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Featured Review: Psychological therapies for women who experience intimate partner violence
Interview with Kelsey Hegarty, Professor Family Violence Prevention, The University of Melbourne and The Royal Women's Hospital and lead author of this Cochrane Review.
Domestic violence (physical, emotional, sexual abuse and controlling behaviour by a partner or ex‐partner) is common worldwide and causes long‐lasting emotional and physical health problems. Psychological therapies (counselling by trained people) may improve women's mental health and enable them to focus on making safety plans, accessing resources for themselves and their children, and ultimately to escape the domestic violence.
We searched scientific literature worldwide up to the end of October 2019 for trials comparing a group of female domestic violence survivors who received psychological therapy with those who did not, to understand whether such therapies are safe and effective.
We found evidence that psychological therapies probably reduce depression and may reduce anxiety symptoms for women who have experienced domestic violence (six to 12 months after the therapy). Psychological therapies do not appear to cause any harm. However, we are uncertain whether psychological therapies improve self‐efficacy, mental health, quality of life, social support, uptake of healthcare and domestic violence services, safety planning or reduce post‐traumatic stress disorder and re‐exposure to any form of domestic violence.
Overall, there is a need for more trials with consistent outcomes at similar follow‐up time points as we were unable to combine much of the research to give an overall picture.
Thus, while women experiencing domestic violence may be helped by psychological therapies to improve their emotional health, which may in turn help their ongoing needs of safety, support and holistic healing from complex trauma, we are uncertain whether psychological therapies improve these aspects of their live
During the COVID-19 pandemic and resulting movement restrictions an upsurge in domestic violence has been reported. What can this review tell us about treatment for women who have experienced intimate partner violence during this time?
Access to help is a real issue during the COVID pandemic for both domestic violence and mental health issues. This review tells us that psychological therapies are likely to improve depression and anxiety symptoms. Some of these therapies are being offered online or through telehealth during COVID so may assist women experiencing IPV. However, their partner may be monitoring their use of technology and it may not be safe for them to receive this help.
Given the world-wide rise in violence against women during the pandemic, how can this review help decision makers facing decisions about where to invest resources? And help clinicians decide the best course of action?
This review reassures decision makers that psychological therapies help women with their emotional health, however currently there is no evidence that it assists with safety issues or healing in a broader sense. Therefore, investment in resources that address these issues as an integrated package would be helpful. Clinicians should be aware of ensuring they know how to address safety in addition to offering therapy.
How can this review help women who have experienced intimate partner violence who want to seek out help?
Women who feel as if their emotional health is something that they want help with can be reassured that in the context of IPV psychological therapies may assist them to feel better. This in turn may help them to take action on a pathway to safety and healing. However, more research is needed as there were limited studies to draw on.
Learn more about the Cochrane Common Mental Disorders Group
#MyCochraneStory
Cochrane's strength is in its collaborative, global community. Our 82,000 members and supporters from more than 130 countries work together to produce credible, accessible health information and help inform health decision making. Though we are spread out across the globe, our shared passion for health evidence unites us.
We want to come together and tell our collective and individual Cochrane stories! To share your #MyCochraneStory please contact Rachel Klabunde - rklabunde@cochrane.org - with the following:
A photo: At your desk, at Cochrane event, something beyond a headshot.
Your country of residence: Are community is diverse and we want to celebrate this!
Your Cochrane Story: We want to hear about what Cochrane work and achievements you are most proud of! 3-4 sentences about yourself and your story and any URLs that could be included.
Rachel Klabunde, from Chile, joined Cochrane in 2019 helping the Cochrane Chile team to plan the 2019 Cochrane Colloquium in Santiago. She now work as part of the Community Support team in People Services and as a Communication Officer in the Knowledge Translation Department of the Cochrane Central Executive Team. Due to widespread violence and civil unrest in Santiago, the annual Colloquium gala dinner was canceled. Our annual event would have featured a four-day wide-reaching scientific programme entitled 'Embracing Diversity' as well as a Gala Dinner open to all delegates. Due to the cancellation, all the pre-ordered food including catering provisions for a three-course Gala dinner was donated to a local charity in Santiago. Turning this negative moment into something positive is definitely something to be proud of!
Muriah Umoquit, from Canada, joined Cochrane in 2015. Working in the Knowledge Translation Department of the Central Executive Team, she is a self-proclaimed 'Cochrane Fangirl'. Knowing how daunting rows of academic posters can be, she was thrilled to work on a project bringing branded #BetterPoster templates to disseminate Cochrane work at Colloquiums and other academic conferences. You can view many of these posters from our virtual 2019 Colloquium - including hers!
Cochrane supports Vivli's accelerated process for sharing data from COVID-19 trials
Members of Vivli, the Center for Clinical Research Data, have announced their commitment to share their COVID-19 trials through Vivli. Members who have committed to sharing their data on the COVID-19 portal, a dedicated search function within Vivli for COVID-19 include Eli Lilly & Company, Regeneron, Roche, Takeda.
Cochrane has previously partnered with Vivli by helping to provide vocabulary for the search platform and has expressed support of these efforts toward sharing COVID-19 data.
"Coronavirus is currently the most searched term on the Vivli platform and the new search experience is coupled with an accelerated process for data sharing. We believe that now, more than ever, sharing the individual participant data that underpins trial results is vital to driving forward both new science as well as scientific consensus," said Rebecca Li, Vivli Executive Director.
"Vivli will continue to waive the fees for sharing for any interventional trial related to COVID-19 and to make the process as easy as possible. You don't have to be a member to share your data using Vivli. We can and do share data from researchers from industry, academia, and non-profits. We have also partnered with vendors who can anonymize these datasets who have offered to anonymize the datasets waiving their normal fees. Vivli is doing all it can as part of the wider ecosystem of the health research community who are collaborating and coming together to do everything we can to find a treatment or vaccine for COVID-19."
Vivli provides researchers with a secure, easy-to-use online platform to archive and share clinical trial data across all diseases and research entities. Vivli also allows researchers to combine and analyze data from multiple trials using state of the art tools.
Editor in Chief of the Cochrane Library, Karla Soares-Weiser said, "The pandemic represents a significant threat to global health, high quality evidence to inform decision making is needed urgently. Now, more than ever, fast, shared access to trial data is needed. Cochrane is pleased to support this initiative from Vivli as it promotes research integrity, transparency and acknowledges the value of timely and responsive production of evidence."
About Vivli
Vivli is a non-profit organization working to advance human health through the insights and discoveries gained by sharing and analyzing data. It is home to an independent global data-sharing and analytics platform which serves all elements of the international research community. The platform includes a data repository, in-depth search engine and cloud-based analytics, and harmonizes governance, policy and processes to make sharing data easier. Vivli acts as a neutral broker between data contributor and data user and the wider data sharing community. For more information, visit www.vivli.org and follow us on Twitter @VivliCenter.
New Cochrane review assesses how accurate antibody tests are for detecting COVID-19
Today Cochrane, a global independent organization that reviews evidence from research to inform health decision-making, publishes a review of studies looking at the accuracy of COVID-19 antibody tests.
The review shows that antibody tests could have a useful role in detecting if someone has had COVID-19, but that timing is important. The tests were better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started. We do not know if this is true for people who have milder disease or no symptoms, because the studies in the review were mainly done in people who were in hospital. In time, we will learn whether having previously had COVID-19 provides individuals with immunity to future infection.
Antibody tests are an important public health tool to identify individuals with previous COVID-19 disease. This enables assessment of the spread of infection and the need for public health interventions. The review summarizes research evidence available up until the end of April 2020 to see whether antibody tests:
are accurate enough to diagnose disease in people with or without symptoms of COVID-19, and
can be used to find out if someone has already had COVID-19.
The immune system of people who have COVID-19 responds by developing proteins in the blood called antibodies that attack the virus. Detecting antibodies in people's blood may indicate whether they currently have COVID-19 or have had it previously. Whilst detecting current infection is usually done using swab tests within the first 5 days of illness, they may miss infection and are not available to all.
Cochrane researchers from universities across the world led by experts from the University of Birmingham searched through the 11,000 publications on COVID-19 available at the end of April to find studies that reported results of antibody tests in groups of people known to have (or have had) COVID-19 and others known not to have had COVID-19 based. They found a total of 54 relevant studies reporting test results for nearly 16,000 samples. The majority of studies were from China and were carried out in people who had been admitted to hospital and likely to have had severe disease.
The studies looked at three types of antibody, IgA, IgG and IgM. Most tests measured both IgG and IgM, but some measured a single antibody or combinations of the three antibodies. Data were only available for 27 tests, a small fraction of the over 200 tests on the market. Data were available on both laboratory based tests, which require blood samples taken from the veins, and point-of-care tests, which can use finger-prick blood samples. There were not enough data to compare the accuracy of different tests. The authors will continue to update this review over the next few months to provide a more complete summary of the research evidence as it accumulates.
The researchers found that the sensitivity (the proportion of the people who have had COVID-19 that the test can detect) of antibody testing is very closely related to when the test is performed. Tests of the IgG and IgM antibodies at 8 to 14 days after onset of symptoms correctly identified only 70% of people who had COVID-19. However, when the researchers looked at data reported at between 15 and 35 days after symptoms first began, antibody tests accurately detected over 90% of people with COVID-19. There are insufficient studies to estimate the sensitivity of antibody tests beyond 35 days after the beginning of symptoms. The tests only wrongly diagnosed COVID-19 in 1% to 2% of people without COVID-19.
To illustrate what these accuracy figures mean, in a sample of 1000 people where 200 people (20%) really have COVID-19, typical of workers in a hospital setting where COVID-19 patients have been treated:
193 people would receive a positive test result but 10 (5%) of those people would not have COVID-19 (known as a false positive result);
807 people would receive a negative test result but 17 (2%) of those people would have COVID-19 (known as false negative result).
In a population where COVID-19 was more common there would be more false negatives and fewer false positives.
Studies showed that antibody tests may have a role in diagnosing COVID-19 in patients who have had COVID-19 symptoms for two or more weeks but who have not had a swab (PCR) test or tested negative despite COVID-19-like symptoms.
Professor Jon Deeks, Professor of Biostatistics and head of the Test Evaluation Research Group at the University of Birmingham, explains: "We've analyzed all available data from around the globe - discovering clear patterns telling us that timing is vital in using these tests. Use them at the wrong time and they don't work. While these first COVID-19 antibody tests show potential, particularly when used two or three weeks after the onset of symptoms, the data are nearly all from hospitalized patients, so we don't really know how accurately they identify COVID-19 in people with mild or no symptoms, or tested more than five weeks after symptoms started.
The researchers also had several concerns about the quality of the studies they found. Studies were small and did not report their results fully. Many papers included multiple samples from the same patients. More than half of the studies were made available before they had been through peer review (publications known as 'preprints'). In one important UK study the biomarker manufacturers did not approve the identification of the tests that had been evaluated.
Dr Jac Dinnes, who worked on the review with the University of Birmingham team commented, "The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data broken down by time since onset of symptoms. Action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan to update this review regularly as more studies are published."
Use the Interactive COVID diagnostic test calculators (based on Woloshin, et al., NEJM, 2020)
Cochrane systematic reviews of interventions (intervention reviews) and Cochrane diagnostic test accuracy reviews (DTA reviews) are two types of systematic review.
They share the following characteristics:
They aim to answer a specific healthcare question to help people make decisions based on up-to-date evidence from research.
They look for all the relevant studies to answer the review question.
They appraise the reliability of the studies.
They summarize the results to produce a picture of the body of evidence available.
They are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.
Intervention reviews
