Exercise-induced muscle damage (EIMD) disrupts muscle structure and function, impairing recovery and performance. Near-infrared spectroscopy (NIRS) offers a non-invasive method to assess muscle oxygenation, yet its sensitivity to EIMD-related changes under practical conditions remains unclear. This study examined whether resting tissue saturation index (TSI) and sprint-phase oxygenation kinetics are altered following EIMD. Seventeen recreationally active males were assigned to a control (n = 5) or experimental group (n = 12). The experimental group performed 10 × 10 eccentric squats at 80% 1RM. Resting TSI, sprint-phase desaturation/resaturation, countermovement jump (CMJ), wellness, and creatine kinase (CK) were measured at baseline and 1, 24, 48, 72, and 96 hours post-exercise. Control data provided typical error and smallest worthwhile change thresholds for reliability and interpretation. No statistically significant differences were found over time or between groups for CK, performance, or NIRS variables (P > 0.05). However, effect size-based inferences revealed small to extremely large effect sizes in CMJ, wellness, CK, and key NIRS metrics. Notably, desaturation amplitude and rate during Sprint 1 showed large effects at 1 h post-EIMD, while resting TSI demonstrated a small increase at 24 h. These observations indicate that resting TSI and selected sprint-phase NIRS indices exhibit small but systematic changes in temporal association with an eccentric squat protocol that induces EIMD, and suggest that NIRS may have the potential to contribute to non-invasive characterisation of muscle status in this context.

Risk of bias (RoB) assessment is an essential part of systematic reviews that requires reading and understanding each eligible trial and RoB tools. RoB assessment is subject to human error and is time-consuming. Machine learning-based tools have been developed to automate RoB assessment using simple models trained on limited corpuses. ChatGPT is a conversational agent based on a large language model (LLM) that was trained on an internet-scale corpus and has demonstrated human-like abilities in multiple areas including healthcare. LLMs might be able to support systematic reviewing tasks such as assessing RoB. We aim to assess interrater agreement in overall (rather than domain-level) RoB assessment between human reviewers and ChatGPT, in randomized controlled trials of interventions within medical interventions. We will randomly select 100 individually- or cluster-randomized, parallel, two-arm trials of medical interventions from recent Cochrane systematic reviews that have been assessed using the RoB1 or RoB2 family of tools. We will exclude reviews and trials that were performed under emergency conditions (e.g., COVID-19), as well as public health and welfare interventions. We will use 25 of the trials and human RoB assessments to engineer a ChatGPT prompt for assessing overall RoB, based on trial methods text. We will obtain ChatGPT assessments of RoB for the remaining 75 trials and human assessments. We will then estimate interrater agreement using Cohen’s κ. The primary outcome for this study is overall human-ChatGPT interrater agreement. We will report observed agreement with an exact 95

