Analysis of labour accidents caused by slope failure during slope cutting and application of a rapid checklist for risk management in Japan.

Slope failure during or immediately after slope-cutting can cause fatal accidents. This study analyses the characteristics of labour accidents caused by slope failure during slope-cutting in Japan and presents a countermeasure to prevent accidents caused by slope failure, such as the implementation of a slope guideline by MHLW. A case history conducted during slope-cutting and nailing was presented as an example of the application of the slope guideline to ensure safety. Furthermore, monitoring methods were implemented to gain a quantitative understanding of slope deformation. Geological conditions other than those assumed prior to excavation and small collapses attributed to groundwater are indications of landslide risk. The guideline's quick checklist reflects the slope condition or deformation, allowing the client, designer and contractor to discuss and agree on a quick solution to a problem. The case study confirmed the effectiveness of the slope guideline as a tool for sharing information during construction.

The Influence of Cognitive and Emotional Factors on Social Media Users' Information-Sharing Behaviours during Crises: The Moderating Role of the Construal Level and the Mediating Role of the Emotional Response.

Understanding the intricate dynamics of social media users' information-sharing behaviours during crises is essential for effective public opinion management. While various scholarly efforts have attempted to uncover the factors influencing information sharing through different lenses, the underlying mechanisms remain elusive. Building upon the heuristic-systematic model (HSM) and construal level theory (CLT), this study explores the complex mechanisms that govern social media users' information-sharing behaviours. The results indicate that both cognition and emotion play crucial roles in shaping users' information-sharing behaviours, with systematic cues having the most significant impact on information-sharing behaviours. In terms of heuristic cues, positive emotions are more influential on information-sharing behaviours than primary cognition and negative emotions. Furthermore, spatial distance emerges as a key moderator, influencing individuals' levels of engagement in information sharing. Emotion also acts as a mediator, connecting cognition to information sharing. This study provides insights into the sophisticated mechanisms of information sharing during crises, offering valuable implications for emergency management agencies to utilise social media for targeted public opinion guidance.

Determinants of users' unverified information sharing on social media platforms: A herding behavior perspective.

The proliferation of unverified or false information by irresponsible users can significantly amplify the spread of misinformation or fake news. Despite growing research on unverified information sharing, a comprehensive understanding of the varying influences of different factors and strategies to mitigate this issue remains under investigation. To address this research gap, this study, rooted in the theory of herd behavior, develops, and tests a model theorizing the reasons behind social media users' unverified information sharing. Data was collected from 510 respondents across six regions of China using a convenience sampling method. The collected data was analyzed using Mplus. The results from this study indicated that perceived severity, state uncertainty, and herding have a significant positive influence on unverified information sharing. These results enrich the understanding of unverified information-sharing behavior among Chinese social media users. Drawing from these results, we suggest platform administrators and policymakers mitigate herd behavior tendencies and stem the spread of misinformation by disseminating timely, accurate, and authoritative information. Since this action will reduce users' perceptions of severity and uncertainty. Social media users are also advised to stay vigilant over the implications of herd behavior and foster a more critical attitude towards information sharing.

Empowering pro-environmental behavior in tourists through digital media: the influence of eco-guilt and empathy with nature.

In the digital economy era, leveraging digital media to foster tourists' pro-environmental behavioral intention (TPEBI) has become crucial in the field of sustainable tourism. While existing studies have mainly focused on the driving mechanism of TPEBI within physical tourism contexts, the correlation between digital media information sharing and TPEBI remains unclear. Our study employs the cognitive-affective-conative framework to construct a theoretical model, considering eco-guilt and empathy with nature as mediating variables. It aims to explore the influencing mechanism of destination environmental information sharing through digital media on TPEBI from a presence perspective. Thereby, two scenario experiments were designed: Study 1 examined the impact of different formats of destination environmental threat information presentation on digital media on the sense of presence, while Study 2 explored the influencing mechanism of presence on TPEBI based on the conclusions of Study 1. Results indicate that (1) vivid and visible presentation formats of destination environmental threat information on digital media enhance individuals' sense of presence; (2) sense of presence positively influences TPEBI; and (3) eco-guilt and empathy with nature mediate between presence and TPEBI. These findings not only contribute to theoretical and empirical research on digital media information sharing in sustainable tourism but also offer guidance for governments and tourism destinations to effectively stimulate TPEBI through digital media, achieve the sustainable development of destinations.

Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan.

Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.

Healthcare communication satisfaction and psychosocial outcomes in adolescents and young adults with differences of sex development.

OBJECTIVES: We examined: (1) healthcare communication satisfaction and psychosocial outcomes (resilience, QoL, and psychological adjustment) in adolescents and young adults (AYA) with differences of sex development (DSD), (2) differences in psychosocial outcomes between those who were highly satisfied and those who were less satisfied, and (3) group differences between adolescents (ages 12-17) and young adults (ages 18-26) regarding associations with healthcare communication and psychosocial outcomes. METHODS: AYA with DSD across four study sites reported on satisfaction with healthcare communication and psychosocial outcomes. Analyses included descriptive statistics (aim 1), independent samples t-tests (aim 2), and Pearson's correlations (aim 3). RESULTS: Participants reported high levels of satisfaction with healthcare communication. Higher healthcare communication satisfaction was associated with greater resilience (p = .01), better QoL (p = .02), and fewer internalizing problems (p = .04). For adolescents, higher healthcare communication satisfaction was associated with better psychosocial outcomes (p values ranging from.01-.04). No significant associations were found in the young adult group. CONCLUSIONS: Satisfaction with healthcare communication is related to positive psychosocial outcomes in adolescents with DSD. PRACTICE IMPLICATIONS: These data underscore the importance of optimizing communication with families, engaging AYA in early and ongoing discussions about their care, and including psychosocial providers in DSD care.

From "exceptional ethics" to public health ethics. Patients and proxies facing COVID-19. Ethics and public health during COVID-19 / D'une « éthique d'exception ¼ à une éthique de la santé publique. Patients et proches face à la COVID-19. Éthique et santé publique en temps de COVID-19.

The study aimed to elicit the perception and ethical considerations of patients and proxies with respect both to the individual medical decisions and public health decisions made during the COVID-19 crisis. It used a qualitative, multi-center study based on semi-directive interviews, conducted by an interdisciplinary team. The analysis was conducted using a thematic analysis approach and an ethical framework. Three themes emerged from the analysis: 1) patients, unlike proxies, did not complain about their diminished role in the decision-making process. Both highlighted the importance of "basic care" as opposed to a technical approach to treatment; 2) despite the transparency of the information process, a deep "crisis of trust" has developed between citizens and public authorities; 3) although both patients and proxies accepted the limitations of personal liberties imposed in the name of public health, they argued that these limitations should respect certain boundaries, both temporal and spacial. Above all, they should not affect basic affective human relationships, even if such boundaries are a factor in an increased risk of infection. The study showed that there is a need to reconsider the definition and the main principles of public health ethics, namely transparency and proportionality.

L'étude vise à analyser la perception que les patients et les proches de patients pris en charge pendant la crise de la COVID-19, ont pu avoir de leur prise en charge, et leurs réflexions éthiques sur la place et la définition de la santé publique. L'étude a utilisé une méthode qualitative et multicentrique. Les entretiens semi-directifs ont été conduits par une équipe pluridisciplinaire et analysés avec une approche thématique et une grille de lecture éthique à partir des principes de l'éthique biomédicale. Trois thèmes ont émergé : 1) Les patients ont exprimé peu de revendications de participer aux décisions médicales les concernant, contrairement aux proches qui se sont sentis exclus de leur rôle. Tous ont mis l'accent sur l'importance des soins de base par rapport aux soins techniques ; 2) La gestion de la crise n'est pas jugée sévèrement, mais une crise de confiance importante a été mise en évidence, malgré la « transparence ¼ affichée de l'information ; 3) les contraintes collectives ont été largement acceptées au nom de la solidarité, mais on a jugé qu'elles doivent avoir des limites (temporelle et spatiales). Surtout, elles ne doivent pas empêcher des relations humaines simples et essentielles. L'étude met en évidence qu'il est nécessaire de développer une réflexion nouvelle autour de l'éthique de la santé publique : il convient de questionner les principes de « transparence ¼ et de « proportionnalité ¼ et d'adopter une définition de « santé publique ¼ plus large que la minimisation du risque infectieux.