Intervention reviews seek to answer questions about the effectiveness of healthcare interventions (medicines, treatments or policies) on the people who receive them. For example: 'How effective is acupuncture for treating depression'; or 'Which treatment is most effective for treating psoriasis?'. To answer such questions, the authors of intervention reviews identify studies that compare one intervention with either another intervention, an inactive intervention (placebo), or no intervention. Depending on the number and reliability of the studies identified, intervention reviews may provide information on whether the intervention works, or whether we need more evidence before we can draw a conclusion. They may identify for whom the intervention works best, which version of the treatment works best, whether another option is just as effective, and whether it causes any unwanted effects.
DTA reviews
DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety
DTA reviews combine the results of all available test accuracy studies to determine the best possible estimate of the accuracy of an index test. Test accuracy studies most often report accuracy using sensitivity and specificity.
Sensitivity means the proportion of people who are correctly diagnosed by the index test. Specificity means the proportion of people without the target condition who are correctly identified by the index test. Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.
An alternative way to report test accuracy is using positive and negative predictive values, which tell us about the usefulness of a positive index test result and a negative index test respectively – this helps patients understand how reliable their test results are. Predictive values measure the number of positive index test results that will be true positives and the number of negative index test results that will be true negatives. The nearer the positive and negative predictive values are to 100%, the better the test.
Cochrane DTA reviews are concerned with evaluating test accuracy. A new test may benefit patients because it offers an improvement in accuracy compared to existing tests. Alternatively, a new test may have similar accuracy to existing tests but with the advantage of being quicker, cheaper or easier to perform so that tests are available to more patients and results are obtained more quickly.
What are systematic reviews?
Cochrane announces new 10-year publishing agreement with Wiley
Cochrane is delighted to announce the signing of a new contract with John Wiley & Sons, Ltd. to publish the Cochrane Library for the next 10 years from January 2021. The agreement guarantees major investment into future development of the Library to sustain Cochrane as the world's pre-eminent collection of high-quality evidence to inform global healthcare decision making.
Cochrane's Chief Executive Officer, Mark Wilson, warmly welcomed today's announcement: "The Cochrane Library is central to Cochrane's mission of producing and making available to the world high-quality, relevant, accessible systematic reviews and other evidence synthesis. Traffic to the Library has greatly increased over the past seven years as we have made it accessible in 12 languages and we have built a publishing platform that will enable us to deliver new journals, new databases and new features that will help us meet that mission as never before. We are confident we have a strong strategic partner with whom to work on the longer-term publishing challenges and opportunities."
Cochrane's current publishing contract with Wiley ends on 31st December 2020. Following a competitive tender process beginning in May 2019 that attracted bids from numerous publishers, Wiley was selected due to its commitment to product development and innovation; a strategic vision meeting the needs of users of Cochrane's evidence; and, support for the organization's multi-lingual strategy, thus increasing the accessibility of its evidence globally.
The agreement also secures a strong financial framework to support Cochrane's organizational ambitions in the next decade, including its Open Access aspirations. Currently, more than 3.6 billion people have free one-click access to the Cochrane Library, with nearly 70% of all 8,300 Cochrane Reviews and all 2,400 Review protocols available to everyone across the world.
"Cochrane is the world-leading provider of medical evidence to support clinical effectiveness," said Jay Flynn, Senior Vice President and Chief Product Officer, Research at Wiley. "We are confident this new agreement provides a strong framework within which to sustain Cochrane's success and advance its future growth."
Karla Soares-Weiser, Cochrane's Editor in Chief, said: "The Cochrane Library is pivotal in delivering Cochrane's mission of producing high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence to inform health decision making. Future publication and dissemination of our content are key to meeting Cochrane's strategic goals and the long-term financial health of our global organization."
Read more about Cochrane's future publishing agreement with Wiley.
To find out more about Cochrane and our health evidence visit: www.cochrane.org, the Cochrane Library or Cochrane Library in Spanish.
Successful 40-hour online training course hosted by Cochrane Sweden
In May 2020, Cochrane Sweden organised a one week, 40-hour online training course attracting 26 doctoral students and Cochraneities from all around the world. This training event was co-organised with the support of Cochrane Nordic, Cochrane Norway, Cochrane Sustainable Health Care and the Faculty of Medicine of Lund University.
Morning sessions organised via zoom videolink included lectures and hands-on training on all steps of the systematic review process, from registering the title, defining the research question, discussing on issues around structure and registration of the protocol, searching, assessing the risk of bias, with special emphasis given on the RoB tool 2, and by using platforms like COVIDENCE and RevMan Web along with sharing some useful tips and tricks on their use.
The values of Cochrane systematic reviews have been emphasised, and some common mistakes and good examples of how a well designed CSRs should look like were shared. In light of such good examples, Barbara Nussbaumer-Streit, the lead author of the recently published CSR on Quarantine shared the findings of the review and also presented interesting methodological aspects of her work.
The cherry on top, as it is supposed to be, was saved for assessing the certainty of evidence, with Karsten Juhl Jørgensen from Cochrane Nordic sharing useful information about the great GRADE.
The whole course was organised in such a way to allow optimal time for short lecture-based education, small-group discussions, individual work with excercises on concrete methodological examples and mutual discussions, but also provided time for meeting people, chatting and getting to know each other. Afternoons were reserved for participants' individual work on Cochrane Interactive Learning (CIL) modules, which followed the topics covered during the morning sessions, so that by the end of the course, they all went through all the available CILs, and earned individual certificates.
The course was filled with lively, spontaneous discussions, allowed oportunities for exchange of experiences, building Cochrane networks and strengthening cooperations. To colleagues from Cochrane this was a nice chance to meet at least online, as besides Barbara and Karsten, the course brought together Liliya from Cochrane Russia, Tina from Cochrane Croatia, Rebecka from Cochrane IT Services and the hosts and organisors Matteo and Minna from Cochrane Sweden.
This course also pointed out that in challenging time like these are, when face-to-face contacts are made impossible, all opportunities and resources available should be used, both in technology, but people power as well, to give our best in sharing knowledge and Cochrane mission.
As for Cochrane Sweden, it has been, as a very skilled three-year old, taking giant steps forward, and has, in these three years since it has been established, enriched the Cochrane community with ideas and enthusiasm, Mediterranean charm and Scandinavian discipline.
Sincere congratulations to Matteo, Minna, Dina, Martin and all members of Cochrane Sweden and best wishes in their future work.
Visit Cochrane Training to view future training events and resources
100th edition of the online Cochrane Journal Club
This month marks the 100th edition of Cochrane Journal Club.
Aimed at trainees, researchers, and practitioners, each Journal Club covers a single Cochrane Review of special interest, selected from the new and updated reviews published in the Cochrane Library. They highlight practice-changing findings, controversial conclusions, new methodology, evidence-based methods, and reviews from diverse health and social care topics
The Journal Club resources provide everything you need to present a relevant and interesting paper at your next journal club, or simply to explore a review in more depth on your own.
Journal Club is edited by Dr. Bill Cayley, he has overseen 100 editions of Journal Club. To mark the 100th edition we wanted to thank Bill and let new Cochrane Members know about Journal Club and remind existing members of this popular resource.
In this interview with Bill we find out more about Journal Club.
Bill, tell us about yourself and why you enjoy editing Journal Club?
I have been practicing rural family medicine and teaching at a community-based family medicine residency for 20 years. Incorporating evidence into clinical practice has been an important principle for me ever since I first heard of evidence-based medicine and the Cochrane collaboration in the early 1990s. I think it is important for both trainees and clinicians to understand how to work with primary evidence-based literature and editing the journal club gives me a chance to share practical examples of critical appraisal for clinical practice with others.
Tell us about Journal Club
The Journal Club is for anyone interested in staying up to date with current systematic reviews and staying fresh with critical appraisal of evidence for clinical practice. Each monthly journal club features a recent Cochrane review, as well as a clinical vignette and discussion questions to help readers explore real-life application of the evidence covered in the review.
What topics has it covered? Have any been very popular? Which reviews do you pick and why?
Each week the Cochrane Content Dissemination team assesses all new and updated Cochrane Reviews and creates a selects a review for Journal Club based on topicality, clinical relevance and ability to inform evidence-based practice. plan for communicating their results, making recommendations for Reviews to feature in Journal Club
The December 2019 issue on the Cochrane Review, "Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis" received the highest engagement in 2019 with 34.4% of people who received the email opening it.
How can someone sign up and what can they expect?
More details of how to sign up and access the most recent issue is here. Once signed up you will receive monthly Journal Club emails. Each focuses on a recently published Cochrane Review and comes with a Clinical Case to help you place the review in the context of a specific scenario and discussion questions to help you think about the review methods and findings in more detail; the monthly Cochrane Review featured is free to access for 30 days.
More information about Journal Club
Cochrane systematic reviews can help us to make healthcare decisions based on up-to-date research evidence. They are systematic because they search for and analyse evidence in a systematic way, according to predetermined and published methods. Each systematic review answers a specific healthcare question by gathering all the relevant studies, assessing the reliability of these studies, then summarising their results to produce a summary of all of the available evidence.
One type of systematic review is a diagnostic test accuracy (DTA) review. In addition to investigating test accuracy, they ideally also investigate why the results may vary among studies, compare the performance of alternative tests, and help the reader to put the evidence in a clinical context. Watch the video below and read on to learn more about DTA reviews.
Cochrane DTA reviews are a type of systematic review that aim to evaluate the accuracy of diagnostic tests. They want to find out whether a new test is more accurate than an existing test, or whether it is quicker, cheaper or easier to perform. Answers to these questions help patients and healthcare workers make informed decisions about which test to use, based on up-to-date evidence.
DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety.
DTA reviews search for all relevant test accuracy studies, appraise the studies for reliability, and combine their results. This gives the best possible estimate of the accuracy of an index test based on all the available evidence. DTA reviews are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.
Test accuracy studies most often report accuracy using sensitivity and specificity.
Sensitivity means the proportion of people with the target condition who are correctly detected by the index test.
Specificity means the proportion of people without the target condition who are correctly identified by the index test.
Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.
View Cochrane DTA training for authors
Visit the Cochrane Screening and Diagnostic Test Methods group website
Learn more: What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?
Working together to beat COVID-19: Cochrane's consumer rapid response group
In April 2020, Cochrane launched the COVID-19 consumer rapid response group. Currently, nearly 100 people with lived experience related to COVID-19 have joined the group, signing up to offer their time, skills, and experience to get involved with Cochrane's work on COVID-19 rapid reviews and accommodate limited timelines. Thus far, 16 consumers have been connected with research teams for 13 COVID-19 rapid reviews, either as members of author teams or as peer reviewers. Interested consumers can still become involved in the COVID-19 consumer rapid response group; find out more and sign up.
As the full implications of the Coronavirus (COVID-19) pandemic became clear earlier in 2020, Cochrane made synthesizing relevant evidence for prevention and treatment its number one priority. Cochrane authors, editors, consumers, and other collaborators were motivated to do COVID-19 research, and Cochrane quickly mobilised its global community to undertake a series of rapid reviews, among other COVID-19 response work. The involvement of healthcare consumers (patients, carers, and the public) is a Cochrane policy and is part of guidance for the production of rapid reviews. With COVID-19, however, it quickly became clear that Cochrane needed to facilitate collaboration between review teams, editorial staff, and consumers in the short time available for completing a rapid review.
Long-time Cochrane collaborator and patient and caregiver involvement researcher, Lyubov Lytvyn (@lyubovlytvyn), was interested in how Cochrane could use its platform. "I lead the patient and caregiver partnership initiative for the MAGIC/BMJ Rapid Recommendations (international clinical practice guidelines with linked systematic reviews, infographics, and decision aids), and am doing my PhD on this topic. When I saw Cochrane's rapid reviews, I reached out to ask how they were involving consumers, to inform my own work. It turned out that, while it was part of their guidance, there wasn't an easy process to help connect consumers and review teams in a short time frame."
