Advancing Accessibility Research in Kinesiology: A Mixed-Methods Case Study of One Survey Website

While some studies in kinesiology have investigated the accessibility of educational material and electronic applications used to promote physical activity (eg, ease to perceive/navigate content resources), few studies report on the accessibility of survey tools before their use in research. PURPOSE: The purpose of this study was to measure the accessibility of one survey website to a study directly investigating comprehension of mock physical activity promotion material created by Thomas et al. (2023). METHODS: The website was for study participants to complete an online version of a cloze form (for a visual, see Nielsen, 2011; eg, see Cardinal et al., 1995). The accessibility check, done before the research website launched, had two phases: (1) a valid and reliable quantitative accessibility rating form was administered by the research team (Jul - Aug 2022, Wu et al. 2022a & 2022b) and (2) after edits were made based on the rating form findings, a pilot test of the website survey instruments was done with mock end users (Feb - Mar 2023). Mock end users (n = 12) were volunteers from the first author’s research lab and were invited to give qualitative feedback on the site’s usability before leaving the website (eg, on webpage/site navigation, on instruction clarity). Ten gave website feedback. The analytic plan was to (1) identify descriptive trends in the mock end user feedback (2) relate feedback trends to rating form criteria scores with unanimous consensus, as a measure of similarity between the two study findings (ie, Phase 1 vs 2). RESULTS: Phase 1 data analysis suggested each webpage fully met accessibility standards in 7 subareas (eg, plain language use, clear navigation). Phase 2 analysis supported most conclusions derived from rating form results (eg, clear instructions & layout), but challenged others (eg, cloze form was somewhat accessible because website platform, Canvas, required scrolling once finished, not due to missing frequently asked questions page). Pilot test showed text at a lower reading level (before edits) had lower comprehension, but text at a higher level had good validity. CONCLUSION: Our results evidenced the rating form could ensure websites have adequate accessibility. Findings also underscored significance of pilot testing research instruments with mock end users outside the research team

Teaching Current and Future Professionals Techniques for Lay Communication: Validation Study of Published Training Material

Thomas et al. (2023), developed two mock physical activity promotion (PAP) material, which university students (and others) could practice critiquing and revising using the suitability assessment of materials (SAM) protocol. Their objective, however, was to produce mock material at two reading grade levels (11th & 8th RGL), meaning they did not compute suitability scores for other sub/main areas (eg, font size, literacy demand, respectively). PURPOSE: The purpose of the present study was to (1) establish trustworthy baseline data in other SAM sub/main areas for students to compare their own scores to (2) compare mock material SAM scores to one another and published research trends (3) interpret the results using our pilot research directly investigating lay adult comprehension of the mock material, using the cloze procedure (Cardinal et al., 1995). METHODS: An expert coder (JDT) rated the mock material to establish valid scores, using an adapted SAM protocol (Thomas et al., 2020). Intra-rater reliability (JDT) was assessed using a three-day grace period, test-retest method (statistical test: Krippendorff’s alpha, k-α). Suitability scores were compared to contemporary trend data (Thomas et al., 2022). RESULTS: Rater reliability was almost perfect (11th RGL, k-α = .889; 8th RGL, k-α = .907). The mock material suitability was overall adequate (11th RGL = 55.88%, 8th RGL = 67.60%). The materials differed in three main areas (eg, literacy demand & learning stimulation), with suitability greater for the 8th RGL material. Both material had three main areas with the same suitability judgments as the published trend data. The 8th RGL material had more subareas with scores equal to, or greater than, the trend data. CONCLUSION: Findings suggest the 8th RGL material had greater suitability than the 11th RGL, and better mirrored PAP material trend data. This suggests PAP material in circulation may be adequately understood by lay adults in non-stressful situations. Our pilot test showed the reverse, however. The 11th RGL material had greater comprehension before the 8th RGL material was revised using the cloze procedure (SAM scores were equivalent for the original & revised draft). We produced valid/reliable SAM scores for the mock material, and further evidenced the need to directly investigate PAP material comprehension

