Words and numbers: a comparative study of medical and journalism students' descriptors of risk, numeracy and preferences for health risk communication.

BACKGROUND: Given the complementary roles of health professionals and journalists in communicating health risks to patients and the public, there have been calls for physicians to work with journalists to improve the quality of health information received by the public. Understanding the preferences of medical and journalism students for the way in which health risks are communicated and their understanding of words used to describe risk is an important first step to inform interdisciplinary learning. METHODS: Medical and journalism students (n = 203) completed an online survey where they were given qualitative descriptors of risk such as 'a chance', 'probably' and 'unlikely', and asked to assign a number that represents what the word means to them. Different formats of communicating risk (percentages, natural frequency and visual aids) were provided and students were asked to select and explain their preference. A thematic analysis of reasons was conducted. Numeracy and perceived mathematics ability were measured. RESULTS: Numbers assigned to the descriptor 'A chance' had the highest variability for medical students. Numbers assigned to the descriptor 'Probably' had the highest variability for journalism students. Using visual aids was the most popular format for risk communication for both courses (56% of medical students and 40% of journalism students). Using percentages was twice as popular with journalism students compared to medical students (36% vs. 18%). Perceived mathematics ability was lower in students with a preference for natural frequencies and in journalism students, however performance on an objective numeracy scale was similar for all three formats (percentages, natural frequency and visual aids). Reasons for choosing a preferred format included good communication, eliciting a response, or learning style. CONCLUSIONS: Education on health risk communication for medical and journalism students should emphasize the need for qualitative descriptors of risk to be combined with the best available number. Students are already considering their role as future communicators of health risks and open to tailoring the mode of presentation to their audience. Further research is required on the design and evaluation of interdisciplinary workshops in health risk communication for medical and journalism students to maximise the opportunities for future inter-professional working.

Identification of monoclonal antibody drug substances using non-destructive Raman spectroscopy.

Monoclonal antibodies provide highly specific and effective therapies for the treatment of chronic diseases. These protein-based therapeutics, or drug substances, are transported in single used plastic packaging to fill finish sites. According to good manufacturing practice guidelines, each drug substance needs to be identified before manufacturing of the drug product. However, considering their complex structure, it is challenging to correctly identify therapeutic proteins in an efficient manner. Common analytical techniques for therapeutic protein identification are SDS-gel electrophoresis, enzyme linked immunosorbent assays, high performance liquid chromatography and mass spectrometry-based assays. Although effective in correctly identifying the protein therapeutic, most of these techniques need extensive sample preparation and removal of samples from their containers. This step not only risks contamination but the sample taken for the identification is destroyed and cannot be re-used. Moreover, these techniques are often time consuming, sometimes taking several days to process. Here, we address these challenges by developing a rapid and non-destructive identification technique for monoclonal antibody-based drug substances. Raman spectroscopy in combination with chemometrics were used to identify three monoclonal antibody drug substances. This study explored the impact of laser exposure, time out of refrigerator and multiple freeze thaw cycles on the stability of monoclonal antibodies. and demonstrated the potential of using Raman spectroscopy for the identification of protein-based drug substances in the biopharmaceutical industry.

Determinants of Intravenous Infusion Longevity and Infusion Failure via a Nonlinear Model Analysis of Smart Pump Event Logs: Retrospective Study.

