Digital Commons Network^™

Why Deliberate Practice Is Not A Basis For Teacher Expertise, Jim Hordern, Nick Pratt, Peter Kelly, Katherine Evans

School of Law, Humanities and Social Sciences

In this paper we examine the notion of ‘deliberate practice’, which has formed the basis of several teacher education programmes in England and the United States and promises to improve the quality of teaching via highly structured training programmes. We identify early criticisms of deliberate practice and unpack the assumptions embedded in its underpinning thinking. We demonstrate that deliberate practice is insufficient as a basis for teacher expertise as teaching is not a ‘performance profession’, the activities of teachers cannot all be easily or meaningfully decomposed, and the ‘goals’ of teaching are not solely geared towards maximising measurable student attainment. …

Data For: "Thresholds Of Wave Forcing: Implications For Atoll Reef Dynamics Under Sea Level Rise", Mathilde Lindhart, Gerd Masselink, Ashley Holsclaw, Tim Scott

Faculty of Science and Engineering Datasets

We investigate the response of shallow reef flow to tidal variability and wave exposure during a four-month field campaign in southern Huvadhu Atoll, Maldives. Incident waves breaking on steep fore reefs and reef crests generate a setup proportional to offshore wave height that drive a cross-reef flow. We identify a critical threshold—where the depth on the reef flat equals the depth at wave breaking—that separates two distinct reef flow regimes: one dominated by strong, unidirectional flow from the ocean into the lagoon, and another where wave breaking ceases, flow rates decrease, and occasionally reverse direction. Recognising the relative importance of …

Integrated Proteomic And Targeted Next Generation Sequencing Reveal Relevant Heterogeneity In Lower-Grade Meningioma And Anxa3 As A New Target In Nf2 Mutated Meningiomas, Maryam Shah, Yeasmin Akther, Claire Adams, Matt Banton, Vikram Sharma, Emanuela Ercolano, David A Hilton, Kathreena M. Kurian, Liyam Laraba, Waldemar Woznica, David Parkinson, Leandro Jose De Assis, Oliver Hanemann

Peninsula Medical School

Background: Meningiomas, the most common primary brain tumours, are classified by the World Health Organization (WHO) into grades 1, 2, and 3. Some grade 1 tumours exhibit increased clinical aggressiveness, with the biallelic mutation of NF2 being the most frequently reported. Methods: In our study, we analysed the most common driver mutations (NF2, AKT1, KLF4, and TRAF7) in meningioma by genomics describing co-occurrences and new mutations. Furthermore, tumour tissue bearing the driver mutations was analysed by proteomics. The relevance of the specific target found in the most common driver mutation in meningiomas (NF2) was validated in vitro using both lower …

Autistic Traits In Fibromyalgia Are Associated With Hypersensitivity And Central Sensitisation, Helen Johnston, Alison Bacon

School of Psychology

Fibromyalgia presents with symptoms of central sensitisation (CS). Allodynia is the defining symptom, with evidence for general hypersensitisation extending beyond the pain symptoms that characterise fibromyalgia, to sensory and psychological domains. Generalised sensory processing sensitivity (SPS) may increase vulnerability to hypersensitisation; while a direct association exists between sensory sensitivity and autistic traits in autistic people, CS symptoms are also associated with autistic traits in a broader participant sample. This study complements previous lines of enquiry by examining the relationship between SPS, CS symptoms and autistic traits in samples with and without fibromyalgia. It proposes that SPS is indirectly associated with …

The Revolving Door Of Epilepsy Emergencies: A Mixed Methods Cross-Sectional Study Of Healthcare Professionals’ Perspectives, Sarah Lennard, Lisa Bunn, Rosi Raine, Rohit Shankar

Peninsula Medical School

BackgroundReattendance rates at UK Emergency Departments (ED) of people with epilepsy (PWE), is higher than other chronic conditions. This is due to a myriad of seizure, biological, psychological and social factors. The aim of this study is to understand these influencers from the perspective of healthcare professionals working in the frontline specifically to reduce seizure related ED re-attendance.MethodsA cross-sectional online mixed methodology survey of 20 closed and free-text questions was conducted of relevant healthcare professional groups. Eligibility was based on those that came into contact with PWE in emergency as part of their role. A non-discriminatory exponential snowballing technique of …

