Ruey-Ying Liu

Older adults, women, and minorities are under‐represented in clinical trials. Our objective was to identify characteristics predicting participation in clinical trials of medications in a diverse sample of older adults; and, secondarily, identify current participation motivators and barriers and trial preferences. A cross‐sectional U.S. community convenience sample survey of adults > 65 years with > 3 chronic medical conditions querying attitudes about participation in clinical trials was conducted from March 2023–October 2024 in English and Spanish. Formats were yes/no or three‐point Likert scale answers. Multivariable logistic regression identified characteristics with higher likelihood of trial participation. Surveys were from 2176 older adults (White (50.3%), Black/African American (18.5%), Hispanic/Latino (17.7%), Asian (13.5%) aged 73.1 ± 6.1 years (mean, SD), 52% women,one 4.1 ± 1.9 medical conditions; taking 7.4 ± 3.2 medications. Characteristics with higher likelihood of trial participation were higher income (1.36, 0.93–1.99; Odds Ratio, 95% Confidence Interval), educational status (1.88, 1.12–3.0), greater health literacy (2.07, 1.29–3.3), having cancer (1.49, 1.11–1.99) or chronic pain (1.55, 1.17–2.06), Black/African American race (1.44, 1.02–2.02) or Hispanic/Latino race/ethnicity (1.55, 1.11–2.16). Females had lower likelihood of participation (0.66, 1.29–3.32) as did age 75 and above (0.67, 0.50–0.92). Disincentives in women were potential side effects, placeboes, visit travel > 1 h, and video visits. Prior participants and nonparticipants were more likely to consider participation after physician recommendation (92% and 76.4%, respectively). Better care would motivate the highest percentage of all respondents. Education about trials including possible benefits, addressing concerns of women, physician involvement during recruitment and trials with in‐person visits may increase representative enrollment.

Background: Older adults with multimorbidity have been under‐represented in clinical drug trials. We sought to determine willingness to enroll in trials and preferences of older adults for learning about clinical trials, visit frequency, travel, locations, and testing. Methods: Cross‐sectional internet and telephone survey of a nationally representative sample of adults ≥ 65 years with ≥ 3 chronic conditions ( NORC University of Chicago Foresight 50+ panel) from March–April 2023 to determine acceptability of aspects of clinical trials. Results: Surveyed 1318 (1142 Internet, 176 phone), mean age 72.3 ± 6.3 ( SD ), 52% women; race: 83% White, 10% Black or African American ( BLAfrAm ), 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Almost half would consider trials of medications for memory problems, hypertension, cancer, chronic pain, diabetes, or high cholesterol. Men and BLAfrAm respondents were the most willing to consider hypertension or diabetes trials. Preferences for where to learn about trials were physician offices (87% overall, 85% of BLAfrAm , 94% of Hispanic); 10% of White respondents considered senior centers versus 30% of BLAfrAm and 20% of Hispanics ( p < 0.001). Two‐thirds wanted written materials and question and answer sessions (no significant sex or racial differences). Respondents anticipated no difficulty with measuring blood pressure at home, and only respondents > 80 years anticipated difficulty wearing activity monitoring devices. All groups preferred monthly or every 3–4 month visits for physical exams, blood or urine tests vs. less frequently and were willing to travel half an hour in each direction for visits. Conclusions: Efforts to increase enrollment of older adults and older adults from previously under‐represented racial populations will need increased physician engagement. Pragmatic trials with infrequent participant contact are not likely to increase participation of older adults with multimorbidity.

This study investigates practicing clinician and staff perspectives on potential protocol modifications for the “Nasal Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Acute Sinusitis” (NOSES) study, a pragmatic randomized controlled trial aiming at improving acute rhinosinusitis management. Focus groups with clinicians and staff at the pretrial stage recommended expanding participant age inclusion criteria, incorporating patients with COVID-19, and shortening the supportive care phase. Participants also discussed patient engagement and recruitment strategies. These practical insights contribute to optimizing the NOSES trial design and underscore the value of qualitative inquiries and healthcare stakeholder engagement in informing clinical trial design.

Background: Older adults with multimorbidity are under‐represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. Methods: Cross‐sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March–April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. Results: Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African‐American respondents, and those ≥80 years). Sixty‐five percent would join all in‐person trials, 49% would join all‐video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). Conclusions: Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in‐person visits are preferred. Proposed changes in trial design to increase enrollment of under‐represented older adults may not align with patient‐reported preferences.

China’s political press conferences have received increasing academic attention as they provide a revealing window into the workings of the political communication system in the authoritarian context. However, the interactional role that interpreters play in these cross-linguistic press conferences remains underexamined. Taking a conversational analytic approach, this qualitative study empirically examines the interactional import of government interpreters’ practices at the Chinese Premier’s Press Conferences (CPPCs) from 2007 to 2023. The analysis reveals that interpreters consistently transform journalists’ questions with respect to (1) word choices, (2) contextual backgrounds, and (3) question forms. These transformative practices work to soften the critical messages that these questions would otherwise convey while also enabling politicians to more easily address these questions without having to deal with the negative consequences that might otherwise follow. I argue that government interpreters in CPPCs actively intervene in substantive ways consistent with a spin doctor role within press conference exchanges.

The discursive construction of institutional identity concerns how speakers, through their verbal conduct, perform actions as incumbents of particular institutional roles. This can be accomplished through the first-person plural pronoun, a salient marker of the ongoing displays, expressions, and constructions of institutional identity. Drawing on the Chinese premier's press conferences, this study investigates how politicians, journalists, and interpreters constitute their institutional identities through their use of the first-person plural pronoun (English we; Mandarin 我们 wǒmen). Relying on qualitative analysis and bivariate analysis, this study shows that Chinese journalists and interpreters tend to constitute their identities as aligned with the Chinese authority. This stands in contrast to patterns identified in independent press systems, in which journalists confront politicians, and interpreters serve as impartial facilitators. The findings illustrate the bounded fluidity of identities in political discourse and provide insight into the workings of the political communication system in an authoritarian context. (Political discourse, identity, personal pronoun, press conference, journalistic norm, mass communication, interpreter-mediated interaction, China, authoritarianism)*

While people are generally considered as having primary rights to know and describe themselves, in parent–child interaction, young children are not always treated as having primary access to and sole authority over matters within their own domain. Drawing on naturally occurring parent–child interactional data, this conversation analytic study shows how parents claim epistemic primacy over young children with respect to matters that, based on norms of adult interaction, should be unequivocally presupposed within children's primary epistemic domain. Two forms of evidence are provided: (1) parents confirm or disconfirm children's asserted claims about their own sensations, thoughts, or experiences; and (2) parents use test questions to request information within children's domain and then evaluate their answers as correct or incorrect. These practices indicate an orientation to young children's reduced rights to claim epistemic autonomy. I argue that this is one way through which childhood is constructed in social interaction.

When adults select young children to answer questions, children’s delays and troubles in responding may lead to a tension between child participation and the preference for progressivity that normally applies to conversations among adults. Drawing on everyday adult-child conversational data, this study focuses on question-answer sequences in which the selected child does not respond in a timely or adequate manner and examines how co-present, nonselected adults balance between progressivity and the need to facilitate child participation. The analysis shows that adults tend to manage this balance by prioritizing child participation over progressivity, thereby socializing children to achieve interactional autonomy. This ordering of preferences in adult-child interaction is in contrast with previous findings in adult conversation. This study provides empirical evidence of the ways adults prioritize child participation and socialize children into active responsive participation in conversation. Data are in Mandarin and English.