Academic literature on the topic 'Hares in literature'
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Journal articles on the topic "Hares in literature"
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Farkas, Péter, Szilvia Kusza, and István Majzinger. "The importance of predator species in the population dynamics of the Brown hares (Lepus europaeus, Pallas 1778) – Literature review." Acta Agraria Debreceniensis, no. 73 (August 29, 2017): 43–49. http://dx.doi.org/10.34101/actaagrar/73/1625.
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One of the conditions for successful small game management is the good management of predator species. The predator species play an important role in the sustainable utilization of the domestic brown hare populations. A portion of these species are under nature protection and with the rest of the species can be utilizing by the wildlife management professionals. Important prey species of brown hares: perspective are red fox, domestic dog and domestic cat. Based on latest date of the National Game Management Database in hunting bags increasing every year the number of the European badger, the stone marten and the golden jackal. In Hungary the brown hare’s most important predator bird species are common buzzard, marsh-harries and goshawk. The human race is not only as a top predator affects the number of the population of brown hares with the wildlife management but indirectly with traffic, (soil cultivation, mowing, and pest control) as well. The control of predators is absolutely necessary for successful small game management, but without sufficient habitat size and habitat development it is hardly sufficient.
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Johannessen, Viviann, and Elisabeth Samset. "Summer diet of the mountain hare (Lepus timidus L.) in a low-alpine area in southern Norway." Canadian Journal of Zoology 72, no. 4 (April 1, 1994): 652–57. http://dx.doi.org/10.1139/z94-088.
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The summer diet of the mountain hare (Lepus timidus L.) was studied in a low-alpine area in southern Norway. Dietary preferences were determined for 11 hares in cafeteria trials. The hares were later equipped with radio transmitters and released, and diet selection was observed directly. The results demonstrate that mountain hares seem able to utilize a wide variety of different plants, although they selected herbs in the field. Based on the available literature, diet overlap and diet niche breadth were estimated for five sympatric herbivores; reindeer, sheep, willow grouse, Norwegian lemming, and mountain hare. Generally, the noncyclic herbivores had broader diet niches and greater dietary overlaps than the cyclic herbivores.
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Hardwick, Paul. "'Hares on the Hearthstones' in medieval England." Reinardus / Yearbook of the International Reynard Society 20 (December 12, 2008): 29–39. http://dx.doi.org/10.1075/rein.20.03har.
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This paper explores the curious image of ‘the hare on the hearthstone’ – a sign of the impending Day of Doom in late medieval literature – investigating reasons why such an apparently harmless creature should be considered a harbinger of misfortune. By addressing a broad range of written sources, it builds up a picture of the hare as a symbol of otherness and instability whose intrusion into the very centre of domestic security would indeed provide a cause for profound unease.
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Farkas, Péter, and István Majzinger. "Comparative analysis of body weight and condition in two brown hare populations." Review on Agriculture and Rural Development 6, no. 1-2 (July 13, 2018): 176–81. http://dx.doi.org/10.14232/rard.2017.1-2.176-181.
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The condition of the populations are useful parameters for the reasonable game management. In this study the physical condition of Brown hare stocks (Lepus europaeus, Pallas 1785) was analyzed, measured body weight (BW) and determined kidney fat index (KFI). These methods were applied during our survey in the hunting period of 2014/15 and 2015/16. In total 272 (123 male and 149 female) samples were collected from two hunting areas in Great Plain (from County Békés and Jász-Nagykun Szolnok). The aim of our work was to collect data concerning the conditions of the populations. All hares was sexed and classified in 2 age groups (young <1years), and (old> 1years). The age was established by Stroh-mark in the hunting field and by dried eye lenses in the laboratory. BW and the weight of the kidney and perirenal fat was measured and the data were statistically analysed (group statistics, Levene’s test for Equality of Variances and, t-tests for Equality of Means). As a result of our examination the range of KFI was 1.25-5.14. The weight of perirenal fat was between 2-34gramm.KFI was greater in females than males. The average BW of the hares in every age groups were less than it is according to literature dates, however the conditions of the hares were good and in very good in both hunting areas. The BW and the amount of the perirenal fat in adult female hares were the greatest.
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Byrne, Andrew W., Ferdia Marnell, Damien Barrett, Neil Reid, Robert E. B. Hanna, Máire C. McElroy, and Mícheál Casey. "Rabbit Haemorrhagic Disease Virus 2 (RHDV2; GI.2) in Ireland Focusing on Wild Irish Hares (Lepus timidus hibernicus): An Overview of the First Outbreaks and Contextual Review." Pathogens 11, no. 3 (February 24, 2022): 288. http://dx.doi.org/10.3390/pathogens11030288.
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Rabbit haemorrhagic disease virus 2 (RHDV2; GI.2) is a pathogenic lagovirus that emerged in 2010, and which now has a global distribution. Outbreaks have been associated with local population declines in several lagomorph species, due to rabbit haemorrhagic disease (RHD)-associated mortality raising concerns for its potential negative impact on threatened or vulnerable wild populations. The Irish hare (Lepus timidus hibernicus) is endemic to Ireland, and is of conservation interest. The first cases of RHDV2 in Ireland were reported in domestic rabbits (Oryctolagus cuniculus) in 2016, soon followed by the first known case in a wild rabbit also in 2016, from a population reported to be experiencing high fatalities. During summer 2019, outbreaks in wild rabbits were confirmed in several locations throughout Ireland. Six cases of RHDV2 in wild hares were confirmed between July and November 2019, at four locations. Overall, 27 cases in wildlife were confirmed in 2019 on the island of Ireland, with a predominantly southern distribution. Passive surveillance suggests that the Irish hare is susceptible to lethal RHDV2 infection, and that spillover infection to hares is geographically widespread in eastern areas of Ireland at least, but there is a paucity of data on epidemiology and population impacts. A literature review on RHD impact in closely related Lepus species suggests that intraspecific transmission, spillover transmission, and variable mortality occur in hares, but there is variability in reported resistance to severe disease and mortality amongst species. Several key questions on the impact of the pathogen in Irish hares remain. Surveillance activities throughout the island of Ireland will be important in understanding the spread of infection in this novel host.
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Yaniv, Bracha. "The Hidden Message of the Hares in the Talons of the Eagle." AJS Review 36, no. 2 (November 2012): 281–94. http://dx.doi.org/10.1017/s0364009412000190.
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When in 1714 the artist Israel ben Mordecai Liśnicki from Jaryczów painted the interior of the wooden synagogue of Chodorów, today in the L'viv (Polish, Lwów) region of western Ukraine, he did not know that one of his paintings would be the subject of divergent interpretations by art historians some three hundred years later. The controversy centers around the depiction of an eagle grasping in its talons two hares trying to escape outward. The hares are grasped by the neck (fig. 1). This depiction, located in the center of the ceiling, is surrounded by a decorative medallion inscribed with the verse “Like an eagle who rouses his nestlings, gliding down to his young, so did He spread His wings and take him, bear him along on His talons” (Deuteronomy 32:11). In the background are the twelve signs of the zodiac.