BACKGROUND: Infusion failure may have severe consequences for patients receiving critical, short-half-life infusions. Continued interruptions to infusions can lead to subtherapeutic therapy. OBJECTIVE: This study aims to identify and rank determinants of the longevity of continuous infusions administered through syringe drivers, using nonlinear predictive models. Additionally, this study aims to evaluate key factors influencing infusion longevity and develop and test a model for predicting the likelihood of achieving successful infusion longevity. METHODS: Data were extracted from the event logs of smart pumps containing information on care profiles, medication types and concentrations, occlusion alarm settings, and the final infusion cessation cause. These data were then used to fit 5 nonlinear models and evaluate the best explanatory model. RESULTS: Random forest was the best-fit predictor, with an F1-score of 80.42, compared to 5 other models (mean F1-score 75.06; range 67.48-79.63). When applied to infusion data in an individual syringe driver data set, the predictor model found that the final medication concentration and medication type were of less significance to infusion longevity compared to the rate and care unit. For low-rate infusions, rates ranging from 2 to 2.8 mL/hr performed best for achieving a balance between infusion longevity and fluid load per infusion, with an occlusion versus no-occlusion ratio of 0.553. Rates between 0.8 and 1.2 mL/hr exhibited the poorest performance with a ratio of 1.604. Higher rates, up to 4 mL/hr, performed better in terms of occlusion versus no-occlusion ratios. CONCLUSIONS: This study provides clinicians with insights into the specific types of infusion that warrant more intense observation or proactive management of intravenous access; additionally, it can offer valuable information regarding the average duration of uninterrupted infusions that can be expected in these care areas. Optimizing rate settings to improve infusion longevity for continuous infusions, achieved through compounding to create customized concentrations for individual patients, may be possible in light of the study's outcomes. The study also highlights the potential of machine learning nonlinear models in predicting outcomes and life spans of specific therapies delivered via medical devices.

Calibrating COVID-19 susceptible-exposed-infected-removed models with time-varying effectivecontact rates.

We describe the population-based susceptible-exposed-infected-removed (SEIR) model developed by the Irish Epidemiological Modelling Advisory Group (IEMAG), which advises the Irish government on COVID-19 responses. The model assumes a time-varying effective contact rate (equivalently, a time-varying reproduction number) to model the effect of non-pharmaceutical interventions. A crucial technical challenge in applying such models is their accurate calibration to observed data, e.g. to the daily number of confirmed new cases, as the history of the disease strongly affects predictions of future scenarios. We demonstrate an approach based on inversion of the SEIR equations in conjunction with statistical modelling and spline-fitting of the data to produce a robust methodology for calibration of a wide class of models of this type. This article is part of the theme issue 'Data science approaches to infectious disease surveillance'.

Identifying the gaps in Irish cancer care: Patient, public and providers' perspectives.

BACKGROUND: The University of Limerick Cancer network (ULCaN) was established in 2019 with funding from the Health Research Institute at the University of Limerick in order to build a network between individuals in academia, primary and secondary care and the general public so that cancer services can be coordinated and more effective. The aim of this paper is to outline our experience of engaging with stakeholders to identify gaps in the cancer journey locally. METHODS: Four focus group discussions were conducted with patients; their carers; members of the public; and healthcare providers with 2 main aims: 1) to investigate gaps in cancer services; 2) to identify knowledge, attitudes and opportunities available to promote cancer research. The focus groups were audio recorded, transcribed and thematically analysed. RESULTS: 15 themes within the topics of cancer care, palliation, communication, clinical trials, diet and exercise and public and patient involvement in research and advocacy were identified. These include directing people to reliable information and navigating misinformation and stigma linked with cancer, promoting awareness of clinical trials and palliative care services and improving communication when multiple healthcare providers are involved. CONCLUSION: The need to make more coherent, efficient and integrated cancer research amongst local stakeholders was evident. Embedding patients and members of the public into ULCaN is an important deliverable for collaborative research.

Understanding the Challenges and Uncertainties of Seroprevalence Studies for SARS-CoV-2.

SARS-CoV-2 continues to widely circulate in populations globally. Underdetection is acknowledged and is problematic when attempting to capture the true prevalence. Seroprevalence studies, where blood samples from a population sample are tested for SARS-CoV-2 antibodies that react to the SARS-CoV-2 virus, are a common method for estimating the proportion of people previously infected with the virus in a given population. However, obtaining reliable estimates from seroprevalence studies is challenging for a number of reasons, and the uncertainty in the results is often overlooked by scientists, policy makers, and the media. This paper reviews the methodological issues that arise in designing these studies, and the main sources of uncertainty that affect the results. We discuss the choice of study population, recruitment of subjects, uncertainty surrounding the accuracy of antibody tests, and the relationship between antibodies and infection over time. Understanding these issues can help the reader to interpret and critically evaluate the results of seroprevalence studies.

