Preferred Design Research Articles

Preferences for Food Vouchers Among Adults with Low Incomes

ABSTRACT There is growing interest in understanding the optimal design of food voucher programs to impchange the word “All foods” in the Table to “SNAP-eligible” to be consistent with the language used in Table 2 and Figure 1rove diet quality and support chronic disease self-management. We examined preferences for voucher program design among adults with low incomes who participated in a randomized trial. Participants preferred vouchers eligible for all foods over those restricted to fruits and vegetables (p = .001) and a monthly over weekly redemption schedule (p = .003). Preferences differed significantly by voucher assignment (pinteraction < 0.0001 for both), with those assigned to the fruit and vegetable voucher more likely to prefer that voucher. Flexibility was identified as a key driver of preference.

Raising awareness about physical activity’s role in reducing cancer risk: qualitative interviews with immigrant women and community agency managers

ObjectivesTo explore how to reach immigrant women through community agencies to raise awareness of the role of physical activity (PA) in reducing cancer risk.Study designQualitative description.MethodsWe conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss the ideal design of an education session on PA and cancer risk, and identified themes using content analysis.ResultsParticipants included 22 women (6 African or Caribbean Black, 4 Chinese, 3 Filipino, 5 Indian, 4 Pakistani) and 16 agency managers from across Canada. Women were not familiar with Canada’s PA guidelines, and few were aware that PA reduces the risk of cancer. All expressed interest in education about PA and cancer. Diverse women and managers expressed similar preferences for education session design including content (e.g. PA amount/type), format (e.g. in person preferred but virtual more practical), personnel (external expert plus agency staff), cultural tailoring (e.g. translated supplemental take home information) and reinforcing (e.g. follow-up with participants) strategies. Women and managers identified few barriers to participating in education sessions, chiefly, that women lacked time due to work and family responsibilities; and noted several enablers of participation (e.g. emphasize social aspect, provide gift cards or recreation centre passes).ConclusionsWe generated insight on the ideal characteristics of a community-based education session that could raise awareness among immigrant women of the importance of PA in reducing cancer risk. Further research is needed to assess the feasibility and impact of PA education sessions designed based on these findings.

Neural network extrapolation to distant regions of the protein fitness landscape

Machine learning (ML) has transformed protein engineering by constructing models of the underlying sequence-function landscape to accelerate the discovery of new biomolecules. ML-guided protein design requires models, trained on local sequence-function information, to accurately predict distant fitness peaks. In this work, we evaluate neural networks’ capacity to extrapolate beyond their training data. We perform model-guided design using a panel of neural network architectures trained on protein G (GB1)-Immunoglobulin G (IgG) binding data and experimentally test thousands of GB1 designs to systematically evaluate the models’ extrapolation. We find each model architecture infers markedly different landscapes from the same data, which give rise to unique design preferences. We find simpler models excel in local extrapolation to design high fitness proteins, while more sophisticated convolutional models can venture deep into sequence space to design proteins that fold but are no longer functional. We also find that implementing a simple ensemble of convolutional neural networks enables robust design of high-performing variants in the local landscape. Our findings highlight how each architecture’s inductive biases prime them to learn different aspects of the protein fitness landscape and how a simple ensembling approach makes protein engineering more robust.

Human-AI Teaming in Critical Care: A Comparative Analysis of Data Scientists' and Clinicians' Perspectives on AI Augmentation and Automation.

