Invited Commentary: Combining Information to Answer Epidemiologic Questions About a Target Population.

Epidemiologists are attempting to address research questions of increasing complexity by developing novel methods for combining information from diverse sources. Cole et al. (Am J Epidemiol. 2023;192(3)467-474) provide 2 examples of the process of combining information to draw inferences about a population proportion. In this commentary, we consider combining information to learn about a target population as an epidemiologic activity and distinguish it from more conventional meta-analyses. We examine possible rationales for combining information and discuss broad methodological considerations, with an emphasis on study design, assumptions, and sources of uncertainty.

Rethinking Barriers and Enablers in Qualitative Health Research: Limitations, Alternatives, and Enhancements.

Explorations of barriers and enablers (or barriers and facilitators) to a desired health practice, implementation process, or intervention outcome have become so prevalent that they seem to be a default in much health services and public health research. In this article, we argue that decisions to frame research questions or analyses using barriers and enablers (B&Es) should not be default. Contrary to the strengths of qualitative research, the B&Es approach often bypasses critical reflexivity and can lead to shallow research findings with poor understanding of the phenomena of interest. The B&Es approach is untheorised, relying on assumptions of linear, unidirectional processes, universally desirable outcomes, and binary thinking which are at odds with the rich understanding of context and complexity needed to respond to the challenges faced by health services and public health. We encourage researchers to develop research questions using informed deliberation that considers a range of approaches and their implications for producing meaningful knowledge. Alternatives and enhancements to the B&Es approach are explored, including using 'whole package' methodologies; theories, conceptual frameworks, and sensitising ideas; and participatory methods. We also consider ways of advancing existing research on B&Es rather than doing 'more of the same': researchers can usefully investigate how a barrier or enabler works in depth; develop and test implementation strategies for addressing B&Es; or synthesise the B&Es literature to develop a new model or theory. Illustrative examples from the literature are provided. We invite further discussion on this topic.

Consensus priority research questions in gastrointestinal and endoscopic surgery in the year 2020: results of a SAGES Delphi study.

INTRODUCTION: The objectives of this study were to identify consensus priority research questions according to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and to explore differences in priorities according to specific membership subgroups. METHODS: A modified Delphi study was conducted including active members of SAGES. An initial list of research questions was compiled by members of 26 SAGES Committees and Task Forces, and was further refined by the SAGES Delphi Task Force. The questions were divided into five research categories: (1) Surgical Outcomes; (2) Education, Training, and Simulation; (3) Health Services Research; (4) New Technology; and (5) Artificial Intelligence. Delphi respondents were asked to rank each question with regards to its importance in the field of gastrointestinal and endoscopic surgery (1-low; 5-high). "Priority" was defined as a single-round mean score of ≥ 3.5, and "consensus" as a single-round standard deviation < 1.0. Subgroup analyses were performed according to a priori selected respondent characteristics. RESULTS: The total number of respondents for each round was: Round 1 (n = 407); Round 2 (n = 569); Round 3 (n = 273). In each round, the majority of respondents were male (Round 1: 77.4%; Round 2: 77.1%; Round 3: 76.7%), self-identified as academic (vs. community) surgeons (Round 1: 57.1%; Round 2: 61.1%; Round 3: 60.2%), and practiced in North America (Round 1: 71.8%; Round 2: 70.8%; Round 3: 75.9%). A total of 29 out of 122 research questions met criteria for both "priority" and "consensus"-Surgical Outcomes, n = 6; Education, Training, and Simulation, n = 9; Health Services Research, n = 5; New Technology, n = 5; and Artificial Intelligence, n = 4. CONCLUSIONS: Consensus priority research questions in gastrointestinal and endoscopic surgery were identified across five different research categories. These results can provide direction and areas of interest for funding and investigation for future studies.

Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda.

BACKGROUND: Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. OBJECTIVE: This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. METHODS: We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. RESULTS: We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). CONCLUSIONS: We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

A Practical Guide to Writing Quantitative and Qualitative Research Questions and Hypotheses in Scholarly Articles.