To address this, a task group was quickly formed, made up of consumers, researchers, and others who have led Cochrane's consumer-involvement work. It swung into action, quickly identifying the ways in which tools and resources could be developed to help consumers and researchers partner together. Drawing on previous work - including Involving People (learning resource for systematic review authors), and Evidence Essentials (free online resource offering an introduction to health evidence and how to use it to make informed health choices) - the group put together a web page of resources, including:
Learning for people who wanted to get involved;
Support for volunteers, including a group of experienced consumers who could offer peer support;
A series of "how to" one-page guidance for consumers and review teams; and
Some short videos that explained how to get involved.
While putting together these resources, recruitment of volunteers from around the world with lived experience related to COVID-19 began, and the response was impressive. To date, 97 people have signed up to assist with the important task of providing consumer input into COVID-19 research. People can continue to get involved here.
Ndi Euphrasia Ebai-atuh (@Euphras01426918) from Cameroon was the first consumer to be linked with a rapid review research team. The review looks at community-level interventions for improving access to food in low- and middle-income countries. Of the experience working with the team thus far, Euphrasia commented "I felt represented as a consumer even during 'no time to waste' research circumstances such as these, under the COVID-19 pandemic...It gave me a platform to amplify the voices of millions of consumers in LMICs with poor food access, despite numerous past and ongoing community-level interventions for improving access to food. I felt once more reassured of Cochrane's commitment to consumer involvement and will call on the entire Cochrane community of researchers to take advantage of consumer involvement in research, for it can greatly improve evidence uptake!"
Jodie Doyle, Managing Editor of the Public Health Group overseeing the review added, "Not only did Euphrasia return her very useful comments to us within 7 days, upon follow-up she also provided advice on organisations and individuals to whom we should disseminate the published review."
Vivek Podder was recruited for the protocol of the Cochrane rapid review, "Effectiveness of Contact Tracing Technologies in Epidemics", as a consumer referee for Cochrane Public Health. Jodie commented, "Vivek got his feedback to us quickly and provided really good insight from the perspective of a consumer in an LMIC. The editorial and authorship team are really grateful for his input."
Over recent months, it has become clear that research on COVID-19 will be a priority for the foreseeable future. The voices of those with lived experience of this disease, whether as a patient, carer, or member of the public, will be important to producing relevant synthesized evidence going forward. Not all volunteers have been connected with research teams yet, and the task group is looking for new ways to involve consumers in Cochrane's COVID-19 efforts. There are also plans to evaluate and present this innovative consumer involvement work for the wider research community.
Karla Soares-Weiser, Editor in Chief of the Cochrane Library, was enthusiastic about the process: "I'm delighted that we have been able to embed consumer involvement in our rapid review processes so efficiently. Involving stakeholders is critical to producing evidence that meets their needs, so it is fantastic to have this COVID consumer group available to provide high quality, rapid input that makes a difference to our reviews."
Richard Morley, Consumer Engagement Officer for Cochrane, says "In these troubling times, it's been so heartening to see people volunteering to help get the evidence that health professionals, patients, carers and policymakers need to respond to this public health crisis. Thank you to everyone."
If you would like to learn more, please email consumers@cochrane.org.
Interested consumers can still become involved in the COVID-19 consumer rapid response group; find out more and sign up.
Cochrane's 2019 Annual Review now available
Find out more about Cochrane's key achievements during 2018 and the strides being made on our major Strategy to 2020 initiatives.
"We exist so that people around the world can use Cochrane evidence to inform their health decision-making; and 2019 saw another substantial increase in the number of people who are doing that. In 2017, 22 million visits were made to Cochrane.org to access our evidence; in 2018 visits rose to 37 million; and in 2019 that figure more than doubled to over 77 million – that's a 350% increase in only two years! Three-quarters of those users are accessing our evidence in non-English language browsers, so we are truly offering a service to healthcare practitioners, policymakers, researchers and patients and the general public around the world."
Mark WilsonCochrane Chief Executive Officer
View or download the 2019 Annual Review.
Wiley Science Talks with Cochrane: Understanding Health Evidence - A COVID-19 Case Study
Cochrane Library Editor in Chief and Deputy Editor in Chief, Karla Soares-Weiser and Toby Lasserson, presented to a large group of international journalists as part of the Wiley Science Talks webinar. This webinar series, supported by the World Federation of Science Journalists and the Association of Health Care Journalists, provides educational webinars for journalists around the world.
Karla and Toby's presentation, entitled "Understanding Health Evidence—A COVID-19 Case Study" introduced Cochrane, explained what systematic reviews are, and shared what makes Cochrane Systematic Reviews unique. They then presented an overview of Cochrane's response to COVID-19 and shared a case study focusing on the quarantine rapid review. Using this review, they showed journalists what conclusions could be drawn from the study, how a well-written article about the review could be constructed, and the importance of keeping study results in context.
Watch the full webinar on Wiley YouTube
Learn more about Cochrane's response to COVID-19
Citizen scientists help to expand Cochrane Library's trial register to include more nursing and allied health research
The Cochrane Central Register of Controlled Trials (CENTRAL) is a highly concentrated source of reports of randomized and quasi-randomized controlled trials (RCTs) that publishes each month as part of Cochrane Library. CENTRAL assists Cochrane authors and other systematic reviewers around the world quickly find evidence to determine whether a treatment works.
We're pleased to announce that the May issue of CENTRAL on Cochrane Library includes approximately 14,000 references to RCTs identified from CINAHL (Cumulative Index of Nursing and Allied Health Literature) and published under license with EBSCO. CINAHL is an essential source of nursing research and publications on 17 allied health disciplines, including physical therapy, occupational therapy, nutrition and dietetics. Along with the RCTs in CENTRAL from PubMed, Embase, ClinicalTrials.gov, the World Health Organization's International Clinical Trial Registry Platform (ICTRP), KoreaMed, and the individual registers of Cochrane Review Groups, CINAHL RCT records expand the subject area coverage of CENTRAL, making it an even more comprehensive source of RCTs.
The project to include CINAHL RCTs in CENTRAL began in September 2018 with the help of our citizen scientist platform, Cochrane Crowd. Cochrane Crowd is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care. The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify RCTs. Reports of RCTs are then fed into Cochrane's Central Register of Controlled Trials.
Thanks to the efforts of the Cochrane Crowd community, Cochrane's Centralised Search Service Project Team and our colleagues at EBSCO, Metaxis, Wiley and HighWire, we are now adding CINAHL RCT records to CENTRAL. We will publish a "backlog" over the next three months that will contain older references as well as newer ones. New CINAHL records available from CENTRAL may increase results for saved searches. By August, we'll add new CINAHL RCTs to CENTRAL monthly just as we do for our other sources.
Learn how CENTRAL is created
Featured Review: Telephone interventions for managing symptoms in adults with cancer
Telephone interventions for managing symptoms in adults with cancer. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.
People with cancer experience a variety of symptoms such as depression, anxiety, fatigue and pain caused by their disease and its treatment. These are often managed, day-to-day, by patients or their family members. Poor management of symptoms may lead to other problems, such as difficulties in carrying out everyday tasks, poor sleep, and poor quality of life.
Cancer specialists have developed psychological and educational interventions to provide support for the management of a range of cancer symptoms. These interventions can often be delivered by telephone in the patients' homes instead of face-to-face in hospital. This is beneficial for patients and their families, who would normally have to travel to hospital for outpatient appointments. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.
Cochrane Review authors aimed to answer the following questions.
Are telephone interventions for adults with cancer effective in relieving symptoms of cancer and cancer treatment?
Which symptoms are most reduced when telephone interventions are used?
What aspects of telephone interventions have the most impact in reducing cancer symptoms?
In this systematic review, telephone interventions were interventions given only, or mainly, by telephone. They were given by health professionals. As well as telephone contact, they could include face-to-face contact, or printed, digital or online information.
The review included 32 studies with a total of 6250 participants. Studies could compare telephone interventions with another telephone intervention, with another type of intervention (e.g. face-to-face), or with usual care. Participants in these studies were adults with any kind of cancer at any stage. Most studies (21) were from the USA. Nine studies recruited women with breast cancer, 11 included people with breast, colorectal, lung, or prostate cancer. Fourteen studies included people with early-stage cancer. Nurses provided interventions in 24 studies. Only 10 studies delivered interventions solely by telephone, and 16 studies combined telephone calls with other materials (printed or digital). Studies measured symptoms of depression, anxiety, emotional distress, uncertainty, fatigue, pain, sexual symptoms, and breathlessness. They also measured the effect of all the symptoms together (the general symptom experience).
Most studies compared a telephone intervention with usual care alone or usual care with additional support. Eight studies compared two telephone interventions against each other; some also compared these with usual care.
The review authors analysed the results from studies that recorded change scores, or for which they were able to calculate change scores.
Twenty-one studies provided evidence on symptoms of depression compared to usual care or other interventions, but only nine provided data that could give change scores. These found that telephone interventions appeared to reduce symptoms of depression. Likewise, telephone interventions appeared effective compared to usual care or other interventions in reducing anxiety (16 studies; 5 contributed change scores); fatigue (9 studies; 6 contributed change scores); and emotional distress (7 studies; 5 contributed change scores).
Telephone interventions are convenient for patients, their families and healthcare workers and they appear to relieve some symptoms of cancer and cancer treatment. However, the studies were small, very different from each other, and some evidence was conflicting. It is unclear whether telephone interventions alone, or combined with face-to-face meetings, or printed or audio materials, are most effective in reducing the many symptoms that people with cancer experience. The authors rated the certainty of the evidence as very low.
This review includes evidence published up to January 2019.
Read the systematic review
Read the special collection on Coronavirus (COVID-19): Remote care through telehealth
The Cochrane Centre of the UTE University of Ecuador receives the "General Rumiñahui" award for its work related to the COVID-19 pandemic
The UTE University of Ecuador has received the "General Rumiñahui" award by the Pichincha Provincial Council for its fight against the spread of COVID-19. The Cochrane Centre's collaborating team has been recognized for their work on epidemiological research at the UTE. This award acknowledges their valuable contribution in modeling the evolution of the pandemic in the province; a fundamental task for taking preventive measures during the country's health emergency.
On May 24th, a virtual event was held at the UTE to celebrate the award. Cochrane and Cochrane Iberoamerica would like to congratulate our colleagues Ricardo Hidalgo, Daniel Simancas, Andrés Viteri, and the rest of the Cochrane Ecuador team on this recognition. We are very grateful and proud of their contribution in managing the pandemic and their involvement in Cochrane.
Visit the Cochrane Ecuador webpage
Visit the Cochrane Iberoamerica website
View COVID-19 resources in Spanish
Reduction in saturated fat intake for cardiovascular disease
Health guidance suggests that reducing the amount of saturated fat we eat, by cutting down on animal fats, is good for our health.
In the process of updating this review the authors wanted to know whether following this advice leads to a reduced risk of dying or getting cardiovascular disease (heart disease or stroke). They assessed the effect of replacing animal fats and hard vegetable fats with plant oils, unsaturated spreads or starchy foods, for at least two years, on health outcomes including dying, heart disease and stroke. They only looked at studies of adults (18 years or older). They included men and women with and without cardiovascular disease. They did not include studies of acutely ill people or pregnant or breastfeeding women.
The review authors found 15 studies with more than 59,000 participants. The review found that cutting down on saturated fat led to a 21% reduction in the risk of cardiovascular disease (including heart disease and strokes) but had little effect on the risk of dying. The review found that health benefits arose from replacing saturated fats with polyunsaturated fat or starchy foods. The greater the decrease in saturated fat, and the more serum total cholesterol is reduced, the greater the protection from cardiovascular events. People who are currently healthy appear to benefit as much as those at increased risk of heart disease or stroke (people with high blood pressure, high serum cholesterol or diabetes, for example), and people who have already had heart disease or stroke. There was no difference in effect between men and women.
This means that, if 56 people without cardiovascular disease, or 32 people who already have cardiovascular disease, reduce their saturated fat for around four years, then one person will avoid a cardiovascular event (heart attack or stroke) that they would otherwise have experienced.
There is a large body of evidence assessing effects of reducing saturated fat for at least two years. These studies suggest that reducing saturated fat reduces our risk of cardiovascular disease. The review authors rated the quality of the evidence as moderate.
The evidence is current to October 2019.
Cochrane Review on Saturated fats included in report published by Public Health England
