Data Analysis Team Research Articles

EP-235 Improving working conditions of junior surgeons

Abstract Aims Significant exception reporting is reflective of difficult working conditions though well-recognised barriers exist to reporting which may reflect the culture within a unit. This study used exception reporting data to understand and improve the working conditions of juniors. Methods Junior surgeons were surveyed in December 2019 to evaluate additional hours worked, reasons for this work and whether exception reports were completed; where they were not, doctors were asked why. After data analysis, rota structures and surgical teams were changed and formal education about exception reporting given at departmental induction. The main changes involved greater opportunities to take leave and enhanced staffing on evenings and weekends. Surgical juniors were re-surveyed in September 2021. Results In December 2019, 49.2 additional hours were worked between 18 juniors. No exception reports were completed with the main reasons being a personal decision to stay late (for training opportunities), lack of understanding on how to report and cultural issues that made juniors unsure about how exception reports would be viewed. In September 2021, only 30 additional hours were worked between 17 respondents. Again, no exception reports were completed with over 95% of respondents citing a personal decision to stay late. Cultural issues within the department were no longer cited and knowledge of how to exception report was greatly increased. Conclusions A positive and open culture, where consultants and surgical leaders engage with juniors about rotas and working conditions can lead to a reduction in additional hours and improve the understanding of exception reporting.

P-682 Predicting the Number of Oocytes Retrieved from Controlled Ovarian Hyperstimulation with Machine Learning

Abstract Study question Can machine learning predict the number of oocytes retrieved from controlled ovarian hyperstimulation (COH) using a third-party dataset without the need for a data transfer? Summary answer Three machine learning models were successfully trained through the Substra Infrastructure to predict the number of oocytes retrieved from COH. No data transfer took place. What is known already A critical stage in in-vitro fertilization cycles is that of COH. Due to large inter- and intra-individual variations in ovarian response, clinicians need to decide on suitable and cost-effective ovarian stimulation protocols for patients with a view to retrieving as many mature oocytes as possible, while also minimizing the risk of complications such as ovarian hyperstimulation syndrome. A number of previous studies have identified and built predictive models on factors that influence the number of oocytes retrieved during COH. Many of these studies are, however, limited in the fact that they only consider a small number of variables in isolation. Study design, size, duration This study was a retrospective analysis of 14,415 cycles performed at a single centre between 2009 and 2020. The analysis was carried out by an external data analysis team using the Substra framework. Substra enabled the data analysis team to send computer code to run securely on the centre’s on-premises server. Thus, a high level of data security was achieved as the data did not leave the centre at any point during the study. Participants/materials, setting, methods The Light Gradient Boosting Machine algorithm was used to produce three predictive models: one that directly predicted the number of oocytes retrieved, and two that predicted which of a set of bins provided by two clinicians the number of oocytes retrieved fell into. The resulting models were evaluated on a held-out test set. In addition, the models themselves were analyzed to identify the parameters that had the biggest impact on their predictions. Main results and the role of chance On average, the model that directly predicted the number of oocytes retrieved deviated from the ground truth by 3.80 oocytes. The model that predicted the first clinician’s bins deviated by 0.73 bins whereas the model for the second clinician deviated by 0.63 bins. For all models, performance was best within the first and third quartiles of the target variable, with the model underpredicting extreme values of the target variable (no oocytes and large numbers of oocytes retrieved). Nevertheless, the erroneous predictions made for these extreme cases were still within the vicinity of the true value. Overall, all three models agreed on the importance of each feature which was estimated using Shapley Additive Explanation (SHAP) values. The feature with the highest mean absolute SHAP value (and thus the highest importance) was serum E2 before triggering, followed by the duration of gonadotropin treatment and antral follicle count. Of the other hormonal features, baseline FSH, AMH and E2 levels were similarly important and baseline LH was least important. The treatment characteristic with the highest SHAP value was the duration of treatment with longer periods being associated with a higher number of oocytes retrieved. Limitations, reasons for caution The models produced in this study were trained on a cohort from a single center. They should thus not be used in clinical practice until trained and evaluated on a larger cohort more representative of the general population. Wider implications of the findings These predictive models developed may be useful in clinical practice, assisting clinicians in optimizing COH protocols for individual patients. Our work also demonstrates the promise of using the Substra framework for allowing external researchers to provide clinically-relevant insights on sensitive fertility data in a fully secure, trustworthy manner. Trial registration number Not Applicable

