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Background: The use of complementary, alternative, and integrative medicine (CAIM) is commonly used among pediatric patients for various conditions. Pediatrics clinicians' and researchers' perceptions towards the incorporation of CAIM therapies have varied. This study aims to investigate the perceptions of both pediatrics researchers and clinicians regarding CAIM., Methods: We conducted a large-scale, international cross-sectional online survey with published pediatrics authors who have published their work in pediatrics medical journals that are indexed in MEDLINE. In total, 34 494 researchers and clinicians were invited to complete the survey. The survey recorded respondents' perceptions on various CAIM therapies. Descriptive statistics were generated from the quantitative survey results. A thematic analysis was conducted for responses to open ended questions., Results: In total, 731 pediatrics clinicians and/or researchers responded to the survey, with about half of the respondents being faculty members/principal investigators (56.10 %) and/or clinicians (43.45 %) and from the Americas (46.56 %) or Europe (30.53 %). Over half of the respondents viewed mind-body therapies favourably (62.01 %) and the fewest respondents held favourable perceptions of biofield therapies (6.98 %). Respondents agreed or strongly agreed that there is value in conducting further research on CAIM therapies (85.52 %) and disagreed or strongly disagreed that they felt comfortable recommending most CAIM therapies to patients (64.83 %). A thematic analysis of our findings demonstrates that many pediatrics clinicians and/or researchers support further research on CAIM., Conclusion: The findings from this study demonstrate that pediatrics clinicians and researchers have varying perceptions towards CAIM therapies. Respondents had the most positive perceptions of mind-body therapies and felt they did not have adequate training on CAIM. Further research is needed to establish more evidence-based educational resources on CAIM., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The field of traditional, complementary, and integrative medicine (TCIM) has garnered increasing attention due to its holistic approach to health and well-being. While the quantity of published research about TCIM has increased exponentially, critics have argued that the field faces challenges related to methodological rigour, reproducibility, and overall quality. This article proposes meta-research as one approach to evaluating and improving the quality of TCIM research. Meta-research, also known as research about research, can be defined as "the study of research itself: its methods, reporting, reproducibility, evaluation, and incentives". By systematically evaluating methodological rigour, identifying biases, and promoting transparency, meta-research can enhance the reliability and credibility of TCIM research. Specific topics of interest that are discussed in this article include the following: 1) study design and research methodology, 2) reporting of research, 3) research ethics, integrity, and misconduct, 4) replicability and reproducibility, 5) peer review and journal editorial practices, 6) research funding: grants and awards, and 7) hiring, promotion, and tenure. For each topic, we provide case examples to illustrate meta-research applications in TCIM. We argue that meta-research initiatives can contribute to maintaining public trust, safeguarding research integrity, and advancing evidence based TCIM practice, while challenges include navigating methodological complexities, biases, and disparities in funding and academic recognition. Future directions involve tailored research methodologies, interdisciplinary collaboration, policy implications, and capacity building in meta-research., Competing Interests: JYN, MSL, JPL, AS, LSW, and HC are part of the editorial board of this journal but this education article was externally peer reviewed and their role for the journal had no bearing on the editorial decision. The authors declare that they have no other competing interests., (© 2024 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

This educational article explores the convergence of open science practices and traditional, complementary, and integrative medicine (TCIM), shedding light on the potential benefits and challenges of open science for the development, dissemination, and implementation of evidence-based TCIM. We emphasize the transformative shift in medical science towards open and collaborative practices, highlighting the limited application of open science in TCIM research despite its growing acceptance among patients. We define open science practices and discuss those that are applicable to TCIM, including: study registration; reporting guidelines; data, code and material sharing; preprinting; publishing open access; and reproducibility/replication studies. We explore the benefits of open science in TCIM, spanning improved research quality, increased public trust, accelerated innovation, and enhanced evidence-based decision-making. We also acknowledge challenges such as data privacy concerns, limited resources, and resistance to cultural change. We propose strategies to overcome these challenges, including ethical guidelines, education programs, funding advocacy, interdisciplinary dialogue, and patient engagement. Looking to the future, we envision the maturation of open science in TCIM, the development of TCIM-specific guidelines for open science practices, advancements in data sharing platforms, the integration of open data and artificial intelligence in TCIM research, and changes in the context of policy and regulation. We foresee a future where open science in TCIM leads to a