Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory.

BACKGROUND: To explore the benefits, barriers and disadvantages of implementing an electronic record system (ERS). The extent that the system has become 'normalised' into routine practice was also explored. METHODS: Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives of different grades, health care assistants) and wards within a maternity unit at a NHS teaching hospital. Interviews were conducted during the first year of the phased implementation of ERS and were analysed thematically. The four mechanisms of Normalisation Process Theory (NPT) (coherence, cognitive participation, collective action and reflexive monitoring) were adapted for use within the study and provided a theoretical framework to interpret the study's findings. RESULTS: Coherence (participants' understanding of why the ERS has been implemented) was mixed - whilst those involved in ERS implementation anticipated advantages such as improved access to information; the majority were unclear why the ERS was introduced. Participants' willingness to engage with and invest time into the ERS (cognitive participation) depended on the amount of training and support they received and their willingness to change from paper to electronic records. Collective action (the extent the ERS was used) may be influenced by whether participants perceived there to be benefits associated with the system. Whilst some individuals reported benefits such as improved legibility of records, others felt benefits were yet to emerge. The parallel use of paper and the lack of integration of electronic systems within and between the trust and other healthcare organisations hindered ERS use. When appraising the ERS (reflexive monitoring) participants perceived the system to negatively impact the patient-clinician relationship, time and patient safety. CONCLUSIONS: Despite expectations that the ERS would have a number of advantages, its implementation was perceived to have a range of disadvantages and only a limited number of 'clinical benefits'. The study highlights the complexity of implementing electronic systems and the associated longevity before they can become 'embedded' into routine practice. Through the identification of barriers to the employment of electronic systems this process could be streamlined with the avoidance of any potential detriment to clinical services.

Gene methylation and early detection of genitourinary cancer: the road ahead.

DNA methylation is a common mechanism of inactivation of tumour-suppressor and other cancer genes in neoplastic cells. The advantages of gene methylation as a target for the detection and diagnosis of cancer in biopsy specimens and non-invasive body fluids such as urine or blood has led to many studies of application in genitourinary cancer. Here, we consider the background, promise and status, challenges and future directions of gene methylation and its clinical utility for the early detection of genitourinary cancer. The challenges of, and strategies for, advancing gene-methylation-based detection are relevant to all types of cancer.

The impact of electronic records on patient safety: a qualitative study.

BACKGROUND: Our aim was to explore NHS staff perceptions and experiences of the impact on patient safety of introducing a maternity system. METHODS: Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives, health care assistants), staff grades (consultant and midwife grades) and wards within a maternity unit. Participants represented a single maternity unit at a NHS teaching hospital in the North of England. Interviews were conducted during the first 12 months of the system being implemented and were analysed thematically. RESULTS: Participants perceived there to be an elevated risk to patient safety during the system's implementation. The perceived risks were attributed to a range of social and technical factors. For example, poor system design and human error which resulted in an increased potential for missing information and inputting error. CONCLUSIONS: The first 12 months of introducing the maternity system was perceived to and in some cases had already caused actual risk to patient safety. Trusts throughout the NHS are facing increasing pressure to become paperless and should be aware of the  potential adverse impacts on patient safety that can occur when introducing electronic systems. Given the potential for increased risk identified, recommendations for further research and for NHS trusts introducing electronic systems are proposed.

Implementing electronic patient record systems (EPRs) into England's acute, mental health and community care trusts: a mixed methods study.

BACKGROUND: Our aim was to explore the approaches to and the challenges and benefits of implementing Electronic Patient Record systems (EPRs) into NHS acute, mental health and community care hospitals throughout England. METHODS: A mixed methods approach was adopted that comprised an online survey (n = 59) and semi-structured telephone interviews (n = 8) with chief information officers (or heads of EPR projects) at NHS trusts throughout England. Survey analysis was descriptive, whilst the qualitative interviews were analysed thematically. RESULTS: A range of devices and approaches to implementing EPRs were described with 32 % of survey respondents utilising a best of breed approach. Interviewees' perceived and expected benefits of implementing an EPR included efficiency, availability and accessibility of clinical information, and patient safety. Key challenges to EPR implementation were securing clinician involvement, difficulties posed by government and national policy and limited availability of financial and human resources. CONCLUSIONS: There was no single approach regarding the approaches taken to implementing EPRs among participating English NHS trusts, with various benefits and challenges cited. Policymakers and researchers need to provide clearer guidance for trusts at various stages of implementation ensuring intelligence is shared across England's NHS trusts.

