Designing the Australian Cancer Atlas: visualizing geostatistical model uncertainty for multiple audiences.

OBJECTIVE: The Australian Cancer Atlas (ACA) aims to provide small-area estimates of cancer incidence and survival in Australia to help identify and address geographical health disparities. We report on the 21-month user-centered design study to visualize the data, in particular, the visualization of the estimate uncertainty for multiple audiences. MATERIALS AND METHODS: The preliminary phases included a scoping study, literature review, and target audience focus groups. Several methods were used to reach the wide target audience. The design and development stage included digital prototyping in parallel with Bayesian model development. Feedback was sought from multiple workshops, audience focus groups, and regular meetings throughout with an expert external advisory group. RESULTS: The initial scoping identified 4 target audience groups: the general public, researchers, health practitioners, and policy makers. These target groups were consulted throughout the project to ensure the developed model and uncertainty visualizations were effective for communication. In this paper, we detail ACA features and design iterations, including the 3 complementary ways in which uncertainty is communicated: the wave plot, the v-plot, and color transparency. DISCUSSION: We reflect on the methods, design iterations, decision-making process, and document lessons learned for future atlases. CONCLUSION: The ACA has been hugely successful since launching in 2018. It has received over 62 000 individual users from over 100 countries and across all target audiences. It has been replicated in other countries and the second version of the ACA was launched in May 2024. This paper provides rich documentation for future projects.

Bridging gaps in traditional research training with iBiology Courses.

iBiology Courses provide trainees with just-in-time learning resources to become effective researchers. These courses can help scientists build core research skills, plan their research projects and careers, and learn from scientists with diverse backgrounds.

A scoping review of the impact of Food Policy Groups on local food systems in high-income countries.

This scoping review aimed to explore international evidence on the impact of Food Policy Groups (FPGs) on local food systems, in urban and rural regions of high-income countries. Peer-reviewed and grey literature were searched to identify thirty-one documents published between 2002 and 2022 providing evidence on the impact of FPGs. Activities spanned domains including increasing food equity (e.g. strengthening school meals programmes); increasing knowledge and/or demand for healthy food (e.g. food literacy programmes with children and adults); increasing food access (e.g. enhancing local food procurement); environmental sustainability (e.g. promoting low-waste food items on café menus); economic development (e.g. ensuring local businesses are not outperformed by large food distributors); and increasing food system resiliency (e.g. establishment of local produce schemes). Most FPGs reported conducting activities that positively influenced multiple food system domains and reported activities in urban areas, and to a lesser extent in rural areas. Our study highlighted a range of qualitative and quantitative evaluation strategies used to measure FPGs' impact on local food systems. Our recommendations focus on regular and systematic evaluation and research surrounding the impact of FPG activities, to build the evidence base of their impact. Ideally, evaluation would utilise comprehensive and established tools. We recommend exploring the establishment of FPGs across more regions of high-income countries, particularly rural areas, and forming partnerships between FPGs, local government and universities to maximise implementation and evaluation of activities.

Analysis of Clinical Outcomes After Robotic Hepatectomy Applying the Western-Model Southampton Laparoscopic Difficulty Scoring System. An Experience From a Tertiary US Hepatobiliary Center.

BACKGROUND: Identification of resections with high risk of intraoperative complications is critical in guiding case selection for minimally invasive liver surgery. Several Japanese and European difficulty scoring systems have been proposed for laparoscopic liver surgery. However, the applicability of these systems for robotic liver resections has not been fully investigated. This study considers the Southampton system and examines its validity when applied to robotic hepatectomies. METHODS: We undertook a retrospective review of 372 patients who underwent robotic hepatectomies for various indications between 2013 and 2022. Of these patients, 63 operations were classified as low risk, 91 as moderate risk, 198 as high risk and 20 as extremely high risk based on Southampton criteria. Patient outcomes were compared by utilizing an ANOVA of repeated measures. Data are presented as median (mean ± SD). RESULTS: The Southampton difficulty scoring system was a strong predictor of intraoperative variables including tumor size, operative duration, estimated blood loss (EBL), and incidence of major vs minor resection (all P < .0001). In contrast, the Southampton system was a weaker predictor of postoperative outcomes including 30-day mortality (P = .15), length of stay (P = .13), and readmissions within 30 days (P = .38). CONCLUSION: The Southampton difficulty scoring system is a valid system for classifying robotic liver resections and is a strong predictor of intraoperative outcomes. However, the system was found to be a weaker predictor of postoperative outcomes. This finding may suggest the need for proposal of a new difficulty scoring system for robotic hepatectomies.