better evidence base, informed decision-making, interdisciplinary collaboration, and transformative impacts on healthcare and research methodologies, highlighting the promising synergy between open science and TCIM for holistic, evidence-based healthcare solutions., Competing Interests: The authors declare that they have no competing interests., (© 2024 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Understanding the stability of mRNA loaded lipid nanoparticles (mRNA-LNPs) is imperative for their clinical development. Herein, we propose the use of size-exclusion chromatography coupled with dual-angle light scattering (SEC-MALS) as a new approach to assessing mRNA-LNP stability in pure human serum and plasma. By applying a dual-column configuration to attenuate interference from plasma components, SEC-MALS was able to elucidate the degradation kinetics and physical property changes of mRNA-LNPs, which have not been observed accurately by conventional dynamic light scattering techniques. Interestingly, both serum and plasma had significantly different impacts on the molecular weight and radius of gyration of mRNA-LNPs, suggesting the involvement of clotting factors in desorption of lipids from mRNA-LNPs. We also discovered that a trace impurity (~1 %) in ALC-0315, identified as its O-tert-butyloxycarbonyl-protected form, greatly diminished mRNA-LNP stability in serum. These results demonstrated the potential utility of SEC-MALS for optimization and quality control of LNP formulations., Competing Interests: Declaration of competing interest We declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The convergence of traditional, complementary, and integrative medicine (TCIM) with artificial intelligence (AI) is a promising frontier in healthcare. TCIM is a patient-centric approach that combines conventional medicine with complementary therapies, emphasizing holistic well-being. AI can revolutionize healthcare through data-driven decision-making and personalized treatment plans. This article explores how AI technologies can complement and enhance TCIM, aligning with the shared objectives of researchers from both fields in improving patient outcomes, enhancing care quality, and promoting holistic wellness. This integration of TCIM and AI introduces exciting opportunities but also noteworthy challenges. AI may augment TCIM by assisting in early disease detection, providing personalized treatment plans, predicting health trends, and enhancing patient engagement. Challenges at the intersection of AI and TCIM include data privacy and security, regulatory complexities, maintaining the human touch in patient-provider relationships, and mitigating bias in AI algorithms. Patients' trust, informed consent, and legal accountability are all essential considerations. Future directions in AI-enhanced TCIM include advanced personalized medicine, understanding the efficacy of herbal remedies, and studying patient-provider interactions. Research on bias mitigation, patient acceptance, and trust in AI-driven TCIM healthcare is crucial. In this article, we outlined that the merging of TCIM and AI holds great promise in enhancing healthcare delivery, personalizing treatment plans, preventive care, and patient engagement. Addressing challenges and fostering collaboration between AI experts, TCIM practitioners, and policymakers, however, is vital to harnessing the full potential of this integration., (© 2024 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

The definition of complementary, alternative, and integrative medicine (CAIM) remains dynamic and complex despite a steady increase in the popularity/usage of CAIM therapies across the globe. A lack of consistency in how these terms are defined remains a challenge for researchers, clinicians, and national and international organizations (e.g., World Health Organization, National Center for Complementary and Integrative Health) alike. In the present article, we provide a brief history of the use of these terminologies, and then outline the process we took to develop and create an operational definition of complementary, alternative, and integrative medicine. Our operational definition is the first to be informed by a systematic search of four quality-assessed information resource types, ultimately yielding 604 unique CAIM therapies. We then developed a single search string for the most common bibliographic databases using the finalized operational definition list of CAIM therapies. These CAIM therapies were searched against the Therapeutic Research Center's "Natural Medicines" database for all 604 therapies, whereby each item's scientific name and/or synonym was included as a keyword or phrase in the search string. While the current definition is not without limitations and ongoing debates still surround the field, this work is arguably a steppingstone towards enabling increased collaboration and communication amongst healthcare clinicians, researchers, and the public. This operational definition provides a foundation for developing well-coordinated research efforts that will assist in the acceptance and understanding of this field, while also focusing on adopting knowledge translation techniques and efforts for further research advancement and use., (© 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Background: Patients are increasingly utilizing the internet to learn about dietary and herbal supplements (DHSs) for various diseases/conditions, including pain management. Online health information has been found to be inconsistent and of poor quality in prior studies, which may have detrimental effects on patient health. This study assessed the quality of online DHSs consumer health information for pain., Methods: Six search items related to DHSs and pain