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Background: Thiazide diuretics, a commonly used class of anti-hypertensives, have been associated with increased areal bone mineral density (aBMD). Data regarding effects on fracture are conflicting and no information is available regarding effects on skeletal microstructure and mechanical competence. Methods: We compared skeletal microstructure, volumetric BMD (vBMD), stiffness and prevalent fractures in current thiazide diuretic users and non-users from a population-based multiethnic cohort of elderly adults age ≥ 65 years (N = 599) with high resolution peripheral quantitative computed tomography (HR-pQCT) and micro-finite element analysis. Results: Female current thiazide diuretic users had higher weight and BMI and were more likely to be non-Caucasian compared to non-users. There were no differences in age, historical fractures or falls between female users and non-users. Female thiazide users tended to have lower calcium and vitamin d intake compared to non-users. After adjusting for age, weight, race and other covariates, 1/3-radius mean aBMD by dual energy x-ray absorptiometry (DXA) was 3.2% (p = 0.03) higher in female users vs. non-users. By HRpQCT, adjusted mean cortical vBMD was 2.4% (p = 0.03) higher at the radius in female users vs. non-users, but there was no difference in stiffness. DXA results were similar in the subset of Black females. There was no difference in any adjusted aBMD or cortical skeletal parameters by DXA or HRpQCT respectively in males. Conclusions: Thiazide use was associated with a modestly higher aBMD at the predominantly cortical 1/3-radius site and radial cortical vBMD by HRpQCT in females. The effect on cortical bone may offer skeletal benefits in women taking thiazides for other indications such as hypertension, hypercalciuria or recurrent nephrolithiasis.

User experience (UX) research relies heavily on survey scales to measure users' subjective experiences with technology. However, repeatedly raised concerns regarding the improper use of survey scales in UX research and adjacent fields call for a systematic review of current measurement practices. Therefore, we conducted a systematic literature review, screening 153 papers from four years of the ACM Conference on Human Factors in Computing Systems proceedings (ACM CHI 2019 to 2022), of which 60 were eligible empirical studies using survey scales to study users' experiences. We identified 85 different scales and 172 distinct constructs measured. Most scales were used once (70.59%), and most constructs were measured only once (66.28%). The System Usability Scale was the most popular scale, followed by the User Experience Questionnaire, and the NASA Task Load Index. Regarding constructs, usability was the most frequently measured, followed by attractiveness, effort, and presence. Furthermore, results show that papers rarely contained complete rationales for scale selection (20.00%) and seldom provided all scale items used (30.00%). More than a third of all scales were adapted (34.19%), while only one-third of papers reported any scale quality investigation (36.67%). On the basis of our results, we highlight questionable measurement practices in UX research and suggest opportunities to improve scale use for UX-related constructs. Additionally, we provide six recommended steps to promote enhanced rigor in following best practices for scale-based UX research.

There is a growing interest in understanding how to best represent complexity using IDNs. We conceptualize this as the aim to make players of such IDNs reflect critically on the complexity being represented. We argue that current understandings of player experience do not lend themselves to this aim. Research on interactive media has assumed immersion to be a universal positive for the player experience. However, in this article we argue that immersion into the Magic Circle of an IDN could be antagonistic to a critical experience. This is because immersion persuades players into suspending their disbelief, rather than facilitating critical reflection. Instead we propose, on the basis of the Epic Theater, an alternative form of play called alienated play. Meaning, a form of play in which the player is playing, while also observing themselves play. This form of play should allow for players to benefit from the enjoyable nature of play, while simultaneously remaining at a critical distance. To illustrate our theory we design two models, one for immersed play and one for alienated play. Furthermore, we present examples of the design for alienation in commercial video games, as well as hypotheses to test out theory in future research. Therefore, this work contributes an initial theoretical and practical informed form of play, specifically designed to facilitate critical reflection on IDNs representing complexity.

Introduction In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient’s perspective.Methods and analysis A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated.Ethics and dissemination This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study.Trial registration number NCT04321005.Protocol version Version 2 (13 December 2019).