Methodological Considerations Research Articles

A consideration of racial/ethnic diversity conceptualization and measurement: Clarifying ambiguities and advancing scholarship

There has been little discussion of racial/ethnic diversity conceptualization and measurement in educational and psychological research. With the surge of research on school diversity and its significant social meaning, the lack of clarity on how diversity is conceptualized and operationalized warrants a systematic review. This article (1) reviews diversity concepts in the literature, (2) describes potential conceptual and methodological concerns, (3) proposes an alternative method to measure two specific types of diversity, and (4) highlights considerations for future research and methodology when studying diversity. More specifically, we conducted a systematic review to summarize the available measures that quantify diversity, mapped these measures onto existing diversity definitions, and elaborated on the similarities and differences of the existing diversity indices. Additionally, we proposed a new measure, the Frequentist-based Representative Diversity index, which can capture two different aspects of diversity, is easy to interpret, and potentially broadens the scope of diversity research. Future research directions and recommendations are also discussed.

Making the case for a new typology of dental care systems.

Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities.

Using the Progression Independent of Relapse Activity Framework to Unveil the Pathobiological Foundations of Multiple Sclerosis.

Progression independent of relapse activity (PIRA), a recent concept to formalize disability accrual in multiple sclerosis (MS) independent of relapses, has gained popularity as a potential clinical trial outcome. We discuss its shortcomings and appraise the challenges of implementing it in clinical settings, experimental trials, and research. The current definition of PIRA assumes that acute inflammation, which can manifest as a relapse, and neurodegeneration, manifesting as progressive disability accrual, can be disentangled by introducing specific time windows between the onset of relapses and the observed increase in disability. The term PIRMA (progression independent of relapse and MRI activity) was recently introduced to indicate disability accrual in the absence of both clinical relapses and new brain and spinal cord MRI lesions. Assessing PIRMA in clinical practice is highly challenging because it necessitates frequent clinical assessments and brain and spinal cord MRI scans. PIRA is commonly assessed using Expanded Disability Status Scale, a scale heavily weighted toward motor disability, whereas a more granular assessment of disability deterioration, including cognitive decline, using composite measures or other tools, such as digital tools, would possess greater utility. Similarly, using PIRA as an outcome measure in randomized clinical trials is also challenging and requires methodological considerations. The underpinning pathobiology of disability accumulation, that is not associated with relapses, may encompass chronic active lesions (slowly expanding lesions and paramagnetic rim lesions), cortical lesions, brain and spinal cord atrophy, particularly in the gray matter, diffuse and focal microglial activation, persistent leptomeningeal enhancement, and white matter tract damage. We propose to use PIRA to understand the main determinant of disability accrual in observational, cohort studies, where regular MRI scans are not included, and introduce the term of "advanced-PIRMA" to investigate the contributions to disability accrual of the abovementioned processes, using conventional and advanced imaging. This is supported by the knowledge that MRI reflects the MS pathogenic mechanisms better than purely clinical descriptors. Any residual disability accrual, which remains unexplained after considering all these mechanisms with imaging, will highlight future research priorities to help complete our understanding of MS pathogenesis.

Methodological and Statistical Considerations for Cross-Sectional, Case-Control, and Cohort Studies.

Epidemiological studies are essential in medicine and public health as they help identify risk factors and causes of diseases. Additionally, they are key to planning, implementing, and evaluating health interventions aimed at preventing and controlling the spread of diseases. Among these studies, analytical observational studies, such as cross-sectional, case-control, and cohort studies, are the most used. The validity of their results largely depends on the robustness of the design, execution, and statistical analysis. Objective: The objective of this study is to examine the most common errors in the selection of methodological design and statistical tests in analytical observational studies and to provide recommendations to correct them. Methodology: A comprehensive review of the available literature on methodology in epidemiological observational studies was conducted, focusing on cross-sectional, case-control, and cohort studies. Common errors in the selection of designs and statistical tests were identified and analyzed. Results and Conclusions: Errors in the selection of methodological design and statistical tests are common in epidemiological observational studies. Based on the identified errors, a series of recommendations is provided to improve the selection of methodological design and statistical tests, thereby increasing the reliability of the results in cross-sectional, case-control, and cohort studies.

Methodological and interpretative considerations in the study of the first Kyasanur Forest disease outbreak in Goa, India.

Methodological and interpretative considerations in the study of the first Kyasanur Forest disease outbreak in Goa, India.

