Review of susceptibility genes in developmental dysplasia of the hip: A comprehensive examination of candidate genes and pathways.

Developmental dysplasia of the hip (DDH) is one of the most prevalent skeletal deformities, primarily due to the incompatibility between the acetabulum and femoral head. It includes complete dislocation, partial dislocation, instability with femoral head subluxation, and a range of imaging abnormalities that reflect inadequate acetabular formation. Known risk factors for DDH include positive family history, sex, premature birth, non-cephalic delivery, oligohydramnios, gestational diabetes mellitus, maternal hypertension, associated anomalies, swaddling clothes, intrauterine space restriction, and post-term pregnancy. Various research designs have been employed in DDH studies to identify relevant genes, including candidate gene association studies (CGAS), genome-wide association studies (GWAS), restriction fragment length polymorphism (RFLP), and whole exome sequencing (WES). To date, multiple DDH-associated genes have been identified in various populations. Despite extensive research into the epidemiology, risk factors, and genes associated with DDH, its pathogenesis remains unclear. This study provides a comprehensive summary of DDH research designs and evidence for relevant gene mutations through a PubMed search.

Sports Medicine Research Practices for Categorizing Transgender and/or Intersex Participants.

CONTEXT: Approximately 1 to 1.4 million individuals (0.58% of the population) in the United States identify as transgender, yet no literature could be found regarding how researchers should adapt clinical research studies when intersex or transgender individuals volunteer as participants. Therefore, the objective was to determine if there is a consensus among recently published researchers in 3 athletic training and sports medicine journals regarding procedures used to categorize participants and data of transgender or intersex individuals in a research study. METHODS: The authors developed a 14-item survey using Qualtrics XM to assess how researchers categorize individuals and their data when intersex or transgender individuals volunteer to participate in clinical research studies that are not intended to focus on intersex or transgender individuals. The survey was sent to 378 individuals in athletic training and related fields who recently published research manuscripts from 2018 to 2020 in one or more of 3 leading journals in the field including the Journal of Athletic Training, the Journal of Sport Rehabilitation, and the Athletic Training and Sports Health Care Journal. RESULTS: A total of 82 respondents completed the survey, yielding a response rate of 21.69%. When categorizing research participants who were not using hormones or surgery to transition, several respondents were unsure how to categorize transgender individuals (n = 14, 17.1%) or intersex individuals (n = 35, 42.7%). If the research participant was using hormones and/or surgery to transition, many respondents were unsure how to categorize the sex of the individual (n = 27, 32.9%). Only 5 (6.1%) respondents indicated that their organization has policies that guide their inclusion of transgender and/or intersex individuals in research studies. CONCLUSIONS: There does not appear to be consensus among researchers who recently published in athletic training and sports medicine journals regarding how to categorize transgender and intersex individuals who volunteer to participate in research studies.

A Systematic Review of External Validity in Pediatric Integrated Primary Care Trials.

OBJECTIVE: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. METHODS: We searched Medline, CINAHL, PsycINFO, the Cochrane Center Register of Controlled Trials, and relevant literature to identify publications from 1998 to 2018 reporting on open, randomized, or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. For each publication, we extracted the information reported in each RE-AIM domain and calculated the proportion of the total studies reviewed. RESULTS: Thirty-nine publications describing 25 studies were included in the review. Publications rarely reported some indicators of external validity, including the representativeness of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies reported on key pragmatic factors such as cost or organizational change processes related to implementation and maintenance. Strengths of some studies included comparisons of multiple active treatments, use of tailorable interventions, and implementation in "real world" settings. CONCLUSIONS: Although IPC interventions appear efficacious under research conditions, there are significant knowledge gaps regarding the degree to which they reach and engage target recipients, what factors impact adoption and implementation of IPC interventions by clinicians, how fidelity can be maintained over time, and cost-effectiveness. Pediatric IPC researchers should embrace dissemination and implementation science methods to balance internal and external validity concerns moving forward.

Data integration using the building technique in mixed-methods instrument development: Methodological discussion.