Accessibility Rating Form for Websites and Other Online Platforms

Background. This file provides a coding form developed to judge how accessible websites and other online platforms are to users. Accessibility may be defined as the ease to which a person can perceive content and navigate material (Ross & Ross, 2021). Users are encouraged to adapt this form for their use. Purpose. The rating form can be used to judge the pages of online media, using 14 criteria under two areas: Accessible Media and Accessible Design. One of three grades could be assigned to each criterion: Not Accessible (0 point), Somewhat Accessible (1 point), Accessible (2 points), adapted from published research by Wallace et al. (2010). Initially, this form was developed to rate the website created using the Learning Management System platform, Canvas (Instructure, n.d.), which was adapted as a research survey website. Form validity and reliability. This form was based on guidelines for accessible websites, provided from the World Wide Web Consortium (Zahra, 2019). This form was found to have excellent rater agreement within a preliminary study, which was presented at the 2022 Southwest Chapter Conference Meeting of the American College of Sports Medicine (October 28-29, Costa Mesa, California). The intraclass coefficient statistic was used (four raters, M = .91, LL = .82, UL = .94; Landers, 2015). Results were interpreted using Cicchetti’s (1994) interpretive cut-points. Further detail is reported in the published abstract to the study’s presentation (Wu et al., in press)

Evaluating Research Survey Websites in Kinesiology: A Case Study Using An Accessibility Rating Form

Advancing equity in the research and educational practice of kinesiology requires intentional efforts to ensure access divides do not widen nor persist (Ross et al., in press, JOPERD). PURPOSE: Given knowledge of suitability assessment of materials (SAM) principles supports the equitable design of lay print and online material, we evaluated the extent they would also support developing a research survey website consistent with accessibility guidelines for digital technology. METHODS: The study website was adapted from the Canvas learning management system. A cross-sectional formative assessment was performed. Using their knowledge of SAM principles (eg, clear layout, text ≤ 8th grade reading level), the second and third author (JDT, RFH) constructed the website webpages (eg, site welcome page, online questionnaire; Jun.-Jul. 2022). The first author (YSW), using guidelines from two reputable sources (ie, a Canvas tutorial and W3C website), developed a 14-item accessibility rating form to critically appraise the website’s 10 webpages (ie, 1 = Not Accessible, 2 = Somewhat Accessible, 3 = Accessible; Wallace et al., 2010, JPAH). Authors 1-4 then performed a formative assessment of the adapted Canvas websites’ accessibility independently (Jul.-Aug. 2022). Form reliability was assessed using the intraclass correlation coefficient and its interpretive cut-points for average absolute-rater agreement (Cicchetti, 1994, Psych Assess; Landers, 2015, Winnower). RESULTS: Average rater agreement was excellent per webpage (M = .91, LL = .82, UL = .94). Mean webpage score ranged between 2.55 (±0.78) to 2.77 (±0.58). Informational pages (eg, welcome page) had greater accessibility than interactive pages (eg, forms). Five discrepant items were systematic, resulting in redundant rater differences (eg, keyboard navigation was hard to notice). All discrepancies were resolved with 100% consensus. CONCLUSION: The findings of the present study suggest knowledge of SAM principles ensures developers can design lay friendly and accessible research survey websites. They further suggest rating forms inclusive of digital accessibility guidelines should be used as a supplement to further meet accessibility and equity goals. We will share our form, then discuss our results using the universal design for learning framework

A fatal case of oral intoxication by mustard gas

Opisan je slučaj peroralne intosikacije iperitom u namjeri samoubojstva i iznesen obdukcioni nalaz. Ukratko su izneseni neki toksikološki pogledi na otrovanje iperifom, te klinički simptomi i patomorfološke promjene kod intoksikacije ovim otrovom.A case is presented of a man aged 27 who swallowed 50 g of mustard gas (dichlor-diethylsulphide) in order to commit suicide. Although immediately treated at the Internal Clinic of the Medical Faculty, he died 8 hours and 20 minutes after taking the poison. A postmortem examination carried out 19 hours after death, as well as histological findings showed congestion and oedema of the brain, fragmentation of cardiac muscle, oedema of mucous membranes of the upper part of gastrointestinal tract, oedema of larynx and epiglotis, oedema of the liver, and congestion of the spleen, adrenal glands, and kidneys. A microscopic examination of the lung tissue revealed hemorrhages probably due to the irritative effect of the poison

Impact of an Early Invasive Strategy versus Conservative Strategy for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome in Patients with Chronic Kidney Disease: A Systematic Review.