Activational vs. organizational effects of sex steroids and their role in the evolution of reproductive behavior: Looking to foot-flagging frogs and beyond.

Sex steroids play an important role in regulation of the vertebrate reproductive phenotype. This is because sex steroids not only activate sexual behaviors that mediate copulation, courtship, and aggression, but they also help guide the development of neural and muscular systems that underlie these traits. Many biologists have therefore described the effects of sex steroid action on reproductive behavior as both "activational" and "organizational," respectively. Here, we focus on these phenomena from an evolutionary standpoint, highlighting that we know relatively little about the way that organizational effects evolve in the natural world to support the adaptation and diversification of reproductive behavior. We first review the evidence that such effects do in fact evolve to mediate the evolution of sexual behavior. We then introduce an emerging animal model - the foot-flagging frog, Staurois parvus - that will be useful to study how sex hormones shape neuromotor development necessary for sexual displays. The foot flag is nothing more than a waving display that males use to compete for access to female mates, and thus the neural circuits that control its production are likely laid down when limb control systems arise during the developmental transition from tadpole to frog. We provide data that highlights how sex steroids might organize foot-flagging behavior through its putative underlying mechanisms. Overall, we anticipate that future studies of foot-flagging frogs will open a powerful window from which to see how sex steroids influence the neuromotor systems to help germinate circuits that drive signaling behavior. In this way, our aim is to bring attention to the important frontier of endocrinological regulation of evolutionary developmental biology (endo-evo-devo) and its relationship to behavior.

The interactive reading task: Transformer-based automatic item generation.

Automatic item generation (AIG) has the potential to greatly expand the number of items for educational assessments, while simultaneously allowing for a more construct-driven approach to item development. However, the traditional item modeling approach in AIG is limited in scope to content areas that are relatively easy to model (such as math problems), and depends on highly skilled content experts to create each model. In this paper we describe the interactive reading task, a transformer-based deep language modeling approach for creating reading comprehension assessments. This approach allows a fully automated process for the creation of source passages together with a wide range of comprehension questions about the passages. The format of the questions allows automatic scoring of responses with high fidelity (e.g., selected response questions). We present the results of a large-scale pilot of the interactive reading task, with hundreds of passages and thousands of questions. These passages were administered as part of the practice test of the Duolingo English Test. Human review of the materials and psychometric analyses of test taker results demonstrate the feasibility of this approach for automatic creation of complex educational assessments.

Investigating Cognitive Load in Energy Network Control Rooms: Recommendations for Future Designs.

This study analyzed and explored the cognitive load of Australian energy market operators managing one of the longest inter-connected electrical networks in the world. Each operator uses a workstation with seven screens in an active control room environment, with a large coordination screen to show information and enable collaboration between different control centers. Cognitive load was assessed during both training scenarios and regular control room operations via the integration of subjective and physiological measures. Eye-tracking glasses were also used to analyze the operators gaze behavior. Our results indicate that different events (normal or unexpected), different participants for the same session, and different periods of one session all have varying degrees of cognitive load. The system design was observed to be inefficient in some situations and to have an adverse affect on cognitive load. In critical situations for instance, operator collaboration was high and the coordination screen was used heavily when collaborating between two control centers, yet integration with the system could be improved. Eye tracking data analysis showed that the layout of applications across the seven screens was not optimal for many tasks. Improved layout strategies, potential combination of applications, redesigning of certain applications, and linked views are all recommended for further exploration in addition to improved integration of procedures and linking alarms to visual cues.

Prevalence and prognostic impact of physical frailty in interstitial lung disease: A prospective cohort study.

BACKGROUND AND OBJECTIVE: Physical frailty is associated with increased mortality and hospitalizations in older adults. We describe the prevalence of physical frailty and its prognostic impact in patients with a spectrum of fibrotic interstitial lung disease (ILD). METHODS: Patients with fibrotic ILD at the McMaster University ILD programme were prospectively followed up from November 2015 to March 2020. Baseline data were used to classify patients as non-frail (score = 0), pre-frail (score = 1-2) or frail (score = 3-5) based on modified Fried physical frailty criteria. The association between physical frailty and mortality was assessed using time-to-event models, adjusted for age, sex, lung function and diagnosis using the ILD Gender-Age-Physiology (ILD-GAP) score. RESULTS: We included 463 patients (55% male, mean [SD] age 68 [11] years); 82 (18%) were non-frail, 258 (56%) pre-frail and 123 (26%) frail. The most common ILD diagnoses were idiopathic pulmonary fibrosis (n = 183, 40%) and connective tissue disease-associated-ILD (n = 79, 17%). Mean time since diagnosis was 2.7 ± 4.6 years. There were 56 deaths within the median follow-up of 1.71 (interquartile range [IQR] 1.24, 2.31) years. Both frail and pre-frail individuals had a higher risk of death compared to those categorized as non-frail at baseline (adjusted hazard ratio [aHR] 4.14, 95% CI 1.27-13.5 for pre-frail and aHR 4.41, 95% CI 1.29-15.1 for frail). CONCLUSION: Physical frailty is prevalent in patients with ILD and is independently associated with an increased risk of death. Assessment of physical frailty provides additional prognostic value to recognized risk scores such as the ILD-GAP score, and may present a modifiable target for intervention.