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Allmert, Tom, Jonathan M. Jeschke, and Thomas Evans. "An assessment of the environmental and socio-economic impacts of alien rabbits and hares." Ambio 51, no. 5 (October 28, 2021): 1314–29. http://dx.doi.org/10.1007/s13280-021-01642-7.
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AbstractDirectly comparable data on the environmental and socio-economic impacts of alien species informs the effective prioritisation of their management. We used two frameworks, the Environmental Impact Classification for Alien Taxa (EICAT) and Socio-Economic Impact Classification for Alien Taxa (SEICAT), to create a unified dataset on the severity and type of impacts caused by alien leporids (rabbits and hares). Literature was reviewed to collate impact data, which was categorised following EICAT and SEICAT guidelines. We aimed to use these data to identify: (1) alien leporid species with severe impacts, (2) their impact mechanisms, (3) the native species and local communities vulnerable to impacts and (4) knowledge gaps. Native species from a range of taxonomic groups were affected by environmental impacts which tended to be more damaging than socio-economic impacts. Indirect environmental impacts were particularly damaging and underreported. No impact data were found for several alien leporid species.
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Pandey, Vikas, Ganesh Thiruchitrambalam, M. Savurirajan, Raj Kiran Lakra, Jawed Equbal, Kunal Satyam, P. Shanmukha Sainath, and Rokkarukala Samson. "An account of the occurrence of Wedge Sea Hare Dolabella auricularia (Lightfoot, 1786) (Gastropoda: Aplysiidae) from Andaman Islands, India." Journal of Threatened Taxa 10, no. 6 (May 26, 2018): 11818. http://dx.doi.org/10.11609/jott.3418.10.6.11818-11821.
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In the present article we provide a detailed account on the occurrence of Wedge Sea Hare Dolabella auricularia, from two different locations (Hut Bay and Burmanallah) of Andaman Islands. This species has been reported by Rao (2003) from Andamans but there is no specific location mentioned. First occurrence of this species was observed in Hut Bay coast of Little Andaman and after a three month interval a group of Wedge Sea Hares were again spotted from Burmanallah, South Andaman. In the present article we have given a detailed account on the occurrence and morphological features with field and laboratory pictures of D. auricularia and its biomedical importance based on literature.
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FEDOTOV, ANDREY, and PAVEL USPENSKIJ. "Nature, Hares, and Nikolay Nekrasov: The Poetics and Economics of Russian Ecocriticism." Russian Review 80, no. 3 (June 7, 2021): 473–96. http://dx.doi.org/10.1111/russ.12322.
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Whitley, James. "STYLE AND PERSONHOOD: THE CASE OF THE AMASIS PAINTER." Cambridge Classical Journal 64 (September 17, 2018): 178–203. http://dx.doi.org/10.1017/s1750270518000088.
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For archaeologists discussion of style is unavoidable. Within classical archaeology ‘style’ is closely associated with connoisseurship as practised by J. D. Beazley. Style identifies individuals, artistic personalities such as the Amasis Painter. This notion of style necessarily overlaps with another debate within both anthropology and prehistoric archaeology (personhood) which also touches on an older discussion within classical studies. These two debates have remained strangers to each other. The article explores these issues in relation to the iconography of hares and arming scenes. Notions of personhood and agency force us to re-evaluate such iconography and its effectiveness as narrative.
Dissertations / Theses on the topic "Hares in literature"
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Zandoná, Jair. "De Orpheu ao Hades." Florianópolis, SC, 2008. http://repositorio.ufsc.br/xmlui/handle/123456789/91316.
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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão. Programa de Pós-graduação em LiteraturaMade available in DSpace on 2012-10-23T21:21:36Z (GMT). No. of bitstreams: 1 251990.pdf: 994821 bytes, checksum: 3fb82e62c3af50a7810a301e820e5e0a (MD5)
Pensar a literatura de Mário de Sá-Carneiro é enveredar por um contexto densamente elaborado. Há os arroubos dos modernistas portugueses - tão bem conectados - que ele e Fernando Pessoa exploraram com maestria, seja em seus projetos pessoais, seja na Revista Orpheu, projeto que desenvolveram em comum. Além disso, há o desenvolvimento de um eu-lírico melancólico, à beira de um abismo de sentimentos. Enquanto Pessoa estava em Lisboa e Sá-Carneiro, em Paris, os dois poetas mantiveram intensa correspondência. Dessas cartas, são conhecidas as enviadas por Sá-Carneiro, as quais extrapolam os limites do pessoal e apresentam fruição poética, uma espécie de arcabouço literário, a que se articula Dispersão - conjunto de poemas publicado em 1915. A melancolia é encontrada também nas linhas consideradas como palavras do próprio Sá-Carneiro em diálogo com o amigo. É aí que a sobreposição literário/extraliterário se evidencia; é aí que ambas as instâncias dialogam. Se as cartas têm notadamente cunho pessoal e os poemas estão no campo do ficcional, as armadilhas da escrita ali tomam corpo, levando o leitor a aproximar ficcional e biográfico, tomando-os por uma escrita confessional, corroborada pelo suicídio do poeta, dado que acaba sendo considerado o elo necessário para dar respaldo a tal leitura.
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Blazek, William. "The Norton-Harjes Ambulance Corps and American literature of World War I." Thesis, University of Aberdeen, 1986. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=228965.
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The Norton-Harjes Ambulance Corps numbered among its members some of the most important American writers of World War I, Including E. E. Cummings and John Dos Passos. What is less well-known is that the ambulance corps had strong tIes to a pre-war generation of American expatriates, whose participation first created the elite aura of the unit known as the "gentlemen volunteers." Henry James served as chairman until his final illness, and the family of the late Charles Eliot Norton operated the organization in France and America. This study, making use of unpublished archival material, outlines the history of the Norton-Harjes during the war, from its beginnings in Paris and London, to its activities on the Western Front, and its dissolution in late 1917. Around this historical context, the foundations of the unit are traced to Harvard University and an ideal of humanitarian service and social duty drawing from the late nineteenth-century concept of the gentleman. The war writings of the Norton-Harjes authors are examined in view of this historical and cultural evidence. Affirmation of the artist's role in society and criticism of American industrial-commercialism feature in the work of the authors connected with the unit, themes which gained new impetus from the war. A discussion of Charles Eliot Norton's moral aestheticism, expatriation, teaching at Harvard, and attitudes towards war, along with an outline of the Harvard careers of Norton's sons Eliot and Richard and of the future Norton-Harjes writers Cummings, Dos Passos, and Robert Hillyer, make up the chapter following the Introduction, which establishes the background of early American involvement in the war. Henry James' work for the ambulance corps and his move from intense observer to direct participant in war-time is explored in the third chapter. The fourth chapter presents the bulk of the historical information about the unit's war activities while examining the career and writings of Richard Norton, founder and leader of the corps. The succeeding three chapters are devoted to the ambulance volunteers who studied together at Harvard. E. E. Cummings' The Enormous Room is interpreted in light of the author's whole experience with the Norton-Harjes, emphasizing his use of primitivism in support of aesthetic individualism. Robert Hillyer's traditionalism stands opposed to Cummings' Modernist experimentation, but the Harvard professor-poet was equally critical of American industrialism. John Dos Passos' war novels attack the commercial basis of American culture and present as alternatives the rural culture of Spain and the ideal of the gentlemen volunteers as represented by Richard Norton. A brief Epilogue describes the last stage of Norton's war career and the post-war attempts to organize former volunteers into an association and to produce a history of the ambulance service.