PCA of waveforms and functional PCA: A primer for biomechanics.

Principal components analysis (PCA) of waveforms and functional PCA (fPCA) are statistical approaches used to explore patterns of variability in biomechanical curve data, with fPCA being an accepted statistical method grounded within the functional data analysis (FDA) statistical framework. This technical note demonstrates that PCA of waveforms is the most rudimentary form of FDA, and consequently can be rationalised within the FDA framework of statistical processes. Mathematical proofing applied demonstrations of both techniques, and an example of when fPCA may be of greater benefit to control over smoothing of functional principal components is provided using an open access motion sickness dataset. Finally, open access software is provided with this paper as means of priming the biomechanics community for using these methods as a part of future functional data explorations.

Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT).

BACKGROUND: One-size-fits-all interventions reduce chronic low back pain (CLBP) a small amount. An individualised intervention called cognitive functional therapy (CFT) was superior for CLBP compared with manual therapy and exercise in one randomised controlled trial (RCT). However, systematic reviews show group interventions are as effective as one-to-one interventions for musculoskeletal pain. This RCT investigated whether a physiotherapist-delivered individualised intervention (CFT) was more effective than physiotherapist-delivered group-based exercise and education for individuals with CLBP. METHODS: 206 adults with CLBP were randomised to either CFT (n=106) or group-based exercise and education (n=100). The length of the CFT intervention varied according to the clinical progression of participants (mean=5 treatments). The group intervention consisted of up to 6 classes (mean=4 classes) over 6-8 weeks. Primary outcomes were disability and pain intensity in the past week at 6 months and 12months postrandomisation. Analysis was by intention-to-treat using linear mixed models. RESULTS: CFT reduced disability more than the group intervention at 6 months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004). There were no between-group differences observed in pain intensity at 6 months (mean difference, 0.76; 95% CI -0.02 to 1.54; p=0.056) or 12 months (mean difference, 0.65; 95% CI -0.20 to 1.50; p=0.134). CONCLUSION: CFT reduced disability, but not pain, at 6 and 12 months compared with the group-based exercise and education intervention. Future research should examine whether the greater reduction in disability achieved by CFT renders worthwhile differences for health systems and patients. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT02145728).

Dance exposure, general health, sleep and injury in elite adolescent Irish dancers: A prospective study.

OBJECTIVES: To investigate dance exposure, sleep, general health and injury in elite adolescent Irish dancers. DESIGN: Prospective study. SETTING: Six Irish dance schools in Ireland. PARTICIPANTS: Thirty-seven elite Irish dancers, aged 13-17, competing at the highest championship level for at least the previous year. MAIN OUTCOME MEASURES: Self-reported weekly hours of dance, general health, sleep quality, monthly and annual height and weight, injury incidence. RESULTS: Overall injury incidence (time-loss plus non-time-loss) and time-loss only injury incidence were 9.3 injuries, and 4.5 injuries, per 1000 hours of dance respectively. At least one injury was incurred by 86.5% of participants, with the foot/ankle most commonly affected. There were no statistically significant associations (p>0.05) between injury and sleep quality, or annual change in height/weight. There was some evidence of a statistically significant association between injury and health quality, with poorer health associated with increased levels of injury. There was no evidence of a statistically significant association between the probability of injury over time and sleep quality one week earlier, health quality one week earlier, or training load one and two weeks earlier. CONCLUSIONS: The incidence of injury in elite adolescent Irish dance is considerable with many dancers continuing to dance when injured. Increased dance exposure is associated with new injury.

Considerations for the use of functional principal components analysis in sports biomechanics: examples from on-water rowing.