The development of research questions and the subsequent hypotheses are prerequisites to defining the main research purpose and specific objectives of a study. Consequently, these objectives determine the study design and research outcome. The development of research questions is a process based on knowledge of current trends, cutting-edge studies, and technological advances in the research field. Excellent research questions are focused and require a comprehensive literature search and in-depth understanding of the problem being investigated. Initially, research questions may be written as descriptive questions which could be developed into inferential questions. These questions must be specific and concise to provide a clear foundation for developing hypotheses. Hypotheses are more formal predictions about the research outcomes. These specify the possible results that may or may not be expected regarding the relationship between groups. Thus, research questions and hypotheses clarify the main purpose and specific objectives of the study, which in turn dictate the design of the study, its direction, and outcome. Studies developed from good research questions and hypotheses will have trustworthy outcomes with wide-ranging social and health implications.

A review and meta-analysis of collaborative research prioritization studies in ecology, biodiversity conservation and environmental science.

Collaborative research prioritization (CRP) studies have become increasingly popular during the last decade. By bringing together a diverse group of stakeholders, and using a democratic process to create a list of research priorities, these methods purport to identify research topics that will better meet the needs of science users. Here, we review 41 CRP studies in the fields of ecology, biodiversity conservation and environmental science that collectively identify 2031 research priorities. We demonstrate that climate change, ecosystem services and protected areas are common terms found in the research priorities of many CRP studies, and that identified research priorities have become less unique over time. In addition, we show that there is a considerable variation in the size and composition of the groups involved in CRP studies, and that at least one aspect of the identified research priorities (lexical diversity) is related to the size of the CRP group. Although some CRP studies have been highly cited, the evidence that CRP studies have directly motivated research is weak, perhaps because most CRP studies have not directly involved organizations that fund science. We suggest that the most important impact of CRP studies may lie in their ability to connect individuals across sectors and help to build diverse communities of practice around important issues at the science-policy interface.

Identifying research questions for HIV, tuberculosis, tuberculosis-HIV, malaria, and neglected tropical diseases through the World Health Organization guideline development process: a retrospective analysis, 2008-2018.

OBJECTIVES: World Health Organization (WHO) guidelines for health programmes and healthcare delivery are the foundation of its technical leadership in public health and essential to decision-making globally. A key function of guideline development is to identify areas in which further evidence is needed because filling these gaps will lead to future improvements in population health. The objective of this study was to examine the knowledge gaps and research questions for addressing those gaps generated through the WHO guideline development process, with the goal of informing future strategies for improving and strengthening the guideline development process. STUDY DESIGN: We did a systematic, retrospective analysis of research questions identified in the published guidelines. METHODS: We analyzed guidelines published between January 1, 2008, and December 31, 2018, by the Communicable Diseases Cluster in five disease areas: tuberculosis (TB), HIV, malaria, TB-HIV, and neglected tropical diseases (NTDs). Research questions were extracted independently by two researchers. We analyzed the distribution of research questions by disease and by topic category and did a qualitative assessment of optimum practice for research question generation during the guideline development process. RESULTS: A total of 48 guidelines were included: 26 on HIV, 1 on malaria, 11 on TB, 5 on TB/HIV, and 5 on NTDs. Overall, 36 (75%) guidelines encompassed a total of 360 explicit research questions; the remainder did not contain specific research questions. The number of research questions that focused on TB was 49, TB/HIV was 38, HIV was 250, and NTDs was 23. The number of research questions that focused on diagnosis was 43 (11.9%) of 360, prevention was 62 (17.2%), treatment was 103 (28.6%), good practice was 12 (3.3%), service delivery was 86 (23.8%), and other areas was 54 (15%). Research questions were often not formulated in a specific or actionable way and were hard to identify in the guideline. Examples of good practice identified by the review team involved the generation of specific and narrowly defined research questions, with accompanying recommendations for appropriate study design. CONCLUSIONS: The WHO must strengthen its approach to identifying and presenting research questions during the guideline development process. Ensuring access to research questions is a key next step in adding value to the guideline development process.

A consensus building exercise to determine research priorities for silver trauma.

BACKGROUND: Emergency care research into 'Silver Trauma', which is simply defined as major trauma consequent upon relatively minor injury mechanisms, is facing many challenges including that at present, there is no clear prioritisation of the issues. This study aimed to determine the top research priorities to guide future research. METHODS: This consensus-based prioritization exercise used a three-stage modified Delphi technique. The study consisted of an idea generating (divergent) first round, a ranking evaluation in the second round, and a (convergent) consensus meeting in the third round. RESULTS: A total of 20 research questions advanced to the final round of this study. After discussing the importance and clinical significance of each research question, five research questions were prioritised by the experts; the top three research priorities were: (1). What are older people's preferred goals of trauma care? (2). Beyond the Emergency Department (ED), what is the appropriate combined geriatric and trauma care? (3). Do older adults benefit from access to trauma centres? If so, do older trauma patients have equitable access to trauma centre compared to younger adults? CONCLUSION: The results of this study will assist clinicians, researchers, and organisations that are interested in silver trauma in guiding their future efforts and funding toward addressing the identified research priorities.