Ngo Decision-Making During Typhoon Disaster Response: Towards A Relational Approach, Pamela Gloria Cajilig, Mona Nasser

Peninsula Dental School

This paper examines the decision-making processes of a non-governmental organisation (NGO) during Typhoon Odette (Rai) in Palawan, Philippines. The typhoon, which struck during the ongoing COVID-19 pandemic, exacerbated vulnerabilities in the province, leading to the destruction of homes and livelihoods, disruptions in education, fatalities and damage to critical infrastructure. Focusing on a health- and development-centred NGO, the qualitative case study draws from phenomenological approaches to decision-making and studies that emphasise relational ontologies. The discussion employs a framework that categorises decision-making into three types of processes that underscore the latter's entangled nature: ‘knot’ represents situations of confusion and desperation and where …

Patient Experiences After Open Heart Surgery: A Qualitative Systematic Review, Halil Kaya, Orachorn Lumprom, Patricia Schofield, Matt Carey, Jos Latour

School of Nursing and Midwifery

Aim: The aim of this systematic review was to synthesise findings from qualitative studies exploring patients' experiences in hospital or at home following open-heart surgery.Methods: Systematic searches were conducted in CINAHL, MEDLINE, PsycINFO, ProQuest Dissertation and Theses, and Web of Science, covering the period from 2006 to 2023. Studies were selected if they reported a qualitative inquiry into patients’ experiences after open-heart surgery. The quality of eligible studies was assessed using the JBI Critical Appraisal tool. A metaaggregation approach was used to synthesise the findings.Results: Twenty-one studies were included, representing 266 patients across 10 countries. Findings were aggregated into five …

An Investigation Of Violence Sustained By Nursing And Midwifery Students, Kevin Hambridge, Matt Carey, Francis Thompson

School of Nursing and Midwifery

AbstractBackgroundMany laws exist which protect healthcare personnel from violence within the workplace. Evidence suggests that violence towards nursing students continues and remains unreported. These violent incidents have been proven to have psychological effects.AimsThe aim of the study was to identify the extent, type and impact of violence and aggression sustained by nursing and midwifery students.MethodsA cross-sectional questionnaire survey was employed in a UK University to investigate the violence and aggression sustained by 369 pre-registration nursing and midwifery students.FindingsIn total, 54.7% (n=202) of students reported sustaining violence or aggression in their current academic year. This included verbal violence and aggression (92.7% …

Experiences Of Occupational Engagement In Young & Middle-Aged Women Post-Stroke: A Qualitative Systematic Review, Li Kiang Regina Toh, Tanja Križaj

School of Health Professions

Purpose: Young and middle-aged women engage in distinct occupations, facing unique post-stroke challenges that complicate their recovery. However, little is known about their experiences with occupational engagement following a stroke. This qualitative systematic review aimed to explore the post-stroke experiences of women aged 18–65 from an occupational perspective of health. Methods: A comprehensive search of five databases identified qualitative studies on post-stroke experiences of women aged 18–65. Two reviewers independently appraised the methodological quality of eligible studies. Data were extracted and synthesised using the Joanna Briggs Institute (JBI) method of meta-aggregation. Results: Seven studies were included. From 103 extracted findings, …

Black Soldier Fly, Hermetia Illucens, Larvae Meal Improves Intestinal Health And Growth Performance Of Nile Tilapia, Oreochromis Niloticus, Juveniles, Sahya Maulu, Ben Eynon, Sherilyn Abarra, Mark Rawling, Daniel Merrifield

School of Biological and Marine Sciences

This study investigated the effects of dietary black soldier fly (BSF) larvae, Hermetia illucens, meal on growth performance, feed utilization, intestinal health, and immune response in Nile tilapia, Oreochromis niloticus, juveniles. The fish (initial weight: 7.28 ± 0.09 g) were reared in a recirculatory aquaculture system (RAS) and fed diets containing different levels of defatted BSF larvae meal: 0% (control diet), 20% (BSF20), and 40% (BSF40). At the end of the feeding trial, the final body weight, weight gain, specific growth rate (SGR), protein efficiency ratio (PER), and feed conversion ratio (FCR) were significantly (p < 0.05) improved with increasing BSF meal inclusion levels in the diet. Histological analysis of the intestine revealed that mucosal fold length (MFL), muscularis thickness (MT), and goblet cell density (GCD) were significantly elevated by the BSF meal compared with the control. In addition, intraepithelial lymphocytes (IELs) and the enterocyte microvilli length were significantly elevated in BSF40-fed fish compared with the control. Gene expression analysis showed that intestinal chitin digestion-related (endochitinase A) and amino acid transporter (Slc6a18) genes were not significantly affected by the BSF meal. However, the expression of peptide transporter Slc15a1a was upregulated in the fish fed BSF40 compared to the control. Moreover, posterior intestine and head kidney cytokine (IL-1β, TNF-α, and IL-10) gene expression levels were not significantly affected by the inclusion of the BSF meal. Therefore, these results suggest that the BSF meal up to a 40% inclusion level can be used as an alternative protein source in the diets of Nile tilapia juveniles to promote growth and intestinal health.