Learn more about Cochrane Heart
Animating COVID-19 Evidence: an interview with stop motion animator, Beth Adams
Interview with the artist who created a stop motion animation of the Cochrane review 'Protective clothes and equipment (PPE) for healthcare workers to prevent coronavirus and other highly infectious diseases'.
Stop motion is an animated filmmaking technique in which objects are physically manipulated in small increments between individually photographed frames so that they will appear to exhibit independent motion or change when the series of frames is played back. UK animator, Beth Adams, uses this technique and paper drawings and cut outs to make short films. She recently created a video about Cochrane PPE evidence and spoke to us more about her work.
It's such an impressive video that you have made. What's your background?
I'm a History and Archaeology graduate from Nottinghamshire. Currently I'm filling the lockdown hours with animation projects.
So you don't have a health background?
No! I am very much the artsy type. However, my medical researcher parents have ingrained in me an appreciation for the importance of clinical trials and evidence lead research.
How did you get started in this craft?
In my final year at university I picked a Outreach and Engagement course, which required the creation of a educational engagement project. I decided to produce an animated video series called Roman About. The aim was to make archaeology accessible and relevant to young people through the themes of identity and multiculturalism in Roman Britain.
In hindsight teaching myself stop motion animation during final year maybe wasn't the best idea, but since then I've become a bit animation obsessed. I love that a thirty second video can convey the same information as a thousand word article, and enjoy making complicated concepts engaging and relevant to a general audience.
You recently did a video about the Cochrane systematic review called 'Protective clothes and equipment (PPE) for healthcare workers to prevent coronavirus and other highly infectious diseases'. It's a different topic area for you - what lead you to it?
I am most interested in producing educational, explanatory animations and was looking for my next topic. My mum, who is involved in the medical research charity Evidence Aid, put me in contact with one of its founders Professor Mike Clarke. Mike is also podcast editor at Cochrane and suggested I make an animation for the PPE review based on the podcast transcript. It made sense to animate this review as it's so topical and well suited for using a few visual aids to bring the words to life.
What was most challenging about this project?
This was my first commission and attempt at animating for an adult audience. I usually write the script with an accompanying animation in mind and don't have to worry and the needs of a second party. Coming up with visual aids that were accurate and appropriate but still had some humour, was definitely a challenge.
Being fairly new to stop motion and entirely self-taught, there's also always the challenge of getting a semi-professional looking video with my B in GCSE art, an old iPhone and a £5 tripod.
You certainly pulled it off! Given your background, did you have to research any of the PPE visuals?
I hadn't heard of most of the PPE examples featured in the podcast, so did some online research to make sure my animations were accurate. I had no idea that PPE varies so much across space and time.
It looks like a tedious process. How long did it take to make?
This video took me about ten days including planning and editing. My parents had had enough of little paper men all over the carpet after about a week.
View other work by Beth Adams
Follow Beth Adams on Instagram
Cochrane offers an array of online learning opportunities for the stay-at-home era
The Cochrane Training team is excited to share an overview of its online learning offerings
Recognizing that many people are abiding by recommendations to stay home in light of the COVID-19 pandemic and may like to do some learning, the Cochrane Training team has compiled the following opportunities for members of the Cochrane community, as well as teachers, students, and anyone interested in brushing up on their evidence synthesis skills.
The Training team has been pleased to hear feedback from several universities using Cochrane's online learning materials to support teaching efforts in these times where most in-person teaching activities are on hold. In parallel, Cochrane is hosting more webinars than ever before, including the recently announced nine-part webinar series on Risk of Bias 2.
Cochrane Interactive Learning, designed with leading experts in the evidence synthesis world, is aimed at new and experienced systematic review authors. It currently comprises 11 in-depth modules on conducting an intervention review. It is quite extensive, providing over 15 hours of self-directed learning materials. Most modules are also available in Spanish.
Highlights include Module 3: Searching for studies, which is practical for anyone looking to brush up on their search skills, and Module 6: Analysing the data, for those skills that even seasoned reviewers need to keep fresh. There are also specialised topics such as conducting a network meta-analysis, equity in reviews and an intro to health economics. The first module, Introduction to conducting systematic reviews, is open to everyone (also in Spanish).
Cochrane Evidence Essentials is an introductory course to evidence based medicine in four modules, covering its history, the importance of randomized controlled trials, understanding systematic reviews and using them for making health decisions. It is excellent for patients, clinicians, undergraduates of health sciences and anyone interested in EBM. Access is open but requires logging in with a Cochrane account (free).
There's a lot of interest in clinical trials for treatments for COVID-19. Evidence Essentials is a set of resources about evidence-based medicine, clinical trials and systematic reviews.
The course follows Eleni, a young woman from Greece that is based in the UK, who becomes involved in a health-related scenario affecting her aunt. As a person without a background in health, she quickly becomes oriented with the basics to be able to apply her knowledge using Cochrane evidence, and make decisions together with her health providers.
In addition to Interactive Learning and Evidence Essentials, there are also various specialised learning modules including the recently launched Synthesis Without Meta-analysis (SWiM) reporting guidelines, teaching authors how to foster transparency in reviews that do not incorporate meta-analysis. Other notable modules include Involving People and Common Errors.
Cochrane Learning Live is the Cochrane Training webinar series. Several webinars are held each month, all of which are open to anyone via sign-up in the link provided. The Learning Live page lists upcoming webinars, and toward the bottom there are archives of all past webinar recordings. See the lists below of top archived webinars by attendance and number of video views; the list below reflects those with more than 20,000 views.
Top archived webinars by attendance
Introduction to new Cochrane Handbook for Systematic Reviews of Interventions, January 2019
Introducing RoB 2, May 2020
Get to know RevMan Web – the new review writing tool, August 2018
Covid-19 Rapid Reviews: Cochrane's Response so far, April 2020
An introduction to individual patient data meta-analysis, November 2018
Top archived webinars by video views
Covidence: Cochrane's new online tool for streamlined review production, March 2016
Using GRADE and the GRADEpro GDT online software in your Cochrane Review, May 2016
RoB 2.0: A revised tool to assess risk of bias in randomized trials, November 2016
Scoping reviews: what they are and how you can do them, August 2017
Remember to follow Cochrane Training on Twitter for announcements of upcoming webinars and new online learning opportunities. Get in touch by contacting the Training team at training@cochrane.org or via Twitter.Particularly notable is the star-studded nine-part Risk of Bias 2 webinar series that recently started. Other notable webinar series include the NMA series and the Patient and Public Involvement Network series.
Free Access to Cochrane's COVID-19 pandemic resources guaranteed
All of Cochrane's COVID-19 related evidence will continue to be freely available to everyone, everywhere on the Cochrane Library (full text) and at Cochrane.org.
Cochrane's response to the COVID-19 pandemic is providing high-quality, relevant and up-to-date synthesized research evidence to inform health decision-making in containing and combating the effects of the virus (for full details see the COVID-19 pages on Cochrane.org and the Cochrane Library).
Since 26th March, Cochrane – with its publishing partner, Wiley – granted everyone in every country of the world, temporary unrestricted access to the complete Cochrane Library. This unprecedented decision ensured Cochrane evidence was accessible for all those involved in combating the pandemic and its effects on global public health until Cochrane could curate, develop and publish more specific COVID-19-related evidence.
Over the last two months Cochrane has published:
Six 'Special Collections' of Cochrane evidence relating to the prevention and treatment of COVID-19, containing 106 Cochrane Reviews and 67 Cochrane Clinical Answers (to support decision-making for health professionals). These Special Collections were developed based on World Health Organization (WHO) interim guidance and are updated in response to new information;
Five Cochrane Rapid Reviews published with accompanying podcasts and six related Cochrane Clinical Answers;
A full Cochrane Review on Personal Protective Equipment for healthcare staff;
All of this evidence is translated in up to 12 other languages to promote its global accessibility and use; and Cochrane Reviews are also being made openly available on the Wiley Online Library along with other relevant Wiley content;
Cochrane's 'COVID-19 Study Register' of primary research studies, in consultation with WHO, which has become one of the largest and most sophisticated registers in the world;
The April 2020 issue of the Cochrane Library App, featuring abridged versions of Cochrane Reviews relevant for COVID-19 (available from Google Play (Android devices) or the App Store (iPhone and iPad));
All of this material – and all of Cochrane's future COVID-19 related evidence – will continue to be freely available to everyone, everywhere on the Cochrane Library (full text) and at Cochrane.org. Cochrane and Wiley will also continue to provide free one-click access to the complete Cochrane Library for those living in 126 Low- and Middle-Income Countries. But normal access controls to the Cochrane Library will be re-introduced today and subscribed content will only be available to users who have a license.
Last week, Cochrane set out the new COVID-19 evidence it was developing to be published and made freely available in the next stage of its response over the coming six months (for more details, see here). This will include:
Two new 'Special Collections' to be published in June on: 'Support for mental health and wellbeing in the healthcare workforce'; and 'Clinical rehabilitation and support following acute illness and traumatic experiences'.
Cochrane Rapid Reviews, Cochrane Systematic Reviews and Network Meta Analyses covering:
Clinical management of COVID-19 related topics on screening and testing; drug treatment; clinical care; prophylaxis; prognosis; and pandemic-related impacts on health;
Public health measures including prevention of infection and personal protection; and
Economic and social responses to the pandemic.
Cochrane's Editor in Chief, Karla Soares Weiser, said: "Cochrane rose to the unprecedented global challenge of responding to COVID-19 by ensuring that our health evidence was immediately accessible for all people in all places across the world as the pandemic accelerated during March and April. This has been a hugely valuable in providing open access to our high-quality, trusted information. We will continue to work on producing and making freely accessible the highest quality evidence on the most important developing questions required to help support the response to this global health crisis."
Learn about Cochrane's COVID-19 response and find other resources and news.
More than 10,000 users in its first month: Cochrane's COVID-19 Study Register supports rapid evidence synthesis in the global challenge to combat COVID-19
Less than two months after its launch, Cochrane's 'COVID-19 Study Register' has become one of the largest, most sophisticated and well-used resources for researchers needing to access and analyze the huge growth in primary studies being conducted on COVID-19. Since 7 April, Cochrane's COVID-19 Study Register has attracted more than 10,000 users from around the world, accessing over 44,000 pages. The Register is constantly improving with the ambition of becoming the definitive source of studies on COVID-19.
The aim of Cochrane's COVID-19 Study Register (accessible at: https://covid-19.cochrane.org/) is to support rapid and living evidence synthesis by all systematic review producers, as well as Cochrane's own work on COVID-19-related Rapid Reviews, Systematic Reviews and Network Meta-Analyses. It provides a 'one-stop shop' for researchers to access all primary studies being published related to COVID-19. Study references are pre-evaluated to meet eligibility for COVID-19 reviews, reducing searching and screening time for author teams. The Register helps systematic reviewers prioritize topics, identify available evidence and produce urgently needed reviews for front-line health professionals, public health policymakers and research teams developing new therapeutic, diagnostic and preventive interventions for COVID-19.
With the rapid proliferation of global research related to COVID-19, it is increasingly challenging for researchers efficiently to find all relevant literature on this topic. The Cochrane COVID-19 Study Register removes the need to conduct extensive searches elsewhere, as it is continually updated with human studies on COVID-19 from trial registry platforms and PubMed. References from preprint archives and grey literature repositories that contain preliminary reports of in-process publications, organizational reports and policy literature produced outside of traditional publishing and distribution channels are also being added to the register. The register makes COVID-19 study evidence easy to find and filter through faceted search and browse options, including study characteristics and PICO (Population Intervention Comparator and Outcome) descriptors. The register's universal data export formats (RIS and CSV) also makes new evidence simple to share and integrate into review production.
Cochrane will continue to develop, improve and extend the comprehensiveness of the COVID-19 Study Register in the weeks and months ahead.
In May and June, the Register will:
Increase its coverage by adding approximately 2,000 records from reputable preprint archives;
Enhance searching with new filters for publication type and studies reporting results;
Add PICO descriptors for all controlled trials; and
Develop new surveillance and alerting features that will notify researchers to emerging evidence from the global response to COVID-19.
Upcoming opportunities to help build the COVID-19 Study Register will be available soon through Cochrane Crowd.
To find out more and get involved:
Explore the Cochrane COVID-19 Study Register.