were used to generate the first 20 websites on Google across four English-speaking countries. The identified 480 webpages produced 68 eligible websites, which were then evaluated using the DISCERN tool. The mean scores and standard deviations (SD) of the reviewers' ratings on each of the 15 DISCERN instrument items as well as the overall total score were calculated., Results: The mean summed score for the 68 eligible websites was 46.6 (SD = 10.1), and the mean overall rating was 3.3 (SD = 0.8). Websites lacked information regarding areas of uncertainty, the effects of no treatment being used, and how treatments affect the overall quality of life. These shortcomings were especially apparent across commercial websites, which frequently displayed bias, failed to report the risks of DHS products, and lacked support for shared decision-making regarding the use of DHSs., Conclusion: Variability exists in the quality of online consumer health information regarding DHS use for pain. Healthcare providers should be aware of and provide guidance to patients regarding the identification of reliable online resources so that they can make informed decisions about DHS use for pain management., (© 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Background: The sharing of health-related information has become increasingly popular on social media. Unregulated information sharing has led to the spread of misinformation, especially regarding complementary, alternative, and integrative medicine (CAIM). This scoping review synthesized evidence surrounding the spread of CAIM-related misinformation on social media during the COVID-19 pandemic., Methods: This review was informed by a modified version of the Arksey and O'Malley scoping review framework. AMED, EMBASE, PsycINFO and MEDLINE databases were searched systematically from inception to January 2022. Eligible articles explored COVID-19 misinformation on social media and contained sufficient information on CAIM therapies. Common themes were identified using an inductive thematic analysis approach., Results: Twenty-eight articles were included. The following themes were synthesized: 1) misinformation prompts unsafe and harmful behaviours, 2) misinformation can be separated into different categories, 3) individuals are capable of identifying and refuting CAIM misinformation, and 4) studies argue governments and social media companies have a responsibility to resolve the spread of COVID-19 misinformation., Conclusions: Misinformation can spread more easily when shared on social media. Our review suggests that misinformation about COVID-19 related to CAIM that is disseminated online contributes to unsafe health behaviours, however, this may be remedied via public education initiatives and stricter media guidelines. The results of this scoping review are crucial to understanding the behavioural impacts of the spread of COVID-19 misinformation about CAIM therapies, and can inform the development of public health policies to mitigate these issues., (© 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Objectives: To create a comprehensive list of all openly available online trainings in scholarly peer review and to analyze their characteristics., Study Design and Setting: A systematic review of online training material in scholarly peer review openly accessible between 2012 and 2022. Training characteristics were presented in evidence tables and summarized narratively. A risk of bias tool was purpose-built for this study to evaluate the included training material as evidence-based., Results: Fourty-two training opportunities in manuscript peer review were identified, of which only twenty were openly accessible. Most were online modules (n = 12, 60%) with an estimated completion time of less than 1 hour (n = 13, 65%). Using our ad hoc risk of bias tool, four sources (20%) met our criteria of evidence-based., Conclusion: Our comprehensive search of the literature identified 20 openly accessible online training materials in manuscript peer review. For such a crucial step in the dissemination of literature, a lack of training could potentially explain disparities in the quality of scholarly publishing., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer., Methods: A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument., Results: From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%)., Conclusions: Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer., Registration: The protocol was registered on PROSPERO (registration number: CRD42022334025)., (© 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Background: Traditional, complementary and integrative medicine (TCIM) is sought by more than 50% of patients with osteoporosis. Despite this, many healthcare providers lack the knowledge to adequately counsel patients on safe and effective TCIM use. The purpose of this study was to determine the quantity and quality of TCIM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of osteoporosis., Methods: MEDLINE, EMBASE and CINAHL databases, in addition to the Guidelines International Network, and the National Center for Complementary and Integrative Health website were searched from 2009-2020. CPGs making TCIM recommendations for the treatment/management of osteoporosis were assessed with the AGREE II instrument., Results: Of 536 unique search results, 27 osteoporosis CPGs made mention of TCIM therapies. From highest to lowest, scaled domain percentages of all eligible CPGs averaged to 92.59% for scope and purpose, 88.79% for clarity in presentation, 55.04% for stakeholder involvement, 47.84% for editorial independence, 46.53% for rigor of development, and 36.96% for applicability. Of the 27 CPGs assessed, 4 CPGs were recommended as is by both appraisers, while 23 