Recognition of Community Pharmacists' Behaviors Related to Information Sharing: A Cross-Sectional Study.

With the recent shift in community pharmacist services toward in-person services and the growing need for centralized and continuous medication management/monitoring, pharmacist-patient information sharing is crucial. This study investigated the pharmacist-patient gap in the recognition of pharmacists' behaviors regarding information sharing and assessed the potential impact of such recognition on patient trust and willingness to self-disclose. This cross-sectional study included 600 patients (aged 21-85 years) using pharmacy services (surveyed online in December 2020) and 591 community pharmacists with ≥1 year of experience (surveyed from September to November 2021). Both groups responded to items on the recognition of pharmacists' behaviors regarding information sharing. There were patient-specific items on trust in community pharmacists and willingness to self-disclose. For all items on the recognition of pharmacists' behaviors, patients' scores were significantly lower (4-5) than pharmacists' own scores (≥5), revealing a notable perception gap. Patients' recognition had a positive, direct effect on trust and willingness, and trust had a positive, direct effect on willingness. Patients' recognition and trust positively influenced their willingness to self-disclose. Pharmacist communication with clear intent is important to bridge the gaps in pharmacist-patient recognition and foster effective patient-pharmacist relationships.

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability.

Background: Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization's Global Strategy on Digital Health 2020-2025. Objective: To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development? Methods: Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research. Results: Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers). Conclusions: When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes.

Understanding Social Media Information Sharing in Individuals with Depression: Insights from the Elaboration Likelihood Model and Schema Activation Theory.

Purpose: How individuals engage with social media can significantly impact their psychological well-being. This study examines the impact of social media interactions on mental health, grounded in the frameworks of the Elaboration Likelihood Model and Schema Activation Theory. It aims to uncover behavioral differences in information sharing between the general population and individuals with depression, while also elucidating the psychological mechanisms underlying these disparities. Methods: A pre-experiment (N=30) and three experiments (Experiment 1a N=200, Experiment 1b N=180, Experiment 2 N=128) were executed online. These experiments investigated the joint effects of information quality, content valence, self-referential processing, and depression level on the intention to share information. The research design incorporated within-subject and between-subject methods, utilizing SPSS and SPSS Process to conduct independent sample t-tests, two-factor ANOVA analyses, mediation analyses, and moderated mediation analyses to test our hypotheses. Results: Information quality and content valence significantly influence sharing intention. In scenarios involving low-quality information, individuals with depression are more inclined to share negative emotional content compared to the general population, and this tendency intensifies with the severity of depression. Moreover, self-referential processing acts as a mediator between emotional content and intention to share, yet this mediation effect weakens as the severity of depression rises. Conclusion: Our study highlights the importance of promoting viewpoint diversity and breaking the echo chamber effect in social media to improve the mental health of individuals with depression. To achieve this goal, tailoring emotional content on social media could be a practical starting point for practice.

Users' unverified information-sharing behavior on social media: The role of reasoned and social reactive pathways.

