Comparative assessment of Riesling wine fault development by the electronic tongue and a sensory panel.

Wine faults threaten brand recognition and consumer brand loyalty. The objective of this study was to compare the acuteness of e-tongue and human sensory evaluation of wine fault development in Riesling wine over 42 days of storage. Riesling wines uninoculated (control) or inoculated with 104 CFU/mL cultures of Wickerhamomyces anomalus, Acetobacter aceti, Lactobacillus brevis, or Pediococcus parvulus were assessed every 7 days with the e-tongue and a rate-all-that-apply (RATA) sensory panel. After 7 days of storage, the e-tongue detected differences in all four wine spoilage microorganism treatments, compared to control wine, with discrimination indices over 86%. The RATA sensory panel detected significant differences beginning on day 35 of storage, 28 days after the e-tongue detected differences. This study showed that the e-tongue was more sensitive than the human panel as a detection tool, without sensory fatigue. PRACTICAL APPLICATION: This research is useful for winemakers seeking additional instrumental methods in the early detection of wine faults. Given the results of this study, the e-tongue can be a useful tool for detecting early chemical changes in white wines that have undergone microbial spoilage, providing winemakers with time to mitigate faults before they surpass sensory thresholds.

Real-World Experience on Why Research Flatlines: A Review of Trials From the Coordinator's Perspective.

INTRODUCTION: Investigator-initiated research trial failure is a national concern that hinders the dissemination of information while wasting resources, time, and funding. The goal of this analysis was to provide an objective review of points to consider increasing an investigator's chances of success. METHODS: The included trials were divided into two groups based on whether they were successful or unsuccessful in meeting enrollment goals. Common issues were noted for each trial to identify prevalent issues and compare their quantity within each group. RESULTS: Unsuccessful trials averaged twice as many issues as trials in the successful group. The most common problems identified in unsuccessful studies involved study planning, whereas the most common problems identified in successful studies revolved around study staff. CONCLUSIONS: There is no single definitive indicator for trial failure; however, awareness of these issues in a trial's planning phase can help prevent their occurrence and aid in overall completion and publication.

Postexamination item analysis of undergraduate pediatric multiple-choice questions exam: implications for developing a validated question Bank.

INTRODUCTION: Item analysis (IA) is widely used to assess the quality of multiple-choice questions (MCQs). The objective of this study was to perform a comprehensive quantitative and qualitative item analysis of two types of MCQs: single best answer (SBA) and extended matching questions (EMQs) currently in use in the Final Pediatrics undergraduate exam. METHODOLOGY: A descriptive cross-sectional study was conducted. We analyzed 42 SBA and 4 EMQ administered to 247 fifth-year medical students. The exam was held at the Pediatrics Department, Qena Faculty of Medicine, Egypt, in the 2020-2021 academic year. Quantitative item analysis included item difficulty (P), discrimination (D), distractor efficiency (DE), and test reliability. Qualitative item analysis included evaluation of the levels of cognitive skills and conformity of test items with item writing guidelines. RESULTS: The mean score was 55.04 ± 9.8 out of 81. Approximately 76.2% of SBA items assessed low cognitive skills, and 75% of EMQ items assessed higher-order cognitive skills. The proportions of items with an acceptable range of difficulty (0.3-0.7) on the SBA and EMQ were 23.80 and 16.67%, respectively. The proportions of SBA and EMQ with acceptable ranges of discrimination (> 0.2) were 83.3 and 75%, respectively. The reliability coefficient (KR20) of the test was 0.84. CONCLUSION: Our study will help medical teachers identify the quality of SBA and EMQ, which should be included to develop a validated question bank, as well as questions that need revision and remediation for subsequent use.

Stumbling Blocks in the Investigation of the Relationship Between Age-Related Hearing Loss and Cognitive Impairment.

The relationship between age-related hearing loss (ARHL) and cognitive impairment (CI) remains intricate. However, there is no robust evidence from experimental or clinical studies to elucidate their relationship. The key unaddressed questions are (a) whether there is a causal effect of ARHL on CI and (b) whether efficacious treatment of ARHL (such as hearing-aid use) ameliorates CI and dementia-related behavioral symptoms. Because of several methodological and systematic flaws/challenges, rigorous verification has not been conducted. Addressing these stumbling blocks is essential to unraveling the relationship between ARHL and CI, which motivated us to undertake this review. Here, we discuss the methodological problems from the perspectives of potential confounding bias, assessments of CI and ARHL, hearing-aid use, functional-imaging studies, and animal models based on the latest information and our experiences. We also identify potential solutions for each problem from the viewpoints of clinical epidemiology. We believe that "objectivity," specifically the use of more objective behavioral assessments and new computerized technologies, may be the key to improving experimental designs for studying the relationship between ARHL and CI.

