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Tikhon Rybakov
Tikhon Rybakov

Biostat Comprehensive Meta Analysis //TOP\\ Crack

Main plot, prevalence estimates grouped by source paper (first author-year format). Filled black squares are prevalence point estimates, error bars are 95% confidence intervals (CI, red horizontal lines). Open diamond represents overall prevalence value and its 95% CI is represented by the width of diamond. (a), prevalence estimates grouped by terrestrial biome with N representing corresponding number of sites; (b), Map of prevalence estimates in 162 sites in the global meta-analysis database. Terrestrial biomes delineated by The Nature Conservancy Map was generated using ArcMap 10.2 ( _Street_Map/MapServer).

biostat comprehensive meta analysis crack

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The ultimate goal of any meta-analysis is to estimate an overall effect size (in this case, prevalence or magnitude of groundwater influence) and associated CI. If the precision across all 138 published papers in our database were equal, we could readily compute for the simple mean of all prevalence (or magnitude) estimates. Since this is obviously not the case, we needed to compute a weighted mean by assigning weights to the studies. There are two computational model approaches in meta-analysis to achieve this: the fixed effect model and the random effects model. A fixed effect model would be appropriate if there was plausible reason to believe that all studies in the synthesis were functionally identical. This is generally not a valid assumption in any meta-analysis that synthesizes data from primary literature170. Thus, here we used the random effects model. In so doing, we weighted each study by the inverse of its original (within-studies) variance plus between-studies variance.

Any meta-analysis is prone to publication bias (i.e. the file-drawer problem182). This is a function, by and large, of the inherent propensity of many journals to not publish negative results. A meta-analysis such as this contribution, therefore, may not be immune to such publication bias in the most fundamental sense. Nevertheless, here we addressed this issue in two phases: (Phase 1) structural intervention to mitigate against bias (before data synthesis and meta-analysis); (Phase 2) statistical assessment of bias (after data synthesis and meta-analysis).

How to cite this article: Evaristo, J. and McDonnell, J. J. Prevalence and magnitude of groundwater use by vegetation: a global stable isotope meta-analysis. Sci. Rep. 7, 44110; doi: 10.1038/srep44110 (2017).

There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children.

A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts.

In a systematic review of 38 studies on substance abuse treatment for women, Ashley, Marsden, and Brady [20] examined specific components of treatment programs and their association with outcomes. Programs with prenatal care or childcare were associated with better outcomes. Orwin, Francisco, and Bernichol [21] conducted a meta-analysis of studies on the effects of substance abuse treatment programs for women on their substance use, maternal well-being, and pregnancy outcomes. Findings suggested that enhancing women-only treatment programs with prenatal care or therapeutic childcare added value above and beyond the effects of standard women-only programs. In recent meta-analyses of the effectiveness of integrated programs for women with substance use issues and their children, we found positive impacts on length of stay, maternal substance use, maternal mental health, and birth outcomes (unpublished data).

Meta-analyses of quantitative data and qualitative meta-syntheses share many similar characteristics including: asking of a focused question; establishment of strict inclusion criteria to guide a comprehensive search of the available evidence; and critical appraisal of the located evidence. The two types of reviews are most distinct in the processes for synthesizing findings across included studies, with quantitative meta-analyses utilizing statistical methods to aggregate data and qualitative meta-syntheses characterized by the integration of common findings into narrative themes and the identification of overarching abstract concepts [22]. While quantitative meta-analyses have the power to answer questions about the effectiveness of interventions for specific populations and pre-determined outcomes, qualitative meta-syntheses add to our holistic understanding of issues by providing insight into the processes by which interventions work, factors that facilitate or inhibit the success or uptake of interventions, and the lived experiences of individuals. This paper describes the approach to, and findings of, a qualitative meta-synthesis of findings from women who participated in integrated treatment programs.

A comprehensive and systematic literature search for studies of outcomes and processes associated with integrated intervention programs for women with substance use issues and their children was conducted simultaneously for a quantitative meta-analysis and the qualitative meta-synthesis. The initial search captured literature published up to August 2007. We used three main strategies to identify outcome studies of intervention programs for women with substance abuse issues and their children: online bibliographic database searches; checking printed sources; and requests to researchers [24, 25]. First, we searched relevant bibliographic databases (PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL) for studies published in English, using the terms substance use/abuse, addiction, alcoholism, intervention, treatment, therapeutic, rehabilitation, women, child, mother, infant, mental health, parenting, prenatal, singly and in combination.

Inclusion and exclusion criteria were developed specifically for the purposes of the meta-analysis and meta-synthesis. Studies had to have explicitly and appropriately defined the study design, the population being served, the intervention and its components, and outcomes or, in the case of qualitative research, processes that contributed to outcomes. Table 1 lists the inclusion criteria used to determine eligibility for the qualitative meta-synthesis. For the purposes of this work, Creswell's [26] definition of qualitative research was used:

Given the lack of a gold standard for assessing the quality of qualitative research [32], we searched for a commonly used rating tool appropriate for our purposes. We chose to use the methodology checklist for qualitative studies developed by the National Institute for Health and Clinical Excellence [33]. The criteria in this tool were adapted from two checklists: criteria for evaluating qualitative studies [34] and 10 questions to help one make sense of qualitative research [35]. This methodology checklist for qualitative studies includes 13 criteria under six broad areas: aims of the research; study design; recruitment and data collection; data analysis; findings/interpretation; and implications of the research. The "Notes on the use of the methodology checklist" provided as an accompaniment to the checklist was consulted throughout the rating process. A summative rating was given based on whether all or most of the criteria were fulfilled (++), some of the criteria were fulfilled (+), or few or no criteria were fulfilled (-). The reviewers agreed that documents that met 10 or more of the 13 criteria would be assigned a ++ rating, those that met 4 to 9 criteria a + rating, and those that met 0 to 3 criteria a - rating. Because guidelines for using the methodology checklist for qualitative studies state that the latter rating implies a study is weak, we decided to exclude studies with this rating from the meta-synthesis.

Thematic analysis of data was conducted using the approach suggested by Atkins et al. [36]. We first arranged the documents in chronological order, starting with the oldest. This allowed the meta-synthesis to capture developments in knowledge related to integrated programs for women with substance use issues and their children over the 14-year span of the studies. We then created a preliminary grid to display themes and concepts within each study under broad headings that reflected the purpose of the meta-synthesis: processes and outcomes.

Perceived outcomes of participating in an integrated intervention program included: a maintained sense of personal agency; improvements in personal well-being; sustained sobriety or decreased substance use; establishment of positive social support networks; greater insight into self, others, and relationships; increased access to community services; and a more positive approach to professional relationships. Women also perceived that their capacity for parenting was enhanced in that they reported increased knowledge, skills, and confidence. They also identified improved maternal-child communication and relationships. Studies included in this meta-analysis did not explore women's perceptions of child health outcomes, with the exception of the study by Sword and colleagues in which women reported that program involvement had a positive impact on their children's behaviour and development [42]. The sources of specific outcome findings are shown in Table 3.


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