meta-analysis

The Danger Within Us

by Jeanne Lenzer  · 12 Dec 2017  · 328pp  · 98,127 words

November of 2013, Johnson & Johnson had set aside $4 billion to settle lawsuits involving the DePuy metal-on-metal hips.280 In 2016, a careful meta-analysis (a study of multiple studies) of death rates among hip-implant recipients was published. The researchers found that patients with metal-on-metal hip implants

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surgery. But it was an assumption not based on any scientific studies, and Lown wasn’t convinced. He was proved right in 2012, when a meta-analysis of stent implants in 7,229 patients found no benefit in terms of a reduction in future heart attacks or death in patients who had

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;167(15):1604–1609. 130. Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(4):312–319. http://www.ncbi.nlm.nih.gov/pubmed/22371919. 131. Boden WE, O’Rourke

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/bmj.h658. 153. Jefferson T, Jones M, Doshi P, Del Mar C. Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis. BMJ. 2009;339(dec07_2):b5106. http://www.bmj.com/cgi/content/abstract/339/dec07_2/b5106. 154. Ioannidis JP. Why most published research findings

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, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women submitted to Essure for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;48(5):556–565. 175. Mao J, Pfeifer S, Schlegel P, Sedrakyan A. Safety and efficacy of hysteroscopic sterilization compared with

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, devices, and veterinary medicine after 1938. http://www.fda.gov/AboutFDA/WhatWeDo/History/Origin/ucm055137.htm. 187. Sivin I. Another look at the Dalkon Shield: meta-analysis underscores its problems. Contraception. 1993;48(1):1–12. 188. Cox ML. The Dalkon Shield saga. J Fam Plann Reprod Health Care. 2003;29(1

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mortality in metal-on-metal versus non-metal-on-metal primary total hip arthroplasty at 10 years and longer follow-up: a systematic review and meta-analysis. PLoS One. 2016;11(6):e0156051. http://dx.doi.org/10.1371%2Fjournal.pone.0156051. 282. Phone interviews with Dr. Kathleen Yaremchuk, May 25, 2016

When the Forest Breathes: Renewal and Resilience in the Natural World

by Suzanne Simard;  · 30 Mar 2026  · 430pp  · 111,698 words

where there are up to four species planted compared with one.[2] Data from the Mother Tree Project’s nine experimental forests agrees with the meta-analysis—that above- and belowground carbon stocks naturally increase in our forests as tree species richness climbs from three to nine species. I thought back to

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TO NOTE REFERENCE 1 E. Warner, S. C. Cook-Patton, O. T. Lewis, et al., Young mixed planted forests store more carbon than monocultures—a meta-analysis, Frontiers in Forests and Global Change 6 (2023): 1226514. doi: 10.3389/​ffgc.2023.1226514. BACK TO NOTE REFERENCE 2 11: The Forest Defenders Indigenous

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(3): 255–66. Zhang, Y., Chen, H. Y., and Reich, P. B. (2012). Forest productivity increases with evenness, species richness and trait variation: A global meta-analysis. Journal of Ecology 100: 742–49. 7: Sister Cedars Antos, J. A., Filipescu, C. N., and Negrave, R. W. (2016). Ecology of western redcedar (Thuja

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of its implementation and effectiveness for biodiversity conservation. Ecological Processes 8(1): 1–22. Beillouin, D., Corbeels, M., Demenois, J., et al. (2023). A global meta-analysis of soil organic carbon in the Anthropocene. Nature Communications 14(1): 3700. Berger, A. L., Palik, B., D’Amato, A. W., et al. (2013). Ecological

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al. Cambridge University Press. https://doi.org/​10.1017/​9781009325844. James, J., and Harrison, R. (2016). The effect of harvest on forest soil carbon: A meta-analysis. Forests 7: 308. Johnson, D. W., and Curtis, P. S. (2001). Effects of forest management on soil C and N storage

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: Meta-analysis. Forest Ecology and Management 140: 227–38. Kimmins, J. P. (1976). Evaluation of the consequences for future tree productivity of the loss of nutrients in

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reduce second rotation forest productivity. Forest Ecology and Management 257(3): 1104–11. Zhou, D., Zhao, S. Q., Liu, S., and Oeding, J. (2013). A meta-analysis on the impacts of partial cutting on forest structure and carbon storage. Biogeosciences 10: 3691–703. 9: Place Matters Boan, J., and Plotkin, R. (2025

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(6): 844–59. Warner, E., Cook-Patton, S. C., Lewis, O. T., et al. (2023). Young mixed planted forests store more carbon than monocultures—A meta-analysis. Frontiers in Forests Global Change 6: 1226514. Wilson, Jeremy. (1998). Talk and Log: Wilderness Politics in British Columbia. University of British Columbia Press. 11: The

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Theoretical Biology 434: 80–87. Li, X., Li, Y., Zhang, J., et al. (2020). The effects of forest thinning on understory diversity in China: A meta-analysis. Land Degradation & Development 31: 1225–40. Lovelock, J. (2016). Gaia: A New Look at Life on Earth. Oxford University Press. Ma’amtagila Nation. Little Big

We Are as Gods: A Survival Guide for the Age of Abundance

by Peter H. Diamandis and Steven Kotler  · 13 Apr 2026  · 225pp  · 76,418 words

population: Ana Sanz-García, Clara Gesteira, Jesús Sanz, and María Paz García-Vera, “Prevalence of Psychopathy in the General Adult Population: A Systematic Review and Meta-Analysis,” Frontiers in Psychology 12 (August 45, 2021), https://doi.org/10.3389/fpsyg.2021.661044. After five people died: Scott Shane, “F.B.I., Laying

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.wnr.0000186598.66243.19. Recovery scores correlate with productivity: J. F. Thayer, Fredrik Åhs, Mats Fredrikson, John J. Sollers III, and Tor D. Wager, “A Meta-Analysis of Heart Rate Variability and Neuroimaging Studies: Implications for Heart Rate Variability as a Marker of Stress and Health,” Neuroscience & Biobehavioral Reviews 36, no. 2

Beyond Inheritance: Our Ever-Mutating Cells and a New Understanding of Health

by Roxanne Khamsi;  · 21 Apr 2026  · 335pp  · 91,958 words

.org/​10.1038/​s41586-025-08922-2. GO TO NOTE REFERENCE IN TEXT A survey of forty-six thousand mutations: Mónica Lopes-Marques et al., “Meta-Analysis of 46,000 Germline De Novo Mutations Linked to Human Inherited Disease,” Human Genomics 18, no. 1 (2024): 20, doi.org/​10.1186/​s40246-024

Science Fictions: How Fraud, Bias, Negligence, and Hype Undermine the Search for Truth

by Stuart Ritchie  · 20 Jul 2020

circulate). Boldt’s faked results made it look as if hydroxyethyl starch was safe for this purpose, a verdict bolstered by the fact that a ‘meta-analysis’ – a review study that pools together all the previous papers on the subject – reached the same conclusion. This was only true, however, because Boldt

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’s fraud hadn’t yet been revealed; the meta-analysis included his fake results as part of its review. When Boldt’s deception became known, and his papers were excluded from the

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of publication bias when we zoom out to look at a whole segment of scientific literature. This zooming-out often takes the form of a meta-analysis, which by combining results from multiple studies can calculate the overall effect (sometimes, perhaps tempting fate, called the ‘true’ effect) on a given topic.

