scholarly journals Perspectives of People Who Are Overweight and Obese on Using Wearable Technology for Weight Management: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ruiqi Hu ◽  
Michelle Helena van Velthoven ◽  
Edward Meinert
Keyword(s):  
Randomized Controlled Trials ◽  
Weight Management ◽  
Data Extraction ◽  
Wearable Technology ◽  
Risk Of Bias ◽  
Qualitative Studies ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Cochrane Library

BACKGROUND Obesity is a large contributor to preventable chronic diseases and health care costs. The efficacy of wearable devices for weight management has been researched; however, there is limited knowledge on how these devices are perceived by users. OBJECTIVE This study aimed to review user perspectives on wearable technology for weight management in people who are overweight and obese. METHODS We searched the online databases Pubmed, Scopus, Embase, and the Cochrane library for literature published from 2008 onward. We included all types of studies using a wearable device for delivering weight-loss interventions in adults who are overweight or obese, and qualitative data were collected about participants' perspectives on the device. We performed a quality assessment using criteria relevant to different study types. The Cochrane risk of bias tool was used for randomized controlled trials. The Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was used for nonrandomized studies. The Oxman and Guyatt Criteria were used for systematic reviews. We used the critical appraisal checklist for qualitative studies. Data were extracted into a data extraction sheet and thematically analyzed. RESULTS We included 19 studies: 5 randomized controlled trials, 6 nonrandomized studies, 5 qualitative studies, and 3 reviews. Mixed perceptions existed for different constructs of wearable technologies, which reflects the differences in the suitability of wearable technology interventions for different individuals in different contexts. This also indicates that interventions were not often tailored to participants' motivations. In addition, very few wearable technology interventions included a thorough qualitative analysis of the participants' view on important features of the intervention that made it successful. CONCLUSIONS This study highlights the importance of determining the type of intervention most suitable for an individual before the intervention is used. Our findings could help participants find a suitable intervention that is most effective for them. Further research needs to develop a user-centered tool for obtaining comprehensive user feedback. CLINICALTRIAL PROSPERO CRD42018096932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96932

scholarly journals Perspectives of People Who Are Overweight and Obese on Using Wearable Technology for Weight Management: Systematic Review

10.2196/12651 ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. e12651 ◽  
Author(s):  
Ruiqi Hu ◽  
Michelle Helena van Velthoven ◽  
Edward Meinert
Keyword(s):  
Randomized Controlled Trials ◽  
Weight Management ◽  
Data Extraction ◽  
Wearable Technology ◽  
Risk Of Bias ◽  
Qualitative Studies ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Cochrane Library

Background Obesity is a large contributor to preventable chronic diseases and health care costs. The efficacy of wearable devices for weight management has been researched; however, there is limited knowledge on how these devices are perceived by users. Objective This study aimed to review user perspectives on wearable technology for weight management in people who are overweight and obese. Methods We searched the online databases Pubmed, Scopus, Embase, and the Cochrane library for literature published from 2008 onward. We included all types of studies using a wearable device for delivering weight-loss interventions in adults who are overweight or obese, and qualitative data were collected about participants' perspectives on the device. We performed a quality assessment using criteria relevant to different study types. The Cochrane risk of bias tool was used for randomized controlled trials. The Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was used for nonrandomized studies. The Oxman and Guyatt Criteria were used for systematic reviews. We used the critical appraisal checklist for qualitative studies. Data were extracted into a data extraction sheet and thematically analyzed. Results We included 19 studies: 5 randomized controlled trials, 6 nonrandomized studies, 5 qualitative studies, and 3 reviews. Mixed perceptions existed for different constructs of wearable technologies, which reflects the differences in the suitability of wearable technology interventions for different individuals in different contexts. This also indicates that interventions were not often tailored to participants' motivations. In addition, very few wearable technology interventions included a thorough qualitative analysis of the participants' view on important features of the intervention that made it successful. Conclusions This study highlights the importance of determining the type of intervention most suitable for an individual before the intervention is used. Our findings could help participants find a suitable intervention that is most effective for them. Further research needs to develop a user-centered tool for obtaining comprehensive user feedback. Trial Registration PROSPERO CRD42018096932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96932

scholarly journals Quality Evaluation of Randomized Controlled Trials of Rhodiola Species: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Xiuzhu Li ◽  
Weijie Chen ◽  
Yingqi Xu ◽  
Zuanji Liang ◽  
Hao Hu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Reporting Quality ◽  
Consort Statement ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
China National Knowledge Infrastructure ◽  
Randomized Controlled ◽  
The Consort Statement ◽  
The Cochrane Library

