Caution is needed when assessing results of home birth–Authors’ reply
Bibliographic record
Abstract
Meta-analyses are employed when clinical equipoise exists without definitive studies to provide certainty. Such analyses include all events from each study; data are treated as a whole data set. No disadvantage results from including small studies; indeed exclusion may bias outcomes. Where larger studies exist, the inclusion of smaller studies may not contribute significantly to point estimates, but are likely to decrease variance [[1]Turner R.M. Bird S.M. Higgins J.P.T The impact of study size on meta-analyses: examination of underpowered studies in Cochrane reviews.PLoSOne. 2013; 8 (Available from) ([accessed Sep 13 2019]): e59202https://www.researchgate.net/publication/236095347_The_Impact_of_Study_Size_on_Meta-analyses_Examination_of_Underpowered_Studies_in_Cochrane_ReviewsCrossref PubMed Scopus (355) Google Scholar]. Only 17% of 3905 meta-analyses in Cochrane Reviews in the specialty of gynecology had at least two adequately powered studies [[1]Turner R.M. Bird S.M. Higgins J.P.T The impact of study size on meta-analyses: examination of underpowered studies in Cochrane reviews.PLoSOne. 2013; 8 (Available from) ([accessed Sep 13 2019]): e59202https://www.researchgate.net/publication/236095347_The_Impact_of_Study_Size_on_Meta-analyses_Examination_of_Underpowered_Studies_in_Cochrane_ReviewsCrossref PubMed Scopus (355) Google Scholar]. Our study includes several large studies for most outcomes [[2]Hutton E.K. Reitsma A. Simioni J. et al.Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: a systematic review and meta-analyses.Lancet E Clin Med. 2019; 14: 59-70https://doi.org/10.1016/j.eclinm.2019.07.005Summary Full Text Full Text PDF Scopus (36) Google Scholar]. When large adequately powered studies exist a rapid meta-analysis to estimate outcomes is possible [[1]Turner R.M. Bird S.M. Higgins J.P.T The impact of study size on meta-analyses: examination of underpowered studies in Cochrane reviews.PLoSOne. 2013; 8 (Available from) ([accessed Sep 13 2019]): e59202https://www.researchgate.net/publication/236095347_The_Impact_of_Study_Size_on_Meta-analyses_Examination_of_Underpowered_Studies_in_Cochrane_ReviewsCrossref PubMed Scopus (355) Google Scholar]. Thus, because the three studies that report late neonatal mortality as an outcome are among the large and better-powered studies together they provide a reasonable estimate [[1]Turner R.M. Bird S.M. Higgins J.P.T The impact of study size on meta-analyses: examination of underpowered studies in Cochrane reviews.PLoSOne. 2013; 8 (Available from) ([accessed Sep 13 2019]): e59202https://www.researchgate.net/publication/236095347_The_Impact_of_Study_Size_on_Meta-analyses_Examination_of_Underpowered_Studies_in_Cochrane_ReviewsCrossref PubMed Scopus (355) Google Scholar]. While no studies report outcomes after 28 days it is reassuring that few infants were admitted to NICU and admissions were less likely to occur among women planning home birth. This exceptionally rare outcome is unlikely to change overall findings of our study. We hope this clarifies why all relevant studies are included. In contrast to the contention that we provide a fragmented picture of infant outcomes we believe our paper assists in summarising literature. The question of how much evidence is enough remains. We support continued research on place of birth noting that despite benefits of hospital birth for low risk births never being demonstrated, the burden of proof lies on the doorstep of homes. No conflicts of interests applies. Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analysesThe risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. Full-Text PDF Open AccessCaution is needed when assessing results of home birthWe commend Hutton et al. [1] for their attempt to improve our understanding of the never ending medical and ethical dilemma of home birth. Full-Text PDF Open Access
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".