Multi-Cohort Exploration Of Repetitive Element Transcription And Dna Methylation In Human Steatotic Liver Disease, Neil A. Youngson, Aikaterini Tourna, Timothy Chalmers, Kelly V. Prates, Josepmaria Argemi, Ramon Bataller, Koroush S. Haghighi, Lindsay E. Wu, Shilpa Chokshi, Peter Starkel, Patrick S. Western, Margaret J. Morris, Stephen M. Riordan

Peninsula Medical School

Transposable elements (TEs) make up around half of the human genome. Their transcription is repressed in most somatic cells to maintain genome integrity and function. The repression is chiefly maintained by a combination of epigenetic modifications such as DNA methylation and histone modifications. However, recent research suggests that liver steatosis is associated with extensive changes to the hepatocyte epigenome. Furthermore, studies in mice have reported diet- and drug-induced changes to TE transcript levels in liver. The confirmation of these effects in human liver has not previously been undertaken. Here, we examined TE transcription in liver tissue from three patient cohorts …

Expertise In Magicians - Testing The Insight Hypothesis., Gustav Kuhn, Alice Pailhès, Gg Cole

School of Psychology

Over the past two decades an abundance of research has examined the psychological mechanisms underpinning magic effects in order to gain new insights into human cognition. As part of this endeavour, it has been suggested that the experience of performing tricks in front of live audiences has given magicians unique insights. The aim of the present paper was to examine the nature of this expertise and investigate the extent to which magicians understand non-magicians’ beliefs about magic and the effectiveness of specific magic principles. In Experiment 1 we describe the skills that magicians believe make them experts, and the type …

Seasonal Vertical Migration Of Large Polar Copepods Reinterpreted As A Dispersal Mechanism Throughout The Water Column, Katie Jones, Giuliano Laudone, Katrin Schmidt, Barbara Niehoff, Astrid Cornils, Wilhelm Hagen, Hauke Flores, Céline Heuzé, Nahid Welteke, Sabrina Dorschner, Matthias Woll, Robert G. Campbell, Carin J. Ashjian, Cecilia E. Gelfman, Katyanne M. Shoemaker, Rebecca Jenkins, Benoit Lebreton, Gael Guillou, Clara J.M. Hoppe, Serdar Sakinan, Fokje L. Schaafsma, Nicole Hildebrandt, Giulia Castellani, Simon Belt, Allison A. Fong, Angus Atkinson, Martin Graeve

School of Geography, Earth and Environmental Sciences

Seasonal vertical migration of large lipid-rich copepods is often described as a mass descent of animals when primary production ceases, with important implications for mesopelagic food webs and global carbon sequestration. This view ignores the existence of surface-resident individuals, but here we show that non-migrants can form a substantial part of the populations of polar migrant species. In the Central Arctic Ocean, the biomass-dominant Calanus hyperboreus was evenly distributed throughout the water column from November 2019 to March 2020, with ~20% of subadults and adult females remaining in the upper 200 m and ~41% migrating to 1000–2000 m. These vertical …

An Isometry Theorem For Persistent Homology Of Circle-Valued Functions, Nathan Broomhead, Mariam Pirashvili

School of Engineering, Computing and Mathematics

This paper explores persistence modules for circle-valued functions, presenting a new extension of the interleaving and bottleneck distances in this setting. We propose a natural generalisation of barcodes in terms of arcs on a geometric model associated to the derived category of quiver representations. The main result is an isometry theorem that establishes an equivalence between the interleaving distance and the bottleneck distance for circle-valued persistence modules.