Artificial intelligence (AI) holds immense potential for enhancing clinical and administrative health care tasks. However, slow adoption and implementation challenges highlight the need to consider how humans can effectively collaborate with AI within broader socio-technical systems in health care. In the example of intensive care units (ICUs), we compare data scientists' and clinicians' assessments of the optimal utilization of human and AI capabilities by determining suitable levels of human-AI teaming for safely and meaningfully augmenting or automating 6 core tasks. The goal is to provide actionable recommendations for policy makers and health care practitioners regarding AI design and implementation. In this multimethod study, we combine a systematic task analysis across 6 ICUs with an international Delphi survey involving 19 health data scientists from the industry and academia and 61 ICU clinicians (25 physicians and 36 nurses) to define and assess optimal levels of human-AI teaming (level 1=no performance benefits; level 2=AI augments human performance; level 3=humans augment AI performance; level 4=AI performs without human input). Stakeholder groups also considered ethical and social implications. Both stakeholder groups chose level 2 and 3 human-AI teaming for 4 out of 6 core tasks in the ICU. For one task (monitoring), level 4 was the preferred design choice. For the task of patient interactions, both data scientists and clinicians agreed that AI should not be used regardless of technological feasibility due to the importance of the physician-patient and nurse-patient relationship and ethical concerns. Human-AI design choices rely on interpretability, predictability, and control over AI systems. If these conditions are not met and AI performs below human-level reliability, a reduction to level 1 or shifting accountability away from human end users is advised. If AI performs at or beyond human-level reliability and these conditions are not met, shifting to level 4 automation should be considered to ensure safe and efficient human-AI teaming. By considering the sociotechnical system and determining appropriate levels of human-AI teaming, our study showcases the potential for improving the safety and effectiveness of AI usage in ICUs and broader health care settings. Regulatory measures should prioritize interpretability, predictability, and control if clinicians hold full accountability. Ethical and social implications must be carefully evaluated to ensure effective collaboration between humans and AI, particularly considering the most recent advancements in generative AI.

Improving the understandability of flood warning messages – Explorative study on design preferences

Early warning systems (EWS) are effective if they prevent loss of lives, injuries and structural damage. Optimization of EWS is often focused on technical aspects such as the dissemination of warnings. Since the audience's response is key for the effectiveness of an EWS, non-technical aspects that improve perception and understandability of warning messages deserve attention, too. German warning messages have been criticized, particularly after fatal and destructive floods in July 2021, as being insufficient and not understandable. Data from an exploratory online survey in Germany (n = 131) reveal insights on preferences in flood warning message (FWM) design. The survey focused on structural appearance of recommendations on action and on graphic support like maps, symbols and photos. Respondents showed clear preferences of including graphics into FWMs (96 %) and structuring recommendations on action in a bullet point format (85 %). Maps were the most favored among the offered graphic options, as they offer visual information on e.g., intensity and extent of inundation. Display of real time flood maps is often not feasible yet, but flood hazard maps are available in Germany and could be integrated into future FWM as an intermediate solution.

Learning analytics dashboard design: Workplace learner preferences for reference frames in immersive training in practice

AbstractBackgroundLearning analytics dashboards are increasingly being used to communicate feedback to learners. However, little is known about learner preferences for dashboard designs and how they differ depending on the self‐regulated learning (SRL) phases the dashboards are presented (i.e., forethought, performance, and self‐reflection phases) and SRL skills. Insight into design preferences for dashboards with different reference frames (i.e., progress, social, internal achievement and external achievement) is important because the effectiveness of feedback can depend upon how a learner perceives it.ObjectiveThis study examines workplace learner preferences for four dashboard designs for each SRL phase and how SRL skills relate to these preferences.MethodsSeventy participants enrolled in a chemical process apprenticeship program took part in the study. Preferences were determined using a method of adaptive comparative judgement and SRL skills were measured using a questionnaire. Preferences were tested on four dashboard designs informed by social and temporal comparison theory and goal setting theory. Multinomial logistic regressions were used to examine the relationship between dashboard preferences and SRL.Results and ConclusionsResults show that the progress reference frame is more preferred before and after task performance, and the social reference frame is less preferred before and after task performance. It was found that the higher the SRL skill score the higher the probability a learner preferred the progress reference frame compared to having no preference before task performance. The results are consistent with other findings, which suggest caution when using social comparison in designing dashboards which provide feedback.

Analysis of Articles on the Nature of Science between 2015 and 2022

It is evident that knowing the nature of science is a requirement for “science education”, which serves as the basis of conscious citizenship. For this reason, articles concerning the nature of science that were published in the Web of Science and EBSCOhost database between 2015 and 2022 were examined in this study in order to establish a broad framework and develop a research road map. A qualitative design approach and a descriptive review method were used. The keywords "Nature of Science (NoS) and Science Education" and "Teaching of Nature of Science (NoS) and Science Education" were used. The majority of the 107 articles on the nature of science that have been examined preferred qualitative research designs, and "Science &amp;amp; Education" is the publication that has published the most articles on the subject in 2017-2018-2020, pre-service teachers were mostly preferred as the sample group, it was applied to groups of “21-50” people as the sample group, open reflective approach was preferred as the teaching approach, the most commonly used method-technique was “discussion”, the activities used in the articles were generally standard, semi-structured interview form was preferred as the evaluation tool and “VNOS-C” was deployed as the questionnaire. Studies may be conducted within the boundaries of further lectures on the topic and internationally published theses.

