Multifactorial Framework Research Articles

A toolbox for surfacing health equity harms and biases in large language models.

Large language models (LLMs) hold promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. We present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and conduct a large-scale empirical case study with the Med-PaLM 2 LLM. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases and EquityMedQA, a collection of seven datasets enriched for adversarial queries. Both our human assessment framework and our dataset design process are grounded in an iterative participatory approach and review of Med-PaLM 2 answers. Through our empirical study, we find that our approach surfaces biases that may be missed by narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. While our approach is not sufficient to holistically assess whether the deployment of an artificial intelligence (AI) system promotes equitable health outcomes, we hope that it can be leveraged and built upon toward a shared goal of LLMs that promote accessible and equitable healthcare.

Evidence-based Ultrasound Education? - A Systematic Literature Review of Undergraduate Ultrasound Training Studies.

Despite a large number of studies previously conducted on educational concepts of ultrasound teaching in medical school, various controversial issues remain. Currently, recommendations for ultrasound curricula that aim to standardize ultrasound teaching are frequently based on expert panel advice instead of relying on valid evidence-based literature. In December 2022, a systematic literature review on the subject of undergraduate ultrasound education was conducted. All ultrasound studies listed in the PubMed and Google Scholar medical databases were filtered and analyzed with respect to various aspects of their methodological conduct and curricular implementation. A total of 259 publications were considered in the data synthesis, including 145 teaching studies in the field of undergraduate ultrasound education. The latter encompassed 58 (40%) studies that did not compare their ultrasound training to a control group. Furthermore, 84 (58%) of these studies did not assess knowledge prior to the applied ultrasound training, neglecting this factor's potential influence on study outcomes. Despite a great interest in the development and further implementation of ultrasound education during medical school, this process is still compromised by significant deficiencies in studies that have been conducted in the past. In order to provide a valid basis for curricular decisions, teaching studies should fulfill essential methodological requirements despite the multifactorial framework in which they are conducted. In the future, a guide for the design of ultrasound studies could be a useful aid for ultrasound enthusiasts and promote scientific knowledge gain.

Towards a multifactorial framework of the Roma’s victimisation: Discrimination, risky situations, and acceptance of violence as correlates of physical assault and harassment

The European Roma population faces violence and discrimination, but the causes of their victimisation are not well understood. This study used a multi-theoretical framework to analyse data from a representative sample of 2,913 Roma surveyed in European Union Minorities and Discrimination Survey II. The results showed that police stops perceived as ethnically motivated, exposure to risky situations, and acceptance of violence when insulted predicted physical victimisation and harassment. To reduce victimisation, recommendations include sensitising police officers, diverse police patrols, crime-reduction measures in neighbourhoods, and education on nonviolent communication. Further research is needed to understand other forms of victimisation among the Roma. The study highlights the usefulness of testing multiple risk factors from different criminological theories to address victimisation of the Roma ethnic minority.

Decision variable classification based multi-objective multifactorial memetic algorithm for multi-objective multi-task optimization problem

Multi-task multi-objective optimization problems need to consider the algorithm's convergence and the population's diversity. The information transfer of decision variables with different characteristics may harm the effect of knowledge reuse. This paper proposes a novel hybrid multi-objective multifactorial memetic algorithm to address this issue. The proposed variable classification method will classify decision variables into convergence-related and diversity-related decision variables. Only the same type of decision variables in the source and target tasks can transfer information to avoid negative transfer. Different evolutionary operators are adopted according to the characteristics of decision variables during individual recombination. In addition, the proposed algorithm hybridizes the immune algorithm as the global evolutionary operator and the evolutionary gradient search algorithm as the local search operator into the multifactorial framework to enhance the searching ability. Finally, the proposed algorithm is compared with the state-of-the-art multi-objective evolutionary multitasking algorithms. The results of the experiments show that the proposed algorithm can achieve promising performance on the classical and complex multi-task multi-objective benchmark test suites.

Psychological Resilience-Based Multifactorial Framework of Expatriate Adjustment.

Expatriates are facing more stressors, such as cross-cultural adjustment, global political instability, family separation, health concern. The black swan events of the pandemic and the Russian-Ukrainian war have posed significant challenges in the current international environment. Adapting to an expatriate environment as soon as possible is critical to expatriate success. This study aims to examine the factors that affect expatriate adjustment through psychological resilience. Guided by person-environment (p-e) fit theory, an expatriate adjustment framework based on psychological resilience is proposed, and 309 valid sample data are used for structural equation model (SEM) analysis. The results show that expatriate adjustment is a psychological process based on the development of resilience. Social support plays a buffering role in dealing with environmental deviations induced stressors. The person-environment transactional process is the most critical adjustment process. The development of expatriate adjustment is divided into four stages (shock, buffer, adjustment, mastery) consistent with resilience development. Project managers can take different expatriate management strategies from multiple aspects. Finally, this study proposes the U-curve hypothesis of expatriates' psychological resilience development aligned with the U-curve process of expatriate adjustment for future research.

A multifactorial framework of psychobehavioral determinants of coping behaviors: an online survey at the early stage of the COVID-19 pandemic.

Coronavirus disease 2019 dramatically changed people's behavior because of the need to adhere to infection prevention and to overcome general adversity resulting from the implementation of infection prevention measures. However, coping behavior has not been fully distinguished from risk perception, and a comprehensive picture of demographic, risk-perception, and psychobehavioral factors that influence the major coping-behavior factors remain to be elucidated. In this study, we recruited 2,885 Japanese participants. Major coping-behavior and risk-perception factors were identified via exploratory factor analysis of 50 candidate items. Then, we conducted a hierarchical multiple regression analysis to investigate factors associated with each coping-behavior factor. We identified four types of coping behavior [CB1 (mask-wearing), CB2 (information-seeking), CB3 (resistance to social stagnation), and CB4 (infection-prevention)] and three risk-perception factors [RP1 (shortages of daily necessities), RP2 (medical concerns), and RP3 (socioeconomic concerns)]. CB1 was positively associated with female sex and etiquette. CB2 was positively related to RP1 and RP3. CB3 was positively related to RP1 and leadership, and negatively associated with etiquette. CB4 was positively associated with female sex, etiquette, and active well-being. This parsimonious model may help to elucidate essential social dynamics and provide a theoretical framework for coping behavior during a pandemic.

Social Justice and Equity: Why Older Adults With Cancer Belong-A Life Course Perspective.

The population of older adults with cancer in the United States is rapidly increasing, which will have a substantial impact on the oncology and public health workforces across the cancer continuum, from prevention to end of life. Unfortunately, inequities in existing social structures that cause increased psychosocial stressors have led to disparities in the incidence of cancer and the morbidity and mortality of cancer for individuals from marginalized backgrounds. It is imperative that older adults, especially those from historically marginalized backgrounds, be adequately represented in all stages of cancer research to address health inequities. Continued efforts and progress toward achieving social justice and health equity require a deeper commitment to and better understanding of the impact of social determinants of health within the cancer domain. Undoubtedly, a more holistic and integrated view that extends beyond the biologic and genetic factors of health must be adopted for health entities to recognize the critical role of environmental, behavioral, and social determinants in cancer health disparities. Against this backdrop, this paper uses a life course approach to present a multifactorial framework for understanding and addressing cancer disparities in an effort to advance social justice and health equity for racially and ethnically diverse older adults.

Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review.

Delayed cerebral ischemia is a major predictor of poor outcomes in patients who suffer subarachnoid hemorrhage. Treatment options are limited and often ineffective despite many years of investigation and clinical trials. Modern advances in basic science have produced a much more complex, multifactorial framework in which delayed cerebral ischemia is better understood and novel treatments can be developed. Leveraging this knowledge to improve outcomes, however, depends on a holistic understanding of the disease process. We conducted a review of the literature to analyze the current state of investigation into delayed cerebral ischemia with emphasis on the major themes that have emerged over the past decades. Specifically, we discuss microcirculatory dysfunction, glymphatic impairment, inflammation, and neuroelectric disruption as pathological factors in addition to the canonical focus on cerebral vasospasm. This review intends to give clinicians and researchers a summary of the foundations of delayed cerebral ischemia pathophysiology while also underscoring the interactions and interdependencies between pathological factors. Through this overview, we also highlight the advances in translational studies and potential future therapeutic opportunities.

3D modelling of tibial plateau fractures: Variability in fracture location and characteristics across Schatzker fracture types

IntroductionNumerous classifications have been developed to assess tibial plateau fractures (TPF). Of these, the Schatzker system is the most widely reported in the literature yet this system is limited in its characterisation of morphological fracture features underlying the fracture location. The purpose of this study was to compare 3D morphological features of TPFs across different Schatzker types. MethodsThis study retrospectively analysed preoperative TPF imaging data to reconstruct 3D models of the fractures. Ninety-one fractures (29 female, 62 male) were analysed and classified using Schatzker. Fracture location across Schatzker types was compared based on division of the articular surface into six ‘zones’. Additionally, morphological characteristics of the fractures were compared based on fracture type, including; the number, volume and shape of the fragments. ResultsSchatzker II, IV and VI fractures were most common, making up 41%, 16% and 20%, respectively. Type II fractures commonly involved both the lateral and central aspect of the tibial plateau, similarly, type IV fractures incorporated the lateral condyle in most cases. Considering the morphological metrics, statistically significant differences were observed between Schatzker types for the number of; total, articular, cortical and volumetrically significant (all P < 0.001) fragments along with the volume of both primary (P < 0.001) and secondary (P = 0.02) fragments. DiscussionAssessment of underlying fracture characteristics in addition to fracture location can serve to provide greater detail relating to fracture morphology, which has the potential to assist with both surgical decision making and assessment of postoperative outcomes. Incorporating this information as part of a hierarchical or multifactorial framework for classifying fractures may help distinguish subtle differences between fracture types that are classifiable using the most current systems.

Regulation of Vessel Permeability by TRP Channels.

The vascular endothelium constitutes a semi-permeable barrier between blood and interstitial fluids. Since an augmented endothelial permeability is often associated to pathological states, understanding the molecular basis for its regulation is a crucial biomedical and clinical challenge. This review focuses on the processes controlling paracellular permeability that is the permeation of fluids between adjacent endothelial cells (ECs). Cytosolic calcium changes are often detected as early events preceding the alteration of the endothelial barrier (EB) function. For this reason, great interest has been devoted in the last decades to unveil the molecular mechanisms underlying calcium fluxes and their functional relationship with vessel permeability. Beyond the dicotomic classification between store-dependent and independent calcium entry at the plasma membrane level, the search for the molecular components of the related calcium-permeable channels revealed a difficult task for intrinsic and technical limitations. The contribution of redundant channel-forming proteins including members of TRP superfamily and Orai1, together with the very complex intracellular modulatory pathways, displays a huge variability among tissues and along the vascular tree. Moreover, calcium-independent events could significantly concur to the regulation of vascular permeability in an intricate and fascinating multifactorial framework.

Climate change and gender-based health disparities

Climate change and gender-based health disparities

Examining discrimination in everyday life: a stated choice experiment on racism in the sharing economy

ABSTRACT Prejudice and discrimination in everyday life are persistent problems for most societies but difficult to uncover and explain by empirical social research. Complementing existing approaches to study discrimination, we demonstrate the usefulness of survey-based stated choice experiments to explore everyday discrimination and its heterogeneity within a multifactorial framework. In our study German respondents (n = 766) were asked to choose between various carpooling offers varying not only in regard to price, car type, and rating but also to the perceived ethnic background of the driver. Random parameter logit models show preference heterogeneity in the sample and that differences in choice behaviour related to perceived ethnic background of the driver can be explained by xenophobic attitudes and lack of regular contact with perceived ‘foreigners’. We find no indication that familiarity with the situation reduces discriminatory preferences. Our survey-based approach adds to existing research by experimentally singling out main and interactions effects of discriminatory attributes and by being able to determine the correlation between personal characteristics of the decision makers and their discriminatory preferences.

A Multifactorial Framework for Short-Term Load Forecasting System as Well as the Jinan’s Case Study

Accurate and reliable short-term electric load forecasting (STLF) plays a critical role in power system to enhance its routine management efficiency and reduce operational costs. However, most of the existing STLF methods suffer from lack of appropriate feature selection procedure. In this paper, a multifactorial framework (MF) possessing the potential to contribute more satisfactory forecasting results and computational speed is proposed. Moreover, a graphical tool for easy and accurate computation of day-ahead load forecast is implemented via MATLAB App Designer. Firstly, we choose the candidate feature set by analyzing the raw electricity consumption data. Then, partial mutual information is adopted as criterion to eliminate these irrelevant and redundant ones among candidate features for the purpose of reducing the input subset and retaining these most relevant. At last, the selected features are used as the input of the well-established artificial neural network (ANN) model optimized by genetic algorithm and cross validation to implement prediction. The MF is applied for the load data measured from 2016 to 2018 in Jinan, and then some competitive experiments and extensive simulations are carried out and results indicates that the ANN-based model with selected features significantly outperforms other alternative models with single features or a few of features regarding mean absolute percent error. In addition, the parallel structure of ANN and the lower dimension of the input space enable the model to achieve faster calculation speed.

Risk Factors of Childhood and Maternal Anemia in India.

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. We analyzed a sample of 112,714 mothers aged 15 to 49 years and their children younger than 5 years from the 2005–2006 Indian National Fertility and Health Survey with available data on anemia to determine the anemia statuses and risk factors associated with maternal and childhood anemia. Logistic regression analyses were used to determine factors associated with anemia. The overall prevalence of maternal anemia was 52.0%, while the overall prevalence of childhood anemia was 66.7%. Predictors of maternal anemia are a young age ( p &lt; .001), maternal health practices ( p &lt; .001), and reproductive health-related infections ( p &lt; .001), among others. On the other hand, predictors of childhood anemia included iron deficiency ( p = .007), vitamin deficiency ( p = .003), and common infections ( p = .008). Other predictors of childhood anemia included poor dietary intake ( p &lt; .01) and childcare practices ( p &lt; .001). Childcare practice has the strongest association with childhood anemia with an odds ratio of 1.67 (95% confidence interval [1.55, 1.79]). With respect to maternal anemia, the strongest risk factor was being infected with reproductive health infections with an odds ratio of 1.157 (95% confidence interval [1.11, 1.21]). Interventions designed to address prevalence of childhood and maternal anemia in India should take the risk factors in a holistic manner. A multifactorial framework should guide such interventions.

Salivary cortisol levels and biological rhythm in schoolchildren with sleep bruxism

ObjectiveSalivary cortisol levels and biological rhythms could be hypothesized as part of the multifactorial framework that explains bruxism etiology. The objective of this study was to examine salivary cortisol levels and biological rhythms in schoolchildren with sleep bruxism (SB). MethodsThis is a cross-sectional study with a school-based sample. The Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K) was used to evaluate biological rhythms. Salivary samples were collected by the spitting method. The salivary cortisol level was measured by electrochemiluminescence. The criteria proposed by the American Academy of Sleep Medicine (AASM) were used to evaluate SB. ResultsThe SB prevalence was 16%. The SB presence was associated with belonging to families of lower economic status (p = 0.003). In addition, children with SB showed greater difficulty in maintaining biological rhythm (p = 0.002) and had higher levels of salivary cortisol (p = 0.034) compared with children without SB. ConclusionsHigher levels of cortisol and disruption of biological rhythm was associated with SB in schoolchildren.

Corporate Social Responsibility Drivers and Barriers According to Managers’ Perception; Evidence from Spanish Firms

Corporate Social Responsibility (CSR) is becoming a dominant issue in both research and practice of management. However, the underlying processes in the relationship between the degree of development of CSR in companies and the drivers/barriers that determine this development are still at the center of an intense debate. The purpose of this empirical study is to examine these relationships. We investigate a sample of 416 Spanish firms; based on a multifactorial framework, our study considers both the subjective and objective drivers/barriers, analyzing their joint effect on the final degree of sustainability. A structural equation model is established and a Bayesian approach is used, enabling exact inferences about the model’s parameters and handling missing data with random imputation, thus increasing the study’s reliability. The results show that this degree is related to what managers believe CSR to be (subjective drivers/barriers) and what managers expect it to accomplish or outcomes (objective drivers/barriers).

Enhanced recovery protocols in total joint arthroplasty: a review of the literature and their implementation.

During recent years, there has been an exponential demand for joint arthroplasty, which has coincided with the global economic recession. In response, the management of patients following arthroplasty is continuously evolving, with the average inpatient length of stay decreasing from weeks to days, and more recently, we have witnessed the development of "outpatient arthroplasty" as a novel concept which aims to address the high volume of patients. The reduction in length of stay has been made possible via implementation of "enhanced recovery programmes" encompassing each stage of the patient journey. Such programmes have aimed to maximise efficiency, whilst maintaining patient satisfaction and achieving exceptional functional outcomes. We have undertaken a thorough review the literature in relation to enhanced recovery programmes (ERPs) and the research that has underpinned individual elements of enhanced recovery. A literature search of enhanced recovery protocols was carried out using PubMed, Cochrane, Embase and OVID. No language restrictions were imposed on the search. ERPs represent a multifactorial framework which may be subdivided into several phases. Pre-operative education programmes, outpatient consultation, pre-anaesthetic assessment, pre-procedural physiotherapy, day-of-surgery admission, pre-operative medications, type of anaesthesia, blood loss reduction protocols, multimodal analgesia delivery, day-of-surgery mobilisation, thromboembolic prophylaxis and ongoing rehabilitation are essential in enhanced recovery. These successful strategies have streamlined the patient pathway of arthroplasty surgery in a cost-effective manner, whilst reducing length of hospital stay and maintaining patient outcomes. Further studies are required to appropriately quantify the impact of individual variables and development of an internationally agreed ERP.

A Practical Methodology for Disaggregating the Drivers of Drug Costs Using Administrative Data.

Prescription drug expenditures represent a significant component of health care costs in Canada, with estimates of $28.8 billion spent in 2014. Identifying the major cost drivers and the effect they have on prescription drug expenditures allows policy makers and researchers to interpret current cost pressures and anticipate future expenditure levels. To identify the major drivers of prescription drug costs and to develop a methodology to disaggregate the impact of each of the individual drivers. The methodology proposed in this study uses the Laspeyres approach for cost decomposition. This approach isolates the effect of the change in a specific factor (e.g., price) by holding the other factor(s) (e.g., quantity) constant at the base-period value. The Laspeyres approach is expanded to a multi-factorial framework to isolate and quantify several factors that drive prescription drug cost. Three broad categories of effects are considered: volume, price and drug-mix effects. For each category, important sub-effects are quantified. This study presents a new and comprehensive methodology for decomposing the change in prescription drug costs over time including step-by-step demonstrations of how the formulas were derived. This methodology has practical applications for health policy decision makers and can aid researchers in conducting cost driver analyses. The methodology can be adjusted depending on the purpose and analytical depth of the research and data availability.

Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions

Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005–2006. The study population consisted of children aged 6–59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3–70.7) and 69.7% (95% CI: 66.3–72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0–17.4) and 15.1% (95% CI: 8.9–21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India.

“The mothers have eaten unripe grapes and the children's teeth are set on edge”: the potential inter-generational effects of the Holocaust on chronic morbidity in Holocaust survivors’ offspring

Modern epidemiology has evolved in the last decades from the simplified “cause-effect” paradigm to a multi-factorial framework of causality. The concept of “Fetal Origin of Adult Diseases” (FOAD) is a good example: it suggests that preconception circumstances and fetal exposures as well as infancy and early childhood experiences may eventually change an individual’s susceptibility to adult morbidity through fetal programming and epigenetic changes. The FOAD concept was supported, between others, by well-designed cohort studies carried out on non-Jewish World War II (WWII) survivors, exposed to hunger during the War years. However, data on late physical morbidity of Jewish WWII survivors are still scarce.The current paper presents some cohorts addressing the FOAD hypothesis in relation to the long-term impact of early exposures to hunger and their main results. It stresses the need for the establishing of a similar cohort in Israel, in order to study the long-term effects of the Holocaust on the health of Holocaust child survivors and on that of the “second” and “third” generations. A framework for such a cohort in Israel is also proposed.Establishing a cohort of this character in Israel should be a national priority and policy. First, taking special care of Holocaust survivors is a somewhat neglected national obligation. Second, if the population of Holocaust survivors and their offspring is indeed a high risk group for late chronic morbidity, higher awareness may lead to better primary prevention and to tailored secondary prevention programs. Third, the population at stack is unique and its contribution to the consolidation of the FOAD theory and its translational applications may be of foremost importance, in the global and national sense.