BACKGROUND:Although physiological reflux is seen in nearly all newborns to varying degrees, symptoms can be severe and cause gastroesophageal reflux disease (GERD). In preterm infants, one symptom that is often attributed to GERD is apnea and associated cardiorespiratory events, such as bradycardia and oxygen desaturation. Although the relationship between GERD and apnea, bradycardia, and desaturation events remains a subject of ongoing investigation, trials of agents that reduce gastric acidity, such as proton pump inhibitors (PPI), have been conducted to assess the effect of these agents on GERD. OBJECTIVES:To assess the benefits and harms of PPIs for the treatment of preterm infants with diagnosed or suspected GERD. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, two trial registries, and Epistemonikos in October 2023. We checked reference lists of included studies, and studies and systematic reviews in which the subject matter was related to the intervention or population examined in this review. SELECTION CRITERIA:We included randomized controlled trials, quasi-randomized controlled trials, cross-over trials, and cluster-randomized trials that assessed the use of PPIs (including esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole) alone or in combination. Infants had to receive treatment for a minimum of three days. We considered the following comparisons: (1) PPIs versus no treatment, (2) PPI versus positioning changes (elevated head of bed or prone positioning), (3) PPI versus dietary changes (thickened feeds). We excluded studies examining alginates and histamine receptor blockers. Studies including other non-pharmacological interventions for GERD were included if these interventions were available to infants in all study groups. DATA COLLECTION AND ANALYSIS:Two review authors independently identified eligible trials, reviewed the methodological quality of each trial, and extracted data on prespecified outcomes. Data were compared and differences resolved. We used standard methods of Cochrane Neonatal to synthesize data using relative risk (RR), risk difference (RD), and mean difference (MD). MAIN RESULTS:After screening 1217 articles, only two studies, enrolling a total of 62 infants, met our criteria. Both studies compared the use of PPIs to no treatment (placebo). One study included ten infants with a mean gestational age of 36.1 ± 0.7 weeks, who were treated with seven days of PPI or placebo, and then crossed over to the other study arm for seven days, with gastric pH monitoring performed at the end of each week. The other study included 52 infants with a mean gestational age of 31 weeks, who were randomized to a PPI or placebo for 14 days, with various outcomes measured at baseline and after 14 days. Both studies were judged to be at low risk of bias. Only one study (N = 52) reported the primary outcome, cardiorespiratory events. The evidence is very uncertain about the effect of PPIs on cardiorespiratory events (MD 6.14 lower, 95% CI 44.51 lower to 32.23 higher). The evidence is very uncertain for the reported secondary outcome measures, including apnea at the end of treatment (MD 0.30 lower, 95% CI 0.93 lower to 0.33 higher), bradycardia at the end of treatment (MD 1.89 higher, 95% CI 1.11 lower to 4.89 higher), desaturation at the end of treatment (MD 7.72 lower, 95% CI 45.86 lower to 30.42 higher), choking at the end of the treatment (MD 0.96 higher, 95% CI 1.88 lower to 3.80 higher), irritability at the end of treatment (MD 0.02 higher, 95% CI 11 lower to 10.96 higher), and vomiting at the end of treatment (MD 0.34 higher, 95% CI 3.15 lower to 3.83 higher). The study was prematurely discontinued due to poor enrollment. One study (N = 10) reported a marked reduction in the percentage of time spent with esophageal acid exposure, with pH < 4. However, there was no effect on the frequency of symptoms. The study sample precludes the ability to extrapolate any significant data. Neither study reported data on length of stay or parental satisfaction. There were insufficient data to perform a meta-analysis. No trials addressed the issue of PPI versus positioning changes, or PPI versus dietary changes (thickened feeds). AUTHORS' CONCLUSIONS:Although widely used, there are insufficient data regarding the benefits and harms of proton pump inhibitors in preterm infants with gastroesophageal reflux disease. The most limiting factor was the paucity of studies on preterm infants. Even the studies that were included in this review were not limited to preterm infants. Hence, further studies are needed to address the safety and efficacy of proton pump inhibitors for the treatment of diagnosed or suspected gastroesophageal reflux disease in preterm neonates.

Precision Nutrition can enhance research in exercise and sports performance by integrating data from exercise performance studies with body composition, genetic, epigenetic, microbiome profiles, and metabolomic data to optimize science-based nutrition recommendations for individuals based on how they respond to exercise and nutritional interventions. The five components of physical fitness that make up total fitness include cardiovascular fitness, muscular strength, muscle endurance, flexibility, and body composition. Precision Nutrition will increase our understanding of the metabolic heterogeneity in response to exercise which will impact many applications of Precision Nutrition from weight management and prevention of common chronic diseases of aging to optimizing the performance of athletes and exercise. Athletes have a special need for evidence-based individualized nutrition recommendations that can effectively enhance their performance, metabolic recovery, and health.

