James Lind Alliance research priorities: should diet and exercise be used as an alternative to drugs for the management of type 2 diabetes or alongside them?

AIM

To review evidence on whether diet and exercise should be used as an alternative to drug therapy for the management of type 2 diabetes or alongside.

METHOD

We present a narrative review that draws on evidence from other systematic reviews and meta-analyses, narrative reviews, trials and cohort studies. We focused mainly on glycaemic control rather than control of blood pressure or cholesterol.

RESULTS

Good-quality dietary advice that results in weight loss of >5% and physical activity interventions of >150 min/week of moderate to vigorous physical activity, combined with resistance exercise, can produce improvements in HbA_1c similar to those produced by the addition of glucose-lowering drugs. These improvements can be seen at all stages of the disease. There are recognized interactions between glucose-lowering drugs and physical activity which may not be synergistic, but these are not well understood, and it is not clear if they are considered in clinical practice. Studies that explicitly compare drugs with diet or physical activity or control for drug use found that lifestyle could delay or reduce medication use, but most people eventually needed to progress to drug treatment. There are few studies, however, that provide strategies for the long-term maintenance of weight loss or physical activity.

CONCLUSION

Diet and physical activity are of key importance in type 2 diabetes management, and attention to them improves glycaemic control and cardiovascular disease risk, but it is not yet known whether maintained lifestyle changes provide an alternative to drug therapy in the long term.

Childhood Sexual Violence in Indonesia: A Systematic Review

There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.

Evaluation of technological competence and operations efficiency in the defense industry: The strategic planning of South Korea

This research aims to contribute to efficiency improvement by providing the implications for decision-making on continuous defense R&D investment strategies and acquisition methods via analyzing the current position and measuring the efficiency of overall weapon systems on technological competence and operations. This research is distinctive in comparison to previous studies because it is structured in a two-stage DEA analysis for efficiency by distinguishing between the technology and operations of the current eight fields of weapon systems and by adding the external index for government competence and market competence. In 2016, in comparison to the year 2013, the eight major weapon systems' efficiency fields of the overall system of Korea, efficiency of technological competence, and efficiency of operations all increased. This research introduced the input and output variable that fits in with the defense industry by connecting the weapon systems efficiency with the national innovation system and the sectoral innovation system that are both projected in this industry. It also formed the concepts of technological competence efficiency and operations efficiency using the two-stage Network DEA method.

Best research practices in clinical science: Reflections on the status quo and charting a path forward

Clinical psychological science is a rapidly evolving field using a diverse set of methods in various populations. Many of our common research practices and everyday decisions on how and when to use certain methods are described with little detail and formal guidelines and open discussion of those (formal and informal) guidelines is often missing. This special section aims to take stock of current practices in our field and to reflect on them by providing user-friendly articles on common practices across a variety of methodologies in. The articles cover 4 broad areas: (a) diagnostic and clinical assessment including the importance of interrater reliability, the challenges of extreme group designs, and transdiagnostic approaches; (b) clinical neuroscience research including clinical psychophysiology work and translational neuroscience; (c) research conducted outside the laboratory setting including experience sampling and online studies; and (d) daily research practices. A particular focus is on how the discussed practices apply specifically to psychiatric and at-risk clinical populations and the unique methodological challenges that arise when working with these sensitive populations. The contributors to this special issue represent a diverse group whose efforts target a variety of settings and processes with the ultimate goal of increasing transparency surrounding our everyday decisions about designs, methods, and data analysis. We hope that each of the pieces in this section offer inspiration and provide a resource as well as a starting point for further discussion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Privacy and Security Issues with Mobile Health Research Applications

This article examines the privacy and security issues associated with mobile application-mediated health research, concentrating in particular on research conducted or participated in by independent scientists, citizen scientists, and patient researchers. Building on other articles in this issue that examine state research laws and state data protection laws as possible sources of privacy and security protections for mobile research participants, this article focuses on the lack of application of federal standards to mobile application-mediated health research. As discussed in more detail below, the voluminous and diverse data collected by some independent scientists who use mobile applications to conduct health research may be at risk for unregulated privacy and security breaches, leading to dignitary, psychological, and economic harms for which participants have few legally enforceable rights or remedies under current federal law. Federal lawmakers may wish to consider enacting new legislation that would require otherwise unregulated health data holders to implement reasonable data privacy, security, and breach notification measures.