BACKGROUND: Clinical practice guidelines support an early invasive approach after NSTE-ACS in patients with chronic kidney disease (CKD). There is no direct randomised controlled trial evidence in the CKD population, and whether the benefit of an early invasive approach is maintained across the spectrum of severity of CKD remains controversial. METHODS: We conducted a systematic review to evaluate the association between an early invasive approach and all-cause mortality in patients with CKD. We searched MEDLINE and EMBASE (1990-May 2015) and article reference lists. Data describing study design, participants, invasive management strategies, renal function, all-cause mortality and risk of bias were extracted. RESULTS: 3,861 potentially relevant studies were identified. Ten studies, representing data on 147,908 individuals with NSTE-ACS met the inclusion criteria. Qualitative heterogeneity in the definitions of early invasive approach, comparison groups and renal dysfunction existed. Meta-analysis of the RCT derived and observational data were generally supportive of an early invasive approach in CKD (RR0.76 (95% CI 0.49-1.17) and RR0.50 (95%CI 0.42-0.59) respectively). Meta-analysis of the observational studies demonstrated a large degree of heterogeneity (I2 79%) driven in part by study size and heterogeneity across various kidney function levels. CONCLUSIONS: The observational data support that an early invasive approach after NSTE-ACS confers a survival benefit in those with early-moderate CKD. Local opportunities for quality improvement should be sought. Those with severe CKD and the dialysis population are high risk and under-studied. Novel and inclusive approaches for CKD and dialysis patients in cardiovascular clinical trials are needed

Identification of genetic effects underlying Type 2 Diabetes in South Asian and European populations

South Asians are at high risk of developing type 2 diabetes (T2D). We carried out a genome-wide association meta-analysis with South Asian T2D cases (n=16,677) and controls (n=33,856), followed by combined analyses with Europeans (neff=231,420). We identify 21 novel genetic loci for significant association with T2D (P=4.7x10-8 to 5.2x10-12), to the best of our knowledge at the point of analysis. The loci are enriched for regulatory features, including DNA methylation and gene expression in relevant tissues, and highlight CHMP4B, PDHB, LRIG1 and other genes linked to adiposity and glucose metabolism. A polygenic risk score based on South Asian-derived summary statistics shows ~4-fold higher risk for T2D between the top and bottom quartile. Our results provide further insights into the genetic mechanisms underlying T2D, and highlight the opportunities for discovery from joint analysis of data from across ancestral populations

Surgical Standards for Management of the Axilla in Breast Cancer Clinical Trials with Pathological Complete Response Endpoint.

Advances in the surgical management of the axilla in patients treated with neoadjuvant chemotherapy, especially those with node positive disease at diagnosis, have led to changes in practice and more judicious use of axillary lymph node dissection that may minimize morbidity from surgery. However, there is still significant confusion about how to optimally manage the axilla, resulting in variation among practices. From the viewpoint of drug development, assessment of response to neoadjuvant chemotherapy remains paramount and appropriate assessment of residual disease-the primary endpoint of many drug therapy trials in the neoadjuvant setting-is critical. Therefore decreasing the variability, especially in a multicenter clinical trial setting, and establishing a minimum standard to ensure consistency in clinical trial data, without mandating axillary lymph node dissection, for all patients is necessary. The key elements which include proper staging and identification of nodal involvement at diagnosis, and appropriately targeted management of the axilla at the time of surgical resection are presented. The following protocols have been adopted as standard procedure by the I-SPY2 trial for management of axilla in patients with node positive disease, and present a framework for prospective clinical trials and practice