How to Conduct Clinical Research in Cardiovascular Imaging: A Primer for Clinical Cardiologists and Researchers. A Statement of the European Association of Cardiovascular Imaging (EACVI) of the ESC.

This statement from the European Association of Cardiovascular Imaging (EACVI) of the ESC aims to address the fundamental principles that guide clinical research in the field of cardiovascular imaging. It provides clinical researchers, cardiology fellows, and Ph.D. students with a condensed, updated, and practical reference document to support them in designing, implementing, and conducting imaging protocols for clinical trials. Although the present article cannot replace formal research training and mentoring, it is recommended reading for any professional interested in becoming acquainted with or participating in clinical trials involving cardiovascular imaging.

Systematic review of teacher well-being research during the COVID-19 pandemic.

Introduction: The COVID-19 period posed great challenges to global education systems, especially teachers even after lock-down. Teachers' wellbeing has been a concern because they have to balance health with work. Since the role of teachers is pivotal in education, there is increased in research on their wellbeing status. Method: The current systematic review aims to analyze the distribution of research on teacher wellbeing from 2020 to mid-February 2024 using a quantitative method. It focuses on yearly distribution of studies, the research methods adopted by scholars, and the group of teachers investigated over the period. The PRISMA guidelines were followed, and 103 empirical studies were selected for the analysis. Results: The review shows notable increase in research, particularly in 2022 and 2023, representing 37.9% and 35.9% of studies, respectively. This suggests a growing interest in teacher wellbeing among educational researchers. The findings also indicate that researchers mostly adopted quantitative methods in form of surveys (79.6%) for studies on teacher wellbeing. However, there has been an increase in qualitative and mixed-methods research recently, with qualitative research accounting for 9.7% and mixed-method research accounting for 10.7%. The review also identified a greater focus on teachers in general than on specific group of teachers.

Every problem is embedded in a greater whole.

Peter Drucker pointed out an important distinction between 'doing things right' and 'doing the right thing', which recognised that all problems are embedded in a context and thus can only be understood within their unique contextual setting. Contemporary research practices in clinical medicine often regards contextual factors as potential confounders that will bias effect estimates and thus must be avoided. However rigorous, research devoid of context ultimately deprives users of understanding of the support factors that make research transferable to policy decisions or managing care of individual patients-it stands in the way of 'doing the right thing' in 'real life' settings. Appreciating that all problems are embedded in a greater context means that one should not ignore their interconnected and interdependent systemic nature, that is, every variable is simultaneously dependent and independent. This is the reason for the cascading effects and feedback loops witnessed in disease progression and policy efforts. We discuss the need for researchers to a-priori consider the context of their research question as well as the structural relationships of the variables under investigation, which in turn provides the basis for choosing the most appropriate research design. We have a moral imperative to first 'do the right thing'-ask questions that address the contextual needs of our patients, and then to 'do it right'-choose the best research method to answer this contextually framed need. Only then will our research efforts have meaningful and lasting impacts on patient care.

APAQ at Forty: Publication Trends.

The purpose of the present study was to analyze Adapted Physical Activity Quarterly (APAQ) publications over the journal's fourth decade (2014-2023) and compare them with previous documentary analyses of the first 3 decades. Consistent with prior documentary analyses, publications were coded and analyzed based on the use of theory, research participants, topic, whether the study was an intervention, first-author country affiliation, and research method. The total number of published research papers increased substantially (n = 61) from the third to the fourth decade. Similar to prior documentary analyses, most of the research was quantitative (n = 140; 57.5%), followed by qualitative research (n = 96; 39.5%). There were far more qualitative-research publications in the fourth decade compared with the third decade (n = 34). This may reflect the continued acceptance and growth of qualitative research compared with 10-20 years ago. It may also reflect the value of rich in-depth exploratory research using small samples. Additional trends included more review papers and meta-analyses, possibly reflecting the increased knowledge base in particular areas requiring synthesis. The diversity of topics also increased, with papers on dignity, classification, coaching, and the Paralympics playing more prominent roles. The number of international publications also grew substantially. In brief, the current paper outlines both similarities and differences in APAQ's published research over the 4 decades of its existence.

Did Reagan Decline?

Background: When Ronald Reagan revealed his Alzheimer's diagnosis in 1994, it rekindled a lingering question: did dementia affect Reagan during his eight years as president? Amid countless countervailing anecdotes, Berisha et al. (2015) stepped in with an inventive systematic test. Scouring Ronald Reagan's 46 formal press conferences for specific linguistic markers, the study discovered "significant differences in variables known to be associated with the onset of dementia" (962). Objective: Here I test whether Reagan's unique word usage rate decline is spurious, a function of reporters' increasing penchant for asking "follow-up" questions. Methods: Focusing on the President's specific responses to distinct questions, I reanalyze Reagan's unique word usage rate while holding constant the number and type of reporter questions. Results: I find Reagan's unique word usage rate held form throughout his eight years in the White House. Conclusions: I conclude by considering the implications for Reagan's legacy and Alzheimer's research.

How fragile the positive results of Chinese herbal medicine randomized controlled trials on irritable bowel syndrome are?

OBJECTIVE: The fragility index (FI), which is the minimum number of changes in status from "event" to "non-event" resulting in a loss of statistical significance, serves as a significant supplementary indicator for clinical physicians in interpreting clinical trial results and aids in understanding the outcomes of randomized controlled trials (RCTs). In this systematic literature survey, we evaluated the FI for RCTs evaluating Chinese herbal medicine (CHM) for irritable bowel syndrome (IBS), and explored potential associations between study characteristics and the robustness of RCTs. METHODS: A comprehensive search was conducted in four databases in Chinese and four databases in English from their inception to January 1, 2023. RCTs encompassed 1:1 ratio into two parallel arms and reported at least one binary outcome that demonstrated statistical significance were included. FI was calculated by the iterative reduction of a target outcome event in the treatment group and concomitant subtraction of a non-target event from that group, until positive significance (defined as P < 0.05 by Fisher's exact test) is lost. The lower the FI (minimum 1) of a trial outcome, the more fragile the positive result of the outcome was. Linear regression models were adopted to explore influence factors of the value of FI. RESULTS: A total of 30 trials from 2 4118 potentially relevant citations were finally included. The median FI of total trials included was 1.5 (interquartile range [IQR], 1-5), and half of the trials (n = 15) had a FI equal to 1. In 12 trials (40%), the total number of participants lost to follow-up surpassed the respective FI. The study also identified that increased FI was significantly associated with no TCM syndrome differentiation for inclusion criteria of the patients, larger total sample size, low risk of bias, and larger numbers of events. CONCLUSIONS: The majority of CHM IBS RCTs with positive results were found to be fragile. Ensuring adequate sample size, scientifically rigorous study design, proper control of confounding factors, and a quality control calibration for consistency of TCM diagnostic results among clinicians should be addressed to increase the robustness of the RCTs. We recommend reporting the FI as one of the components of sensitivity analysis in future RCTs to facilitate the assessment of the fragility of trials.

Lie detection algorithms disrupt the social dynamics of accusation behavior.

Humans, aware of the social costs associated with false accusations, are generally hesitant to accuse others of lying. Our study shows how lie detection algorithms disrupt this social dynamic. We develop a supervised machine-learning classifier that surpasses human accuracy and conduct a large-scale incentivized experiment manipulating the availability of this lie-detection algorithm. In the absence of algorithmic support, people are reluctant to accuse others of lying, but when the algorithm becomes available, a minority actively seeks its prediction and consistently relies on it for accusations. Although those who request machine predictions are not inherently more prone to accuse, they more willingly follow predictions that suggest accusation than those who receive such predictions without actively seeking them.

Bidirectional link between periodontitis and systemic inflammation in diabetic retinopathy.

