George A. Kelley

Background: International college students in the United States experience unique academic, cultural, financial, and immigration-related challenges that place them at increased risk of adverse mental health outcomes, including stress, anxiety, depression, and suicidal ideation. The COVID-19 pandemic further intensified these challenges through disruptions in education, travel restrictions, social isolation, and uncertainty regarding immigration and visa policies. Although numerous studies have examined international students’ mental health during this period, the available evidence has not been comprehensively mapped to characterize the extent, nature, and methodological characteristics of the literature or to identify gaps requiring further investigation. Objective: The objective of this scoping review is to systematically map the available evidence on stress, anxiety, depression, and suicidal ideation among international college students enrolled in US institutions during and following the COVID-19 pandemic, describe the characteristics of the existing literature, and identify knowledge gaps to inform future research, policy, and practice. Methods: This protocol follows the Joanna Briggs Institute methodology for scoping reviews and the methodological frameworks. The completed review will be reported in accordance with the PRISMA-ScR, and the search strategy will be developed and reported following the PRISMA-S recommendations. Electronic searches will be conducted in PubMed (MEDLINE), PsycINFO, CINAHL Complete, Scopus, ERIC, and Web of Science Core Collection for peer-reviewed English-language studies published between January 1, 2020, and December 31, 2025. Eligible studies will include quantitative, qualitative, and mixed methods research examining stress, anxiety, depression, or suicidal ideation among international college students enrolled in US institutions. The 2 independent reviewers will screen studies, extract data on study characteristics, participant demographics, mental health outcomes, measurement instruments, COVID-19-related contextual factors, and key findings, and synthesize the evidence using descriptive and narrative approaches. Consistent with scoping review methodology, no formal risk of bias assessment will be conducted. Results: The a priori protocol for this unfunded scoping review was registered with the Open Science Framework. We conducted the review from December 25, 2025, through April 17, 2026. After protocol registration, we added 2 additional reviewers to assist with study screening and data abstraction. After screening, 253 records underwent further eligibility assessment, and 16 studies met the eligibility criteria for inclusion. Data analysis and synthesis are complete, and the findings and discussion are being revised and formatted for manuscript submission. Publication of the completed review is tentatively anticipated by December 31, 2026. Conclusions: This scoping review will provide the first comprehensive evidence map of stress, anxiety, depression, and suicidal ideation among international college students enrolled in US institutions during and following the COVID-19 pandemic. The completed review will identify research gaps, summarize methodological trends, and provide evidence to inform future investigations, institutional initiatives, and policies aimed at improving mental health support for international college students.

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The most recent American College of Rheumatology Guidelines concluded, based on meta-analyses, that moderate certainty evidence from randomized controlled trials (RCT) existed to recommend that exercise, compared to no exercise, increased physical function and reduced pain in adults with rheumatoid arthritis (RA). However, effect size stability was not quantitatively established. To address this gap, the purpose of this study was to use quantitative methods to determine whether further RCT and meta-analyses are needed or stability has been reached. Using meta-analytic data from these guidelines, a recently developed and novel approach, the Doi–Abdulmajeed Trial Stability (DAts) index was used to determine effect size stability, i.e., exit status, of exercise on physical function and pain in adults with RA. A DAts < 0 = exit, 0–0.05 = possibly exit, and > 0.05 = no exit. Across all types of exercise, the DAts index was 0.0095 for physical function (20 studies, 1487 participants) and 0.0018 for pain (14 studies, 998 participants), suggesting possible exit status. These findings add to the American College of Rheumatology Guidelines assessment of “moderate” strength of evidence rating, suggesting that additional RCT and subsequent meta-analyses are needed on the effects of exercise on physical function and pain in adults with RA before true stability/exit status can be reached. Key Points • A novel quantitative method was used to examine the stability, i.e., exit status, of exercise on physical function and pain in adults with rheumatoid arthritis (RA). • Only "possible exit" status was found for the eff ects of exercise on physical function and pain in adults with RA. • Additional studies are needed on the eff ects exercise on physical function and pain in adults with RA before stability can be determined.

Objective : We aimed to explore the effect of supervised exercise training on neonatal neurological examination outcomes in neonates exposed to exercise in utero. Methods : Five hundred and sixty pregnant women were recruited from the hospital, and randomized (NCT03838146) to 1 of 4 intervention groups: aerobic, resistance, combination, and control group. Exercise was conducted 3 times per week from 16 weeks gestation until delivery. This is a secondary post hoc analysis of the study in which the primary outcome was offspring health outcomes; this analysis focuses on neonatal neurological examination at delivery. Statistical analyses were performed using both intention-to-treat and per-protocol (>75% adherence); 1-way analysis of variance, Pearson chi-square, and linear regression tests were used to analyze data with SPSS. Results : For the analysis, we had aerobic (n = 95), resistance (n = 63), or combination (n = 73) in comparison with a control group (n = 95). Groups were similar for maternal and neonatal descriptors. Per-protocol, the analyses showed a difference between combination and control groups in neonatal neurological examination (traction, P = .017) for all women. After controlling for type of exercise and weekly exercise intensity, gravida ( P = .022) and parity after delivery ( P = .009) were significant predictors for neonatal traction reflex ( R ² = .047, P = .016). Conclusions : Exercise during pregnancy effectively improves the traction reflex in neonates.