Pushing MP2RAGE boundaries: Ultimate time-efficient parameterization combined with exhaustive T1 synthetic contrasts.

PURPOSE: MP2RAGE parameter optimization is redefined to allow more time-efficient MR acquisitions, whereas the T1 -based synthetic imaging framework is used to obtain on-demand T1 -weighted contrasts. Our aim was to validate this concept on healthy volunteers and patients with multiple sclerosis, using plug-and-play parallel-transmission brain imaging at 7 T. METHODS: A "time-efficient" MP2RAGE sequence was designed with optimized parameters including TI and TR set as small as possible. Extended phase graph formalism was used to set flip-angle values to maximize the gray-to-white-matter contrast-to-noise ratio (CNR). Several synthetic contrasts (UNI, EDGE, FGATIR, FLAWSMIN , FLAWSHCO ) were generated online based on the acquired T1 maps. Experimental validation was performed on 4 healthy volunteers at various spatial resolutions. Clinical applicability was evaluated on 6 patients with multiple sclerosis, scanned with both time-efficient and conventional MP2RAGE parameterizations. RESULTS: The proposed time-efficient MP2RAGE protocols reduced acquisition time by 40%, 30%, and 19% for brain imaging at (1 mm)3 , (0.80 mm)3 and (0.65 mm)3 , respectively, when compared with conventional parameterizations. They also provided all synthetic contrasts and comparable contrast-to-noise ratio on UNI images. The flexibility in parameter selection allowed us to obtain a whole-brain (0.45 mm)3 acquisition in 19 min 56 s. On patients with multiple sclerosis, a (0.67 mm)3 time-efficient acquisition enhanced cortical lesion visualization compared with a conventional (0.80 mm)3 protocol, while decreasing the scan time by 15%. CONCLUSION: The proposed optimization, associated with T1 -based synthetic contrasts, enabled substantial decrease of the acquisition time or higher spatial resolution scans for a given time budget, while generating all typical brain contrasts derived from MP2RAGE.

Cerebrospinal and Blood Biomarkers in Alzheimer's Disease: Did Mild Cognitive Impairment Definition Affect Their Clinical Usefulness?

Despite Alzheimer's Disease (AD) being known from the times of Alois Alzheimer, who lived more than one century ago, many aspects of the disease are still obscure, including the pathogenesis, the clinical spectrum definition, and the therapeutic approach. Well-established biomarkers for AD come from the histopathological hallmarks of the disease, which are Aß and phosphorylated Tau protein aggregates. Consistently, cerebrospinal fluid (CSF) Amyloid ß (Aß) and phosphorylated Tau level measurements are currently used to detect AD presence. However, two central biases affect these biomarkers. Firstly, incomplete knowledge of the pathogenesis of diseases legitimates the search for novel molecules that, reasonably, could be expressed by neurons and microglia and could be detected in blood simpler and earlier than the classical markers and in a higher amount. Further, studies have been performed to evaluate whether CSF biomarkers can predict AD onset in Mild Cognitive Impairment (MCI) patients. However, the MCI definition has changed over time. Hence, the studies on MCI patients seem to be biased at the beginning due to the imprecise enrollment and heterogeneous composition of the miscellaneous MCI subgroup. Plasma biomarkers and novel candidate molecules, such as microglia biomarkers, have been tentatively investigated and could represent valuable targets for diagnosing and monitoring AD. Also, novel AD markers are urgently needed to identify molecular targets for treatment strategies. This review article summarizes the main CSF and blood AD biomarkers, underpins their advantages and flaws, and mentions novel molecules that can be used as potential biomarkers for AD.

Discrete element simulation of compression failure mechanism of SiC ceramic considering collinear flaws.

A particle-based numerical simulation model was established for SiC ceramics, and a method of deleting the particles along the specified direction was chosen to produce a pair of pre-existing collinear flaws. A serial of simulations were carried out to investigate the effects of inclination angle and ligament length on the failure mechanism under uniaxial compression. The laws of crack initiation and propagation as well as the distribution laws of the stress field and displacement field around the pre-existing flaws were analyzed. The results showed that the influence of inclination angle θ on micro-crack initiation, propagation and coalescence was more significant than that of ligament length L for pre-existing collinear flaws. Meanwhile, three coalescence models can be found with the increase of the inclination angle. By analyzing the evolution process of the displacement and stress fields during the loading process, it was clearly that the first crack was induced by the tensile stress concentration, and the secondary crack was initiated and propagated with tensile and shear stress. Moreover, the propagation mechanism of the micro-crack was closely related to the evolution behaviours of the stress and displacement fields.

Administrative failures contributing to the proliferation and growth of informal settlements in Ethiopia: The case of Woldia Township.

Informal settlements continue to grow steadily in the urban and peri-urban areas of Ethiopia. So, studying the main triggering factors for the emergence of such settlements is timely and could support decision-makers in making an informed decision. Indeed, this study aims to identify the main administrative deficiencies that contribute to the growth of informal settlements. This informal settlement is reflected in the illegal land use, small-scale constructions, and individual housing in the rural interface areas of Woldia (in Ethiopia) where there is an authority vacuum and planning policies are unclear. The paper is based mainly on the original research, including findings from interviews, FGDS, and observations. Diagrams, tables, and photos added extra information to the discussion. The findings of the study revealed that there is laxity from the local administration in controlling the emergence and expansion of informal settlements. To this end, the findings of the work suggest that despite the public authorities being responsible for enforcing laws in controlling the development of informal settlements, for the most part, they do it incompetently due to inadequate management capacity, lack of urban land information systems, and authority vacuum among land administration institutions. Other reasons include widespread corruption, backdoor deals, and a lack of accountability. The paper concludes that the growth of such settlements is unlikely to be reversed in the future unless a viable and appropriate policy measure is in place.

Multi T1-weighted contrast imaging and T1 mapping with compressed sensing FLAWS at 3 T.

OBJECTIVE: The Fluid And White matter Suppression (FLAWS) MRI sequence provides multiple T1-weighted contrasts of the brain in a single acquisition. However, the FLAWS acquisition time is approximately 8 min with a standard GRAPPA 3 acceleration factor at 3 T. This study aims at reducing the FLAWS acquisition time by providing a new sequence optimization based on a Cartesian phyllotaxis k-space undersampling and a compressed sensing (CS) reconstruction. This study also aims at showing that T1 mapping can be performed with FLAWS at 3 T. MATERIALS AND METHODS: The CS FLAWS parameters were determined using a method based on a profit function maximization under constraints. The FLAWS optimization and T1 mapping were assessed with in-silico, in-vitro and in-vivo (10 healthy volunteers) experiments conducted at 3 T. RESULTS: In-silico, in-vitro and in-vivo experiments showed that the proposed CS FLAWS optimization allows the acquisition time of a 1 mm-isotropic full-brain scan to be reduced from [Formula: see text] to [Formula: see text] without decreasing image quality. In addition, these experiments demonstrate that T1 mapping can be performed with FLAWS at 3 T. DISCUSSION: The results obtained in this study suggest that the recent advances in FLAWS imaging allow to perform multiple T1-weighted contrast imaging and T1 mapping in a single [Formula: see text] sequence acquisition.

Manipulação e fabricação de dados em pesquisa científica: as consequências são tão simples como pensamos? / Data manipulation and fabrication in scientific research: are the consequences as simple as we think?

A má conduta científica vem sendo observada ao longo da história da ciência, entretanto, nas últimas décadas teve um crescimento exponencial, e um exemplo disso foi a época da pandemia da COVID-19. Ficamos a refletir sobre o potencial impacto que uma evidência frágil pode gerar a partir de um convencimento de uma prática ou tomada de decisão profissional. Isso pode ocorrer devido a falhas no sistema educacional, na formação de pesquisadores e até mesmo a desvios morais e éticos.

Scientific misconduct has been observed throughout the history of science. However, it has grown exponentially in recent decades, an example of which was the time of the COVID-19 pandemic. We reflect on the potential impact of weak evidence from a convincing practice or professional decision-making. This situation can occur due to educational system failures, training of researchers, and even moral and ethical deviations.

Nondestructive Examination of Carbon Fiber-Reinforced Composites Using the Eddy Current Method.