Enhancing Productivity through Optimized Reading Spaces

In today's fast-paced, information-driven world, productivity is paramount for personal and professional success. Effective reading, a crucial cognitive process, significantly impacts knowledge acquisition, critical thinking, and innovation. This research offers an extensive examination of optimizing reading spaces to boost productivity. The study investigates the intricate relationship between reading environments and cognitive performance, considering factors like lighting, ergonomics, acoustics, spatial layout, and technology integration. These elements profoundly influence reader engagement, information retention, and cognitive load. Moreover, the study delves into environmental psychology's role in shaping concentration, creativity, and comfort within reading spaces. It analyzes the psychological effects of design elements like color, nature, and organization on cognitive processes. Understanding these responses empowers designers and individuals to tailor spaces for better focus and well-being. The integration of technology within reading spaces is explored, assessing digital platforms, interactive displays, and personalized content curation's benefits for efficient information consumption. It addresses challenges in balancing printed materials and digital resources. Additionally, the study considers personalized reading spaces' impact on diverse demographic groups, accounting for age, cognitive abilities, and preferences in design and customization. It emphasizes adaptable spaces catering to various needs and learning styles. This research offers a comprehensive view of reading spaces and productivity enhancement. By examining design elements, psychological factors, and technological integration, it provides insights for creating spaces that empower individuals to engage effectively with information, think critically, and achieve higher productivity in academic and professional endeavors.

Constructing a theory-informed workplace design framework: co-design case study for knowledge work environment satisfaction improvement

ABSTRACT Addressing work environment design methods has become increasingly important due to pandemic-induced changes in the ways and locations of work. This research addresses work environment design through a theory-informed workplace design framework to study the co-design process, the impact of spatial atmosphere on workplace experience and satisfaction, and infrequently studied spaces, i.e. meeting rooms and breakout areas. This case study is based on co-design methods, a workplace design intervention study and its evaluation. Comprehensive design is addressed through analytical dimensions of design, i.e. instrumental, symbolic, aesthetic and perceived dimensions of atmosphere and affordances. Furthermore, the spatial experience is explored through need-supply fit theory and workplace satisfaction. The pre-design results showed that employees have distinct design preferences based on perceived and analytical dimensions for technical, hybrid and creative meetings and individual work and recovery events. The workspace interventions were designed using the design information gathered from the co-design process; the changes implemented in intervention spaces increased employee satisfaction towards them. The study’s methodology contributes to establishing a theory-informed workplace design framework supporting user-centred workplace design and evaluation and indicates a role for spatial atmosphere in need-supply fit formation.

Developing Catchment Area Data Dashboards for Cancer Centers: A Stakeholder- engaged Approach.

Data dashboards that can communicate complex and diverse catchment area data effectively can transform cancer prevention and care delivery and strengthen community engagement efforts. Engaging stakeholders in data dashboard development, by seeking their inputs and collecting feedback, has the potential to maximize user-centeredness. To describe a systematic, stakeholder-driven, and theory-based approach for developing catchment area data visualization tools for cancer centers. Cancer-relevant catchment area data were identified from national- and state-level data sources (including cancer registries, national surveys, and administrative claims databases). A prototype tool for data visualization was designed, developed, and tested based on the OPT-In [ O rganize, P lan, T est, In tegrate] framework. A working group of multi-disciplinary experts collected stakeholder feedback through formative assessment to understand data and design preferences. Thematic areas, data elements, and the composition and placement of data visuals in the prototype were identified and refined by working group members. Visualizations were rendered in Tableau © and embedded in a public-facing website. A mixed-method approach was used to assess the understandability and actionability of the tool and to collect open-ended feedback that informed action items for improvisation. We developed a visualization dashboard that illustrates cancer incidence and mortality, risk factor prevalence, healthcare access, and social determinants of health for the Hollings Cancer Center catchment area. Color-coded maps, time-series plots, and graphs illustrate these catchment area data. A total of 21 participants representing key stakeholders [general audience (n=4), community advisory board members and other representatives (n=7), and researchers (n=10)] were identified. The understandability and actionability scores exceeded the minimum (80%) threshold. Stakeholders' feedback confirmed that the tool is effective in communicating cancer data and is useful for education and advocacy. Themes that emerged from qualitative data suggest that additional changes to the tool such as a warm color palette, data source transparency, and the addition of analytical features (data overlaying and area-resolution selection) would further enhance the tool. Integration of communication efforts and messages within a broader context is in progress. A catchment area data resource developed through a systematic, stakeholder- driven, and theory-based approach can meet (and surpass) benchmarks for understandability and actionability, and lead to an overall positive response from stakeholders. Creating channels for advocacy and forming community partnerships will be the next step necessary to promote policies and programs for improving cancer outcomes in the catchment areas.

