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This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments and guideline developers can rate the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA) on the domains imprecision, inconsistency, publication bias, and other domains. It also provides guidance for how to present synthesized information in evidence profiles and summary of findings tables. We present guidance for rating certainty in TA in clinical and public health and review the presentation of results of a body of evidence regarding tests. Supplemented by practical examples, we describe how raters of the evidence can apply the GRADE domains inconsistency, imprecision, and publication bias to a body of evidence of TA studies. Using GRADE in Cochrane and other reviews as well as World Health Organization and other guidelines helped refining the GRADE approach for rating the certainty of a body of evidence from TA studies. Although several of the GRADE domains (e.g., imprecision and magnitude of the association) require further methodological research to help operationalize them, judgments need to be made on the basis of what is known so far.

This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments and guideline developers can assess the results and the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA). We present an overview of the GRADE approach and guidance for rating certainty in TA in clinical and public health and review the presentation of results of a body of evidence regarding tests. Part 1 of the two parts in this 21st guidance article about how to apply GRADE focuses on understanding study design issues in test accuracy, provide an overview of the domains, and describe risk of bias and indirectness specifically. Supplemented by practical examples, we describe how raters of the evidence using GRADE can evaluate study designs focusing on tests and how they apply the GRADE domains risk of bias and indirectness to a body of evidence of TA studies. Rating the certainty of a body of evidence using GRADE in Cochrane and other reviews and World Health Organization and other guidelines dealing with in TA studies helped refining our approach. The resulting guidance will help applying GRADE successfully for questions and recommendations focusing on tests.

This article describes GRADE guidance for assessing imprecision when rating the certainty of the evidence from network meta-analysis. A project group within the GRADE working group conducted iterative discussions, computer simulations, and presentations at GRADE working group meetings to produce and obtain approval for this guidance. When addressing imprecision of a network estimate, reviewers should consider the 95% confidence or credible interval, and the optimal information size. If the 95% confidence or credible interval crosses a pre-specified threshold, reviewers should rate down the certainty of the evidence. If the 95% confidence interval does not cross any pre-specfied threshold, reviewers should consider the optimal information size. Because addressing the optimal information size may be challenging, reviewers can use the effect size to decide if any calculations are necessary. When the size of the effect is modest or the optimal information size is met, reviewers should not rate down for imprecision. Reviewers should use this guidance when to appropriately address imprecision in the context of the assessment of certainty of evidence from network meta-analysis.

The objective of this study was to provide guidance on the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine certainty in estimates of association between prognostic factors and future outcomes. We developed our guidance through an iterative process that involved review of published systematic reviews and meta-analyses of prognostic factors, consultation with members, feedback, presentation, and discussion at the GRADE Working Group meetings. For questions of prognosis, a body of observational evidence (potentially including patients enrolled in randomized controlled trials) begins as high certainty in the evidence. The five domains of GRADE for rating down certainty in the evidence, that is, risk of bias, imprecision, inconsistency, indirectness, and publication bias, as well as the domains for rating up, also apply to estimates of associations between prognostic factors and outcomes. One should determine if their ratings do not consider (noncontextualized) or consider (contextualized) the clinical context as this will may result in variable judgments on certainty of the evidence. The same principles GRADE proposed for bodies of evidence addressing treatment and overall prognosis work well in assessing individual prognostic factors, both in noncontextualized and contextualized settings.

The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT. Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE working group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people), and twice in September 2023 (approximately 60 and 90 people) for approval. This GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by doing the following: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing evidence-to-decision (EtDs), when available or developing new EtDs, if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. This updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over 6 years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.

Despite an attempt to break with the hierarchical picture in traditional emergentist thought, non-standard accounts of emergence are often still committed to a premise that ontology is prior to epistemology. This paper aims to topple this last remnant of the traditional hierarchy by explicating a pragmatic view of emergence based on John Dewey’s work. Dewey argued that the traditional notion of ontology is premised on a view of existence as complete. Through a discussion of Dewey’s work it is argued that this premise results in a process of reification that unduly excludes from ontology many precarious and indeterminate aspects involved both in everyday life and in philosophic and scientific inquiry. Building on a recent explication of transformational emergence the paper proposes a diachronic and non-hierarchical account of emergence, called pragmatic emergence. According to that account the relation between ontology and epistemology is a temporally reciprocal one. This means that ontological and epistemological features co-determine each other over time. Determinacy and continuity become historical features of a multitude of unfinished processes that we view from within.

Intro. The aim of the work is to prove the effectiveness of the recommendations developed by the authors for introducing the basics of storytelling into the educational process in the context of the development of sophisticated social skills. Methods. A survey method was used to determine students’ knowledge of storytelling. Previously 52% of students used the storytelling techniques only partly in classes, and 30% of students are not familiar with the storytelling features and have not previously used them. Results. The survey revealed students’ insufficient knowledge about storytelling. Comparison of students’ skills before and after the experiment showed that the developed recommendations have an impact on learning effectiveness. Such findings are attributed to the fact that after the experiment 89% of students had high scores (90–98 points), while before the experiment only 15% of students possessed such skills, with their scores ranging from 82 to 90 points. Conclusion. Research findings may be used to develop creative texts that, among other things, drive sophisticated social skills. Practical significance. The research findings may be used by future and present scientific journalists, television journalists and presenters seeking to improve their professional and creative skills which would help them to stay competitive in the media industry.

Emergence is typically discussed in the context of mental properties or the properties of the natural sciences, and accounts of emergence within these contexts tend to look a certain way. The emergent property is taken to emerge instantaneously out of, or to be proximately caused by, complex interaction of colocated entities. Here, however, I focus on the properties instantiated by the elements of certain systems discussed in social ontology, such as being a five-dollar bill or a pawn-movement, and I suggest that these properties emerge in a distinctive way. They emerge in part because of a system that is far beyond and typically before the object that instantiates them. I characterize how emergence occurs in these cases, juxtaposing it with how emergence is typically discussed. I then consider whether their emergence is best framed as weak or strong as these notions are characterized in the literature, and I reveal what debates are central to answering this question. Though I will not resolve these debates, I do show a collection of views that would vindicate these properties as strongly emergent and downwardly causing.

This paper proposes an integrated-structure notion of interlevel (part-whole) emergence, from a dynamic relational ontological perspective. First, I will argue that only the individualist essentialism of atomistic metaphysics can block the possibility of interlevel emergence. Then I will show that we can make sense of emergence by recognizing the formation of structures of transformative and interdependent causal relations in the generation and development of a particular class of mereological complexes called integrated systems. Finally, I shall argue that even though the emergent structural attributes of such systems are not micro-determined nor micro-reducible, they can still be accounted for by an interlevel integrative neo-mechanistic form of explanation.