the management of acne: A systematic review

Acne diagnosis, severity assessment and treatment follow-up rely primarily on clinical examination. In vivo reflectance confocal microscopy (RCM) provides non-invasively, real-time images of skin lesions with a level of detail close to histopathology. This systematic literature review aims to provide an overview of RCM utility in acne and a summary of specific features with clinical application that may increase objectivity in evaluating this condition. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting our results. We systematically searched three databases: PubMed, Clarivate and Google Scholar (January 2022). All included studies used RCM to investigate acne in human patients and reported the investigated skin area and type (acne lesions or clinically uninvolved skin), the substance used in the case of treatment. Our search identified 2184 records in the three databases investigated. After duplicate removal, 1608 records were screened, 35 were selected for full-text assessment, and 14 were included in this review. We used the QUADAS-2 tool to evaluate the risk of bias and applicability concerns. RCM was selected as the index test and clinical examination as the reference standard. The total number of patients from all studies was 291, with 216 acne patients and 60 healthy participants aged between 13 and 45 years. The 14 considered studies analysed 456 follicles from healthy participants, 1445 follicles from uninvolved skin in acne patients and 1472 acne lesions. Consistent RCM findings concerning follicles of acne patients reported across studies were increased follicular infundibulum size, thick, bright border, intrafollicular content and inflammation. Our analysis indicates that RCM is a promising tool for acne evaluation. Nevertheless, standardization, a unified terminology, consistent research methods and unitary reporting of RCM findings are necessary. PROSPERO registration number CRD42021266547.

A Primer on Systematic Review and Meta-analysis in Diabetes Research

A systematic review is a rigorous process that involves identifying, selecting, and synthesizing available evidence pertaining to an a priori-defined research question. The resulting evidence base may be summarized qualitatively or through a quantitative analytic approach known as meta-analysis. Systematic review and meta-analysis (SRMAs) have risen in popularity across the scientific realm including diabetes research. Although well-conducted SRMAs are an indispensable tool in informing evidence-based medicine, the proliferation of SRMAs has led to many reviews of questionable quality and misleading conclusions. The objective of this article is to provide up-to-date knowledge and a comprehensive understanding of strengths and limitations of SRMAs. We first provide an overview of the SRMA process and offer ways to identify common pitfalls at key steps. We then describe best practices as well as evolving approaches to mitigate biases, improve transparency, and enhance rigor. We discuss several recent developments in SRMAs including individual-level meta-analyses, network meta-analyses, umbrella reviews, and prospective meta-analyses. Additionally, we outline several strategies that can be used to enhance quality of SRMAs and present key questions that authors, editors, and readers should consider in preparing or critically reviewing SRMAs.

Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia

Introduction

Despite a large preclinical literature demonstrating neuroprotective effects of estrogen, use of menopausal hormone therapy (HT) for Alzheimer's disease (AD) risk reduction has been controversial. Herein, we conducted a systematic review and meta-analysis of HT effects on AD and dementia risk.

Methods

Our systematic search yielded 6 RCT reports (21,065 treated and 20,997 placebo participants) and 45 observational reports (768,866 patient cases and 5.5 million controls). We used fixed and random effect meta-analysis to derive pooled relative risk (RR) and 95% confidence intervals (C.I.) from these studies.

Results

Randomized controlled trials conducted in postmenopausal women ages 65 and older show an increased risk of dementia with HT use compared with placebo [RR = 1.38, 95% C.I. 1.16-1.64, p < 0.001], driven by estrogen-plus-progestogen therapy (EPT) [RR = 1.64, 95% C.I. 1.20-2.25, p = 0.002] and no significant effects of estrogen-only therapy (ET) [RR = 1.19, 95% C.I. 0.92-1.54, p = 0.18]. Conversely, observational studies indicate a reduced risk of AD [RR = 0.78, 95% C.I. 0.64-0.95, p = 0.013] and all-cause dementia [RR = .81, 95% C.I. 0.70-0.94, p = 0.007] with HT use, with protective effects noted with ET [RR = 0.86, 95% C.I. 0.77-0.95, p = 0.002] but not with EPT [RR = 0.910, 95% C.I. 0.775-1.069, p = 0.251]. Stratified analysis of pooled estimates indicates a 32% reduced risk of dementia with midlife ET [RR = 0.685, 95% C.I. 0.513-0.915, p = 0.010] and non-significant reductions with midlife EPT [RR = 0.775, 95% C.I. 0.474-1.266, p = 0.309]. Late-life HT use was associated with increased risk, albeit not significant [EPT: RR = 1.323, 95% C.I. 0.979-1.789, p = 0.069; ET: RR = 1.066, 95% C.I. 0.996-1.140, p = 0.066].

Discussion

These findings support renewed research interest in evaluating midlife estrogen therapy for AD risk reduction.