When IRBs Say No to Participating in Research about Single IRBs

In response to a policy of the National Institutes of Health and requirements in the revised Common Rule, a protocol for a multisite study must be reviewed by a single institutional review board (IRB), rather than by the IRB at each study site. The goal of the single IRB approach is to increase the efficiency of IRB review of multisite research without jeopardizing protections for research subjects. Yet the extent to which these joint goals are being achieved is unclear. To better understand how single IRBs function, we recruited academic, government, and commercial single IRBs (N = 49) to participate in a study involving observation of protocol review meetings and/or interviews with their members, chairs, and administrators. Twenty (40.8%) agreed to participate, of which 50% agreed to both interviews and observation. While 81.8% (9/11) of academic and 50% (4/8) of government single IRBs participated in some way, only 23.3% (7/30) of commercial single IRBs did so. The four largest commercial single IRBs declined to participate. Because evaluation of single IRBs is important to inform development, implementation, monitoring, and refinement of federal policies, single IRBs should be encouraged to participate in research that examines how they function.

Misinterpreting p: The discrepancy between p values and the probability the null hypothesis is true, the influence of multiple testing, and implications for the replication crisis

The p value is still misinterpreted as the probability that the null hypothesis is true. Even psychologists who correctly understand that p values do not provide this probability may not realize the degree to which p values differ from the probability that the null hypothesis is true. Importantly, previous research on this topic has not addressed the influence of multiple testing, often a reality in psychological studies, and has not extensively considered the influence of different prior probabilities favoring the null and alternative hypotheses. Simulation studies are presented that emphasize the magnitude by which p values are distinct from the posterior probability that the null hypothesis is true, under an extensive set of conditions including multiple testing. Particular emphasis is placed on p values just under .05, given the prevalence of these p values in the published literature, though p values in other intervals are also assessed. In diverse conditions, results indicate that posterior probabilities favoring the null hypothesis are often far removed from .05, and this pattern quickly gets much worse when multiple testing is conducted. Rather than simply telling researchers that p values do not reflect the probability favoring the null hypothesis, as has been done previously, the results presented here allow psychologists to see the evidence provided by various p values. These results have particularly topical implications for the replication crisis, for how much weight should be placed on a single study, and for how the term statistical significance should be interpreted, particularly in conditions typical in psychological research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Culture counts more than money: Israeli critiques of German science

While economic investments and organizational reforms may support Germany's scientific ambitions, its culture remains a significant influence on how those ambitions work themselves out. The study relied on interviews with 125 Israeli scientists and on responses of nineteen of their German collaborators to a questionnaire. Data analysis found four cultural priorities that - in the context of comparisons with Israeli scientific culture - respondents suggest cut short the potential of German science: privileging technology over meaning and insight, privileging hierarchy over creativity, privileging cosmos over chaos, and privileging German over English. Respondents suggest that these cultural priorities silence alternative points of view and censor young scientists, limit motivation and stifle imagination, preordain problem-solving orientations, and restrict communication flows. As they consider policy targets for 2020 and beyond, the new German government, foundation leaders, and scientists need to discuss those cultural challenges. The study calls for scholars in science and technology studies to pay more attention to national cultures as decisive factors in framing the limits and possibilities of science.

[Biohazards in research laboratories]

Objectives. To deal with biohazards in research laboratories (RL), identify exposure features, types and incidence of laboratory-acquired infections/diseases (LAI), and prevention strategies. Methods. Literature search and appraisal, non-systematic, last 40 years; legislation, guidelines and good practices evaluation. Results. Biohazards are relevant in RL, in various biomedical, agri-food and industrials sectors, with a variety of LAI (especially viruses and bacteria), modes of exposure and transmission; LAI decrease after preventive measures, vaccinations and clinical treatments; LAI underestimation, due to underreporting and subclinical LAI; need to implement and comply with well-known and available technical and scientific guidelines, good medical and laboratory practices; need for specific health education and training; lack of reporting and epidemiologic surveillance systems, with consequent limited data on risk assessment and effectiveness of preventive interventions. Conclusions. The roles of the occupational physician must be underlined, especially for risk assessment, health and clinicepidemiologic surveillance, with the need to monitor seconeffectiveness of preventive interventions, particularly for biosafety and biosecurity levels in RL. It should be useful to increase capacity of epidemiologic surveillance for LAI, through networking or dedicated websites, in order to collect and analyze accidents, injuries, infections, or adverse events occurred to workers in RL.

