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Little is known about why people with disability choose to take part in disability research and what their experience is like. Knowledge of this may help researchers and research ethics committees improve the empowered and ethical participation of people with disability in disability, healthcare, and human service focussed research. This cross-sectional mixed-methods study explored the perspectives and experiences of a group of Australian adults with disability regarding their involvement in research. Online surveys (N = 29) and follow-up interviews (N = 15) were conducted. The study found the decision to participate was a complex appraisal of benefit to self and others, research relevance, value, comfort, convenience, safety and risk. The attitudes and behaviours of researchers in cultivating trust by adopting an empathic approach to the conduct of disability research appear to be an important aspect of participant experience. Research ethics committees may benefit from knowledge of the ‘microethical’ moments that occur in such research.

Sub-epidermal moisture scanning (SEMS) is a novel point-of-care technology that measures localised oedema and detects early tissue damage that may develop into a pressure injury (PI). It provides objective data that may assist PI prevention (PIP) decision making. This study aimed to determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to test the effectiveness of SEMS.This pilot RCT recruited medical and surgical patients at risk of developing a PI in one Australian hospital. All participants received routine PIP care and daily visual skin assessment to determine the presence of a PI. The intervention group also received daily SEMS. Clinical staff were told if the sub-epidermal moisture (SEM) value was abnormal but were not given advice for PIP. Blinding of patients, care staff and outcome assessors was not practical. Feasibility outcomes included recruitment, retention, intervention fidelity, and patient outcomes.Of 1185 patients screened prior to eligibility, 950 were excluded (80%); 235 were then assessed for eligibility and 160 met the inclusion criteria (68.1%); 100 were recruited (70.0%) and randomised and 99 completed the trial (intervention n = 50; control n = 49) with one person withdrawn due to inappropriate recruitment (100% retention). Of the 657 expected SEMS observations, 598 were completed (91% intervention fidelity). Only 34 of 454 (7.4%) patient outcome data points were missing.Most feasibility criteria were met, indicating a definitive trial to assess the effectiveness of SEMS in a medical-surgical patient population is realistic. However, recruitment may be resource intensive and require specific strategies.

Context The time course of male reproductive hormone recovery after stopping injectable testosterone undecanoate (TU) treatment is not known. Objective The aim of this study was to investigate the rate, extent, and determinants of reproductive hormone recovery over 12 months after stopping TU injections. Materials and Methods Men (n = 303) with glucose intolerance but without pathologic hypogonadism who completed a 2-year placebo (P)-controlled randomized clinical trial of TU treatment were recruited for further 12 months while remaining blinded to treatment. Sex steroids (testosterone (T), dihydrotestosterone, oestradiol, oestrone) by liquid chromatography-mass sprectometry, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) by immunoassays and sexual function questionnaires (Psychosexual Diary Questionnaire, International Index of Erectile Function, and short form survey (SF-12)) were measured at entry (3 months after the last injection) and 6, 12, 18, 24, 40, and 52 weeks later. Results In the nested cohort of TU-treated men, serum T was initially higher but declined at 12 weeks remaining stable thereafter with serum T and SHBG at 11 and 13%, respectively, lower than P-treated men. Similarly, both questionnaires showed initial carry-over higher scores in T-treated men but after 18 weeks showed no difference between T- and P-treated men. Initially, fully suppressed serum LH and FSH recovered slowly towards the participant’s own pre-treatment baseline over 12 months since the last injection. Conclusions After stopping 2 years of 1000 mg injectable TU treatment, full reproductive hormone recovery is slow and progressive over 15 months since the last testosterone injection but may take longer than 12 months to be complete. Persistent proportionate reduction in serum SHBG and T reflects lasting exogenous T effects on hepatic SHBG secretion rather than androgen deficiency.

This paper explores a new framework for calculating hybrid system metrics using software quality metrics aspect-oriented and object-oriented programming. Software metrics for qualitative and quantitative measurement is a mix of static and dynamic software metrics. It is noticed from the literature survey that to date, most of the architecture considered only the evaluation focused on static metrics for aspect-oriented applications. In our work, we mainly discussed the collection of static parameters , long with AspectJ-specific dynamic software metrics.The structure may provide a new direction for research while predicting software attributes because earlier dynamic metrics were ignored when evaluating quality attributes such as maintainability, reliability, and understandability of Asepect Oriented software. Dynamic metrics based on the fundamentals of software engineering are equally crucial for software analysis as are static metrics. A similar concept is borrowed with the introduction of dynamic software metrics to implement aspect-riented software development.Currently, we only propose a structure and model using static and dynamic parameters to test the aspect-oriented method, but we still need to validate the proposed approach.

Some people with disabilities may have greater risk of contracting COVID-19 or experiencing worse outcomes if infected. Although COVID-19 is a genuine threat for people with disabilities, they also fear decisions that might limit lifesaving treatment should they contract the virus. During a pandemic, health systems must manage excess demand for treatment, and governments must enact heavy restrictions on their citizens to prevent transmission. Both actions can have a negative impact on people with disabilities. Ironically, the sociotechnical advances prompted by this pandemic could also revolutionize quality of life and participation for people with disabilities. Preparation for future disasters requires careful consideration.

Background: The comprehensive representation of functional requirements is a crucial activity in the analysis phase of the software development life cycle. Representation of a complete set of functional requirements helps in tracing business goals effectively throughout the development life cycle. Use case modelling is one of the most widely-used methods to represent and document functional requirements of the system. Practitioners exploit use case modelling to represent interactive functional requirements of the system while overlooking some of the non-interactive functional requirements. The non-interactive functional requirements are the ones which are performed by the system without an initiation by the user, for instance, notifying something to the user or creating an internal backup. Aim: This paper addresses the representation of non-interactive requirements along with interactive ones (use cases) in one model. This paper calls such requirements `operation cases' and proposes a new set of graphical and textual notations to represent them. Method: The proposed notations have been applied on a case study and have also been empirically evaluated to demonstrate the effectiveness of the new notations in capturing non-interactive functional requirements. Results and Conclusion: The results of the evaluation indicate that the representation of operation cases helps in documenting a complete set of functional requirements, which ultimately results in a comprehensive translation of requirements into design.

At the IceCube Neutrino Observatory, neutrino interactions are observed across a broad energy range extending from ~ 5 GeV to ~ 1 PeV. Above ~ 100 TeV, neutrinos primarily originate from distant astrophysical objects whose identity is yet unknown. At lower energies, most neutrinos result from cosmic-ray interactions in Earth's atmosphere. In this work, two studies of contained neutrino interactions in IceCube are presented.In the first study, three years of IceCube data recorded from May 2010 to May 2013 are analyzed to measure the flavor composition of astrophysical neutrinos in the energy range from 35 TeV to 1.9 PeV. The flavor composition is found to be consistent with the ratio of ~ (1/3 : 1/3 : 1/3) expected from the oscillation of neutrinos produced by complete pion decay in distant astrophysical sources. Limits are placed on non-standard flavor compositions that could arise in exotic physics scenarios. The energy spectrum of astrophysical neutrinos is also measured and is well-described by a falling power law with index 2.6+-0.15.In the second study, five years of IceCube data from May 2011 to May 2016 are analyzed with improved background rejection and event classification techniques, and the inelasticity in charged-current muon neutrino interactions is reconstructed. Improved limits on the flavor composition of astrophysical neutrinos are obtained, and there is consistency with the expected flavor ratio of ~ (1/3 : 1/3 : 1/3). Additionally, the energy spectrum of astrophysical neutrinos is found to be consistent with a power-law with index 2.62+-0.07 in the energy range from 6.6 TeV to 2.2 PeV. Limits are placed on a power-law flux from a second population of astrophysical sources that may explain the harder power-law index of 2.13+-0.13 found in an IceCube analysis of up-going muons at higher energies.The inelasticity distribution of charged-current muon neutrino interactions is also obtained and is found to be consistent with the calculation of Cooper-Sarkar et al. across an energy range from 1 TeV to 100 TeV. The inelasticity distribution can also be used measure the neutrino to antineutrino ratio of the atmospheric neutrino flux. A scaling factor on the muon neutrino to antineutrino flux ratio calculated by Honda et al. is found to be 0.77+0.44-0.25 in the energy range from 770 GeV to 21 TeV. Lastly, the inelasticity distribution can also be used to perform an indirect search for charged-current charm production by neutrinos. Assuming a leading-order calculation of the inelasticity distribution for charm production events, zero charm production can be excluded at 91% confidence level in the energy range from 1.5 TeV to 340 TeV. In the future, it is expected that the techniques developed for this analysis can be applied to search for neutrino interactions beyond the Standard Model in IceCube and next-generation neutrino telescopes.

Background: Sickle cell trait (SCT) has received attention as a cause of death in college athletes, leading to mandatory lab SCT screening in National Collegiate Athletic Association (NCAA) athletes. High-school athletes are commonly screened by self-report. There are no known studies for evaluating whether this method is effective as a screening tool. Hypothesis: The local prevalence rate of SCT as self-reported on the preparticipation evaluation (PPE) forms would be lower than the national accepted average. Methods: PPE forms from the Department of Orthopedics and Rehabilitation of the University of Florida (UF) were reviewed between January 1, 2017, and April 30, 2018. The Florida High School PPE form includes a yes/no question to assess the diagnosis of SCT. The prevalence established by self-report was then compared with the national prevalence for SCT in the comparable race/ethnicity groups reported by the CDC. The response rate of SCT questions was also compared to other common cardiac screening questions. Results: A total of 401 forms were reviewed. Six (1.5%) students answered “yes,” 351 answered “no,” and 44 left the SCT question blank. All six athletes who self-reported “yes” were Black and made up 3.7% of the 162 known Black respondents. This self-report rate for Black/African Americans was well below the expected 7.3% described by the CDC. Response rates were also lower than the comparable cardiac screening questions. Conclusions: Self-report SCT status rates are lower than the accepted prevalence in a similar population. Significant inconsistencies in reporting were also determined. Clinical relevance: This is a rare study to evaluate the self-reported prevalence of SCT in high-school athletes. Below average reporting of SCT and inconsistency in completion of the forms increase the concern for accuracy and effectiveness of current high-school SCT screening methods relying on self-report.

BACKGROUND Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-person learning activities forced every aspect of medical education and student engagement to pivot to a web-based format, including activities supporting the performance and dissemination of scholarly work. At that time, social media had been used to augment in-person conference learning, but it had not been used as the sole platform for scholarly abstract presentations. OBJECTIVE Our aim was to assess the feasibility of using Twitter to provide a completely web-based forum for real-time dissemination of and engagement with student scholarly work as an alternative to a traditional in-person poster presentation session. METHODS The Brody School of Medicine at East Carolina University launched an online Medical Student Scholarship Forum, using Twitter as a platform for students to present scholarly work and prepare for future web-based presentations. A single student forum participant created posts using a standardized template that incorporated student research descriptions, uniform promotional hashtags, and individual poster presentations. Tweets were released over 5 days and analytic data were collected from the Twitter platform. Outcome measures included impressions, engagements, retweets, likes, media engagements, and average daily engagement rate. RESULTS During the conference, the student leader published 63 tweets promoting the work of 58 students (55 medical and 3 dental students) over 5 days. During the forum and the following week, tweets from the @BrodyDistinctly Twitter account received 63,142 impressions and 7487 engagements, including 187 retweets, 1427 likes, and 2082 media engagements. During the 5 days of the forum, the average daily engagement rate was 12.72%. CONCLUSIONS Using Twitter as a means of scholarly dissemination resulted in a larger viewing community compared to a traditional in-person event. Early evidence suggests that social media platforms may be an alternative to traditional scholarly presentations. Presenting via Twitter allowed students to receive instantaneous feedback and effectively network with wider academic communities. Additional research is needed to evaluate the effectiveness of knowledge uptake, feedback, and networking.

We present a case of a 17-year-old White male high school American football player who was diagnosed with an anomalous left coronary artery arising from the right coronary sinus after experiencing dizziness, near-syncope, and altered mental status during a football practice. The symptoms were recognized by an on-site certified athletic trainer who activated emergency medical response. After unremarkable initial emergency evaluation, referral to a sports cardiologist unveiled an anomalous left coronary artery arising from the right coronary sinus on echocardiogram. After surgical correction and rehabilitation, the patient was able to return to exercise activity. Anomalous coronary arteries are the second most common cause of autopsy-positive episodes of sudden cardiac death among athletes and are rarely recognized with abnormal electrocardiogram (EKG) findings prior to events. This case highlights the importance of prompt recognition, evaluation, and treatment of athletes with cardiac symptoms, and contributes to an ongoing discussion on whether echocardiograms should be considered in preparticipation evaluations.

Dental caries are the most common chronic disease of childhood. Untreated caries can result in severe pain and infection; and in some cases, difficulties in eating, speech, and education. Hospitalization and general anesthesia are often necessary for treating extensive disease in young children, which adds significant risk and expense. Interventions, such as community-based preventative care, utilization of pre-authorizations for treatment, and at-risk contracts, have been deployed as innovative strategies to reduce the incidence of caries and the cost of treatment. Value-based payment structures give payors flexibility to design a multipronged system to impact the health of consumers. This practice brief will identify interventions at a systems level that reduced the utilization of general anesthesia treating dental caries in children under the age of six. Dental claims data from the period of Q1 2011 to Q2 2020 were utilized to analyze the trends in utilization of the operating room (OR) to treat dental conditions among children under 6 years. Fixed effects analysis was utilized to identify key over time changes in the reduction of children's OR utilization. A reduction in utilization of general anesthesia and hospitalization for treating dental caries in young children was seen. The expansion of the community care team, metrics to reinforce the systems of provider education and training, and the use of incentive payments were all associated with reductions in the rate of OR utilization. Between 2012 and 2017, multiple initiatives were implemented without a systematic approach to quality improvement to evaluate.