CPGs were recommended with modifications., Conclusions: Recommendations pertaining to calcium and vitamin D supplementation and exercise were favorably recommended across nearly all CPGs. In the case of other TCIM interventions, recommendations varied greatly, which may present challenges for CPGs target users due to a lack of consistency. Given the varying quality of osteoporosis CPGs found, those requiring improvement may benefit from their guideline development panel utilizing the AGREE II instrument to inform future updates., (© 2021 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Objectives: To estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in the Indonesian population from a payer perspective using a prevalence-based approach., Methods: The direct medical costs in 2016 were estimated using the database of Indonesia's National Health Insurance, known as Jaminan Kesehatan Nasional, which included diagnosis-related group costs and unbundled costs for patients accessing advanced care. The study population included people aged 30 years or older having a diagnosis of T2DM. T2DM and its related complications were identified using the International Classification of Diseases, 10th Revision, code. Hypoglycemia and all complications listed in the Diabetes Severity Complications Index were included. Descriptive analysis was conducted. Costs were converted to 2016 US dollar equivalent., Results: Of the 18.9 million Jaminan Kesehatan Nasional members who accessed secondary and tertiary care, 812 204 (4%) were identified with T2DM, of which 57% had complications. The most common complication was cardiovascular diseases (24%). The total direct medical cost was US $576 million, with 56% spent on hospitalization, 38% on specialist visits, 4% on unbundled non-diabetes-related medication, and 2% on unbundled anti-hyperglycemic medications. Approximately 74% of the total costs was used for the management of people with complications. People with complications (US $930/person/year ± US $1480/person/year) incurred twice the cost of those without complications (US $421/person/year ± US $745/person/year)., Conclusion: The direct medical cost for management of people with T2DM in Indonesia was high. Early diagnosis and optimal management of T2DM to prevent complications may reduce the costly sequelae and have a possibility of cost savings., (Copyright © 2021. Published by Elsevier Inc.)

Background: Postoperative pulmonary complications, including pneumonia, are a substantial cause of morbidity. We hypothesised that routine noninvasive respiratory support was associated with a lower incidence of pneumonia after surgery., Methods: Systematic review and meta-analysis of RCTs comparing the routine use of continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal oxygen (HFNO) against standard postoperative care in the adult population. We searched MEDLINE (PubMed), EMBASE, and CENTRAL from the start of indexing to July 27, 2021. Articles were reviewed and data extracted in duplicate, with discrepancies resolved by a senior investigator. The primary outcome was pneumonia, and the secondary outcome was postoperative pulmonary complications. We calculated risk difference (RD) with 95% confidence intervals using DerSimonian and Laird random effects models. We assessed risk of bias using the Cochrane risk of bias tool., Results: From 18 513 records, we included 38 trials consisting of 9782 patients. Pneumonia occurred in 214/4403 (4.9%) patients receiving noninvasive respiratory support compared with 216/3937 (5.5%) receiving standard care (RD -0.01 [95% confidence interval: -0.02 to 0.00]; I 2 =8%; P=0.23). Postoperative pulmonary complications occurred in 393/1379 (28%) patients receiving noninvasive respiratory support compared with 280/902 (31%) receiving standard care (RD -0.11 [-0.23 to 0.01]; I 2 =79%; P=0.07). Subgroup analyses did not identify a benefit of CPAP, NIV, or HFNO in preventing pneumonia. Tests for publication bias suggest six unreported trials., Conclusion: The results of this evidence synthesis do not support the routine use of postoperative CPAP, NIV, or HFNO to prevent pneumonia after surgery in adults., Clinical Trial Registration: PROSPERO: CRD42019156741., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: The Internet is increasingly utilized by patients to acquire information about dietary and herbal supplements (DHSs). Previously published studies assessing the quality of websites providing consumer health information about DHSs have been found to contain inaccuracies and misinformation that may compromise patient safety.. The present study assessed the quality of online DHSs consumer health information for fatigue., Methods: Six unique search terms were searched on Google, each relating to fatigue and DHSs, across four countries. Across 480 websites identified, 48 were deemed eligible and were quality assessed using the DISCERN instrument, a standardized index of the quality of consumer health information., Results: Across 48 eligible websites, the mean summed score was 47.64 (SD = 10.38) and the mean overall rating was 3.06 (SD = 0.90). Commercial sites were the most numerous in quantity, but contained information of the poorest quality. In general, websites lacked discussion surrounding uncertainty of information, describing what would happen if no treatment was used, and how treatment choices affect overall quality of life., Conclusion: Physicians and other healthcare professionals should be aware of the high variability in the quality of online information regarding the use of DHSs for fatigue and facilitate open communication with patients to guide them towards reliable online sources., (© 2021 Published by Elsevier B.V. on behalf of Korea Institute of Oriental Medicine.)