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Vincelette, Mélanie. "Nomadismes, suivi de Le sérail dans le récit de voyage en Orient." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ64204.pdf.
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Harfouch, Mohammad. "A critical analysis of the works of David Hare." Thesis, University of Sheffield, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262709.
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Hasler, Antony J. "Allegories of authority in the poems of John Skelton, Stephen Hawes and William Dunbar." Thesis, University of Cambridge, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343403.
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Homden, Carol. "A war on two fronts : The plays of David Hare 1973-86." Thesis, University of East Anglia, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329324.
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This thesis, which encompasses a comprehensive survey of David Hare's published plays from the period 1973-86, examines his work as a product of a war on two fronts - with conventional/established British history and within himself about the nature of socialist ideals. The result is a challenge to the tendency to place him within a European tradition of documentary or Epic Theatre initiated by Erwin Piscator and Bertolt Brecht. Nevertheless, to resolve his own conflicts, Hare commonly uses distancing techniques. He sets his plays in the past, he mediates his (necessarily male) perspective through women protagonists and the action is frequently located at a geographical distance - either in the English provinces or beyond England altogether. His search is to accommodate the modern and to achieve a valid perspective from which to make a moral judgement within the clamour of conflicting propagandas. His use of film and television - Hare writes, edits and directs his own work - reflects this search for a single perspective. What might seem a political anger stands revealed as a form of revenge against a supposed class alienation and generational disinheritance. The war on two fronts is not - as is commonly supposed- the world war and the class war, but the nature of history and of the self. In this sense Hare's work is classical, based on the dualism of good and evil, life and death. This is evident from as early as 1975, when an extended exploration of the nature of art commences. After a period of self-conscious argument, history becomes a matter of personal memory and of catharsis rather than of political solution, and art itself the only salvation.
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Fendrich, Raphaël [Verfasser]. "Grenzland und Erinnerungsland : Die Identität des Elsass im Werk Marie Harts (1856-1924) / Raphael Fendrich." Baden-Baden : Ergon Verlag, 2018. http://d-nb.info/1212401786/34.
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Fendrich, Raphael [Verfasser]. "Grenzland und Erinnerungsland : Die Identität des Elsass im Werk Marie Harts (1856-1924) / Raphael Fendrich." Baden-Baden : Ergon Verlag, 2018. http://d-nb.info/1212401786/34.
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Phelps, Paul Chandler. "'Wounded Harts' : metaphor and desire in the epic-romances of Tasso, Sidney, and Spenser." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:6314229f-2797-4727-91c8-64265a16f6b3.
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If we consider the representation of the body in the epic-romances of Torquato Tasso, Philip Sidney, and Edmund Spenser, certain instances of wounding and laceration emerge as crucial turning points in the development of their respective narratives: Clorinda’s redemptive mutilation, Parthenia’s blood-drenched pallor, Amavia’s disquieting suicide, Venus’s insatiable orifice, Amoret’s “perfect hole.” This thesis affords a detailed comparative study of such passages, contending that the wound assumed a critical metaphoric dimension in sixteenth-century epic-romance literature, particularly in relation to the perceived association between body condition and erotic desire. Along with its function as a marker of martial valor and somatic sacredness, the wound, I argue, increasingly is designated in these epic-romances as an interiorizing apparatus, one liable to accrue at any instance into a surplus of unanticipated meaning. As such, the wound becomes an emblem in these texts of what I call the phenomenology of desire—the equation of consummation and loss—as well as the aesthetic and metaphoric mechanism by which these writers seek to overcome it. The four chapters of this thesis constitute individual but cumulative points of response to the problem of thinking about desire as a type of wound. For Tasso, a wound poses a challenge to physical, psychological, and spiritual integrity, but its remarkable capacity for aestheticization also allows Tasso to envision it as a synthesizer of sacred and erotic affects. For Sidney, the prospect that a wound could define a body as courageous or pathetic, as sacred or corrupt, became both politically and socially troubling, and the New Arcadia, I argue, proleptically attempts to defend Sidney against interpretations of wounds that register them as manifestations of corrupt desire. For Spenser, body fracture and erotic wounding are analogic (indeed, almost indistinguishable), and The Faerie Queene investigates the prospect that confusing these analogies can become an empowering, even revelatory experience. In each of these epic-romances, a wound serves both a literal and a figurative function and, in this way, is established as the foremost image by which these writers imagine strength and mutilation, affect and heroism, epic and romance as being inextricably bound.
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Hjelt, Pernilla. "Hopp som i hare : Om undanträngningens roll i arbetet med min diktsamling." Thesis, Växjö University, School of Humanities, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-2552.
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The aim of this essay is to analyse what roll repression has had in the making of my unpublished collection of poems entitled Hopp som i hare. I examine how the autobiographical subject abortion has influenced the writing process and the outcome of the poems. By presenting literature that’s been important in the making of the collection I show some thoughts and ideas about Post Abortion Stress Disorder, a diagnosis without scientific grounds. In a discussion I go through the whole writing process from subject and genre choice through the revisions till the final version that were sent to be commented by the class in creative writing at Växjö University 2008. Finally I analyse my own reading before and after the workshop where the class commented the collection. It shows how repression influenced my reading before the workshop and how the class comments changed the way I red it afterwards. By hearing the class comment on my collection I also came to the conclusion that the poems was under repression and that constituted the ground of this essay.
Books on the topic "Hares in literature"
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Palatini, Margie. Goldie and the three hares. New York, NY: Katherine Tegen Books, 2010.
Find full textBook chapters on the topic "Hares in literature"
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O’Connor, Sarah. "Hares and Hags: Becoming Animal in Éilís Ní Dhuibhne’s Dún na mBan trí Thine." In Animals in Irish Literature and Culture, 92–104. London: Palgrave Macmillan UK, 2015. http://dx.doi.org/10.1057/9781137434807_7.
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Melman, Billie. "Harem Literature, 1763–1914: Tradition and Innovation." In Women’s Orients: English Women and the Middle East, 1718–1918, 59–76. London: Palgrave Macmillan UK, 1992. http://dx.doi.org/10.1007/978-1-349-10157-3_3.
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Melman, Billie. "Harem Literature, 1763–1914: Tradition and Innovation." In Women’s Orients: English Women and the Middle East, 1718–1918, 59–76. London: Palgrave Macmillan UK, 1995. http://dx.doi.org/10.1007/978-1-349-24197-2_3.