Ensemble model for estimating continental-scale patterns of human movement: a case study of Australia.

Understanding human movement patterns at local, national and international scales is critical in a range of fields, including transportation, logistics and epidemiology. Data on human movement is increasingly available, and when combined with statistical models, enables predictions of movement patterns across broad regions. Movement characteristics, however, strongly depend on the scale and type of movement captured for a given study. The models that have so far been proposed for human movement are best suited to specific spatial scales and types of movement. Selecting both the scale of data collection, and the appropriate model for the data remains a key challenge in predicting human movements. We used two different data sources on human movement in Australia, at different spatial scales, to train a range of statistical movement models and evaluate their ability to predict movement patterns for each data type and scale. Whilst the five commonly-used movement models we evaluated varied markedly between datasets in their predictive ability, we show that an ensemble modelling approach that combines the predictions of these models consistently outperformed all individual models against hold-out data.

Uplift: A Tangible and Immersive Tabletop System for Casual Collaborative Visual Analytics.

Collaborative visual analytics leverages social interaction to support data exploration and sensemaking. These processes are typically imagined as formalised, extended activities, between groups of dedicated experts, requiring expertise with sophisticated data analysis tools. However, there are many professional domains that benefit from support for short 'bursts' of data exploration between a subset of stakeholders with a diverse breadth of knowledge. Such 'casual collaborative' scenarios will require engaging features to draw users' attention, with intuitive, 'walk-up and use' interfaces. This paper presents Uplift, a novel prototype system to support 'casual collaborative visual analytics' for a campus microgrid, co-designed with local stakeholders. An elicitation workshop with key members of the building management team revealed relevant knowledge is distributed among multiple experts in their team, each using bespoke analysis tools. Uplift combines an engaging 3D model on a central tabletop display with intuitive tangible interaction, as well as augmented-reality, mid-air data visualisation, in order to support casual collaborative visual analytics for this complex domain. Evaluations with expert stakeholders from the building management and energy domains were conducted during and following our prototype development and indicate that Uplift is successful as an engaging backdrop for casual collaboration. Experts see high potential in such a system to bring together diverse knowledge holders and reveal complex interactions between structural, operational, and financial aspects of their domain. Such systems have further potential in other domains that require collaborative discussion or demonstration of models, forecasts, or cost-benefit analyses to high-level stakeholders.

Tilt Map: Interactive Transitions Between Choropleth Map, Prism Map and Bar Chart in Immersive Environments.

We introduce Tilt Map, a novel interaction technique for intuitively transitioning between 2D and 3D map visualisations in immersive environments. Our focus is visualising data associated with areal features on maps, for example, population density by state. Tilt Map transitions from 2D choropleth maps to 3D prism maps to 2D bar charts to overcome the limitations of each. Our article includes two user studies. The first study compares subjects' task performance interpreting population density data using 2D choropleth maps and 3D prism maps in virtual reality (VR). We observed greater task accuracy with prism maps, but faster response times with choropleth maps. The complementarity of these views inspired our hybrid Tilt Map design. Our second study compares Tilt Map to: a side-by-side arrangement of the various views; and interactive toggling between views. The results indicate benefits for Tilt Map in user preference; and accuracy (versus side-by-side) and time (versus toggle).

The Access to Literacy Assessment System for Phonological Awareness: An Adaptive Measure of Phonological Awareness Appropriate for Children With Speech and/or Language Impairment.