Separation and Characterization of Plastic Waste Packaging Contaminated with Food Residues.

In this paper, we present the development of a novel processing technology to tackle hard-to-recycle plastic packaging waste contaminated with food residues. The proof-of-concept (POC) technology can effectively separate food residual amounts from plastic waste materials to a level acceptable for further re-use or recycling of the plastic packaging. To assess this technology, we have conducted spectroscopic, thermal, and calorimetric characterizations of the obtained fractions, such as cleaned mixed plastics (CMP), food waste with mixed plastics (FWMP), and a mixture of microplastics (MP). The analyses were carried out with the aid of Fourier-Transform Infrared spectroscopy (FT-IR), Thermo-Gravimetric Analysis (TGA), Microcone Combustion Calorimetry (MCC), and 'bomb' calorimetry. The highest ratio of CMP to FWMP and the lowest amount of MP were obtained utilizing 700 rpm blade rotational speed and 15 s residence time of contaminated plastics in a cutting mill chamber. The plastics were freed from food contamination by 93-97%, which highlights a strong potential of the POC as a solution for 'dry-cleaning' of similar wastes on a larger scale. The main components of the CMP fraction were low-density polyethylene (LDPE), polypropylene (PP), and polyethylene terephthalate (PET), which are recyclable plastics. The knowledge and understanding of thermal degradation behaviours and calorimetric attributes of separated fractions, determined in this study, are essential in informing the industrial players using pyrolysis as a technique for recycling plastics.

Links between problem gambling and spending on booster packs in collectible card games: A conceptual replication of research on loot boxes.

Loot boxes are digital containers of randomised rewards present in some video games which are often purchasable for real world money. Recently, concerns have been raised that loot boxes might approximate traditional gambling activities, and that people with gambling problems have been shown to spend more on loot boxes than peers without gambling problems. Some argue that the regulation of loot boxes as gambling-like mechanics is inappropriate because similar activities which also bear striking similarities to traditional forms of gambling, such as collectable card games, are not subject to such regulations. Players of collectible card games often buy sealed physical packs of cards, and these 'booster packs' share many formal similarities with loot boxes. However, not everything which appears similar to gambling requires regulation. Here, in a large sample of collectible card game players (n = 726), we show no statistically significant link between in real-world store spending on physical booster and problem gambling (p = 0.110, η2 = 0.004), and a trivial in magnitude relationship between spending on booster packs in online stores and problem gambling (p = 0.035, η2 = 0.008). Follow-up equivalence tests using the TOST procedure rejected the hypothesis that either of these effects was of practical importance (η2 > 0.04). Thus, although collectable card game booster packs, like loot boxes, share structural similarities with gambling, it appears that they may not be linked to problem gambling in the same way as loot boxes. We discuss potential reasons for these differences. Decisions regarding regulation of activities which share structural features with traditional forms of gambling should be made on the basis of definitional criteria as well as whether people with gambling problems purchase such items at a higher rate than peers with no gambling problems. Our research suggests that there is currently little evidence to support the regulation of collectable card games.

Haploinsufficiency of the germ cell-specific nuclear RNA binding protein hnRNP G-T prevents functional spermatogenesis in the mouse.