Unverified or false information spread by irresponsible users can amplify the dissemination of fake news or misinformation. This phenomenon may not only undermine the credibility of social media platforms but also pose severe consequences for individuals and society. This study applies and extends the prototypical willingness model with the aim of comprehending the reasons, and decision-making process driving users' unverified information-sharing behavior a reasoned and intended pathway or an impulsive and unconscious one. Data from a sample of 646 users were analyzed using Structural Equation Modeling to assess the determinative effect of both the reasoned pathway (attitude toward unverified information-sharing, subjective norm, and perceived behavioral control) and the social-reaction pathway (prototype favorability and similarity). Findings highlight the substantial role of the social-reaction pathway in forecasting users' unverified information-sharing behavior, with prototype similarity and attitude being the dominant predictors. Meanwhile, components of the reasoned pathway, specifically perceived behavior control, and attitude, also exhibited significant contributions toward predicting the behavior. In summary, while a deliberate, reasoned process has some influence, the sharing of unverified information on social media by users is primarily an intuitive, spontaneous response to specific online circumstances. This study therefore offers valuable insights that could aid relevant stakeholders in effectively regulating the spread of misinformation. Against this backdrop, highlighting potential risks associated with sharing unverified information and the negative portrayal of users propagating misinformation may contribute to the development of a more critical perspective toward online information sharing by users themselves.

Investigating the Roles and Responsibilities of Institutional Signing Officials After Data Sharing Policy Reform for Federally Funded Research in the United States: National Survey.

BACKGROUND: New federal policies along with rapid growth in data generation, storage, and analysis tools are together driving scientific data sharing in the United States. At the same, triangulating human research data from diverse sources can also create situations where data are used for future research in ways that individuals and communities may consider objectionable. Institutional gatekeepers, namely, signing officials (SOs), are therefore at the helm of compliant management and sharing of human data for research. Of those with data governance responsibilities, SOs most often serve as signatories for investigators who deposit, access, and share research data between institutions. Although SOs play important leadership roles in compliant data sharing, we know surprisingly little about their scope of work, roles, and oversight responsibilities. OBJECTIVE: The purpose of this study was to describe existing institutional policies and practices of US SOs who manage human genomic data access, as well as how these may change in the wake of new Data Management and Sharing requirements for National Institutes of Health-funded research in the United States. METHODS: We administered an anonymous survey to institutional SOs recruited from biomedical research institutions across the United States. Survey items probed where data generated from extramurally funded research are deposited, how researchers outside the institution access these data, and what happens to these data after extramural funding ends. RESULTS: In total, 56 institutional SOs participated in the survey. We found that SOs frequently approve duplicate data deposits and impose stricter access controls when data use limitations are unclear or unspecified. In addition, 21% (n=12) of SOs knew where data from federally funded projects are deposited after project funding sunsets. As a consequence, most investigators deposit their scientific data into "a National Institutes of Health-funded repository" to meet the Data Management and Sharing requirements but also within the "institution's own repository" or a third-party repository. CONCLUSIONS: Our findings inform 5 policy recommendations and best practices for US SOs to improve coordination and develop comprehensive and consistent data governance policies that balance the need for scientific progress with effective human data protections.

The Health History of First-Degree Relatives' Dyslipidemia Can Affect Preferences and Intentions following the Return of Genomic Results for Monogenic Familial Hypercholesterolemia.

Genetic testing is key in modern healthcare, particularly for monogenic disorders such as familial hypercholesterolemia. This Tohoku Medical Megabank Project study explored the impact of first-degree relatives' dyslipidemia history on individual responses to familial hypercholesterolemia genomic results. Involving 214 participants and using Japan's 3.5KJPN genome reference panel, the study assessed preferences and intentions regarding familial hypercholesterolemia genetic testing results. The data revealed a significant inclination among participants with a family history of dyslipidemia to share their genetic test results, with more than 80% of participants intending to share positive results with their partners and children and 98.1% acknowledging the usefulness of positive results for personal health management. The study underscores the importance of family health history in genetic-testing perceptions, highlighting the need for family-centered approaches in genetic counseling and healthcare. Notable study limitations include the regional scope and reliance on questionnaire data. The study results emphasize the association between family health history and genetic-testing attitudes and decisions.

Ultrafast diffusion tensor imaging based on deep learning and multi-slice information sharing.

