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Critically appraised paper: Physiotherapy-led overground gait training using a wearable robot may enhance gross motor function for children and adolescents with cerebral palsy [Synopsis]
Full text linkSummary of: Choi JY, Kim SK, Hong J, Park H, Yang SS, Park D, et al. Overground gait training with a wearable robot in children with cerebral palsy: a randomized clinical trial. JAMA Netw Open. 2024;7 (7):e2422625
Last chance tourism: A systematic literature review and future research directions
Full text linkAs last-chance tourism (LCT) gains prominence as a significant research domain, inherent challenges include limited destination lifespans and unsustainable visitor surges. The increasing tourism demand at LCT sites often exceeds carrying capacity, accelerating environmental and cultural degradation, which necessitates a stronger theoretical foundation for researchers and managers. Despite the growing body of research, fragmentation persists, highlighting the need for a systematic synthesis to consolidate knowledge and guide future research in the LCT domain. This study conducts the first systematic review of the LCT literature, synthesizing 25 articles from 13 reputed tourism and hospitality journals. Using a two-step thematic analysis with Excel and NVivo, this review mitigates method bias and enhances objectivity. The findings reveal four key thematic areas: 1) LCT definitions; 2) Theoretical frameworks and research methods employed; 3) Locations and contexts studied; and 4) Motivations for LCT research. To strengthen methodological rigour, this review integrates Covidence software, enhancing screening reliability with an interrater agreement (Cohen's Kappa 0.535). This systematic review paper identifies gaps in LCT conceptualisation, visitor behaviour theories, and sustainability models, proposing new directions for research development. It also provides practical implications and opportunities for destination managers, highlighting strategies to balance visitor demand and conservation efforts. Ultimately, this review advances LCT scholarship by offering a structured research agenda, encouraging interdisciplinary engagement, and broadening theoretical perspectives on sustainable tourism
Pelvic health in female military personnel: Broadening the conversation
Full text linkPelvic health is an understudied area for female military personnel. This study aimed to explore the pelvic health concerns, prevalence rates, and co-existence of a wide range of pelvic health issues in Australian servicewomen. An online questionnaire was offered to adult females (sex-assigned at birth) who had completed a minimum of 6-month active-duty service in the Australian Defence Force (ADF). Data analyses were focused on calculating prevalence for the included female pelvic health issues and identifying trends within the data (frequencies, 95% CI). Of the 987 survey responses, 496 were excluded, leaving 491 responses (49.7%) to inform this study. Over two-thirds of servicewomen reported pelvic health concerns (n = 350, 71%, 95% CI 67–75%), including sexual dysfunction (41%), gynecological surgery (34%), menstrual cycle manipulation (32%), frequent pelvic pain (20%), endometriosis (18%), irregular menstrual cycles (17%), pelvic organ prolapse (12%), pelvic injury (10%), and frequent episodes of fecal incontinence (2%). Coexistence of pelvic health issues were also reported by 24%. Pelvic health concerns, beyond lower urinary tract symptoms, are common and can co-exist in Australian servicewomen. Consideration of sex-responsive health services within military organizations may help to mitigate potential risks, enhancing wellbeing, operational readiness, and mission outcomes
SPIRIT 2025 statement: Updated guideline for protocols of randomised trials
No full textIMPORTANCE: The protocol of a randomised trial is the foundation for study planning, conduct, reporting, and external review. However, trial protocols vary in their completeness and often do not address key elements of design and conduct. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was first published in 2013 as guidance to improve the completeness of trial protocols. Periodic updates incorporating the latest evidence and best practices are needed to ensure that the guidance remains relevant to users.OBJECTIVE: To systematically update the SPIRIT recommendations for minimum items to address in the protocol of a randomised trial.DESIGN: We completed a scoping review and developed a project specific database of empirical and theoretical evidence to generate a list of potential changes to the SPIRIT 2013 checklist. The list was enriched with recommendations provided by lead authors of existing SPIRIT/CONSORT (Consolidated Standards of Reporting Trials) extensions (Harms, Outcomes, Non-pharmacological Treatment) and other reporting guidelines (TIDieR). The potential modifications were rated in a three-round Delphi survey followed by a consensus meeting.FINDINGS: Overall, 317 individuals participated in the Delphi consensus process and 30 experts attended the consensus meeting. The process led to the addition of two new protocol items, revision to five items, deletion/merger of five items, and integration of key items from other relevant reporting guidelines. Notable changes include a new open science section, additional emphasis on the assessment of harms and description of interventions and comparators, and a new item on how patients and the public will be involved in trial design, conduct, and reporting. The updated SPIRIT 2025 statement consists of an evidence-based checklist of 34 minimum items to address in a trial protocol, along with a diagram illustrating the schedule of enrolment, interventions, and assessments for trial participants. To facilitate implementation, we also developed an expanded version of the SPIRIT 2025 checklist and an accompanying explanation and elaboration document.CONCLUSIONS AND RELEVANCE: Widespread endorsement and adherence to the updated SPIRIT 2025 statement have the potential to enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, funders, research ethics committees, journals, trial registries, policymakers, regulators, and other reviewers.</p
SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials
No full textHigh quality protocols facilitate proper planning, conduct, reporting, and external review of randomised trials, yet their completeness varies and key elements are often not considered. To strengthen good reporting of trial protocols, the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement has been updated to incorporate new evidence and emerging perspectives. This SPIRIT 2025 explanation and elaboration document provides users with exemplars of reporting in contemporary trial protocols, contextual elaboration, more detailed guidance on reporting, references to key empirical studies, an expanded checklist, and a link to a website for further information. The document is intended to be used in conjunction with the SPIRIT 2025 statement and serves as a resource for researchers planning a trial and for others interested in trial protocols
Altered states of consciousness induced by online chanting meditation
Full text linkChanting is a universal practice with deep ethnocultural roots. More recently, chanting has become popular on online platforms and meditation apps which have extended chanting practices beyond their original cultural, sacred, and healing traditions. The aim of the current study was to determine if online chanting meditation promotes altered states of consciousness and psychosocial benefits when compared to a narrative listening control and whether there are different effects of online chanting for experienced and novice meditators. Experienced and novice chanters completed a 10-minute online chanting or listening activity prior to measures of ego dissolution, mystical states, mindfulness, social connection and anxiety. Differences between chanting conditions (chanting vs. listening) and experience (experienced vs. novice meditators) were examined using 2 × 2 ANOVAs and ANCOVAs, controlling for spirituality. Results showed ego dissolution and mystical state scores were higher in the chanting compared to the listening condition for experienced chanters, but not for novices. Spirituality was also a significant covariate for ego dissolution, mystical experience and mindfulness, suggesting these states of consciousness were partially dependent on spiritual or religious beliefs. This research shows that an online chanting intervention can lead to marked altered states of consciousness for individuals with prior experience with chanting. The findings may inform future design and development of contemplative activities.</p
Prevalence of Intolerance to Amines and Salicylates in Individuals with Atopic Dermatitis: A Systematic Review and Meta-Analysis
Full text linkBackground/Objectives: Elimination diets targeting amines and salicylates have been used since the 1980s to diagnose pharmacological food intolerance in individuals with atopic dermatitis (eczema), yet supporting evidence regarding relevance is limited. To our knowledge, this systematic review with meta-analysis is the first to examine the prevalence and association between atopic dermatitis flares and amine intolerance (including histamine intolerance) and salicylate intolerance in individuals with atopic dermatitis. Methods: Following the PRISMA guidelines, searches of PubMed, Embase, CINAHL, and Cochrane were conducted. Included studies involved children and adults with atopic dermatitis who underwent dietary elimination and double-blind placebo-controlled challenges involving histamine, other amines, or salicylates. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Meta-analysis of the prevalence of atopic dermatitis flare by food chemical type was performed using a random effects model in Stata/MP, version 16.1 for Windows. Heterogeneity was assessed using the I2 statistic and Cochrane’s Q test. Results: A total of 2323 titles and abstracts were screened, with 46 full-text articles evaluated independently by two reviewers, resulting in the inclusion of four prevalence studies involving 188 participants. Meta-analysis of two trials showed histamine intolerance prevalence at 31% [95% CI, 20–41%] with no heterogeneity (I2 = 0.01%). Two trials showed amine intolerance prevalence at 32% [95% CI, 16–48%] with moderate heterogeneity (I2 = 34.91%). Two trials showed salicylate intolerance prevalence at 53% [95% CI, 44–62%] with no heterogeneity (I2 = 0.00%). Conclusions: This review suggests there may be low-certainty evidence linking intolerance to histamine, amines, and salicylates to atopic dermatitis flare in a substantial proportion of individuals with atopic dermatitis. Further, well-designed studies are needed to confirm these findings and clarify the role of pharmacological food intolerance in atopic dermatitis
Artificial intelligence in construction risk management: a decade of developments, challenges, and integration pathways
No full textThe increasing complexity and uncertainty of construction projects have driven a paradigm shift in risk management, with Artificial Intelligence (AI) emerging as a transformative tool. This systematic review examines 87 peer-reviewed studies published between 2014 and 2024, assessing the role of AI technologies—including machine learning (ML), natural language processing (NLP), knowledge-based reasoning (KBR), optimisation algorithms (OAs), and computer vision (CV)—across the construction risk management lifecycle. Using PRISMA guidelines and NVivo-based mixed-method analysis, the review identifies AI’s core functions in risk identification, assessment, response, and monitoring, while uncovering key barriers such as fragmented implementation, limited adaptability, and socio-organisational resistance. ML and CV dominate predictive and visual analysis, while NLP and KBR support compliance and rule-based decision-making; OAs optimise resource trade-offs. Despite increasing research, critical gaps persist, including fragmented AI integration, limited attention to implementation barriers, and underrepresentation of adaptive response and monitoring stages. This paper makes four specific contributions: (1) it offers a functional taxonomy that maps AI methods to distinct risk management tasks and phases; (2) it synthesizes technical, organisational, and ethical challenges hindering real-world AI adoption; (3) it introduces an integrated AI–risk management lifecycle framework that aligns AI capabilities with construction project needs; and (4) it extends classical risk epistemologies by embedding Beck’s, Power’s, and Aven’s perspectives into the discourse on AI governance. These contributions provide a structured foundation for advancing research and guiding practitioners toward responsible, resilient, and explainable AI deployment in high-stakes construction environments.</p
Democracy, Human Capital and Foreign Direct Investment: Evidence from Developing Economies
No full textThis paper examines the role of human capital in democracy and foreign direct investment (FDI) relationship in 129 developing countries from 1980 to 2022. Democracy is viewed as a multidimensional concept with five measures: electoral, liberal, egalitarian, participatory, and participation democracy. Employing the dynamic generalized method of moments, the findings demonstrate that democracy indices and human capital have direct, positive, and significant impact on FDI. Additionally, we observe that democracy indices increase FDI inflows when the human capital index is above a certain threshold, while democracy variables decrease FDI inflows below this threshold. The paper also reveals that democracy reduces FDI inflows to low-income economies, sub-Saharan Africa, and Middle East and North Africa countries. However, it increases FDI inflows to middle-income economies and other developing regions. These findings are robust to alternative econometric techniques and model specifications. The findings underscore the importance of enhancing democratization and human capital development to attract FDI to developing economies
Hismile: Bootstrapping an Oral Care Industry Disruptor?
No full textIn December 2024, Nik Mirkovic and Alex Tomic, the young co-founders of the Australian teeth whitening and toothpaste brand Hismile Pty Ltd. (Hismile), had grown their company from an initial A700 million in gross sales in 2024. Headquartered on the Gold Coast, Australia, Hismile pioneered the field of smilecare through a lean, agile approach based on an intense customer focus, grassroots social media influencer campaigns, small teams, bootstrapping, and innovation. But could it continue this way even as its products appeared in major stores and pharmacies? Could Hismile continue to grow as new entrants and established players adopted its strategies? And could it replicate its success outside the field of oral care products