Periodontitis is independently associated with numerous lifestyle diseases. Diabetic patients have approximately threefold increased odds of periodontitis, which in turn increases the risk of systemic inflammation. The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic re-tinopathy (DR) and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR. To further advance the study, we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR, larger sample size and improved sampling methodology, matching of baseline characteristics of the two groups, as well as improved statistical approach and interpretation of the study findings. Measurement of hemoglobin A1c (HbA1c) in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.

Causal Inference in Oncology: Why, What, How and When.

Oncologists are faced with choosing the best treatment for each patient, based on the available evidence from randomized controlled trials (RCTs) and observational studies. RCTs provide estimates of the average effects of treatments on groups of patients, but they may not apply in many real-world scenarios where for example patients have different characteristics than the RCT participants, or where different treatment variants are considered. Causal inference defines what a treatment effect is and how it may be estimated with RCTs or outside of RCTs with observational - or 'real-world' - data. In this review, we introduce the field of causal inference, explain what a treatment effect is and what important challenges are with treatment effect estimation with observational data. We then provide a framework for conducting causal inference studies and describe when in oncology causal inference from observational data may be particularly valuable. Recognizing the strengths and limitations of both RCTs and observational causal inference provides a way for more informed and individualized treatment decision-making in oncology.

A Cross-Sectional Study Evaluating the Basic Course in Biomedical Research Among Medical Postgraduates and Teachers.

Introduction and methodology This study aims to give feedback on the Basic Course in Biomedical Research (BCBR) program, an initiative of the National Medical Council (NMC) in collaboration with the National Institute of Epidemiology (ICMR-NIE) using the SWAYAM ("Study Webs of Active-Learning for Young Aspiring Minds") portal. The objectives of the study areto evaluate the usefulness of BCBR and the content and conduct of the BCBR program using a questionnaire among medical postgraduates and teachers. The study design used was a cross-sectional study and collected data from 392 participants who completed the BCBR program. A validated questionnaire was utilized to gather information on participant demographics, reasons for enrolment, satisfaction with course material, assignments, technical issues during exams, and perceived usefulness of the course. Results The study found a predominance of postgraduate students among participants (65.31%), reflecting their inclination towards research. Primary reasons for enrolment included institutional requirements and eligibility criteria to appear for the final postgraduate examination. Most participants utilized both videos and lecture hand-outs. This course facilitated its participants to improve their ability to conduct research by 89.03%. Feedback suggested a need for improvement in course content, particularly in simplifying statistical concepts and incorporating more interactive sessions and practical demonstrations. Conclusion The findings highlight the effectiveness of the BCBR program to up-skill the ability of participants to perform research. Overall, the study offers valuable feedback about the BCBR course.

Competency development for pharmacy: adopting and adapting the FIP global advanced development framework.

Background: Pharmacy education shifts toward competency-based training to meet healthcare demands. This study aims to develop and validate the Kuwait Advanced Competency Framework (KACF) for pharmacists. The study adopts the FIP Global Advanced Development Framework (GADF) to develop a country-specific framework, emphasizing the importance of aligning with global standards while adapting to local contexts. The developed framework builds upon the Kuwait Foundation Competency Framework to address the need for advanced pharmacy services. Methods: This is a mixed methods study that employed an "adopt and adapt" approach. The KACF was adopted from the FIP GADF and adapted following four phases. Phase one involved checking and validating the Arabic version of the FIP GADF. Phase two employed a series of focus groups to validate accuracy and relevancy of competency statements. Phase three utilized a workshop with different stakeholders as a final step of validation. Phase four involved a national survey to assess the national pharmacy workforce against the framework competencies. Qualitative feedback from focus groups and workshops informed competencies modifications. Quantitative data were analyzed using descriptive and multiple correspondence analyses (MCA). Results: The translation phase verified a bilingual framework that could be utilized by pharmacists in Kuwait. The initial and final validation phases identified 20 behavioral statements (out of 22 in the original document) that are relevant to pharmacy practice in Kuwait. The national survey, comprising 169 respondents, validated the KACF's applicability, revealing variations in career stage progression across competency clusters. Findings highlighted associations between career stages and practice settings, offering insights for tailored workforce development strategies. Conclusion: The KACF emerges as a pivotal tool for advancing pharmacy services in Kuwait, aligning with global trends toward competency-based education. Findings underscored the necessity for context-specific approaches in advancing pharmacy practice, providing a comprehensive understanding of competency progression and readiness for advanced roles.

Factors Influencing Interest and Engagement in Biomedical Research Among Community Medicine Residents in India: A Descriptive Cross-Sectional Study.

Introduction Medical science must be based on sound and scientific evidence and requires continuous research. Engaging in research allows students and faculty to explore new frontiers, question existing paradigms, and discover innovative solutions to medical challenges. As a specialty, community medicine plays a pivotal role in addressing public health issues. However, the engagement of community medicine residents in biomedical research remains suboptimal, which may impede the generation of evidence-based practices tailored to the Indian context. This study was conducted to find the interest and engagement of community medicine residents, and factors influencing their interest in biomedical research. Methods An online survey was conducted among community medicine residents of Uttar Pradesh, from February to April 2024, using Google Forms having a semi-structured, pretested questionnaire. Results One hundred and ninety-six residents participated in the study, where females (52.6%; 103/196) outnumbered males (47.4%; 93/196). The majority of participants were third-year residents (40.8%). Most participants seemed interested in biomedical research (83.2%) and thought that Basic Course in Biomedical Research (BCBR) helps conduct research projects (75%). Around half had previous experience in research projects, with cross-sectional studies being the most common (75.9%) study design. Enhancing research skills and a desire to contribute to medical knowledge emerged as primary motivators. On the other hand, the lack of time due to being overburdened with academic and educational activities was seen as the most common barrier to conducting research. Conclusions The majority of participants were found interested in research activities. The opportunity to improve research skills, desire to serve the medical fraternity, and a positive impact on resumes were the leading motivating factors for conducting research. Difficulty in sparing time, little knowledge, and poor support from mentors were found as important barriers.

Introducing prediction intervals for sample means.

Researchers and practitioners are typically familiar with descriptive statistics and statistical inference. However, outside of regression techniques, little attention may be given to questions around prediction. In the current paper, we introduce prediction intervals using fundamental concepts that are learned in descriptive and inferential statistical training (i.e., sampling error, standard deviation). We walk through an example using simple hand calculations and reference a simple R package that can be used to calculate prediction intervals.

Barriers and Facilitators to Youth Decision-Making Involvement in Families Referred for Stem Cell Transplant.

Youth prefer to be involved in treatment decisions, yet youth participation is minimally present in decisions like stem cell transplant (SCT) that require frequent medications and social isolation to be successful in curing cancer and chronic illness. The purpose of our study is to identify the barriers and facilitators to youth decision-making involvement in the youth-parent interaction when referred for treatment with SCT. We report qualitative findings from our theory-driven mixed-methods study. We thematically analyzed our field notes of youth and parent observations and audio-recordings during SCT consultations and semi-structured interviews. Data were collected from 10 youth, 8 to 16 (median 12) years of age, and their parents (n = 20). Three themes emerged: (a) Reluctant unless motivated, (b) Uncertain but capable, and (c) Limited unless supported. Our findings emphasize the critical role parents may take in facilitating youth involvement in decisions.

The Role of Philosophical Tools in Nursing Research.

The objective of this article is to illustrate the importance of the role philosophy and its tools play in the designing and undertaking of nursing research and its importance to be understood by the practicing researcher to ensure the selected methodology and the tools used provide the framework for obtaining reliable and valid answers to their research questions. The article discusses the three major paradigms (Positivism, Interpretivism, and Pragmatism) which have characterized much of health-related research together with a set of essential and practical tools with no metaphysical assumptions that will hopefully provide an explicit framework and a nomenclature which can be applied as we proceed through the research process.