text:
Branden Williams, The Creative Thinker and Dedicated Real Estate Star
Celebrity haunt, Beverly Hills is known to be the home of many Hollywood stars, rose gardens, and fountains. Not to forget that this Los Angeles city features the upscale shopping street of Rodeo Drive, and has undoubtedly marketed itself as the high-end shopping paradise for the rich and famous. Moreover, the city has also built a reputation for being the basis of many popular TV shows.
And of course, Beverly Hill is also the home of the real estate superstar, Branden Williams. Born and raised right in the city, Branden Williams has brought "hometown advantage" to his well-reputed Williams & Williams Estates Group brand.
Branden opened his eyes in the city on October 13, 1974, and from when he was just a kid, he showed great skills, exceptional ideas, and unmatched talent with regard to being a salesman. But before he could fathom where his interest and success truly lay, he was on the road to be a Hollywood star!
Growing in the haven for celebrities, the desire to be something was obviously natural. Branden grew up with Hollywood, where Angeline Jolie and Tobey Maguire were his classmates at Beverly Hills High School. Branden was first scouted by a casting director at a movie theater where he was hanging with some friends on a night off from busing tables at the Ivy.
Branden Williams has had several appearances in several 1990s classics, including Never Been Kissed, starring Drew Barrymore, Jessica Alba, and James Franco. Branden almost got the role of Seth Green in the teen chick-flick Can't Hardly Wait. Even though he had landed many successful small roles, he knew he didn't want to be an actor forever.
A student at the Fashion Institute of Technology in Los Angeles, Branden, gave his career a start quite early by helping his father sell sheepskin car covers on the side of Fairfax Avenue. While still in college, Branden began working in the customer service and entertainment industry.
It wasn't until a potential gig with Warner Bros. sitcom went awry, that Branden amitted his time in the industry was up. That paired with his interest in fashion and style transitioning to architecture and later design and, ultimately, luxury real estate made Branden come face-to-face with his true calling.
In 2004, Branden completely shifted towards selling homes, which was the prime time of the real estate market. A resident of this deverse city had already instilled an exceptional understanding of how the real estate market worked in Beverly Hills.
While Branden was working at his first brokerage firm, he met Rayni Romito, his wife. For two years, Branden worked hard in the industry, with the aim of making his mark in real estate. Two years later, Branden and Rayni founded Williams & Williams Estates Group, becoming the ultimate duo, the top brokers in all of Beverly Hills.
Together, the team put in devotion, exceptional strategies, and tireless efforts to make their brand known worldwide. Branden and Rayni are known to represent several celebrity personalities, including Markus Persson, Dr. Dre, Jennifer Lopez, and Bruce Willis. The power couple also represented the buyers of Jonathan Frakes and Genie Francis' Beverly Hills home for $12 million.
Under Branden's influence, the company sold the Hillcrest Road property to Persson for $70 million, the highest-ever sale price in Beverly Hills. The company also sold Beverly Crest home of former Sumner Redstone girlfriend Sydney Holland to Jennifer Lawrence for $8.2 million, and Jeremy Renner and Kristoffer Winters' Hollywood flip for $4.3 million.
His dedication and hard work bore fruit when the company was able to represent a number of national and local accolades, including The Wall Street Journal's Top-Producing Agents, The Hollywood Reporter's Top Real Estate Agents, and Variety's Real Estate Elite.
Of course, since the talent was no more hidden, Branden's advice was sought by various top-tier national news outlets, including Larry King Now, The Wall Street Journal, Bloomberg, Fox Business, ABC News, People, CNN, CBS Money and more.
Branden has also appeared on HBO's hit show "Entourage" after showing properties to its creator Doug Ellin, playing his true self, a real estate agent. He is also an active member of the Los Angeles County Museum of Art and. In 2017, Branden, along with his wife, Rayni were honored by Zimmer's Children Museum too!
Musicians, YouTubers, Digital Creators Head to Fantagious, the Future of Digital Growth
From Barrel Rolls to Flipping Houses: Bill Allen Shares His 7-Figure Secrets
The idea of Bigtime Daily landed this engineer cum journalist from a multi-national company to the digital avenue. Matthew brought life to this idea and rendered all that was necessary to create an interactive and attractive platform for the readers. Apart from managing the platform, he also contributes his expertise in business niche.

redpajama_set_name: RedPajamaCommonCrawl


Nestled in a small wooded site, Margaret A. Cargill Philanthropies (MAC) provides support to programs benefiting society, the arts and the environment. Conceptualized and designed by Gensler, MAC's 42,000-square-foot, LEED® Gold-certified building expresses Margaret's many passions, from her Swedish heritage to her love of Native American folk art and commitment to environmental stewardship. Infused with a warm, residential feel and inspired by Margaret's personal furnishings, photographs and artwork, the space reflects Margaret's passion for art, culture, and environmental sustainability, connecting staff and visitors to her life and work. A family-style kitchen, outdoor terrace, and dedicated library and lounge areas encourage collaboration and social gatherings for the foundation's employees, members and community leaders.


Damien Jurado is the artist I most identify with in regards to the writing, style and production of songs, his influence is probably very noticeable on all my albums so far. The first album I heard from him was passed to me by a friend, "And Now That I'm In Your Shadow", it sounded like nothing I'd ever heard before, I had no idea you could communicate such depth from such sparse arrangements. I began changing my writing style at that time after hearing that, and I was trying to listen to any other similar artists that I could find. It was like discovering a hidden world of music, and everything in it was new to me.
It wasn't until I heard "Caught In The Trees" that I decided that I was going to record my first album. I remember very clearly hearing a song from that record for the first time, and realising that the chord progression was the same as a song I had written a couple of months previously. A simple thing, and coincidental, but it made me think "hey, maybe I can do this".
I've not a missed a chance to see him perform live when he travels to Scotland, even having the pleasure of shaking his hand and getting records signed a couple of times. The cover of "Reel to Reel" that I'm doing is based off my memory of his solo performances from those shows, I remembered that track being particularly great when broken down and stripped back.
Lastly today we have Jeremy Squires and his beauty of a song, Sheets. This one is also one of my favourite songs from Jurado (but again, I have more than a few 'favourites') – the tale of the love triangle. Knowing you are 'trapped' and unable to let go of a lover, even when sleeping in the "…still I sleep in the very sheets he's been in". Squires makes it his own with the fully acoustic cover that includes just enough of a Southern drawl peeking out of his voice – a song perfect for a bit of drawl if I ever heard one.
Day three down! Pretty damn good so far, right? Remember to visit Damien Jurado whenever possible. You might even purchase some originals by visiting Secretly Canadian.
Thanks for profiling, Sandy. Keep up the great work.
Hey, did Jurado ever catch wind of this? If so, did he respond and what was his response?


This time I had an Elemis Coconut and Milk Ritual Wrap - a full body scrub with warm oil and warm milk bath poured over you before you are wrapped up in a warm cocoon. On my heated bad, having my face, neck and head massaged I floated away on a little warm cloud of relaxation!
We spent some time in the Garden Lounge reading magazines in front of the fire and we may have gone to the Palm Conservatory for tea and scones before heading home. And I may have treated myself to some Elemis goodies from the spa shop. It's my birthday after all!
This looks lovely Rachael! I've always promised myself I would do this but never actually got round to it! Maybe for my 40th in October! I'm new to your blog and so far I have really enjoyed reading back over your posts. May I wish you a happy birthday and best of luck with your new house!
I LOVE spa days. Me and my mum go together at least once a year and I never want to leave!
Looks like an amazing time :) Happy birthday!


text:
J.D. McKissic
, Washington Commanders
ADP: 156
28.8 95 0 27 173
Commanders place J.D. McKissic on IR, ending his season
Commanders RB J.D. McKissic was placed on injured reserve Saturday by the Commanders and his season is over.
McKissic has been out with a neck injury he suffered in Week 8 against the Colts and the injury will require months of rehab. Antonio Gibson was starting to take over the third-down role for Washington and now it's a clear two-back group with him and Brian Robinson. McKissic has one year left on his 2-year contract he signed with the team in March.
by Jordan Heck
· Nov 04, 2022 · 1:40 AM EDT
WAS RB J.D. McKissic - Week 9 Fantasy Football Outlook
J.D. McKissic ran the ball twice for six yards last week, and caught three passes for 14 yards on five targets. McKissic averaged 4.8 receptions for 30.5 yards in the four games before Brian Robinson returned, and has averaged 2.0 receptions for 12.8 yards in the four games since. Washington has been utilizing Antonio Gibson out of the backfield more with Robinson handling ground duties, leaving scraps left for McKissic. There just aren't enough touches for McKissic at this point to make him someone worth playing in fantasy.
2022 Strength of Schedule - WAS
JAX 4
@DET 18
@DAL 3
@CHI 23
GB 25
@IND 22
@PHI 31
@HOU 21
ATL 26
@NYG BYE 26
NYG 2
@SF 28
CLE 12
1 JAX 3 8 0 0 2.67 3 20 0 3 6.67 4.8 6.30 7.8 31/77 40.3%
2 @DET 3 9 0 0 3.00 7 54 0 7 7.71 6.3 9.80 13.3 34/74 45.9%
3 PHI 3 8 0 0 2.67 6 32 0 9 5.33 4.0 7.00 10.0 41/77 53.2%
4 @DAL 8 40 0 0 5.00 3 16 0 4 5.33 5.6 7.10 8.6 38/74 51.4%
5 TEN 0 0 0 0 0.00 5 37 0 7 7.40 3.7 6.20 8.7 26/63 41.3%
6 @CHI 2 20 0 0 10.00 0 0 0 3 0.00 2.0 2.00 2.0 17/57 29.8%
7 GB 1 4 0 0 4.00 0 0 0 2 0.00 0.4 0.40 0.4 12/74 16.2%
8 @IND 2 6 0 0 3.00 3 14 0 5 4.67 2.0 3.50 5.0 22/61 36.1%
Injury: Neck
9 MIN - - - - - - - - - - - - - - -
10 @PHI - - - - - - - - - - - - - - -
11 @HOU - - - - - - - - - - - - - - -
12 ATL - - - - - - - - - - - - - - -
13 @NYG - - - - - - - - - - - - - - -
15 NYG - - - - - - - - - - - - - - -
17 CLE - - - - - - - - - - - - - - -
18 DAL - - - - - - - - - - - - - - -
Per game 2.75 11.88 0 0 4.32 3.38 21.63 0 5.00 6.41 3.60 5.29 6.98 27.63/69.63 39.27%
Totals 22 95 0 0 4.32 27 173 0 40 6.41 28.8 42.3 55.8 221/557 39.27%


text:
Q: Acessing ordered Class Properties I'm really new to coding and would like some help with this problem: I want to access the objects in my class in some ordered way until I acces the first three.
I thought this[1] could mean this.x but I found out it can't:
class TargetingSolution{
    constructor(config){
        this.x = config.x
        this.y = config.y
        this.z = config.z
        this.solution = [];
    }

    target (){
        for (var i = 0; i < 3; i++){
            this.solution.push(this[i])
          }
    }
}

// The following lines of code are not required for the solution, but can be
// used by you to test your solution.
const m = new TargetingSolution({
    x: 10,
    y: 15,
    z: 900
  });

  console.log(m.target()); // would print "(10, 15, 900)"

So I found this solution down here after trying a lot of different stuff for hours
class TargetingSolution{
    constructor(config){
        this.x = config.x
        this.y = config.y
        this.z = config.z
        this.solution = [];
    }

    target (){
            for (var a in this) {
                if(a === 'x' | a === 'y' | a === 'z'){
                    this.solution.push(this[a])
                }
                else{
                    break
                }
            }
            return this.solution;
          }
}

// The following lines of code are not required for the solution, but can be
// used by you to test your solution.
const m = new TargetingSolution({
    x: 10,
    y: 15,
    z: 900
  });

  console.log(m.target()); // would print "(10, 15, 900)"

But I wonder if there are smarter (but simpler) ways to do that.
Another example of something I tried and I'm not sure whether I got near or not was this:
class TargetingSolution{
    constructor(config){
        this.x = config.x
        this.y = config.y
        this.z = config.z
        this.solution = [];
    }

    target (){
       return config.forEach(element => this.solution.push(element));
    }
}

// The following lines of code are not required for the solution, but can be
// used by you to test your solution.
const m = new TargetingSolution({
    x: 10,
    y: 15,
    z: 900
  });

  console.log(m.target()); // would print "(10, 15, 900)"

(but it doesn't work because of the config in the
return config.forEach(element => this.solution.push(element)); line

redpajama_set_name: RedPajamaStackExchange


text:
Overall Green alert Tropical Cyclone for FUNG-WONG-19
in Japan, Philippines, China
Tropical Cyclone FUNG-WONG-19 can have a low humanitarian impact based on the maximum sustained wind speed, exposed population and vulnerability.
GDACS ID TC 1000633
Name FUNG-WONG-19
From - To 19 Nov - 23 Nov
Exposed countries Japan, Philippines, China
Exposed population No people in Category 1 or higher
Maximum wind speed 111 km/h, Tropical storm
Maximum storm surge 0.8 m (22 Nov 17:00 UTC)
Vulnerability Medium (Philippines)
+ Wind Storm surge Rainfall GDACS score
GDACS 111 km/h 0.8 m n.a. 0.5
Single TC: maximum expected impact (wind, storm surge, rainfall)
HWRF 126 km/h 1.2 m 465 mm 0.5
GFS 194 km/h 0.9 m 318 mm 1.5
ECMWF 112 km/h 0.9 m 622 mm 0.5
Beta Version - All weather systems in the area: maximum expected impact (wind, storm surge, rainfall)
Maximum expected impact (wind, storm surge and rainfall) using different data sources.
Meteo assessment
Philippines, Japan, Taiwan - Tropical Cyclone FUNG-WONG and KALMAEGI update (ECHO 22 Nov 2019)Fri, 22 Nov 2019 11:00
Tropical Cyclone FUNG-WONG (named SARAH in the Philippines), is weakening as it moves over the eastern Philippine Sea toward Miyako-jima Island. On 22 November at 00:00 UTC, its centre was located approximately 170 km south-east of coast of Yaeyama Island with maximum sustained winds of 95 km/h (tropical storm).
FUNG-WONG will pass over Miyako-jima Island on 22 November afternoon (UTC) and it is forecast to enter in the East China Sea, weakening and dissipating on 23 November.
Following the passage of Tropical Cyclone KALMAEGI that affected northern and central Luzon (Philippines), 13,342 people have been displaced (of which 10,741 sheltered in 221 evacuation centres) and 21,103 affected. In addition, at least 11 roads and 11 bridges have been closed.
Over the next 24 hours, moderate to heavy rain is forecast over northern and eastern Taiwan, while heavy rain and strong winds are forecast across Yaeyama and Miyako Islands where a red warning for high waves is in effect. In the Philippines, heavy rain is also forecast over northern Luzon, the Babuyan Islands, and the Batanes Islands.
Philippines, Japan - Tropical Cyclone KALMAEGI and FUNG-WONG update (ECHO 21 Nov 2019)Thu, 21 Nov 2019 11:03
Tropical Cyclone KALMAEGI's (RAMON in the Philippines) centre was approximately 200 km west-southwest of Manila on 21 November at 0.00 UTC, with maximum sustained winds of 46 km/h (tropical depression) but it will weaken and dissipate as it moves across the South China Sea.
12,060 people have been affected, 9,320 have been evacuated, 8,099 of which are sheltered in 156 centres. 19 houses have been damaged and 8 roads and 7 bridges closed.
Antoher Tropical Cyclone FUNG-WONG (SARAH in the Philippines) is moving over the western Philippine Sea and its centre was approximately 300 km east of Batan Island on 21 November at 0.00 UTC (Batanes Islands, northern Philippines) with maximum sustained winds of 111 km/h.
FUNG-WONG will approach the islands of Ishigaki and Iriomote (Yaeyama Islands, southern Japan) on 22 November with maximum sustained winds up to 83 km/h.
On 21-22 November, moderate to heavy rain and strong winds are forecast for northern Luzon and the Yaeyama Islands (Japan) and light to moderate rain in the central and eastern Philippines.
Detailed event map. European Union, 2015. Map produced by EC-JRC.
The boundaries and the names shown on this map do not imply official endorsement or acceptance by the European Union.
Updates on volcanic activity (Smithsonian)
Latest media headlines
Estimated casualties (PAGER)
USGS estimates the number of casualties for each earthquake for the Prompt Assessment of Global Earthquakes for Response (PAGER) product.
The graph shows the current fatalities estimate.
Exposed population
Daily Maps: Philippines, Japan - Tropical Cyclone KALMAEGI and FUNG-WONG update
21/Nov/2019 05:32 UTC
Data, images, links, services and documents
For this events, GDACS has links to information from the following sources: JRC (57), (2), BOM (1), JTWC (1), NASA (1), NOAA (1), OCHA (1), TRMM (1), WMO (1), INFORM (2),


text:
Focus on the Family Broadcast >> All Episodes
Embracing Biblical Womanhood (Part 1 of 2)
Original Air Date 07/16/2013
Get Social and Listen
Dr. Tony Evans and his daughter, author Chrystal Hurst, provide biblical wisdom on the concept of the Proverbs 31 woman and remind women to find their value in the Lord and His kingdom, instead of the world around them. (Part 1 of 2)
Listen here, watch recent episodes on our YouTube channel, or download our app.
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Dr. Tony Evans is founder and senior pastor of Oak Cliff Bible Fellowship in Dallas, founder and president of The Urban Alternative, former chaplain of the NFL's Dallas Cowboys, and present chaplain of the NBA's Dallas Mavericks. His radio broadcast, The Alternative with Dr. Tony Evans, can be heard on nearly 1,000 US radio outlets daily and in more than 130 countries. For more information, visit TonyEvans.org.
Chrystal Evans Hurst
Chrystal Evans Hurst is a talented writer, speaker, and worship leader. As the eldest child of Dr. Tony and Lois Evans, she assists her mom in leading the women's ministry at their family's church, Oak Cliff Bible Fellowship. Chrystal shares her poignant reflections on her faith and day-to-day experiences on her popular blog, Chrystal's Chronicles, and she recently co-authored a book with her dad titled Kingdom Woman. Chrystal and her husband, Jessie, have five children. Learn more about Chrystal at her website, chrystalevanshurst.com.
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text:
Llantwit Fardre Rugby Football Club is a rugby union team from the village of Llantwit Fardre, South Wales. The club was formed in its present state in 1946 and obtained membership of the Welsh Rugby Union in 1949. Llantwit Fardre RFC is a feeder club for the Cardiff Blues.

Early history
'Parish Rugby was played as early as 1886 on the Duffryn Bach field and continued to be played there until 1908 when the team moved to Tynywaun field, Hollybush, where the game continued until the Great War. At about the same time as the senior side, a junior club came into existence. Before 1908 this team played in the field where, later, The Parade and Lewis Street were built.'

A South Wales Daily News article for December 1900 named a Llantwit Fardre team that played Ystrad Stars. Some of these players appear in photographs of the 1908 and 1911 Llantwit Fardre teams in the clubhouse, giving credence to the assumption that Llantwit Fardre RFC was in existence in the season 1900–01.

After the First World War, Llantwit Fardre Rugby Football Club was a member of the Pontypridd and Rhondda League, but little evidence exists after 1926, where it appears the team disbanded.

History after the Second World War

The present day club was founded in 1946 as a result of a casual meeting at the Carpenter's Arms, Efail Isaf. A public meeting was held at Bethel Baptist Church in The Parade, Church Village, on Wednesday 22 May 1946. This was later to become the site of the new clubhouse in 1961

On Saturday 19 September 1946 the Club played its first match in the Pontypridd & Rhondda League away to Rhondda Transport. The Club colours were black shirts with white collars. From 1946 to the end of the 1949 season home fixtures were played on fields at Duffryn Dowlais Farm. At the beginning of the 1949–50 season the team transferred to the Vicarage Field. Club Headquarters and changing rooms were based at the Cross Inn, Church Village, some distance from the playing fields. Within three seasons the Club achieved membership of the WRU

In 1951 the Llantrisant and Llantwit Fardre Rural District Council made a field available at Cae Fardre, Church Village. It was officially opened on 1 September 1951 with Pontypridd RFC providing the opposition.

Colours

Club badge
The club badge comprises a Welsh dragon holding a bunch of five keys, symbolic of St. Illtyd, celebrated as the saint of the five keys. The five keys symbolise:- Youth, Learning, Chivalry, Priesthood and Knighthood.

Club honours
 1994-95 Welsh League Division 8A Central - Champions

Notable former players
  Neil Jenkins - the first player to break the 1000 points barrier on an international level.

