Combining follow-up and change data is valid in meta-analyses of continuous outcomes: a meta-epidemiological study

OBJECTIVE To investigate whether it is valid to combine follow-up and change data when conducting meta-analyses of continuous outcomes. STUDY DESIGN AND SETTING Meta-epidemiological study of randomized controlled trials in patients with osteoarthritis of the knee/hip, which assessed patient-reported pain. We calculated standardized mean differences (SMDs) based on follow-up and change data, and pooled within-trial differences in SMDs. We also derived pooled SMDs indicating the largest treatment effect within a trial (optimistic selection of SMDs) and derived pooled SMDs from the estimate indicating the smallest treatment effect within a trial (pessimistic selection of SMDs). RESULTS A total of 21 meta-analyses with 189 trials with 292 randomized comparisons in 41,256 patients were included. On average, SMDs were 0.04 standard deviation units more beneficial when follow-up values were used (difference in SMDs: -0.04; 95% confidence interval: -0.13, 0.06; P=0.44). In 13 meta-analyses (62%), there was a relevant difference in clinical and/or significance level between optimistic and pessimistic pooled SMDs. CONCLUSION On average, there is no relevant difference between follow-up and change data SMDs, and combining these estimates in meta-analysis is generally valid. Decision on which type of data to use when both follow-up and change data are available should be prespecified in the meta-analysis protocol.

Effects of study precision and risk of bias in networks of interventions: a network meta-epidemiological study

BACKGROUND Empirical research has illustrated an association between study size and relative treatment effects, but conclusions have been inconsistent about the association of study size with the risk of bias items. Small studies give generally imprecisely estimated treatment effects, and study variance can serve as a surrogate for study size. METHODS We conducted a network meta-epidemiological study analyzing 32 networks including 613 randomized controlled trials, and used Bayesian network meta-analysis and meta-regression models to evaluate the impact of trial characteristics and study variance on the results of network meta-analysis. We examined changes in relative effects and between-studies variation in network meta-regression models as a function of the variance of the observed effect size and indicators for the adequacy of each risk of bias item. Adjustment was performed both within and across networks, allowing for between-networks variability. RESULTS Imprecise studies with large variances tended to exaggerate the effects of the active or new intervention in the majority of networks, with a ratio of odds ratios of 1.83 (95% CI: 1.09,3.32). Inappropriate or unclear conduct of random sequence generation and allocation concealment, as well as lack of blinding of patients and outcome assessors, did not materially impact on the summary results. Imprecise studies also appeared to be more prone to inadequate conduct. CONCLUSIONS Compared to more precise studies, studies with large variance may give substantially different answers that alter the results of network meta-analyses for dichotomous outcomes.

PEDro or Cochrane to Assess the Quality of Clinical Trials? A Meta-Epidemiological Study.

OBJECTIVE There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria. DESIGN Meta-epidemiological study within Cochrane Database of Systematic Reviews. METHODS Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score ≥5 or ≥6 points. We combined trials of adequate quality using random-effects meta-analysis. RESULTS Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores ≥5, 37 (90.2%) included trials with PEDro scores ≥6 and only 22 (53.7%) meta-analyses included trials of adequate quality according to the Cochrane criteria. Agreement between PeDro and Cochrane was poor for PeDro scores of ≥5 points (kappa = 0.12; 95% CI 0.07 to 0.16) and slight for ≥6 points (kappa 0.24; 95% CI 0.16-0.32). When combining effect sizes of trials deemed to be of adequate quality according to PEDro or Cochrane criteria, we found that a substantial difference in the combined effect size (≥0.15) was evident in 9 (22%) out of the 41 meta-analyses for PEDro cutoff ≥5 and 10 (24%) for cutoff ≥6. CONCLUSIONS The PeDro and Cochrane approaches lead to different sets of trials of adequate quality, and different combined treatment estimates from meta-analyses of these trials. A consistent approach to assessing RoB in trials of physical therapy should be adopted.

What is the influence of randomisation sequence generation and allocation concealment on treatment effects of physical therapy trials? A meta-epidemiological study.

OBJECTIVE To determine if adequacy of randomisation and allocation concealment is associated with changes in effect sizes (ES) when comparing physical therapy (PT) trials with and without these methodological characteristics. DESIGN Meta-epidemiological study. PARTICIPANTS A random sample of randomised controlled trials (RCTs) included in meta-analyses in the PT discipline were identified. INTERVENTION Data extraction including assessments of random sequence generation and allocation concealment was conducted independently by two reviewers. To determine the association between sequence generation, and allocation concealment and ES, a two-level analysis was conducted using a meta-meta-analytic approach. PRIMARY AND SECONDARY OUTCOME MEASURES association between random sequence generation and allocation concealment and ES in PT trials. RESULTS 393 trials included in 43 meta-analyses, analysing 44 622 patients contributed to this study. Adequate random sequence generation and appropriate allocation concealment were accomplished in only 39.7% and 11.5% of PT trials, respectively. Although trials with inappropriate allocation concealment tended to have an overestimate treatment effect when compared with trials with adequate concealment of allocation, the difference was non-statistically significant (ES=0.12; 95% CI -0.06 to 0.30). When pooling our results with those of Nuesch et al, we obtained a pooled statistically significant value (ES=0.14; 95% CI 0.02 to 0.26). There was no difference in ES in trials with appropriate or inappropriate random sequence generation (ES=0.02; 95% CI -0.12 to 0.15). CONCLUSIONS Our results suggest that when evaluating risk of bias of primary RCTs in PT area, systematic reviewers and clinicians implementing research into practice should pay attention to these biases since they could exaggerate treatment effects. Systematic reviewers should perform sensitivity analysis including trials with low risk of bias in these domains as primary analysis and/or in combination with less restrictive analyses. Authors and editors should make sure that allocation concealment and random sequence generation are properly reported in trial reports.

Analytical study and evaluation results of power optimizers for distributed power conditioning in PV arrays

The use of modular or ‘micro’ maximum power point tracking (MPPT) converters at module level in series association, commercially known as “power optimizers”, allows the individual adaptation of each panel to the load, solving part of the problems related to partial shadows and different tilt and/or orientation angles of the photovoltaic (PV) modules. This is particularly relevant in building integrated PV systems. This paper presents useful behavioural analytical studies of cascade MPPT converters and evaluation test results of a prototype developed under a Spanish national research project. On the one hand, this work focuses on the development of new useful expressions which can be used to identify the behaviour of individual MPPT converters applied to each module and connected in series, in a typical grid-connected PV system. On the other hand, a novel characterization method of MPPT converters is developed, and experimental results of the prototype are obtained: when individual partial shading is applied, and they are connected in a typical grid connected PV array

Experimental and Analytical Study of Masonry Infill Reinforced Concrete Frames Retrofitted with Steel Braces

In the present work a seismic retrofitting technique is proposed for masonry infilled reinforced concrete frames based on the replacement of infill panels by K-bracing with vertical shear link. The performance of this technique is evaluated through experimental tests. A simplified numerical model for structural damage evaluation is also formulated according to the notions and principles of continuum damage mechanics. The proposed model is calibrated with the experimental results. The experimental results have shown an excellent energy dissipation capacity with the proposed technique. Likewise, the numerical predictions with the proposed model are in good agreement with experimental results.

Empirical and analytical study of instabilities in hybrid optical bistable systems

As it is well known from the work by Gibbs et al., optical turbulence and periodic oscillations are easily seen in hybrid optical bistable devices when a delay is added to the feedback. Such effects, as it was pointed out by Gibbs, may be used to convert cw laser power into a train of light pulses.

Analytical study of the thermal behaviour and stability of a small satellite

In this work the thermal analysis of a small satellite orbiting around the Earth has been approached by direct integration of the heat balance equations of a two-node reduced model, obtaining a linearized second order ODE problem, similar in form to the classical case of the forced vibration of a damped system. As the thermal loads (solar radiation, albedo, etc.) are harmonic, the problem is solved by means of Fourier analysis methods. Research on that field can be directly applied to the analysis of thermal problems and the results obtained are satisfactory. Working on the frequency domain streamlines the analysis, simplifies the study and facilitates the experimental testing. The transfer functions are obtained for the two-node case but the study can be extended to an n-node model.

Improving urban park design: A comparative and analytical study addressing resources available and components necessary to improve the environmental and economic sustainability of urban parks

Urban parks have long been valued for the environmental, social, and economic benefits they provide. Increasingly, parks are also being recognized as features important for sustainable city design. This Capstone Project will identify, compare, analyze, and discuss means for designing sustainable urban parks. Recommendations for designing sustainable urban parks, based on project results, include: 1) ensure park features will support high levels of human activity; 2) use gravel to construct park trails; 3) purchase playground structures made of recycled materials; 4) plant a high number of perennials in flowerbeds and other vegetated areas; 5) plant climate-appropriate plants in vegetated areas; 6) ensure parks have high levels of plant diversity; and 7) develop future studies further exploring sustainable park design.

Analytical study of the legal and operational aspects of the Minnesota law entitled "Chemical test for intoxication" - M.S.A. Sec. 169.123. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Our weakened Constitution : an historical and analytical study of the Constitution of the United States and of the additions to the original text undertaken to place the facts before the American people, and to emphasize the present necessity for a movement in behalf of an unvolated Constitution, state integrity and the rights and immunities established by the founders of this republic /

Mode of access: Internet.

Presentence investigation and rehabilitation. Analytical study no. 5/6. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

An analysis of ultimate performance measures to determine total project impact. Analytical study #1. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

An analysis of ASAP patrol activity. Analytical study #3. Final report.

National Highway Traffic Safety Administration, Washington, D.C.