Objective. Diffusion tensor imaging (DTI) is excellent for non-invasively quantifying tissue microstructure. Theoretically DTI can be achieved with six different diffusion weighted images and one reference image, but the tensor estimation accuracy is poor in this case. Increasing the number of diffusion directions has benefits for the tensor estimation accuracy, which results in long scan time and makes DTI sensitive to motion. It would be beneficial to decrease the scan time of DTI by using fewer diffusion-weighted images without compromising reconstruction quality.Approach. A novel DTI scan scheme was proposed to achieve fast DTI, where only three diffusion directions per slice was required under a specific direction switching manner, and a deep-learning based reconstruction method was utilized using multi-slice information sharing and correspondingT1-weighted image for high-quality DTI reconstruction. A network with two encoders developed from U-Net was implemented for better utilizing the diffusion data redundancy between neighboring slices. The method performed direct nonlinear mapping from diffusion-weighted images to diffusion tensor.Main results. The performance of the proposed method was verified on the Human Connectome Project public data and clinical patient data. High-quality mean diffusivity, fractional anisotropy, and directionally encoded colormap can be achieved with only three diffusion directions per slice.Significance. High-quality DTI-derived maps can be achieved in less than one minute of scan time. The great reduction of scan time will help push the wider application of DTI in clinical practice.

Differential effects of digital media platforms on climate change risk information-sharing intention: A moderated mediation model.

This study analyzes the mechanisms through which risk messages about climate change lead to people's risk information-sharing intention, and how digital media platform type serves as a context that moderates those mechanisms. Our analysis is informed by the influence of presumed influence (IPI) model, and we adapt and expand that model in three ways. First, we apply the concept of perceived media reach to the context of digital media platforms, specifically news aggregators and social networking sites. Second, we integrate the two mediators of risk perception and presumed influence. Third, we examine potential moderating roles of digital media platforms in the IPI model. An online survey was conducted among 1000 South Korean adults, and a moderated mediation model (PROCESS Macro Model 59) generated the following results. (1) Perceived media reach was positively related to both mediators-risk perception and presumed influence. (2) By way of those two mediators, perceived reach significantly led to information-sharing intention. (3) Presumed influence, but not risk perception, was significantly related to information-sharing intention. (4) Digital media platforms moderated the relation between perceived reach and risk perception: the role of content-related risk perception was more pronounced in news aggregators, while the role of context-related presumed influence was greater in social networking sites. Theoretical and practical implications for risk communication are discussed.

Security screening metrics for information-sharing partnerships.

Recent history has shown both the benefits and risks of information sharing among firms. Information is shared to facilitate mutual business objectives. However, information sharing can also introduce security-related concerns that could expose the firm to a breach of privacy, with significant economic, reputational, and safety implications. It is imperative for organizations to leverage available information to evaluate security related to information sharing when evaluating current and potential information-sharing partnerships. The "fine print" or privacy policies of firms can provide a signal of security across a wide variety of firms being considered for new and continued information-sharing partnerships. In this article, we develop a methodology to gauge and benchmark information security policies in the partner-selection process that can help direct risk-based investments in information sharing security. We develop a methodology to collect and interpret firm privacy policies, evaluate characteristics of those policies by leveraging natural language processing metrics and developing benchmarking metrics, and understand how those characteristics relate to one another in information-sharing partnership situations. We demonstrate the methodology on 500 high-revenue firms. The methodology and managerial insights will be of interest to risk managers, information security professionals, and individuals forming information sharing agreements across industries.

Surgeon Information-Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy.