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Melman, Billie. "Harem Literature, 1763–1914: Tradition and Innovation." In Imperialism, 334–51. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003101536-14.
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Heller-Goldenberg, Lucette. "Charef, Mehdi: Le thé au harem d'Archi Ahmed." In Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_3118-1.
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Eagleton, Mary. "‘The Haves’ and ‘The Have-Nots’." In Clever Girls and the Literature of Women's Upward Mobility, 165–88. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-71961-0_7.
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Jarman, Alfred O. H., and Marion Löffler. "Hiraethog, Gwilym: Aelwyd F'Ewythr Robert neu, Hanes Caban F'Ewythr Tomos." In Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_4696-1.
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Burdett, Natalie. "We Try to Keep Sunday Best, Though Mom Hates Sundays." In Smell, Memory, and Literature in the Black Country, 139–40. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-57212-9_14.
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Valovirta, Elina. "Repeated Pleasure: Reading the Threesome Ménage Romance as Digital Literature." In Powerful Prose, 45–62. Bielefeld, Germany: transcript Verlag, 2021. http://dx.doi.org/10.14361/9783839458808-004.
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In this chapter, Elina Valovirta discusses a type of romantic love explored by recent New Adult literature; the polyamorous romance. Titles, such as Two Close for Comfort (2015) and Two Billionaires for Christmas (2017) are examples of the 'reverse harem' or 'MFM menage' e-romance bracket, which capitalizes on the erotic and exotic obstacle of two male friends falling in love with - and, ultimately, sharing - the same woman. The polyamorous romance's particular way of eliciting pleasure in readers is tied with specific stylistic strategies, such as alternating first-person narrators and using the plural form in dialogue. The chapter interrogates, how these elements are repeated throughout the genre to titillate and arouse readers.
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van Rijswijk, Honni. "Harms of the Stolen Generations Claimed Under the Flag: Contesting National World-Making Through Literature." In Flags, Color, and the Legal Narrative, 593–603. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-32865-8_27.
Full textConference papers on the topic "Hares in literature"
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Nuraini, Azizah, and Donald Jupply. "Logical Choice in Hades Does Home Improvement and Its Bahasa Indonesia Translation." In Proceedings of the 10th UNNES Virtual International Conference on English Language Teaching, Literature, and Translation, ELTLT 2021, 14-15 August 2021, Semarang, Indonesia. EAI, 2022. http://dx.doi.org/10.4108/eai.14-8-2021.2317618.
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Simin, Simin. "Smartphone, Generasi Alpha, dan Pembelajaran Matematika: Suatu Kajian Literatur." In Seminar Nasional Penerapan Ilmu Pengetahuan dan Teknologi : kampus merdeka meningkatkan kecerdasan sumberdaya manusia melalui interdispliner ilmu pengetahuan dan teknologi : Pontianak, 24 Agustus 2021. Untan Press, 2021. http://dx.doi.org/10.26418/pipt.2021.46.
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Tulisan ini bertujuan mendeskripsikan penggunaan aplikasi smartphone sebagai media pembelajaran matematika. Generasi alpha merupakan generasi abad ke-21 atau anak-anak yang terlahir di generasi millennial, generasi ini tumbuh dan berinteraksi dengan beragam teknologi. Studi literatur dijadikan dasar dalam membuat tulisan ini. Penulisan dimulai dengan meninjau dari sisi latar belakang, pandangan historis, pengantar smartphone dan seterusnya. Manfaat dan kelemahan penggunaan smartphone sebagai media dalam pembelajaran juga dijadikan fokus penulisan. Dari hasil studi literatur terungkap bahwa banyak manfaat maupun kelemahan tentang penggunaan aplikasi smartphone dalam pembelajaran matematika. Salah satu cara mengoptimalkan penggunaan smartphone adalah dengan memilih aplikasi yang tepat dan bermanfaat. Guru sebagai perencana pengguna aplikasi smartphone dalam pembelajaran juga harus bijak dan tepat dalam memilih aplikasi yang terdapat dalam smartphone. Beberapa saran untuk menghadapi tantangan juga dipaparkan seperti: memberi pengertian kepada orang tua, program pelatihan guru tentang peningkatan kemampuan guru dalam menggunakan media yang berbasiskan smartphone dalam rangka meningkatkan proses pembelajaran, kebijakan yang tepat dalam hal penggunaan smartphone sebagai media pembelajaran matematika, memberikan pengertian dan bimbingan kepada generasi alpha tentang manfaat smartphone yang positif, dan tentang pentingnya pengendalian diri dalam penggunaan smartphone.
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Heiser, Rebecca, Aga Palalas, and Ashley Gollert. "Designing for Digital Wellness: Videoconferencing Guidelines for Inclusion." In Tenth Pan-Commonwealth Forum on Open Learning. Commonwealth of Learning, 2022. http://dx.doi.org/10.56059/pcf10.4810.
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Digital wellness intends to promote academic achievement and holistic wellbeing while avoiding the potential harms of technology in the application of videoconferencing solutions. Drawing from extant literature in a systematic review, we found six design themes for course designers to utilize, create, and plan inclusive learning experiences in videoconferencing learning spaces. Based on our examination of the following themes, accessibility, active learning strategies, multimodal communication, readiness, social presence, and socio-cultural sensitivity, we have provided guiding questions to inform design considerations for digital wellness and inclusive learning through videoconferencing technologies.
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Rafikasari, Astri. "Pemetaan Elit Politik Lokal di Pulau Biak dan Pengaruhnya terhadap Rencana Pembangunan Bandar Antariksa." In Seminar Nasional Kebijakan Penerbangan dan Antariksa II. Bogor: In Media, 2018. http://dx.doi.org/10.30536/p.sinaskpa.ii.6.
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Tulisan ini mejelaskan kondisi sosial-budaya dan politik di Pulau Biak, pemetaan terhadap elit politik lokal, dan mengidentifikasi karakteristiknya untuk dihubungkan pengaruhnya terhadap rencana pembangunan bandar antariksa. Metodologi yang digunakan adalah kualitatif deskriptif dengan studi literatur dan wawancara. Masyarakat di Pulau Biak masih menjunjung nilai adat istiadat, serta banyak elit politik lokal yang memiliki posisi kuat dalam mempengaruhi kebijakan daerah. Berkaitan dengan rencana pembangunan bandar antariksa maka pertanyaan pokok yang akan dijawab dalam artikel ini adalah: Bagaimana Karakteristik Elit Politik Lokal di Pulau Biak dan Sejauh mana Pengaruhnya Terhadap Rencana Pembangunan Bandar Antariksa? Elit politik di Biak tercipta dari kehidupan adat istiadat serta adanya Otonomi Khusus Papua. Elit politik lokal di Pulau Biak dipetakan menjadi 2 kelompok menggunakan teori Pareto, yaitu governing elite dan non-governing elite. Governing elit cenderung berkarakter pro pada rencana pembangunan bandar antariksa, sedangkan nongoverning elite kontra terhadap rencana pembangunan bandar antariksa di Biak. Elit politik lokal di Biak menjadi poin penting dalam mendukung keberlanjutan rencana pembangunan bandar antariksa yang harus diperhatikan. Sehingga rekomendasi dari tulisan ini adalah pentingnya dialog sektoral inklusif diantara elit politik lokal di Biak sebagai langkah optimalisasi peran elit politik lokal Biak dalam proses pembangunan bandar antariksa ke depan. Selain itu rencana pembangunan bandar antariksa juga harus memperhatikan kearifan lokal di Biak sebagai upaya meminimalkan potensi cost and conflict yang akan terjadi.