Background: Point of care tests (POCTs) have the potential to improve the urinary tract infection (UTI) diagnostic pathway, as they can provide a diagnosis quickly in near-patient settings, and some also identify causative pathogens/antimicrobial sensitivity. Objectives: To assess the clinical impact, accuracy, and technical characteristics of POCT for diagnosing UTI. Methods of data synthesis: Narrative summary and bivariate random effects meta-analyses to estimate summary sensitivity and specificity. Data sources: Five electronic databases, two clinical trial registries, study reports and review reference lists, and websites. Study eligibility criteria: Randomized controlled trials/non-randomized studies and diagnostic test accuracy studies published since 2000. Participants: People with suspected UTI. Tests: Rapid tests (results <40 minutes): Astrego PA-10 0 system, Lodestar DX, Uriscreen, UTRiPLEX. Culture tests (results <24 hours): Flexicult Human, ID Flexicult, Diaslide, Dipstreak, Chromostreak, Uricult, Uricult Trio, Uricult Plus. Reference standard: Any. Assessment of risk of bias: Risk of Bias-2, Quality Assessment of Diagnostic Accuracy Studies-2, Quality Assessment of Diagnostic Accuracy Studies-C. Results: Two randomized controlled trials evaluated Flexicult Human (one against standard care; one against ID Flexicult). No difference was reported in antibiotic use concordant with culture results (OR 0.84 95% CI 0.58-1.20) or appropriate antibiotic prescribing (OR 1.44 95% CI 1.03-1.99). Initial antibiotic prescribing was lower with Flexicult than standard care (OR 0.56 95% CI 0.35-0.88). No difference for other measures of antibiotic use, symptom duration, patient enablement, or resource use. Fifteen studies reported accuracy data. Limited data were available, with most POCT evaluated in single studies or not evaluated at all. Uriscreen (four studies), Uricult Trio (three studies), Flexicult Human (four studies), and ID Flexicult (two studies) had modest sensitivity and specificity. POCTs were easier to use and interpret than standard culture. Conclusions: There is currently insufficient evidence to support the use of POCTs in UTI diagnosis. Due to the rapid development of POCT, this review should be updated regularly. Eve Tomlinson, Clin Microbiol Infect 2024;30:197 (c) 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Objectives: To review the findings of studies that have evaluated the design and/or usability of key risk of bias (RoB) tools for the assessment of RoB in primary studies, as categorized by the Library of Assessment Tools and InsTruments Used to assess Data validity in Evidence Synthesis Network (a searchable library of RoB tools for evidence synthesis): Prediction model Risk Of Bias ASessment Tool (PROBAST) , Risk of Bias-2 (RoB2), Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C), Quality Assessment of Prognostic Accuracy Studies (QUAPAS), Risk Of Bias in Non-randomised Studies of Exposures (ROBINS-E), and the COnsensusbased Standards for the selection of health Measurement INstruments (COSMIN) RoB checklist. Study Design and Setting: Systematic review of methodological studies. We conducted a forward citation search from the primary report of each tool, to identify primary studies that aimed to evaluate the design and/or usability of the tool. Two reviewers assessed studies for inclusion. We extracted tool features into Microsoft Word and used NVivo for document analysis, comprising a mix of deductive and inductive approaches. We summarized findings within each tool and explored common findings across tools. Results: We identified 13 tool evaluations meeting our inclusion criteria: PROBAST (3), RoB2 (3), ROBINS-I (4), and QUADAS-2 (3). We identified no evaluations for the other tools. Evaluations varied in clinical topic area, methodology, approach to bias assessment, and tool user background. Some had limitations affecting generalizability. We identified common findings across tools for 6/14 themes: (1) challenging items (eg, RoB2/ROBINS-I "deviations from intended interventions"domain), (2) overall RoB judgment (concerns with overall risk calculation in PROBAST/ROBINS-I), (3) tool usability (concerns about complexity), (4) time to complete tool (varying demands on time, eg, depending on number of outcomes assessed), (5) user agreement (varied across tools), and (6) recommendations for future use (eg, piloting) and development (add intermediate domain answer to QUADAS-2/PROBAST; provide clearer guidance for all tools). Of the other eight themes, seven only had findings for the QUADAS-2 tool, limiting comparison across tools, and one ("reorganization of questions") had no findings. Conclusion: Evaluations of key RoB tools have posited common challenges and recommendations for tool use and development. These findings may be helpful to people who use or develop RoB tools. Guidance is necessary to support the design and implementation of future RoB tool evaluations.