How to undertake a literature search: a step-by-step guide.

Undertaking a literature search can be a daunting prospect. Breaking the exercise down into smaller steps will make the process more manageable. This article suggests 10 steps that will help readers complete this task, from identifying key concepts to choosing databases for the search and saving the results and search strategy. It discusses each of the steps in a little more detail, with examples and suggestions on where to get help. This structured approach will help readers obtain a more focused set of results and, ultimately, save time and effort.

Seventy-one important questions for the conservation of marine biodiversity.

The ocean provides food, economic activity, and cultural value for a large proportion of humanity. Our knowledge of marine ecosystems lags behind that of terrestrial ecosystems, limiting effective protection of marine resources. We describe the outcome of 2 workshops in 2011 and 2012 to establish a list of important questions, which, if answered, would substantially improve our ability to conserve and manage the world's marine resources. Participants included individuals from academia, government, and nongovernment organizations with broad experience across disciplines, marine ecosystems, and countries that vary in levels of development. Contributors from the fields of science, conservation, industry, and government submitted questions to our workshops, which we distilled into a list of priority research questions. Through this process, we identified 71 key questions. We grouped these into 8 subject categories, each pertaining to a broad component of marine conservation: fisheries, climate change, other anthropogenic threats, ecosystems, marine citizenship, policy, societal and cultural considerations, and scientific enterprise. Our questions address many issues that are specific to marine conservation, and will serve as a road map to funders and researchers to develop programs that can greatly benefit marine conservation.

Originating Research Ideas.

Research aimed at generating new knowledge is the heart of the scholarship of discovery. The author of this paper explores how original research ideas can be generated for formal investigations and artsciencing. Curiosity and creativity are presented as "seeds" for originating ideas, and seven patterns (adjacent possible, liquid networks, the slow hunch, serendipity, error, exaptation, and platforms) are described as synergistic potentiators for geminating original research ideas.

Mycotoxins: Emerging toxic mechanisms, and unanswered research questions.

Recently, a series of toxic mechanisms have been explored in mycotoxins. Emerging evidence show that mycotoxins may induce human neurodegenerative diseases (ND); however, this idea is still unproven. Besides to identify this hypothesis, some questions, for example, how the mycotoxins induce this disease and what the molecular mechanism is, as well as whether the brain-gut axis is involved in this context, should be answered. Very recent studies further reported an "immune evasion" mechanism in trichothecenes; moreover, hypoxia seems to play important function in this process; nevertheless, whether this "immune evasion" process is present in other mycotoxins, especially in aflatoxins, should be tested. In this work, we mainly discussed some key scientific questions that need to be answered in the toxic mechanisms of mycotoxins. We especially focused on the research questions in the key signaling pathways, balance mechanism of immunostimulatory and immunosuppressive effects, and the relationship between autophagy and apoptosis. Interesting topics such as mycotoxins and aging, cytoskeleton and immunotoxicity are also discussed. More importantly, we compile a special issue: "New insight into mycotoxins and bacterial toxins: toxicity assessment, molecular mechanism and food safety" for Food and Chemical Toxicology. Researchers are encouraged to submit their newest work to this special issue.

Critical elements of synthesis questions are incompletely reported: survey of systematic reviews of intervention effects.

OBJECTIVES: To examine the characteristics of population, intervention and outcome groups and the extent to which they were completely reported for each synthesis in a sample of systematic reviews (SRs) of interventions. STUDY DESIGN AND SETTING: We coded groups that were intended (or used) for comparisons in 100 randomly sampled SRs of public health and health systems interventions published in 2018 from the Health Evidence and Health Systems Evidence databases. RESULTS: Authors commonly used population, intervention and outcome groups to structure comparisons, but these groups were often incompletely reported. For example, of 41 SRs that identified and/or used intervention groups for comparisons, 29 (71%) identified the groups in their methods description before reporting of the results (e.g., in the Background or Methods), 12 (29%) defined the groups in enough detail to replicate decisions about which included studies were eligible for each synthesis, 6 (15%) provided a rationale, and 24 (59%) stated that the groups would be used for comparisons. Sixteen (39%) SRs used intervention groups in their synthesis without any mention in the methods. Reporting for population, outcome and methodological groups was similarly incomplete. CONCLUSION: Complete reporting of the groups used for synthesis would improve transparency and replicability of reviews, and help ensure that the synthesis is not driven by what is reported in the included studies. Although concerted effort is needed to improve reporting, this should lead to more focused and useful reviews for decision-makers.

How to Build and Assess the Quality of Healthcare-Related Research Questions.

The objective of this article is to describe a simplified process for building and assessing the quality of healthcare-related research questions. This process consisted of three stages. The first stage aimed to select and explore a field of science. This field would be the area for which to identify outputs, such as units of analysis, variables, and objectives. The second stage aimed to write structured research questions, taking into account the outputs of the first stage. In general, the structure of research questions starts with interrogative adverbs (e.g., what and when), auxiliary verbs (e.g., is there and are there), or other auxiliaries (e.g., do, does, and did); followed by nouns nominalized from verbs of research objectives, such as association, correlation, influence, causation, prediction, application; research variables (e.g., risk factors, efficiency, effectiveness, and safety); and units of analysis (e.g., patients with hypertension and general hospitals). The third stage aimed to assess the quality and feasibility of the research questions against a set of criteria such as relevance, originality, generalizability, measurability, communicability, availability of resources, and ethical issues. By following the proposed simplified process, novice researchers may learn how to write structured research questions of sound scientific value.

Military chaplaincy in Sweden: A contemporary perspective.

Pastors serving as military chaplains have been an integral part of the Swedish Armed Forces for hundreds of years. This close relationship has continued even after the Church of Sweden was formally separated from the state in 2000. Yet contemporary research drawing from experiences of Swedish military chaplains during their pastoral and spiritual assignments within a military context is virtually non-existent. This research explores the contemporary situation for military chaplaincy in Sweden through the lenses of proportional accessibility for military personnel, availability to civilian congregations, increasing cultural and ethnic diversity, religious embeddedness in military culture, theological tension, and personal identity development among chaplains. It furthermore suggests that military chaplains navigate a complex situation: they are expected to serve professional service members, many of whom have war zone experiences, in addition to shepherding increasing volumes of conscripts now that conscription has been reinstated, all within a new interreligious paradigm.

The question of the question: impactful implementation science to address the HIV epidemic.

INTRODUCTION: Questions about the implementation of evidence-based intervention to treat and prevent HIV have risen to the top of the field's scientific priorities. Despite the availability of highly efficacious treatment and prevention interventions, impact has fallen short of targets because these interventions are used with insufficient reach, consistency, sustainability and equity in diverse real-world settings. At present, substantial excitement for implementation science - defined as research methods and strategies to improve use of evidence-based interventions - has focused on developing and disseminating methods to conduct rigorous research. Yet, impactful answers depend on a sometimes less visible, but even more important, step: asking good questions about implementation. DISCUSSION: In this commentary, we offer several considerations for researchers formulating implementation research questions based on several distinctive features of the field. First, as findings are used not only by other researchers but by implementers, scientific questions must incorporate a range of stakeholder and community perspectives to be most relevant. Second, real-world settings are contextually diverse, and the most relevant scientific questions must position answers to make sense within these contexts (whether geographical, organizational and sociological), rather than apart from them. Third, implementation is complex and dynamic; consequently, research questions must make use of emerging standards in describing implementation strategies and their effects whenever possible. Finally, the field of implementation science continues to evolve, so framing problems with a diverse disciplinary lens will enable researchers to pose insightful and impactful questions. CONCLUSIONS: We are now at a juncture marked by both rich evidence-based interventions and a persistent global pandemic. To achieve continued scientific progress against the HIV epidemic, asking the right questions might be part of the answer itself.

More than meets the AI: The possibilities and limits of machine learning in olfaction.

Can machine learning crack the code in the nose? Over the past decade, studies tried to solve the relation between chemical structure and sensory quality with Big Data. These studies advanced computational models of the olfactory stimulus, utilizing artificial intelligence to mine for clear correlations between chemistry and psychophysics. Computational perspectives promised to solve the mystery of olfaction with more data and better data processing tools. None of them succeeded, however, and it matters as to why this is the case. This article argues that we should be deeply skeptical about the trend to black-box the sensory system's biology in our theories of perception. Instead, we need to ground both stimulus models and psychophysical data on real causal-mechanistic explanations of the olfactory system. The central question is: Would knowledge of biology lead to a better understanding of the stimulus in odor coding than the one utilized in current machine learning models? That is indeed the case. Recent studies about receptor behavior have revealed that the olfactory system operates by principles not captured in current stimulus-response models. This may require a fundamental revision of computational approaches to olfaction, including its psychological effects. To analyze the different research programs in olfaction, we draw on Lloyd's "Logic of Research Questions," a philosophical framework which assists scientists in explicating the reasoning, conceptual commitments, and problems of a modeling approach in question.

One hundred research questions in conservation physiology for generating actionable evidence to inform conservation policy and practice.

Environmental change and biodiversity loss are but two of the complex challenges facing conservation practitioners and policy makers. Relevant and robust scientific knowledge is critical for providing decision-makers with the actionable evidence needed to inform conservation decisions. In the Anthropocene, science that leads to meaningful improvements in biodiversity conservation, restoration and management is desperately needed. Conservation Physiology has emerged as a discipline that is well-positioned to identify the mechanisms underpinning population declines, predict responses to environmental change and test different in situ and ex situ conservation interventions for diverse taxa and ecosystems. Here we present a consensus list of 10 priority research themes. Within each theme we identify specific research questions (100 in total), answers to which will address conservation problems and should improve the management of biological resources. The themes frame a set of research questions related to the following: (i) adaptation and phenotypic plasticity; (ii) human-induced environmental change; (iii) human-wildlife interactions; (iv) invasive species; (v) methods, biomarkers and monitoring; (vi) policy, engagement and communication; (vii) pollution; (viii) restoration actions; (ix) threatened species; and (x) urban systems. The themes and questions will hopefully guide and inspire researchers while also helping to demonstrate to practitioners and policy makers the many ways in which physiology can help to support their decisions.

Fundamental research questions in subterranean biology.

Five decades ago, a landmark paper in Science titled The Cave Environment heralded caves as ideal natural experimental laboratories in which to develop and address general questions in geology, ecology, biogeography, and evolutionary biology. Although the 'caves as laboratory' paradigm has since been advocated by subterranean biologists, there are few examples of studies that successfully translated their results into general principles. The contemporary era of big data, modelling tools, and revolutionary advances in genetics and (meta)genomics provides an opportunity to revisit unresolved questions and challenges, as well as examine promising new avenues of research in subterranean biology. Accordingly, we have developed a roadmap to guide future research endeavours in subterranean biology by adapting a well-established methodology of 'horizon scanning' to identify the highest priority research questions across six subject areas. Based on the expert opinion of 30 scientists from around the globe with complementary expertise and of different academic ages, we assembled an initial list of 258 fundamental questions concentrating on macroecology and microbial ecology, adaptation, evolution, and conservation. Subsequently, through online surveys, 130 subterranean biologists with various backgrounds assisted us in reducing our list to 50 top-priority questions. These research questions are broad in scope and ready to be addressed in the next decade. We believe this exercise will stimulate research towards a deeper understanding of subterranean biology and foster hypothesis-driven studies likely to resonate broadly from the traditional boundaries of this field.

Patient Centered Studies Focusing on Diabetes Self-Management: A Scoping Review.

BACKGROUND: Type 2 diabetes continues to be a significant burden to patients and health systems globally. Addressing this condition from an alternative perspective, patients and various other stakeholders from three northern Mississippi communities co-created patient-centered research questions focused on type 2 diabetes management. OBJECTIVE: The objective of this scoping review was to explore current literature focusing on nine patient- centered research questions to establish current knowledge and identify future research needs in the area of type 2 diabetes. METHODS: A scoping review was conducted to obtain an overview of research related to the study purpose. The PubMed database was searched from March 2013 to March 2018 to identify patient-centered studies focused on type 2 diabetes and relevant to one of the nine research questions. RESULTS: A total of 33 studies were identified and included. For five of the research questions, there was either no previous research literature or only "related" studies could be identified. These largely unexplored topics included how the understanding of guidelines by healthcare providers, specialty, and communication of medication side-effects impact patients' understanding and outcomes, the impact of improving patients' preparedness to communicate with providers, and whether younger patients require weight management programs that account for this populations' needs. CONCLUSION: This lack of previous literature presents a unique opportunity to partner with patients to conduct this study and help improve the management of type 2 diabetes.