bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond home language: Heritage language maintenance practices of Yorùbá–English bilingual immigrants
Authors: Kupolati Oluwateniola Oluwabukola
Published: June 2023

Purpose:

This research investigates the heritage language (HL) as a core value of first-generation Yorùbá English bilingual immigrants in the United States and explicates HL maintenance practices among them.

Methodology:

It uses observation and semi-structured interviews with first-generation Yorùbá–English bilingual immigrants residing in New York, Texas and Maryland.

Data and analysis:

Transcripts from the interviews and field notes from the observation were analysed and coded using Reflexive Thematic Analysis (RTA) and some features of the Interlinear Morpheme Glossing (IMG) rules which are conventions useful for transliterations and translations.

Findings:

The heritage language is the distinctive identity of first-generation Yorùbá–English bilingual immigrants in the United States. Hence, they adopt maintenance strategies similar to those of other immigrants identified in previous studies (home language, language of familiarity, language as code and language for admonition) and devise ingenious strategies to ensure maintenance including language for setting intergroup boundaries, language for maintaining connectedness and language for naming realities.

Originality:

Previous studies have examined HL maintenance among Asian, Hispanic and European immigrants who have HLs with high numeric strength, but this study examines immigrants of African descent and an HL with low numeric strength. It also presents unobserved HL maintenance strategies which are peculiar to first-generation Yorùbá–English bilingual immigrants in the United States.

Implications:

Despite English monism, immigrants/ethnic minorities can go beyond common HL maintenance strategies and create unique ones that will ensure the continued use of their languages. The ability to do this advances a positive ethnic identity, guarantees an improved lifespan for HLs in host communities and reduces instances of identity crisis among immigrants.
Exploring audience perceptions of, and preferences for, data-driven ‘quantitative’ journalism
Authors: Stalph Florian , Thurman Neil , Thäsler-Kordonouri Sina
Published: June 2023

Although data-driven ‘quantitative' journalism has increased in volume and visibility, little is known about how it is perceived and evaluated by audiences. This study helps fill this research gap by analysing the characteristics of quantitative journalism that a diverse group of 31 news consumers pay attention to and, within those characteristics, where their preferences might lie. In eight group interviews, participants read and discussed articles chosen to represent the diversity that exists in the forms and production of data-driven journalism. Our analysis reveals 28 perception criteria that we group into four major categories: antecedents of perception, emotional and cognitive impacts, article composition, and news and editorial values. Several criteria have not been used in prior research on the perception of quantitative journalism. Our criteria have obvious application in future research on how audiences perceive different types of quantitative journalism, including that produced with the help of automation. The criteria will be of interest too for researchers studying audience perceptions and evaluations of news in general. For journalists and others communicating with numbers, our findings indicate what audiences might want from data-driven journalism, including that it is constructive, concise, provides analysis, has a human angle, and includes visual elements.
Representing tradition: The construction of culturally-specific visual narratives in Chinese picture books and hand scroll paintings
Authors: Qi Fenfen , Fauzi Tetriana Ahmed , Yahaya Siti Rohaya
Published: June 2023

The picture book plays a fundamental role in the intellectual and social development of young children. While the simplest of picture books offer an accessible entry-point into basic literacy through the combination of printed word and an image of its referent, picture books in narrative form constitute a significant instrument of socialisation, as a source of both overt and covert ‘ideological’ messages about the world and about social values. This study establishes a referenceable method and framework for identifying the extent to which a given picture book produced for consumption within the Chinese market utilizes pictorial and narratological strategies that are understood to be historically accurate within - and emblematic of – Chinese society’s ideologies and cultural traditions. Ten recently-published picture books for children, each produced by ethnically Chinese authors and widely distributed in the Chinese market are scrutinized using quantitative, qualitative, semiotic and mediaanalysis methodologies. Historic Chinese hand scroll paintings are presented as a useful point of comparison with these picture books, insofar as they provide an enduring example of culturally-specific pictorial conventions of composition, character depictions and interrelations, narrative context and the interplay of text and image. Drawing upon Clare Painter, Martin and Unsworth’s influential work on visual narratives and the Multimodel Discourse Analysis approach, a basic grammar of Chinese visual narratives is established, with conclusions drawn regarding how these inform contemporary picture books for Chinese children.
The effects of chronic high-dose morphine on microgliosis and the microglial transcriptome in rat spinal cord
Authors: Ahlström Fredrik HG , Viisanen Hanna , Karhinen Leena , Mätlik Kert , Blomqvist Kim J , Lilius Tuomas O , Sidorova Yulia A , Palada Vinko , Rauhala Pekka V , Kalso Eija A
Published: June 2023

Background: Opioids are efficacious and safe analgesic drugs in short-term use for acute pain but chronic use can lead to tolerance and dependence. Opioid-induced microglial activation may contribute to the development of tolerance and this process may differ between males and females. A link is suggested between this microglial activation and inflammation, disturbances of circadian rhythms, and neurotoxic effects. We set out to further delineate the effects of chronic morphine on pain behaviour, microglial and neuronal staining, and the transcriptome of spinal microglia, to better understand the role of microglia in the consequences of long-term high-dose opioid administration. Experimental Approach: In two experiments, we administered increasing subcutaneous doses of morphine hydrochloride or saline to male and female rats. Thermal nociception was assessed with the tail flick and hot plate tests. In Experiment I, spinal cord (SC) samples were prepared for immunohistochemical staining for microglial and neuronal markers. In Experiment II, the transcriptome of microglia from the lumbar SC was analysed. Key Results: Female and male rats had similar antinociceptive responses to morphine and developed similar antinociceptive tolerance to thermal stimuli following chronic increasing high doses of s.c. morphine. The area of microglial IBA1-staining in SC decreased after 2 weeks of morphine administration in both sexes. Following morphine treatment, the differentially expressed genes identified in the microglial transcriptome included ones related to the circadian rhythm , apoptosis, and immune system processes. Conclusions: Female and male rats showed similar pain behaviour following chronic high doses of morphine. This was associated with decreased staining of spinal microglia, suggesting either decreased activation or apoptosis. High-dose morphine administration also associated with several changes in gene expression in SC microglia, e.g., those related to the circadian rhythm ( Per2, Per3, Dbp). These changes should be considered in the clinical consequences of long-term high-dose administration of opioids.
Aspidiata E, a New Spirostanol Saponin From Aspidistra triradiata and its Cytotoxic Activity
Authors: Le Hien Bich Thi , Tran Van Anh Thi , Nguyen Hien Minh , Nguyen Linh Thuy Khanh , Ho Duc Viet , Nguyen Hoai Thi
Published: June 2023

Aspidiata E (1), a new spirostanol saponin {(22 S*,25 R*)-1 β,3 β,4 β,5 β,6 β-pentahydroxyspirostan-2 β-yl β-D-xylopyranoside), together with 2 known compounds, (22 S*,25 R*)-spirost-5-ene-3 β-yl O- α-L-rhamnopyranosyl-(1→2)- O-[ O- α-L-rhamnopyranosyl-(1→5)- α-L-arabinofuranosyl-(1→4)]- β-D-glucopyranoside (2), and (22 S*)-16-[( β-D -glucopyranosyl)oxy]-1 β,3 β,22-trihydroxycholest-5-en-1 β-yl α-L-rhamnopyranoside (3), were isolated from Aspidistra triradiata. Their structures were determined by NMR spectroscopic and high resolution electrospray ionisation mass spectrometry analysis and by comparison with published data. Compound 2 revealed strong cytotoxic potential against MCF7, HepG2, SK-LU-1, and HT-29 cancer cell lines with IC50 values ranging from 0.28 to 0.81 µM. In contrast, compound 1 showed a weak inhibitory effect on MCF7, HepG2, and HT-29 cell lines, with IC50 values within the range of 68.85 to 84.19 µM. All compounds 1-3 were discovered for the first time in the genus Aspidistra.
Alternative Systems: The Interplay Between Criminal Groups’ Influence and Political Trust on Civic Honesty in the Global Context
Authors: Travaglino Giovanni A. , Burgmer Pascal , Mirisola Alberto
Published: June 2023

Individuals’ endorsement of standards of civic honesty is necessary for democracies to flourish. A critical driver of civic honesty is the relationship of trust between individuals and institutions. Research has yet to systematically assess the contextual factors that may moderate this relationship. In this study, we examined the societal influence of organized criminal groups. Criminal groups operate as alternative systems of authority that erode the reliability of institutions’ moral standards. We employed a new indicator that quantifies their societal influence to test the hypothesis that the association between individuals’ political trust and civic honesty would weaken in countries more strongly affected by criminal groups. Multilevel evidence across 83 representative national samples ( N = 128,839) supported this hypothesis. Moreover, the association between political trust and civic honesty was negative in contexts where criminal groups’ influence was more extreme. We discuss the implications of the findings and future research directions.
Judging Guilt: Implicit Evaluations of Defendants Predict Verdicts
Authors: Korkmaz Arin , Mann Thomas C. , Eibelman Joshua , Sommers Roseanna , Ferguson Melissa J.
Published: June 2023

Cognitive jurisprudence research that has used indirect measures has mostly focused on how people’s implicit biases (e.g., race) predict people’s verdicts for an individual belonging to an out-group. We aim to expand on this work by investigating implicit evaluations’ predictive strength for verdicts using an impression formation approach. In three preregistered studies, we presented mock jurors with a fictional murder trial in which the evidence against a defendant was mixed: some witnesses provided testimony suggesting guilt, whereas others sowed doubt. In all studies, implicit evaluations of the defendant, operationalized by the Affect Misattribution Procedure (AMP) scores, uniquely predicted verdicts above and beyond explicit evaluations (Studies 1–3), the reason for evidence exclusion (Study 2), and demographics of the defendant (Study 3). These findings advance our understanding of implicit social cognition by demonstrating that implicit evaluations, operationalized by the AMP scores, can have predictive power in complex, ecologically rich contexts.
Data arenas: The relational dynamics of data activism
Authors: Ślosarski Bartosz
Published: June 2023

The article proposes the theoretical category of data arenas as a relational field for strategic actors in diverse areas of the contentious politics of data (Beraldo and Milan, 2019). The paper argues that the conceptualization of data activism needs to be related to the immediate data arena in which the action takes place, in order to select the interactive opportunities and threats for emerging data-driven repertoires of action. To fully work through the relational dynamics of data activism, it is necessary to move from a conceptualization of data infrastructure to the notion of data arenas as an ‘open-ended bundle of rules and resources that allows certain kinds of interaction to proceed’ (Jasper, 2006: 141). Using the case of environmental data activism, I highlight four key dimensions to study: (a) strategic use of data as capital that differentiates and positions actors, as well as influences their further choices; (b) practices of defining the boundaries of the problem on which the arena focuses and outlining the pool of actors who participate in the process of solving it; (3) sets of relationships among the outlined pool of actors which represent opportunities and threats for the actors, related to the position they occupy within an arena; and (4) power as the ability to control and shape an arena. Data arena approach shed new light on data activism as a relational practice, combining the latest developments in research on data contexts and the political situatedness of data with the emerging field of research on data activism.
A systematic review to identify and collate factors influencing patient journeys through clinical trials
Authors: Dobra Rebecca , Wilson Gemma , Matthews Jessie , Boeri Marco , Elborn Stuart , Kee Frank , Davies Jane C , Madge Susan
Published: June 2023

Summary

Patient-centred trial design and delivery; improves recruitment and retention; increases participant satisfaction; encourages participation by a more representative cohort; and allows researchers to better meet participants’ needs. Research in this area mostly focusses on narrow facets of trial participation. We aimed to systematically identify the breadth of patient-centred factors influencing participation and engagement in trials, and collate them into a framework. Through this we hoped to assist researchers to identify factors that could improve patient-centred trial design and delivery. Robust qualitative and mixed methods systematic reviews are becoming increasingly common in health research. The protocol for this review was prospectively registered on PROSPERO, CRD42020184886. We used the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type) framework as a standardised systematic search strategy tool. 3 databases were searched as well as references checking, and thematic synthesis was conducted. Screening agreement was performed and code and theme checking were conducted by 2 independent researchers. Data were drawn from 285 peer-reviewed articles. 300 discrete factors were identified, and sorted into 13 themes and subthemes. The full catalogue of factors is included in the Supplementary Material . A summary framework is included in the body of the article. This paper focusses on outlining common ground that themes share, highlighting critical features, and exploring interesting points from the data. Through this, we hope researchers from multiple specialities may be better able to meet patients’ needs, protect patients’ psychosocial wellbeing, and optimise trial recruitment and retention, with direct positive impact on research time and cost efficiency.
Alarmism and Accountability in Climate Communication During Extreme Events
Authors: Russill Chris
Published: June 2023

The attribution of extreme events to climate change is now a recurrent feature of public communication. These statements are part of a wider refashioning of science and societal institutions to address the catastrophic risks of climate change. This incorporation of catastrophe into climate communication has heightened the tension between scholars concerned with undue alarmism and scholars emphasizing accountability to those most at risk or harmed by climate change. I discuss this tension in the context of extreme event attributions, their role in public discussions of losses and damages, and their implication in problems of climate communication more generally. I suggest it is time for assessments of accountability to balance fears of alarmism during discussions of disaster and denial.
Critical Approaches to the Climate Crisis
Authors: Nishime Leilani
Published: June 2023

This essay turns to theories developed in critical rhetoric and cultural studies to give us an alternate understanding of what is at stake in the climate crisis and offer tools to respond to the crisis. Scholars from those fields, especially decolonial scholars, help us access alternate scales of both time and geography by shifting our perspective from universal to specific, from dominant to insurgent, and, even from human to more-than-human. This article focuses on examples that can expand our understanding of who can combat climate change, what counts as climate activism, and our epistemological understanding of the climate crisis. Through an attention to power and the centering of those most marginalize and, consequently, those most affected by the climate crisis, Communication studies can give us the tools to address climate anxiety and envision a better, more sustainable, and more sustaining future.
Christian-holistic teaching as an instrument to combat reductionism in education
Authors: Christiaan van Olst Peter
Published: June 2023

Cultural change and global pluralism are causing an increasing plea for Christian-holistic education. However, this term lacks clear definition based on a proper description of the cultural background that provoked it. A secular definition of holistic education is taken from a worldwide movement for Whole Child Development and compared with the culture-critical thinking of three visionaries from the Christian tradition. This leads to the definition that Christian-holistic education seeks all dimensions of human development, aiming at the heart as the undivided principle of its existence, placing it with pedagogical optimism before God to seek its restoration and longing to serve.
Is Belonging Stable Over Time?: A Four-Year Longitudinal Examination of University Belonging Differences Among Students
Authors: Ruedas-Gracia Nidia , Jiang Ge , Maghsoodi Amir H.
Published: June 2023

Sense of belonging is crucial for thriving in various contexts and must be maintained over time. However, we know little about how belonging fluctuates. In education, changes in school belonging differ by gender identity. Unfortunately, this evidence does not assess differences by racial identity or socioeconomic status. Because low belonging among students that espouse minoritized racial socioeconomic identities is a pervasive concern, it is important to understand how it functions among diverse groups. Via growth curve modeling this study explores changes in university belonging among individuals (Ns = 136, MT1age = 19 years) from diverse backgrounds (Black 16%, Latinx 15%, Asian 19%, White 34%, Native American 3%, Multiracial 13%; 36% low-income; 61% female identifying) over 4 years of college.
Impact of Individual Spinopelvic Anatomy on the Localization and Severity of Symptomatic Isthmic Spondylolisthesis
Authors: Labbus Kirsten , Bürger Justus , Löchel Jannis , Schäfer Frederik Maximilian , Putzier Michael , Zahn Robert Karl
Published: June 2023

Study Design

Retrospective analysis of prospectively collected data.

Objectives

Isthmic spondylolisthesis (iSPL) occurs most commonly in L5/S1 and L4/5. This study investigates the association between spinopelvic anatomy and the pathogenesis of iSPL.

Methods

Spinopelvic parameters as well as severity of slip grade were measured in sagittal spine radiographs of symptomatic patients with iSPL in segments L4/5 and L5/S1. Means were calculated and differences between both groups were analyzed. A correlation between the analyzed parameters and degree of slippage was performed.

Results

We included 73 subjects in this study; 11 in L4/5 group and 62 in L5/S1 group. Pelvic anatomy significantly differed between L4/5 and L5/S1 iSPL (Pelvic Incidence (PI) 54.8° vs 66.3°, P value = .006; Pelvic Radius (PR) 124.4 mm vs 137.4 mm; P value = .005 and Sacral Table Angle (STA) 101.0° vs 92.2°, P value < .001). The relative degree of slippage was significantly higher in the L5/S1 group (L4/5 29.1% vs L5/S1 40.1%, P value .022). We also observed a significant correlation between pelvic anatomy and the severity of the slip in iSPL at the L5/S1 level.

Conclusions

Pelvic parameters PI and STA play an important role concerning the level of occurrence and severity of iSPL. Spinopelvic anatomy determines the pathogenesis of iSPL.
Identifying EHR Novice Users’ Cognitive Challenges: Mapping Critical Nursing Tasks Using HTA
Authors: Vaughn Austin , Son Changwon , Baek Seungyeon , Caballero Sandra , Decker Sharon
Published: June 2023

Rapid and widespread implementation of electronic health record (EHR) systems has been attributed to rising medical incidents in healthcare systems. Although previous research has evaluated and improved the usability of the EHR systems, there is limited understanding of EHR users’ cognitive challenges along the lifecycle of EHR data. Especially, nursing students, a novice user group, are considered amenable to reveal the user issues because of underdeveloped workarounds and automaticity. Therefore, this research aims to identify nursing students’ cognitive challenges and efforts regarding the use of the EHR system. As a first step of a multi-study research, the current study investigated cognitive work associated with five common critical nursing tasks that involve EHR usage. A Hierarchical Task Analysis (HTA) was conducted to build a hierarchical structure that represents critical functions and individual steps of each task, which will be used to explore potential areas that pose cognitive challenges to novice EHR users (i.e., nursing students). Preliminary findings are illustrated through HTA construction, which provides preliminary clues for possible cognitive errors. Additional studies are planned to triangulate HTA findings. Results from combined studies will provide a comprehensive examination of problem areas that require greater cognitive effort from novice users.
Using Machine Learning to Develop a Predictive Model of Infant Hypoglycemia Based on Maternal and Infant Variables in an Electronic Health Record
Authors: Gerard Joseph , Stuebe Alison , Sweeney Alison , Allen Theodore T. , Brunette Maria , Gill Carolina , Umstead Kelly , Patterson Emily S.
Published: June 2023

All newborns experience low blood glucose levels when they first initiate carbohydrate metabolism. Some levels remain low, with potential seizures and severe brain injury. Predicting newborns at higher risk is clinically useful because newborns can have their blood sugar raised with breastfeeding, donor milk, formula, or oral dextrose gels. Additionally, informing parents of this higher risk can enhance shared decision-making in the first 48 hours after birth. To address this, we propose three predictive models using binary logistic regression for newborns receiving treatment with oral dextrose gels for hypoglycemia. The first is a parsimonious model, where a high-risk newborn's first blood glucose value is highly predictive of requiring an oral dextrose gel treatment. The second model can be used earlier in the clinical workflow. It is based on the most predictive variables that are also electronically available for all newborns and do not change much in the electronic health record. The third model explores the most predictive variables based on a conceptual model of factors associated with health disparities. These three models are informed from insights gleaned by an exploratory analysis of alternative outcome measures, variables, and threshold cutoffs using a standard heuristic of greedily finding the highest average difference for records on both sides of partitions. We discuss how the dynamics of when data are available during a hospital stay in the postnatal care unit for all patients impact the selection of useful variables for electronically-based decision support. We plan to modify handouts for postnatal care nurses that detail treatment guidance and support shared decision-making. We plan to embed stratified guidance, recommended scripts for high and low-risk cohorts, orientation materials for float and junior nurses, and patient-facing educational materials.
Analysis of General Event Types and Contributing Factors in Patient Safety System Data
Authors: Tabaie Azade , Fong Allan
Published: June 2023

Patient safety event reporting systems (PSRS) aim to identify safety hazards by encouraging hospital staff to report adverse events, errors, and potential errors in the healthcare system. PSRS collect different information regarding a safety event such as contributing factors and general event types. Users select contributing factors and general event types of a safety incident from predefined lists; therefore, most frequent general event types and contributing factors are commonly recorded together. Contributing factors are often related to the leading cause of an unsafe condition; therefore, identifying contributing factors can help with detecting and mitigating safety issues. In this study, we identified the general event types and contributing factors which were frequently recorded together. We calculated point-wise mutual information (PMI) between each pair to find the association between a contributing factor and a general event type. Our analysis demonstrated strong association between general event type and contributing factors which were most frequently recorded together. Fall and lost/impaired balance (PMI=15.12), skin/tissue and friction/shear (PMI=14.32), and blood bank and patient/sample incorrectly identified (PMI=13.78) were the three pairs of general event type and contributing factors which presented strong association.
Creating A Reliable Digital Maternal Health Platform Using Maslow's Hierarchy and Nielsen Heuristics
Authors: Patel Nikhil , Gleiser Arianne , Khashe Yalda
Published: June 2023

This research seeks to build on previous efforts to serve the needs of expectant mothers in terms of providing effective digital healthcare. The first task in accomplishing this was to determine a list of basic features needed to completely satisfy all key performance indicators and needs of a maternal healthcare website. Once this was completed and each category of the established hierarchy had been addressed, the second task could be approached. This was to ensure the platform’s usability by designing sub features with the Nielsen Heuristics in mind. The result of these tasks is a complete framework for an all-in-one platform powerful enough to assist women through pregnancy. This research is intended for doctors, specifically those interested in the evolving virtual landscape, and other healthcare professionals. We believe these people have a significant stake in the development of virtual platforms and welcome their interest and criticism. The significance of this research lies in its future potential: the actualization of the platform. A sound framework for the feature set has been established, so what follows is the implementation, which will prove useful to doctors and expectant mothers alike.
Amplifiers and Dampeners of Patient Safety Risk in the Operating Room: Interim Analysis of Surgical Video Recorded with the Operating Room Black Box
Authors: Tung Arthur , Fan Mark , Pinkney Sonia J. , Armstrong Bonnie A. , Catchpole Ken , Trbovich Patricia L.
Published: June 2023

Preventable intraoperative adverse events (iAEs) may emerge from interactions between multiple work system factors (WSFs) (e.g., technology design, organizational policy, physical environment); these interactions may amplify or dampen patient safety risk. We conducted an exploratory observational study using audiovisual data captured by the Operating Room Black Box to characterize the relationships between associated WSFs. Human factors specialists reviewed video recordings of surgical procedures before transcribing events of interest and classifying them into the relevant WSF categories as defined by the Systems Engineering Initiative for Patient Safety model. Each WSF code was categorized as either a safety threat (ST) or resilience support (RS), and their interactions with associated WSFs were characterized. We transcribed 706 events over 73.5 hours of surgery, and 32 iAEs were identified. We coded 382 STs and 312 RSs, and 249 co-occurring WSF pairings. Co-occurring team (e.g., clear communication, feedback, and leadership) RSs were found to be the most prevalent mechanism to dampen all categories of ST. Co-occurring task (e.g., challenging anatomy) and environment (e.g., disruptive working environments, suboptimal ergonomic monitor setups) STs were the most common risk amplifiers contributing to the occurrence of iAEs. By assessing WSFs in the context of other WSFs, future research may develop interventions that more precisely target risk reduction in the operating room.
Applying Failure Mode Effects Analysis (FMEA) to Improve Choking Risk Prevention in a Mental Health Setting: Analysis Outcomes and Lessons Learned on Human Factors Collaboration
Authors: Soung Yee Anthony , Cyr Laurel , Bañez Carleene , Gelmi Stefano , Gaulton Catherine , Hall Trevor
Published: June 2023

This paper describes the collaborative work performed as part of a patient safety and quality improvement choking risk prevention initiative in a specialty mental health hospital in Ontario, Canada. In 2021, Ontario Shores Centre for Mental Health Sciences (Ontario Shores), in collaboration with the Healthcare Insurance Reciprocal of Canada (HIROC), conducted a Failure Modes and Effects Analysis (FMEA) to identify potential failure modes for their choking risk prevention process. “Failure modes” refer to states in a process that have the potential for unintended consequences. The interdisciplinary project team developed and validated a current-state process map, through which identified all opportunities for process improvement. A thematic analysis of the barriers revealed 14 distinct failure modes, each of which were rated along three scales (Severity, Occurrence, and Detectability) to form a ranked list based on Risk Priority Number. As part of a prospective analysis, several system-based and people-based mitigations were generated for each of the failure modes. As a result of the FMEA, Ontario Shores developed, and is in the process of, implementing a choking risk prevention and risk mitigation strategies action plan. In addition, the authors offer some reflections on the collaborative work between the two organizations, in recognition of the opportunity for healthcare organizations to benefit from human factors expertise and principles of applied safety science, usability engineering, and user-centered design.
Integrating Usability Assessments into Medical Device Evaluations
Authors: Tremoulet Patrice
Published: June 2023

ECRI, a non-profit dedicated to advancing effective, evidence-based healthcare globally, has been evaluating medical devices for over a half century. Project officers develop evaluation criteria and then perform laboratory tests to assess device performance, safety, and reliability. To help incorporate usability assessments into ECRI’s evaluations, a human factors consultant provided guidance on selecting assessment technique(s) based upon the type of device being evaluated, the nature of the environment in which it is used (e.g. operating room, intensive care patient area, nursing station), the target user population, and the resources available to support the evaluation. The consultant also developed a decision-tree to help ECRI project officers select among seven freely-available standardized usability questionnaires.
Best Practices for Use-Related Risk Analysis Through Collaboration of Human Factors and Clinical
Authors: Mehrzad Heidi M. , Stüdeli Thomas , Quie Helene
Published: June 2023

Integrating the human factors engineering (HFE) process, and its user-centered approach, into the medical device and combination Product and Development Process (PDP), has been an ongoing challenge for its respective industries and Human Factors (HF) practitioners within it for decades. Yet, despite continuous process adaptation and evolution of the HFE process, as well as the introduction of standards and health authority guidelines, the early integration of a risk-based and user-centered approach within the development and design process remains an ongoing practical challenge occupying the minds of most. With the introduction of the European MDR 2017/745 in 2017, an additional emphasis was put on the importance of use-related risk identification, assessment, and data based evaluation within the clinical evaluation process, and with such introduces clinical teams to (new) ‘use-related risk challenges’ as well.

This paper provides a framework for early integration of an iterative use-related risk analysis approach, addressing common practical challenges, and providing best practices for such. Furthermore, it highlights how applying a collaborative approach between HF and clinical efforts would permit for collection of more robust use-related data sets, thus potentially optimizing use-related risk, residual risk, and risk-benefit analyses and their processes.
Proxy Users for Usability Testing of Medical Devices for Use in Sub-Saharan Africa
Authors: Matin Shababa , Asma Elizabeth , Allen Elizabeth , Mangwiro Lucky , Mjumira Rowland , Valle Maureen , Acemyan Claudia , Oden Maria , Kawaza Kondwani , Kortum Philip , Richards-Kortum Rebecca
Published: June 2023

Medical device implementation in global health requires careful considerations around usability and the use of proxy user groups. Working with appropriate proxy users can address the cost burden of conducting international studies with target users. This study evaluated whether proxy users are a practical substitution for conducting usability testing on devices for implementation in low-resource international settings. Identical usability studies were conducted with 18 clinicians from Blantyre, Malawi, and a carefully selected proxy group of 13 clinicians from Houston, Texas, U.S.A., across seven newborn-focused medical devices. Task success rate, System Usability Scale (SUS) scores, and NASA-Task Load (NASA TLX) scores from the two groups were compared. No significant differences were found between groups other than NASA-TLX temporal demand sub-scale, showing it is possible to use a carefully selected proxy group for usability evaluation in international settings. However, there was no consistent agreement between the groups on a task level, indicating that proxy groups should be used with an abundance of caution. Studies with target users must be additionally conducted to confirm results. Further work needs to be done with a larger sample size to test the viability of a proxy group for international studies on medical devices.
Evaluation of Spin in the Clinical Literature of Suture Tape Augmentation for Ankle Instability
Authors: Thompson Ashley A. , Hwang N. Mina , Mayfield Cory K. , Petrigliano Frank A. , Liu Joseph N. , Peterson Alexander B.
Published: June 2023

Background:

Spin is defined as the use of specific reporting strategies to highlight the beneficial effect of a treatment despite nonsignificant results. The presence of spin in peer-reviewed literature can negatively impact clinical and research practices. The purpose of this study was to identify the quantity and types of spin present in primary studies and systematic reviews using suture tape augmentation for ankle instability as a model.

Methods:

This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each abstract was assessed for the presence of the 15 most common types of spin. Extracted data included study title, authors, publication year, journal, level of evidence, study design, funding, reported adherence to PRISMA guidelines, and PROSPERO registration. Full texts of systematic reviews were used in the assessment of study quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2).

Results:

Nineteen studies were included in the final sample. At least 1 type of spin was identified in each study except one (18 of 19, 94.7%). The most common type of spin observed was type 3 (“selective reporting or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention”) (6 of 19, 31.6%), The second most reported category of spin was type 4 (“the conclusion claims safety based on non-statistically significant results with a wide confidence interval”) (4 of 19, 21.1%). Among systematic reviews, we identified type 5 (“the conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies”) in 4 out of 6 (66.7%) of the articles that were included. No significant associations were found between study characteristics and type of spin.

Conclusion:

In this exploration of the introduction of a new technology, we identified spin to be highly present in the abstracts of primary studies and systematic reviews concerning suture tape augmentation for ankle instability. Steps should be taken by scientific journals to ensure that spin is minimized in the abstract to accurately reflect the quality of the intervention.
Reemployment premium effect of furlough programs: evaluating Spain’s scheme during the COVID-19 crisis
Authors: Garcia-Clemente J. , Rubino N. , Congregado E.
Published: June 2023

This paper presents an average treatment effect analysis of Spain’s furlough program during the onset of the COVID-19 pandemic. Using 2020 labour force quarterly microdata, we construct a counterfactual made of comparable nonfurloughed individuals who lost their jobs and apply propensity score matching based on their pretreatment characteristics. Our findings show that the probability of being re-employed in the next quarter significantly increased for the treated (furlough granted group). These results appear robust across models, after testing a wide range of matching specifications that reveal a reemployment probability premium of near 30 percentage points in the group of workers who had been furloughed for a single quarter. Nevertheless, a different time arrangement affected the magnitude of the effect, suggesting that it may decrease with the furlough duration. Thus, an analogous analysis for a longer (two quarter) scheme estimated a still positive but smaller effect, approximately 12 percentage points. Although this finding might alert against long lasting schemes under persistent recessions, this policy still stands as a useful strategy to face essentially transitory adverse shocks.
Multi-omics analysis reveals changes in tryptophan and cholesterol metabolism before and after sexual maturation in captive macaques
Authors: Liu Xu , Liu Xuyuan , Wang Xinqi , Shang Ke , Li Jiawei , Lan Yue , Wang Jiao , Li Jing , Yue Bisong , He Miao , Fan Zhenxin
Published: June 2023

Rhesus macaques (Macaca mulatta, RMs) are widely used in sexual maturation studies due to their high genetic and physiological similarity to humans. However, judging sexual maturity in captive RMs based on blood physiological indicators, female menstruation, and male ejaculation behavior can be inaccurate. Here, we explored changes in RMs before and after sexual maturation based on multi-omics analysis and identified markers for determining sexual maturity. We found that differentially expressed microbiota, metabolites, and genes before and after sexual maturation showed many potential correlations. Specifically, genes involved in spermatogenesis (TSSK2, HSP90AA1, SOX5, SPAG16, and SPATC1) were up-regulated in male macaques, and significant changes in gene (CD36), metabolites (cholesterol, 7-ketolithocholic acid, and 12-ketolithocholic acid), and microbiota (Lactobacillus) related to cholesterol metabolism were also found, suggesting the sexually mature males have stronger sperm fertility and cholesterol metabolism compared to sexually immature males. In female macaques, most differences before and after sexual maturity were related to tryptophan metabolism, including changes in IDO1, IDO2, IFNGR2, IL1Β, IL10, L-tryptophan, kynurenic acid (KA), indole-3-acetic acid (IAA), indoleacetaldehyde, and Bifidobacteria, indicating that sexually mature females exhibit stronger neuromodulation and intestinal immunity than sexually immature females. Cholesterol metabolism-related changes (CD36, 7-ketolithocholic acid, 12-ketolithocholic acid) were also observed in female and male macaques. Exploring differences before and after sexual maturation through multi-omics, we identified potential biomarkers of sexual maturity in RMs, including Lactobacillus (for males) and Bifidobacterium (for females) valuable for RM breeding and sexual maturation research.
Identification and validation of a DNA methylation-driven gene-based prognostic model for clear cell renal cell carcinoma
Authors: Deng Qiong , Du Ye , Wang Zhu , Chen Yeda , Wang Jieyan , Liang Hui , Zhang Du
Published: June 2023

Background

Clear cell renal cell carcinoma (ccRCC) is a malignant tumor with heterogeneous morphology and poor prognosis. This study aimed to establish a DNA methylation (DNAm)-driven gene-based prognostic model for ccRCC.

Methods

Reduced representation bisulfite sequencing (RRBS) was performed on the DNA extracts from ccRCC patients. We analyzed the RRBS data from 10 pairs of patient samples to screen the candidate CpG sites, then trained and validated an 18-CpG site model, and integrated the clinical characters to establish a Nomogram model for the prognosis or risk evaluation of ccRCC.

Results

We identified 2261 DMRs in the promoter region. After DMR selection, 578 candidates were screened, and was correspondence with 408 CpG dinucleotides in the 450 K array. We collected the DNAm profiles of 478 ccRCC samples from TCGA dataset. Using the training set with 319 samples, a prognostic panel of 18 CpGs was determined by univariate Cox regression, LASSO regression, and multivariate Cox proportional hazards regression analyses. We constructed a prognostic model by combining the clinical signatures. In the test set (159 samples) and whole set (478 samples), the Kaplan–Meier plot showed significant differences; and the ROC curve and survival analyses showed AUC greater than 0.7. The Nomogram integrated with clinicopathological characters and methylation risk score had better performance, and the decision curve analyses also showed a beneficial effect.

Conclusions

This work provides insight into the role of hypermethylation in ccRCC. The targets identified might serve as biomarkers for early ccRCC diagnosis and prognosis biomarkers for ccRCC. We believe our findings have implications for better risk stratification and personalized management of this disease.
iAstrocytes do not restrain T cell proliferation in vitro
Authors: Colombo Emanuela , De Angelis Anthea , Bassani Claudia , Ruffini Francesca , Ottoboni Linda , Garzetti Livia , Finardi Annamaria , Martino Gianvito , Furlan Roberto , Farina Cinthia
Published: June 2023

The cross-talk between T cells and astrocytes occurring under physiological and, even more, neuroinflammatory conditions may profoundly impact the generation of adaptive immune responses in the nervous tissue. In this study, we used a standardized in vitro co-culture assay to investigate the immunomodulatory properties of astrocytes differing for age, sex, and species. Mouse neonatal astrocytes enhanced T cell vitality but suppressed T lymphocyte proliferation in response to mitogenic stimuli or myelin antigens, regardless of the Th1, Th2 or Th17 T cell phenotype. Studies comparing glia cells from adult and neonatal animals showed that adult astrocytes were more efficient in inhibiting T lymphocyte activation than neonatal astrocytes, regardless of their sex. Differently from primary cultures, mouse and human astrocytes derived from reprogrammed fibroblasts did not interfere with T cell proliferation. Overall, we describe a standardized astrocyte-T cell interaction in vitro assay and demonstrate that primary astrocytes and iAstrocytes may differ in modulating T cell function.
Anti-tissue transglutaminase antibodies (TG2A) positivity and the risk of vitamin D deficiency among children - a cross-sectional study in the generation R cohort
Authors: van der Velde Laura A. , Beth Sanne A. , Voortman Trudy , van Zelm Menno C. , Moll Henriette A. , Kiefte-de Jong Jessica C.
Published: June 2023

Background

Suboptimal vitamin D status is common in people with celiac disease (CeD), a disease that can be characterized by the presence of serum anti-tissue transglutaminase antibodies (TG2A) (i.e., TG2A positivity). To date, it remains unclear whether childhood TG2A positivity is associated with vitamin D status and how this potential association can be explained by other factors than malabsorption only, since vitamin D is mainly derived from exposure to sunlight. The aim of our study was therefore to assess whether childhood TG2A positivity is associated with vitamin D concentrations, and if so, to what extent this association can be explained by sociodemographic and lifestyle factors.

Methods

This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort. We measured serum anti-tissue transglutaminase antibodies (TG2A) concentrations and serum 25-hydroxyvitamin D (25(OH)D) concentrations of 3994 children (median age of 5.9 years). Children with serum TG2A concentrations ≥ 7 U/mL were considered TG2A positive. To examine associations between TG2A positivity and 25(OH)D concentrations, we performed multivariable linear regression, adjusted for sociodemographic and lifestyle factors.

Results

Vitamin D deficiency (serum 25(OH)D < 50 nmol/L) was found in 17 out of 54 TG2A positive children (31.5%), as compared to 1182 out of 3940 TG2A negative children (30.0%). Furthermore, TG2A positivity was not associated with 25(OH)D concentrations (β -2.20; 95% CI -9.72;5.33 for TG2A positive vs. TG2A negative children), and this did not change after adjustment for confounders (β -1.73, 95% CI -8.31;4.85).

Conclusions

Our findings suggest there is no association between TG2A positivity and suboptimal vitamin D status in the general pediatric population. However, the overall prevalence of vitamin D deficiency in both populations was high, suggesting that screening for vitamin D deficiency among children, regardless of TG2A positivity, would be beneficial to ensure early dietary intervention if needed.
Congenital hepatic hemangioma: an unusual case report of pulmonary hypertension
Authors: Zhou Qianqin , Jiang Juan , Xu Yinquan , Qiu Hanyan , Wen Xiaoyan , He Shaoqi , Lv Qin
Published: June 2023

Background

Pulmonary hypertension (PH) in newborns is a rare but serious condition that often requires immediate intervention and quick diagnosis of the correct etiology to prevent mortality. Congenital hepatic hemangioma (CHH) is an example of an extrathoracic etiology of PH.

Case presentation

Herein, we report the case of a newborn with a giant liver hemangioma, who presented with an early onset of PH and was successfully treated with intra-arterial embolization.

Conclusions

This case illustrates the importance of suspicion and prompt evaluation of CHH and related systemic arteriovenous shunts among infants with unexplained PH.