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random fluctuations caused by error should cancel out across different samples – the overall effect size calculated in a meta-analysis is normally considered more reliable than the estimates from individual studies. A meta-analysis doesn’t calculate the overall effect simply by averaging the effect sizes reported by all the included studies. It

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more limited snapshots and are more affected by sampling error, will have more variability, over- and under-estimating the true effect by wider margins. A meta-analysis therefore gives more weight to the effect sizes from big studies, because they’re likely to be more accurate.28 In the context of publication

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one dot per study, you’d expect your graph to look something like Figure 2A below. (Note that this is an idealised version of a meta-analysis; real datasets almost never look this clear-cut.) Looking at this ‘funnel plot’ (so named for what are hopefully obvious reasons), you can see

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funnel shape is just what we’d expect if all the studies had converged upon a real effect. Figure 2. Funnel plots from an imaginary meta-analysis, in two different scenarios. In scenario A, the distribution of the thirty studies is about what you’d expect if every study ever done

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The vertical line in the middle of each graph is the overall effect size calculated by each meta-analysis. In the case of scenario B, it’s been shifted to the right, meaning that the meta-analysis is coming up with a bigger effect than it should. Just as in an archaeological dig,

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a lack of weapons might mean they were civilians rather than soldiers – we can learn a lot from what we don’t see in a meta-analysis. What if our plot looks more like Figure 2B? Here, we’ve lost a chunk from the expected shape. The studies we’d expect

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that fits our pre-existing beliefs and desires), is what’s at the root of publication bias. If you consider the overall conclusions of a meta-analysis based on Figure 2B rather than 2A, you can see how publication bias deranges the scientific literature. If the studies with small effects have

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been removed from the funnel shape, the overall effect that shows up in the meta-analysis will by definition be larger than is justified. We get an exaggerated view of the importance of the effects and can be misled into believing

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or ambiguous studies, researchers force blinkers onto anyone who reads the scientific literature. One of the most striking recent funnel plots was featured in a meta-analysis by the psychologist David Shanks and his colleagues.29 It examined yet another variation on the priming theme: ‘romantic priming’. This is the idea that

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consumption’ to attract partners). Fifteen published papers, documenting forty-three separate experiments, seemed to support this hypothesis. However, when those studies were plotted for the meta-analysis, the funnel had a huge chunk missing: compelling evidence that many of the studies that hadn’t found the effect had been nixed prior to

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have weird shapes for reasons other than publication bias, especially if there are a lot of differences between the assorted studies that go into the meta-analysis.36 There are many cases where publication bias is more subtle, and thus harder to discern, than in those described above. Are there better

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analyses we covered earlier. Even leaving aside the fact that some research is often missing due to publication bias, if the studies included in the meta-analysis are all themselves exaggerated by p-hacking, the overall combined effect – in what’s supposed to be an authoritative overview of all the knowledge on

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powerful forces that affect individuals and shape society. The evidence for the phenomenon is quite weak, and possibly subject to publication bias, for a 2015 meta-analysis reviewing all the relevant stereotype threat studies found a clear gap where the small, null studies on the subject – those that showed girls were equally

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idea that there’s a single ‘quick fix’ for anything as complex as a child’s education.38 To be charitable to Dweck, the meta-analysis came over a decade after the publication of Mindset in 2006. Perhaps it was unclear then how things would turn out for the findings (though

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more unsaturated ones. This is a cornerstone of nutritional advice, repeated in countless dietary guidelines.95 But it didn’t hold up in a 2017 meta-analysis that compared saturated fatty acids to polyunsaturated fatty acids for their effects on heart disease and death.96 This was probably for three reasons. First

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Third, many trials were designed incompetently, with changes in factors other than the diets that could have affected their results.99 The conclusion of the meta-analysis was that there was little compelling evidence for the benefits of replacing saturated with unsaturated fat, and that previous meta-analyses – the ones on which

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so. The first thing to do is to search to see if there are any published replications.6 There might also be a review or meta-analysis of the main result, or of similar results, that can tell you if this study is just an outlier, and also whether its result

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). Of course, reviews and meta-analyses can themselves be corrupted by poor research and publication bias in their source material; if you find a meta-analysis of studies that were all themselves pre-registered, then you’ve hit the jackpot, but I don’t think I’ve ever encountered such a

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31 July 2018; https://www.the-scientist.com/features/replication-failures-highlight-biases-in-ecology-and-evolution-science-64475. Sparrows: Alfredo Sánchez-Tójar et al., ‘Meta-analysis challenges a textbook example of status signalling and demonstrates publication bias’, eLife 7 (13 Nov. 2008): e37385; https://doi.org/10.7554/eLife.37385.001

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-version-of-report-suggests-fujii-will-take-retraction-record-with-172/ 92.  Daniele Fanelli, ‘How Many Scientists Fabricate and Falsify Research? A Systematic Review and Meta-Analysis of Survey Data’, PLOS ONE 4, no. 5 (29 May 2009): e5738; https://doi.org/10.1371/journal.pone.0005738 93.  Ibid. 94.  Gross, ‘

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Zarychanski et al., ‘Association of Hydroxyethyl Starch Administration With Mortality and Acute Kidney Injury in Critically Ill Patients Requiring Volume Resuscitation: A Systematic Review and Meta-Analysis’, JAMA 309, no. 7 (20 Feb. 2013): pp. 678–88; https://doi.org/10.1001/jama.2013.430 122.  And yet, even after 100

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that children with autism spectrum disorder have higher levels of some gastrointestinal symptoms (B. O. McElhanon et al., ‘Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-Analysis’, Pediatrics 133, no. 5 (1 May 2014): pp. 872–83; https://doi.org/10.1542/peds.2013-3995), but there’s no evidence that

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, dir. (Twenty Twenty Television, 2004); https://youtu.be/7UbL8opM6TM 126.  Luke E. Taylor et al., ‘Vaccines Are Not Associated with Autism: An Evidence-Based Meta-Analysis of Case-Control and Cohort Studies’, Vaccine 32, no. 29 (June 2014): pp. 3623–29; https://doi.org/10.1016/j.vaccine.2014.04.085

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ed. (London: Weidenfeld & Nicolson, 2016). 26.  The impact a vaccine has on reducing mortality from a disease was the subject of the first ever medical meta-analysis, carried out by the statistician Karl Pearson in 1904 (the disease being typhoid) – though the technique hadn’t yet been named

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2288 (5 Nov. 1904): pp. 1243–46; https://doi.org/10.1136/bmj.2.2288.1243. A useful history and summary of meta-analysis is provided in: Jessica Gurevitch et al., ‘Meta-Analysis and the Science of Research Synthesis’, Nature 555, no. 7695 (Mar. 2018): pp. 175–82; https://doi.org/10.1038/nature25753

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. Climate change: A. J. Challinor et al., ‘A Meta-Analysis of Crop Yield under Climate Change and Adaptation’, Nature Climate Change 4, no. 4 (April 2014): pp. 287–91; https://doi.org/10.1038/nclimate2153

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58; https://doi.org/10.1037/xge0000116. For another example, this time from priming research, with similar results, see Paul Lodder et al., ‘A Comprehensive Meta-Analysis of Money Priming’, Journal of Experimental Psychology: General 148, no. 4 (April 2019): pp. 688–712; https://doi.org/10.1037/xge0000570 30.  Panayiotis A

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of Medicine 358, no. 3 (17 Jan. 2008): pp. 252–60; https://doi.org/10.1056/NEJMsa065779. At the time of writing, the most recent meta-analysis of antidepressants does show a (modest) effect on depression symptoms: Andrea Cipriani et al., ‘Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute

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Treatment of Adults with Major Depressive Disorder: A Systematic Review and Network Meta-Analysis’, Lancet 391, no. 10128 (April 2018): pp. 1357–66; https://doi.org/10.1016/S0140-6736(17)32802-7 33.  Akira Onishi & Toshi A.