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Aljuaid, Awad. "Hypoglycemia Vehicle Detection System Using Non-Invasive Sensors Applying Both EEG And HRV Real Time Measures: Neuroergonomics Theoretical Design." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1001480.
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During COVID 19 pandemic the global needs for online shopping, ride-sharing transportation, and food delivery services have been dramatically increased. The drivers who suffer from diabetes especially low blood sugar level (Hypoglycemia) are more likely at risk than others. Earlier literature has revealed that hypoglycemic issues in patients with diabetes are correlated with significant changes in scalp electroencephalography (EEG); signals amplitude (time domain) or power spectral density (frequency domain). In addition, Haret rate variability HRV which reflects the balance between the sympathetic and parasympathetic nervous system has been proven as one of the indicators of Hypoglycemia. The aim of this paper to propose a conceptual design of a Vehicle detection system using both EEG and HRV measures at the same time in real time feed using non-invasive sensors to reduce the potential of driver’s cognitive dysfunction.
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Lang, Eddy, and Samantha Craigie. "9 Preventionplus: a free access literature awareness portal that surveilles high quality research and guidelines to inform the harms and benefits of screening and prevention strategies in healthcare." In Preventing Overdiagnosis, Abstracts, August 2018, Copenhagen. BMJ Publishing Group Ltd, 2018. http://dx.doi.org/10.1136/bmjebm-2018-111070.9.
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Lim, D., R. Seliktar, J. Wee, L. Nunes, and E. Farrell. "Morphological and Elastic Properties of the Glenoid Region of the Shoulder." In ASME 2003 International Mechanical Engineering Congress and Exposition. ASMEDC, 2003. http://dx.doi.org/10.1115/imece2003-43054.
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Researchers have tried to assess the morphological and mechanical characteristics of bone using various methods with a limited success (Mow and Hayes, 1997, and Cowin, 2001). This may be due to the complexity for documentation and characterization of architecture by the anisotropic and nonhomogeneous characteristic of the bone. The bones of the shoulder joint complex are particularly deprived of information on their mechanical and morphological properties. Very little is known for example on the mechanics and morphology of the glenoid of the shoulder. The present work presents an attempt to identify a proper method for the measurement and characterization of the morphology and mechanics of bone, particularly in the glenoid. Our results show that trabecular lines are directed at 82.15° ± 7.98° relative to the glenoid articular surface, young’s modulus obtained from CT scan was 230 ± 8 MP, and the elastic tensors obtained from cadaver were 326 ± 78 MPa for E2222, 144 ± 22 MPa for E1111=E3333, 49 ± 7 MPa for E3311, 59 ± 9 MPa for E1122=E2233, 51 ± 8 MPa for E1313, and 70 ± 10 MPa for E1212=E2323. These results were consistent with Wolf’s Law and were in agreement with results reported in literatures (Anglin et al., 1999, Frich et al., 1998, and Mansat et al., 1998).
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Albeanu, Grigore, and Marin Vlada. "NEUTROSOPHIC APPROACHES IN E-LEARNING ASSESSMENT." In eLSE 2014. Editura Universitatii Nationale de Aparare "Carol I", 2014. http://dx.doi.org/10.12753/2066-026x-14-208.
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Due to the large number of variables necessary to evaluate the e-learning and their imprecision or uncertainty aspects, a new approach based on neutrosophy [4] can provide a better interpretation of the assessment results. The following classes of variables will be modelled by neutrosophic entities (sets, numbers, logics, probabilities, statistics): learner variables - including learner attitude and motivation, learning environment variables - including real, augmented or virtual environments, contextual variables - including informal, formal, or adult education, technology variables - including classic and new paradigms like mobile, and cloud/fog environments, and pedagogic variables - including methodologies, examination, and certification. Every variable is defined under both crisp and neutrosophic views. E-learning metrics are reviewed and extended to support neutrosophic computing models using [1]. Finally, considerations on implementing an automated tool for e-assessment of e-learning under classic and neutrosophic approaches are presented. The work uses the Smarandache's development on neutrosophy [4], neutrosophic computing models [1], e-learning metrics and assessment procedures available in literature [5] or developed by authors [2, 3]. References: 1. G. Albeanu, Neutrosophic computational models, Analele Universitatii Spiru Haret, Seria Matematica-Informatica, 2(2013). 2. G. Albeanu, e-Learning metrics, Proceedings of ICVL, 2007: http://www.cniv.ro/2007/disc2/icvl/documente/pdf/invited/invited2.pdf 3. G. Albeanu, Quality indicators and metrics for capability and maturity in e_learning, http://adlunap.ro/eLSE_publications/papers/2007/lucrare_21.pdf 4. F. Smarandache, Neutrosophy, http://www.gallup.unm.edu/~smarandache/neutrosophy.htm 5. Graham Attwell (ed.), Evaluating E-Learning: A Guide to the Evaluation of E-Learning, Evaluate Europe Handbook Series Volume 2, Leonardo da Vinci Programme, 2006.
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Vele, Kimberly, Jessica Cavalli, and Anita Cservenka. "Effort-Based Decision Making and Self-Reported Apathy in Frequent Cannabis Users and Healthy Controls." In 2021 Virtual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2022. http://dx.doi.org/10.26828/cannabis.2022.01.000.28.
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Background: Cannabis use rates have been escalating in recent years within the United States, and the effects of cannabis on motivation and effort-based decision making have been of increased interest. Amotivational syndrome is a term used to refer to lack of motivation, passive personality, non-productive behavior, and lower educational attainment related to chronic cannabis use. However, past literature has reported mixed findings for the effects of cannabis on motivation across both behavioral and self-report studies; therefore, the current study aimed to evaluate the association between frequent cannabis use, motivated behavior, and self-reported apathy in individuals 18 years and older. Methods: Cannabis users who reported, on average, 3 or more days/week of cannabis use over the past year, and healthy controls who reported once/month or less cannabis use over the past year were recruited. Participants withheld from substance use 12 hours prior to the study visit. They completed a breathalyzer test, urine toxicology screen, the Apathy Evaluation Scale (AES), and the Effort Expenditure for Rewards Task (EEfRT), a computerized button-pressing task that measures effort-based decision making whereby individuals must increase effort for monetary reward. There were no significant differences between groups on any demographic characteristics except for past 30-day alcohol use (p = 0.001), and depression scores (p = 0.005; determined by the Beck Depression Inventory-II), which were both greater in cannabis users relative to healthy controls. A repeated measures analysis of covariance (ANCOVA) was used to examine the effects of Group, reward magnitude, probability, and their interaction on hard task selections on the EEfRT, controlling for alcohol and depressive symptoms. A separate ANCOVA examined between-group differences on the AES with the same covariates. Results: The main results indicated that relative to healthy controls, cannabis users were significantly more likely to select hard tasks on the EEfRT regardless of reward magnitude or probability of winning the reward (p = 0.014, partial η2=0.10). Self-reported apathy was higher in cannabis users relative to controls (p = 0.02), but after controlling for alcohol use and depressive symptoms, these group differences were no longer significant (p = 0.46). Furthermore, the number of hard task selections on the EEfRT was not significantly related to self-reported apathy in cannabis users (p = 0.68), or healthy controls (p = 0.52). Conclusions: These findings indicate that cannabis users exhibit a greater likelihood of exerting more effort for reward, suggesting enhanced motivation relative to healthy controls. Thus, the current results do not support the amotivation hypothesis in adult frequent cannabis users. Despite some harms of frequent cannabis use, amotivation may not be among them.
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Stout, Madison, Juan Barrera-Barker, Alexis Blessing, Patricia Russell, and Sandra Morissette. "The Influence of Anxiety and Avoidant Coping Style on Probable CUD." In 2022 Annual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2022. http://dx.doi.org/10.26828/cannabis.2022.02.000.11.
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Introduction: Cannabis is frequently used to cope with anxiety symptoms (Sexton et al., 2016). Unfortunately, individuals with anxiety are also at greater risk for developing probable cannabis use disorder (CUD; Marel et al., 2019), although mechanisms are not well understood. Previous literature suggests avoidant coping styles (AVC) are associated with higher anxiety levels, whereas action oriented coping styles (AOC) are associated with lower anxiety levels (Ribadier & Varescon, 2019). While cannabis coping motives are a significant predictor of probable CUD for those with anxiety (Buckner & Zvolensky, 2014), no research has identified how anxiety and specific coping styles predict probable CUD. The aim of the present study was to determine how AVC and AOC interact with anxiety to predict the presence of probable CUD. It was hypothesized that overall individuals with high anxiety would be more likely to endorse probable CUD than low anxiety. Among both anxiety levels, AVC would be more likely to have probable CUD than those with low AVC. Furthermore, individuals with high anxiety and high AOC would be less likely to have probable CUD, compared with those with low AOC, even when anxiety is high. Methods: College students (N = 371; 72.2% female) who used cannabis in the past six months were recruited as part of a study examining the influence of cannabis use on academic success. Participants completed self-report measures to assess anxiety (DASS-21), coping (B-COPE), and probable CUD (CUDIT-R). A confirmatory factor analysis was used to derive coping subscales using items from the B-COPE (Grosso et al., 2014). Results: The data was analyzed through a logistic regression conducted in HAYES Process Macro. Even after controlling for gender, anxiety (b = .032, SE = .016, p = .046) was a positive significant predictor of probable CUD, however neither AOC (b = .030, SE = .025, p = .221) or AVC (b = .048, SE = .056, p = .392) were significant predictors of probable CUD. The interaction between Anxiety X AVC on probable CUD was significant (b = -.011, SE = .005, p = .026), indicating that those with low anxiety and high AVC were more likely to have probable CUD than those with low anxiety and low AVC; however, this interaction did not apply when anxiety levels were high. The interaction between AOC and anxiety was not significant (b = .004, SE = .003, p = .134), which did not support our initial hypothesis. Discussion: Even when anxiety levels are low, individuals with higher AVC are more likely to endorse probable CUD. In contrast, individuals with higher anxiety are more likely to exhibit probable CUD, regardless of AVC levels. Interestingly, anxiety and AOC did not interact to predict probable CUD, suggesting that risk for CUD may be more about what people avoid than what they do to actively cope. These findings emphasize the importance of targeting both anxiety and AVC when considering risk for probable CUD. Longitudinal data are needed to examine how anxiety and AVC contribute to the development of CUD over time.
Reports on the topic "Hares in literature"
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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.
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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.
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Murad, M. Hassan, Stephanie M. Chang, Celia Fiordalisi, Jennifer S. Lin, Timothy J. Wilt, Amy Tsou, Brian Leas, et al. Improving the Utility of Evidence Synthesis for Decision Makers in the Face of Insufficient Evidence. Agency for Healthcare Research and Quality (AHRQ), April 2021. http://dx.doi.org/10.23970/ahrqepcwhitepaperimproving.
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Background: Healthcare decision makers strive to operate on the best available evidence. The Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) Program aims to support healthcare decision makers by producing evidence reviews that rate the strength of evidence. However, the evidence base is often sparse or heterogeneous, or otherwise results in a high degree of uncertainty and insufficient evidence ratings. Objective: To identify and suggest strategies to make insufficient ratings in systematic reviews more actionable. Methods: A workgroup comprising EPC Program members convened throughout 2020. We conducted interative discussions considering information from three data sources: a literature review for relevant publications and frameworks, a review of a convenience sample of past systematic reviews conducted by the EPCs, and an audit of methods used in past EPC technical briefs. Results: Several themes emerged across the literature review, review of systematic reviews, and review of technical brief methods. In the purposive sample of 43 systematic reviews, the use of the term “insufficient” covered both instances of no evidence and instances of evidence being present but insufficient to estimate an effect. The results of the literature review and review of the EPC Program systematic reviews illustrated the importance of clearly stating the reasons for insufficient evidence. Results of both the literature review and review of systematic reviews highlighted the factors decision makers consider when making decisions when evidence of benefits or harms is insufficient, such as costs, values, preferences, and equity. We identified five strategies for supplementing systematic review findings when evidence on benefit or harms is expected to be or found to be insufficient, including: reconsidering eligible study designs, summarizing indirect evidence, summarizing contextual and implementation evidence, modelling, and incorporating unpublished health system data. Conclusion: Throughout early scoping, protocol development, review conduct, and review presentation, authors should consider five possible strategies to supplement potential insufficient findings of benefit or harms. When there is no evidence available for a specific outcome, reviewers should use a statement such as “no studies” instead of “insufficient.” The main reasons for insufficient evidence rating should be explicitly described.
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Kain, Dylan, Nathan M. Stall, Vanessa Allen, Gerald A. Evans, Jessica Hopkins, Fiona G. Kouyoumdjian, Allison McGeer, et al. Routine Asymptomatic SARS-CoV-2 Screen Testing of Ontario Long-Term Care Staff After COVID-19 Vaccination. Ontario COVID-19 Science Advisory Table, March 2021. http://dx.doi.org/10.47326/ocsat.2021.02.15.1.0.