Clinical Education Coordinators' Selection and Deselection Criteria of Clinical Education Experiences

Context Athletic training students have identified clinical education as the most important aspect of their education when transitioning to practice. However, athletic training students have been frustrated with a lack of engagement, mentorship, and diversity within their clinical education experiences. As such, the selection and deselection of clinical sites is critical to creating effective learning experiences. Objective To explore how clinical education coordinators (CECs) select and deselect clinical education experiences (sites and preceptors) for clinical integration and immersion. Design Consensual qualitative research. Setting Individual teleconference interviews. Patients or Other Participants Thirteen CECs (age = 42 ± 8 years, experience in current role = 8 ± 8 years) from accredited professional master's programs who were in their position for at least 1 year and had at least 1 immersive rotation. Data Collection and Analysis All interviews were audio recorded and transcribed. A 3-person data analysis team used a multiphase process to identify the emerging domains and categories. Trustworthiness was established through member checking, multiple researcher triangulation, and auditing. Results Two themes emerged from the participant responses: accreditation compliance and strategic choices. We found participants expressed the theme of accreditation compliance as a major facilitator when selecting or deselecting clinical education placements. Strategic choices, such as student aspirations and focus on the quantity over the quality, were used by CECs to select clinical education placements which develop student autonomy and provide diverse experiences. However, the CECs engaged in convenient preceptor selection based on geographical location and previous relationships. Conclusion(s) Our findings suggest CECs leverage convenient clinical education opportunities that comply with accreditation expectations. CECs should be strategically selecting clinical education opportunities that move beyond accreditation minimum standards and focus on high-quality experiential learning, which leads to autonomous practice and embraces the diversity of the profession.

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Context Clinical reasoning is an inferential process of collecting and evaluating data in patient cases, necessary in all care. Athletic training residency programs are emerging rapidly as the industry standard for developing clinical specialists who possess advanced clinical reasoning needed for complex cases. Objective The purpose of this study was to explore current practices of advanced clinical reasoning development and assessment in athletic training residency programs. Design Inductive qualitative research. Setting Web-based teleconferencing platform (Zoom Video Communications). Patients or Other Participants Seven of 10 Commission on Accreditation of Athletic Training Education–accredited residency program directors (RPDs) (age = 46 ± 9 years, years as RPD = 5 ± 6). Data Collection and Analysis We used qualitative, semistructured interviews. Audio files were transcribed verbatim, checked for accuracy, deidentified, and member checked before analysis. We used a 2-person data analysis team and an inductive coding approach. The researchers reviewed the transcripts independently, met to develop a codebook, applied the codes, and conducted internal auditing. Trustworthiness was established through member checking, multiple-analyst coding, and auditing. Results Three themes emerged from the RPDs about developing advanced clinical reasoning: (1) defining clinical reasoning, (2) instructional tactics, and (3) assessment tactics. RPDs defined clinical reasoning as the process of the resident justifying their decision-making and the accuracy of their decisions. RPDs described both clinical and didactic instructional tactics, including mentoring, lectures and discussions, case presentations, and journal club. RPDs described assessing advanced clinical reasoning through patient and preceptor feedback in structured and unstructured formats, self-reflection, and knowledge testing to measure clinical reasoning. RPDs highly relied on preceptors and clinical mentoring, but also described a singular reliance on residents to appraise the clinical reasoning capacity of their own preceptors. Conclusions RPDs define clinical reasoning as rationalization and accuracy of decisions. Although the programs are engaged in effective clinical and didactic approaches to teach advanced clinical reasoning, they rely heavily on the subjectivity of preceptors and residents to assess these outcomes.

Athletic Training Preceptors' Perceptions of the Characteristics for Contemporary Expertise