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pp. 931–37; https://doi.org/10.1093/annonc/mdw691 35.  There’s a whole set of techniques to adjust the effect size in your meta-analysis when you discover that there’s publication bias. Since these are guesswork (about how much you should reduce the effect size) stacked on guesswork (

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and Wastes Billions (New York: Basic Books, 2017). 84.  This has been called the ‘Garbage In, Garbage Out’ principle in meta-analysis. Morton Hunt, How Science Takes Stock: The Story of Meta-Analysis (New York: Russell Sage Foundation, 1998). 85.  The absolute number of industry-funded trials has increased over time, although their proportion

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/is-stereotype-threat-overcooked-overstated-and-oversold 101.  Paulette C. Flore & Jelte M. Wicherts, ‘Does Stereotype Threat Influence Performance of Girls in Stereotyped Domains? A Meta-Analysis’, Journal of School Psychology 53, no. 1 (Feb. 2015): pp. 25–44; https://doi.org/10.1016/j. jsp.2014.10.002 and Paulette

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in stereotype threat studies, see Oren R. Shewach et al., ‘Stereotype Threat Effects in Settings with Features Likely versus Unlikely in Operational Test Settings: A Meta-Analysis’, Journal of Applied Psychology 104, no. 12 (Dec. 2019): pp. 1514–34; https://doi.org/10.1037/apl0000420 102.  Subsequently, the same authors ran

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://doi.org/10.3389/978-2-88945-434-1 104.  Jill B. Becker et al, ‘Female Rats Are Not More Variable than Male Rats: A Meta-Analysis of Neuroscience Studies’, Biology of Sex Differences 7, no. 1 (Dec. 2016): 34; https://doi.org/10.1186/s13293-016-0087-5 105.  International

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there have been a great many reliable twin studies since the time of Cyril Burt. For a review, see Tinca J. C. Polderman et al., ‘Meta-Analysis of the Heritability of Human Traits Based on Fifty Years of Twin Studies’, Nature Genetics 47, no. 7 (July 2015): 702–9; https://doi.

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2003): pp. 1141–42; https://doi.org/10.1038/nn1146 55.  Marcus R. Munafò et al., ‘Serotonin Transporter (5-HTTLPR) Genotype and Amygdala Activation: A Meta-Analysis’, Biological Psychiatry 63, no. 9 (May 2008): pp. 852–57; https://doi.org/10.1016/j.biopsych.2007.08.016 56.  Nowadays you can send

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/ 62.  For example, low power is mentioned in the Abstract of: H. Clarke et al., ‘Association of the 5-HTTLPR Genotype and Unipolar Depression: A Meta-Analysis’, Psychological Medicine 40, no. 11 (Nov. 2010): pp. 1767–78; https://doi.org/10.1017/S0033291710000516. Incidentally, you can bet that there was a

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average of the controls. If there was no effect, the probability of this would be 50 per cent (the averages are identical). In the meta-analysis, the mindset effect meant that those who’d been trained to have a growth mindset had a 52.3 per cent chance of being higher

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than the average of the control group. Calculated using https://rpsychologist.com/d3/cohend/ 36.  In the meta-analysis, there was some evidence that particularly at-risk children (those from poorer backgrounds, for example) might benefit more from mindset interventions. This was also

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the case in a recent large-scale study by proponents of growth mindsets, which found similar results to the meta-analysis in general. David S. Yeager et al., ‘A National Experiment Reveals Where a Growth Mindset Improves Achievement’, Nature 573, no. 7774 (Sept. 2019): pp.

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/books/why-we-sleep/ 51.  Xiaoli Shen et al., ‘Nighttime Sleep Duration, 24-Hour Sleep Duration and Risk of All-Cause Mortality among Adults: A Meta-Analysis of Prospective Cohort Studies’, Scientific Reports 6, no. 1 (Feb. 2016): p. 21480; https://doi.org/10.1038/srep21480 52.  Yuheng Chen et al. (

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2018), ‘Sleep Duration and the Risk of Cancer: A Systematic Review and Meta-Analysis Including Dose–Response Relationship’, BMC Cancer 18, no. 1 (Dec. 2018): p. 1149; https://doi.org/10.1186/s12885-018-5025-y 53.  Andrew Gelman

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. nih.gov/pubmed/13592638 75.  Wenjia Hui et al., ‘Fecal Microbiota Transplantation for Treatment of Recurrent C. Difficile Infection: An Updated Randomized Controlled Trial Meta-Analysis’, PLOS ONE 14, no. 1 (2019): e0210016; https://doi.org/10.1371/journal.pone.0210016; Theodore Rokkas et al., ‘A Network

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/in-depth/fat/art-20045550 96.  Steven Hamley, ‘The Effect of Replacing Saturated Fat with Mostly N-6 Polyunsaturated Fat on Coronary Heart Disease: A Meta-Analysis of Randomised Controlled Trials’, Nutrition Journal 16, no. 1 (Dec. 2017): p. 30; https://doi.org/10.1186/s12937-017-0254-5 97.  Also,

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, that are more conservative and thus come up with lower numbers. 38.  Bram Duyx et al., ‘Scientific Citations Favor Positive Results: A Systematic Review and Meta-Analysis’, Journal of Clinical Epidemiology 88 (Aug. 2017): pp. 92–101; https://doi.org/10.1016/j.jclinepi.2017.06.002; see also R. Leimu

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.org/10.1093/ije/dyw314. For an historical example of triangulation, see George Davey Smith, ‘Smoking and Lung Cancer: Causality, Cornfield and an Early Observational Meta-Analysis’, International Journal of Epidemiology 38, no. 5 (1 Oct. 2009): pp. 1169–71; https://doi.org/10.1093/ije/dyp317. Again, though, if we

The Impact of Early Life Trauma on Health and Disease

by Lanius, Ruth A.; Vermetten, Eric; Pain, Clare  · 11 Jan 2011

vociferous discussion of a Psychological Bulletin article by Rind et al. [27]. This controversy is worth a brief review. Rind et al. [27] published a meta-analysis on the effects of child sexual abuse on adjustment in college samples. After finding a small overall effect size, the authors concluded that lasting psychological

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[28]), and the study’s conclusions began to appear in amicus briefs written by the False Memory Syndrome Foundation. On July 30, 1999, the Rind meta-analysis became the first scientific study to be formally denounced by the US Congress. The APA took a stance ultimately satisfactory to no one. Ray Fowler

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Child Sexual Abuse, 135–155. 34. Lillienfeld, S. (2002). When worlds collide:€social science, politics, and the Rind et al. (1998) child sexual abuse meta-analysis. American Psychologist, 57, 176–188. 35. Boag, S. (2006). Freudian repression, the common view, and pathological science. Review of General Psychology, 10, 74–86. 36

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patterns of early care. The association between disorganization in infancy and frightened, frightening or disrupted maternal behaviors has been confirmed in several independent samples (for meta-analysis, see Madigan, et al. [20]). 49 Section 1: Impact on health and disease Parental care and infant physiological stress reactions 50 Research using animal and

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early maternal care, infant disorganized attachment and childhood maltreatment Disorganized attachment patterns in infancy have been associated with childhood onset of aggressive behavior problems (for meta-analysis, see van Ijzendoorn � et al. [21]) and with psychopathology in young adulthood [44,45]. Because of the links between early caregiving environments and disorganized

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of attachment:€A psychological study of the strange situation. Hillsdale, NJ:€Erlbaum. 13. Atkinson, L., Niccols, A., Paglia, A. et al. (2000). A meta-analysis of time between maternal sensitivity and attachment assessment:€Implications for internal working models in infancy/toddlerhood. Journal of Social and Personal Relationships, 17, 791

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, S., Bakers-Kranenburg, M., van Ijzendoorn,€M. et al. (2006). Unresolved states of mind, anomalous parent behaviour, and disorganized attachment:€A review and meta-analysis of a transmission gap. Attachment and Human Development, 8, 89–111. 21. van Ijzendoorn, M., Schuengel, C. and BakermansKranenburg, M. (1999). Disorganized attachment in early

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childhood:€Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249. 22. Fish, E. W., Shahrock, D., Bagot, R. et al. (2004). Epigenetic programming of

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antisocial personality disorder and adult violence in response to childhood maltreatment in preadolescent males [38]. Since publication of this finding, several other studies including a meta-analysis have replicated the association between the low expression MAOA genotype and conduct disorder, antisocial behavior and impulsivity in response to childhood maltreatment in males [39

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:€A review and a hypothesis concerning gene–environment interaction. Journal of Affective Disorders, 111, 1–12. 12. Taylor, A. and Kim-Cohen, J. (2007). Meta-analysis of gene–environment interactions in developmental psychopathology. Development and Psychopathology, 19, 1029–1037. 13. Kendler, K. S., Kessler, R. C., Walters, E. E. et al

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-Cohen, J., Caspi, A., Taylor, A. et al. (2006). MAOA, maltreatment, and gene–environment interaction predicting children’s mental health:€New evidence and a meta-analysis. Molecular Psychiatry, 11, 903–913. Foley, D. L., Eaves, L. J., Wormley, B. et al. (2004). Childhood adversity, monoamine oxidase a genotype, 155 Section 2

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volume was observed in women with depression and a history of childhood abuse, but not in depressed women without childhood abuse [64]. In a 2005 meta-analysis study [65], data were pooled from all the published studies on hippocampal volume. There were smaller hippocampal volumes for both the left and the right

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sides, equally in adult men and women with chronic PTSD, and no change in children. Another meta-analysis published the same year had similar findings [66]. One study showed that women with abuserelated PTSD had deficits in hippocampal activation while performing a verbal

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., Vaccarino, V., Kutner, M., Weiss, P. and Bremner, J. D. (2005). Magnetic resonance imaging (MRI) measurement of hippocampal volume in posttraumatic stress disorder:€A meta-analysis. Journal of Affective Disorders, 88, 79–86. 66. Smith, M. E. (2005). Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder:€A

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meta-analysis of structural MRI studies. Hippocampus, 15(6), 798–807. 67. Vermetten, E., Vythilingam, M., Southwick, S. M., Charney, D. S. and Bremner, J. D. (2003).