Prenatal Social Determinants of Health: Narrative review of maternal environments and neonatal brain development.

The Social Determinants of Health, a set of social factors including socioeconomic status, community context, and neighborhood safety among others, are well-known predictors of mental and physical health across the lifespan. Recent research has begun to establish the importance of these social factors at the earliest points of brain development, including during the prenatal period. Prenatal socioeconomic status, perceived stress, and neighborhood safety have all been reported to impact neonatal brain structure and function, with exploratory work suggesting subsequent effects on infant and child behavior. Secondary effects of the Social Determinants of Health, such as maternal sleep and psychopathology during pregnancy, have also been established as important predictors of infant brain development. This research not only establishes prenatal Social Determinants of Health as important predictors of future outcomes but may be effectively applied even before birth. Future research replicating and extending the effects in this nascent literature has great potential to produce more specific and mechanistic understanding of the social factors that shape early neurobehavioral development. IMPACT: This review synthesizes the research to date examining the effects of the Social Determinants of Health during the prenatal period and neonatal brain outcomes. Structural, functional, and diffusion-based imaging methodologies are included along with the limited literature assessing subsequent infant behavior. The degree to which results converge between studies is discussed, in combination with the methodological and sampling considerations that may contribute to divergence in study results. Several future directions are identified, including new theoretical approaches to assessing the impact of the Social Determinants of Health during the perinatal period.

Transitions from primary to secondary school in Greater Manchester: A qualitative exploration of the perspectives of Year 6 children who receive pupil premium funding

AbstractPrimary–secondary school transitions are widely recognised as pivotal developmental periods, which can have positive and negative longitudinal implications on the education, wellbeing and mental health of children. Yet few studies have sought the voice of children through interviews, and especially children in receipt of pupil premium funding (PPF) (a government grant given to schools in England to support disadvantaged pupils from low socio‐economic status [SES] backgrounds). This is concerning, given that children who receive PPF are at greater risk of poorer academic, social and emotional outcomes and exclusion during this time. Our study aims to explore the perspectives of such children to better understand their lived experience of primary–secondary school transitions. The sample consisted of nine Year 6 (last year of primary school in England) children who received PPF, recruited from two schools in Greater Manchester. The children participated in semi‐structured Zoom interviews. Transcribed audio‐recordings were analysed using reflexive thematic analysis. The children discussed a mixture of contrasting feelings towards the emotional, social, academic and practical aspects of primary–secondary school transitions. In addition, children highlighted the supportive value of having older siblings, cousins and friends already at secondary school and discussed the range of support that had been offered by their schools and how this could be improved. The study makes a unique empirical contribution to understanding the lived experiences of children in receipt of PPF leading up to primary–secondary school transitions. In doing so, we make a unique theoretical contribution to multiple and multi‐dimensional transitions theory in exploring the impact of wider social factors, such as SES, on primary–secondary school transitions experiences. This understanding has important implications for educational policy and practice, in addition to further research, especially given the methodological, theoretical and conceptual considerations discussed.

Comment on: influence of the time-task constraint on ocular metrics of semi-elite soccer

ABSTRACT This letter offers a constructive review of the article ‘Influence of the time-task constraint on ocular metrics of semi-elite soccer’ by Luis-del Campo et al. (2023), focusing on methodological considerations and avenues for future research enhancement. The study investigates the impact of task constraints on eye-tracking metrics among semi-elite soccer players, aiming to gauge mental workload during training sessions. While the study presents valuable insights, there are opportunities for methodological refinement. Suggestions include emphasizing sample size determination, randomization of the experimental conditions, and employing robust statistical analyses to mitigate potential biases. Moreover, future studies could benefit from integrating external load measures alongside heart rate monitoring to comprehensively assess training task variations. Despite these considerations, the study underscores the promising application of eye-tracking techniques in evaluating mental workload during soccer training, paving the way for further exploration and refinement of methodologies to enhance player performance assessment and training optimization in the field.

Exposure to Noise or Music in Clinical Trials: A Scoping Review on Ethical and Methodological Considerations.

Use of noise or music in experimental human studies requires balancing the need to avoid subjecting participants to potentially harmful noise levels while still reaching levels that will produce a measurable change in the primary outcome. Several methodological and ethical aspects must be considered. This study aims to summarize ethical and methodological aspects, and reported outcomes, of previously published experimental paradigms using loud noise/music. Four databases (Medline, Central, Web of Science, and Scopus) and two trials registries (Clinicaltrials.gov and EU Clinical Trials) were searched. Extracted items had the details of author and year of publication, study design and purpose, population, setting timeline and material, selected battery test, and effect of noise/music on participants' hearing. Thirty-four studies were included. Exposure safety considerations were reported in five studies. Eleven studies assessing hearing loss used white or narrow-band noise [(NBN (0.5-4 kHz), up to 115 dBA, duration range: 3'-24 hours)], and 10 used pop music (up to 106 dBA, duration range: 10'-4 hours). Experimental setting varied significantly. Temporary thresholds shift (TTS) and reduction in distortion product otoacoustic emissions were found at 1-8 kHz, with maximum average TTS∼21.5 dB at 4 kHz after NBN and ∼11.5 dB at 6 kHz after music exposure. All participants recovered their hearing, except for one participant in one study. In the 13 non-hearing loss studies, no hearing testing was performed after exposure, but loud noise was associated with temporary stress, bradygastria, and cardiovascular changes. Noise-induced subjective stress may be higher for participants with tinnitus. Loud noise (100 dBA, 10') increased diastolic and mean blood pressure only in participants with hypertension. Experimental exposure paradigms can produce temporary changes to hearing without measurable long-term health consequences. Methodological and ethical aspects identified in this review should be considered for the development of future paradigms.

Navigating Disease Management: A Comprehensive Review of the De Ritis Ratio in Clinical Medicine.

The De Ritis ratio, defined as the serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, is a widely recognized biochemical marker with significant applications in diagnosing and managing various diseases, particularly liver disorders. This comprehensive review synthesizes current knowledge surrounding the clinical relevance of the De Ritis ratio, examining its historical development, diagnostic utility, and prognostic significance across various medical conditions, including liver diseases, cardiovascular disorders, and muscular pathologies. Through an in-depth analysis of literature spanning several decades, this review highlights the role of the De Ritis ratio not only in differential diagnosis but also as a prognostic indicator for disease progression and patient outcomes. The ratio's ability to distinguish between different types of liver pathology, aid in early disease detection, and its potential use in monitoring treatment response are discussed. Additionally, the review addresses the methodological considerations, such as confounding factors and interpretation challenges, that impact the clinical utility of the De Ritis ratio. Given the evolving landscape of clinical diagnostics and the push toward more personalized medicine, the review concludes with recommendations for further research. These include longitudinal studies to explore the ratio's changes over time, comparative research across diverse populations, and technological integration to enhance diagnostic accuracy and patient care. This review aims to reaffirm the importance of the De Ritis ratio in modern clinical practice and encourages continued exploration into its potential applications and benefits in healthcare.

Informing the United States Medicare Drug Price Negotiation for Apixaban and Rivaroxaban: Methodological Considerations for Value Assessments Many Years After Launch

ObjectivesTo demonstrate how health technology assessment methods can be used to support Medicare’s price negotiations for apixaban and rivaroxaban. MethodsFollowing the statutory outline of evidence that will be considered by Medicare, we conducted a systematic literature review, network meta-analyses, and decision analyses to evaluate the health outcomes and costs associated with apixaban and rivaroxaban compared with warfarin and dabigatran for patients with nonvalvular atrial fibrillation. Our methods inform discussions about the therapeutic impact of apixaban and rivaroxaban and suggest price premiums above their therapeutic alternatives over a range of cost-effectiveness thresholds. ResultsNetwork meta-analyses found apixaban resulted in a lower risk of major bleeding compared with warfarin and dabigatran and a lower risk of stroke/systemic embolism compared with warfarin but not compared with dabigatran. Rivaroxaban resulted in a lower risk of stroke/systemic embolism versus warfarin but not dabigatran, and there was no difference in major bleeding. Decision-analytic modeling of apixaban suggested annual price premiums up to $4350 above the price of warfarin and up to $530 above the price for dabigatran at cost-effectiveness thresholds up to $200 000 per equal value of life-years gained. Analyses of rivaroxaban showed an annual price premium of up to $3920 above warfarin and no premium above that paid for dabigatran. ConclusionsAlthough health technology assessment is typically performed near the time of regulatory approval, with modifications, we produced comparative clinical and relative cost-effectiveness findings to help guide negotiations on a “fair” price for drugs on the market for over a decade.

Brain hemodynamics in septic patients.

Brain dysfunction is a frequent complication of sepsis. Most likely, sepsis-associated brain dysfunction (SABD) results from the interaction between multiple factors: neurodegeneration due to microglial activation, altered neurotransmission, neuroinflammation and impairment of cerebral macro- and microcirculation. Altered brain perfusion might results from several mechanism: global or regional alterations in cerebral blood flow (CBF); reduced cerebral perfusion pressure - which is the driving force propelling blood through cerebral blood vessels - due to systemic hypotension; global or regional vasoconstriction; dysfunction of the intrinsic regulatory mechanisms of CBF, such as cerebral autoregulation and cerebrovascular reactivity; endothelial and blood-brain barrier dysfunction; autonomic nervous system dysfunction and metabolic uncoupling. Disorders of brain perfusion and CBF regulation are frequently observed in humans with sepsis, and intracranial hemodynamics monitoring can potentially be useful in clinical management of septic patients. The aim of this review is to provide an update of the current knowledge on alterations in brain hemodynamics associated with sepsis, along with physiological and methodological considerations intended to help the reader navigate the diverse results from published literature and a practical guide to apply non-invasive intracranial hemodynamics monitoring to septic patients in clinical practice.

Malpresentation and autism spectrum disorder in the study to explore early development: Methodological challenges and considerations.

Malpresentation and autism spectrum disorder in the study to explore early development: Methodological challenges and considerations.

Comparative evaluation of spatiotemporal variations of surface water quality using water quality indices and GIS

AbstractThere is a need for a comprehensive comparative analysis of spatiotemporal variations in surface water quality, particularly in regions facing multiple pollution sources. While previous research has explored the use of individual water quality indices (WQIs), there is limited understanding of how different WQIs perform in assessing water quality dynamics in complex environmental settings. The objective of this study is to evaluate the effectiveness of three WQIs (Canadian Council of Ministers of the Environment (CCME), National Sanitation Foundation (NSF) and System for Evaluation of the Quality of rivers (SEQ-Eau) and a national water quality regulation in assessing water quality dynamics. The pilot study area is the Acısu Creek in Antalya City of Turkey, where agricultural practices and discharge of treated wastewater effluents impair the water quality. A year-long intensive monitoring study was conducted includig on-site measurements, analysis of numerous physicochemical and bacteriological parameters. The CCME and SEQ-Eau indices classified water quality as excellent/good at the upstream, gradually deteriorating to very poor downstream, showing a strong correlation. However, the NSF index displayed less accuracy in evaluating water quality for certain monitoring stations/sessions due to eclipsing and rigidity problems. The regulatory approach, which categorized water quality as either moderate or good for different sampling sessions/stations, was also found less accurate. The novelty of this study lies in its holistic approach to identify methodological considerations that influence the performance of WQIs. Incorporating statistical analysis, artificial intelligence or multi-criteria decision-making methods into WQIs is recommended for enhanced surface water quality assessment and management strategies.

Making Sense of Legitimacy Across Universities: Ecocritical Ontological Perspective

This paper reflects on research methodological considerations of how legitimacy of publicly funded universitiesoccurs. From an ecocritical ontological perspective the paper uses a metaphor and sense-making techniques to shed light into effective modalities universities use to connect with local economies. The Milky way Galactic ecosystem metaphor is used not only to make sense of the ecocritical ontological stance taken to make sense of legitimacy but is used as a metaphor to make sense of the findings. The paper asserts that the legitimacy theoretical lens is particularly appropriate to probe universities’ legitimacy and connectedness to the local communities they are embedded in. The rationale behind this assertion is that legitimacy is only conferred to the extent the actions of an entity are perceived as desirable, efficient, proper, or appropriate by the ecosystem stakeholders. The theory is thus useful for examining connectedness of publicly funded universities to its local community. The paper argues that the university system that is delinked from local economic development is like a Milky way Galaxy delinked from its Galactic ecosystem. Against this backdrop, the paper juxtaposes Mondragon University, located in a rural part of Northern Spain with two South African universities embedded in poverty stricken rural South Africa. Mondragon University is presented as a hallmark of success when it comes to local community legitimacy. The paper is centered around the following question: (1) how does university legitimacy yield impactful local community outcomes? Using the Milky way Galaxy metaphor, the findings show a considerable variety in local community connectedness depending on bureaucratic arrangements of the universities. The findings also showed that alternative income sources, outside the public purse, just like the gravitational force in the galactic ecosystem, is the key force that determines legitimacy in a university setting. The paper contributes to business research methods by fusing metaphorical as well as sense-making research techniques to bring to sharp focus permeability of the university space to enable local economic development.

A Systematic Review on Education Outside the Classroom: Lessons for Science EOC Practices

The United Nations’ sustainable development goals highlight the importance of embracing our natural environment through action in education. In science education, it is therefore important to enhance our understanding of pedagogical approaches that promote Education Outside the Classroom (EOC). The aim of this systematic review is to investigate EOC methods and pedagogies and examine how they can help inform students’ acquisition of scientific knowledge and skills. In total, 157 full texts were read and considered for inclusion in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The final review included 49 empirical studies that examined EOC research between 2012 and 2021 across all disciplines. Positive outcomes are reported regarding student learning, motivation, and enjoyment, which highlight the benefits and rationale for adopting such approaches to support learning. However, a lack of longitudinal data was evident regarding the impact of the EOC experiences. This review shows that the pedagogical models underpinning the approaches to EOC were not always explicit or clearly stated. In terms of the methodological considerations, a number of gaps emerged in relation to the reporting of geographical and gender differences. We offer recommendations to implement EOC in science education and suggest areas for future research.

Facebook recruitment: understanding research relations Prior to data collection

ABSTRACT This article considers the multiple relations that emerge from and between Facebook commenters, as well as between commenters, researchers, and the research project during recruitment. To do so, we draw on our experiences of recruiting individuals who have concerns about or are opposed to a range of recent social and legal changes in ‘post-equality’ contexts. Understanding research as co-created rather than ‘collecting data from’ participants, we consider the researcher, commenters, and Facebook technologies as active agents, and ask how the emergent relationalities between these agents shapes the social media recruitment process. We develop thinking regarding these relationalities through an in-depth exploration of our processes that reveal key methodological considerations relevant to social media recruitment in the social sciences. As the process of recruitment is mutually constructed online through multiple relationalities across researcher/project and commenter, as well as between commenters themselves, we conclude that there is a need for dynamic, iterative, and reflexive responses and engagements rather than pre-defined frameworks.

Improving retrospective intervention descriptions: Lessons learned from research on type 2 diabetes programmes in the United Kingdom and the Republic of Ireland.

In recent years, multiple countries worldwide have implemented behavioural interventions within national healthcare systems. Describing the content of these interventions is critical to improve their implementation, replication, and effectiveness, as well as to advance behavioural science. Tools, such as the Behaviour Change Technique Taxonomy, can enhance the quality of intervention description and reporting. As interventions are frequently developed without the use of such tools, retrospective coding of existing interventions to accurately characterise their content is becoming more common. However, the use of these tools for retrospective coding poses various challenges, the discussion of which has been neglected to date. This commentary discusses the challenges encountered when retrospectively describing the content of five nationally implemented programmes for type 2 diabetes in the United Kingdom and the Republic of Ireland and suggests recommendations to tackle these challenges. We present important methodological, practical, and ethical considerations for researchers to reflect on, relevant to the retrospective description of existing interventions. Specifically, we discuss (i) the importance of positive relationships and collaboration with intervention stakeholders, (ii) the practical and ethical considerations when analysing the content of implemented interventions, (iii) the independence of research teams and the potential for misclassification of intervention content, and (iv) the challenges associated with the analysis of intervention content using behavioural science tools. There is a growing demand for more robust approaches to address the methodological, practical, and ethical challenges associated with such studies. The present commentary describes key issues to be considered by research teams, as well as concrete recommendations to improve the retrospective characterisation of intervention content.

Medication management in long-term care: using evidence generated from real-world data to effect policy change in the Australian setting.

Older individuals residing in long-term care facilities (LTCFs) are often living with multimorbidity and exposed to polypharmacy, and many experience medication-related problems. Because randomized controlled trials seldom include individuals in LTCFs, pharmacoepidemiological studies using real-world data are essential sources of new knowledge on the utilization, safety and effectiveness of pharmacotherapies and related health outcomes in this population. In this commentary, we discuss recent pharmacoepidemiological research undertaken to support the investigations and recommendations of a landmark public inquiry into the quality and safety of care provided in the approximately 3,000 Australian LTCFs which house over 240,000 residents annually and informed subsequent national medication-related policy reforms. Suitable sources of real-world data for pharmacoepidemiological studies in long-term care cohorts and methodological considerations are also discussed.

Child Telomere Length at 11–12 Years of Age Is Not Associated with Pregnancy Complications

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings.