Lodge CJ, Tan DJ, Lau MX, Dai X, Tham R, Lowe AJ, Bowatte G, Allen KJ, Dharmage SC. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr. 2015;104:38-53 [the journal is open access, so you should have no trouble obtaining the article] To lighten your workload, you only need consider the outcome asthma throughout this assignment. You will need to download the article and the supplementary web material. You do not need to read all the supplementary tables and figures – the questions below will indicate which of the supplementary tables and figures you need to examine. Some of the questions have been adapted from the PRISMA checklist for reporting systematic reviews. http://www.prisma-statement.org/ Registration of protocol 1.Did the authors provide evidence that the protocol for their systematic review was registered (e.g., with PROSPERO)? [1 mark] Rationale and objective 2.Does the introduction clearly describe the rationale in the context of what is already known? [Item 3 in PRISMA checklist] [2 marks] 3.Does the introduction provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design? [Item 4 in PRISMA checklist] [3 marks] Search strategy Item 8 in the PRISMA checklist states: “Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.” 4.Would it be possible for another person to replicate the electronic search strategy for at least one of the databases used by the authors? [2 marks] Flow diagram 5.From the flow diagram, are you able to determine why some studies that were included in the box labelled “Total Studies Included” were not included in the meta-analysis (last box in the diagram)? [2 marks] Descriptive information about each study in relation to selection bias, information bias and confounding Table 2 in the supplementary information provided data/information extracted from each of the studies that were included in the review of asthma. An important purpose of this table is to enable the reader to assess each study’s risk of bias due to selection bias, information bias and confounding. 6. [6 marks] What key items should be extracted from each of the study reports (articles) and included in Supplementary table 2 to enable the reader to assess the risk of selection bias in each of the studies? Was each item included in Supplementary table 2? You can ignore possible selection bias due to inclusion of prevalent cases for the cross-sectional studies, since this would be an issue common to them all. Please use the table below for your answers. You will see it asks you to list items separately for each of the three types of studies included in the review. Add extra rows as necessary. Don’t assume that the number of rows indicates how many items you need to mention! If an item was only partially included (i.e. some but not all of the relevant information was included, state what was missing). Please do not format the table in landscape mode. It makes marking in Turnitin very difficult. Marks will be allocated on a scale 6 marks – outstanding, all key points covered 5 marks – excellent, only minor problems 4 marks – very good, a few problems 3 marks – good, several problems 2 marks – poor, many problems 1 mark – very poor 0 marks – not answered Type of study Items that should be included Was the item included? (Yes/No/Partially) Cohort Cross-sectional Case-control 7. [6 marks] What key items should be extracted from each of the study reports (articles) and included in Supplementary table 2 to enable the reader to assess the risk of information bias in each of the studies? Was each item included in Supplementary table 2? Please make a copy of the table at the end of this document for your answers. As for selection bias, you will need to list items separately for each of the three types of studies included in the review. Please use the table below for your answers. You will see it asks you to list items separately for each of the three types of studies included in the review. If you feel that the information is the same for more than one type of study (e.g. cohort and cross-sectional studies), you can amalgamate the relevant rows. If you do that, justify why you did it. Add extra rows as necessary. Don’t assume that the number of rows indicates how many items you need to mention! If an item was only partially included (i.e. some but not all of the relevant information was included, state what was missing). Please do not format the table in landscape mode. It makes marking in Turnitin very difficult. Marks will be allocated on a scale: 6 marks – outstanding, all key points covered 5 marks – excellent, only minor problems 4 marks – very good, a few problems 3 marks – good, several problems 2 marks – poor, many problems 1 mark – very poor 0 marks – not answered Measurement of: Items that should be included Was the item included? (Yes/No/Partially) Outcome Cohort studies Cross-sectional studies Case-control studies Exposure Cohort studies Cross-sectional studies Case-control studies 8.What information is necessary for a reader to assess the risk of confounding? Is this provided in Supplementary table 2? [3 marks] Assessing risk of bias of individual studies & overall quality 9.What tool did the authors use to assess risk of bias (or quality) of individual studies? [1 mark] 10.What tool did the authors use to assess the overall quality of studies for each association? [1 mark] Results for asthma In the blue box on page 38, the authors state “There is low grade quality evidence that longer duration of breastfeeding is associated with a reduced risk of asthma in children aged 5–18 years.” 11.In your own words, describe the relevant results. (Don’t describe subgroup analyses or any of the results in Table 2) [3 marks] 12.On page 41, the authors stated “There was some evidence of publication bias from the funnel plot and Egger’s test (p = 0.018), with a propensity for publishing small studies showing protective effects (Fig. S3)”. Look at supplementary figure 3. Discuss why the authors reached this conclusion. (You can ignore the test and p-value.) [3 marks] 13.Table 2 shows the results of an analysis designed to explore reasons for heterogeneity in the associations between asthma and any type of breast feeding. The analysis is called meta-regression. The pooled odds ratios for cohort and cross-sectional studies are quite different. a)Does that make you feel more or less comfortable about including cross-sectional studies in the overall meta-analysis? [2 marks] b)How does the finding of different odds ratios for cohort and cross-sectional studies relate to the following sentence from the abstract? “Some of the protective effect of breastfeeding for asthma may be related to recall bias in studies of lesser methodological quality.” [3 marks] Bradford Hill guidelines for assessing causality We will consider the outcome asthma at 5-18 years of age only. You can ignore the other outcomes for the questions about the Bradford Hill guidelines. Unless specified otherwise, you should consider all three categorisations of breast feeding discussed in the paper. Consistency of the association 14.How consistent is the evidence that breast feeding is associated with reduced risk of asthma? [4 marks] Temporality 15.How strong is the evidence that the exposure (breast feeding) precedes asthma at 5-18 years of age? [3 marks] Strength of the association 16.How strong do you consider the associations between breast feeding and asthma at 5-18 years of age? [4 marks] Dose-response relationship 17.Does the paper provide evidence on whether there is a dose-response relationship between breast feeding and risk of asthma? [2 marks] Biological plausibility 18.Do the authors attempt to make a case for the biological mechanisms by which breast feeding might affect risk of asthma? [we just want to know whether you think they have provided an argument that might convince an expert] [2 marks] Evidence to action 19.Based only on this systematic review and your responses to the previous questions, do you think the evidence that breast feeding reduces the risk of asthma is of sufficient quality to take public health action? If yes, why? If not, why not? Please write a paragraph of between 50 and 100 words summarising the evidence and stating your conclusion. [7 marks]

Part A Why is it important for companies to consider ethics in their capital budgeting? Give an example of an ethical consideration in the capital-budgeting process. Limit your answer between 250 to 300 words. (2 marks) Part B Medigard is an innovative international company that specialises in retractable safety medical devices for the global market. Established as Medisafe Instruments Pty Ltd in 1999, Medigard focused on leading the way in safety equipment. As a result of extensive research and development, Medigard brought innovative, world-leading medical devices to the market. In 2004, the Company listed on the ASX in 2004 as Medigard Limited (MGZ), raising $3.4 million capital. As an R&D company, Medigard sought to design and develop a suite of safety medical devices and associated products, instrumental in the medical industry for transforming the safety of disposable medical devices and associated equipment. Medigard products are simple in designs with minimal parts that enable inexpensive production. i. Being a part of the treasury team of Medigard, your first exercise is to categorise Medigard’s capital structure into debt and equity capital. Begin by visiting the company’s website for 2016 financial report.http://www.medigard.com.au/investor-centre ii. Calculate after-tax Weighted Average Cost of Capital. (2 marks) iii. What alternative capital structure would you recommend to lower the cost of capital for the company? (3 marks) Guidelines: • You are to calculate cost of debt and cost of equity capital to work out weighted average cost of capital based on 2016 company financials. • To lower the cost of capital of the company, you are to suggest an alternative capital mix. Part C In 2018 Bluegum Enterprise is considering the acquisition of a new cooling system for one of its plants. The system requires an initial outlay of $54,200 in Year 0 and have an expected life of five years. The cooling system is expected to reduce the firm’s overall costs by $20,608 at the end of each year over its five-year life. In addition to the $20,608 cash flow from operations during the fifth and final year, there will be an additional cash flow of $13,200 at the end of the fifth year associated with the salvage value of the system, making the cash flow in year 5 equal to $33,808. Given a required return of 15%, calculate the following: (a) Payback period (1 mark) (b) Discounted payback period (1 mark) (c) Net present value (1 mark) (d) Profitability index (1 mark) (e) Internal rate of return (1 mark) (f) Should this project be accepted? (1 mark) (g) If the required rate of return is 20%, should this project be accepted? (2 marks)
The post Lodge CJ, Tan DJ, Lau MX, Dai X, Tham R, Lowe AJ, Bowatte G, Allen KJ, Dharmage SC. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr. 2015;104:38-53 [the journal is open access, so you should have no trouble obtaining the article] To lighten your workload, you only need consider the outcome asthma throughout this assignment. You will need to download the article and the supplementary web material. You do not need to read all the supplementary tables and figures – the questions below will indicate which of the supplementary tables and figures you need to examine. Some of the questions have been adapted from the PRISMA checklist for reporting systematic reviews. http://www.prisma-statement.org/ Registration of protocol 1.Did the authors provide evidence that the protocol for their systematic review was registered (e.g., with PROSPERO)? [1 mark] Rationale and objective 2.Does the introduction clearly describe the rationale in the context of what is already known? [Item 3 in PRISMA checklist] [2 marks] 3.Does the introduction provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design? [Item 4 in PRISMA checklist] [3 marks] Search strategy Item 8 in the PRISMA checklist states: “Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.” 4.Would it be possible for another person to replicate the electronic search strategy for at least one of the databases used by the authors? [2 marks] Flow diagram 5.From the flow diagram, are you able to determine why some studies that were included in the box labelled “Total Studies Included” were not included in the meta-analysis (last box in the diagram)? [2 marks] Descriptive information about each study in relation to selection bias, information bias and confounding Table 2 in the supplementary information provided data/information extracted from each of the studies that were included in the review of asthma. An important purpose of this table is to enable the reader to assess each study’s risk of bias due to selection bias, information bias and confounding. 