Human HNRNPGT, encoding the protein hnRNP G-T, is one of several autosomal retrogenes derived from RBMX. It has been suggested that HNRNPGT functionally replaces the sex-linked RBMX and RBMY genes during male meiosis. We show here that during normal mouse germ cell development, hnRNP G-T protein is strongly expressed during and after meiosis when proteins expressed from Rbmx or Rbmx-like genes are absent. Amongst these Rbmx-like genes, DNA sequence analyses indicate that two other mouse autosomal Rbmx-derived retrogenes have evolved recently in rodents and one already shows signs of degenerating into a non-expressed pseudogene. In contrast, orthologues of Hnrnpgt are present in all four major groups of placental mammals. The sequence of Hnrnpgt is under considerable positive selection suggesting it performs an important germ cell function in eutherians. To test this, we inactivated Hnrnpgt in ES cells and studied its function during spermatogenesis in chimaeric mice. Although germ cells heterozygous for this targeted allele could produce sperm, they did not contribute to the next generation. Chimaeric mice with a high level of mutant germ cells were infertile with low sperm counts and a high frequency of degenerate seminiferous tubules and abnormal sperm. Chimaeras made from a 1:1 mix of targeted and wild-type ES cell clones transmitted wild-type germ cells only. Our data show that haploinsufficiency of Hnrnpgt results in abnormal sperm production in the mouse. Genetic defects resulting in reduced levels of HNRNPGT could, therefore, be a cause of male infertility in humans.

Nothing else matters: Video games create sustained attentional selection away from task-irrelevant features.

Feature-based attention allocates resources to particular stimulus features and reduces processing and retention of unattended features. We performed four experiments using self-paced video games to investigate whether sustained attentional selection of features could be created without a distractor task requiring continuous processing. Experiments 1 and 2 compared two versions of the game Two Dots, each containing a sequence of images. For the more immersive game post-game recognition of images was very low, but for the less immersive game it was significantly higher. Experiments 3 and 4 found that post-game image recognition was very low if the images were irrelevant to the game task but significantly higher if the images were relevant to the task. We conclude that games create sustained attentional selection away from task-irrelevant features, even if they are in full view, which leads to reduced retention. This reduced retention is due to differences in attentional set rather than a response to limited processing resources. The consistency of this attentional selection is moderated by the level of immersion in the game. We also discuss possible attentional mechanisms for the changes in recognition rates and the implications for applications such as serious games.

The prevalence of loot boxes in mobile and desktop games.

BACKGROUND AND AIMS: Loot boxes are items in video games that may be bought for real-world money but provide randomized rewards. Formal similarities between loot boxes and gambling have led to concerns that they may provide a 'gateway' to gambling amongst children. However, the availability of loot boxes is unclear. This study aimed to determine what proportion of top-grossing video games contained loot boxes, and how many of those games were available to children. DESIGN, SETTING AND CASES: Survey of the 100 top-grossing games on both the Google Play store and the Apple App store, and the top 50 most-played games on Steam according to the data aggregator SteamSpy. MEASUREMENTS: The prevalence of loot boxes was measured for each platform outlined above, split by age rating. FINDINGS: A total of 58.0% of the top games on the Google Play store contained loot boxes, 59.0% of the top iPhone games contained loot boxes and 36.0% of the top games on the Steam store contained loot boxes; 93.1% of the Android games that featured loot boxes and 94.9% of the iPhone games that featured loot boxes were deemed suitable for children aged 12+. Age ratings were more conservative for desktop games. Only 38.8% of desktop games that featured loot boxes were available to children aged 12+. CONCLUSIONS: Loot boxes appear to be prevalent in video games that are deemed suitable for children, especially on mobile platforms.

Promoter methylation and the detection of breast cancer.

Mammographic screening has been shown to reduce breast cancer mortality in women over the age of 50 years, and to a lesser extent in younger women. The sensitivity of mammography, however, is reduced in some groups of women. There remains a need for a minimally invasive, cost-effective procedure that could be used along side mammography to improve screening sensitivity. Silencing of tumor suppressor genes through promoter hypermethylation is known to be a frequent and early event in carcinogenesis. Further, changes in methylation patterns observed in tumors are also detectable in the circulation of women with breast cancer. This makes these alterations candidate markers for early tumor detection. In this paper, we review the current literature on promoter hypermethylation changes and breast cancer and discuss issues that remain to be addressed in order for the potential of these markers to augment the sensitivity of screening mammography. In general, studies in well-defined populations, including appropriate controls and larger numbers are needed. Further, focus on the optimization of methods of methylation detection in small amounts of DNA is needed.

5'-azacytidine expression arrays.

Epigenetic silencing of a gene can be reversed, resulting in reactivation of expression, by drugs such as the DNA methylation inhibitor 5-Aza-2'-deoxycytidine (5Aza-dC, azacytidine). This drug is added to cell culture media and is incorporated into the new strand during DNA replication in the cell. 5Aza-dC forms a covalent complex with the active sites of the DNA methyltransferase, depleting methyltransferase activity, which results in generalized demethylation. Until recently, global analyses of gene methylation in cancer cells were largely restricted to array or gel-based comparisons of the methylation status of CpG islands between normal and tumor cell DNA. An expression microarray-based screen has the advantage of a more genome-wide analysis with a better gene annotation and, coupled with a reactivation strategy, has the further advantage that it should preferentially identify reexpression of epigenetically silenced genes over methylated CpG islands that do not influence transcription. However, the direct reactivation of methylated genes, as well as secondary effects of azacytidine treatment, can lead to a cascade of deregulation in downstream unmethylated gene expression. A validation strategy is therefore the key for efficient identification of genes methylated in the wild-type cultured tumor cells. An azacytidine-based reactivation approach can only be used on cell lines so validation should include analysis of primary tumors. The potential of this approach for the identification of new hypermethylated genes and pathways has been demonstrated in bladder, colorectal, esophageal, and most other cancer types.

Towards Clinical Application of Methylated DNA Sequences as Cancer Biomarkers: A Joint NCI's EDRN and NIST Workshop on Standards, Methods, Assays, Reagents and Tools.

The workshop report, entitled Towards Clinical Application of Methylated DNA Sequences as Cancer Biomarkers: A Joint National Cancer Institute's Early Detection Research Network and National Institute of Standards and Technology Workshop, presents a summary of the main issues, current challenges, outcomes, and recommendations toward application of methylated DNA sequences as cancer biomarkers.

Correction: Video game loot boxes are linked to problem gambling: Results of a large-scale survey.

[This corrects the article DOI: 10.1371/journal.pone.0206767.].

Loot boxes are again linked to problem gambling: Results of a replication study.

Loot boxes are items in video games that contain randomised contents and can be purchased with real-world money. Similarities between loot boxes and forms of gambling have led to questions about their legal status, and whether they should be regulated as gambling. Previous research has suggested a link between the amount that gamers spend on loot boxes and their problem gambling: The more individuals spent on loot boxes, the more severe their problem gambling. However, the generalisability of prior work may be limited by both the self-selected nature of the sample under test, and the fact that participants were aware of the study's aims. A large-scale survey of gamers (n = 1,172) was undertaken to determine if this link remained when these limitations of previous work were taken into account. These gamers did not self-select into a loot box study and were not aware of the study's aims. This study found similar evidence for a link (η2 = 0.051) between the amount that gamers spent on loot boxes and the severity of their problem gambling. Previous research strongly suggested both the size and the direction of link between loot box use and problem gambling. This paper provides further support for this link. These results suggest either that loot boxes act as a gateway to problem gambling, or that individuals with gambling problems are drawn to spend more on loot boxes. In either case, we believe that these results suggest there is good reason to regulate loot boxes.

The effect of interruptions on postcompletion and other procedural errors: an account based on the activation-based goal memory model.

A postcompletion error (PCE) is a specific kind of cognitive slip that involves omitting a final task step after the main goal of the task is accomplished. It is notoriously difficult to provoke (and hence study) slips under experimental conditions. In this paper, the authors present an experimental task paradigm that has been shown to be effective for studying PCEs in routine procedural tasks. Two studies were carried out to examine the effect of interruption position and task structure on the prevalence of PCEs. It was found that significantly more PCEs were obtained when an interruption occurred just before the PC step than when an interruption occurred at any other position in the task. The authors account for this effect in terms of Altmann and Trafton's activation-based goal memory model. The same interruption effect was obtained for some, but not all, other procedural errors; the authors discuss the nature of these errors and likely explanations for the differences.