Aims: Approximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and subsequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM., Data Synthesis: MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.7%, 79.8%), clarity of presentation (85.7%, 48.4%), stakeholder involvement (67.9%, 28.2%), applicability (54.8%, 20.2%), rigour of development (49.7%, 35.7%), and editorial independence (44.1%, 44.1%)., Conclusions: Quality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap exists for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Predatory journals (PJs) pose a threat to the quality/integrity of scientific publishing. Checklists have been proposed to identify PJs, but few are "evidence-based". This study's objective was to search for/assess evidence-based checklists (EBCs) for reliability and validity, based on a new consensus definition of PJs., Methods: A published methods guideline for scale development was used to identify how many steps were completed in the generation of identified EBCs. Items from each EBC were compared against the consensus definition, and a list of items to be considered in the creation of a composite EBC to identify PJs was generated., Results: Four EBCs were identified. None of these had completed the first of the nine steps for scale development and validation. Forty-seven items from the four EBCs were assessed against the consensus definition, of which 28 items fell within the definition. A proposed composite EBC was created from items matching components of the consensus definition., Conclusion: EBCs to detect PJs lack assessment of reliability and validity. To a varying degree, the EBCs contain items that match the scope of the new consensus definition of PJs. With the recent consensus definition, EBCs creators now have a clearer target, and can make adjustments., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Low back pain (LBP) is expected to globally affect up to 80% of individuals at some point during their lifetime. While conventional LBP therapies are effective, they may result in adverse side-effects. It is thus common for patients to seek information about complementary and alternative medicine (CAM) online to either supplement or even replace their conventional LBP care. The present study sought to assess the quality of web-based consumer health information available at the intersection of LBP and CAM., Methods: We searched Google using six unique search terms across four English-speaking countries. Eligible websites contained consumer health information in the context of CAM for LBP. We used the DISCERN instrument, which consists of a standardized scoring system with a Likert scale from one to five across 16 questions, to conduct a quality assessment of websites., Results: Across 480 websites identified, 32 were deemed eligible and assessed using the DISCERN instrument. The mean overall rating across all websites 3.47 (SD = 0.70); Summed DISCERN scores across all websites ranged from 25.5-68.0, with a mean of 53.25 (SD = 10.41); the mean overall rating across all websites 3.47 (SD = 0.70). Most websites reported the benefits of numerous CAM treatment options and provided relevant information for the target audience clearly, but did not adequately report the risks or adverse side-effects adequately., Conclusion: Despite some high-quality resources identified, our findings highlight the varying quality of consumer health information available online at the intersection of LBP and CAM. Healthcare providers should be involved in the guidance of patients' online information-seeking., (© 2021 Published by Elsevier B.V. on behalf of Korea Institute of Oriental Medicine.)

Background: Ephedra sinica (ES) is a natural health product used to promote weight loss, enhance athletic performance, and treat common ailments such as the common cold or flu. Due to restrictions within Canada, Canadians interested in purchasing this product turn to online vendors for the ease and discrete nature of online transactions. However, the information available on these websites for consumers looking to purchase the substance is variable. This study investigated the quality of information about ES available to Canadian consumers on the websites of these online vendors., Methods: Following searches on Google.ca, eligible websites were assessed using the DISCERN instrument, a tool consisting of 16 questions, each rated on a five-point Likert scale, to assess the quality of health information about a treatment choice. The data was used to determine the overall quality of information about ES available to consumers on these websites., Results: A total of 660 webpages were identified, of which 28 websites were found to be eligible. It was determined that the overall quality of information of websites selling ES products online was poor, as 79 % of online vendors received an average score of 2 or below., Conclusion: Consumers looking to purchase ES online are lacking critical information about this herbal product that is necessary to make an informed decision about its use. This study's findings can be used by clinicians and researchers to inform patients about the poor quality of information about ES on these websites and help them identify quality sources of information., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Complementary and integrative medicine (CIM) use is widely sought by those diagnosed with cancer, with up to 50% of lung cancer patients seeking these therapies in the United States. The purpose of this study was to identify the quantity and assess the quality of CIM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of lung cancer., Methods: A systematic review was conducted to identify lung cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018, along with the Guidelines International Network and the National Center for Complementary and Integrative Health websites. Eligible guidelines containing recommendations for the treatment and/or management of lung cancer were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument., Results: From 589 unique search results, 4 guidelines mentioned CIM, of which 3 guidelines made CIM recommendations. Scaled domain percentages from highest to lowest were: scope and purpose (82.4% overall, 76.9% CIM), clarity and presentation (96.3% overall, 63.0% CIM), editorial independence (61.1% overall, 61.1% CIM), rigour of development (62.5% overall, 54.9% CIM), stakeholder involvement (66.7% overall, 42.6% CIM) and applicability (29.9% overall, 18.8% CIM). Quality varied within and across guidelines., Conclusion: Guidelines that scored well could serve as a framework for discussion between patients and healthcare professionals regarding use of CIM therapies in the context of lung cancer. Guidelines that scored lower could be improved according to the AGREE II instrument, with insight from other guidelines development resources., (© 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.)