The proliferation of new biomechanical technology in laboratory and field settings facilitates the capture of data-sets consisting of complex time-series. An understanding of the appropriate statistical approaches for analysing and interpreting these data-sets is required and the functional data analysis (FDA) family of statistical techniques has emerged in the biomechanical literature. Given the use of FDA is currently in its infancy with biomechanical data, this paper will form the first of a two part series aiming to address practical issues surrounding the application of FDA techniques in biomechanics. This work focuses on functional principal components analysis (fPCA), which is explored using existing literature and sample data from an on-water rowing database. In particular methodological considerations for the implementation of fPCA such as temporal normalisation of data, removal of unwanted forms of variation in a data-set and documented methods for preserving the original temporal properties within a set of curves are explored in detail as a part of this review. Limitations and strengths of the technique are outlined and recommendations are provided to encourage the appropriate use of fPCA within the field of applied sports biomechanics.

Bivariate functional principal components analysis: considerations for use with multivariate movement signatures in sports biomechanics.

Sporting performance is often investigated through graphical observation of key technical variables that are representative of whole movements. The presence of differences between athletes in such variables has led to terms such as movement signatures being used. These signatures can be multivariate (multiple time-series observed concurrently), and also be composed of variables measured relative to different scales. Analytical techniques from areas of statistics such as Functional Data Analysis (FDA) present a practical alternative for analysing multivariate signatures. When applied to concurrent bivariate time-series multivariate functional principal components analysis (referred to as bivariate fPCA or bfPCA in this paper) has demonstrated preliminary application in biomechanical contexts. Despite this, given the infancy of bfPCA in sports biomechanics there are still necessary considerations for its use with non-conventional or complex bivariate structures. This paper focuses on the application of bfPCA to the force-angle graph in on-water rowing, which is a bivariate structure composed of variables with different units. A normalisation approach is proposed to investigate and standardise differences in variability between the two variables. The results of bfPCA applied to the non-normalised data and normalised data are then compared. Considerations and recommendations for the application of bfPCA in this context are also provided.

Pain and Injury in Elite Adolescent Irish Dancers: A Cross-Sectional Study.

Dance is an extremely popular activity among adolescents and has a range of associated physical and psychological health benefits. However, pain and injury in young elite dancers is pervasive, and the underlying risk factors are poorly understood. This study investigated the incidence of pain and injury in elite adolescent Irish dancers and examined a range of potentially associated biopsychosocial risk factors. Thirty-seven championship level Irish dancers completed baseline questionnaires recording any episode of pain or injury over the previous 12 months. Additionally, dancers provided information regarding their dance practices, general health, sleep, eating habits, and a range of psychological factors including mood, catastrophizing, passion for dance, and achievement motivation. A baseline physical screening protocol including assessment of balance, fitness, flexibility, endurance, and functional movement was conducted. Subjects were separated into a "more pain and injury (MPI)" group (N = 17) or "less pain and injury (LPI)" group (N = 20) based on their reported pain and injury history over the previous year. Statistical analysis was conducted using independent samples ttest, the Mann-Whitney U test for skewed variables, and the test of independence for categorical variables as appropriate. Eighty-four percent of subjects recorded at least one pain or injury during the previous year. The lower limb, particularly the foot and ankle, was most commonly affected. Factors significantly associated with pain and injury included having an unusual number of troublesome body parts (p = 0.002), often or always dancing in pain (p = 0.033), and high levels of anger or hostility (p = 0.045). This study demonstrates that elite adolescent Irish dance is associated with a substantial risk of pain and injury that appears to be greater than that incurred by young dancers from other genres. Proposed explanations include inappropriate technique progression, unique choreographic features, and an overly arduous calendar of competitive events. A prospective study nearing completion will help clarify causal factors in these dancers.

A force profile analysis comparison between functional data analysis, statistical parametric mapping and statistical non-parametric mapping in on-water single sculling.