Identification of novel target genes by an epigenetic reactivation screen of renal cancer.

Aberrant promoter hypermethylation is a common mechanism for inactivation of tumor suppressor genes in cancer cells. To generate a global profile of genes silenced by hypermethylation in renal cell cancer (RCC), we did an expression microarray-based analysis of genes reactivated in the 786-0, ACHN, HRC51, and HRC59 RCC lines after treatment with the demethylating drug 5-aza-2 deoxycytidine and histone deacetylation inhibiting drug trichostatin A. Between 111 to 170 genes were found to have at least 3-fold up-regulation of expression after treatment in each cell line. To establish the specificity of the screen for identification of genes, epigenetically silenced in cancer cells, we validated a subset of 12 up-regulated genes. Three genes (IGFBP1, IGFBP3, and COL1A1) showed promoter methylation in tumor DNA but were unmethylated in normal cell DNA. One gene (GDF15) was methylated in normal cells but more densely methylated in tumor cells. One gene (PLAU) showed cancer cell-specific methylation that did not correlate well with expression status. The remaining seven genes had unmethylated promoters, although at least one of these genes (TGM2) may be regulated by RASSF1A, which was methylated in the RCC lines. Thus, we were able to show that up-regulation of at least 6 of the 12 genes examined was due to epigenetic reactivation. The IGFBP1, IGFBP3, and COL1A1 gene promoter regions were found to be frequently methylated in primary renal cell tumors, and further study will provide insight into the biology of the disease and facilitate translational studies in renal cancer.

Video game loot boxes are linked to problem gambling: Results of a large-scale survey.

Loot boxes are items in video games that can be paid for with real-world money and contain randomised contents. In recent years, loot boxes have become increasingly common. There is concern in the research community that similarities between loot boxes and gambling may lead to increases in problem gambling amongst gamers. A large-scale survey of gamers (n = 7,422) found evidence for a link (η2 = 0.054) between the amount that gamers spent on loot boxes and the severity of their problem gambling. This link was stronger than a link between problem gambling and buying other in-game items with real-world money (η2 = 0.004), suggesting that the gambling-like features of loot boxes are specifically responsible for the observed relationship between problem gambling and spending on loot boxes. It is unclear from this study whether buying loot boxes acts as a gateway to problem gambling, or whether spending large amounts of money on loot boxes appeals more to problem gamblers. However, in either case these results suggest that there may be good reason to regulate loot boxes in games.

Interactive numerals.

Although Arabic numerals (like '2016' and '3.14') are ubiquitous, we show that in interactive computer applications they are often misleading and surprisingly unreliable. We introduce interactive numerals as a new concept and show, like Roman numerals and Arabic numerals, interactive numerals introduce another way of using and thinking about numbers. Properly understanding interactive numerals is essential for all computer applications that involve numerical data entered by users, including finance, medicine, aviation and science.

Image-based search and retrieval for biface artefacts using features capturing archaeologically significant characteristics.

Archaeologists are currently producing huge numbers of digitized photographs to record and preserve artefact finds. These images are used to identify and categorize artefacts and reason about connections between artefacts and perform outreach to the public. However, finding specific types of images within collections remains a major challenge. Often, the metadata associated with images is sparse or is inconsistent. This makes keyword-based exploratory search difficult, leaving researchers to rely on serendipity and slowing down the research process. We present an image-based retrieval system that addresses this problem for biface artefacts. In order to identify artefact characteristics that need to be captured by image features, we conducted a contextual inquiry study with experts in bifaces. We then devised several descriptors for matching images of bifaces with similar artefacts. We evaluated the performance of these descriptors using measures that specifically look at the differences between the sets of images returned by the search system using different descriptors. Through this nuanced approach, we have provided a comprehensive analysis of the strengths and weaknesses of the different descriptors and identified implications for design in the search systems for archaeology.