Background: Low back pain (LBP) is highly prevalent in the general population and is responsible for increased health-care costs, pain, impairment of activity, and if chronic, is associated with a range of comorbidities., Objectives: The purpose of this review was to identify the quantity and assess the quality of evidence-based clinical practice guidelines (CPGs) for the treatment and/or management of LBP in adults., Methods: MEDLINE, EMBASE, CINAHL, and the Guidelines International Network were systematically searched from 2008 to 2018 to identify LBP CPGs. Eligible CPGs were assessed in duplicate using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument across 6 domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence., Results: Of 181 unique search results, 22 CPGs for the treatment and/or management of LBP were eligible. Scaled domain percentages from highest to lowest were: scope and purpose (90.0%), clarity of presentation (84.0%), stakeholder involvement (54.0%), rigour of development (51.2%), editorial independence (39.6%) and applicability (28.5%). Quality varied within and across CPGs., Conclusions: CPGs varied in quality, with most scoring the highest in the scope and purpose and clarity of presentation domains. CPGs achieved variable and lower scores in the stakeholder involvement, rigour of development, applicability, and editorial independence domains. CPGs with higher AGREE II scores can serve as suitable evidence-based resources for clinicians involved in LBP care; CPGs with lower scores could be improved in future updates using the AGREE II instrument, among other guideline development resources, as a guide., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Complementary and alternative medicine (CAM) use is prevalent among individuals with multiple sclerosis (MS), yet the quantity and quality of CAM recommendations in MS clinical practice guidelines (CPGs) has not been assessed. The objective of this study was to determine the mention of CAM in MS CPGs and assess the quality of CAM recommendations., Design/setting: A systematic review was conducted to identify MS CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs containing CAM recommendations published by non-profit agencies on the treatment of MS for adults were assessed for quality and reporting using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument., Outcome/results: From 204 unique search results, six CPGs mentioned CAM and four made CAM recommendations. Scaled domain percentages from highest to lowest were clarity of presentation (90.3 % Overall, 83.3 % CAM), scope and purpose (87.5 % Overall, 86.8 % CAM), rigour of development (80.0 % Overall, 61.7 % CAM), applicability (55.2 % Overall, 44.3 % CAM), editorial independence (49.0 % Overall, 47.9 % CAM), and stakeholder involvement (55.6 % Overall, 39.6 % CAM). Quality varied within and across CPGs. Three of the four CPGs were recommended by both appraisers; one was recommended as "No" or "Yes with modifications"., Conclusion: CAM recommendations were only present in one third of all eligible CPGs. CPGs that scored highly can be used by patients and healthcare professionals as the basis for discussion about the use of CAM therapies for MS treatment/management. Although many people living with MS (PwMS) seek CAM therapies, few CPGs are available to provide guidance for clinicians and patients., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The use of natural health products (NHPs) is common in North America. In 2003, we found that 42% of NHP users had not disclosed this information to their primary care medical doctors (MDs). We repeated our survey in 2018/2019 to explore if the rate of NHP use disclosure had improved., Methods: From November 2018-February 2019, a 21-item survey about NHP use and disclosure was administered to adult patients who visited the Robert Schad Naturopathic Clinic in Toronto, Canada., Results: Almost all patients surveyed were using NHPs (99%), and 46% were using NHPs and prescription medication concurrently. Consistent with our 2003 findings, 42% of respondents who used NHPs did not disclose this information to their MD., Conclusion: Disclosure of NHP use to MDs by naturopathic patients is limited and remained unchanged over the past 15 years. Future research should explore primary care MDs' hesitancy to inquire about patient NHP use., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to determine the quantity of complementary medicine (CM) recommendations and their quality across clinical practice guidelines (CPGs) for the treatment and/or management of hypertension., Design/setting: A systematic review was conducted to identify hypertension CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018, alongside the Guidelines International Network and the National Centre for Complementary and Integrative Health websites. Eligible articles were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument., Outcome/results: From 1445 unique search results, 18 CPGs for the treatment and/or management of hypertension published in 2008 or later