Background. Rhodiola is a worldwide used medicinal plant for its various medicinal functions, and the number of randomized controlled trials (RCTs) of Rhodiola is increasing in recent years. This study aims to evaluate the reporting quality and risk of bias of the current RCT reports of different Rhodiola species. Methods. Six databases including Embase, PubMed, Web of Science, the Cochrane Library, ClinicalTrial.gov, and China National Knowledge Infrastructure were searched to identify RCTs that used Rhodiola as a single intervention and were published in English or Chinese from inception to December 2020. The Consolidated Standards of Reporting Trials (CONSORT) 2010 statement was used as the checklist for assessment, and a scoring system was applied to the evaluation of RCTs. Score 0 represents no reporting or inadequate reporting, and score 1 represents adequate reporting. The risk of bias of the included studies was also assessed using the Cochrane Risk of Bias tool. Results. A total of 39 RCTs were included in this study, including 23 RCTs of Rhodiola rosea (R. rosea), 8 RCTs of Rhodiola crenulata (R. crenulata), and 8 RCTs of Rhodiola wallichiana (R. wallichiana). None of the included studies met all the CONSORT statement criteria, and the reporting quality of RCTs of the three Rhodiola species was all generally poor. Based on the risk of bias assessment, the majority of included studies were judged to have an unclear risk of bias in most domains due to inadequate reporting. Conclusions. There is inadequate reporting among the included RCTs of different Rhodiola species, and RCTs of Rhodiola with higher reporting quality and better methodological quality are needed.

scholarly journals Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2984
Author(s):  
Stepan M. Esagian ◽  
Christos D. Kakos ◽  
Emmanouil Giorgakis ◽  
Lyle Burdine ◽  
J. Camilo Barreto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Transarterial Chemoembolization ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Curative Intent ◽  
Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

scholarly journals Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. 135-148
Author(s):  
Zifeng Xu
Keyword(s):  
Cesarean Section ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Control Effect ◽  
Randomized Controlled ◽  
Time Required ◽  
The Cochrane Library

Background: The pain control effect of ketamine versus control in women during cesarean operation is not well determined. Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. Study Design: We used meta-analysis to address this concern. Setting: Meta-analysis-based study. Methods: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limitations: Limited patients were included with moderate strength. Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis

scholarly journals Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 17 (19) ◽  
pp. 7049
Author(s):  
Thi Mai Nguyen ◽  
Thi Thanh Toan Do ◽  
Tho Nhi Tran ◽  
Jin Hee Kim
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trials ◽  
Risk Of Bias ◽  
Menopausal Symptoms ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Study Objective ◽  
Positive Effects ◽  
Randomized Controlled

Menopausal symptoms are associated with deterioration in physical, mental, and sexual health, lowering women’s quality of life (QoL). Our study objective is to examine the effect of exercise on QoL in women with menopausal symptoms. After initially identifying 1306 studies published on PubMed, Web of Science, Scopus, and Cochrane Library before June 2020, two researchers independently selected nine randomized controlled trials (RCTs) in which any type of exercise was compared with no active treatment. We assessed the risk of bias in the included studies using the Cochrane risk-of-bias 2.0 tool for RCTs and computed the converged standardized mean difference with a 95% confidence interval. We found evidences for the positive effects of exercise on physical and psychological QoL scores in women with menopausal symptoms. However, there was no evidence for the effects of exercise on general, social, and menopause-specific QoL scores. The most common interventions for women with menopausal and urinary symptoms were yoga and pelvic floor muscle training (PFMT), respectively. In our meta-analyses, while yoga significantly improved physical QoL, its effects on general, psychological, sexual, and vasomotor symptoms QoL scores as well as the effect of PFMT on general QoL were not significant. Our findings suggest that well-designed studies are needed to confirm the effect of exercise on QoL in women with menopausal symptoms.

scholarly journals Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Pajaree Sriuttha ◽  
Buntitabhon Sirichanchuen ◽  
Unchalee Permsuwan
Keyword(s):  
Side Effects ◽  
Randomized Controlled Trials ◽  
Cochrane Library ◽  
Bibliographic Databases ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Clinically Significant ◽  
The Cochrane Library