The SOFA score-development, utility and challenges of accurate assessment in clinical trials

The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients' SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.

Nursing students' attitudes toward research: An integrative review

OBJECTIVE

This paper describes the state of the science related to undergraduate nursing students' attitudes toward research.

DESIGN

The updated integrative review method was used to systematically examine the published nursing literature about students' attitudes toward nursing research.

DATA SOURCES

Data sources for this review included: the Cumulative Index of Nursing and Allied Health Literature, PubMed, and Education Resources Information Center databases.

REVIEW METHODS

Database searches identified 207 articles. Abstracts were screened for relevance, and, if appropriate, the full article was obtained and reviewed. Ancestral searches of reference lists yielded an additional 29 articles, thus a total of 236 articles were screened for this review.

RESULTS

This comprehensive screening process yielded a total of 11 quantitative, 2 qualitative, and 2 mixed method studies about undergraduate nursing students' attitudes toward research.

CONCLUSIONS

Nursing students have generally positive attitudes toward research and see the value of research to professional nursing practice. Engaging in a research course or other active research-related activity improves attitudes toward nursing research. More rigorous study is warranted to determine best teaching/learning strategies to enhance students' perceptions of research. Future research is also needed to gain a better understanding of the demographic, academic, and program factors that affect nursing students' attitudes toward nursing research.

The scientific term paper at the Charité: a project report on concept, implementation, and students' evaluation and learning

Aim: Better training in scientific skills, such as the ability to conduct research independently, has been one of the main drivers of reform in medical education. The aim of this article is to report on the scientific term paper module in the modular curriculum of medicine (MCM) at the Charité. This module is an established example of undergraduate medical students conducting their own scientific investigations. Project outline: A faculty-wide, outcome-oriented process resulted in a four-week module for writing a scientific term paper in the 6^th semester of the MCM as part of a longitudinal science curriculum. Acquired competencies were assessed through a written term paper and an oral presentation. Two student cohorts (winter terms 2013 and 2014) were surveyed on how they rated the module concept, organizational aspects and the quality of support. We further analysed the chosen topics of the papers as well as student assessment results. Results: The student evaluation (return rates of 193 and 197, 71% and 77%) showed high overall satisfaction with the module. This result was evident in the high rating of the module concept and organizational aspects, a positive attitude towards scientific research, and strong motivation to pursue further scientific research. There was a wide spectrum of term paper topics with a focus on literature reviews. Most of the student work was assessed as good or very good. Conclusion: The scientific term paper module has proven itself as a curricular concept for students to perform own scientific research in the MCM, with strong acceptance and good performance by students. This project report can serve as basis and guidance for development and further improvements to promote scientific competencies in undergraduate medical education in other faculties.

The state of social science research on antimicrobial resistance

This paper investigates the genealogy of social science research into antimicrobial resistance (AMR) by piecing together the bibliometric characteristics of this branch of research. Drawing on the Web of Science as the primary database, the analysis shows that while academic interest in AMR has increased substantially over the last few years, social science research continues to constitute a negligible share of total academic contributions. More in-depth network analysis of citations and bibliometric couplings suggests how the impact of social science research on the scientific discourse on AMR is both peripheral and spread thin. We conclude that this limited social science engagement is puzzling considering the clear academic and practical demand and the many existing interdisciplinary outlets.

Advancing research integrity: a programme to embed good practice in Africa

In Africa, training programmes as well as institutional policies on research integrity are lacking. Institutions have a responsibility to oversee research integrity through various efforts, including policies and training. We developed, implemented and evaluated an institutional approach to promote research integrity at African institutions, comprising a workshop for researchers ("bottom-up") and discussions with senior faculty on institutional policies ("top-down"). During the first day, we facilitated a workshop to introduce research integrity and promote best practices with regards to authorship, plagiarism, redundant publication and conflicts of interest. We used a variety of interactive teaching approaches to facilitate learning, including individual and group activities, small group discussions and case-based learning. We met with senior faculty on the following day to provide feedback and insights from the workshop, review current institutional policies and provide examples of what other research groups are doing. We evaluated the process. Participants actively engaged in discussions, recognised the importance of the topic and acknowledged that poor practices occurred at their institution. Discussions with senior researchers resulted in the establishment of a working group tasked with developing a publication policy for the institution. Our approach kick-started conversations on research integrity at institutions. There is a need for continued discussions, integrated training programmes and implementation of institutional policies and guidelines to promote good practices.

On the relationship between road safety research and the practice of road design and operation

How do the findings of road safety research affect the practice by which the road infrastructure is built and operated? The question is seldom asked. I discuss the complexities of the research-practice symbiosis in the light of two historical anecdotes. These allow me to point out several issues of concern. My general conclusion is that the relationship, as it evolved over time, is unpremeditated and occasionally dysfunctional. Issues of concern are the lightness with which decisions affecting road-user safety can be based on opinion that is unsupported by evidence, that such opinions can trump inconvenient evidence, that research findings can be willfully distorted or disregarded, that questionable results can be given a ring of consensual truth, and that the questions which research asks and what findings get published are at times influenced by external interest. In sum, the concern is that practice is not sufficiently evidence-based. Road users have a right to expect that decisions substantially affecting their safety take into account fact-based expectation of safety consequences. It is therefore time to endow the research-practice relationship with a premeditated and purposeful structure.

Congress of the United States, Ramazzini Institute and its affiliates, IARC: questions on scientific transparency

No abstract available.

The "Top 10" research and development priorities for battlefield surgical care: Results from the Committee on Surgical Combat Casualty Care research gap analysis

BACKGROUND

The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.

METHODS

A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.

RESULTS

13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented.

CONCLUSIONS

This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers.

LEVEL OF EVIDENCE

Study design, level IV.

Informant discrepancies in assessments of psychosocial functioning in school-based services and research: Review and directions for future research

Psychosocial functioning plays a key role in students' wellbeing and performance inside and outside of school. As such, techniques designed to measure and improve psychosocial functioning factor prominently in school-based service delivery and research. Given that the different contexts (e.g., school, home, community) in which students exist vary in the degree to which they influence psychosocial functioning, educators and researchers often rely on multiple informants to characterize intervention targets, monitor intervention progress, and inform the selection of evidence-based services. These informants include teachers, students, and parents. Across research teams, domains, and measurement methodologies, researchers commonly observe discrepancies among informants' reports. We review theory and research-occurring largely outside of school-based service delivery and research-that demonstrates how patterns of informant discrepancies represent meaningful differences that can inform our understanding of psychosocial functioning. In turn, we advance a research agenda to improve use and interpretation of informant discrepancies in school-based services and research.

A rapid research needs appraisal methodology to identify evidence gaps to inform clinical research priorities in response to outbreaks-results from the Lassa fever pilot

BACKGROUND

Infectious disease epidemics are a constant threat, and while we can strengthen preparedness in advance, inevitably, we will sometimes be caught unaware by novel outbreaks. To address the challenge of rapidly identifying clinical research priorities in those circumstances, we developed and piloted a protocol for carrying out a systematic, rapid research needs appraisal (RRNA) of existing evidence within 5 days in response to outbreaks globally, with the aim to inform clinical research prioritization.

METHODS

The protocol was derived from rapid review methodologies and optimized through effective use of pre-defined templates and global time zones. It was piloted using a Lassa fever (LF) outbreak scenario. Databases were searched from 1969 to July 2017. Systematic reviewers based in Canada, the UK, and the Philippines screened and extracted data using a systematic review software. The pilot was evaluated through internal analysis and by comparing the research priorities identified from the data, with those identified by an external LF expert panel.

RESULTS

The RRNA pilot was completed within 5 days. To accommodate the high number of articles identified, data extraction was prioritized by study design and year, and the clinical research prioritization done post-day 5. Of 118 potentially eligible articles, 52 met the data extraction criteria, of which 46 were extracted within the 5-day time frame. The RRNA team identified 19 clinical research priorities; the expert panel independently identified 21, of which 11 priorities overlapped. Each method identified a unique set of priorities, showing that combining both methods for clinical research prioritization is more robust than using either method alone.

CONCLUSIONS

This pilot study shows that it is feasible to carry out a systematic RRNA within 5 days in response to a (re-) emerging outbreak to identify gaps in existing evidence, as long as sufficient resources are identified, and reviewers are experienced and trained in advance. Use of an online systematic review software and global time zones effectively optimized resources. Another 3 to 5 days are recommended for review of the extracted data and to formulate clinical research priorities. The RRNA can be used for a "Disease X" scenario and should optimally be combined with an expert panel to ensure breadth and depth of coverage of clinical research priorities.