BACKGROUND:The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA). If a PDA is clinically symptomatic, it can lead to overcirculation in the lungs, and reduced perfusion to the gut and kidneys. Most clinical practice guidelines suggest fluid restriction as a conservative management strategy for the treatment of symptomatic PDA. Restricting fluid has been shown to reduce the incidence of PDA in older preterm infants. However, aggressive restriction of fluids may affect systemic blood flow in extremely preterm infants. Given the potential adverse effects, it is important to systematically evaluate the evidence on the use of fluid restriction to treat symptomatic PDA to inform clinical decisions. OBJECTIVES:To assess the effects of fluid restriction on morbidity and mortality for symptomatic PDA in preterm infants. SEARCH METHODS:We searched CENTRAL, MEDLINE, and Embase in October 2023. We also searched Clinicaltrials.gov, ICTRP, ANZCTR, and Epistemonikos. We planned to search the reference list of included studies and relevant systematic reviews for studies not identified by the database searches, but did not identify any. SELECTION CRITERIA:We planned to include randomized controlled trials (RCTs), quasi-RCTs, cluster-RCTs, and cross-over RCTs. We planned to include neonates who were born preterm (less than 37 weeks' gestational age), or with low birth weight (less than 2500 g), with a symptomatic PDA, diagnosed either clinically or by echocardiographic criteria, in the neonatal period. We planned to include studies that compared therapeutic restriction of parenteral or enteral fluids, or both, with or without diuretics, with control groups that received standard fluid intake, defined as no parenteral or enteral restriction, with or without diuretic use. DATA COLLECTION AND ANALYSIS:We used standard Cochrane methods. Our primary outcome was closure of PDA. Other relevant outcomes were all-cause mortality by 36 weeks' postmenstrual age, need for interventional closure of the PDA, need for treatment with a cyclooxygenase inhibitor, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and duration of hospitalization. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS:We did not identify any completed or ongoing RCTs that met our inclusion criteria and explored the effectiveness and safety of fluid restriction to treat symptomatic PDA. AUTHORS' CONCLUSIONS:No evidence from RCTs is currently available to evaluate the benefits and harms of fluid restriction for the treatment of symptomatic patent ductus arteriosus in preterm infants. We identified no ongoing studies. Evidence from sufficiently powered RCTs evaluating fluid restriction for treatment of symptomatic PDA in preterm neonates is needed to inform clinical decisions.

AbstractThe clinical utility of hemoglobin-based oxygen carriers (HBOC) is limited by adverse heme oxidative chemistry. A variety of tyrosine residues were inserted on the surface of the γ subunit of recombinant fetal hemoglobin to create novel electron transport pathways. This enhanced the ability of the physiological antioxidant ascorbate to reduce ferryl heme and decrease lipid peroxidation. The γL96Y mutation presented the best profile of oxidative protection unaccompanied by loss of protein stability and function. N-terminal deletions were constructed to facilitate the production of recombinant hemoglobin by fermentation and phenylalanine insertions in the heme pocket to decrease the rate of NO dioxygenation. The resultant mutant (αV1del. αL29F, γG1del. γV67F, γL96Y) significantly decreased NO scavenging and lipid peroxidation in vitro. Unlike native hemoglobin or a recombinant control (αV1del, γG1del), this mutation showed no increase in blood pressure immediately following infusion in a rat model of reperfusion injury, suggesting that it was also able to prevent NO scavenging in vivo. Infusion of the mutant also resulted in no meaningful adverse physiological effects apart from diuresis, and no increase in oxidative stress, as measured by urinary isoprostane levels. Following PEGylation via the Euro-PEG-Hb method to increase vascular retention, this novel protein construct was compared with saline in a severe rat reperfusion injury model (45% blood volume removal for 90 minutes followed by reinfusion to twice the volume of shed blood). Blood pressure and survival were followed for 4 h post-reperfusion. While there was no difference in blood pressure, the PEGylated Hb mutant significantly increased survival.

Aim: To assess the accuracy and technical characteristics of CYP2C19 point of care tests (POCTs).Patients & methods: Systematic review of primary studies, in any population or setting, that evaluated POCTs for detecting CYP2C19 loss of function (LOF) alleles.Results: Eleven studies provided accuracy data (eight Spartan; one Genomadix Cube; one GMEX; one Genedrive). The POCTs had very high sensitivity and specificity for the alleles they tested for. Twenty-two studies reported technical characteristics: POCTs were easy to operate and provided results quickly. Limited data were reported for test failure rate and cost.Conclusion: CYP2C19 POCTs may be a useful alternative to laboratory-based testing to guide antiplatelet therapy. Further data are required on accuracy (GMEX; Genedrive), test failure and cost (all POCT).

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it 'the Conventional Approach'. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called 'A Tailored Approach'. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user's interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation.

The aim of the present study was to examine whether full leg-length compression tights modify physiological and kinematic measures during treadmill running at a competitive race pace in moderately trained runners. Thirteen males and five females completed two 15-minute running tests at a speed corresponding to a recent race time wearing compression tights or loose-fitting running shorts. Running economy (RE) was determined by oxygen consumption and carbon dioxide expiration during the final 3 minutes of treadmill running. Muscle oxygenation, skin temperature, heart rate (HR), vertical oscillation, step frequency and ground contact time (GCT) were measured continuously. GCT was shorter with compression compared with control trials ( p = 0.03), however, no differences in RE, muscle oxygenation, vertical oscillation, step frequency, HR or skin temperature were revealed. Despite a shorter GCT with compression tights, the findings suggest that moderately trained runners do not benefit nor limit physiological responses at a competitive race pace.