Using “Ways Of Thinking And Practising” To Analyse Final Year Medical Student Reflections And Underlying Concepts In Preparedness For Practice, Rachel Leyland, Hilary Neve, Elizabeth Drake, Tracey Collett

Peninsula Medical School

Introduction: Ensuring that medical students are prepared for future practice is challenging for all medical schools. Most studies of preparedness involve newly qualified doctors and use quantitative methods such as self-report surveys focused on defined competencies, and often find graduates are unprepared for the complex and challenging areas of real-world practice. Qualitative methods, using conceptual ideas linked to learning such as ‘Ways of Thinking and Practising’ (WTP) are little explored in this area but could offer rich and useful insights about graduates’ preparedness. WTP recognises that, in addition to specific knowledge and skills, students need to understand the complex links …

The Density Of Virgin, Consumer And Environmental Plastics: An Investigation Using Gas Displacement Pycnometry, Andrew Turner, Katie Jones, Montserrat Filella

School of Geography, Earth and Environmental Sciences

Density is a fundamental property of plastics and is particularly significant in determining the transport and fate of waste plastics that enter aquatic systems. However, densities are rarely determined in the environmental literature and values employed for modelling or impacts are often unsourced or derived from secondary databases. In this study, we employ helium displacement pycnometry to determine the skeletal densities of non-porous plastics whose polymer composition had been established from manufacturer's data, resin codes or Fourier transform infrared spectrometry. Two independent, collaborative laboratories, providing measurements within 3.5 % of each other and with precisions of <1 % (as relative standard deviation), analysed a total of 42 virgin, consumer and environmental plastics consisting of ten common polymer types. Measured densities of plastics in all categories, and most notably for polybutylene terephthalate, polyethylene terephthalate, polypropylene and polyvinyl chloride, were often outside the ranges reported by a comprehensive online resource. Possible reasons for discrepancies include the occurrence of dense additives (evaluated by X-ray fluorescence analysis), the presence of inaccessible microscopic pores below a laminated surface, contamination of the main polymer by a secondary one, and structural changes on weathering. Regardless of precise causes, most results suggest that individual polymers have a broader range of densities than is generally published or considered in the literature. Accordingly, and in particular where buoyancy is critical, more precise, sample-specific measurements are recommended.

The Silicon Shrink: How Artificial Intelligence Made The World An Asylum By Daniel Oberhaus: Reviewed By Hannah Drayson, Hannah Drayson

School of Art, Design and Architecture

No abstract provided.

Developing Human-Autonomy Teaming Strategies For Maritime Cyber Security Resilience In Uncrewed Autonomous And Remote Surface Vessel Operations, Juan Palbar Misas, Kimberly Tam, Kevin Jones

School of Engineering, Computing and Mathematics

The development of new technologies and digital capabilities for Uncrewed Autonomous and Remote Surface Vessel Operations (UARSVO) is driven by various industry stakeholders. This evolution impacts the maritime industry's human role, transforming from Human-Autonomy Hybrid (HAH) to Human-Autonomy Teaming (HAT). Human-Autonomy Collaboration (HAC) is vital for maritime safety, security, and sustainability, particularly in light of increasing cyber incidents in remote operations, which necessitates greater cyber resilience due to technology at sea and ashore. This paper aims to provide a holistic socio-technical approach to investigate and present an overview of the current state-of-the-art research, focusing on the human perspective in maritime …

A Holistic Approach Is Needed For The Treatment Of Alcohol Use Disorder, Victoria T. Kronsten, Ashwin Dhanda

Peninsula Medical School

EditorialsA holistic approach is needed for the treatment of alcohol use disorderKronsten, Victoria T.1; Dhanda, Ashwin2Author Information1Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, Roger Williams Institute of Liver Studies, King’s College London, London, UK2Faculty of Health, School of Immunology and Microbial Sciences, University of Plymouth, Plymouth, UKAbbreviations: AUD, alcohol use disorder; AUDIT-C, Alcohol Use Disorders Identification Test— Consumption; EtG, ethyl glucuronide.Correspondence Victoria T. Kronsten, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, Roger Williams Institute of Liver Studies, King’s College London, London, UK. Email: [email protected] Transplantation 31(6):p 699-700, June 2025. | …

Exploration Of Radiotherapy-Related Insufficiency Fractures And Risk Factors Of Patients Diagnosed With Gynaecological Cancer Treated With Radiotherapy: A Service Evaluation, Vicki Hands

South West Clinical School Journal

#400WORDS: CHIEF NURSING OFFICER’S RESEARCH FELLOWS EVIDENCE IMPLEMENTATION PROJECTS

Darkening Of The Global Ocean, Thomas Davies, Tim Smyth

School of Biological and Marine Sciences

The photic zones of the oceans – where sunlight and moonlight drive ecological interactions - are one of the most productive habitats on the planet, and fundamental to the maintenance of healthy global biogeochemical cycles. Ocean darkening occurs when changes in the optical properties of the oceans reduces the depth to which sufficient light penetrates to facilitate biological processes guided by sunlight and moonlight. We analysed a 9km resolution annual time series of MODIS Aqua’s diffuse attenuation coefficient of light at 490nm [Kd(490)] to quantify whether the oceans have darkened over the last twenty years, and the impact of this …

Tumour-Associated Macrophage Infiltration Differs In Meningioma Genotypes, And Is Important In Tumour Dynamics, Ting Zhang, Claire L. Adams, Gyorgy Fejer, Emanuela Ercolano, Jonathan Cutajar, Juri Na, Felix Sahm, C. Oliver Hanemann

Peninsula Medical School

Background: Meningiomas are the most common primary intracranial tumours, with clinical behaviours ranging from benign to highly aggressive forms. The World Health Organisation classifies meningiomas into various grades, guiding prognosis and treatment. While surgery is effective for low-grade meningiomas, certain grade 1 tumours, as well as grade 2, 3, and recurrent cases are more aggressive and require new therapeutic approaches. Immunotherapy shows promise, with early-stage clinical trials demonstrating encouraging results. The tumour microenvironment (TME), particularly tumour-associated macrophages (TAMs), plays a pivotal role in tumour progression. TAMs influence tumour growth, metastasis, and immune evasion. However, their role in meningiomas, especially in …

A Quantum Reservoir Computing Approach To Computer-Aided Music Composition, Eduardo Miranda, Hari Shaji

School of Art, Design and Architecture

This paper presents an approach to developing computer-aided music composition (CAMC) systems with quantum computing. CAMC systems are aimed at supporting musicians in creating music rather than generating complete pieces of music autonomously. For instance, they may generate ideas or prompts to be further developed during the creative process. We developed a CAMC system using a machine learning method called Quantum Reservoir Computing (QRC) that learns to create tunes in the style of given examples. The system proved to run satisfactorily on the Noisy Intermediate-Scale Quantum (NISQ) machines available today. It does not require large amounts of qubits to outperform …

Scaling Up Eco-Engineering: The Role Of Topographic Complexity And Spatial Variability In Shaping Biodiversity On Coastal Structures, Charlotte Clubley, Antony Knights, Jessica Allen, David T Bilton, Andy Foggo, Mick Hanley, James Murphy, Louisa E Wood, Louise Firth

School of Biological and Marine Sciences

In response to the depauperate biodiversity often associated with the largely homogenous surfaces of artificial structures, ecological (eco-) engineering has emerged as a tool to introduce topographic complexity to coastal development. Although relatively small-scale studies using topographically complex panels and artificial rockpools are commonplace, determining how the configuration of these interventions works over greater and more realistic spatial scales has received comparatively little attention. Given the importance of spatial variability in habitat complexity for shaping community composition and, therefore, regional diversity, filling this knowledge gap is key to enhancing the ‘design catalogue’ for future eco-engineering installations. Here, we manipulated topographic …

No Escape From Microplastics: Contamination Of Reef Manta Ray Feeding Areas In A Remote, Protected Archipelago, Jessica Savage, Joanna Harris, Heather J. Koldewey, Tom B. Letessier, M Rowcliffe, D Morritt

School of Biological and Marine Sciences

Remote islands receive plastic debris from elsewhere, ranging from microplastics (>5 mm) to macroplastics, which can further breakdown into microplastics. The ingestion of microplastics by marine species has been linked to decreased fitness. Reef manta rays, Mobula alfredi, are liable to ingest microplastics due to their filter-feeding strategy and habitat overlap with plastic hotspots. Their population is in decline due to unsustainable fishing pressures and a slow life history, with potential additional demographic pressure from plastic pollution. This study investigates the concentration and characteristics of microplastics in the top 0.5 m of the water column in reef manta rays …

Redefining The Photic Zone: Beyond The Autotroph-Centric View Of Light In The Ocean, Thomas Davies, Tim Smyth

School of Biological and Marine Sciences

Traditional measures of the photic zone have remained focused on autotrophs, limiting understanding of how changing marine lightscapes impact heterotrophs that use light as a resource or an environmental cue. We propose a new photic zone definition that encompasses all biological processes influenced by celestial light, and a new measure of photic zone depth, the minimum light intensity that elicits biological responses. This approach allows photic zone measures to be inclusive of all marine photobiology driven by sunlight, moonlight, or starlight, and enables urgently needed exploration of the nature, extent and ecological implications of changing marine lightscapes.

Prevalence, Experience, And Awareness Of Substandard And Falsified Medicines Among The Public And Healthcare Professionals In Jordan., Maysa Falah, Eman Daar, Daniel Zahra, Michael Dillon

Peninsula Medical School

INTRODUCTION: This study aimed to assess the awareness, experiences and perspectives on substandard and falsified (SF) medicines among the general public and healthcare professionals in Jordan. SF medicines pose a global public health concern, yet data on their prevalence and associated risks in Jordan remain limited.

METHODS: A cross-sectional study was conducted between January and June 2023 using a convergent mixed-methods approach. Quantitative data were collected through structured surveys administered to 209 members of the public and 136 healthcare professionals (pharmacists and clinicians) recruited via convenience sampling across Jordan's 12 governorates. Surveys were conducted in English and Arabic. Qualitative data …

The Rapid Synthesis Of Integral Stimuli, Charlotte E.R. Edmunds, Fraser Milton, Andy J. Wills

School of Psychology

Integral stimuli (e.g., colors varying in saturation and brightness) are classically considered to be processed holistically (i.e., as undifferentiated stimulus wholes); people analyze such stimuli into their consistent dimensions only with substantial time, effort, training, or instruction (Foard & Kemler, 1984). In contrast, Combination Theory (Wills et al., 2015) argues that the dimensions of integral stimuli are quickly combined. Through an investigation of the effects of stimulus presentation time, we support Combination Theory over the classical holistic-to-analytic account. Specifically, using colored squares varying in saturation and brightness, we demonstrate that the prevalence of single-dimension classification increases as stimulus presentation time …

What We Think Others Think And Do About Climate Change: A Multicountry Test Of Pluralistic Ignorance And Public-Consensus Messaging, Sandra J. Geiger, Jana K. Köhler, Zenith N. C. Delabrida, Karla A. Garduño-Realivazquez, Christian A. P. Haugestad, Hirotaka Imada, Aishwarya Iyer, Carya Maharja, Daniel C. Mann, Michalina Marczak, Olivia Melville, Sari R. R. Nijssen, Nattavudh Powdthavee, Radisti A. Praptiwi, Gargi Ranade, Claudio D. Rosa, Valeria Vitale, Małgorzata Winkowska, Lei Zhang, Mathew P. White

School of Psychology

Most people believe in human-caused climate change, yet this public consensus can be collectively underestimated (pluralistic ignorance). Across two studies using primary data (n = 3,653 adult participants; 11 countries) and secondary data (ns = 60,230 and 22,496 adult participants; 55 countries), we tested (a) the generalizability of pluralistic ignorance about climate-change beliefs, (b) the effects of a public-consensus intervention on climate action, and (c) the possibility that cultural tightness-looseness might serve as a country-level predictor of pluralistic ignorance. In Study 1, people across 11 countries underestimated the prevalence of proclimate views by at least 7.5% in Indonesia (90% credible …

Core Grade 5: Rating Certainty Of Evidence—Assessing Indirectness, Gordon Guyatt, Alfonso Iorio, Hans De Beer, Andrew Owen, Thomas Agoritsas, M. Hassan Murad, Ganesan Karthikeyan, Carlos Cuello, Manya Prasad, Kevin Kim, Dalal S. Ali, Arnav Agarwal, Lars G. Hemkens, Liang Yao, Monica Hultcrantz, Jamie Rylance, Derek K. Chu, Per Olav Vandvik, Benjamin Djulbegovic, Reem A. Mustafa, Linan Zeng, Prashanti Eachempati, Bram Rochwerg, Kameshwar Prasad, Victor M. Montori, Romina Brignardello-Petersen

Peninsula Dental School

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a …