ObjectiveTo compare the effects of treatments for coronavirus disease 2019 (covid-19).DesignLiving systematic review and network meta-analysis.Data sourcesUS Centers for Disease Control and Prevention COVID-19 Research Articles Downloadable Database, which includes 25 electronic databases and six additional Chinese databases to 20 July 2020.Study selectionRandomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.MethodsAfter duplicate data abstraction, a bayesian random effects network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance.Results23 randomised controlled trials were included in the analysis performed on 26 June 2020. The certainty of the evidence for most comparisons was very low because of risk of bias (lack of blinding) and serious imprecision. Glucocorticoids were the only intervention with evidence for a reduction in death compared with standard care (risk difference 37 fewer per 1000 patients, 95% credible interval 63 fewer to 11 fewer, moderate certainty) and mechanical ventilation (31 fewer per 1000 patients, 47 fewer to 9 fewer, moderate certainty). These estimates are based on direct evidence; network estimates for glucocorticoids compared with standard care were less precise because of network heterogeneity. Three drugs might reduce symptom duration compared with standard care: hydroxychloroquine (mean difference −4.5 days, low certainty), remdesivir (−2.6 days, moderate certainty), and lopinavir-ritonavir (−1.2 days, low certainty). Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, and remdesivir probably does not substantially increase the risk of adverse effects leading to drug discontinuation. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation.ConclusionGlucocorticoids probably reduce mortality and mechanical ventilation in patients with covid-19 compared with standard care. The effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations.Systematic review registrationThis review was not registered. The protocol is included as a supplement.Readers’ noteThis article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

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The purpose of this paper is to present the clinical and radiological correlation of 360 intracerebral lesions placed in 300 patients who underwent surgery for the treatment of Parkinson's disease. These cases represent a consecutive series of patients, part of a total of more than 800 basal ganglia operations performed on our service since 1952. Details of the surgical technique employed have already been reported (St. Barnabas Symposium on "Surgical Therapy of Extrapyramidal Disorders", 1956;Cooper, 1956;Cooper and Bravo, 1958a).The cases selected for this study have been those operated on by using the balloon cannula technique (Bravo and Cooper, 1957) which allows testing of the physiological effects of a temporary lesion before the injection of alcohol and, by creating a small cavity, facilitates the production of a well-circumscribed alcohol lesion (Cooper and Bravo, 1958b). Such lesions, when the alcohol has been mixed with pantopaque, can be visualized radiographically.In an earlier report we presented the anatomical evidence and the corresponding radiological landmarks obtained as a result of a study carried out in 65 cadaver brains . In that report we studied the anatomical location of 120 intracerebral lesions visualized radiographically and confirmed by anatomical studies of each brain. The conclusions of that paper regarding the radiological and anatomical correlations of certain lesions have been confirmed by other investigators (Amador, personal communication). The results of our anatomical study are also in essential agreement with the data that can be obtained from some of the available brain atlases (Stelmasiak, 1956;Spiegel and Wycis, 1952).The surgical target in the present series of patients was the globus pallidus and/or the thalamus. In our anatomical studies we were also concerned with the radiological projection of these structures and estimation of limits of safety according to shape and size of the skull, size of the ventricles, and relative position of the foramen of Monro and pineal gland. As a result of continuing investigations a series of intracerebral structures have been radiographically outlined (Figs. 1 and 2) and the landmarks for the two surgical targets, namely the mesial globus pallidus and ventrolateral thalamus, were established (Cooper, Bravo, Riklan, Davidson, and Gorek, 1958). The results of the earlier studies can now be related to radiographically visualized lesions in patients.In this paper we are going to consider the radiological location of these lesions in terms of the neurological results which they produced. With the information obtained from the cadaver study it is possible to correlate, with a fair degree of accuracy, the anatomical site of these lesions with the observed effects. However, until definite anatomical proof of the structures involved can be shown, when and if the brains of those patients come to post-mortem examination, we should limit ourselves to an evaluation of the clinical and radiological data. Material and MethodsThree hundred consecut...

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Background: With the aging of the population, the number of older drivers is on the rise. This poses significant challenges for public health initiatives, as older drivers have a relatively higher risk for collisions. While many studies focus on developing screening tools to identify medically at-risk drivers, little research has been done to develop training programs or interventions to promote, maintain or enhance driving-related abilities among healthy individuals. The purpose of this systematic review is to synopsize the current literature on interventions that are tailored to improve driving in older healthy individuals by working on components of safe driving such as: selfawareness, knowledge, behaviour, skills and/or reducing crash/collision rates in healthy older drivers. Methods: Relevant databases such as Scopus and PubMed databases were selected and searched for primary articles published in between January 2007 and December 2017. Articles were identified using MeSH search terms: ("safety" OR "education" OR "training" OR "driving" OR "simulator" OR "program" OR "countermeasures") AND ("older drivers" OR "senior drivers" OR "aged drivers" OR "elderly drivers"). All retrieved abstracts were reviewed, and full texts printed if deemed relevant. Results: Twenty-five (25) articles were classified according to: 1) Classroom settings; 2) Computer-based training for cognitive or visual processing; 3) Physical training; 4) In-simulator training; 5) On-road training; and 6) Mixed interventions. Results show that different types of approaches have been successful in improving specific driving skills and/or behaviours. However, there are clear discrepancies on how driving performance/behaviours are evaluated between studies, both in terms of methods or dependent variables, it is therefore difficult to make direct comparisons between these studies. Conclusions: This review identified strong study projects, effective at improving older drivers' performance and thus allowed to highlight potential interventions that can be used to maintain or improve older drivers' safety behind the wheel. There is a need to further test these interventions by combining them and determining their effectiveness at improving driving performance.

BACKGROUND: Worldwide ageing and thus, workforce ageing, is a concern for both developed and developing nations. OBJECTIVE: The aim of the current research was to determine, through a systematic literature review, the effects of age in three dimensions that are often used to define or assess productivity at work. METHODS: PICO framework was used to generate search strategies, inclusion criteria and terms. Scopus and PubMed databases were used. Peer-reviewed journal papers written in English and published (or in press) between January 2014 and December 2018 were included. RESULTS: After filtering through inclusion criteria, 74 papers were included in the review. Considering productivity, 41%of the findings showed no differences between younger and older workers, 31%report better productivity of younger workers and 28%reported that older workers had better productivity than younger workers. Performance was better in older workers (58%), presenteeism generally showed no significant differences between age groups (61%). Absenteeism was the only outcome where younger workers outperformed older workers (43%). CONCLUSION: Overall, there was no difference in productivity between older and younger workers. Older workers performed better than younger workers, but had more absenteeism, while presenteeism showed no differences. As ageing has come to workplaces, holistic approaches addressing total health are suggested to overcome the worldwide workforce ageing phenomenon.

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