Hypercapnia increases cerebral blood flow. The effects on cerebral metabolism remain incompletely understood although studies show an oxidation of cytochrome c oxidase, Complex IV of the mitochondrial respiratory chain. Systems modelling was combined with previously published non-invasive measurements of cerebral tissue oxygenation, cerebral blood flow, and cytochrome c oxidase redox state to evaluate any metabolic effects of hypercapnia. Cerebral tissue oxygen saturation and cytochrome oxidase redox state were measured with broadband near infrared spectroscopy and cerebral blood flow velocity with transcranial Doppler ultrasound. Data collected during 5-min hypercapnia in awake human volunteers were analysed using a Fick model to determine changes in brain oxygen consumption and a mathematical model of cerebral hemodynamics and metabolism (BrainSignals) to inform on mechanisms. Either a decrease in metabolic substrate supply or an increase in metabolic demand modelled the cytochrome oxidation in hypercapnia. However, only the decrease in substrate supply explained both the enzyme redox state changes and the Fick-calculated drop in brain oxygen consumption. These modelled outputs are consistent with previous reports of CO2 inhibition of mitochondrial succinate dehydrogenase and isocitrate dehydrogenase. Hypercapnia may have physiologically significant effects suppressing oxidative metabolism in humans and perturbing mitochondrial signalling pathways in health and disease.

CONTEXT:Cold-water immersion (CWI) has been reported to reduce tissue metabolism postimmersion, but physiological data are lacking regarding the muscle metabolic response to its application. Near-infrared spectroscopy (NIRS) is a noninvasive optical technique that can inform muscle hemodynamics and tissue metabolism.OBJECTIVE:To investigate the effects of CWI at 2 water temperatures (10°C and 15°C) on NIRS-calculated measurements of muscle oxygen consumption (mVO2).DESIGN:Crossover study.SETTING:University sports rehabilitation center.PATIENTS OR OTHER PARTICIPANTS:A total of 11 male National Collegiate Athletic Association Division II long-distance runners (age = 23.4 ± 3.4 years, height = 1.8 ± 0.1 m, mass = 68.8 ± 10.7 kg, mean adipose tissue thickness = 6.7 ± 2.7 mm).INTERVENTION(S):Cold-water immersion at 10°C and 15°C for 20 minutes.MAIN OUTCOME MEASURE(S):We calculated mVO2 preimmersion and postimmersion at water temperatures of 10°C and 15°C. Changes in tissue oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb), hemoglobin difference (Hbdiff), and tissue saturation index (TSI %) were measured during the 20-minute immersion at both temperatures.RESULTS:We observed a decrease in mVO2 after immersion at both 10°C and 15°C (F1,9 = 27.7801, P = .001). During the 20-minute immersion at both temperatures, we noted a main effect of time for O2Hb (F3,27 = 14.227, P = .001), HHb (F3,27 = 5.749, P = .009), tHb (F3,27 = 24.786, P = .001), and Hbdiff (F3,27 = 3.894, P = .020), in which values decreased over the course of immersion. Post hoc pairwise comparisons showed that these changes occurred within the final 5 minutes of immersion for tHb and O2Hb.CONCLUSIONS:A 20-minute CWI at 10°C and 15°C led to a reduction in mVO2. This was greater after immersion at 10°C. The reduction in mVO2 suggests a decrease in muscle metabolic activity (ie, O2 use after CWI). Calculating mVO2 via the NIRS-occlusion technique may offer further insight into muscle metabolic responses beyond what is attainable from observing the NIRS primary signals.

Objectives This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To evaluate the diagnostic accuracy of procalcitonin in culture proven early‐ or late‐onset neonatal sepsis. Secondary objectives To evaluate the diagnostic accuracy of procalcitonin in all sepsis (including both culture‐proven and culture‐negative early‐ or late‐onset neonatal sepsis). To evaluate the diagnostic accuracy of procalcitonin in all sepsis at the most common threshold ranges used (0.5 to 1 ng/mL and ≥ 2 ng/mL). We plan to investigate heterogeneity with respect to the following covariates if adequate data are available. Timing of sepsis onset: a) EOS (≤ 72 hours), b) LOS (> 72 hours). Maturity of infant: a) term (≥ 37 week gestation) b) preterm gestation (< 37 weeks gestation). Pathogen type: a) bacterial b) fungal. Nature of threshold determination: a) threshold identified a priori b) post‐hoc ascertainment of threshold.