Context As a part of the Commission on Accreditation of Athletic Training Education (CAATE) 2020 Standards for Accreditation of Professional Athletic Training Programs, all preceptors affiliated with accredited programs must identify an area of contemporary expertise in a routine area of athletic training practice. However, little is known regarding preceptors' perceptions of contemporary expertise. Objective To explore preceptors' perceptions of the characteristics of contemporary expertise. Design Cross-sectional. Setting Online survey with open-ended questions. Patients or Other Participants A total of 277 preceptors affiliated with 80 CAATE-accredited professional programs accessed the survey; 259 respondents completed at least 1 open-ended question, and 201 completed the survey in its entirety (77.6% completion rate). Main Outcome Measure(s) We used a 16-item survey including demographic (10 items), Likert-scale (1 item), and open-ended (5 items) questions. Descriptive statistics were conducted to characterize respondent demographics and familiarity with contemporary expertise. Guided by consensual qualitative research, a 3-person data analysis team coded responses from the open-ended questions following a structured, 4-phase progression. An external auditor confirmed accuracy and representation of the findings. Results Approximately 36% of preceptors reported they were not at all familiar with contemporary expertise. Preceptors identified several defining characteristics (eg, knowledge or skills possessed, clinical practice experience, intentional continuing education, evidence-based practice [EBP]) and parameters (eg, CAATE curricular content standards, Board of Certification domains of practice, areas of specific interest) of contemporary expertise. Additionally, 85% of preceptors discussed how identifying areas of contemporary expertise would improve their practice, while the remaining 15% discussed how it would not. Conclusions Preceptors affiliated with CAATE-accredited professional programs appear to be largely in favor of developing an area of contemporary expertise and believe it will improve their own clinical practice. More education is needed to acquaint preceptors who are not yet familiar with the notion of contemporary expertise.

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness.

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness.

Athletic Trainers’ Hand Hygiene Behaviors During the COVID-19 Pandemic

Purpose: Hand hygiene (HH) is a cost-effective public health intervention to prevent infectious disease transmission, including COVID-19. Health care professionals have shown poor adherence to HH best practices, and little is known about athletic trainer (AT) HH. ATs typically work in dynamic, unpredictable environments, creating barriers to HH compliance. The purpose of this study was to understand the self-reported behaviors and challenges with adherence to HH of secondary school ATs, particularly related to mitigating infection transmission during the COVID-19 pandemic. Methods: In this qualitative study, we conducted 11 semi-structured interviews with secondary school ATs actively engaged in direct patient care (age=31±9 years; experience=9±8 years). A 2-person data analysis team used a multi-phase inductive coding process to identify emerging domains and themes to create a codebook. Trustworthiness and credibility were established with member checking, multi-researcher analysis, and internal auditing. Results: We identified four themes: 1) best practices awareness, 2) impact of COVID-19, 3) resources, and 4) community-based prevention. Participants indicated HH training was included during on-boarding, but lacked contextual knowledge for HH in clinical practice, despite identifying ATs as health care providers. Participants expressed increased HH frequency due to the COVID-19 pandemic and concern for transmission. Participants noted an overall positive perception of access to physical resources, like hand sanitizer, sinks, and soap, as well as financial support to provide those resources. Participants noted decreased perceived risk and lack of formal policy or enforcement of HH expectations for facility users. Conclusion: ATs have general knowledge and resources but lack contextual knowledge and behaviors to employ HH best practices. The COVID-19 pandemic increased awareness, but HH by athletic training facility users remains poor. ATs should engage in HH based on best practice recommendations consistent with a traditional healthcare facility. Policies should be developed and enforced to limit disease transmission.

Athletic Trainers' Perceptions of Advanced Clinical Practice: Defining Advanced Clinical Practice in Athletic Training

Context Advanced clinical practice is inherent in contemporary athletic training education, such as residency programs and Doctor of Athletic Training programs; however, as a concept, advanced clinical practice in athletic training has been poorly studied to date. Objective To explore athletic trainers' perceptions of advanced clinical practice. Design Cross-sectional. Setting Online survey with open-ended questions. Patients or Other Participants Three hundred fifty of 1992 athletic trainers accessed the survey (17.6% access rate); 321 respondents completed at least 1 open-ended question; and 196 completed the survey in its entirety (61.1% completion rate). Intervention(s) We used a 13-item survey including demographic items (9 items) and open-ended response questions (4 items). Main Outcome Measure(s) Guided by the consensual qualitative research approach, a 3-person data analysis team coded the open-ended responses. Each member coded 50 responses and a consensus codebook was developed. Two members of the team coded the remaining responses, which were confirmed by the third member. Emergent data were organized into themes and categories, and frequency counts were determined for each category. Results Athletic trainers' definitions of advanced clinical practice were categorized into 4 emergent categories: (1) formal training and education; (2) informal training and education; (3) knowledge, skills, and behaviors; and (4) experience and uncertainty. Conclusions The categories of formal and informal training and education focused on athletic trainers acquiring additional knowledge and skills through mechanisms such as postprofessional degree programs, residency programs, or other areas of study. The knowledge, skills, and behaviors category included areas related to specialized skills and the core competencies. These 3 categories aligned with one another to provide both the types of knowledge, skills, and behaviors that define advanced clinical practice, and the specific mechanisms through which an athletic trainer can achieve advanced clinical practice.