AIMS: To discuss and illustrate how meaningful integration can be achieved in instrument development design. DESIGN: Discussion paper. DATA SOURCES: A mixed-methods study about challenges of nurse educators in Pakistan. The building technique was implemented when the findings of the qualitative phase were integrated to develop an instrument to determine educators' challenges while teaching nursing students in academic and clinical settings. IMPLICATIONS FOR NURSING: Nurses are required to use cultural- and population-specific instruments for data collection. The six-step building approach can enable nurses to develop such instruments using rigorous and robust mixed-methods design. CONCLUSION: Building and merging techniques are used in instrument development design during and after the completion of the study, respectively. However, building technique is essential for using the qualitative findings to develop the instrument. The proposed building approach starts with a robust qualitative data analysis and is strengthened with the selection of key themes and subthemes, linking them to the participants' quotes and then the conversion of the quotes into meaningful and pertinent items. Using the proposed building integration technique can enable researchers to meaningfully and efficiently use qualitative findings for developing instruments using mixed-methods designs. IMPACT: Mixed methods are valuable for the development of data collection instruments that are tailored to the study context and relevant for the study participants. There is limited guidance about how meaningful integration can be achieved when developing research instruments using mixed methods. We proposed a practical building technique that allows researchers to meaningfully use qualitative findings from one phase to develop an instrument for the subsequent phase. The proposed approach is useful for researchers aiming to develop data collection instruments using mixed methods.

Mode and Intensity of Physical Activity During the Postacute Phase of Sport-Related Concussion: A Systematic Review.

INTRODUCTION: Sports-related concussions (SRCs) have received attention due to their prevalence in youth. An SRC results from a strong force causing neurological impairment. Recent research has recommended rehabilitation within the first week post-SRC after 24 to 48 hours of rest. The postacute phase is defined as 48 hours to 7 days post-SRC. It is imperative to evaluate the most effective mode and intensity of physical activity to reduce symptoms and improve outcomes. METHODS: CINAHL, PubMed, SPORTDiscus, and Web of Science databases were used to search the terms "brain concussion" AND "exercise" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. The methodological rigor of each study was evaluated using a scale adapted from Medlicott and Harris. RESULTS: Two thousand sixty-eight records were identified. Six studies were included in this systematic review. Three studies were classified as moderately strong. The remaining 3 studies were considered weak. Five of the studies used either a cycle ergometer or a treadmill. The sixth study used walking, cycling, and swimming, as well as sports drills. All of these modes of exercise were determined to be safe. All studies utilized low- and moderate-intensity interventions, which were found to be nondetrimental and showed improved recovery time and symptom resolution. Five of the studies also incorporated components of high-intensity exercise that was also found to be nondetrimental, and they showed a positive influence on recovery time and symptom resolution. However, all activity in each of the reviewed studies started at a low level and progressed up to a higher level only as each individual client's symptoms permitted. DISCUSSION: Overall, this review found that various modes of activity at light-, moderate-, and high-intensity levels are efficacious and can be safely used during the postacute phase of SRC. CONCLUSION: Though the volume of literature at this time is limited, therapists should consider prescribing closely monitored individualized exercise programs utilizing progressive intensities when treating patients during the postacute phase of SRC.

Reliability of a Novel Semiautomated Ultrasound Segmentation Technique for Assessing Average Regional Femoral Articular Cartilage Thickness.