The effect of compression tights on running economy is unclear. The purpose of this investigation was to assess the influence of compression tights on economy. Following an incremental test to exhaustion to determine aerobic capacity (V̇O2max) and peak running speed (vV̇O2max), twenty-six moderately endurance-trained males (28 ± 7 years; 76.1 ± 8.4 kg; V̇O2max = 54.7 ± 4.8 mL·kg−1·min−1) were allocated to either a 60% (n = 8), 62.5% (n = 9) or 65% vV̇O2max group (n = 9) using block randomisation. Participants ran for 15 min at the allocated vV̇O2max with compression tights and a non-compression control condition in a randomised, counter-balanced order, separated by seven days. Oxygen consumption (V̇O2) and expired carbon dioxide (V̇CO2) was measured to determine economy as caloric unit cost. No difference was observed between conditions for the 60% and 62.5% vV̇O2max groups, however economy was improved with compression at 65% vV̇O2max ( P < 0.01). Combined analysis of all participants revealed ΔRE (Δ = control − compression) correlated with relative aerobic capacity (%V̇O2max) ( r = 0.50, P < 0.01) but not running speed ( r = 0.04, P < 0.84). These data suggest that compression tights influence economy at 65% vV̇O2max or at relative exercise intensities of approximately 75–85%V̇O2max.

Dear Professor Babidge, You recently published: “A Technical Review of the ISPOR Presentations Database Identified Issues in the Search Interface and Areas for Future Development” (1). We would like to update you on the work undertaken by the Professional Society for Health Economics and Outcomes Research (ISPOR) in response to the paper, and some next steps for the ISPOR Presentations Database (2). This letter is cowritten by the authors of the original paper and colleagues from ISPOR.

BACKGROUND:Machine learning (ML) tools exist that can reduce or replace human activities in repetitive or complex tasks. Yet, ML is underutilized within evidence synthesis, despite the steadily growing rate of primary study publication and the need to periodically update reviews to reflect new evidence. Underutilization may be partially explained by a paucity of evidence on how ML tools can reduce resource use and time-to-completion of reviews. METHODS:This protocol describes how we will answer two research questions using a retrospective study design: Is there a difference in resources used to produce reviews using recommended ML versus not using ML, and is there a difference in time-to-completion? We will also compare recommended ML use to non-recommended ML use that merely adds ML use to existing procedures. We will retrospectively include all reviews conducted at our institute from 1 August 2020, corresponding to the commission of the first review in our institute that used ML. CONCLUSION:The results of this study will allow us to quantitatively estimate the effect of ML adoption on resource use and time-to-completion, providing our organization and others with better information to make high-level organizational decisions about ML.

OBJECTIVE:To undertake a technical review of the search interface of the ISPOR Presentations Database. By technical review, we mean an evaluation of the technical aspects of the search interface and functionality, which a user must navigate to complete a search. METHODS:A validated checklist (Bethel and Rogers, 2014, Health Info Libr J, 31, 43-53) was used to identify where the interface performed well, where the interface was adequate, where the interface performed poorly, where functionality available in core biomedical bibliographic databases does not exist in the ISPOR database, and to establish a list of any issues arising during the review. Two researchers independently undertook the technical review in October 2021. RESULTS:The ISPOR database scored 35 of a possible 165 (27/111 essential criteria and 8/54 desirable criteria). Two issues arising were identified, both of which will cause searchers to miss potentially eligible abstracts: (i) that search terms, which include * or ? as truncation or wildcard symbols should not be capitalized (e.g., cost* not Cost*; organi?ation not Organi?ation) and (ii) that quotation marks should be straight sided in phrase searching (e.g., "cost analyses" not "cost analyses"). CONCLUSIONS:The ISPOR database is a promising and free database to identify abstracts/posters presented at ISPOR. We summarize two key issues arising, and we set out proposed changes to the search interface, including: adding the ability to export abstracts to a bibliographic tool, exporting search strategies, adding a researcher account, and updating the help guide. All suggestions will further improve this helpful database.

Purpose This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders. Methods Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively. Results Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates. Conclusion Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.