External links
 Llantwit Fardre Rugby Football Club

References

Welsh rugby union teams
Rugby clubs established in 1946

redpajama_set_name: RedPajamaWikipedia


text:
Q: Large latency when thread interrupted using hibernate and c3p0 I am seeing these warnings in our logs, and when I do, I see larger-than-normal latencies on transactions in our database. I've scoured the internet looking for more information.
2014-12-01 18:14:03,866 [BoundedFuturePool-2] WARN  com.mchange.v2.resourcepool.BasicResourcePool  - {} com.mchange.v2.resourcepool.BasicResourcePool@2f18b0cb -- an attempt to checkout a resource was interrupted, and the pool is still live: some other thread must have either interrupted the Thread attempting checkout!
java.lang.InterruptedException
at java.lang.Object.wait(Native Method)
at com.mchange.v2.resourcepool.BasicResourcePool.awaitAvailable(BasicResourcePool.java:1414)
at com.mchange.v2.resourcepool.BasicResourcePool.prelimCheckoutResource(BasicResourcePool.java:606)
at com.mchange.v2.resourcepool.BasicResourcePool.checkoutResource(BasicResourcePool.java:526)
at com.mchange.v2.c3p0.impl.C3P0PooledConnectionPool.checkoutAndMarkConnectionInUse(C3P0PooledConnectionPool.java:755)
at com.mchange.v2.c3p0.impl.C3P0PooledConnectionPool.checkoutPooledConnection(C3P0PooledConnectionPool.java:682)
at com.mchange.v2.c3p0.impl.AbstractPoolBackedDataSource.getConnection(AbstractPoolBackedDataSource.java:140)
at org.springframework.orm.hibernate3.LocalDataSourceConnectionProvider.getConnection(LocalDataSourceConnectionProvider.java:81)
at org.hibernate.jdbc.ConnectionManager.openConnection(ConnectionManager.java:446)
at org.hibernate.jdbc.ConnectionManager.getConnection(ConnectionManager.java:167)
at org.hibernate.jdbc.BorrowedConnectionProxy.invoke(BorrowedConnectionProxy.java:74)
at com.sun.proxy.$Proxy40.setReadOnly(Unknown Source)
at org.springframework.jdbc.datasource.DataSourceUtils.prepareConnectionForTransaction(DataSourceUtils.java:155)
at org.springframework.orm.hibernate3.HibernateTransactionManager.doBegin(HibernateTransactionManager.java:508)
at org.springframework.transaction.support.AbstractPlatformTransactionManager.getTransaction(AbstractPlatformTransactionManager.java:371)
at org.springframework.transaction.interceptor.TransactionAspectSupport.createTransactionIfNecessary(TransactionAspectSupport.java:329)
at org.springframework.transaction.interceptor.TransactionInterceptor.invoke(TransactionInterceptor.java:105)
at org.springframework.aop.framework.ReflectiveMethodInvocation.proceed(ReflectiveMethodInvocation.java:172)
at org.springframework.aop.framework.Cglib2AopProxy$DynamicAdvisedInterceptor.intercept(Cglib2AopProxy.java:622)
at com.twitter.amplify.videoediting.data.TranscodingDao$$EnhancerByCGLIB$$696749fa.getTranscodeInfo(<generated>)
at com.twitter.amplify.videoediting.GetTranscodeInfoHandler$$anonfun$7.apply(GetTranscodeInfoHandler.scala:78)
at com.twitter.amplify.videoediting.GetTranscodeInfoHandler$$anonfun$7.apply(GetTranscodeInfoHandler.scala:78)
at com.twitter.util.Try$.apply(Try.scala:13)
at com.twitter.util.ExecutorServiceFuturePool$$anon$2.run(FuturePool.scala:112)
at java.util.concurrent.Executors$RunnableAdapter.call(Executors.java:471)
at com.twitter.amplify.util.LocalExecutorService$1.call(LocalExecutorService.java:36)
at java.util.concurrent.FutureTask.run(FutureTask.java:262)
at java.util.concurrent.ThreadPoolExecutor.runWorker(ThreadPoolExecutor.java:1145)
at java.util.concurrent.ThreadPoolExecutor$Worker.run(ThreadPoolExecutor.java:615)
at java.lang.Thread.run(Thread.java:745)

Below is our configuration object.
Using DataSource [com.mchange.v2.c3p0.ComboPooledDataSource [ acquireIncrement -> 5, acquireRetryAttempts -> 30, acquireRetryDelay -> 1000, autoCommitOnClose -> false, automaticTestTable -> null, breakAfterAcquireFailure -> false, checkoutTimeout -> 0, connectionCustomizerClassName -> null, connectionTesterClassName -> com.mchange.v2.c3p0.impl.DefaultConnectionTester, dataSourceName -> 2u120u951sgpypjpvvovo|73f2f11, debugUnreturnedConnectionStackTraces -> false, description -> null, driverClass -> com.mysql.jdbc.Driver, factoryClassLocation -> null, forceIgnoreUnresolvedTransactions -> false, identityToken -> 2u120u951sgpypjpvvovo|73f2f11, idleConnectionTestPeriod -> 0, initialPoolSize -> 0, jdbcUrl -> jdbc:mysql://db-hat-rw-master-001.global-db.twttr.net/amplify?defaultFetchSize=200, maxAdministrativeTaskTime -> 0, maxConnectionAge -> 0, maxIdleTime -> 60, maxIdleTimeExcessConnections -> 60, maxPoolSize -> 200, maxStatements -> 0, maxStatementsPerConnection -> 0, minPoolSize -> 0, numHelperThreads -> 3, preferredTestQuery -> select 1, properties -> {user=******, password=******}, propertyCycle -> 0, statementCacheNumDeferredCloseThreads -> 0, testConnectionOnCheckin -> false, testConnectionOnCheckout -> true, unreturnedConnectionTimeout -> 300, userOverrides -> {}, usesTraditionalReflectiveProxies -> false ]]

Thank you for your help!
Max

A: So, the warning is telling you as much as c3p0 knows directly: a client Thread seeking to check out a Connection -- and wait()ing to get ahold of one -- had interrupt() called on it, forcing the Thread to break from its wait(). The Thread that was blocked is an application Thread (it's a scala app, calling something in com.twitter.amplify.videoediting.GetTranscodeInfoHandler). Most likely, some other part of the application watches these Threads and interrupt()s them if they hang. If this is so, it's the latency you are observing that is the core problem. Your Connection pool is maxed out, either because it has hit maxPoolSize or it has not but needs to acquire more Connections from the DBMS. Threads get stuck wait()ing for Connections, then they wait for too long and get killed by an external monitor.
Your maxPoolSize of 200 is pretty big, but obviously big must be judged relative to demand. Maybe you have more than 200 simultaneous client Threads. (You can monitor this stuff by JMX, by the way, to see pretty directly whether your pool is hitting its ceiling.)
But my guess (and it is only that) is that your problem has to do with failing to scale the pool up rapidly enough. For an application at the scale you are running, c3p0's default Thread pool size (quaintly described by a configuration parameter called numHelperThreads, sorry about that) is way too small at 3. The first thing I'd do is ramp that up to 10 or 20. If that doesn't solve your problem, you might check JMX to see if you in fact are bumping up against your DataSource's maxPoolSize of 200. (If you are, you can raise that too, although eventually there will be diminishing returns as Thread contention bites.) You might also monitor numThreadsAwaitingCheckoutDefaultUser, which should also be available by JMX.
But I'd start with numHelperThreads. It's way-too-small value may well be the problem.

A: This exception will always occur when a thread enters BasicResourcePool.awaitAvailable and sleeps at line 1414 and another thread enters BasicResourcePool.close( boolean ) line 1225 when broken == false.
In this situation thread inside close will call Thread.interrupt() on the awaiting threads.
See this code, line 1276. It is interupting the threads sleeping at line 1441 of BasicResourcePool.awaitAvailable.
        for (Iterator ii = acquireWaiters.iterator(); ii.hasNext(); )
            ((Thread) ii.next()).interrupt();

Its important to note, that AwaitAvailable is called prelimCheckoutResource - line 568, which is synchronized. Thus when it sleeps at line 1414, it releases the lock, which allows another Thread to enter close, which is also synchronized.
Thus once Thread.interrupt is called inside close, none of the sleeping threads can actually wake up until after the interrupting thread in BasicResourcePool.close() has returned from the synchronized block and released the lock, because returning from .wait() requires the thread to re-acquire the lock.
ie. Once another thread enters a synchronized block, your sleeping thread wont wake up once the timeout expires or indeed to handle the InterruptedException until the other thread exits the synchronized block.
Thus if a situation exists when a synchronized method that calls close from a loop, your thread will not be able to return until that other thread releases the lock.
It's worth mentioning that BasicResourcePool.connectionErrorOccurred() calls the synchronized method BasicResourcePool.resetPool() and this method in a loop, calls close, which will interrupt your thread, but block it from awaking until after resetPool releases the lock.
Just speculating that this is occurring, but if it did, it would cause the exception you see and may also explain the latency.


text:
Julia Hubbel
Are Your Depression Drugs Making You Worse?
Julia Hubbel December 21, 2017
Rather than help me work out my feelings, I got medicated. Society's pat answer to angry women. ...
Featured ArticlesMindRelationshipsWith Myself0 Comments660 views 4
Julia Hubbel is a prize-winning journalist, professional speaker, international adventure traveler. She is the author of the multiple prize-winning books WordFood: How We Feed or Starve our Relationships and Tackling the Titans: How to Sell to the Fortune 500. Her travels take her on extraordinary solo adventures all over the globe. From horseback riding in Central Asia to kayaking the freezing fjords of Iceland, Julia pushes the outer boundaries of her athletic skill and endurance. She seeks stories and journeys that erase her impossible. Her travel blog can be found at www.TheGallopingGaia.com. Today, Julia is committed to helping women achieve their best health after forty. She provides consulting, articles and advice for those seeking the best out of their most productive years. She permanently beat a 90-lb weight battle, quit a five-pack-a-day smoking habit, and dethroned a multi-decade eating disorder. She has spent three decades working with the Fortune 500 as a executive and consultant, working with women's networks, women- and veteran-owned business. A dynamic and popular speaker, she has been featured at women's conferences all across America, Australia and Canada. In 2012, Diversity Plus Magazine named her of the Top Twenty five Most Powerful Women in Diversity. Julia is a disabled, decorated Vietnam Era veteran who served as a journalist and television producer-director in the Army, and Chief of Military Protocol for the Jimmy Carter Presidential Inaugural in 1977.