6. [6 marks] What key items should be extracted from each of the study reports (articles) and included in Supplementary table 2 to enable the reader to assess the risk of selection bias in each of the studies? Was each item included in Supplementary table 2? You can ignore possible selection bias due to inclusion of prevalent cases for the cross-sectional studies, since this would be an issue common to them all. Please use the table below for your answers. You will see it asks you to list items separately for each of the three types of studies included in the review. Add extra rows as necessary. Don’t assume that the number of rows indicates how many items you need to mention! If an item was only partially included (i.e. some but not all of the relevant information was included, state what was missing). Please do not format the table in landscape mode. It makes marking in Turnitin very difficult. Marks will be allocated on a scale 6 marks – outstanding, all key points covered 5 marks – excellent, only minor problems 4 marks – very good, a few problems 3 marks – good, several problems 2 marks – poor, many problems 1 mark – very poor 0 marks – not answered Type of study Items that should be included Was the item included? (Yes/No/Partially) Cohort Cross-sectional Case-control 7. [6 marks] What key items should be extracted from each of the study reports (articles) and included in Supplementary table 2 to enable the reader to assess the risk of information bias in each of the studies? Was each item included in Supplementary table 2? Please make a copy of the table at the end of this document for your answers. As for selection bias, you will need to list items separately for each of the three types of studies included in the review. Please use the table below for your answers. You will see it asks you to list items separately for each of the three types of studies included in the review. If you feel that the information is the same for more than one type of study (e.g. cohort and cross-sectional studies), you can amalgamate the relevant rows. If you do that, justify why you did it. Add extra rows as necessary. Don’t assume that the number of rows indicates how many items you need to mention! If an item was only partially included (i.e. some but not all of the relevant information was included, state what was missing). Please do not format the table in landscape mode. It makes marking in Turnitin very difficult. Marks will be allocated on a scale: 6 marks – outstanding, all key points covered 5 marks – excellent, only minor problems 4 marks – very good, a few problems 3 marks – good, several problems 2 marks – poor, many problems 1 mark – very poor 0 marks – not answered Measurement of: Items that should be included Was the item included? (Yes/No/Partially) Outcome Cohort studies Cross-sectional studies Case-control studies Exposure Cohort studies Cross-sectional studies Case-control studies 8.What information is necessary for a reader to assess the risk of confounding? Is this provided in Supplementary table 2? [3 marks] Assessing risk of bias of individual studies & overall quality 9.What tool did the authors use to assess risk of bias (or quality) of individual studies? [1 mark] 10.What tool did the authors use to assess the overall quality of studies for each association? [1 mark] Results for asthma In the blue box on page 38, the authors state “There is low grade quality evidence that longer duration of breastfeeding is associated with a reduced risk of asthma in children aged 5–18 years.” 11.In your own words, describe the relevant results. (Don’t describe subgroup analyses or any of the results in Table 2) [3 marks] 12.On page 41, the authors stated “There was some evidence of publication bias from the funnel plot and Egger’s test (p = 0.018), with a propensity for publishing small studies showing protective effects (Fig. S3)”. Look at supplementary figure 3. Discuss why the authors reached this conclusion. (You can ignore the test and p-value.) [3 marks] 13.Table 2 shows the results of an analysis designed to explore reasons for heterogeneity in the associations between asthma and any type of breast feeding. The analysis is called meta-regression. The pooled odds ratios for cohort and cross-sectional studies are quite different. a)Does that make you feel more or less comfortable about including cross-sectional studies in the overall meta-analysis? [2 marks] b)How does the finding of different odds ratios for cohort and cross-sectional studies relate to the following sentence from the abstract? “Some of the protective effect of breastfeeding for asthma may be related to recall bias in studies of lesser methodological quality.” [3 marks] Bradford Hill guidelines for assessing causality We will consider the outcome asthma at 5-18 years of age only. You can ignore the other outcomes for the questions about the Bradford Hill guidelines. Unless specified otherwise, you should consider all three categorisations of breast feeding discussed in the paper. Consistency of the association 14.How consistent is the evidence that breast feeding is associated with reduced risk of asthma? [4 marks] Temporality 15.How strong is the evidence that the exposure (breast feeding) precedes asthma at 5-18 years of age? [3 marks] Strength of the association 16.How strong do you consider the associations between breast feeding and asthma at 5-18 years of age? [4 marks] Dose-response relationship 17.Does the paper provide evidence on whether there is a dose-response relationship between breast feeding and risk of asthma? [2 marks] Biological plausibility 18.Do the authors attempt to make a case for the biological mechanisms by which breast feeding might affect risk of asthma? [we just want to know whether you think they have provided an argument that might convince an expert] [2 marks] Evidence to action 19.Based only on this systematic review and your responses to the previous questions, do you think the evidence that breast feeding reduces the risk of asthma is of sufficient quality to take public health action? If yes, why? If not, why not? Please write a paragraph of between 50 and 100 words summarising the evidence and stating your conclusion. [7 marks] appeared first on Homework Aider.

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