were eligible for review, though only 1 contained CM recommendations. This CPG was published by the European Society of Cardiology and the European Society of Hypertension, and made a recommendation regarding the Mediterranean diet. The scaled domain percentages of this CPG overall scored significantly better than the CM section across every domain, and were as follows: (overall, CM): scope and purpose (88.9 %, 66.7 %), clarity-of-presentation (88.9 %, 0.0 %), stakeholder involvement (66.7 %, 16.7 %), applicability (60.4 %, 0.0 %), rigor-of-development (35.4 %, 15.6 %), and editorial independence (4.2 %, 0.0 %)., Conclusion: A lack of CM treatment recommendations exists in CPGs for the treatment and/or management of hypertension. Given that it is known that a high proportion of patients with hypertension seek CM, current hypertension guidelines' lack of CM treatment and/or management recommendations reflects a large gap in guidance for both clinicians and patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: This paper explains the regulation of complementary and alternative medicine (CAM) health professions, through the comparison of four distinct examples in Ontario, Canada including: chiropractors, naturopaths, homeopaths, and traditional Chinese medicine (TCM) practitioners., Methods: This study analyzes the agenda setting and formulation stage of the policy process. In other words, it explores what happened between stakeholders before each of these CAM professions achieved regulation. Alford's model of dominant, challenging and repressed structured interests (DSIs, CSIs, and RSIs respectively) is used to describe the competition between various players within the healthcare system and their position in the health policy process., Results: All four CAM professions have existed as a RSI at some point in their history, however, over the last century has sought to align themselves with various (or even become) challenging structural interests (CSIs) in order to be recognized as a regulated health profession. Dominant structural interests (DSIs), particularly the medical profession, initially largely ignored these professions' practices, unless sufficient public support of CAM practitioners' therapies warranted them to consider the need to regulate them., Conclusion: Unregulated CAM professions may increase their likelihood of becoming regulated if they: (1) gain popularity/strong support from patients or the general public, (2) organize themselves sufficiently that they pose a direct threat to one or more scopes of practice desirable by the DSIs and/or (3) are willing to adopt standards in education, training, and ethics that may [initially] reduce their scope of practice or profession's membership or slow their profession's growth., (© 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.)

We evaluated reasons for and perceived benefits of using homeopathic and herbal therapies in U.S. adults. Data were collected from the 2012 National Health Interview Survey, which represents non-institutionalized U.S. adults (n = 33,167 unweighted). In the past 12 months, 18.6% (41.95 million) of U.S. adults reported using either homeopathy and/or herbal therapies. Among these users, 34.8% and 5.1% used them for wellness only and treatment only, respectively. 60.1% reported using homeopathic and herbal therapies for a combination of both treatment and wellness. In four out of seven self-reported perceived benefit measures, users for wellness only and for a combination of both treatment and wellness had higher likelihood of reporting benefits, compared to those who used CAM for treatment only (p < 0.001). Overall, homeopathic and herbal therapies maybe a promising lifestyle approach to enhance health-related quality of life in U.S. adults, but future research is needed to establish safety and efficacy issues., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

An important and plausible impact of a changing global climate is altered power generation from hydroelectric dams. Here we project 21st century global hydropower production by forcing a coupled, global hydrological and dam model with three General Circulation Model (GCM) projections run under two emissions scenarios. Dams are simulated using a detailed model that accounts for plant specifications, storage dynamics, reservoir bathymetry and realistic, optimized operations. We show that the inclusion of these features can have a non-trivial effect on the simulated response of hydropower production to changes in climate. Simulation results highlight substantial uncertainty in the direction of change in globally aggregated hydropower production (~-5 to +5% change in mean global production by the 2080s under a high emissions scenario, depending on GCM). Several clearly impacted hotspots are identified, the most prominent of which encompasses the Mediterranean countries in southern Europe, northern Africa and the Middle East. In this region, hydropower production is projected to be reduced by approximately 40% on average by the end of the century under a high emissions scenario. After accounting for each country's dependence on hydropower for meeting its current electricity demands, the Balkans countries emerge as the most vulnerable (~5-20% loss in total national electricity generation depending on country). On the flipside, a handful of countries in Scandinavia and central Asia are projected to reap a significant increase in total electrical production (~5-15%) without investing in new power generation facilities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The aim of our study is to determine if a goal-directed program improves weight loss after sleeve gastrectomy., Methods: Our goal-directed program involves setting excess weight loss targets at fixed intervals after sleeve gastrectomy. We identified patients in 3 bariatric centers between April 2010 and July 2013 and compared the center that has a goal-directed weight loss program (goal-directed program) with the other 2 centers (standard program)., Results: A total of 211 patients were included, with 129 patients in the goal-directed weight loss program. The 2 groups were similar in terms of gender distribution, ethnicity distribution, age, and preoperative weight, preoperative body mass index, and surgical technique. The follow-up rates at 3, 6, 9, and 12 months for patients in the goal-directed program was 84.5%, 75.2%, 59.7%, and 82.2%, respectively, compared with 65.9%, 68.3%, 51.2%, and 68.3% for the standard program. The percentage total weight loss at 3, 6, 9, and 12 months was 17.1%, 23.3%, 26.8%, and 28.6%, respectively, for the goal-directed program, compared with 15.3%, 21.8%, 24.4%, and 25.4%, respectively, for the standard program. The mean excess weight loss at 3, 6, 9, and 12 months were 40%, 54%, 62%, and 67%, respectively, for the goal-directed program group, and 36%, 50%, 54%, and 55%, respectively, for the standard program, where statistical significance (P<.005) was achieved at 12 months., Conclusion: Our results suggest that a goal-directed protocol may improve weight loss outcomes after laparoscopic sleeve gastrectomy., (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Predictors and outcomes of weight concerns in pre-adolescent and adolescent girls are well known, but few models have incorporated concerns reported directly by mothers as a predictor, and both eating and exercise outcomes. Using questionnaires, a comprehensive model of 232 pre-adolescent and early adolescent girls' weight concerns, eating restraint, and exercise behavior was tested. Structural equation modeling showed that daughters' weight concerns were predicted primarily by their perceptions of their mothers' concerns about the daughters' weight, as well as by daughters' BMI, appearance conversations with friends, and perceived media pressure. Mothers' concerns with their daughters' weight were indirectly associated with daughters' own concerns, via the daughters' perceptions of their mothers' concerns. Daughters' concerns with their weight were a strong predictor of eating restraint, but not exercise behavior., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To report the ocular features, underlying systemic conditions, and management of diet-induced vitamin A deficiency in Scottish adults., Design: Retrospective case series., Methods: Three middle-aged white adults presented with ocular signs of xerophthalmia and keratomalacia that led to the diagnosis of previously undiagnosed vitamin A deficiency. Case 1 presented with rapidly progressing bilateral keratomalacia with corneal perforation, whereas Cases 2 and 3 presented with conjunctival and corneal xerosis., Results: Corneal gluing was performed in Case 1. Cases 2 and 3 were treated topically with preservative-free tears, retinoic acid, and punctual plugs to optimize the ocular surface. This, combined with dietary supplementation, resulted in normalizing the ocular surface., Conclusions: Diet-induced vitamin A deficiency can occur in middle-aged white adults. Ocular surface changes may be the presenting sign of hypovitaminosis A in the Western world. A high degree of suspicion with prompt recognition and management of the underlying dietary deficiency can lead to complete reversal of the ocular surface changes., (© 2013 Canadian Ophthalmological Society Published by Canadian Ophthalmological Society All rights reserved.)

Methionyl aminopeptidase 2 (MetAP2) plays an important role in the regulation of angiogenesis. This study examined whether nitration of MetAP2 alters its enzymatic activity in vitro. The activity of unmodified, nitrated and oxidised MetAP2 was assessed and it was found that nitration significantly reduced its ability to cleave a chromogenic substrate. Mass spectrometry analysis identified Tyr336 as a nitrated residue in MetAP2. Structural and evolutionary analysis indicate that this is an important residue for MetAP2 activity. Combined, the results show that the activity of MetAP2 is reduced by nitration and raise the possibility that nitration of MetAP2 is a mechanism contributing to endothelial dysfunction., (Copyright © 2013 Elsevier Inc. All rights reserved.)