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cortical midline structures. Neuroscience, 157, 120–131. Northoff, G., Heinzel, A., de Greck, M. et al. (2006). Self-referential processing in our brain:€A meta-analysis of imaging studies on the self. Neuroimage, 31, 440–457. Johnson, S. C., Baxter, L. C., Wilder, L. S. et al. (2002). Neural correlates of

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stress disorder during script-driven imagery. Biological Psychiatry, 57, 832–840. Etkin, A. and Wager, T. D. (2007). Functional neuroÂ� imaging of anxiety:€A meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164, 1476–1488. Hopper, J. W., Frewen, P. A., van

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, encoding the promotor region, attenuated the effects of stressful life events by decreasing the risk for major depression and suicide attempts. However, a recently published meta-analysis of similar studies that have been conducted since then failed to show that such a relationship between 5-HTTLPR and stressful life events exists [63

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, N., Herrell, R., Lehner, T. et al. (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression:€A meta-analysis. Journal of the American Medical Association, 301, 2462–2471. 64. Kaufman, J., Yang, B. Z., Douglas-Palumberi, H. et al. (2006). Brain-derived neurotrophic factor

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classification system. Berkeley, CA: Department of Psychology, University of California. 77. van Ijzendoorn, M. (1995). Adult attachment representations, parental responsiveness, and infant attachment:€A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychology Bulletin, 117, 387–403. 78. Bartholomew, K. and Horowitz, L. M. (1991). Attachment styles among

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mothers, fathers, and their infants. Child Development, 67, 541–555. van Ijzendoorn, M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment:€A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117, 387–403. Slade, A. (2005). Parental reflective functioning:€An introduction. Attachment and

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the effects of individual and combined models on very specific individual characteristics to improve therapy–client matching. It is important to note that in a meta-analysis of PTSD treatment studies, Bradley and colleagues [54] remarked that many PTSD studies exclude individuals with comorbid diagnoses such as medical conditions or substance use

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–305). New York:€Guilford Press. 43. Davidson, P. R. and Parker, K. C. H. (2001). Eye moveÂ� ment desensitization and reprocessing (EMDR):€A meta-analysis. Journal of Counseling and Clinical Psychology, 69, 305–316. 44. American Academy of Child and Adolescent Psychiatry (1998). Practice parameters for the assessment and treatment

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long-term maintenance. Journal of Clinical Psychiatry, 68, 37–46. 54. Bradley, R., Greene, J., Russ, E., Dutra, L. and Westen, D. (2005). A multidimensional meta-analysis of psychoÂ� therapy for PTSD. American Journal of Psychiatry, 162, 214–227. 55. Schnurr, P. P. and Green, B. L. (eds.) (2004). Trauma and health

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partial hospitalization:€An 18-month follow-up. American Journal of Psychiatry, 158, 36–42. Brewin, C. R., Andrews, B. and Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766. 28. Frewen, P. A., Pain

Human Diversity: The Biology of Gender, Race, and Class

by Charles Murray  · 28 Jan 2020  · 741pp  · 199,502 words

. The same thing happens within different kinds of STEM occupations: In 2015, two of the same authors, Rong Su and James Rounds, conducted another meta-analysis focusing on distinctions within scientific and technical occupations. Again, their database of vocational preferences and a database of actual jobs held by the U.S

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: Women have a pronounced neurological tendency to respond to negative stimuli; men have a pronounced neurological tendency to respond to positive stimuli. The Stevens meta-analysis is useful for establishing the reality of an overall relationship—in this case between regional sex differences in the brain and emotional response—but the

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But the most extensive technical literature involves the Big Five personality factors—emotional stability, extraversion, conscientiousness, openness, and agreeableness—so much that a 2014 meta-analysis of the relationship of personality to academic performance by psychologist Arthur Poropat had two dozen samples to work with. Conscientiousness consistently played the most important

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Psychological Bulletin by a team of psychologists at the University of Minnesota (first author was Paul Sackett). The authors presented results for a meta-analysis of College Board data, a meta-analysis of other studies using a composite measure of parental SES, and a reanalysis of major longitudinal datasets. A table summarizing the results

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controlling for the admissions test score, the correlation of parental SES and college grades dropped from +.22 to –.01 in the SAT meta-analysis, from .09 to .00 in the meta-analysis of studies with composite SES measures, and from a mean of .06 to .01 among the longitudinal studies. After controlling for the

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measure of SES, the correlation between admission test score and grades was reduced only fractionally: from +.53 to +.50 in the SAT meta-analysis, from +.37 to +.36 in the meta-analysis of studies with composite SES measures, and from a mean of +.313 to +.308 among the longitudinal studies. For practical purposes, parental

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environment can be affected by outside interventions.” “But you’re ignoring epigenetics!” “The First Premise Is Wrong for Some Important Outcomes” In the Polderman meta-analysis discussed in chapter 11, there were exceptions to the generalization that the role of the shared environment is trivially small. The shared environment explained 36

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The authors conducted extensive tests for the robustness of this finding, all of which it passed. Their main conclusion is worth quoting in full: This meta-analysis of published and unpublished data provided clear answers to our three questions. First, studies from the United States supported a moderately sized Gene × SES

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settings with conditions most similar to operational testing is small and inflated by publication bias.39 Given this assessment from the largest and most rigorous meta-analysis of a quarter century of attempts to demonstrate stereotype threat, it seems unlikely that a significant role for stereotype threat exists. The Growth Mindset

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mindset and academic achievement? Is there evidence that growth mindset interventions produce improvements in academic achievement? The relationship of growth mindset to academic achievement. This meta-analysis analyzed the results of 273 studies with a combined sample of 365,915. The mean correlation between growth mindset and academic achievement was .10.

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the literature had grown so large that an international team of neuroscientists drawn primarily from Cambridge University (first author was Amber Ruigrok) could publish “A Meta-analysis of Sex Differences in Human Brain Structure” that combined 77 different studies involving 14,597 individuals. The table below shows the results for the basic

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volume measures. META-ANALYSIS OF SEX DIFFERENCES IN THE MAJOR VOLUMES Volume: Intracranial volume Studies: 77 Sample size: 14,957 Mean difference (ml): 135.3 Percentage difference: 12

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of articles that Maccoby and Jacklin had underestimated the role of differential socialization (e.g., Block (1978), Block (1983)). Lytton and Romney (1991), a subsequent meta-analysis of 172 studies of gender socialization, examined socialization regarding eight topics: amount of interaction, achievement encouragement, warmth, nurturance, responsiveness (including praise), encouragement of dependency,

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restrictiveness/low encouragement of independence, disciplinary strictness, encouragement of sex-typed activities, sex-typed perception, and clarity of communication/use of reasoning. The meta-analysis found few differences on any of them. “The effect sizes for most socialization areas are nonsignificant and generally very small, fluctuating in direction across studies