Co‐working office spaces in Sydney: Spatiotemporal dynamics and industry patterns

AbstractCo‐working spaces have emerged as cost‐effective office space management solutions for workers from diverse industries who share space, which generates cost savings and facilitates networking opportunities. Past studies have mainly focused on needs for and benefits of co‐working spaces and range in emphasis from design preferences to potential social and economic impacts. However, limited attention has been given to the temporal clustering and geographical distribution patterns of co‐working spaces. This study examines the spatial distribution patterns of co‐working spaces establishments in terms of building floor plans. We discern the subcategory of ‘co‐working office space’ from the floor space and employment survey data, spanning 2007, 2012, and 2017 as collected by the City of Sydney, a municipal government in Australia. Both co‐working offices offered by conventional enterprises and co‐working providers are identified, and the spatial associations between co‐working spaces and their relationships with industry composition are analysed. Using establishment analysis, three co‐working spaces are identified: (1) dedicated co‐working enterprises providing office service and well‐design spaces; (2) conventional office rental enterprises diversifying into co‐working style office; and (3) standard enterprises converting fixed office spaces to co‐working office configurations. The spatial analysis reveals an outward diffusion of co‐working spaces from the centre of Sydney CBD, which is of importance in geographical research focused on urban, social, and economic change.

Expert and Public Preferences and Perceptions of Different Color Schemes and Map Overlays on a Tropical Cyclone Wind Exceedance Forecast Graphic

Abstract Map graphics are often used for hazard risk communication, layered with numerical, verbal, and visual information to describe an uncertain threat. In the hurricane context, graphics are used to communicate the probability of different threats over a forecasting period. While hurricane graphics have been studied in the past, they have not been designed with colorblind-friendly accessibility and localization in mind. This study presents the results of a mixed-method study, testing the perceptions of different color schemes and map overlays on a wind exceedance map graphic with samples of experts (emergency managers and meteorologists) and the public. Nineteen experts from Florida and Louisiana were interviewed about their preferences for and risk perceptions of the design elements of the new wind exceedance graphic. The graphic prototypes were also tested using a public sample (n = 624) from Florida and Louisiana to study participants’ design preferences and risk perceptions. Both expert and public samples preferred a yellow-to-red scheme, though experts thought the yellow-to-red scheme presented the hazard as riskier and the public thought the reds-only scheme was riskier. Experts and the public preferred a map graphic with overlays; they scored a map graphic with overlays as riskier than a version without overlays. Understanding the connection between color scheme preference and risk perception for both experts and the public has important implications on risk communication as new graphics are designed. The conclusion of this study provides avenues for future research for experts who want to apply universal design aspects into hurricane graphics. Significance Statement This study investigates user preferences and risk perceptions for a new wind exceedance hurricane graphic designed with universal design principles. Experts (emergency managers and meteorologists) and the public from Florida and Louisiana participated in a mixed-method study, capturing qualitatively and quantitatively how a yellow-to-red and reds-only color scheme, as well as interstate or city overlays, impacted their engagement with the graphic. Studying the design features of forecast graphics from a social science perspective before they are operational is important, as the findings from this study reveal how different groups could perceive the graphic.