OBJECTIVES: To examine whether the Functional Data Analysis (FDA), Statistical Parametric Mapping (SPM) and Statistical non-Parametric Mapping (SnPM) hypothesis testing techniques differ in their ability to draw inferences in the context of a single, simple experimental design. DESIGN: The sample data used is cross-sectional (two-sample gender comparison) and evaluation of differences between statistical techniques used a combination of descriptive and qualitative assessments. METHODS: FDA, SPM and SnPM t-tests were applied to sample data of twenty highly skilled male and female rowers, rowing at 32 strokes per minute in a single scull boat. Statistical differences for gender were assessed by applying two t-tests (one for each side of the boat). RESULTS: The t-statistic values were identical for all three methods (with the FDA t-statistic presented as an absolute measure). The critical t-statistics (tcrit) were very similar between the techniques, with SPM tcrit providing a marginally higher tcrit than the FDA and SnPM tcrit values (which were identical). All techniques were successful in identifying consistent sections of the force waveform, where male and female rowers were shown to differ significantly (p<0.05). CONCLUSIONS: This is the first study to show that FDA, SPM and SnPM t-tests provide consistent results when applied to sports biomechanics data. Though the results were similar, selection of one technique over another by applied researchers and practitioners should be based on the underlying parametric assumption of SPM, as well as contextual factors related to the type of waveform data to be analysed and the experimental research question of interest.

How gender and boat-side affect shape characteristics of force-angle profiles in single sculling: Insights from functional data analysis.

OBJECTIVES: To examine whether gender or side of the boat influenced shape characteristics of the force-angle profile in on-water single sculling. DESIGN: Cross-sectional study design. METHODS: Bivariate functional principal components analysis (bfPCA) was applied to force-angle data to identify the main modes of variance in curves of forty highly skilled male and female rowers (national and international level), rowing at 32 strokes per minute in a single scull boat. RESULTS: Separate discriminant function analyses for each side of the boat showed strong classification of rowers for gender. Force application close to (or closely around) the perpendicular oar position was demonstrated to be different between genders. A mixed ANOVA exploring gender, boat side and their interaction revealed that bow and stroke side forces were also statistically different from each other independently of gender. A main effect, independent of side of the boat, was also present for gender and no interaction was found between gender and boat side. Bow side forces seemingly acted as a driver of power and peak force production, while stroke side forces may have acted as a mediator of propulsive forces with an additional potential role in steering due to known asymmetrical offsets in boat rigging. CONCLUSIONS: Results demonstrate that propulsive force differences according to gender and boat-side are evident and must be acknowledged and accounted for before force-angle graphs are explored relative to performance measures.

Understanding the relationship between duration of untreated psychosis and outcomes: A statistical perspective.

AIM: Although the relationships between duration of untreated psychosis (DUP) and outcomes are often assumed to be linear, few studies have explored the functional form of these relationships. The aim of this study is to demonstrate the potential of recent advances in curve fitting approaches (splines) to explore the form of the relationship between DUP and global assessment of functioning (GAF). METHODS: Curve fitting approaches were used in models to predict change in GAF at long-term follow-up using DUP for a sample of 83 individuals with schizophrenia. RESULTS: The form of the relationship between DUP and GAF was non-linear. Accounting for non-linearity increased the percentage of variance in GAF explained by the model, resulting in better prediction and understanding of the relationship. CONCLUSION: The relationship between DUP and outcomes may be complex and model fit may be improved by accounting for the form of the relationship. This should be routinely assessed and new statistical approaches for non-linear relationships exploited, if appropriate.

Impact of grass cover on the magnetic susceptibility measurements for assessing metal contamination in urban topsoil.