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SARS-CoV-2 screen testing is routine serial testing of asymptomatic individuals outside of outbreak or known exposure settings to identify staff infectious with SARS-CoV-2 and exclude them from work. Routine asymptomatic screen testing of staff has been proposed as a potential mitigating strategy to reduce SARS-CoV-2 introduction and transmission in long-term care (LTC) homes. A rapid review of the literature found no real-world evidence to either support or refute screen testing in preventing LTC home COVID-19 outbreaks. There are several direct harms associated with screen testing, as well as opportunity costs, including exacerbating LTC staffing shortages. On the basis of the evidence reviewed, and given the high rates of protection of COVID-19 vaccines against symptomatic and asymptomatic SARS-CoV-2 infection, the potential harms and costs of screen testing among vaccinated LTC home staff likely outweigh the benefits.
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Li, Shujuan, Qiaoqiao Zhu, Juan Wu, and Yuping Sa. Clinical Evidence for Acupuncture Related to the Improvement of Female Stress Urinary Incontinence:A systematic Review and Meta-Analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, May 2022. http://dx.doi.org/10.37766/inplasy2022.5.0135.
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Review question / Objective: The purpose of this systematic review is to evaluate the effect of acupuncture on SUI and the quality of life-based on the latest literature. Condition being studied: At least 25% of adult females in the world have urinary incontinence in some measure, of which more than half are stress urinary incontinence (SUI). SUI seriously affects the mental health of patients, but also leads to perineal rash, urinary tract infection, and other harms. The American Urological Association recommends pelvic floor muscle training (PFMT) as a conservative treatment for patients with mild to moderate SUI, but the cost of treatment is the main obstacle to its wide use of it. Acupuncture is one of the traditional therapies in ancient China, which is simple and cheap. Some systematic reviews and meta-analyses provide evidence for acupuncture in the treatment of SUI. Due to the quality of the study, these research results are not very reliable.
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Viswanathan, Meera, Jennifer Cook Middleton, Alison Stuebe, Nancy Berkman, Alison N. Goulding, Skyler McLaurin-Jiang, Andrea B. Dotson, et al. Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Agency for Healthcare Research and Quality (AHRQ), April 2021. http://dx.doi.org/10.23970/ahrqepccer236.
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Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.
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Treadwell, Jonathan R., Mingche Wu, and Amy Y. Tsou. Management of Infantile Epilepsies. Agency for Healthcare Research and Quality (AHRQ), October 2022. http://dx.doi.org/10.23970/ahrqepccer252.
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Objectives. Uncontrolled seizures in children 1 to 36 months old have serious short-term health risks and may be associated with substantial developmental, behavioral, and psychological impairments. We evaluated the effectiveness, comparative effectiveness, and harms of pharmacologic, dietary, surgical, neuromodulation, and gene therapy treatments for infantile epilepsies. Data sources. We searched Embase®, MEDLINE®, PubMed®, the Cochrane Library, and gray literature for studies published from January 1, 1999, to August 19, 2021. Review methods. Using standard Evidence-based Practice Center methods, we refined the scope and applied a priori inclusion criteria to the >10,000 articles identified. We ordered full text of any pediatric epilepsy articles to determine if they reported any data on those age 1 month to <36 months. We extracted key information from each included study, rated risk of bias, and rated the strength of evidence. We summarized the studies and outcomes narratively. Results. Forty-one studies (44 articles) met inclusion criteria. For pharmacotherapy, levetiracetam may cause seizure freedom in some patients (strength of evidence [SOE]: low), but data on other medications (topiramate, lamotrigine, phenytoin, vigabatrin, rufinamide, stiripentol) were insufficient to permit conclusions. Both ketogenic diet and the modified Atkins diet may reduce seizure frequency (SOE: low for both). In addition, the ketogenic diet may cause seizure freedom in some infants (SOE: low) and may be more likely than the modified Atkins diet to reduce seizure frequency (SOE: low). Both hemispherectomy/hemispherotomy and non-hemispheric surgical procedures may cause seizure freedom in some infants (SOE: low for both), but the precise proportion is too variable to estimate. For three medications (levetiracetam, topiramate, and lamotrigine), adverse effects may rarely be severe enough to warrant discontinuation (SOE: low). For topiramate, non-severe adverse effects include loss of appetite and upper respiratory tract infection (SOE: moderate). Harms of diets were sparsely reported. For surgical interventions, surgical mortality is rare for functional hemispherectomy/hemispherotomy and non-hemispheric procedures (SOE: low), but evidence was insufficient to permit quantitative estimates of mortality or morbidity risk. Hydrocephalus requiring shunt placement after multilobar, lobar, or focal resection is uncommon (SOE: low). No studies assessed neuromodulation or gene therapy. Conclusions. Levetiracetam, ketogenic diet, modified Atkins diet, and surgery all appear to be effective for some infants. However, the strength of the evidence is low for all of these modalities due to lack of control groups, low patient enrollment, and inconsistent reporting. Future studies should compare different pharmacologic treatments and compare pharmacotherapy with dietary therapy. Critical outcomes underrepresented in the literature include quality of life, sleep outcomes, and long-term development.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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Shumway, Dean A., Kimberly S. Corbin, Magdoleen H. Farah, Kelly E. Viola, Tarek Nayfeh, Samer Saadi, Vishal Shah, et al. Partial Breast Irradiation for Breast Cancer. Agency for Healthcare Research and Quality (AHRQ), January 2023. http://dx.doi.org/10.23970/ahrqepccer259.
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Objectives. To evaluate the comparative effectiveness and harms of partial breast irradiation (PBI) compared with whole breast irradiation (WBI) for early-stage breast cancer, and how differences in effectiveness and harms may be influenced by patient, tumor, and treatment factors, including treatment modality, target volume, dose, and fractionation. We also evaluated the relative financial toxicity of PBI versus WBI. Data sources. MEDLINE®, Embase®, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and various grey literature sources from database inception to June 30, 2022. Review methods. We included randomized clinical trials (RCTs) and observational studies that enrolled adult women with early-stage breast cancer who received one of six PBI modalities: multi-catheter interstitial brachytherapy, single-entry catheter brachytherapy (also known as intracavitary brachytherapy), 3-dimensional conformal external beam radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), proton radiation therapy, intraoperative radiotherapy (IORT). Pairs of independent reviewers screened and appraised studies. Results. Twenty-three original studies with 17,510 patients evaluated the comparative effectiveness of PBI, including 14 RCTs, 6 comparative observational studies, and 3 single-arm observational studies. PBI was not significantly different from WBI in terms of ipsilateral breast recurrence (IBR), overall survival, or cancer-free survival at 5 and 10 years (high strength of evidence [SOE]). Evidence for cosmetic outcomes was insufficient. Results were generally consistent when PBI modalities were compared with WBI, whether compared individually or combined. These PBI approaches included 3DCRT, IMRT, and multi-catheter interstitial brachytherapy. Compared with WBI, 3DCRT showed no difference in IBR, overall survival, or cancer-free survival at 5 and 10 years (moderate to high SOE); IMRT showed no difference in IBR or overall survival at 5 and 10 years (low SOE); multi-catheter interstitial brachytherapy showed no difference in IBR, overall survival, or cancer-free survival at 5 years (low SOE). Compared with WBI, IORT was associated with a higher IBR rate at 5, 10, and over 10 years (high SOE), with no difference in overall survival, cancer-free survival, or mastectomy-free survival (low to high SOE). There were significantly fewer acute adverse events (AEs) with PBI compared with WBI, with no apparent difference in late AEs (moderate SOE). Data about quality of life were limited. Head-to-head comparisons between the different PBI modalities showed insufficient evidence to estimate an effect on main outcomes. There were no significant differences in IBR or other outcomes according to patient, tumor, and treatment characteristics; however, data for subgroups were insufficient to draw conclusions. Eight studies addressed concepts closely related to financial toxicity. Compared with conventionally fractionated WBI, accelerated PBI was associated with lower transportation costs and days away from work. PBI was also associated with less subjective financial difficulty at various time points after radiotherapy. Conclusions. Clinical trials that compared PBI with WBI demonstrate no significant difference in the risk of IBR. PBI is associated with fewer acute AEs and may be associated with less financial toxicity. The current evidence supports the use of PBI in appropriately selected patients with early-stage breast cancer. Further investigation is needed to evaluate the outcomes of PBI in patients with various clinical and tumor characteristics, and to define optimal radiation treatment dose and technique for PBI.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: May 2021 Update. Agency for Healthcare Research and Quality (AHRQ), June 2021. http://dx.doi.org/10.23970/ahrqepccerplantpain3.
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Overview This is the third quarterly progress report for an ongoing living systematic review on cannabis and other plant-based treatments for chronic pain. The first progress report was published in January 2021 and the second in March 2021. The draft systematic review was available for public comment from May 19 through June 15, 2021, on the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care website. The systematic review synthesizes evidence on the benefits and harms of plant-based compounds (PBCs), such as cannabinoids and kratom, used to treat chronic pain, addressing concerns about severe adverse effects, abuse, misuse, dependence, and addiction. The purpose of this progress report is to describe the cumulative literature identified thus far. This report will be periodically updated with new studies as they are published and identified, culminating in an annual systematic review that provides a synthesis of the accumulated evidence. Main Points In patients with chronic (mainly neuropathic) pain with short-term treatment (4 weeks to <6 months): • Studies of cannabis-related products were grouped based on their tetrahydrocannabinol (THC) to cannabidiol (CBD) ratio using the following categories: high THC to CBD, comparable THC to CBD, and low THC to CBD. • Comparable THC to CBD ratio oral spray is probably associated with small improvements in pain severity and may be associated with small improvements in function. There was no effect in pain interference or serious adverse events. There may be a large increased risk of dizziness and sedation, and a moderate increased risk of nausea. • Synthetic THC (high THC to CBD) may be associated with moderate improvement in pain severity and increased risk of sedation, and large increased risk of nausea. Synthetic THC is probably associated with a large increased risk of dizziness. • Extracted whole-plant high THC to CBD ratio products may be associated with large increases in risk of withdrawal due to adverse events and dizziness. • Evidence on whole-plant cannabis, low THC to CBD ratio products (topical CBD), other cannabinoids (cannabidivarin), and comparisons with other active interventions was insufficient to draw conclusions. • Other key adverse event outcomes (psychosis, cannabis use disorder, cognitive deficits) and outcomes on the impact on opioid use were not reported. • No evidence on other plant-based compounds, such as kratom, met criteria for this review.
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Halker Singh, Rashmi B., Juliana H. VanderPluym, Allison S. Morrow, Meritxell Urtecho, Tarek Nayfeh, Victor D. Torres Roldan, Magdoleen H. Farah, et al. Acute Treatments for Episodic Migraine. Agency for Healthcare Research and Quality (AHRQ), December 2020. http://dx.doi.org/10.23970/ahrqepccer239.
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Objectives. To evaluate the effectiveness and comparative effectiveness of pharmacologic and nonpharmacologic therapies for the acute treatment of episodic migraine in adults. Data sources. MEDLINE®, Embase®, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO®, Scopus, and various grey literature sources from database inception to July 24, 2020. Comparative effectiveness evidence about triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) was extracted from existing systematic reviews. Review methods. We included randomized controlled trials (RCTs) and comparative observational studies that enrolled adults who received an intervention to acutely treat episodic migraine. Pairs of independent reviewers selected and appraised studies. Results. Data on triptans were derived from 186 RCTs summarized in nine systematic reviews (101,276 patients; most studied was sumatriptan, followed by zolmitriptan, eletriptan, naratriptan, almotriptan, rizatriptan, and frovatriptan). Compared with placebo, triptans resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (high strength of the body of evidence [SOE]). Data on NSAIDs were derived from five systematic reviews (13,214 patients; most studied was ibuprofen, followed by diclofenac and ketorolac). Compared with placebo, NSAIDs probably resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (moderate SOE). For other interventions, we included 135 RCTs and 6 comparative observational studies (37,653 patients). Compared with placebo, antiemetics (low SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), and acetaminophen (moderate SOE) reduced acute pain. Opioids were evaluated in 15 studies (2,208 patients).Butorphanol, meperidine, morphine, hydromorphone, and tramadol in combination with acetaminophen may reduce pain at 2 hours and 1 day, compared with placebo (low SOE). Some opioids may be less effective than some antiemetics or dexamethasone (low SOE). No studies evaluated instruments for predicting risk of opioid misuse, opioid use disorder, or overdose, or evaluated risk mitigation strategies to be used when prescribing opioids for the acute treatment of episodic migraine. Calcitonin gene-related peptide (CGRP) receptor antagonists improved headache relief at 2 hours and increased the likelihood of being headache-free at 2 hours, at 1 day, and at 1 week (low to high SOE). Lasmiditan (the first approved 5-HT1F receptor agonist) restored function at 2 hours and resolved pain at 2 hours, 1 day, and 1 week (moderate to high SOE). Sparse and low SOE suggested possible effectiveness of dexamethasone, dipyrone, magnesium sulfate, and octreotide. Compared with placebo, several nonpharmacologic treatments may improve various measures of pain, including remote electrical neuromodulation (moderate SOE), magnetic stimulation (low SOE), acupuncture (low SOE), chamomile oil (low SOE), external trigeminal nerve stimulation (low SOE), and eye movement desensitization re-processing (low SOE). However, these interventions, including the noninvasive neuromodulation devices, have been evaluated only by single or very few trials. Conclusions. A number of acute treatments for episodic migraine exist with varying degrees of evidence for effectiveness and harms. Use of triptans, NSAIDs, antiemetics, dihydroergotamine, CGRP antagonists, and lasmiditan is associated with improved pain and function. The evidence base for many other interventions for acute treatment, including opioids, remains limited.