Beyond human-likeness: Socialness is more influential when attributing mental states to robots.

We sought to replicate and expand previous work showing that the more human-like a robot appears, the more willing people are to attribute mind-like capabilities and socially engage with it. Forty-two participants played games against a human, a humanoid robot, a mechanoid robot, and a computer algorithm while undergoing functional neuroimaging. We confirmed that the more human-like the agent, the more participants attributed a mind to them. However, exploratory analyses revealed that the perceived socialness of an agent appeared to be as, if not more, important for mind attribution. Our findings suggest top-down knowledge cues may be equally or possibly more influential than bottom-up stimulus cues when exploring mind attribution in non-human agents. While further work is now required to test this hypothesis directly, these preliminary findings hold important implications for robotic design and to understand and test the flexibility of human social cognition when people engage with artificial agents.

Determining an Appropriate Sample Size for Qualitative Interviews to Achieve True and Near Code Saturation: Secondary Analysis of Data.

BACKGROUND: In-depth interviews are a common method of qualitative data collection, providing rich data on individuals' perceptions and behaviors that would be challenging to collect with quantitative methods. Researchers typically need to decide on sample size a priori. Although studies have assessed when saturation has been achieved, there is no agreement on the minimum number of interviews needed to achieve saturation. To date, most research on saturation has been based on in-person data collection. During the COVID-19 pandemic, web-based data collection became increasingly common, as traditional in-person data collection was possible. Researchers continue to use web-based data collection methods post the COVID-19 emergency, making it important to assess whether findings around saturation differ for in-person versus web-based interviews. OBJECTIVE: We aimed to identify the number of web-based interviews needed to achieve true code saturation or near code saturation. METHODS: The analyses for this study were based on data from 5 Food and Drug Administration-funded studies conducted through web-based platforms with patients with underlying medical conditions or with health care providers who provide primary or specialty care to patients. We extracted code- and interview-specific data and examined the data summaries to determine when true saturation or near saturation was reached. RESULTS: The sample size used in the 5 studies ranged from 30 to 70 interviews. True saturation was reached after 91% to 100% (n=30-67) of planned interviews, whereas near saturation was reached after 33% to 60% (n=15-23) of planned interviews. Studies that relied heavily on deductive coding and studies that had a more structured interview guide reached both true saturation and near saturation sooner. We also examined the types of codes applied after near saturation had been reached. In 4 of the 5 studies, most of these codes represented previously established core concepts or themes. Codes representing newly identified concepts, other or miscellaneous responses (eg, "in general"), uncertainty or confusion (eg, "don't know"), or categorization for analysis (eg, correct as compared with incorrect) were less commonly applied after near saturation had been reached. CONCLUSIONS: This study provides support that near saturation may be a sufficient measure to target and that conducting additional interviews after that point may result in diminishing returns. Factors to consider in determining how many interviews to conduct include the structure and type of questions included in the interview guide, the coding structure, and the population under study. Studies with less structured interview guides, studies that rely heavily on inductive coding and analytic techniques, and studies that include populations that may be less knowledgeable about the topics discussed may require a larger sample size to reach an acceptable level of saturation. Our findings also build on previous studies looking at saturation for in-person data collection conducted at a small number of sites.

Pain cues override identity cues in baby cries.

Baby cries can convey both static information related to individual identity and dynamic information related to the baby's emotional and physiological state. How do these dimensions interact? Are they transmitted independently, or do they compete against one another? Here we show that the universal acoustic expression of pain in distress cries overrides individual differences at the expense of identity signaling. Our acoustic analysis show that pain cries, compared with discomfort cries, are characterized by a more unstable source, thus interfering with the production of identity cues. Machine learning analyses and psychoacoustic experiments reveal that while the baby's identity remains encoded in pain cries, it is considerably weaker than in discomfort cries. Our results are consistent with the prediction that the costs of failing to signal distress outweigh the cost of weakening cues to identity.