In recent decades, magnetic susceptibility monitoring has developed as a useful technique in environmental pollution studies, particularly metal contamination of soil. This study provides the first ever examination of the effects of grass cover on magnetic susceptibility (MS) measurements of underlying urban soils. Magnetic measurements were taken in situ to determine the effects on κ (volume magnetic susceptibility) when the grass layer was present (κgrass) and after the grass layer was trimmed down to the root (κno grass). Height of grass was recorded in situ at each grid point. Soil samples (n=185) were collected and measurements of mass specific magnetic susceptibility (χ) were performed in the laboratory and frequency dependence (χfd%) calculated. Metal concentrations (Pb, Cu, Zn and Fe) in the soil samples were determined and a gradiometry survey carried out in situ on a section of the study area. Significant correlations were found between each of the MS measurements and the metal content of the soil at the p<0.01 level. Spatial distribution maps were created using Inverse Distance Weighting (IDW) and Local Indicators of Spatial Association (LISA) to identify common patterns. κgrass (ranged from 1.67 to 301.00×10-5 SI) and κno grass (ranged from 2.08 to 530.67×10-5 SI) measured in situ are highly correlated [r=0.966, n=194, p<0.01]. The volume susceptibility datasets in the presence and absence of grass coverage share a similar spatial distribution pattern. This study re-evaluates in situ κ monitoring techniques and the results suggest that the removal of grass coverage prior to obtaining in situ κ measurements of urban soil is unnecessary. This layer does not impede the MS sensor from accurately measuring elevated κ in soils, and therefore κ measurements recorded with grass coverage present can be reliably used to identify areas of urban soil metal contamination.

Arsenic contamination of drinking water in Ireland: A spatial analysis of occurrence and potential risk.

The presence of arsenic in groundwater has become a global concern due to the health risks from drinking water with elevated concentrations. The Water Framework Directive (WFD) of the European Union calls for drinking water risk assessment for member states. The present study amalgamates readily available national and sub-national scale datasets on arsenic in groundwater in the Republic of Ireland. However, due to the presence of high levels of left censoring (i.e. arsenic values below an analytical detection limit) and changes in detection limits over time, the application of conventional statistical methods would inhibit the generation of meaningful results. In order to handle these issues several arsenic databases were integrated and the data modelled using statistical methods appropriate for non-detect data. In addition, geostatistical methods were used to assess principal risk components of elevated arsenic related to lithology, aquifer type and groundwater vulnerability. Geographic statistical methods were used to overcome some of the geographical limitations of the Irish Environmental Protection Agency (EPA) sample database. Nearest-neighbour inverse distance weighting (IDW) and local indicator of spatial association (LISA) methods were used to estimate risk in non-sampled areas. Significant differences were also noted between different aquifer lithologies, indicating that Rhyolite, Sandstone and Shale (Greywackes), and Impure Limestone potentially presented a greater risk of elevated arsenic in groundwaters. Significant differences also occurred among aquifer types with poorly productive aquifers, locally important fractured bedrock aquifers and regionally important fissured bedrock aquifers presenting the highest potential risk of elevated arsenic. No significant differences were detected among different groundwater vulnerability groups as defined by the Geological Survey of Ireland. This research will assist management and future policy directions of groundwater resources at EU level and guide future research focused on understanding arsenic mobilisation processes to facilitate in guiding future development, testing and treatment requirements of groundwater resources.

Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Non-specific chronic low back pain (NSCLBP) is a very common and costly musculoskeletal disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) represents a novel, patient-centred intervention which directly challenges pain-related behaviours in a cognitively integrated, functionally specific and graduated manner. CFT aims to target all biopsychosocial factors that are deemed to be barriers to recovery for an individual patient with NSCLBP. A recent randomised controlled trial (RCT) demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy combined with exercise. However, several previous RCTs have suggested that class-based interventions are as effective as individualised interventions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to a relatively cheaper exercise and education class. The current study will compare the clinical effectiveness of individualised CFT with a combined exercise and pain education class in people with NSCLBP. METHODS AND ANALYSIS: This study is a multicentre RCT. 214 participants, aged 18-75 years, with NSCLBP for at least 6 months will be randomised to one of two interventions across three sites. The experimental group will receive individualised CFT and the length of the intervention will be varied in a pragmatic manner based on the clinical progression of participants. The control group will attend six classes which will be provided over a period of 6-8 weeks. Participants will be assessed preintervention, postintervention and after 6 and 12 months. The primary outcomes will be functional disability and pain intensity. Non-specific predictors, moderators and mediators of outcome will also be analysed. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Mayo General Hospital Research Ethics Committee (MGH-14-UL). Outcomes will be disseminated through publication according to the SPIRIT statement and will be presented at scientific conferences. TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT02145728).