Photosynthesis regulation, cell membrane stabilization and methylglyoxal detoxification seems major altered pathways under cold stress as revealed by integrated multi-omics meta-analysis

Climate change has altered cold weather patterns, resulting in irregular cold weather conditions, and changing the global plant distribution pattern affecting plant development processes resulting in severe yield losses. Although molecular mechanisms and interconnections are quite well studied, a cumulative understanding of plant responses to cold stress (CS) is still lacking. Through meta-analysis, integration of data at the multi-omics level and its correlation with known physiological changes to map and understand the global changes in response to CS was made. Meta-analysis was conducted using the metafor R package program based on physiological parameters like relative electrolytic leakage, malondialdehyde, soluble sugar, proline and antioxidant enzymes activity. Proline and soluble sugars showed the highest (> 1.5 mean fold) change over control thus qualifying as global markers for studying CS. Surprisingly most up-regulated (> 15-fold) DEGs corresponded with the dehydrin family and glyoxalase superfamily proteins. Functional annotations of DEGs corresponded with photosynthesis and glycolysis pathway. Proteins responsible for cell signalling and increased soluble sugars were common in all the datasets studied thus correlating with the transcriptome and proteomic data. Proline and soluble sugars were positively regulated in all the metabolomics datasets. This study supported the earlier known players like proline and soluble sugars. Surprisingly, a new player glyoxalase seems to be contributing in CS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12298-023-01367-9.

Meta-analysis of soluble tumour necrosis factor receptors in severe mental illnesses

Tumour necrosis factor (TNF), as an innate immune defense molecule, functions through binding to TNF receptor 1 (TNFR1) or TNF receptor 2 (TNFR2). Peripheral levels of soluble TNFR1 (sTNFR1) and soluble TNFR2 (sTNFR2) were widely measured in severe mental illnesses (SMIs) including schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) but inconsistencies existed. Hence, the present meta-analysis was conducted to identify the overall association between plasma/serum sTNFR1 and sTNFR2 levels and SMIs. Published studies were searched using Pubmed and Scopus. Data were analysed using Comprehensive Meta-Analysis version 2. Hedges's g effect sizes and 95% confidence intervals were pooled using fixed-effect or random-effects models. Heterogeneity, publication bias and study quality were assessed. Sensitivity analysis and subgroup analysis were performed. Our findings revealed that sTNFR1 level was significantly higher in SMI, particularly in BD. The sTNFR2 level significantly elevated in SMI but with smaller effect size. These findings further support the association between altered immune system and inflammatory abnormalities in SMI, especially in patients with BD. Subgroup analysis showed that younger age of onset, longer illness duration and psychotropic medication raised both sTNFR levels, especially sTNFR1, as these factors may contribute to the activation of inflammation. Future studies were suggested to identify the causality between TNFR pathway and SCZ, BD and MDD respectively using homogenous group of each SMI, and to determine the longitudinal effect of each psychotropic medication on TNFR pathway.

Corrigendum: A systematic review and meta-analysis of interventions to decrease cyberbullying perpetration and victimization: an in-depth analysis within the Asia Pacific region

[This corrects the article DOI: 10.3389/fpsyt.2023.1014258.].

The cellular mechanisms associated with the anesthetic and neuroprotective properties of xenon: a systematic review of the preclinical literature

Introduction

Xenon exhibits significant neuroprotection against a wide range of neurological insults in animal models. However, clinical evidence that xenon improves outcomes in human studies of neurological injury remains elusive. Previous reviews of xenon's method of action have not been performed in a systematic manner. The aim of this review is to provide a comprehensive summary of the evidence underlying the cellular interactions responsible for two phenomena associated with xenon administration: anesthesia and neuroprotection.

Methods

A systematic review of the preclinical literature was carried out according to the PRISMA guidelines and a review protocol was registered with PROSPERO. The review included both in vitro models of the central nervous system and mammalian in vivo studies. The search was performed on 27th May 2022 in the following databases: Ovid Medline, Ovid Embase, Ovid Emcare, APA PsycInfo, and Web of Science. A risk of bias assessment was performed utilizing the Office of Health Assessment and Translation tool. Given the heterogeneity of the outcome data, a narrative synthesis was performed.

Results

The review identified 69 articles describing 638 individual experiments in which a hypothesis was tested regarding the interaction of xenon with cellular targets including: membrane bound proteins, intracellular signaling cascades and transcription factors. Xenon has both common and subtype specific interactions with ionotropic glutamate receptors. Xenon also influences the release of inhibitory neurotransmitters and influences multiple other ligand gated and non-ligand gated membrane bound proteins. The review identified several intracellular signaling pathways and gene transcription factors that are influenced by xenon administration and might contribute to anesthesia and neuroprotection.

Discussion

The nature of xenon NMDA receptor antagonism, and its range of additional cellular targets, distinguishes it from other NMDA antagonists such as ketamine and nitrous oxide. This is reflected in the distinct behavioral and electrophysiological characteristics of xenon. Xenon influences multiple overlapping cellular processes, both at the cell membrane and within the cell, that promote cell survival. It is hoped that identification of the underlying cellular targets of xenon might aid the development of potential therapeutics for neurological injury and improve the clinical utilization of xenon.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: 336871.

Mechanical Properties of Three-Dimensional Printed Provisional Resin Materials for Crown and Fixed Dental Prosthesis: A Systematic Review

The emergence of digital dentistry has led to the introduction of various three-dimensional (3D) printing materials in the market, specifically for provisional fixed restoration. This study aimed to undertake a systematic review of the published literature on the Mechanical Properties of 3D- Printed Provisional Resin Materials for crown and fixed dental prosthesis (FDP). The electronic database on PubMed/Medline was searched for relevant studies. The search retrieved articles that were published from January 2011 to March 2023. The established focus question was: "Do provisional 3D-printed materials have better mechanical properties than conventional or milled provisional materials?". The systematically extracted data included the researcher's name(s), publication year, evaluation method, number of samples, types of materials, and study outcome. A total of 19 studies were included in this systematic review. These studies examined different aspects of the mechanical properties of 3D-printed provisional materials. Flexural Strength and Microhardness were the frequently used mechanical testing. Furthermore, 3D-printed provisional restorations showed higher hardness, smoother surfaces, less wear volume loss, and higher wear resistance compared to either milled or conventional, or both. 3D-printed provisional resin materials appear to be a promising option for fabricating provisional crowns and FDPs.

The effects of exercise on non-motor experiences of daily living experienced in Parkinson's Disease: A systematic review and network meta-analysis

Introduction

Whilst non-motor experiences of daily living (NMeDL) reduce quality of life (QoL) in people with Parkinson's Disease (PD), research dedicated to NMeDL is lacking compared to motor symptoms. The aim of this Network Meta-Analysis (NMA) was to compare and determine the effects of exercise and dual-task training interventions on NMeDL for people with early-to-mid stage PD.

Methods

Eight electronic databases were systematically searched, identifying randomised control trials (RCTs) that assessed the effect of interventions on the Movement Disease Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS); Part I scores. A fixed-effect pairwise and NMA were completed and confidence in estimates were assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.

Results

Five RCTs involving exercise were identified, involving 218 participants. No dual-tasking studies were suitable. Pairwise comparisons favoured tango and mixed-treadmill training (TT) when compared to control, however 95% Confidence Intervals (CI) crossed the line of no effect (MD = 0). Indirect comparisons revealed tango had clinically meaningful reductions in Part I scores compared to speed-TT and body-weight resistance training, (MD -4.47; 95% CI -8.50 to -0.44 and MD -4.38; 95% CI -7.86 to -0.90), indicating improved NMeDL. Compared to control, low confidence evidence suggests tango and mixed-TT improves NMeDL.

Conclusions

Tango and mixed-TT are the most effective exercise interventions for improving NMeDL. Adoption of an exercise program in the early stages of PD, irrespective of modality, may be effective and holds potential clinical importance immediately following a diagnosis of PD.Other: Prospero Registration Number; CRD42022322470.

The Linear-Logistic Model: A Novel Paradigm for Estimating Dietary Amino Acid Requirements

This study aimed to determine whether current methods for estimating AA requirements for animal health and welfare are sufficient. An exploratory data analysis (EDA) was conducted, which involved a review of assumptions underlying AA requirements research, a data mining approach to identify animal responses to dietary AA levels exceeding those for maximum protein retention, and a literature review to assess the physiological relevance of the linear-logistic model developed through the data mining approach. The results showed that AA dietary levels above those for maximum growth resulted in improvements in key physiological responses, and the linear-logistic model depicted the AA level at which growth and protein retention rates were maximized, along with key metabolic functions related to milk yield, litter size, immune response, intestinal permeability, and plasma AA concentrations. The results suggest that current methods based solely on growth and protein retention measurements are insufficient for optimizing key physiological responses associated with health, survival, and reproduction. The linear-logistic model could be used to estimate AA doses that optimize these responses and, potentially, survival rates.

Health literacy status among community in the protected area: A protocol for systematic review and meta-analysis

BACKGROUND

Adequate health literacy is necessary for individuals as it enables them to readily acquire information, process it, and apply it to health-related decisions. Various factors including geographical area will determine the disparity in health literacy status. Communities living in protected areas have limited health literacy and health status owing to a lack of access to infrastructure and medical facilities. Existing studies have discussed health literacy among various populations disproportionately affected by certain diseases. However, research remains underdeveloped, and the causal factors are largely untested. This research aims to better understand how population living conditions especially those who are living in protected areas are affected and exposed to limited health literacy.

METHOD

This study will comprehensively review full-text papers published between 2013 and 2023. We will search 3 databases, PubMed, SCOPUS, and Web of Science, using the keyword search strategy to find articles related to the issue. Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used to guide the selection of relevant studies. The results will then be assessed using the standard Cochrane Quality assessment method. The outcome is addressed in light of a narrative synthesis that utilizes a theme category and focuses on each component's main conclusions.

RESULT

This protocol describes the planned scope and methodology for the systematic review and meta-analysis that will provide current evidence on; The status of health literacy among the community in protected areas and; The effect of Protected Areas on health literacy according to their types and characteristics.

CONCLUSION

Meta-analysis of low-to-high health literacy status will benefit the development of policy recommendations for protected areas.

Craniofacial Bones and Teeth in Spacefarers: Systematic Review and Meta-analysis

INTRODUCTION

Estimating the risk of dental problems in long-duration space missions to the Moon and Mars is critical for avoiding dental emergencies in an environment that does not support proper treatment. Previous risk estimates were constructed based on the experience in short-duration space missions and isolated environments on Earth. However, previous estimates did not account for potential changes in dental structures due to space travel, even though bone loss is a known problem for long-duration spaceflights. The objective of this study was to systematically analyze the changes in hard tissues of the craniofacial complex during spaceflights.

METHODS

Comprehensive search of Medline, Embase, Scopus, the NASA Technical Report Server, and other sources identified 1,585 potentially relevant studies. After screening, 32 articles that presented quantitative data for skull in humans (6/32) and for calvariae, mandible, and lower incisors in rats (20/32) and mice (6/32) were selected.

RESULTS

Skull bone mineral density showed a significant increase in spacefaring humans. In spacefaring rodents, calvariae bone volume to tissue volume (BV/TV) demonstrated a trend toward increasing that did not reach statistical significance, while in mandibles, there was a significant decrease in BV/TV. Dentin thickness and incisor volume of rodent incisors were not significantly different between spaceflight and ground controls.

DISCUSSION

Our study demonstrates significant knowledge gaps regarding many structures of the craniofacial complex such as the maxilla, molar, premolar, and canine teeth, as well as small sample sizes for the studies of mandible and incisors. Understanding the effects of microgravity on craniofacial structures is important for estimating risks during long-duration spaceflight and for formulating proper protocols to prevent dental emergencies.

KNOWLEDGE TRANSFER STATEMENT

Avoiding dental emergencies in long-duration spaceflights is critical since this environment does not support proper treatment. Prior risk estimates did not account for changes in dental structures due to space travel. We reviewed and synthesized the literature for changes in craniofacial complex associated with spaceflight. The results of our study will help clinicians and scientists to better prepare to mitigate potential oral health issues in space travelers on long-duration missions.

Activation methods increase biochar's potential for heavy-metal adsorption and environmental remediation: A global meta-analysis

Removal of heavy metals (HMs) by adsorption on biochar's surface has shown promising results in the remediation of contaminated soil and water. The adsorption capacity of biochar can be altered by pre- or post-pyrolysis activation; however, the effect of activation methods on biochar's adsorption capacity varies widely. Here, we conducted a meta-analysis to identify the most effective methods for activation to enhance HM removal by biochar using 321 paired observations from 50 published articles. Activation of biochar significantly improves the adsorption capacity and removal efficiency of HMs by 136 and 80 %, respectively. This study also attempts to find suitable feedstocks, pyrolysis conditions, and physicochemical properties of biochar for maximizing the effect of activation of biochar for HMs adsorption. Activation of agricultural wastes and under pyrolysis temperatures of 350-550 °C produces biochars that are the most effective for HM adsorption. Activation of biochars with a moderate particle size (0.25-0.80 mm), low N/C (<0.01) and H/C ratios (<0.03), and high surface area (> 100 m² g^-1) and pore volume (> 0.1 cm³ g^-1) are the most desirable characteristics for enhancing HM adsorption. We conclude that pre-pyrolysis activation with metal salts/oxides was the most effective method of enhancing biochar's potential for adsorption and removal of a wide range of HMs. The results obtained from this study can be helpful in choosing appropriate methods of activations and the suitable choice of feedstocks and pyrolysis conditions. This will maximize HM adsorption on biochar surfaces, ultimately benefiting the remediation of contaminated environments.

The interplay among HIV, monocytes/macrophages, and extracellular vesicles: a systematic review

Despite effective antiretroviral therapies, chronic inflammation and spontaneous viral "blips" occur in HIV-infected patients. Given the roles for monocytes/macrophages in HIV pathogenesis and extracellular vesicles in intercellular communication, we performed this systematic review to delineate the triad of HIV, monocytes/macrophages, and extracellular vesicles in the modulation of immune activation and HIV activities. We searched PubMed, Web of Science, and EBSCO databases for published articles, up to 18 August 2022, relevant to this triad. The search identified 11,836 publications, and 36 studies were deemed eligible and included in this systematic review. Data were extracted for the characteristics of HIV, monocytes/macrophages, and extracellular vesicles used for experiments and the immunologic and virologic outcomes in extracellular vesicle recipient cells. Evidence for the effects on outcomes was synthesized by stratifying the characteristics by outcomes. In this triad, monocytes/macrophages were potential producers and recipients of extracellular vesicles, whose cargo repertoires and functionalities were regulated by HIV infection and cellular stimulation. Extracellular vesicles derived from HIV-infected monocytes/macrophages or the biofluid of HIV-infected patients enhanced innate immune activation and HIV dissemination, cellular entry, replication, and latency reactivation in bystander or infected target cells. These extracellular vesicles could be synthesized in the presence of antiretroviral agents and elicit pathogenic effects in a wide range of nontarget cells. At least eight functional types of extracellular vesicles could be classified based on the diverse extracellular vesicle effects, which were linked to specific virus- and/or host-derived cargos. Thus, the monocyte/macrophage-centered multidirectional crosstalk through extracellular vesicles may help sustain persistent immune activation and residual viral activities during suppressed HIV infection.

Proteomics as a tool to decipher plant responses in arbuscular mycorrhizal interactions: a meta-analysis

The beneficial symbiosis between plants and arbuscular mycorrhizal (AM) fungi leads to a deep reprogramming of plant metabolism, involving the regulation of several molecular mechanisms, many of which are poorly characterized. In this regard, proteomics is a powerful tool to explore changes related to plant-microbe interactions. This study provides a comprehensive proteomic meta-analysis conducted on AM-modulated proteins at local (roots) and systemic (shoots/leaves) level. The analysis was implemented by an in-depth study of root membrane-associated proteins and by a comparison with a transcriptome meta-analysis. A total of 4262 differentially abundant proteins were retrieved and, to identify the most relevant AM-regulated processes, a range of bioinformatic studies were conducted, including functional enrichment and protein-protein interaction network analysis. In addition to several protein transporters which are present in higher amounts in AM plants, and which are expected due to the well-known enhancement of AM-induced mineral uptake, our analysis revealed some novel traits. We detected a massive systemic reprogramming of translation with a central role played by the ribosomal translational apparatus. On one hand, these new protein-synthesis efforts well support the root cellular re-organization required by the fungal penetration, and on the other they have a systemic impact on primary metabolism.

Quantitative review summarizing the effects of oil pollution on subarctic and arctic marine invertebrates

While meta-analyses are common in the health and some biological sciences, there is a lack of such analyses for petroleum-related marine research. Oil is a highly complex substance consisting of thousands of different compounds. Measurement limitations, different protocols and a lack of standards in recording and reporting various elements of laboratory experiments impede attempts to homogenize and compare data and identify trends. Nevertheless, oil toxicology research would benefit from meta-analyses, through which we could develop meaningful research questions and design robust experiments. Here we report findings from an effort to quantitatively summarize results from oil toxicology studies on arctic and subarctic marine invertebrates. We discovered that the vast majority of studies was conducted on crustaceans, followed by molluscs. Analyzing the sensitivity of response measures across taxa we found that the most sensitive responses tend to rank low in ecological relevance, while less sensitive response measures tend to be more ecologically relevant. We further uncovered that crustaceans appear to be more sensitive to mechanically dispersed than chemically dispersed oil while the opposite seems true for molluscs, albeit not statistically significant. Both crustaceans and molluscs show a higher sensitivity to fresh than to weathered oil. No differences in the sensitivities of crustacean life stages were found. However, due to a lack of data, many questions remain unanswered. Our study revealed that while trends in responses can be elucidated, heterogeneous experimental protocols and reporting regimes prevent a proper meta-analysis.

Removing Mn, Cu and Fe from Real Wastewaters with Macrophytes: Reviewing the Relationship between Environmental Factors and Plants' Uptake Capacity

Heavy metal pollution creates environmental health concerns. Among these, iron (Fe), copper (Cu) and manganese (Mn) are commonly found in aquatic environments due to the release of wastewaters. Phytoremediation in hydroponics uses macrophytes to treat contaminated environments, and this is influenced by environmental factors. However, the relationship between these factors and the removal of Fe, Cu and Mn by macrophytes is not known. Therefore, a meta-analysis serves to determine the correlations between environmental factors and the removal of these metals in real wastewater by macrophytes, as well as to identify the role of different aquatic forms of macrophytes in phytoremediation. Emergent macrophytes had higher concentrations of manganese in their tissues, and higher bioconcentrations factor of iron and manganese than floating plants. Regardless of the biotope, higher concentrations of Fe and Cu decreased the ability of plants to bioconcentrate them. The correlations among exposure time, pH, dissolved oxygen, nitrogen, phosphorus, photoperiod and metal phytoremediation by plants were also found. It can be concluded that the emergent macrophytes showed better performance in terms of the removal of Fe, Cu and Mn, and that the significant correlations between environmental factors and removal vary with the type of metal and the environmental factor analyzed.

A systematic review and meta-analysis of interventions to decrease cyberbullying perpetration and victimization: An in-depth analysis within the Asia Pacific region

BACKGROUND

Cyberbullying perpetration and victimization are prevalent issues in adolescent development and are a rising public health concern. Numerous interventions have been developed and implemented to decrease cyberbullying perpetration and victimization. Through an updated systematic review and meta-analysis, this study aimed to tackle a significant gap in the cyberbullying literature by addressing the need to empirically determine the effectiveness of programs with non-school-aged samples with a specific focus on studies conducted within the Asia-Pacific region.

METHODS

A systematic literature review was conducted to identify intervention research to reduce cyberbullying perpetration and victimization published from January 1995 to February 2022. Ten electronic databases-Cambridge Journal Online, EBSCOHOST, ERIC, IEEE XPLORE, Oxford Journal Online, ProQuest Dissertations and Theses, PubMed (Medline), Science Direct, Scopus, Springerlink-and a subsequent manual search were conducted. Detailed information was extracted, including the summary data that could be used to estimate effect sizes. The studies' methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

FINDINGS

Eleven studies were included in the review of the 2,540 studies identified through databases, and 114 additional records were discovered through citation searching. Only four studies were included in the meta-analysis, exploring game-based, skill-building, school-based, and whole-school interventions. The first meta-analysis pooled estimates from these four studies that assessed cyberbullying perpetration frequency using continuous data post-intervention. These studies reported data from 3,273 participants (intervention n = 1,802 and control n = 1,471). A small but not statistically significant improvement favoring the intervention group from pre- to post-intervention was shown by the pooled effect size, -0.04 (95% CI [-0.10,0.03], Z = 1.11, P = 0.27). The second meta-analysis included two qualified studies investigating cyberbullying victimization frequency using continuous data at post-intervention among 2,954 participants (intervention n = 1,623 and control n = 1,331). A very small but non-significant effect favoring the intervention group was discovered.

CONCLUSION

This research primarily highlights that the endeavor for cyberbullying intervention is still developing in the Asia-Pacific region, currently involving a limited set of stakeholders, settings, and delivery modes. Overall, meta-analyses of cyberbullying interventions conducted in the Asia Pacific found no significant effects in reducing cyberbullying perpetration and victimization.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42022313369.

A systematic review and Bayesian meta-analysis of the acoustic features of infant-directed speech

When speaking to infants, adults often produce speech that differs systematically from that directed to other adults. To quantify the acoustic properties of this speech style across a wide variety of languages and cultures, we extracted results from empirical studies on the acoustic features of infant-directed speech. We analysed data from 88 unique studies (734 effect sizes) on the following five acoustic parameters that have been systematically examined in the literature: fundamental frequency (f₀), f₀ variability, vowel space area, articulation rate and vowel duration. Moderator analyses were conducted in hierarchical Bayesian robust regression models to examine how these features change with infant age and differ across languages, experimental tasks and recording environments. The moderator analyses indicated that f₀, articulation rate and vowel duration became more similar to adult-directed speech over time, whereas f₀ variability and vowel space area exhibited stability throughout development. These results point the way for future research to disentangle different accounts of the functions and learnability of infant-directed speech by conducting theory-driven comparisons among different languages and using computational models to formulate testable predictions.

A meta-analysis to observe silage microbiome differentiated by the use of inoculant and type of raw material

Silage fermentation is naturally carried out by lactic acid bacteria (LAB) to mainly produce lactic acid (LA) and other organic acids as preservatives. Along with fermentation time, the growth of LAB will replace and suppress undesirable microorganisms. This meta-analysis study aimed to explore silage microbiome differentiated by LAB inoculants and type of raw materials. A total of 37 articles with 185 studies and 475 datasets were used for building up the meta-database. Data were subjected to the mixed model methodology. The parameters observed were silage quality and silage microbiome post-ensiling process. Results revealed that four bacterial genera along with Weissella dominated the post-ensiling process. The addition of lactic acid inoculants in the silage has increased the abundance of Lactobacillus spp. and decreased the Shannon index significantly. Moreover, the abundance of both L. plantarum and L. buchneri increased, and subsequently, Weissella, Pseudomonas, Proteobacteria, pH value, ammoniacal nitrogen (NH₃-N), coliforms, and the yeasts were decreased significantly due to the addition of LAB inoculants in silage (p < 0.05). Environmental factors such as temperature affected the existence of Pseudomonas, Exiguobacterium, and Acinetobacter. However, the dry matter, LA, acetic acid (AA), the ratio of LA to AA, and the LAB population were enhanced significantly (p < 0.05). Among the LAB types, the lowest abundance of Pseudomonas was due to the LAB group, while the lowest abundance of Weissella and Proteobacteria was due to the addition of the combined LAB group. In conclusion, the addition of LAB is effectively enhancing the silage microbiome and silage quality by altering bacterial diversity and the metabolic products of the silage materials for safe preservation.

A meta-analysis: the efficacy and effectiveness of polypeptide vaccines protect pigs from foot and mouth disease

The protective effects of peptides on pigs are controversial. In this study, meta-analysis was used to analyze the protective immune response of peptides. The China National Knowledge Infrastructure, PubMed, Wanfang Data, Cochrane Library, Embase, and gray literature sources were searched for FMDV articles published from the inception of the databases to March 2022. Of the 1403 articles obtained, 14 were selected using inclusion criteria. The experimental data on polypeptide vaccines were analyzed using Microsoft Office Home and Student 2019 Software. From the results, polypeptide vaccine doses (PPVDs) ≤ 1 mg offered protection against FMDV in 69.41% pigs lower than World Organization for Animal Health (OIE) standard (75%, 12/16). PPVDs ≥ 2 mg provided protection against FMDV in 97.22% pigs. When the two groups were compared directly, PPVDs ≥ 2 mg (93.75%) was higher than PPVDs ≤ 1 mg (63.16%). PPVDs ≤ 1 mg provided protection 56% pigs and the inactivated vaccine was 93.33% in direct comparison. In conclusion, PPVDs has a dose-dependent protective effect on pigs and PPVDs ≤ 1 mg group was lower than the inactivated vaccines group.

Arcobacter species in milk contamination: a prevalence-based systematic review and meta-analysis

AIMS

Milk is consumed raw or minimally processed and plays a role in the dissemination of pathogens of public health concerns. The present investigation is aimed at assessing the occurrence of pathogenic Arcobacter species in 2945 milk samples.

METHODS AND RESULTS

Arcobacter data systematically retrieved from five repositories until 20 February 2022 according to PRISMA principles were logit transformed and fitted using a generalized linear mixed-effects model. The between-study heterogeneity was estimated as I2-value. Leave-one-out cross-validation and funnel plot with Egger's tests were used to assess the hardiness and bias in the model. The global prevalence of Arcobacter genus in the milk was 12% [95% confidence interval (CI): 7-19%; I2 = 87.3%, 95% CI: 83.0-90.6%] and no publication bias observed (Egger's test: P = 0.112). Arcobacter genus prevalence in milk was 13% (95% CI: 5-30%), 10% (95% CI: 1-46%), and 9% (95% CI: 4-19%) in Europe, South America, and Asia, respectively. Arcobacter butzleri was the most prevalent [8% (95% CI: 4-13%)], followed by A. cryaerophilus [0.6% (95% CI: 0.2-33.2%)] and A. skirrowii [0.19% (95% CI: 0.03-1.2%)]. Also, species-specific prevalence of A. butzleri, A. cryaerophilus, and A. skirrowii varied continentally, but the test for species-specific/continental differences was not significantly different (P > 0.5).

Effect of Experimental Electrical and Biological Parameters on Gene Transfer by Electroporation: A Systematic Review and Meta-Analysis

The exact mechanisms of nucleic acid (NA) delivery with gene electrotransfer (GET) are still unknown, which represents a limitation for its broader use. Further, not knowing the effects that different experimental electrical and biological parameters have on GET additionally hinders GET optimization, resulting in the majority of research being performed using a trial-and-error approach. To explore the current state of knowledge, we conducted a systematic literature review of GET papers in in vitro conditions and performed meta-analyses of the reported GET efficiency. For now, there is no universal GET strategy that would be appropriate for all experimental aims. Apart from the availability of the required electroporation device and electrodes, the choice of an optimal GET approach depends on parameters such as the electroporation medium; type and origin of cells; and the size, concentration, promoter, and type of the NA to be transfected. Equally important are appropriate controls and the measurement or evaluation of the output pulses to allow a fair and unbiased evaluation of the experimental results. Since many experimental electrical and biological parameters can affect GET, it is important that all used parameters are adequately reported to enable the comparison of results, as well as potentially faster and more efficient experiment planning and optimization.

Meta-analysis of Diabetes Mellitus-Associated Differences in Bone Structure Assessed by High-Resolution Peripheral Quantitative Computed Tomography

PURPOSE OF REVIEW

Diabetes mellitus is defined by elevated blood glucose levels caused by changes in glucose metabolism and, according to its pathogenesis, is classified into type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Diabetes mellitus is associated with multiple degenerative processes, including structural alterations of the bone and increased fracture risk. High-resolution peripheral computed tomography (HR-pQCT) is a clinically applicable, volumetric imaging technique that unveils bone microarchitecture in vivo. Numerous studies have used HR-pQCT to assess volumetric bone mineral density and microarchitecture in patients with diabetes, including characteristics of trabecular (e.g. number, thickness and separation) and cortical bone (e.g. thickness and porosity). However, study results are heterogeneous given different imaging regions and diverse patient cohorts.

RECENT FINDINGS

This meta-analysis assessed T1DM- and T2DM-associated characteristics of bone microarchitecture measured in human populations in vivo reported in PubMed- and Embase-listed publications from inception (2005) to November 2021. The final dataset contained twelve studies with 516 participants with T2DM and 3067 controls and four studies with 227 participants with T1DM and 405 controls. While T1DM was associated with adverse trabecular characteristics, T2DM was primarily associated with adverse cortical characteristics. These adverse effects were more severe at the radius than the load-bearing tibia, indicating increased mechanical loading may compensate for deleterious bone microarchitecture changes and supporting mechanoregulation of bone fragility in diabetes mellitus. Our meta-analysis revealed distinct predilection sites of bone structure aberrations in T1DM and T2DM, which provide a foundation for the development of animal models of skeletal fragility in diabetes and may explain the uncertainty of predicting bone fragility in diabetic patients using current clinical algorithms.

A Systematic Literature Review and Meta-Analysis of Studies on Online Fake News Detection

The ubiquitous access and exponential growth of information available on social media networks have facilitated the spread of fake news, complicating the task of distinguishing between this and real news. Fake news is a significant social barrier that has a profoundly negative impact on society. Despite the large number of studies on fake news detection, they have not yet been combined to offer coherent insight on trends and advancements in this domain. Hence, the primary objective of this study was to fill this knowledge gap. The method for selecting the pertinent articles for extraction was created using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). This study reviewed deep learning, machine learning, and ensemble-based fake news detection methods by a meta-analysis of 125 studies to aggregate their results quantitatively. The meta-analysis primarily focused on statistics and the quantitative analysis of data from numerous separate primary investigations to identify overall trends. The results of the meta-analysis were reported by the spatial distribution, the approaches adopted, the sample size, and the performance of methods in terms of accuracy. According to the statistics of between-study variance high heterogeneity was found with τ2 = 3.441; the ratio of true heterogeneity to total observed variation was I2 = 75.27% with the heterogeneity chi-square (Q) = 501.34, the degree of freedom = 124, and p ≤ 0.001. A p-value of 0.912 from the Egger statistical test confirmed the absence of a publication bias. The findings of the meta-analysis demonstrated satisfaction with the effectiveness of the recommended approaches from the primary studies on fake news detection that were included. Furthermore, the findings can inform researchers about various approaches they can use to detect online fake news.

Reliability Generalization Meta-Analysis of Internet Gaming Disorder Scale

The objective of this study was to carry out a reliability generalization meta-analysis of the Internet Gaming Disorder Scale (IGDS) to find out if it presents adequate values that justify its application in its four versions: original and abbreviated with dichotomous or ordinal response. A systematic review including 26 studies that apply this instrument from 2015 to June 2022 was conducted. For each version, a reliability generalization meta-analysis was performed with the random coefficients (RC) and varying coefficients (VC) model. Results showed reliability levels > 0.80 in the ordinal versions (IGDS9P and IGDS27P) and in the dichotomous 27-item version (IGDS27D), while the dichotomous 9-item version (IGDS9D) produced levels > 0.70. High heterogeneity was found in all versions (I2 > 95%; Rb > 90%). Cronbach’s α means with both models (RC-VC) did not differ significantly except for the IGDS9D version. It is concluded that, considering the dependence of the results on sample size, abbreviated versions do not guarantee that reliability remains acceptable, and dichotomous versions may provide limited but acceptable reliability. Finally, IGDS27P version is recommended in contexts where high precision is required.

Predicting COVID-19 disease severity from SARS-CoV-2 spike protein sequence by mixed effects machine learning

Epidemiological studies show that COVID-19 variants-of-concern, like Delta and Omicron, pose different risks for severe disease, but they typically lack sequence-level information for the virus. Studies which do obtain viral genome sequences are generally limited in time, location, and population scope. Retrospective meta-analyses require time-consuming data extraction from heterogeneous formats and are limited to publicly available reports. Fortuitously, a subset of GISAID, the global SARS-CoV-2 sequence repository, includes "patient status" metadata that can indicate whether a sequence record is associated with mild or severe disease. While GISAID lacks data on comorbidities relevant to severity, such as obesity and chronic disease, it does include metadata for age and sex to use as additional attributes in modeling. With these caveats, previous efforts have demonstrated that genotype-patient status models can be fit to GISAID data, particularly when country-of-origin is used as an additional feature. But are these models robust and biologically meaningful? This paper shows that, in fact, temporal and geographic biases in sequences submitted to GISAID, as well as the evolving pandemic response, particularly reduction in severe disease due to vaccination, create complex issues for model development and interpretation. This paper poses a potential solution: efficient mixed effects machine learning using GPBoost, treating country as a random effect group. Training and validation using temporally split GISAID data and emerging Omicron variants demonstrates that GPBoost models are more predictive of the impact of spike protein mutations on patient outcomes than fixed effect XGBoost, LightGBM, random forests, and elastic net logistic regression models.

Blueprint for the ideal microplastic effect study: Critical issues of current experimental approaches and envisioning a path forward

This article presents a novel conceptual blueprint for an 'ideal', i.e., ecologically relevant, microplastic effect study. The blueprint considers how microplastics should be characterized and applied in laboratory experiments, and how biological responses should be measured to assure unbiased data that reliably reflect the effects of microplastics on aquatic biota. This 'ideal' experiment, although practically unachievable, serves as a backdrop to improve specific aspects of experimental research on microplastic effects. In addition, a systematic and quantitative literature review identified and quantified departures of published experiments from the proposed 'ideal' design. These departures are related mainly to the experimental design of microplastic effect studies failing to mimic natural environments, and experiments with limited potential to be scaled-up to ecosystem level. To produce a valid and generalizable assessment of the effect of microplastics on biota, a quantitative meta-analysis was performed that incorporated the departure of studies from the 'ideal' experiment (a measure of experimental quality) and inverse variance (a measure of the study precision) as weighting coefficients. Greater weights were assigned to experiments with higher quality and/or with lower variance in the response variables. This double-weighting captures jointly the technical quality, ecological relevance and precision of estimates provided in each study. The blueprint and associated meta-analysis provide an improved baseline for the design of ecologically relevant and technically sound experiments to understand the effects of microplastics on single species, populations and, ultimately, entire ecosystems.