Purpose The Access to Literacy Assessment System-Phonological Awareness (ATLAS-PA) was developed for use with children with speech and/or language impairment. The subtests (Rhyming, Blending, and Segmenting) are appropriate for children who are 3-7 years of age. ATLAS-PA is composed entirely of receptive items, incorporates individualized levels of instruction, and is adaptive in nature. Method To establish the construct validity of ATLAS-PA, we collected data from children with typical development (n = 938) and those who have speech and/or language impairment (n = 227). Results Rasch analyses indicated that items fit well together and formed a unidimensional construct of phonological awareness. Differential item functioning was minimal between the two groups of children, and scores on ATLAS-PA were moderately to strongly related to other measures of phonological awareness. Information about item functioning was used to create an adaptive version of ATLAS-PA. Conclusions Findings suggest that ATLAS-PA is a valid measure of phonological awareness that can be used with children with typical development and with speech and/or language impairment. Its adaptive format minimizes testing time and provides opportunities for monitoring progress in preschool and early elementary classrooms. Supplemental Material https://doi.org/10.23641/asha.12931691.

Where Should Critically Ill Adolescents Receive Care? A Qualitative Interview-Based Study of Perspectives of Staff Working in Adult and Pediatric Intensive Care Units.

PURPOSE: In the United Kingdom, critically ill adolescents are treated in either adult or pediatric intensive care units (AICUs or PICUs). This study explores staff perspectives on where and how best to care for this distinct group. MATERIALS AND METHODS: Semistructured interviews were conducted with 12 members of staff (3 medical, 6 nursing, and 3 allied health professionals) working in 4 ICUs; 2 general hospital AICUs and 2 tertiary centre-based PICUs in England. Interviews were audio-recorded, transcribed, and analyzed using framework analysis. FINDINGS: One overarching theme was identified, reflecting staff understanding of the term "adolescent," and this was linked to 2 further themes, each of which had several subthemes. "Needs of the critically ill adolescent" included medical needs, dignity and privacy, issues around consent, and the impact of intensive care admission. "Implications for staff" included managing parental presence and lack of familiarity, and emotional impact, of dealing with this patient group. Some of these factors are currently better accommodated in adult settings. CONCLUSIONS: Decision-making about the place of care should take into account the individual circumstances of the patient (e.g., nature of their medical condition and previous experiences, maturity, family preference) and not be based only on age at admission. We should work across disciplines to ensure we can discover, and consistently deliver, best practice to meet the needs of critically ill adolescents.

Early acid/base and electrolyte changes in permanent middle cerebral artery occlusion: Aged male and female rats.

BACKGROUND: Early changes in acid/base and electrolyte concentrations could provide insights into the development of neuropathology at the onset of stroke. We evaluated associations between acid/base and electrolyte concentrations, and outcomes in permanent middle cerebral artery occlusion (pMCAO) model. METHODS: 18-month-old male and female Sprague-Dawley rats underwent pMCAO. Pre-, post- (7 min after occlusion), and at 72 hr of pMCAO venous blood samples provided pH, carbon dioxide, oxygen, glucose, hematocrit, hemoglobin, and electrolyte values of ionized calcium, potassium, and sodium. Multiple linear regression determined predictors of infarct and edema volumes from these values, Kaplan-Meier curve analyzed morality between males and females at 72 hr, and a Cox regression model was used to determine predictors for mortality. RESULTS: Analysis indicated significant differences in acid/base balance and electrolyte levels in aged rats not dependent on sex between the three time points in the pMCAO model. Changes in pH (from pre- to post and post- to 72 hr) and changes in sodium and ionized calcium (from post- to 72 hr) were predictors of infarct volume and edema volume, respectively. Cox Regression revealed there is a 3.25 times increased risk for mortality based on changes in bicarbonate (pre- to post-MCAO). CONCLUSIONS: These early venous blood changes in acid/base balance and electrolytes can be used to predict stroke outcomes in our rat model of stroke. This study provides potential biomarkers to be examined in the human condition that could provide profound prognostic tools for stroke patients.

A safety lancet for neonatal blood spot tests: a design that facilitates pain-free, atraumatic samples.

Safety lancets are used to collect capillary blood samples to test if neonates have rare but serious congenital conditions, such as sickle cell disease, cystic fibrosis, congenital hypothyroidism and inherited metabolic diseases. Blood samples are taken from the heel, but the procedure can cause the neonate pain or discomfort, as well as a risk of local trauma to the nerves and blood vessels, bleeding, infection and scarring. This article explores the need for blood sampling in neonates, discusses the procedure and outlines the types of lancets available. It describes the Neoheel Safety Lancet (Smiths Medical), whose features are designed to avoid pain and trauma during the procedure. Three case studies are included to describe its use in clinical practice.

A cross-sectional evaluation of the idiopathic pulmonary fibrosis patient satisfaction and quality of life with a care coordinator.