Background. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used medication in several countries, including Thailand. NSAIDs have been associated with hepatic side effects; however, the frequency of these side effects is uncertain. Aim of the Review. To systematically review published literature on randomized, controlled trials that assessed the risk of clinically significant hepatotoxicity associated with NSAIDs. Methods. Searches of bibliographic databases EMBASE, PubMed, and the Cochrane Library were conducted up to July 30, 2016, to identify randomized controlled trials of ibuprofen, naproxen, diclofenac, piroxicam, meloxicam, mefenamic acid, indomethacin, celecoxib, and etoricoxib in adults with any disease that provide information on hepatotoxicity outcomes. Results. Among the 698 studies, 18 studies met the selection criteria. However, only 8 studies regarding three NSAIDs (celecoxib, etoricoxib, and diclofenac) demonstrated clinically significant hepatotoxic evidence based on hepatotoxicity justification criteria. Of all the hepatotoxicity events found from the above-mentioned three NSAIDs, diclofenac had the highest proportion, which ranged from 0.015 to 4.3 (×10−2), followed by celecoxib, which ranged from 0.13 to 0.38 (×10−2), and etoricoxib, which ranged from 0.005 to 0.930 (×10−2). Conclusion. Diclofenac had higher rates of hepatotoxic evidence compared to other NSAIDs. Hepatotoxic evidence is mostly demonstrated as aminotransferase elevation, while liver-related hospitalization or discontinuation was very low.

scholarly journals Efficacy of remdesivir versus placebo for the treatment of COVID-19: A protocol for systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Desye Gebrie ◽  
Desalegn Getnet ◽  
Tsegahun Manyazewal
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Antiviral Drug ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
List Type ◽  
Randomized Controlled

AbstractBackgroundIn spite of the global containment on prevention efforts, the spread of coronavirus disease 2019 (COVID-19) is continuing to rise, with 1.1 million confirmed cases and 60,124 deaths recorded worldwide since 04 April 2020. The outbreak has a significant threat to international health and economy. At present, there is no approved vaccine or treatment for the disease, while efforts are underway. Remdesivir, a nucleotide-analogue antiviral drug developed for Ebola, is determined to prevent and stop infections with COVID-19, while results are yet controversial. Here, we aim to conduct a systematic review and meta-analysis of randomized controlled trials to compare the effectiveness of remdesivir and placebo in patients with COVID-19.Method and analysisWe will search MEDLINE-PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Google scholar databases without restriction in year of publication. We will include randomized controlled trials that assessed the effectiveness of remdesivir versus placebo for patients confirmed with COVID-19. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2015) guidelines for the design and reporting of the results. The primary endpoint will be time to clinical recovery. The secondary endpoints will be all cause mortality, discharged date, frequency of respiratory progression, and treatment-emergent adverse events. Two independent authors will perform study selection, data extraction, and methodology quality assessment. RevMan 5.3 software will be used for statistical analysis. Random/fixed effect model will be carried out to calculate mean differences for continuous outcomes and risk ratio for dichotomous outcomes between remdesivir and placebo.Ethics and disseminationThis study does not require ethical approval, because no participant’s data will be involved in this systematic review and meta-analysis. The findings of this study will be published in reputable and peer-reviewed journal.RegistrationThis review protocol is submitted in PROSPERO database for registration and we will include the registration number in the revised version of the manuscript.Strengths and limitations of this study➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will increase the quality of evidences.➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will reduce between study heterogeneity.➣Subgroup and sensitivity analysis will be carried out to identify possible reasons that may cause significant heterogeneity between studies.➣The use of Cochrane risk of bias tool to assess risk of bias for each included studies to extract and synthesize evidence based conclusions.➣One of the limitation of this study might be the restriction of trials published in English language.

scholarly journals Are Randomized Controlled Trials on Pharmacotherapy and Psychotherapy for Positive Symptoms of Schizophrenia Comparable? A Systematic Review of Patient and Study Characteristics

2019 ◽  
Vol 46 (3) ◽  
pp. 496-504 ◽  
Author(s):  
Irene Bighelli ◽  
Claudia Leucht ◽  
Maximilian Huhn ◽  
Cornelia Reitmeir ◽  
Felicitas Schwermann ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Positive Symptoms ◽  
Randomized Controlled ◽  
Study Characteristics