Preceptors' Frequency and Supervision of Athletic Training Students' Medical Documentation During Clinical Education

Context Athletic trainers (ATs) who serve as preceptors for athletic training students must model, facilitate, and guide professional skills and behaviors, including medical documentation. Preceptors have the unique ability to combine skill practice with real-time patient encounters for athletic training students. Objective To describe the frequency of preceptors who allow athletic training students to complete medical documentation and rationale for their decisions. Design Cross-sectional. Setting Qualitative study. Patients or Other Participants Of 9578 ATs, 1150 responded to an electronic survey (access rate = 12.0%), and 385 of 1150 respondents who completed an electronic survey (33.5%) indicated being a preceptor for a professional athletic training program. Respondents (age = 34 ± 11 years, clinical practice experience = 11 ± 10 years) were predominantly female (53.8%, n = 207) and held a master's degree (67.3%, n = 259). Main Outcome Measure(s) A 3-member data analysis team coded the open-ended responses following the consensual qualitative research approach. Each member coded 50 responses and a consensus codebook was created. The principal investigator coded the remaining responses, and the data analysis team confirmed the findings. Data were organized into emergent domains and categories. Frequency counts were calculated for each category. Results A majority of preceptors (81.8%, n = 315) allowed their athletic training students to document patient care. Respondents indicated an intention for student involvement (domain 1), whereby they wanted students to engage in learning and develop knowledge (43.4%, n = 167) or practice and gain experience (41.3%, n = 159). However, others discussed deterrents (20.0%, n = 77) working against the preceptor's intentions. Respondents also indicated a need to mentor (domain 2). Specifically, they reported needing to manage the logistics of documentation (63.6%, n = 245) and the degree of oversight (48.8%, n = 188) needed during practice (either direct [79.8%, n = 150 of 188] or indirect [20.2%, n = 38 of 188]). Conclusions Although preceptors intend to integrate students into medical documentation, they may benefit from formal guidance from the academic program on how to best integrate athletic training students into documenting day-to-day patient care.

Vascular Surgery in Japan: 2012 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatments performed by vascular surgeons in Japan in 2012, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the NCD vascular surgery data analysis team, including the number of treatments and early clinical results such as operative and in-hospital mortality.Results: In total 95,979 vascular treatments were registered by 1,043 institutions in 2012. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 19,600, 13,141, 4,600, 1,623, 1,973, 30,725, and 24,332, respectively. In the field of aneurysm treatment, 15,745 cases with abdominal aortic aneurysms (AAA) including common iliac aneurysms were registered, and 47.6% were treated by stent graft. Among AAA cases, 1,704 (10.8%) cases were registered as ruptured AAA. The operative mortality of ruptured and non-ruptured AAA was 17.8%, and 0.8%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 7,859 cases, including 1,173 distal bypasses to the crural or pedal artery, whereas endovascular procedures were performed in 5,282 cases. Venous treatment including 30,088 cases with varicose vein treatments and 395 cases with lower limb deep venous thrombosis were registered. Regarding other vascular operations, 22,654 cases of vascular access operations and 1,390 amputation surgeries were included. The number of lower limb amputations was still increasing and the mortality rate of amputation surgery was also still high; both of these issues require improvement.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially endovascular aneurysm repair (EVAR) for aneurysms and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2018; 27: 437–456.)

Learning about Student Research Practices through an Ethnographic Investigation: Insights into Contact with Librarians and Use of Library Space

Abstract
 
 Objective – Student research habits and expectations continue to change, complicating the design of library spaces and the provision of research support. This study’s intent was to explore undergraduate and graduate student research and study needs at a mid-sized university’s two campuses in the Northeastern United States, and to improve librarians’ understandings of these practices so that more appropriate services and spaces may be developed to support student learning.
 