CONTEXT: Ultrasound imaging is a clinically feasible tool to assess femoral articular cartilage and may have utility in tracking early knee osteoarthritis development. Traditional assessment techniques focus on measurements at a single location, which can be challenging to adopt for novice raters. OBJECTIVE: To introduce a novel semiautomated ultrasound segmentation technique and determine the intrarater and interrater reliability of average regional femoral articular cartilage thickness and echo intensity of a novice and expert rater. DESIGN: Descriptive observational study. SETTING: Orthopedic clinic. PATIENTS OR OTHER PARTICIPANTS: Fifteen participants (mean [SD]; age 23.5 [4.6] y, height = 172.6 [9.3] cm, mass = 79.8 [15.7] kg) with a unilateral history of anterior cruciate ligament reconstruction participated. INTERVENTION: None. MAIN OUTCOME MEASURES: One rater captured anterior femoral cartilage images of the participants' contralateral knees using a transverse suprapatellar ultrasound assessment. The total femoral cartilage cross-sectional area of each image was segmented by a novice and expert rater. A novel custom program automatically separated the cartilage segmentations into medial, lateral, and intercondylar regions to determine the cross-sectional area and cartilage length. The average cartilage thickness in each region was calculated by dividing the cross-sectional area by the cartilage length. Echo intensity was calculated as the average gray-scale pixel value of each region. Two-way random effect intraclass correlations coefficient (ICC) for absolute agreement were used to determine the interrater reliability between a novice and expert rater, as well as the intrarater reliability of the novice rater. RESULTS: The novice rater demonstrated excellent intrarater (ICC [2,k] range = .993-.997) and interrater (ICC [2,k] range = .944-.991) reliability with the expert rater of all femoral articular cartilage average thickness and echo intensity regions. CONCLUSIONS: The novel semiautomated average cartilage thickness and echo-intensity assessment is efficient, systematic, and reliable between an expert and novice rater with minimal training.

Practical mixed methods strategies used to integrate qualitative and quantitative methods in community-based primary health care research.

BACKGROUND: Mixed methods (MM) are common in community-based primary health care (CBPHC) research studies. Several strategies have been proposed to integrate qualitative and quantitative components in MM, but they are seldom well conceptualized and described. The purpose of the present review was to identify and describe practical MM strategies and combinations of strategies used to integrate qualitative and quantitative methods in CBPHC research. METHODS: A methodological review with qualitative synthesis (grouping) was performed. Records published in English in 2015 were retrieved from the Scopus bibliographic database. Eligibility criteria were: CBPHC empirical study, MM research with detailed description of qualitative and quantitative methods and their integration. Data were extracted from included studies and grouped using a conceptual framework comprised of three theoretical types of MM integration, the seven combinations of these types and nine practical strategies (three per type of integration) and multiple combinations of strategies. RESULTS: Among the 151 articles reporting CBPHC and MM studies retrieved, 54 (35.7%) met the inclusion criteria for this review. The included studies provided examples of the three theoretical types of MM integration, the seven combinations of these types as well as the nine practical strategies. Overall, 15 combinations of these strategies were observed. No emerging strategy was observed that was not predicted by the conceptual framework. CONCLUSIONS: This review can provide guidance to CBPHC researchers for planning, conducting and reporting practical strategies and combinations of strategies used for integrating qualitative and quantitative methods in MM research.

Understanding Research Study Designs.

In this article, we will look at the important features of various types of research study designs used commonly in biomedical research. HOW TO CITE THIS ARTICLE: Ranganathan P. Understanding Research Study Designs. Indian J Crit Care Med 2019;23(Suppl 4):S305-S307.

Studying Stepfamilies: Four Eras of Family Scholarship.

Historically, there have always been stepfamilies, but until the early 1970s, they remained largely unnoticed by social scientists. Research interest in stepfamilies followed shortly after divorce became the primary precursor to stepfamily formation. Because stepfamilies are structurally diverse and much more complex than nuclear families, they have created considerable challenges for both researchers and clinicians. This article examines four eras of stepfamily scholarship, tracing the development of research questions, study designs and methods, and conceptual frameworks from the mid-1970s to the present and drawing implications for the current state of the field.

Palliative Care Research--A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012.

BACKGROUND: In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci. METHODS: A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'. RESULTS: A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age. CONCLUSIONS: The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes.

A SMART design to optimize treatment strategies for patient and family caregiver outcomes.