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0.43 (boys got more encouragement) and the effect size for physical punishment was –0.37 (boys got more physical punishment). Seven years later, another meta-analysis, Leaper, Anderson, and Sanders (1998), focused specifically on studies that observed the language that parents use with their children. There were sex differences in the

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, van Aken et al. (2006); Rothbaum and Weisz (1994); Kawabata, Alink, Tseng et al. (2011). In 2016, the Dutch scholars cited earlier published a meta-analysis of the literature on gender-differentiating parenting regarding control strategies. Their conclusion was generically similar to those of the other meta-analyses: The evidence showed

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56 studies limited to those that report direct contrasts between men and women participating in the same visual emotion-eliciting task within each study. The meta-analysis focused on which regions were activated, with broad characterizations of the results rather than specific hypotheses about how they related to phenotypic differences. Here

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in females in early puberty before peaking and decreasing, while males show increasing amygdala volumes throughout puberty. Marwha, Halari, and Eliot (2017), a recent meta-analysis that found no significant difference in amygdala size after correcting for total brain volume, disputes this, reporting that “our findings do not support a marked

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a 10% downward bias in the reported estimates of h2 in comparison to those based on twin correlations, consistent with the observed discrepancy between our meta-analysis of variance component estimates calculated from twin correlations and the reported variance components.” Polderman, Benyamin, de Leeuw et al. (2015): 705. 15. Plomin (2011):

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The results are limited to meta-analyses incorporating corrections for restriction of range and criterion unreliability using conservative criterion reliability estimates. When more than one meta-analysis reported operational validities for a given category, I report the mean of those results. The chapter also includes analyses comparing the operational validities of different

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various positions would take us deep into the psychometric weeds. For me, a single source that is both rigorous and judicious is a 2010 integrative meta-analysis by psychologists Dana Joseph and Daniel Newman. They conclude the article with “Practical Advice for Using Emotional Intelligence Measures in Personnel Selection” that seems

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. 36. The table below is adapted from Sackett, Kuncel, Arneson et al. (2009): Table 4. The figures for the SAT meta-analysis are corrected for national population range restriction. Sample: Meta-analysis of College Board data Correlation N: SES–test: +.42 SES–grade: +.22 Test–grade: +.53 Partial correlation Test–grade controlling for

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stereotyped students performed better than nonstereotyped students) for tests under “safe conditions that reduce threat.” (p. 1137). The study also reported results from a meta-analysis of 39 samples that included several studies of race-based stereotype threat but did not break out separate effect sizes for the race-based studies

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. (2015), restricting them to ones with samples of healthy adults and correcting for restriction of range. They reached an estimated correlation of +.31. The 2017 meta-analysis also classified studies according to their quality of measurement—“fair,” “good,” and “excellent.” The estimated correlations for these subsets were +.23, +.32, and +.39

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?” Journal of Policy Analysis and Management 31 (4): 837–60. Arcelus, Jon, Walter Bouman, Wim Van Den Noortgate et al. 2015. “Systematic Review and Meta-analysis of Prevalence Studies in Transsexualism.” European Psychiatry 30 (6): 807–15. Archer, John. 2019. “The Reality and Evolutionary Significance of Human Psychological Sex Differences.” Biological

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Biology and Medicine.” Lancet 392 (10149): 777–86. Doyle, Randi A., and Daniel Voyer. 2016. “Stereotype Manipulation Effects on Math and Spatial Test Performance: A Meta-Analysis.” Learning and Individual Differences 47: 103–16. Duckworth, Angela Lee, and Stephanie M. Carlson. 2013. “Self-Regulation and School Success.” In Self-Regulation and

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New York: Springer Science + Business Media. Flore, Paulette C., and Jelte M. Wicherts. 2015. “Does Stereotype Threat Influence Performance of Girls in Stereotyped Domains? A Meta-analysis.” Journal of School Psychology 53 (1): 25–44. Foley, Sallie, and George W. Morley. 1992. “Care and Counseling of the Patient with Vaginal Agenesis.” The

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Differences 53 (2): 126–31. Irwing, Paul, and Richard Lynn. 2005. “Sex Differences in Means and Variability on the Progressive Matrices in University Students: A Meta-analysis.” British Journal of Psychology 96: 505–24. Jablonsky, N. G., and G. Chaplin. 2010. “Human Skin Pigmentation as an Adaptation to UV Radiation.” Proceedings

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Genetic Variation Is Driven by Extreme Polygenicity of Human Traits and Diseases.” bioRxiv. Joseph, Dana L., and Daniel A. Newman. 2010. “Emotional Intelligence: An Integrative Meta-analysis and Cascading Model.” Journal of Applied Psychology 95 (1): 54–78. Kaczkurkin, Antonia N., Armin Raznahan, and Theodore D. Satterthwaite. 2019. “Sex Differences in

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Nature Communications 9 (1): 3258. Leaper, Campbell, Kristin J. Anderson, and Paul Sanders. 1998. “Moderators of Gender Effects on Parents’ Talk to Their Children: A Meta-analysis.” Developmental Psychology 34 (1): 3–27. Lechner, Clemens, Daniel Danner, and Beatrice Rammstedt. 2017. “How Is Personality Related to Intelligence and Achievement? A Replication and

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and Games.” American Sociological Review 43: 471–83. Lewis, Neil A., and Nicholas M. Michalak. 2019. “Has Stereotype Threat Dissipated over Time? A Cross-Temporal Meta-analysis.” PsyArXiv Preprints. Lewontin, Richard C. 1970. “Race and Intelligence.” Bulletin of the Atomic Scientists 26 (3): 2–8. . 1972. “The Apportionment of Human Diversity.”

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Individual Differences 34 (3): 411–29. Linn, M. C., and A. C. Peterson. 1985. “Emergence and Characterization of Sex Differences in Spatial Ability: A Meta-analysis.” Child Development 56: 1479–98. Lippa, Richard A. 2010. “Sex Differences in Personality Traits and Gender-Related Occupational Preferences Across 53 Nations: Testing Evolutionary and

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“Single-Dose Testosterone Administration Impairs Cognitive Reflection in Men.” Psychological Science 28 (10): 1398–407. Nazareth, Alina, Xing Huang, Daniel Voyer, et al. 2019. “A Meta-Analysis of Sex Differences in Human Navigation Skills.” Psychonomic Bulletin & Review. Published online July 3, 2019. Nédélec, Yohann, Joaquín Sanz, Golshid Baharian et al. 2016. “Genetic

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. Chicago: University of Chicago Press. Nguyen, Hannah-Hanh D., and Ann Marie Ryan. 2008. “Does Stereotype Threat Affect Test Performance of Minorities and Women? A Meta-analysis of Experimental Evidence.” Journal of Applied Psychology 93 (6): 1314–34. Nielsen, Rasmus, Joshua M. Akey, Mattias Jakobsson et al. 2017. “Tracing the Peopling

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Lehner. 2019. “Intergenerational and Transgenerational Epigenetic Inheritance in Animals.” Nature Cell Biology 21: 143–51. Peterson, Jennifer. 2018. “Gender Differences in Verbal Performance: A Meta-analysis of United States State Performance Assessments.” Educational Psychology Review. Published online September 3, 2018. Pettersson, Erik, Jane Mendle, Eric Turkheimer et al. 2014. “Do Maladaptive

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–82. Picho, Katherine, Ariel Rodriguez, and Lauren Finnie. 2013. “Exploring the Moderating Role of Context on the Mathematics Performance of Females Under Stereotype Threat: A Meta-Analysis.” The Journal of Social Psychology 153 (3): 299–333. Pickrell, Joseph K., Tomaz Berisa, Jimmy Z. Liu et al. 2016. “Detection and Interpretation of

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Selection in a Worldwide Sample of Human Populations.” Genome Research 19 (5): 826–37. Pietschnig, Jakob, Lars Penke, Jelte M. Wicherts et al. 2015. “Meta-analysis of Associations Between Human Brain Volume and Intelligence Differences: How Strong Are They and What Do They Mean?” Neuroscience and Biobehavioral Reviews 57: 411–32