 Methods – The research project utilized a primarily qualitative design for data collection that spanned from fall 2012 to summer 2013, consisting of an online questionnaire, unobtrusive observations, and in-depth semi-structured interviews. Data collection commenced with a questionnaire consisting of 51 items, distributed through campus email to all students and receiving 1182 responses. Second, 32 hours of unobtrusive observations were carried out by librarians, who took ethnographic “field notes” in a variety of Library locations during different times and days of the week. The final method was in-depth interviews conducted with 30 undergraduate and graduate students. The qualitative data were analyzed through the application of a codebook consisting of 459 codes, developed by a data analysis team of 4 librarians.
 
 Results – The results address topical areas of student interactions with librarians, contact preferences, and use of library space. Of the interviewees, 60% contacted a librarian at least once, with texting being the most popular method of contact (27%). In being contacted by the library, students preferred a range of methods and generally indicated interest in learning about library news and events through posters and signage. Participants were less interested in receiving library contact via social media, such as Facebook or Twitter. Regarding student use of and preference for library space, prominent themes were students creating their own spaces for individual study by moving furniture, leaving personal items unattended, the presence of unwanted noise, and a general preference for either working nearby other students in groups or in carrels to facilitate individual study.
 
 Conclusions – Being aware of student research processes and preferences can result in the ability to design learning environments and research services that are more responsive to their needs. Ethnographic research methods, as part of an ongoing research process, are recommended as a means to better understand library user practices and expectations.

Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial

Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70-86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76-91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, -5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, -4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P < .001), consistent with the known higher expulsion rate with immediate vs delayed postpartum intrauterine device insertion. No intrauterine device perforations occurred in either group. Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.

Stigma as a Facet of Community-Academic Partnership.

Stigma as a Facet of Community–Academic Partnership Sally Mason The Positive Families Project is a partnership between parents living with HIV, service providers, and myself, an academic at a public university. Our projects investigate the need for and develop social services with HIV–affected families. Often services focus only on the person living with HIV. Our mission is to support people living with HIV who are also parents so that families with an HIV+ member can be healthy and productive. Stigma reduction is key to our approach as stigma can contribute to multiple risks for parents and their children. The partnership has encompassed several projects, starting with pilot studies in 2006–2010 on the stigma experiences of non–HIV+ teens living with HIV+ parents. Parents and community–based service providers originally were research participants and the data analysis team. The team reviewed transcripts, identifying themes and making recommendations for future services. Currently parents and service providers meet monthly to develop ideas for family–focused services and review funding possibilities. Recently, we received funding to implement psychoeducational group sessions for parents with HIV. Parents and service providers recruited participants, co–facilitated groups, and reviewed evaluation data. Originally my role was researcher and a program coordinator/facilitator. Now I convene and facilitate the planning group, assist with programming when funded, and provide resources such as meeting space, writing skills, and supplies. I was drawn to partnership and participatory methods through our pilot studies on stigma. One finding about stigma was that positive parents and their non–positive but HIV–affected children used silence as a form of protection from stigma. They identified wanting to find “safe others” who they could trust with their secret. If we, as researchers, asked them to open up, to be less vigilant for an hour or two in an interview, first, how could we reduce (and not reproduce) stigma for them during this process and, second, what was our responsibility to give them a safe place to talk in the future? Coincidentally, I was meeting regularly with researchers committed to community collaboration and participatory methods. I became increasingly convinced that participatory methods have the potential to, at least, not reproduce stigma and, at most, reduce stigma’s impact. By leveling the power differential between researchers, service providers, and families (a difference which may be exacerbated by stigma), participation can be an antidote to stigma, by engaging families, as Paolo Freire would say, in “the struggle for their redemption.” [End Page 30] As a service provider, I had experienced courtesy stigma as described by Goffman or stigma–by–association with people living with HIV. Due to my status—race, class—and with support from educated family and friends, I was able to thwart efforts to label me as less than “normal” or to be silenced in my work. What I had not anticipated was how, as boundaries between academic and community members blur, parents’ stigma situations became part of the process, immersing me in their experience and confronting me with fresh personal and professional dilemmas. A prime example occurred while convening a community group to help with the analysis of data collected during focus groups with HIV+ parents and their non–infected adolescent children. Sandy (pseudonym) was an African–American woman who had been engaged with our projects over the years. She had known her HIV status for at least 15 years and had often been a peer facilitator in our parenting groups. She called me one day saying that she had told a church member about our project. This church member was a graduate student in community psychology and was intrigued by our recent research. Sandy thought this young woman would be an asset to our process providing some assistance as we prepared the final reports and articles. Sandy was excited to involve the student and asked if she could give this young woman my number. As we always need more resources, I heartily agreed. After hanging up the phone, I realized that I did not know if the graduate student or anyone at Sandy’s church knew Sandy’s HIV status. I called Sandy back. She said that only the minister at her church knew...