OBJECTIVE: We characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease-specific knowledge for parents of children with obstructive sleep-disordered breathing (OSDB). STUDY DESIGN: Mixed-methods sequential explanatory analysis. SETTING: Outpatient otolaryngology clinics. METHODS: We analyzed audio-recorded communication during outpatient encounters for children undergoing initial evaluation for adenotonsillectomy. We identified discrete triadic instances of clinician discussion of individual risks and benefits, parent verbal responses coded as passive ("Right") or active ("Would that repeat the recovery time?"), and corresponding parent answer (correct or incorrect) on a postconsult knowledge questionnaire. Primary outcomes included parent knowledge and decisional conflict. We qualitatively analyzed substantive questions asked by parents during the encounter. RESULTS: In 30 consults, clinicians (n = 8) provided 156 instances of discussion (101 risk, 55 benefit), to which parents provided 34% active responses. Clinician discussion of risks and benefits was associated with greater parent knowledge (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.25-6.09; P < .001), however parent active engagement was not associated with greater parent knowledge (OR = 1.04, 95% CI: 0.42-2.58, P = .93). Parents demonstrated greater knowledge of benefits than risks (χ2 = 23.16, V = 1.13; P < .001). Parents who responded actively (OR = 0.26, 95% CI: 0.09-0.72; P = .010) or had greater knowledge (OR = 0.41, 95% CI: 0.21-0.81; P = .010) had less decisional conflict. CONCLUSION: Clinician information-sharing was associated with greater parent knowledge about OSDB treatment. Greater parent engagement and knowledge were independently associated with less decisional conflict. These findings may inform clinicians' approaches to counseling and engaging parents in decisions for surgery.

How Do Physicians Frame Medical Information in Talks With Their Patients? An Inductive Microanalysis.

During medical consultations, physicians need to share a substantial amount of information with their patients. How this information is framed can be crucial for patient understanding and outcomes, but little is known about the details of how physicians frame information in practice. Using an inductive microanalysis approach in the study of videotaped medical interactions, we aimed to identify the information frames (i.e., higher-level ways of organizing and structuring information to reach a particular purpose) and the information-framing devices (i.e., any dialogic mechanism used to present information in a particular way that shapes how the patient might perceive and interpret it) physicians use spontaneously and intuitively while sharing information with their patients. We identified 66 different information-framing devices acting within nine information frames conveying: (1) Do we agree that we share this knowledge?, (2) I don't like where I (or where you are) am going with this, (3) This may be tricky to understand, (4) You may need to think, (5) This is important, (6) This is not important, (7) This comes from me as a doctor, (8) This comes from me as a person, and (9) This is directed to you as a unique person. The kaleidoscope of information-framing devices described in this study reveals the near impossibility for neutrality and objectivity in the information-sharing practice of medical care. It also represents an inductively derived starting point for further research into aspects of physicians' information-sharing praxis.

Conversations About Congenital Clubfoot: Investigating How Parents Share Information About a Structural Diagnosis With Their Children.

Background and objective Clubfoot is a common congenital musculoskeletal condition that is treated with manipulation and casting in the first few weeks of life, followed by bracing that extends into early childhood. While children typically do not recall treatment with Ponseti casting in infancy, childhood treatment and monitoring may result in a sense of heightened awareness. In light of this, this study explores how parents share information about clubfoot diagnosis and guide their children in understanding the importance of treatment. Methods Parents of clubfoot children aged 5-18 years were eligible to participate. Primary recruitment was done through social media via Facebook clubfoot support groups. Participants who gave consent completed an electronic survey and were invited to take part in a semi-structured interview to share additional experiences. Significant themes elicited from study interviews were analyzed along with survey responses. Results Survey responses were received from 74 parents, and 23 participated in the semi-structured interview. Of note, 91% of parents indicated discussing clubfoot with their children, beginning at a median age of three years. The age at which parents first discussed clubfoot with their child was significantly earlier for those who "strongly agree" that their children understand their condition versus those who "agree". Although 68% of parents indicated that receiving guidance from their orthopedic provider would be helpful for these discussions, only 18% noted receiving direct advice. Recurrent themes across interviews included being open and honest about the children's diagnosis and treatment, aiding the children in taking ownership of their diagnosis, and validating emotional responses throughout treatment.  Conclusions This study provides valuable insights into initiating conversations with children about structural diagnoses like congenital clubfoot. Recurrent themes from conversations with families provide information on helpful strategies to encourage early discussions about clubfoot diagnosis and treatment to aid children in taking ownership of their diagnosis.