This paper presents the results of experiments using the eddy current system designated for nondestructive inspection of carbon fiber-reinforced composites. For this purpose, the eddy current testing system with a differential transducer with two pairs of excitation coils oriented perpendicularly and a central pick-up coil was utilized. The transducer measures the magnetic flux difference flowing through the pick-up coil. The transducer of this design has already been successfully utilized to inspect isotropic metal structures. However, the anisotropy of the composites and their lower conductivity compared to metal components made the transducer parameters adjustment essential. Thus, various excitation frequencies were considered and investigated. The system was evaluated using a sample made of orthogonally woven carbon fiber-reinforced composites with two artificial flaws (the notches with a maximum relative depth of 30% and 70%, respectively, thickness of 0.4 mm, and a length of 5 mm). The main goal was to find a configuration suitable for detecting hidden flaws in such materials.

A patient advocating for transparent science in rare disease research.

300 million people live with at least one of 6,000 rare diseases worldwide. However, rare disease research is not always reviewed with scrutiny, making it susceptible to what the author refers to as nontransparent science. Nontransparent science can obscure animal model flaws, misguide medicine regulators and drug developers, delay or frustrate orphan drug development, or waste limited resources for rare disease research. Flawed animal models not only lack pharmacologic relevance, but also give rise to issue of clinical translatability. Sadly, these consequences and risks are grossly overlooked. Nontransparency in science can take many forms, such as premature publication of animal models without clinically significant data, not providing corrections when flaws to the model are discovered, lack of warning of critical study limitations, missing critical control data, questionable data quality, surprising results without a sound explanation, failure to rule out potential factors which may affect study conclusions, lack of sufficient detail for others to replicate the study, dubious authorship and study accountability. Science has no boarders, neither does nontransparent science. Nontransparent science can happen irrespective of the researcher's senority, institutional affiliation or country. As a patient-turned researcher suffering from Bietti crystalline dystrophy (BCD), I use BCD as an example to analyze various forms of nontransparent science in rare disease research. This article analyzes three papers published by different research groups on Cyp4v3-/-, high-fat diet (HFD)-Cyp4v3-/-, and Exon1-Cyp4v3-/- mouse models of BCD. As the discussion probes various forms of nontransparent science, the flaws of these knockout mouse models are uncovered. These mouse models do not mimic BCD in humans nor do they address the lack of Cyp4v3 (murine ortholog of human CYP4V2) expression in wild type (WT) mouse retina which is markedly different from CYP4V2 expression in human retina. Further, this article discusses the impact of nontransparent science on drug development which can lead to significant delays ultimately affecting the patients. Lessons from BCD research can be helpful to all those suffering from rare diseases. As a patient, I call for transparent science in rare disease research.

Writing Multiple Choice Questions-Has the Student Become the Master?

CONSTRUCT: We compared the quality of clinician-authored and student-authored multiple choice questions (MCQs) using a formative, mock examination of clinical knowledge for medical students. BACKGROUND: Multiple choice questions are a popular format used in medical programs of assessment. A challenge for educators is creating high-quality items efficiently. For expediency's sake, a standard practice is for faculties to repeat items in examinations from year to year. This study aims to compare the quality of student-authored with clinician-authored items as a potential source of new items to include in faculty item banks. APPROACH: We invited Year IV and V medical students at the University of Adelaide to participate in a mock examination. The participants first completed an online instructional module on strategies for answering and writing MCQs, then submitted one original MCQ each for potential inclusion in the mock examination. Two 180-item mock examinations, one for each year level, were constructed. Each consisted of 90 student-authored items and 90 clinician-authored items. Participants were blinded to the author of each item. Each item was analyzed for item difficulty and discrimination, number of item-writing flaws (IWFs) and non-functioning distractors (NFDs), and cognitive skill level (using a modified version of Bloom's taxonomy). FINDINGS: Eighty-nine and 91 students completed the Year IV and V examinations, respectively. Student-authored items, compared with clinician-authored items, tended to be written at both a lower cognitive skill and difficulty level. They contained a significantly higher rate of IWFs (2-3.5 times) and NFDs (1.18 times). However, they were equally or better discriminating items than clinician-authored items. CONCLUSIONS: Students can author MCQ items with comparable discrimination to clinician-authored items, despite being inferior in other parameters. Student-authored items may be considered a potential source of material for faculty item banks; however, several barriers exist to their use in a summative setting. The overall quality of items remains suboptimal, regardless of author. This highlights the need for ongoing faculty training in item writing.