Design and optimization of reactive distillation for enhancing supercritical transesterification process to produce biodiesel

The present study explored the optimization of a reactive distillation column (RDC) for biodiesel production using supercritical transesterification (SCTE). The SCTE process at high pressure and temperature, is known for water-sensitive flexibility and catalyst-free operation, and has shown promising advantages in biodiesel production. The steady-state simulations were conducted using Aspen Plus, with two RDC configurations: RDC-1, employing a single feed of oil and methanol, and RDC-2, utilizing separate feeds. Surprisingly, high conversion rates were achieved at only 8.5 MPa pressure. The study aiming to identify an optimized RDC design, systematically examined the impact of design parameters such as reflux ratio, feed temperature, and the number of reactive stages on conversion and energy requirements. Internal column specifications and species flow through each stage were investigated to comprehend reaction and separation processes. Temperature analysis revealed that preheating to 380 °C significantly improved conversion and reduced reboiler heat duty. RDC-1, with 9 reactive stages, demonstrated greater conversion efficiency, while RDC-2, with 11 stages, exhibited better biodiesel separation. By optimizing reflux ratios, the study achieved remarkable conversions with enhanced methanol separation. Cost estimation revealed that RDC-1 promoted lower capital and operating costs, making it a preferred design and an efficient option for SCTE-based biodiesel production.

Параметры шагающего устройства для добычи полезных ископаемых, рассредоточенных по морскому дну

The purpose of the work is to analyze the aggregates of complexes for the extraction of marine minerals. In particular, the variants of complexes, their advantages and disadvantages are considered. The complex is analyzed, which uses robotic pickers/reclaimers of the walking type to perform mining operations of ferromanganese nodules (FMN) or cobalt-bearing manganese crusts (CMC). Results. The variants of complexes for mining of bottom deposits are analyzed, advantages and disadvantages of different variants are indicated. The device for collecting minerals on the bottom, developed in SPMU, is described, laboratory studies of the model of such a device are considered, the main parameters are presented, the dependence of productivity on the size and time of operations of the cycle of work is indicated. It is determined that for minimal impact on the seabed biota it is necessary to use walking submersibles with an actuator for extraction in the form of rarefaction chambers or a grapple with an impactor (depending on the type of solid minerals). It is shown that the productivity of the walking underwater vehicle varies with the diameter of the rarefaction chamber plates: the optimum plate diameter is 1.5 m. Experimental study of hydrodynamic resistance of “foot” models with different midships cross-section has been carried out. According to the experimental results, the conclusion about the preferred design of the “foot” was made: the cross-section should be a streamlined shape with the smallest drag coefficient cx and have a continuous surface without holes. Experimental studies of tine models movement in water have shown that it is reasonable to use as tine parts the structures without holes, streamlined ellipsoidal shape. Calculations of productivity of mining units when using rope hoisting from the bottom to the ship have shown the necessity of using four or more hoisting devices for realization of the required annual productivity of more than 1 million tons per year. The stages of creating a workable extraction unit including a vessel, vertical lifting device and a system of deep-water collectors require very significant material and monetary costs, so they should be carried out in accordance with the R&amp;D plan and tasks of the relevant ministry and agency and require coordination of efforts of investors, scientists and machine builders.

Verification and Establishment of Techniques of Ajami Artwork

Ajami, a technique of painted wood paneling, was popular in the Ottoman Empire from the 17th to the late 18th centuries. Ajami art became prominent in Syria after the decline of tile production, and it rose to a sophisticated level of art in both local and global markets. Today, however, Ajami art has become almost forgotten and unknown by the modern generation, due to being an exclusive art that can be seen only in palaces, museums, and historical houses. This study investigates the traditional method and techniques of making Ajami, with a focus on the work of a renowned Syrian Ajami art master artisan named Mr. Abdulraouf. The study aims to identify and document the traditional method of Ajami production and determine the materials and techniques used for making Ajami. The study found that Ajami art consists of natural elements that are utilized in four main stages; foundation, design, painting, and finishing. The artisans have a strong preference for floral and geometric designs, influenced by Islamic religious beliefs. The findings of this study could serve as an educational guide to preserve heritage and make it presentable for the present and future generations.

Balcony usage as a space to achieve human well-being during pandemic COVID-19

ABSTRACT People who lived through the COVID-19 lockdowns have been reported to experience temporary depression, loneliness, and discomfort. Balcony can serve as an accessible place of respite to ease emotional distress when being confined at home. This research aims to systematically study balcony usage and design preference as a space to achieve well-being. It is based on views of apartment dwellers who experienced lockdown measures during the COVID-19 pandemic. From literature reviews and surveys, 14 popular balcony activities and 29 balcony design elements were derived and used in a questionnaire supplemented with drawings to best illustrate some of the concept. 505 effective samples (N = 505) were received from Taiwan, Vietnam, Indonesia and Portugal. Statistical analyzed results showed that Getting sun and air, Gardening, and Watching/Observing the street are the three most preferred balcony activities among these countries. The preferred balcony views, types, enclosures, decorations, and sizes are ranked with Friedman Test and summarized in this paper along with the relevant cultures and lifestyles discussion. The comprehensive findings of this study can offer architects and housing developers valuable insights for making design decision and promote well-being in apartment dwelling balcony design. Ultimately, balcony is an important component in an apartment. It can be used, not only, to reduce feelings of isolation, but also, to conduct social activities and housework during a pandemic lockdown.

"When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners.

Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design. 21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care. Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.

Prototyping a Zoomorphic Interactive Robot Companion with Emotion Recognition and Affective Voice Interaction for Elderly People

An aging society paired with a skilled labor shortage, particularly in European countries, requires a rethinking of deprecated structures. Intelligent assistive technologies, specifically socially assistive robots, addressing the gap between caretakers and elderly people in need of care have moved into the focus of debate due to their potentials to reduce costs, improve independence, and eventually raise quality of life. In this work, we outline the potentials of zoomorphic robot companions combining intelligent conversational abilities and emotion recognition. We then describe the prototyping of an emotion-sensing zoomorphic interactive robot companion including the development and implementation of a multimodal emotion recognition framework. This framework uses speech emotion recognition, sentiment analysis, and affective voice interaction based on a large language model. The prototyping has been accompanied by two studies on elderly peoples' design preferences regarding the proposed feature set as well as different embodiments to find the appropriate casing for the robot companion. This work provides valuable insights into the prototyping and can thus support future research endeavors in this area.

Municipal Flag Design Preferences of United States Residents

ABSTRACT Contemporary place branding practices face occasional pushback in the form of public rejection of the identity elements deployed as part of the brand. In United States municipalities, one important symbol – and one increasingly contested – is the city flag. The flag occupies a unique space outside the core group of identity elements that commonly form the iconography of a place brand and flag design or redesign efforts can be particularly emotive. Using a mixed methods approach, this study sought to identify trends in public preferences for civic flag design in the United States. Its findings reinforce the popular appeal of traditional practices in flag design, such as textless flags and simple composition, while outlining possible perils associated with market-oriented designs single-mindedly driven by a city’s external concerns. These findings will be useful to the civic marketer as a grounding point from which a meaningful public discussion on the design, redesign, or retention of a city flag can be initiated.

Glucocorticoid Minimization in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: An International Survey of Clinicians

Rationale & ObjectiveResearch in anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) has focused on reducing treatment toxicities, notably through reduction of exposure to glucocorticoids. Glucocorticoid-sparing therapies such as avacopan are not widely available in many countries and patients are exposed to high glucocorticoid doses. There is little data concerning what clinicians would accept as the lowest glucocorticoid dosing that could be used in induction therapy for AAV. Study DesignInternational, online survey Setting & ParticipantsClinicians in various countries, with experience in managing vasculitis. Exposure and OutcomesSurvey questions to gauge interest and preferences in studying an induction of remission regimen for severe AAV using only 2 or 4 weeks of glucocorticoids, without avacopan. Data collected included general opinions about standard of care for induction agents, glucocorticoids and avacopan. Respondents were presented with three candidate trial designs, two of which proposed a combination of cyclophosphamide and rituximab induction. Analytical ApproachUsing a 10-point Likert scale, respondents ranked each candidate trial on its usefulness in demonstrating whether a minimal glucocorticoid regimen will be safe and effective, and their willingness to randomize into the trial. ResultsThere were 210 respondents to the survey. The candidate trials were rated moderate-to-high for usefulness to demonstrate safety and efficacy (scores 6-7/10), and moderate (scores 5-6/10) for willingness to randomize. Four weeks glucocorticoid duration was preferred to 2 weeks, and combination cyclophosphamide-rituximab with 4 weeks glucocorticoids was the most preferred design. 42% of respondents felt avacopan had to be incorporated into a minimal GC trial design to want to recruit patients. LimitationsRepresentativeness of survey sample and generalisability of findings. ConclusionsCombination cyclophosphamide-rituximab may be the ideal way of studying minimal glucocorticoid use in severe AAV. Given its increasing uptake, incorporating avacopan into a potential trial design would be important.