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of the Human Past. New York: Pantheon. Reilly, David, David L. Neumann, and Glenda Andrews. 2015. “Sex Differences in Mathematics and Science Achievement: A Meta-analysis of National Assessment of Educational Progress Assessments.” Journal of Educational Psychology 107 (3): 645–62. . 2018. “Gender Differences in Reading and Writing Achievement: Evidence from

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Shewach, Oren R., Paul R. Sackett, and Sander Quint. 2019. “Stereotype Threat Effects in Settings with Features Likely Versus Unlikely in Operational Test Settings: A Meta-Analysis.” Journal of Applied Psychology. In press. Shiao, Jiannbin Lee, Thomas Bode, Amber Beyer et al. 2012. “The Genomic Challenge to the Social Construction of Race

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.” Journal of Personality and Social Psychology 69: 797–811. Stevens, Jennifer S., and Stephan Hamann. 2012. “Sex Differences in Brain Activation to Emotional Stimuli: A Meta-analysis of Neuroimaging Studies.” Neuropsychologia 50 (7): 1578–93. Stewart, J. R., and C. B. Stringer. 2012. “Human Evolution out of Africa: The Role of

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The Diet Myth: The Real Science Behind What We Eat

by Tim Spector  · 13 May 2015  · 382pp  · 115,172 words

is the role of exercise in expending calories? If you are trying to get fit and healthy, exercise works – you don’t need a fancy meta-analysis to prove that. Even the experts and the nutritionists can agree that regular exercise improves your heart and muscles and increases your lifespan. They don

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successfully lost weight in three to six months through diet, can exercise work to keep it off? The short answer is no. In a recent meta-analysis of seven studies exploring exercise alone or exercise plus diet versus diet alone, exercise failed dramatically to have any effect over placebo or control interventions

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However, when supplements are given in randomised trials to alter our ratios, no clear benefits are seen. This lack of effect is confirmed by careful meta-analysis of observational studies, which also shows no definite or beneficial effect.3 In fact in a large multi-country study of blood levels, high omega

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that although diets could reduce levels of cholesterol – contrary to the conclusions at the time – they had no effect on reducing heart disease.7 A meta-analysis summarised twenty-one large observational studies exploring saturated-fat consumption across the world comprising a total of 347,000 people. Of the 11,000 who

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a pathogenic bacteria that can take over the antibiotic-treated gut in a significant proportion of hospitalised people, particularly females and the elderly. A recent meta-analysis of twenty-one clinical trials found a 60 per cent benefit in taking these probiotics for three weeks; although it doesn’t always work, on

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of porridge is released. For the moment neither side is giving ground, and large-scale responsible probiotic trials in humans seem a way off. A meta-analysis of several probiotic trials concluded that there was little evidence of consistent benefit, either because they don’t work or because most are small and

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caused the disease in the first place. This ignores the large amount of unsaturated fat in meat, and as we saw earlier the most recent meta-analysis studies of saturated-fat contents in food have now cast major doubts over fat being the real cause. Importantly, the massive global experiment of replacing

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to prevent the inflammatory adverse effects of high-fat diets in rats and may act like a prebiotic, encouraging healthy microbes to grow.32 A meta-analysis of a number of small-scale Chinese clinical studies suggests berberine could be used as an alternative treatment for diabetes, and it is widely touted

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that fish is the perfect health food is, surprisingly, not that convincing. There are no good trials of actual fish eating, only of supplements. Recent meta-analysis of all the trials of fish oils concluded that the benefits of fish-oil supplements are hard to detect and have been previously overestimated.26

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that, in some teenagers).20 Across the world, these changes mirrored increases in the incidence of obesity and diabetes.21 Confirmatory epidemiological evidence from the meta-analysis of other large observational studies showed that the consumption of soft drinks was associated with a later risk of obesity and diabetes.22 When fructose

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less. At the time the Food and Drug Administration approved a health claim for fibre, the observational data was in fact pretty shaky. A recent meta-analysis of these twenty-two reports on heart disease found quite big differences between studies (which is always a worrying indication of their quality). Nevertheless, it

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and it became ‘the croissant of the 80s’. Conflicting studies followed which cast some doubt on the amazing health benefits claimed, until a more recent meta-analysis of sixty-six oat studies clarified the evidence. This showed no effect on diabetes or blood pressure but confirmed a consistent beneficial effect on blood

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’s effect on lowering cholesterol and improving lipid profiles does seem more likely to be real, based on multiple replications of the results and a meta-analysis of several randomised studies.13 The benefits of garlic may, though, depend on what else you are eating, as well as which microbes are already

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bifidobacteria. There are many prebiotics that haven’t been formally tested in humans, though this doesn’t stop them being marketed and sold. A recent meta-analysis summarised the results of twenty-six trials exploring prebiotics’ effect on weight, which involved a total of 831 people. The overall quality of the trials

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foods, is under strong genetic influence.20 This may be partly to do with taste genes, but collaborating with another team in a gene-association meta-analysis we found these preferences depended on different specific genes which control the way coffee and its thousands of chemicals are processed by the liver. The

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been associated with alcohol drinking, but a large gene-based study lacking most of the biases couldn’t confirm this.16 In 2014 a large meta-analysis study of 260,000 people using genes for alcohol intolerance (alcohol dehydrogenase) as a marker for drinking rather than using self-report questionnaires has cast

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likely to eat fruit and vegetables. More recently, the benefits of multivitamins have been assessed and reported on with considerable attendant publicity. Reports included a meta-analysis of over 27 existing studies, and two new large randomised gold-standard studies of multivitamins, totalling close to half a million people. They have shown

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that the heart disease story was spurious. A dozen trials of folic acid supplements were started, to explore its anti-cancer potential, but a summary meta-analysis showed no benefit whatsoever.7 Pregnant or pre-conception women are a special case and advised in most countries to take around 2 to 5

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taking the placebo, although most other small studies that didn’t adjust for genes reported an effect.18 However, the truth was revealed recently when meta-analysis of over fifty trials involving over 95,000 patients taking vitamin D replacements showed no convincing evidence that supplements do reduce death or fracture.19

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if you escaped antibiotics as a child, like me you may not have avoided being born by C-section. After adjusting for other factors, a meta-analysis showed that if you were born by C-section and didn’t get the magic tampon treatment, your risk of obesity probably increases by 20

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’s milk. Are more ketogenic than other fats. Despite lack of evidence, believed by some to have health properties. Contained in palm and coconut oil. meta-analysis: a technique for combining the results of different studies or trials to produce a single summary result. Provides better evidence than any single study, but

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., Ann Intern Med (18 Mar 2014); 160(6): 398–406. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. 4 Würtz, P., Circulation (8 Jan 2015). pii:114.013116. Metabolite profiling and cardiovascular event risk: a prospective study of three population-based cohorts. 5

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controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. 8 Siri-Tarino, P.W., Am J Clin Nutr (2010); 91: 535–46. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. 9 Hjerpsted, J., Am J

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Blueprint, 2013) 13 Chen, M., Am J Clin Nutr (Oct 2012); 96(4): 735–47. Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials. 14 Martinez-Gonzalez, M., Nutr Metab Cardiovasc Dis (Nov 2014); 24(11): 1189–96. Yogurt consumption, weight change and risk of

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balance of evidence? 18 Guo, Z., Nutr Metab Cardiovasc Dis (2011); 21: 844–50. Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. 19 Jones, M.L., Br J Nutr (May 2012); 107(10): 1505–13. Cholesterol-lowering efficacy of a microencapsulated bile salt

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, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. 5 Siri-Tarino, P.W., Am J Clin Nutr (2010); 91: 535–46. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. 6 Price, W.A., Nutrition and Physical Degeneration, 6th edn (La Mesa

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.B., Br J Nutr (Oct 2013); 110(7): 1178–87. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. 4 Paoli, A., Int J Environ Res Public Health (19 Feb 2014); 11(2): 2092–107. Ketogenic diet for obesity: friend

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basis of cardiovascular disease. 26 Kotwal, S., Circ Cardiovasc Qual Outcomes (2012); 5: 808–18. Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis. 27 Mozaffarian, D., JAMA (2006); 296(15): 1885–99. Fish intake, contaminants, and human health: evaluating the risks and the benefits. 28 Lajous, M., Am

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, J.L., Ann Intern Med (21 Feb 2012); 156: 291–304. Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. 32 Kelishadi, R., Nutrition (May 2014); 30: 503–10. Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and

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meta-analysis. 11 Carbohydrates: Non-sugars 1 Claesson, M.J., Nature (9 Aug 2012); 488(7410): 178–84. Gut microbiota composition correlates with diet and health in

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la Hunty, A., Obes Facts (2013); 6(1): 70–85. Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. 15 Brown, A.W., Am J Clin Nutr (Nov 2013); 98(5): 1298–308. Belief beyond the evidence: using the proposed effect of breakfast on

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risk: a continuing conundrum. 2 Threapleton, D.E., BMJ (19 Dec 2013); 347: f6879. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. 3 Kim, Y., Am J Epidemiol (15 Sep 2014);180(6): 565–73. Dietary fiber intake and total mortality: a

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meta-analysis of prospective cohort studies. 4 Thies, F., Br J Nutr (Oct 2014); 112 Suppl 2: S19–30. Oats and CVD risk markers: a systematic literature

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common cold with a garlic supplement: a double-blind, placebo-controlled survey. 13 Zeng, T., J Sci Food Agric (2012); 92 (9): 1892–1902. A meta-analysis of randomized, double-blind, placebo-controlled trials for the effects of garlic on serum lipid profile. 14 O’Brien, C.L., PLoS One (1 May

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cocoa solids. 15 Zhang, C., Eur J Epidemiol (30 Oct 2014); Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. 16 Ludwig, I.A., Food Funct (Aug 2014); 5(8): 1718–26. Variations in caffeine and chlorogenic acid contents of coffees

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? 17 Crippa, A., Am J Epidemiol (24 Aug 2014); pii: kwu194. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. 18 Denoeud, F., Science (2014); 345: 1181–4. The coffee genome provides insight into the convergent evolution of caffeine biosynthesis. 19 http://www.dailymail.co

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Di Castelnuovo, A., Arch Intern Med (11–25 Dec 2006); 166(22): 2437– 45. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. 6 Chawla, R., BMJ (4 Dec 2004); 329 (7478): 1308. Regular drinking might explain the French paradox. 7 Spitaels, F., PLoS

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with multiple cardiovascular risk factors. 7 Qin, X., Int J Cancer (1 Sep 2013); 133(5): 1033–41. Folic acid supplementation and cancer risk: a meta-analysis of randomized controlled trials. 8 Burdge, G.C., Br J Nutr (14 Dec 2012); 108(11): 1924–30. Folic acid supplementation in pregnancy: Are there

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the detail? 9 Qin, X., Clin Nutr (Aug 2014); 33(4): 603–12. Folic acid supplementation with and without vitamin B6 and revascularization risk: a meta-analysis of randomized controlled trials. 10 Murto, T., Acta Obstet Gynecol Scand (Jan 2015); 94(1): 65–71. Folic acid supplementation and methylenetetrahydrofolate reductase (MTHFR) gene

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modifying bone metabolism using identical twin pairs. 19 Schöttker, B., BMJ (17 Jun 2014); 348: g3656.doi:10.1136/bmj.g3656. Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States. 20 Bjelakovic, G., Cochrane Database Syst Rev (10

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(May 2013); 120(6): 661–9.doi:10.1111/1471-0528.12036. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. 5 Kozhimannil, K.B., PLoS Med (21 Oct 2014); 11(10): e1001745. Maternal clinical diagnoses and hospital variation in the risk of Cesarean delivery: analyses

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–54. Cesarean section and development of the immune system in the offspring. 11 Thavagnanam, S., Clin Exp Allergy (Apr 2008); 38(4): 629–33. A meta-analysis of the association between caesarean section and childhood asthma. 12 Gough, E.K., BMJ (15 Apr 2014); 348: g2267. The impact of antibiotics on growth

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in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials. 13 Blaser, M., Missing Microbes (Henry Holt, 2014) 14 http://www.cdc.gov/obesity/data/adult.html 15 Trasande, L., Int

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(2014); 9(2): e87896.doi:10.1371. Mode of delivery and offspring body mass index, overweight and obesity in adult life: a systematic review and meta-analysis. 20 http://www.wired.com/wiredscience/2010/12/news-update-farm-animals-get-80-of-antibiotics-sold-in-us/ 21 Visek, W.J., J Animal

How to Read a Paper: The Basics of Evidence-Based Medicine

by Trisha Greenhalgh  · 18 Nov 2010  · 321pp  · 97,661 words

ratios Clinical prediction rules References Chapter 9: Papers that summarise other papers (systematic reviews and meta-analyses) When is a review systematic? Evaluating systematic reviews Meta-analysis for the non-statistician Explaining heterogeneity New approaches to systematic review References Chapter 10: Papers that tell you what to do (guidelines) The great guidelines

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(see Chapter 7) Checklist for a paper that claims to validate a diagnostic or screening test (see Chapter 8) Checklist for a systematic review or meta-analysis (see Chapter 9) Checklist for a set of clinical guidelines (see Chapter 10) Checklist for an economic analysis (see Chapter 11) Checklist for a

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4. Potentially eradicates bias by comparing two otherwise identical groups (but see subsequent text and section ‘Was systematic bias avoided or minimised?’). 5. Allows for meta-analysis (combining the numerical results of several similar trials) at a later date; see section ‘Ten questions to ask about a paper that claims to validate

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are unnecessary, impractical or inappropriate: RCTs are unnecessary when a clearly successful intervention for an otherwise fatal condition is discovered; when a previous RCT or meta-analysis has given a definitive result (either positive or negative—see section ‘Probability and confidence’). Arguably, it is actually unethical to ask patients to be randomised

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critically appraised according to rigorous criteria (see Chapter 9). Note, however, that not even the most hard-line protagonist of EBM would place a sloppy meta-analysis or an RCT that was seriously methodologically flawed above a large, well-designed cohort study. And as Chapter 12 shows, many important and valid studies

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Lancet 1907;1:1776. 9 Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ: British Medical Journal 2001;323(7304):101. 10 Cuff A. Sources of Bias in Clinical Trials. 2013. http://applyingcriticality.wordpress.com/2013/06/19

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more rigorous (in particular, does it address any specific methodological criticisms of previous studies)? Will the numerical results of this study add significantly to a meta-analysis of previous studies? Is the population studied different in any way (e.g. has the study looked at different ethnic groups, ages or gender than

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(5):S16–23. 10 Ronksley PE, Brien SE, Turner BJ, et al. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ: British Medical Journal 2011;342:d671. 11 Stockwell T, Greer A, Fillmore K, et al. How good is the science? BMJ: British Medical

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, et al. The effect of combination treatment with aliskiren and blockers of the renin–angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis. BMJ: British Medical Journal 2012;344:e42. 17 Bero L. Industry sponsorship and research outcome: a Cochrane review. JAMA Internal Medicine 2013;173(7):

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disadvantaged children [5]. In 19 studies, all of which had tested this complex intervention in a randomised controlled trial (see the linked Cochrane review and meta-analysis [6]), I found a total of six different mechanisms by this intervention may have improved nutritional status, school performance or both: long-term correction of

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of other-language studies is not, generally, associated with biased results (it's just bad science) [10]. Furthermore, particularly where a statistical synthesis of results (meta-analysis) is contemplated, it may be necessary to write and ask the authors of the primary studies for data that were not originally included in the

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published review (see section ‘Meta-analysis for the non-statistician’). Even when all this has been done, the systematic reviewer's search for material has hardly begun. As Knipschild and colleagues

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. Overall, the ‘trials’ showed no significant benefit from the three therapies. However, the simulation of a number of perfectly plausible events in the process of meta-analysis—such as the exclusion of several of the ‘negative’ trials through publication bias (see section ‘Randomised controlled trials’), a subgroup analysis that excluded data on

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for good physiological reasons. The inclusion in systematic reviews of irrelevant studies is guaranteed to lead to absurdities and reduce the credibility of secondary research. Meta-analysis for the non-statistician If I had to pick one term that exemplifies the fear and loathing felt by so many students, clinicians and consumers

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towards EBM, that word would be ‘meta-analysis’. The meta-analysis, defined as a statistical synthesis of the numerical results of several trials that all addressed the same question, is the statisticians' chance to pull

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control group that received no active treatment and in whom pharmacotherapy (PHA—i.e. drug treatment) was discontinued [14]. The primary (main) outcome in this meta-analysis was relapse within 1 year. Figure 9.2 Forest plot showing long-term effects of cognitive behaviour therapy (CBT) compared with no active treatment and

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the relative merits of this therapy compared to other treatments for depression. The paper from which Figure 9.2 is taken also described a second meta-analysis that showed no significant difference between CBT and continuing antidepressant therapy, suggesting, perhaps, that patients who prefer not to have CBT may do just

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shown by the narrower width of the diamond compared with the individual lines, demonstrates the strength of the evidence in favour of this intervention. This meta-analysis showed that infants of steroid-treated mothers were 30–50% less likely to die than infants of control mothers. This example is discussed further in

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Logo. You may have worked out by now that anyone who is thinking about doing a clinical trial of an intervention should first do a meta-analysis of all the previous trials on that same intervention. In practice, researchers only occasionally do this. Dean Fergusson and colleagues of the Ottawa Health

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Research Institute published a cumulative meta-analysis of all randomised controlled trials carried out on the drug aprotinin in peri-operative bleeding during cardiac surgery [16]. They lined up the trials in

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the research communities. The beneficial effect of aprotinin reached statistical significance after only 12 trials—that is, back in 1992. But because nobody did a meta-analysis at the time, a further 52 clinical trials were undertaken (and more may be ongoing). All these trials were scientifically unnecessary and unethical (because half

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textbook on the topic [18]. Explaining heterogeneity In everyday language, ‘homogeneous’ means ‘of uniform composition’, and ‘heterogeneous’ means ‘many different ingredients’. In the language of meta-analysis, homogeneity means that the results of each individual trial are compatible with the results of any of the others. Homogeneity can be estimated at a

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‘Were preliminary statistical questions addressed?’) to detect small but important levels of heterogeneity.) A χ2 value much greater than the number of trials in a meta-analysis tells us that the trials that contributed to the analysis are different in some important way from one another. There may, for example, be known

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of studies that were performed on different populations in different places at different times and for different reasons. Eysenck's reservations about meta-analysis are borne out in the infamously discredited meta-analysis that demonstrated (wrongly) that there was significant benefit to be had from giving intravenous magnesium to heart attack victims. A subsequent

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terms of publication bias, methodological weaknesses in the smaller trials and clinical heterogeneity [22] [23]. (Incidentally, for more debate on the pros and cons of meta-analysis versus megatrials, see this recent paper [24].) Eysenck's mathematical naiveté is embarrassing (‘if a medical treatment has an effect so recondite and obscure as

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, Hollon SD, van Straten A, et al. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open 2013;3(4) doi: 10.1136/bmjopen-2012-002542[published Online First: Epub Date]. 15 Egger M, Smith GD, Altman D. Systematic

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reviews in health care: meta-analysis in context. Chichester: Wiley.com, 2008. 16 Fergusson D, Glass KC, Hutton B, et al. Randomized controlled trials of aprotinin in cardiac surgery: could clinical

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reviews using individual patient data. Evaluation & the Health Professions 2002;25(1):76–97. 18 Borenstein M, Hedges LV, Higgins JP, et al. Introduction to meta-analysis. Chichester: Wiley.com, 2011. 19 Thompson SG. Why and how sources of heterogeneity should be investigated. In: Egger M, Davey Smith G, Altman DG,

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eds. Systematic reviews in health care: meta-analysis in context. London: BMJ Publications, 2001;157–175. 20 Greenhalgh T. Outside the box: why are Cochrane reviews so boring? The British Journal of General

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Practice 2012;62(600):371;157–175. 21 Eysenck H. Problems with meta-analysis. In: Chalmers I, Altman DG, eds. Systematic reviews. London: BMJ Publications, 1995. 22 Higgins JP, Spiegelhalter DJ. Being sceptical about meta-analyses: a Bayesian

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perspective on magnesium trials in myocardial infarction. International Journal of Epidemiology 2002;31(1):96–104. 23 Egger M, Smith GD. Misleading meta-analysis. BMJ: British Medical Journal 1995;311(7007):753–4. 24 Hennekens CH, DeMets D. The need for large-scale randomized evidence without undue emphasis on

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: The Journal of the American Medical Association 2009;302(21):2361–2. 25 Griffin S, Greenhalgh T. Diabetes care in general practice: meta-analysis of randomised control trials Commentary: meta-analysis is a blunt and potentially misleading instrument for analysing models of service delivery. BMJ: British Medical Journal 1998;317(7155):390–6. 26

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Greenhalgh T. Commentary: meta-analysis is a blunt and potentially misleading instrument for analysing models of service delivery. BMJ: British Medical Journal (Clinical research ed.) 1998;317(7155):395–6

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have been pulled together (that is, synthesised) in the context of the clinical and policy needs being addressed. For one thing, a systematic review and meta-analysis might have been appropriate, and if the latter, issues of probability and confidence should have been dealt with acceptably (see section ‘Summing up’). But systematic

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or it may not. Sensitivity analysis, or exploration of ‘what-ifs’, was described in section ‘Validating diagnostic tests against a gold standard’ in relation to meta-analysis. Exactly the same principles apply here: if adjusting the figures to account for the full range of possible influences gives you a totally different answer

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quality improvement studies are often small, local and even somewhat parochial, critically appraising such studies is often more of a headache than appraising a large meta-analysis! References 1 Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Quality and Safety in Health Care 2007;16(

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not until the mid-1980s that an effective product was developed. By the late 1980s, a number of randomised trials had taken place, and a meta-analysis published in 1990 suggested that the benefits of artificial surfactant greatly outweighed its risks. In 1990, a 6000-patient trial (OSIRIS) was begun, involving

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fetal maturation on perinatal outcomes. JAMA: The Journal of the American Medical Association 1995;273(5):413–8. 3 Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. American Journal of Obstetrics and Gynecology 1995;173(1):322–35. 4 Halliday H. Overview of clinical trials

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F, Grimshaw J, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2012;10. 22 Hysong SJ. Meta-analysis: audit and feedback features impact effectiveness on care quality. Medical Care 2009;47(3):356–63. 23 Flodgren G, Eccles MP, Shepperd S, et al

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based’ assumption was that the more intensively a person's blood glucose was controlled, the better the outcomes would be. But more recently, a large meta-analysis showed that intensive glucose control had no benefit over moderate control, but was associated with a twofold increase in the incidence of severe hypoglycaemia [13

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still being performance-managed through a scheme called the Quality and Outcomes Framework (QOF) to strive for intensive glucose control after the publication of that meta-analysis had shown an adverse benefit–harm ratio [14]. This is because it takes time for practice and policy to catch up with the evidence –

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T, Saadatian-Elahi M, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ: British Medical Journal 2011;343:d4169. 14 Calvert M, Shankar A, McManus RJ, et al. Effect of the quality and

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, other controlled clinical trial, cohort study, case–control study, cross-sectional survey, longitudinal survey, case report, or case series)? Secondary research (simple overview, systematic review, meta-analysis, decision analysis, guideline development, economic analysis)? 3. Was the study design appropriate to the broad field of research addressed (therapy, diagnosis, screening, prognosis, causation)? 4

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clinical question that reflects a problem of relevance to patients? Do they provide evidence on safety, tolerability, efficacy and price? 5. Has each trial or meta-analysis defined the condition to be treated, the patients to be included, the interventions to be compared and the outcomes to be examined? 6. Does the

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. Has this test been placed in the context of other potential tests in the diagnostic sequence for the condition? Checklist for a systematic review or meta-analysis (see Chapter 9) 1. Did the review address an important clinical question? 2. Was a thorough search carried out of the appropriate database(s)

The Barbell Prescription: Strength Training for Life After 40

by Jonathon Sullivan and Andy Baker  · 2 Dec 2016  · 742pp  · 166,595 words

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