Cultural Health Assets of Somali and Oromo Refugees and Immigrants in Minnesota: Findings from a Community-Based Participatory Research Project.

This community-based participatory research study sought to identify the cultural health assets of the Somali and Oromo communities in one Minnesota neighborhood that could be mobilized to develop culturally appropriate health interventions. Community asset mappers conducted 76 interviews with Somali and Oromo refugees in in Minnesota regarding the cultural assets of their community. A community-university data analysis team coded data for major themes. Key cultural health assets of the Somali and Oromo refugee communities revealed in this study include religion and religious beliefs, religious and cultural practices, a strong culture of sharing, interconnectedness, the prominence of oral traditions, traditional healthy eating and healthy lifestyles, traditional foods and medicine, and a strong cultural value placed on health. These cultural health assets can be used as building blocks for culturally relevant health interventions.

Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room.

The authors aimed to map and explicate what surgeons perceive they learn in the operating room. The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from "signs" making parallels with other medical specialties.

Bigger on the inside: building Research Data Services at the University of Virginia

Every story has a beginning, where the narrator chooses to start, though this is rarely the genesis. This story begins with the launch of the University of Virginia Library's new Research Data Services unit in October 2013. Born from the conjoining of a data management team and a data analysis team, Research Data Services expanded to encompass data discovery and acquisitions, research software support, and new expertise in the use of restricted data. Our purpose is to respond to the challenges created by the growing ubiquity and scale of data by helping researchers acquire, analyze, manage, and archive these resources. We have made serious strides toward becoming ‘the face of data services at U.Va.’ This article tells a bit of our story so far, relays some early challenges and how we've responded to them, outlines several initial successes, and summarizes a few lessons going forward.

Bayesian statistics for the calibration of the LISA Pathfinder experiment

The main goal of LISA Pathfinder (LPF) mission is to estimate the acceleration noise models of the overall LISA Technology Package (LTP) experiment on-board. This will be of crucial importance for the future space-based Gravitational-Wave (GW) detectors, like eLISA. Here, we present the Bayesian analysis framework to process the planned system identification experiments designed for that purpose. In particular, we focus on the analysis strategies to predict the accuracy of the parameters that describe the system in all degrees of freedom. The data sets were generated during the latest operational simulations organised by the data analysis team and this work is part of the LTPDA Matlab toolbox. A post-publication change was made to this article on 26 Jun 2020 to add an author.

In-flight thermal experiments for LISA Pathfinder: Simulating temperature noise at the Inertial Sensors

Thermal Diagnostics experiments to be carried out on board LISA Pathfinder (LPF) will yield a detailed characterisation of how temperature fluctuations affect the LTP (LISA Technology Package) instrument performance, a crucial information for future space based gravitational wave detectors as the proposed eLISA. Amongst them, the study of temperature gradient fluctuations around the test masses of the Inertial Sensors will provide as well information regarding the contribution of the Brownian noise, which is expected to limit the LTP sensitivity at frequencies close to 1 mHz during some LTP experiments. In this paper we report on how these kind of Thermal Diagnostics experiments were simulated in the last LPF Simulation Campaign (November, 2013) involving all the LPF Data Analysis team and using an end-to-end simulator of the whole spacecraft. Such simulation campaign was conducted under the framework of the preparation for LPF operations.

Effect of neonatal vitamin A supplementation on mortality in infants in Tanzania (Neovita): a randomised, double-blind, placebo-controlled trial