The Clinician's Guide to Baseball Pitching Biomechanics.

CONTEXT: Improper baseball pitching biomechanics are associated with increased stresses on the throwing elbow and shoulder as well as an increased risk of injury. EVIDENCE ACQUISITION: Previous studies quantifying pitching kinematics and kinetics were reviewed. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: At the instant of lead foot contact, the elbow should be flexed approximately 90° with the shoulder at about 90° abduction, 20° horizontal abduction, and 45° external rotation. The stride length should be about 85% of the pitcher's height with the lead foot in a slightly closed position. The pelvis should be rotated slightly open toward home plate with the upper torso in line with the pitching direction. Improper shoulder external rotation at foot contact is associated with increased elbow and shoulder torques and forces and may be corrected by changing the stride length and/or arm path. From foot contact to maximum shoulder external rotation to ball release, the pitcher should demonstrate a kinematic chain of lead knee extension, pelvis rotation, upper trunk rotation, elbow extension, and shoulder internal rotation. The lead knee should be flexed about 45° at foot contact and 30° at ball release. Corrective strategies for insufficient knee extension may involve technical issues (stride length, lead foot position, lead foot orientation) and/or strength and conditioning of the lower body. Improper pelvis and upper trunk rotation often indicate the need for core strength and flexibility. Maximum shoulder external rotation should be about 170°. Insufficient external rotation leads to low shoulder internal rotation velocity and low ball velocity. Deviation from 90° abduction decreases the ability to achieve maximum external rotation, increases elbow torque, and decreases the dynamic stability in the glenohumeral joint. CONCLUSION: Improved pitching biomechanics can increase performance and reduce risk of injury. SORT: Level C.

Simultaneous Optimization of MP2RAGE T1 -weighted (UNI) and FLuid And White matter Suppression (FLAWS) brain images at 7T using Extended Phase Graph (EPG) Simulations.

PURPOSE: The MP2RAGE sequence is typically optimized for either T1 -weighted uniform image (UNI) or gray matter-dominant fluid and white matter suppression (FLAWS) contrast images. Here, the purpose was to optimize an MP2RAGE protocol at 7 Tesla to provide UNI and FLAWS images simultaneously in a clinically applicable acquisition time at <0.7 mm isotropic resolution. METHODS: Using the extended phase graph formalism, the signal evolution of the MP2RAGE sequence was simulated incorporating T2 relaxation, diffusion, RF spoiling, and B1 + variability. Flip angles and TI were optimized at different TRs (TRMP2RAGE ) to produce an optimal contrast-to-noise ratio for UNI and FLAWS images. Simulation results were validated by comparison to MP2RAGE brain scans of 5 healthy subjects, and a final protocol at TRMP2RAGE  = 4000 ms was applied in 19 subjects aged 8-62 years with and without epilepsy. RESULTS: FLAWS contrast images could be obtained while maintaining >85% of the optimal UNI contrast-to-noise ratio. Using TI1 /TI2 /TRMP2RAGE of 650/2280/4000 ms, 6/8 partial Fourier in the inner phase-encoding direction, and GRAPPA factor = 4 in the other, images with 0.65 mm isotropic resolution were produced in <7.5 min. The contrast-to-noise ratio was around 20% smaller at TRMP2RAGE  = 4000 ms compared to that at TRMP2RAGE  = 5000 ms; however, the 20% shorter duration makes TRMP2RAGE  = 4000 ms a good candidate for clinical applications example, pediatrics. CONCLUSION: FLAWS and UNI images could be obtained in a single scan with 0.65 mm isotropic resolution, providing a set of high-contrast images and full brain coverage in a clinically applicable scan time. Images with excellent anatomical detail were demonstrated over a wide age range using the optimized parameter set.

Crowdsourcing Operational and Design Flaws of Diabetes Mobile Apps.

Unfortunately, many of the diabetes mobile apps have operational and design flaws that are debarring users from maximizing from the self-management paradigm. We, therefore, aim to identify the markers of operational and design flaws of diabetes mobile apps to facilitate a better user-centred design. e crowdsourced negative user review comments (rating score: 1-3) of 47 diabetes mobile apps from the google play store. A total of 781 negative user comments (rating score 1-3) from the apps are coded to identify and categorize the themes relating to the operational and design flaws. The operational and design flaws account for 50.32% of the challenges faced by the unhappy diabetes mobile apps users. Among them, 44.73% have issues with app crashing, 17.3% are concerned about device compatibility that inhibits seamless operations, 9.67% are worried about the problem of data uploading. Poor design is a worry to 19.29% of the users who complain of the crowded user interface, poor data management, poor analytics, difficulty scheduling doctors' appointments, and transferring data. More patients with diabetes can be encouraged to continue using diabetes mobile apps for self-management of diabetes through improved design and a pace-wise software advancement to match the ever-growing enhancements in android operating systems and telecommunication devices. This will help to counter most of the challenges identified in this study.