BACKGROUND: Canadian and international guidelines recommend specialized, multidisciplinary teams for the treatment of patients with idiopathic pulmonary fibrosis (IPF). The objective of this cross-sectional clinical study was to investigate the effect of a care coordinator on IPF patient satisfaction and quality of life. METHODS: Forty IPF patients were enrolled from the practices of two physicians (n=20/physician), with either low (LCU) or high-coordinator use (HCU). Patient satisfaction was measured with modified FAMCARE and IPF Care UK Patient Support Program (UK-CARE) surveys. Health related quality of life (HRQoL) was assessed with the living with IPF impacts (L-IPFi) survey. An economic model assessed the impact of the coordinator; staff surveys informed patient management requirements, and costs were derived from published literature. RESULTS: Patient satisfaction was similar between the clinics; a trend (P=0.1) towards increased satisfaction among HCU patients was observed. Patients in the HCU clinic reported increased satisfaction (P<0.05) with their current care compared with care prior to joining the tertiary-care clinic, while LCU patients did not. IPF patient HRQoL did not differ between clinics. The coordinator was estimated to alleviate approximately 30% of a physician's IPF-related work load, and to facilitate the care of more patients per physician. Modelled estimates suggest the coordinator lead to annual cost-savings of $137,212. CONCLUSIONS: Reliance upon a coordinator during routine management of IPF patients may improve patient satisfaction, spare physician time and lead to annual cost-savings. Future studies should examine the impact of a coordinator on healthcare resource utilization.

Efficacy of leukemia inhibitory factor as a therapeutic for permanent large vessel stroke differs among aged male and female rats.

Preclinical studies using rodent models of stroke have had difficulty in translating their results to human patients. One possible factor behind this inability is the lack of studies utilizing aged rodents of both sexes. Previously, this lab showed that leukemia inhibitory factor (LIF) promoted recovery after stroke through antioxidant enzyme upregulation. This study examined whether LIF promotes neuroprotection in aged rats of both sexes. LIF did not reduce tissue damage in aged animals, but LIF-treated female rats showed partial motor skill recovery. The LIF receptor (LIFR) showed membrane localization in young male and aged rats of both sexes after stroke. Although LIF increased neuronal LIFR expression in vitro, it did not increase LIFR in the aged brain. Levels of LIFR protein in brain tissue were significantly downregulated between young males and aged males/females at 72 h after stroke. These results demonstrated that low LIFR expression reduces the neuroprotective efficacy of LIF in aged rodents of both sexes. Furthermore, the ability of LIF to promote motor improvement is dependent upon sex in aged rodents.

Characteristics of adolescents requiring intensive care in the United Kingdom: A retrospective cohort study.

OBJECTIVES: To describe the case mix, resource use and outcomes for adolescents admitted to intensive care units in the UK. METHODS: Analysis of national prospectively collected data for all adolescents aged 12-19 years admitted to UK adult or paediatric intensive care units. RESULTS: There were 37,320 admissions of adolescents during the eight-year study period. Excluding elective surgery, respiratory diagnoses were the most common reason for paediatric intensive care unit (PICU) admission, with trauma and intoxication the most common reasons for adult intensive care unit (AICU) admission. Intensive care unit mortality was 6.0% and 5.7% for those admitted to PICUs and AICUs, respectively. CONCLUSIONS: Mortality is similar among adolescents admitted to AICUs and PICUs; however, these rates have not been corrected for severity of acute illness or underlying burden of chronic illness, which may be different between AICUs and PICUs. Services planned for the majority of AICU and PICU patients may not be optimal for critically ill adolescents treated in UK intensive care units, who may need special consideration.

A Framework for Creative Visualization-Opportunities Workshops.

Applied visualization researchers often work closely with domain collaborators to explore new and useful applications of visualization. The early stages of collaborations are typically time consuming for all stakeholders as researchers piece together an understanding of domain challenges from disparate discussions and meetings. A number of recent projects, however, report on the use of creative visualization-opportunities (CVO) workshops to accelerate the early stages of applied work, eliciting a wealth of requirements in a few days of focused work. Yet, there is no established guidance for how to use such workshops effectively. In this paper, we present the results of a 2-year collaboration in which we analyzed the use of 17 workshops in 10 visualization contexts. Its primary contribution is a framework for CVO workshops that: 1) identifies a process model for using workshops; 2) describes a structure of what happens within effective workshops; 3) recommends 25 actionable guidelines for future workshops; and 4) presents an example workshop and workshop methods. The creation of this framework exemplifies the use of critical reflection to learn about visualization in practice from diverse studies and experience.

Eliciting the experiences of the adolescent-parent dyad following critical care admission: a pilot study.

Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14-17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis. CONCLUSION: The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents' awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children. • The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions. • The significance of these depended on adolescents' awareness of their surroundings, which was often limited and changed over the course of their illness.