Supplementation of vitamin A in children aged 6-59 months improves child survival and is implemented as global policy. Studies of the efficacy of supplementation of infants in the neonatal period have inconsistent results. We aimed to assess the efficacy of oral supplementation with vitamin A given to infants in the first 3 days of life to reduce mortality between supplementation and 180 days (6 months). We did an individually randomised, double-blind, placebo-controlled trial of infants born in the Morogoro and Dar es Salaam regions of Tanzania. Women were identified during antenatal clinic visits or in the labour wards of public health facilities in Dar es Salaam. In Kilombero, Ulanga, and Kilosa districts, women were seen at home as part of the health and demographic surveillance system. Newborn infants were eligible for randomisation if they were able to feed orally and if the family intended to stay in the study area for at least 6 months. We randomly assigned infants to receive one dose of 50,000 IU of vitamin A or placebo in the first 3 days after birth. Infants were randomly assigned in blocks of 20, and investigators, participants' families, and data analysis teams were masked to treatment assignment. We assessed infants on day 1 and day 3 after dosing, as well as at 1, 3, 6, and 12 months after birth. The primary endpoint was mortality at 6 months, assessed by field interviews. The primary analysis included only children who were not lost to follow-up. This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12610000636055. Between Aug 26, 2010, and March 3, 2013, 31,999 newborn babies were randomly assigned to receive vitamin A (n=15,995) or placebo (n=16,004; 15,428 and 15,464 included in analysis of mortality at 6 months, respectively). We did not find any evidence for a beneficial effect of vitamin A supplementation on mortality in infants at 6 months (26 deaths per 1000 livebirths in vitamin A vs 24 deaths per 1000 livebirths in placebo group; risk ratio 1·10, 95% CI 0·95-1·26; p=0·193). There was no evidence of a differential effect for vitamin A supplementation on mortality by sex; risk ratio for mortality at 6 months for boys was 1·08 (0·90-1·29) and for girls was 1·12 (0·91-1·39). There was also no evidence of adverse effects of supplementation within 3 days of dosing. Neonatal vitamin A supplementation did not result in any immediate adverse events, but had no beneficial effect on survival in infants in Tanzania. These results strengthen the evidence against a global policy recommendation for neonatal vitamin A supplementation. Bill & Melinda Gates Foundation to WHO.

Efficacy of early neonatal supplementation with vitamin A to reduce mortality in infancy in Haryana, India (Neovita): a randomised, double-blind, placebo-controlled trial

Vitamin A supplementation in children aged 6 months to 5 years has been shown to reduce mortality. The efficacy of neonatal supplementation with vitamin A to reduce mortality in the first 6 months of life is plausible but not established. We aimed to assess the efficacy of neonatal oral supplementation with vitamin A to reduce mortality between supplementation and 6 months of age. We undertook an individually randomised, double-blind, placebo-controlled trial in Haryana, India. We identified pregnant women through a surveillance programme undertaken every 3 months of all female residents in two districts of Haryana, India, aged 15-49 years, and screened every identified livebirth. Eligible participants were neonates whose parents consented to participate, were likely to stay in the study area until at least 6 months of age, and were able to feed orally at the time of enrolment. Participants were randomly assigned to receive oral capsules containing vitamin A (retinol palmitate 50,000 IU plus vitamin E 9·5-12·6 IU) or placebo (vitamin E 9·5-12·6 IU) within 72 h of birth. Randomisation was in blocks of 20 according to a randomisation list prepared by a statistician not otherwise involved with the trial. Investigators, participants' families, and the data analysis team were masked to treatment allocation. The primary outcome was mortality between supplementation and 6 months of age. Analysis included all participants assigned to study groups. This trial is registered with ClinicalTrials.gov, number NCT01138449, and the Indian Council of Medical Research Clinical Trial Registry, number CTRI/2010/091/000220. Between June 24, 2010, and July 1, 2012 we screened 47,777 neonates and randomly assigned 44,984 to receive vitamin A (22,493) or placebo (22,491). Between supplementation and 6 months of age, 656 infants died in the vitamin A group compared with 726 in the placebo group (29·2 per 1000 vs 32·3 per 1000; difference -3·1 per 1000, 95% CI -6·3 to 0·1; risk ratio 0·90, 95% CI 0·81 to 1·00). We noted no significant interactions between the intervention effect and sex on mortality at 6 months (p=0·409). Supplementation with 50,000 IU vitamin A within the first 72 h of life was generally safe and well tolerated, with the exception of a small excess risk of transient bulging fontanelle (205 cases in the vitamin A group confirmed by physician vs 80 cases in the placebo group, risk ratio 2·56 [95% CI 1·98-3·32]). The findings of this study, done in a population in which vitamin A deficiency is a moderate public health problem, are consistent with a modest reduction in mortality between supplementation and 6 months of age. These findings must be viewed together with similar trials in other populations to enable determination of appropriate public health policy. Bill & Melinda Gates Foundation to WHO.