Sequential multiple randomization trial (SMART) designs are experimental designs used to identify treatment strategies that maximize targeted health outcomes. SMART designs are receiving greater attention in nursing and other health disciplines to develop multicomponent interventions that are tailored to the patient's (or family caregiver's) needs and preferences. A SMART design resembles a traditional randomized controlled trial (RCT) design in that it scientifically examines intervention effects with randomization. However, the two designs address very different research inquiries. In this article, we compare traditional RCT designs and SMART designs, describe the adaptive treatment framework that underlies SMART designs and key features of SMART designs, and illustrate the application of a SMART design to develop an adaptive palliative care treatment to improve patient and caregiver outcomes.

Designs for Evaluating the Community-Level Impact of Comprehensive Prevention Programs: Examples from the CDC Centers of Excellence in Youth Violence Prevention.

This article discusses the opportunities and challenges of developing research designs to evaluate the impact of community-level prevention efforts. To illustrate examples of evaluation designs, we describe six projects funded by the Centers for Disease Control and Prevention to evaluate multifaceted approaches to reduce youth violence in high-risk communities. Each of these projects was designed to evaluate the community-level impact of multiple intervention strategies to address individual and contextual factors that place youth at risk for violent behavior. Communities differed across projects in their setting, size, and how their boundaries were defined. Each project is using multiple approaches to compare outcomes in one or more intervention communities to those in comparison communities. Five of the projects are using comparative interrupted time-series designs to compare outcomes in an intervention community to matched comparison communities. A sixth project is using a multiple baseline design in which the order and timing of intervention activities is randomized across three communities. All six projects are also using regression point displacement designs to compare outcomes within intervention communities to those within broader sets of similar communities. Projects are using a variety of approaches to assess outcomes including archival records, surveys, and direct observations. We discuss the strengths and weaknesses of the designs of these projects and illustrate the challenges of designing high-quality evaluations of comprehensive prevention approaches implemented at the community level.

Conducting Nursing Research to Advance and Inform Health Policy.

The primary roles of nurse scientists in conducting health policy research are to increase knowledge in the discipline and provide evidence for informing and advancing health policies with the goal of improving the health outcomes of society. Health policy research informs, characterizes, explains, or tests hypotheses by employing a variety of research designs. Health policy research focuses on improving the access to care, the quality and cost of care, and the efficiency with which care is delivered. In this article, we explain how nurses might envision their research in a policy process framework, describe research designs that nurse researchers might use to inform and advance health policies, and provide examples of research conducted by nurse researchers to explicate key concepts in the policy process framework. Health policies are well informed and advanced when nurse researchers have a good understanding of the political process. The policy process framework provides a context for improving the focus and design of research and better explicating the connection between research evidence and policy. Nurses should focus their research on addressing problems of importance that are on the healthcare agenda, work with interdisciplinary teams of researchers, synthesize, and widely disseminate results.

Investigation of Two Preliminary Analysis-Altering Elements: Ordinate Scaling and DPPXYR.

The purpose of this pre-registered study (Peltier & McKenna) was to conceptually replicate if the truncation of the ordinate and DPPXYR increased analysts' estimation of a functional relation and magnitude of treatment effect. Visual analysts (n = 27) evaluated eight data sets reporting null (n = 2), small (n = 2), moderate (n = 2), and large (n = 2) effects. Each data set was graphed six times with manipulations of the ordinate and DPPXYR, resulting in 48 ABAB graphs. We estimated two separate three-level mixed effect models with variations nested in datasets and nested in participants to evaluate the impact of graph characteristics for (1) confidence in determining a functional relation and (2) the estimated magnitude of the treatment effect. We included ordinate scaling and DPPXYR at level 1 and graph effect size at level 2, including all interactions. Overall, graph manipulation consistently did not impact confidence in a functional relation. Results suggest mixed findings for graph manipulation on the estimated magnitude of the treatment effect. Findings will be couched in current literature and recommendations for graph construction and future research will be discussed.

The latest developments with internet-based psychological treatments for depression.

INTRODUCTION: Internet-based psychological treatments for depression have been around for more than 20 years. There has been a continuous line of research with new research questions being asked and studies conducted. AREAS COVERED: In this paper, the author reviews studies with a focus on papers published from 2020 and onwards based on a Medline and Scopus search. Internet-based cognitive behavior therapy (ICBT) programs have been developed and tested for adolescents, older adults, immigrant groups and to handle a societal crisis (e.g. COVID-19). ICBT works in regular clinical settings and long-term effects can be obtained. Studies on different treatment orientations and approaches such as acceptance commitment therapy, unified protocol, and tailored treatments have been conducted. Effects on quality-of-life measures, knowledge acquisition and ecological momentary assessment as a research tool have been reported. Factorial design trials and individual patient data meta-analysis are increasingly used in association with internet intervention research. Finally, prediction studies and recent advances in artificial intelligence are mentioned. EXPERT OPINION: Internet-delivered treatments are effective, in particular if therapist guidance is provided. More target groups have been covered but there are many remaining challenges including how new tools like artificial intelligence will be used when treating depression.

Are Currently Selected Laboratory Animals Useful in the Research of How Female Hormones Influence Orthodontic Biomechanics?

Animal testing was and remains the only method of introducing a certain treatment and medical procedure on humans. On the other hand, animals have their rights resulting from applicable legal acts, including Directive 2010/63/EU and, indirectly, the World Medical Association International Code of Medical Ethics (Helsinki Declaration, 1975, amended 2000). Thus, the question arises whether the credibility of the results of hormonal and orthodontic tests obtained so far and their usefulness for the human population is scientifically justified and worth sacrificing laboratory animals for. Especially that, according to statistical data, about 50% of laboratory animals are euthanized at the conclusion of the experiments. The aim of this article was to determine whether animal experiments are scientifically or morally justified in bringing significant evidence in studies that may validate the influence of changes in the concentration of female hormones secreted by the ovaries in various phases of the menstrual cycle in young patients on the duration of an increased tooth movement rate in orthodontic treatment. Papers reporting the results of the original research into female hormones, either natural or exogeneous ones, likely to alternate the orthodontic tooth movement rate were critically evaluated in terms of animal selection. Thorough analysis supported by veterinary knowledge proved that none of the publications enabled an extrapolation of the results to humans. The evaluation of the relation between the rate of tooth movement upon loading with orthodontic forces and hormones either secreted during the menstrual cycle of women or released from the contraceptives already present in the market, does not require sacrificing laboratory animals.

Single-case intervention research design standards: Additional proposed upgrades and future directions.

Single-case intervention research design standards have evolved considerably over the past decade. These standards serve the dual role of assisting in single-case design (SCD) intervention research methodology and as guidelines for literature syntheses within a particular research domain. In a recent article (Kratochwill et al., 2021), we argued for a need to clarify key features of these standards. In this article we offer additional recommendations for SCD research and synthesis standards that have been either underdeveloped or missing in the conduct of research and in literature syntheses. Our recommendations are organized into three categories: expanding design standards, expanding evidence standards, and expanding the applications and consistency of SCDs. The recommendations we advance are for consideration for future standards, research design training, and they are especially important to guide the reporting of SCD intervention investigations as they enter the literature-synthesis phase of evidence-based practice initiatives.

Clinical Research: A Review of Study Designs, Hypotheses, Errors, Sampling Types, Ethics, and Informed Consent.

Recently, we have been noticing an increase in the emergence and re-emergence of microbial infectious diseases. In the previous 100 years, there were several incidences of pandemics caused by different microbial species like the influenza virus, human immunodeficiency virus (HIV), dengue virus, severe acute respiratory syndrome Coronavirus (SARS-CoV), middle east respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 that were responsible for severe morbidity and mortality among humans. Moreover, non-communicable diseases, including malignancies, diabetes, heart, liver, kidney, and lung diseases, have been on the rise. The medical fraternity, people, and governments all need to improve their preparedness to effectively tackle health emergencies. Clinical research, therefore, assumes increased significance in the current world and may potentially be applied to manage human health-related problems. In the current review, we describe the critical aspects of clinical research that include research designs, types of study hypotheses, errors, types of sampling, ethical concerns, and informed consent.