Characterization of Damage Progress in the Defective Grouted Sleeve Connection Using Combined Acoustic Emission and Ultrasonics.

The grouted sleeve connection is one of the most widely used connections for prefabricated buildings (PBs). Usually, its quality can have a significant impact on the safety of the whole PB, especially for the internal flaws that form during sleeve grouting. It is directly related to the mechanical performance and failure behavior of the grouted sleeve. Therefore, it is essential to understand the damage progression of the defective grouted sleeve connection. However, destructive testing is the mainstream measure to evaluate the grout sleeves, which is not applicable for in situ inspection. Therefore, this paper proposes a combined acoustic emission (AE) and ultrasonic testing (UT) method to characterize the damage progress of a grouted sleeve with different degrees of internal flaws under tensile loading. The UT was conducted before loading to evaluate the internal flaws. Additionally, the AE was used as the processing monitoring technique during the tensile testing. Two damage modes were identified: (i) brittle mode associated with the rebar pullout; (ii) ductile mode associated with the rapture of the rebar. The UT energy ratio was selected as the most sensitive feature to the internal flaws, both numerically and experimentally. The AE signatures of different damage phases and different damage modes were determined and characterized. For the brittle and ductile damage modes, two and three phases appeared in the AE activities, respectively. The proposed combined AE and UT method can provide a reliable and convenient nondestructive evaluation of grouted sleeves with internal flaws. Moreover, it can also characterize the damage progress of the grouted sleeve connections in real-time.

Construction and Writing Flaws of the Multiple-Choice Questions in the Published Test Banks of Obstetrics and Gynecology: Adoption, Caution, or Mitigation?

Background The item-writing flaws (IWFs) in multiple-choice questions (MCQs) can affect test validity. The purpose of this study was to explore the IWFs in the published resources, estimate their frequency and pattern, rank, and compare the current study resources, and propose a possible impact for teachers and test writers. Methods This cross-sectional study was conducted from September 2017 to December 2020. MCQs from the published MCQ books in Obstetrics and Gynecology was the target resources. They were stratified into four clusters (study-book related, review books, self-assessment books, and online-shared test banks). The sample size was estimated and 2,300 out of 11,195 eligible MCQs were randomly selected. The MCQs (items) were judged on a 20-element compiled checklist that is organized under three sections as follows: (1) structural flaws (seven elements), (2) test-wiseness flaws (five elements), and (3) irrelevant difficulty flaws (eight elements). Rating was done dichotomously, 0 = violating and 1 = not violating. Item flaws were recorded and analyzed using the Excel spreadsheets and IBM SPSS. Results Twenty three percent of the items ( n = 537) were free from any violations, whereas 30% ( n = 690) contained one violation, and 47% ( n = 1073) contained more than one violation. The most commonly reported IWFs were "Options are Not in Order (61%)." The best questions with the least flaws (75th percentiles) were obtained from the self-assessment books followed by study-related MCQ books. The average scores of good-quality items in the cluster of self-assessment books were significantly higher than other book clusters. Conclusion There were variable presentations and percentages of item violations. Lower quality questions were observed in review-related MCQ books and the online-shared test banks. Using questions from these resources needs a caution or avoidance strategy. Relative higher quality questions were reported for the self-assessment followed by the study-related MCQ books. An adoption strategy may be applied with mitigation if needed.

The nature and consequences of a nuclear war: lessons for prevention from Ukraine 2022.

This article attempts to put the Ukrainian conflict in the wider context of nuclear weapons possession and potential use, to point out how its conduct should affect public perception of such use, and the urgency for effective nuclear arms control measures including a determined resolve to implement the United Nations' 2017 Treaty on the Prevention of Nuclear Weapons.

A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment.

BACKGROUND: It is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems. OBJECTIVE: This study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital's computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems. METHODS: The Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability. RESULTS: The participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals' knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity. CONCLUSIONS: This initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems.