The effects of air pollutants CO, NO₂, O₃, PM₁₀ and SO₂ on congenital heart anomalies are represented by the odds ratio of each disease per unit increase in the concentration of each pollutant. In this study, the effects of air pollutants are summarized using multivariate GLS approach with correlation between outcomes being taken into account, where the correlations are sampled from uniform [-1,1]. Meta-analysis conducted here found no statistically significant increase in odds ratio of any disease. This result is different from what Vrijheid et al. 2011 suggested when correlation is not considered using the same set of data. The difference in conclusions from the two meta-analysis indicate that correlation between outcomes may play an important role when synthesizing effect sizes. Thus, before conduct meta-analysis, a thorough consideration about whether to incorporate the correlation in synthesizing should be given. / text

Human memory systems have been divided into two broad domains, one responsible for 'declarative memory' and the other for 'non-declarative memory'. The evidence for multiple memory systems is reviewed with respect to the human SRT, a sensitive measure of non-declarative memory. A qualitative review of the human SRT literature concludes that damage to extrapyramidal brain systems disrupts SRT performance whereas limbic system neuropathology (LSN) leaves performance intact. However, a meta-analysis of the SRT literature with neuropathological patients revealed unexpectedly that patients with explicit memory disorders are impaired on the SRT task, although less severely than patients with extrapyramidal damage. Other evidence suggested that the apparent SRT impairment in humans with LSN might be due to the additional pathology (eg frontal) often evident in these patients. A brief review of the animal evidence for multiple memory systems concluded that, like humans, animals too have multiple memory systems but none of the animal tasks used to model non-declarative memory make good conceptual or behavioural contact with the corresponding human tasks. Thus a novel animal-analogue of the human-SRT task, the 'fan-maze', was developed. Although rats displayed a reasonable ability to perform the fan-maze SRT task it was abandoned due to technical and conceptual problems in favour of a better design. The second new SRT task used intra-cranial self-stimulation to promote prolonged, rapid and continuous responding. A control study determined that the optimal conditions for sequence learning was a single large (2820 trial) session. Intact rats that experienced a switch from the repeating to a random sequence under these conditions demonstrated a clear interference effect, the primary measure of SRT performance. A lesion study used these optimal conditions and showed that small caudate lesions impaired, whereas small hippocampal lesions facilitated, rat-SRT performance. Hence, this second task has proven to be a valid animal-analogue of the human SRT task, as rats performed it in a manner similar to that shown by humans and relied on the same neural substrate to perform the task as humans. In addition, this second task resolved the discrepancy of the LSN meta-analysis. Quantitative findings are reviewed in light of theories and studies presented earlier in the thesis. Limitations of the thesis are identified and suggestions are made as to future SRT research in animals or humans.

The term "attention placebo" has been used in an imprecise and often seemingly thoughtless way for decades, and it is often confusing to encounter "attention placebo group" in outcome studies. The purpose of this study was to investigate attention placebo empirically, focusing on anxiety or phobia related problems. The two aims were (1) to describe and summarize how researchers define attention placebo in empirical studies and the intervention procedures involved in these studies; and (2) to explore the possibility of estimating the magnitude of the attention placebo effects on anxiety or phobia related problems.A thorough literature search was carried out with the keywords of attention placebo synonyms and the resulting list of 1304 articles was screened for unique empirical articles on anxiety or phobia related problems. A total of 545 articles were identified as attention placebo empirical studies, and 83 involved anxiety or phobia related problems. These 83 constituent articles were coded for the purpose of qualitative overview, and 63 articles with sufficient data were included in the meta-analysis of attention placebo effects.The results of the qualitative overview of attention placebo on anxiety or phobia related problems showed that most articles did not discuss explicitly any rationale for using an attention placebo group, but simply included one as a comparison group. The arrangements for attention placebo interventions were diverse and often reflected little concern for emulating the nonspecific features of the treatment(s) of interest. Two meta-analyses were performed based on the comparison of attention placebo and a no-treatment control, and attention placebo and the verum. The overall estimated effect of attention placebo is Hedges's g=0.32, a small effect, significantly different from the effect size of the other control groups. Compared to the verum, the effects of attention placebo are not consistent in magnitude but were nearly all smaller than the effects of the verum treatments. Meta-regression and subgroup analyses indicated that estimating attention placebo effects is a sensible and meaningful research activity.In conclusion, attention placebo is not so much about attention, and it is possible to estimate the effects of attention placebo.

This dissertation makes use of data from three large and detailed rural household surveys conducted in Haiti to examine elements of economic behavior in poor rural households. We use the earliest survey to formulate a set of hypotheses and use statistical meta-analysis to test them against all three surveys. Results in the areas of household vulnerability, form, migration, and education contribute to theory-refinement in Economic Anthropology.

This thesis consists of two sections, the first of which is a systematic review of selfreport measures of mindfulness. The review aims were to evaluate the psychometric properties of each of the identified measures and examine their utility for research and clinical practice. Definitions of mindfulness were central to the differences found between measures, and as such this review also provides an overview of how mindfulness has been conceptualised in the literature. This review has been presented in the format required by the journal, Clinical Psychology Review. The second section is a meta-analysis which examines the efficacy of mindfulnessbased stress reduction (MBSR). Mindfulness-based interventions are increasingly being applied in a range of settings and the evidence base is growing. Specifically, this review aimed to determine the effectiveness of MBSR on quality of life for people suffering from chronic physical health conditions. The methods and results of the meta-analysis are described in detail, followed by a discussion of the findings. A more concise overview is then provided as a journal article, in the format required by the British Journal of Clinical Psychology. The guidelines for submission to both journals are included in Appendix 1 and 2 respectively.

Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

Background: Despite substantial research and development investment in Alzheimer's disease (AD), effective therapeutics remain elusive. Significant emerging evidence has linked cholesterol, beta-amyloid and AD, and several studies have shown a reduced risk for AD and dementia in populations treated with statins. However, while some clinical trials evaluating statins in general AD populations have been conducted, these resulted in no significant therapeutic benefit. By focusing on subgroups of the AD population, it may be possible to detect endotypes responsive to statin therapy. Methods: Here we investigate the possible protective and therapeutic effect of statins in AD through the analysis of datasets of integrated clinical trials, and prospective observational studies. Results: Re-analysis of AD patient-level data from failed clinical trials suggested by trend that use of simvastatin may slow the progression of cognitive decline, and to a greater extent in ApoE4 homozygotes. Evaluation of continual long-term use of various statins, in participants from multiple studies at baseline, revealed better cognitive performance in statin users. These findings were supported in an additional, observational cohort where the incidence of AD was significantly lower in statin users, and ApoE4/ApoE4-genotyped AD patients treated with statins showed better cognitive function over the course of 10-year follow-up. Conclusions: These results indicate that the use of statins may benefit all AD patients with potentially greater therapeutic efficacy in those homozygous for ApoE4.

Mental health professionals are routinely called upon to assess the violence risk of their patients. An increasingly common method for conducting such assessments is the use of structured risk assessment tools. The aim of this thesis was to investigate the utility of such instruments: to identify and explore current uncertainties concerning their applicability and to design a novel measure that could be used as part of a stepped strategy to risk assessment. Though a number of risk assessment tools have been developed and there is a considerable literature concerning their psychometric properties, uncertainty remains regarding their effective use. In order to identify key contemporary uncertainties, a metareview of the forensic assessment literature was conducted. The metareview found that previous systematic reviews and meta-analyses of the risk assessment literature have come to conflicting conclusions on a number of issues, including the comparative predictive validity of risk assessment tools, the efficacy of actuarial tools versus clinical judgement, and the influence of demographic factors and study design characteristics on predictive accuracy. These uncertainties were then investigated in a comprehensive meta-analysis of nine commonly used risk measures. The meta-analysis concluded that there were significant differences between the predictive validity of the risk assessment tools, with instruments designed for more specific purposes performing better than those designed for more general use. Tools performed best when administered to samples demographically similar to their calibration sample. Actuarial instruments and structured clinical judgement were found to perform comparably. The final study presented in this thesis explored the feasibility of a stepped approach to risk assessment in which individuals at very low risk of future violence are screened out prior to resource-intensive clinically based assessment. High-quality national registers were used to construct a simple tool to identify patients with schizophrenia at very low risk of violent conviction after being discharged from hospital. The tool was found to produce high rates of sensitivity as well as high negative predictive values at 1, 2, and 5 years follow.up. In light of the findings of these three studies, risk assessment procedures and guidelines by mental health services and criminal justice systems may need review.

A review of the literature reveals a difference of opinion regarding whether open or closed reduction of condylar fractures produces the best results. It would be beneficial to critically analyze past studies that have directly compared the two methods in an attempt to answer this question. A Medline search for articles using the key words 'mandibular condyle fractures' and 'mandibular condyle fractures surgery' was performed. The articles chosen for the meta-analysis contained data on at least one of the following: postoperative maximum mouth opening, lateral excursion, protrusion, deviation on opening, asymmetry, and joint pain or muscle pain. Several common statistical methods were used to test for differences between open and closed surgery, including the weighted average method for fixed and random effects as well as the Mantel-Haenszel method for fixed effects. Some of the outcome variables were found to be statistically significant but were interpreted with caution because of the poor quality of the studies assessed. There is a need for more standardized data collection as well as patient randomization to treatment groups.

Clustered data often feature nested structures and repeated measures. If coupled with binary outcomes and large samples (>10,000), this complexity can lead to non-convergence problems for the desired model especially if random effects are used to account for the clustering. One way to bypass the convergence problem is to split the dataset into small enough sub-samples for which the desired model convergences, and then recombine results from those sub-samples through meta-analysis. We consider two ways to generate sub-samples: the K independent samples approach where the data are split into k mutually-exclusive sub-samples, and the cluster-based approach where naturally existing clusters serve as sub-samples. Estimates or test statistics from either of these sub-sampling approaches can then be recombined using a univariate or multivariate meta-analytic approach. We also provide an innovative approach for simulating clustered and dependent binary data by simulating parameter templates that yield the desired cluster behavior. This approach is used to conduct simulation studies comparing the performance of the K independent samples and cluster-based approaches to generating sub-samples, the results from which are combined either with univariate and multivariate meta-analytic techniques. These studies show that using natural clusters leaded to lower biased test statistics when the number of clusters and treatment effect were large, as compared to the K independent samples approach for both the univariate and multivariate meta-analytic approaches. And the independent samples approach was preferred when the number of clusters and treatment effect were small. We also apply these methods to data on cancer screening behaviors obtained from electronic health records of n=15,652 individuals and showed that these estimated results support the conclusions from the simulation studies.