Abstract Background We examined patient and study characteristics of pharmacotherapy and psychotherapy trials to establish whether the effects of these 2 treatment strategies can be compared meaningfully. Methods We inspected all randomized controlled trials included in 2 recent meta-analyses on antipsychotics and psychotherapy in patients with positive symptoms of schizophrenia, searching EMBASE, MEDLINE, PsycINFO, Cochrane Library, and ClinicalTrials.gov. Differences between psychotherapy and pharmacotherapy trials were analyzed with Wilcoxon–Mann–Whitney and chi-square tests. Results Eighty studies with 18 271 participants on antipsychotic drugs and 53 studies with 4068 participants on psychotherapy were included. Psychotherapy studies included less severely ill patients (P &lt; .0001), with a shorter duration of illness (P = .021), lasted for a longer period (P &lt; .0001), administered the intervention as add-on to antipsychotics (P &lt; .0001), had higher risk of bias in some domains including blinding of outcome assessment (P &lt; .0001), and were funded publicly more frequently (P &lt; .0001). Antipsychotic trials had larger sample sizes (P &lt; .0001) and more study centers (P &lt; .0001), included more males (P = .0001), inpatients (P &lt; .0001), and slightly older patients (P = .031), more often used diagnostic operationalized criteria (P = .006), and were sponsored by pharmaceutical companies. They did not differ in conflict of interest (P = .24). Conclusions We found key differences between the 2 groups of studies that encompass higher risk of bias in psychotherapy studies and the inclusion of more severe patients in drug trials. These differences imply that study and patient characteristics should be carefully taken into account before considering a network meta-analysis. In the interest of patients, psychopharmacologists and psychotherapists should optimize their treatments rather than seeing them in competition.

scholarly journals Pharmacological treatment for bipolar mania: a systematic review and network meta-analysis of double-blind randomized controlled trials

2021 ◽  
Author(s):  
Taro Kishi ◽  
Toshikazu Ikuta ◽  
Yuki Matsuda ◽  
Kenji Sakuma ◽  
Makoto Okuya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Bipolar Mania ◽  
The Cochrane Library

AbstractA systematic review and random-effects model network meta-analysis was conducted to compare the efficacy, acceptability, tolerability, and safety of pharmacological interventions for adults with acute bipolar mania. We searched PubMed, the Cochrane Library, and Embase databases for eligible studies published before March 14, 2021. Randomized controlled trials (RCTs) of oral medication monotherapy lasting ≥10 days in adults with mania were included, and studies that allowed the use of antipsychotics as a rescue medication during a trial were excluded. The primary outcomes were response to treatment (efficacy) and all-cause discontinuation (acceptability). The secondary outcomes were the improvement of mania symptoms and discontinuation due to inefficacy. Of the 79 eligible RCTs, 72 double-blind RCTs of 23 drugs and a placebo were included in the meta-analysis (mean study duration = 3.96 ± 2.39 weeks, n = 16442, mean age = 39.55 years, with 50.93% males). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed response to treatment (N = 56, n = 14503); aripiprazole, olanzapine, quetiapine, and risperidone had lower all-cause discontinuation; however, topiramate had higher all-cause discontinuation (N = 70, n = 16324). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed the improvement of mania symptoms (N = 61, n = 15466), and aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, valproate, and ziprasidone had lower discontinuation due to inefficacy (N = 50, n = 14284). In conclusions, these antipsychotics, carbamazepine, lithium, tamoxifen, and valproate were effective for acute mania. However, only aripiprazole, olanzapine, quetiapine, and risperidone had better acceptability than the placebo.

scholarly journals Effects of soy isoflavones on cognitive function: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 78 (2) ◽  
pp. 134-144 ◽  
Author(s):  
Chendi Cui ◽  
Rahel L Birru ◽  
Beth E Snitz ◽  
Masafumi Ihara ◽  
Chikage Kakuta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Randomized Controlled Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Soy Isoflavones ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Design Characteristics

Abstract Context The results of preclinical and observational studies support the beneficial effect of soy isoflavones on cognition. Objective This review aimed to evaluate the effects of soy isoflavones on cognition in adults. Data Sources The PUBMED, EMBASE, Ovid Medline, Cochrane Library, and clinicaltrials.gov databases were searched. Study Selection Two researchers independently screened 1955 records, using the PICOS criteria: participants were adults; intervention was dietary sources with soy isoflavones or isolated soy isoflavones; comparator was any comparator; outcome was cognitive function; study type was randomized controlled trials (RCTs). A third researcher was consulted to resolve any discrepancies. Sixteen RCTs were included and their quality assessed. Data Extraction Information on study design, characteristics of participants, and outcomes was extracted. PRISMA guidelines were followed. Data Analysis A random-effects meta-analysis was used to pool estimates across studies. In the 16 RCTs (1386 participants, mean age = 60 y), soy isoflavones were found to improve overall cognitive function (standardized mean difference [SMD], 0.19; 95% confidence interval [CI], 0.07–0.32) and memory (SMD, 0.15; 95%CI, 0.03–0.26). Conclusion The results showed that soy isoflavones may improve cognitive function in adults. Systematic Review Registration PROSPERO registration no. CRD42018082070.

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