This study was the first to test how specific prenatal exercise dose, i.e., the FITT-V (frequency, intensity, time, type, volume) metrics, could influence the storage of triglycerides in infant adipogenic mesenchymal stem cells (MSCs). Prenatal exercise led to a reduction in infant whole body fat percentage (BF%), which was reflected by lower lipid storage in infant MSCs. Changes in lipid content were observed in offspring born to participants exercising beyond the minimum recommended weekly volume, 450 metabolic equivalent (MET)·min/wk.

Background : Acute exercise has been demonstrated to improve cognitive functioning among the general population. We provide the first review to establish the evidence for acute exercise to improve cognitive function among adults with cognitive impairment (CI). Methods : We conducted a systematic review with meta-analysis of randomized controlled trials that investigated the effects of a single exercise session on cognitive function. Data sources were PubMed, SportDiscus, PsychINFO, Cochrane Central, PEDro, and Embase. Eligibility criteria were randomized controlled trials of acute exercise with participants aged 18+ and physician diagnosed or self-reported CI. We used dual data abstraction, risk-of-bias assessment, and strength of evidence assessment. We pooled results using the inverse variance heterogeneity model or with narrative synthesis. Results : Fifteen studies (8 parallel group and 7 crossover) representing 500 participants were included, 10 in the meta-analysis. Acute exercise significantly improved executive function (moderate evidence, 9 studies, 330 participants, g = 0.33, small effect, 95% CI, 0.07–0.59, P = .01, I ² = 26.77%). However, this was only for high risk of bias/crossover studies. Acute exercise improved reaction time but not significantly (very low evidence, 7 studies, 271 participants, g = 0.17, small effect, 95% CI, −0.20–0.54, P = .36, I ² = 50.18%). Narratively, improvements were noted for memory, but there was mixed evidence for attention, information processing, and motor memory. Conclusions : Acute exercise provides a small improvement in executive function and may also improve reaction time and memory for adults with CI. Additional research is needed before reaching an evidence-based consensus on the promotion of acute exercise for adults with CI.

Aims: Recommendations for cancer survivors concur regarding physical activity (PA), and elucidating factors governing PA uptake among colorectal cancer (CRC) survivors is needed. This study examined the impact of PA interventions and investigated the variation in PA across several characteristics, including race/ethnicity. Design: We performed a systematic review and aggregate data meta-analysis of randomized controlled trials (RCTs) of PA interventions. Data Sources: We used studies from CENTRAL, PubMed (NCBI), PsycINFO (EBSCOhost), CINAHL (EBSCOhost) with full text, Scopus (ELSEVIER), and the Web of Science (CLARIVATE) (1 May 1993–1 September 2023). Methods: For the meta-analysis, the inverse variance heterogeneity (IVhet) model was used to pool standardized mean difference effect sizes (Hedge’s g) for our primary outcome, changes in PA. Results: Sixteen studies representing 1668 participants were included in the meta-analysis. A moderate, statistically significant increase in PA was observed (g = 0.44, 95% CI 0.12–0.76; p = 0.01). However, a large amount of inconsistency was observed (I² = 80.8%, 95% CI, 36.1% to 90.9%), as well as major asymmetry suggestive of small-study effects (publication bias, LFK = 3.04). Only 28% of trials reported race/ethnicity, limiting equity analyses. Subgroups comparing atheoretical vs. theory-based interventions did not differ statistically. Meta-regression results suggested associations with specific behavior change theories and delivery features. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment, the overall certainty of evidence was considered low. Conclusions: There is low-certainty evidence that PA interventions may improve PA among CRC survivors. Future trials should (i) recruit and report diverse samples in a clear and transparent manner, (ii) explicitly map theory constructs to techniques and test mechanisms, and (iii) report fidelity and clinically meaningful thresholds alongside behavioral outcomes.

Background/purpose The production of systematic reviews with meta-analysis in the field of analgesia and pain medicine has increased dramatically over the years and is increasingly used to guide clinical practice as well as decisions by others (policymakers, etc). A common metric for pooling data from studies that use different scales to assess the outcome of interest, for example, pain, is to convert the results from each study using the standardized mean difference (SMD) effect size. However, this is problematic because the SMD is not easy to interpret by the non-statistician. In this brief technical report, we describe how to easily rescale data into a common and more easily interpretable metric, including the provision of an easy-to-use Excel worksheet for rescaling one’s own data. Methods Data from a previous meta-analysis of randomized controlled trials that examined the effects of transcutaneous electrical nerve stimulation on pain, assessed using different pain scales, were used. Using an Excel spreadsheet and selected formulas, data for each study were rescaled to a metric commonly used to assess pain in the clinical setting, 0–10. Results were then pooled using the inverse-variance heterogeneity model. Results Rescaling pain data to 0–10 were easily accomplished using this ‘real-world’ dataset. Conclusion Rescaling data into a more understandable metric intended for a wider variety of audiences is plausible. It is the hope that future systematic reviews that include a meta-analysis will use this approach when the results for an outcome of interest such as pain are reported using different scales.