bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Variation in the Mechanical and Microstructural Properties of the Human Anterior Cruciate Ligament
Authors: Skelley Nathan W. , Castile Ryan M. , Cannon Paul C. , Weber Christian I. , Brophy Robert H. , Lake Spencer P.
Published: July 2016

Background:

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) has a higher modulus and failure stress than does the posterolateral (PL) bundle. However, it is unknown how these properties vary within each bundle.

Purpose:

To quantify mechanical and microstructural properties of samples within ACL bundles to elucidate any regional variation across the ligament. We hypothesized that there are no differences within each bundle in contrast to cross-bundle variation.

Study Design:

Descriptive laboratory study.

Methods:

Sixteen human ACLs were dissected into AM and PL bundles. Three samples were taken from each bundle in an ordered sequence from AM (region 1 AM bundle) to PL (region 6 PL bundle). Each sample was tested in uniaxial tension, using quantitative polarized light imaging (QPLI) to quantify collagen fiber alignment. After preconditioning, samples were subjected to a stress-relaxation (SR) test followed by quasistatic ramp-to-failure (RF). Peak and equilibrium stress values were computed from the SR test and modulus quantified in the toe- and linear-regions of the RF. QPLI values describing collagen orientation (angle of polarization [AoP]) and strength of alignment (degree of linear polarization [DoLP]) were computed for the SR test and at points corresponding to the zero, transition point, and linear region of the RF.

Results:

Toe- and linear-region modulus values decreased from region 1 to 6. Slopes of regression lines increased for the average DoLP during RF, with significance at higher strains. The standard deviation of AoP values decreased during RF, indicating tighter distribution of orientation angles, with significant correlations at all points of the RF. During SR, stress values uniformly decreased but did not show significant linear regression by region. DoLP and AoP values changed slightly during SR and demonstrated significant linear variation by region at both peak and equilibrium points.

Conclusion:

Most microstructural and material properties evaluated in this study appear to follow a linear gradient across the ACL, rather than varying by bundle.

Clinical Relevance:

This AM-to-PL variation provides a more accurate description of functional tissue anatomy and can be used to assess and guide techniques of ACL reconstruction.
The construction of religion as a ‘public problem’: The emergence of Islam in the public space during Tunisia’s transition to democracy (2011–14)
Authors: Nachi Mohamed
Published: July 2016

The object of the present study is to analyze how, over the transition period of 2011–14, Islam became a ‘public problem’, to understand how it came to pervade the public space. I will investigate the place of religion in the public space both before and after the 2011 elections, and to do so will start with a few ‘affairs’ and controversies surrounding Islam and its place in the new Constitution as well as in the broader framework of Tunisian society.
Exploring Empathy and Callous–Unemotional Traits as Predictors of Animal Abuse Perpetrated by Children Exposed to Intimate Partner Violence
Authors: Hartman Christie , Hageman Tina , Williams James Herbert , Mary Jason St. , Ascione Frank R.
Published: July 2016

We explored the relation between empathy, callous–unemotional (CU) traits, and animal abuse in a sample of 290 seven- to twelve-year-old children whose mothers were exposed to intimate partner violence (IPV). The sample comprises mostly Latino and White participants, and 55% of the children’s mothers were born outside the United States (primarily Mexico). To our knowledge, among studies examining child-perpetrated animal abuse, this study is the first to examine empathy levels and one of only a few to examine CU traits. When comparing Griffith Empathy Measure (empathy) and Inventory of Callous–Unemotional Traits (callous–unemotional [CU] traits) scores with those from studies of White schoolchildren, our sample scored lower on affective empathy, higher on cognitive empathy, and lower for overall CU scores as well as Callous and Unemotional subscales. Of 290 children, 47 (16.2%) harmed an animal at least once according to either mother or child report. There were no significant sex or age differences between Abuse and No Abuse groups. The Abuse group scored significantly higher on affective empathy, CU, and Callousness/Unemotional subscales, and significantly lower on cognitive empathy. However, in regression analyses that controlled for income, only lower cognitive empathy and higher CU significantly predicted having abused an animal. In summary, low cognitive empathy (but not affective empathy) and CU traits may serve as reliable predictors of child animal abuse. However, replication of these results is necessary. A larger sample with a high percentage of Latino children whose mothers were exposed to IPV, along with a non-exposed comparison group, would be ideal.
Cyberbullying Perpetration by Arab Youth: The Direct and Interactive Role of Individual, Family, and Neighborhood Characteristics
Authors: Khoury-Kassabri Mona , Mishna Faye , Massarwi Adeem Ahmad
Published: July 2016

This study adopts a social-ecological/contextual perspective to explore Arab youth involvement in cyberbullying perpetration. We explored the association between individual (age, gender, and impulsivity), family (socioeconomic status and parental monitoring), and community (experiencing neighborhood violence) characteristics and cyberbullying perpetration. A moderation model exploring individual, family, and context interactions was tested. A sample of 3,178 Arab students in Grades 7 to 11 completed a structured, anonymous self-report questionnaire. The findings suggest that almost 14% of the participants have cyberbullied others during the last month. Adolescent boys with high impulsivity, low parental monitoring, and who experience a high level of violence in their neighborhood are at especially high risk of cyberbullying perpetration. Parental monitoring moderated the effects of impulsivity and experiencing neighborhood violence on adolescents’ involvement in perpetrating cyberbullying. Furthermore, the results show that impulsive adolescents who experience high levels of neighborhood violence are at higher risk of cyberbullying perpetration than low impulsive children who experience the same levels of neighborhood violence. The results highlight the central role parenting plays in protecting their children from involvement in cyberbullying perpetration by buffering the effects of personal and situational risk factors.
Early-Holocene to present palaeoenvironmental shifts and short climate events from the tropical wetland and lake sediments, Kukkal Lake, Southern India: Geochemistry and palynology
Authors: Rajmanickam Vijayaraj , Achyuthan Hema , Eastoe Christopher , Farooqui Anjum
Published: July 2016

The Kukkal basin, Tamil Nadu, India, receives most of its rain from the southwest monsoon (SWM). A sediment core from Kukkal Lake preserves a continuous sediment record from the early-Holocene to present (9000 yr BP to present). The present lake is situated at an elevation of ~1887 m a.s.l., in a small basin that appears to have alternated between a and wetland depositional environment. Climate proxies, including sediment texture, total organic carbon (TOC), total nitrogen (TN), C/N, pollen and geochemical composition indicate a steady progression to wetter conditions, with two stepwise changes at about 8000, and between 3200 and 1800 yr BP. The change at 8000 yr BP appears to correspond to a brief (100–150 years) dry spell recorded elsewhere in India. The change at 3200–1800 yr BP consisted in a rapid intensification of the SWM, and may correlate with the initiation of the ‘Roman Warm Period’. There is no clear evidence of changes at the times of the ‘Medieval Warm Period’ (‘MWP’) and the ‘Little Ice Age’ (‘LIA’). The C/N ratio of the sediments ranges from 14.02 to 8.31, indicating that the organic matter originated from a mixture of lacustrine algae, vascular and terrestrial plants. Chemical weathering indices (Chemical Index of Alteration (CIA), Chemical Index of Weathering (CIW), and Plagioclase Index of Alteration (PIA)) are consistent with extreme silicate weathering. Pollen data show a development from savanna vegetation prior to about 8000 yr BP, followed by grassland with palms, the appearance of ferns just prior to 3200 yr BP and the establishment of the tropical humid forest between 3200 and about 1800 yr BP.
Solo works of mixed music with live electronics: A qualitative enquiry in timbre and gesture from the performer’s perspective
Authors: Boutard Guillaume
Published: July 2016

The performance of mixed music with live electronics is challenging for performers. In this context, idiosyncratic sound processing and synthesis tools are developed specifically for each work, inclined to technological obsolescence, and thus creating transmission and preservation issues. Still, performers, especially in the case of solo works, develop an expertise over time and over multiple performances by multiple performers. From this perspective, the question of co-construction of meaning in relation to performance is especially relevant. We designed an experiment to study this process of co-construction of expertise and appropriation of live electronics from the perspective of instrumentalists. We commissioned four solo works (each one for a different instrument) and asked two instrumentalists (for each work) to play the piece during a concert. We used qualitative methods stemming from psychology of work to study the performance activity in relation to gesture and timbre from the point of view of instrumentalists. For each work, the instrumentalists were confronted with the traces of their own activity, that is to say, the video and audio recordings of their performance and, subsequently, with those of the other instrumentalist in his/her presence. The data was then compared to conceptual frameworks designed mainly in relation to instrumental music. This study provides us with a better understanding of the appropriation of live electronics by instrumentalists, the strategies for transmitting an expertise, and proposes theoretical and practical grounds for new frameworks for documenting and disseminating mixed music with live electronics.
Dinutuximab
Authors: Bartholomew Joy , Washington Tanea , Bergeron Sharon , Nielson Danelle , Saggio Jennifer , Quirk Lindsay
Published: July 2016

Therapy combining dinutuximab with granulocyte macrophage colony stimulating factor, interleukin 2, and isotretinoin has significant side effects; however, these complications are generally predictable and can be managed proactively.
On the use of product portfolio and variant maps as visualization tools to support platform-based development strategies
Authors: Ulonska Sören , Welo Torgeir
Published: July 2016

Current implementation methodologies for platform-based development strategies presume that product variants are made clear and explicit prior to application. However, this might not be the case in many engineer-to-order companies where product variants typically emerge from individual developments over time, commonly without a predefined product strategy. Also, information related to different product variants is usually spread across multiple sources. This makes it difficult to identify the information on which a future configure-to-order strategy can be built. In this article, a systematic, visual approach to identify, analyze, and structure product variant information has been developed. A real-world, proof-of-concept demonstrator case has been defined to verify the proposed modeling approach applied to the unstructured product portfolio of a small- and medium-sized enterprise company that manufactures road signpost masts and gantries. The outcome is a product portfolio map that visualizes the product variants in the product family side by side, and a variant map that provides a closer overview of functional structure and related physical variants. Hence, these two maps combined provide a systemized overview of the product variants at different abstraction levels as a knowledge source. It is concluded that this study has demonstrated the potential of a step-by-step methodology for preparing a dispersed product portfolio as a basis for the implementation of a configure-to-order strategy.
Comparison on wavelets techniques for solving fractional optimal control problems
Authors: Sahu PK , Saha Ray S
Published: July 2016

This paper presents efficient numerical techniques for solving fractional optimal control problems (FOCP) based on orthonormal wavelets. These wavelets are like Legendre wavelets, Chebyshev wavelets, Laguerre wavelets and Cosine And Sine (CAS) wavelets. The formulation of FOCP and properties of these wavelets are presented. The fractional derivative considered in this problem is in the Caputo sense. The performance index of FOCP has been considered as function of both state and control variables and the dynamic constraints are expressed by fractional differential equation. These wavelet methods are applied to reduce the FOCP as system of algebraic equations by applying the method of constrained extremum which consists of adjoining the constraint equations to the performance index by a set of undetermined Lagrange multipliers. These algebraic systems are solved numerically by Newton's method. Illustrative examples are discussed to demonstrate the applicability and validity of the wavelet methods.
Intergenerational Effects of Childhood Trauma
Authors: McDonnell Christina G. , Valentino Kristin
Published: July 2016

Maternal adverse childhood experiences (ACEs) have been associated with negative physical and mental health outcomes in adulthood. Less is known regarding how maternal ACEs relate to perinatal depressive symptoms or the intergenerational effect of maternal childhood trauma history on birth outcomes and infant functioning. To address this gap, an at-risk sample of 398 pregnant women was recruited from Women, Infants, and Children health clinics. Participants completed a prenatal ( M = 4.84 months before due date) and postnatal ( M = 6.76 months after birth) assessment and provided birth outcome data. At the prenatal assessment, mothers completed an ACEs measure which assessed experiences of childhood maltreatment and household dysfunction. Self-report measures of maternal depressive symptoms were obtained at both time points. Mothers reported on infant socioemotional functioning at 6 months. Maternal ACEs predicted higher levels of prenatal depressive symptoms. Childhood maltreatment experiences, in particular, predicted higher postnatal depressive symptoms and a smaller reduction in depressive symptoms across the perinatal period. Regarding intergenerational associations, maternal childhood maltreatment directly predicted higher levels of maladaptive infant socioemotional symptoms, whereas maternal household dysfunction indirectly related to infant socioemotional symptoms through maternal age at first pregnancy and infant birth weight. Limitations and future directions are discussed.
The Power of Constructivist Grounded Theory for Critical Inquiry
Authors: Charmaz Kathy
Published: July 2016

The pragmatist roots of constructivist grounded theory make it a useful method for pursuing critical qualitative inquiry. Pragmatism offers ways to think about critical qualitative inquiry; constructivist grounded theory offers strategies for doing it. Constructivist grounded theory fosters asking emergent critical questions throughout inquiry. This method also encourages (a) interrogating the taken-for-granted methodological individualism pervading much of qualitative research and (b) taking a deeply reflexive stance called methodological self-consciousness, which leads researchers to scrutinize their data, actions, and nascent analyses. The article outlines how to put constructivist grounded theory into practice and ends with where this practice could take us.
Temporary Clusters and Communities of Practice in the Creative Economy: Festivals as Temporary Knowledge Networks
Authors: Comunian Roberta
Published: July 2016

The article explores the role of art festivals as platforms for knowledge and network development in the creative industries and creative policy intervention using the case of a small street art festival ( Fuse Festival in Medway, UK). The analysis provides a broader perspective on the current research and debate on the impact and role played by arts festivals in local economic and cultural development—which usually concentrate on either their socioeconomic impact on local communities—to focus instead of their role in building knowledge communities and communities of practice. The results highlight the key role played by the festival in supporting and commissioning artistic work. The results also expose the temporary and explorative nature of many artistic practices and the role of interaction with audiences and other creative producers. Following a network perspective, the findings highlight the role of temporary clusters not only in shaping career opportunities for artists but also in drawing new pathways for local economic development for contexts undergoing regeneration.
‘No one wants to be taught from a textbook!’
Authors: Olson Rebecca , Laidlaw Penelope , Steel Kylie
Published: July 2016

Changes to the purpose and scope of health and physical education (HPE) in schools have prompted revisions in teacher education degrees within Australia. Using a qualitative approach, this study explored HPE teachers’ perceptions of these changes. Of particular interest was pre-service HPE teachers’ reflections on the importance of skill acquisition (also referred to as motor learning) content in their university degree, which focuses on the theories and practices involved in learning movement and perceptual skills. Findings were based on the thematic analysis of four semi-structured focus groups with 25 pre-service HPE teachers at one Australian metropolitan university. Analysis suggests that the importance of skill acquisition and the imperative to increase physical activity without a focus on competence are contradictory priorities within pre-service HPE curricula. The goal of promoting enjoyment of physical education sustained this tension, implying that there is a new discourse in HPE and suggesting the need for further research into the self-reflection and emotional dynamics of pre-service HPE teachers’ reflections on curricula.
The mirror image of asylums and prisons: A study of institutionalization trends in France (1850–2010)
Authors: Raoult Sacha , Harcourt Bernard E
Published: July 2016

This article analyzes trends in prison rates and mental hospital rates in France since the earliest available statistics. It shows that, on almost two centuries of data and amidst an agitated political history, every asylum trend in France is “countered” by an inverse prison trend, and vice-versa. Both trends are like a mirror image of each other. We reflect on the possible explanations for this intriguing fact and show that the most obvious ones (a population transfer or a building transfer) are not able to account for most of the relationship. After these explanations have been dismissed, we are left with an enigma with wide theoretical and practical implications. How is it that when prisons fall, asylums rise and when prison rise, asylums fall? We suggest possible research avenues drawing on the 1960s and 1970s critical literature on “total institutions” and offer implications for current theories of the “punitive turn” and current quantitative studies of prison rates.
Fusion Imaging to Support Endovascular Aneurysm Repair Using 3D-3D Registration
Authors: Schulz Christof J. , Schmitt Matthias , Böckler Dittmar , Geisbüsch Philipp
Published: July 2016

Purpose: To evaluate the feasibility and accuracy of fusion imaging (FI) during endovascular aneurysm repair (EVAR). Methods: FI was performed in 101 consecutive EVAR patients (median age 72 years; 93 men) using automatic registration of the preoperative computed tomography angiography (CTA) with an intraoperative noncontrast cone beam CT (nCBCT; 3D-3D registration). Operative landmarks defined on the CTA were then overlaid in 3 dimensions on fluoroscopy images. Accuracy was measured as the deviation of the position of the lowest renal artery between the FI and angiography. Factors potentially influencing accuracy (α angle, β angle, anesthesia, tortuosity index, neck calcification, neck length, CTA slice thickness, and conventional or sac sealing stent-graft) were analyzed in a multivariate linear regression model. Results: Median procedure time for nCBCT was 3 minutes (range 2–20), with 4 minutes (range 0.4–15) for registration. An automatic registration tool was used successfully in 90 (89%) patients. Median craniocaudal deviation of the FI was 3 mm (range 0–15). Full accuracy (<1-mm deviation) was seen in 23 (23%) patients, 1- to 3-mm deviation in 23 (23%), 4- to 5-mm deviation in 22 (22%), and >5-mm deviation in 33 (33%). Caudal deviation potentially resulting in renal coverage was seen in 9 (9%). Lateral plus craniocaudal deviation was a median 5.8 mm (range 0–22). The position of the lowest renal artery compared to the FI was left and cranial in 62 (61%). Aneurysm morphology (β angle, p=0.04), CTA slice thickness (p=0.02), and the use of 2 stiff guidewires in endovascular aneurysm sealing (p=0.01) influenced the overlay accuracy. Conclusion: Fusion imaging can be integrated into a daily workflow adding little to the procedure time. Craniocaudal accuracy (<5 mm) was achieved in 68% of cases, allowing optimal C-arm and angiographic catheter positioning or cannulation of target vessels in most patients. However, the accuracy of FI does not allow a noncontrast EVAR procedure without confirmation of FI overlay by a minimal contrast injection or vessel cannulation.
Gene Expression Analysis Reveals the Concurrent Activation of Proapoptotic and Antioxidant-Defensive Mechanisms in Flavokawain B–Treated Cervical Cancer HeLa Cells
Authors: Yeap Swee Keong , Abu Nadiah , Akthar Nadeem , Ho Wan Yong , Ky Huynh , Tan Sheau Wei , Alitheen Noorjahan Banu , Kamarul Tunku
Published: July 2016

Flavokawain B (FKB) is known to possess promising anticancer abilities. This is demonstrated in various cancer cell lines including HeLa cells. Cervical cancer is among the most widely diagnosed cancer among women today. Though FKB has been shown to be effective in treating cancer cells, the exact molecular mechanism is still unknown. This study is aimed at understanding the effects of FKB on HeLa cells using a microarray-based mRNA expression profiling and proteome profiling of stress-related proteins. The results of this study suggest that FKB induced cell death through p21-mediated cell cycle arrest and activation of p38. However, concurrent activation of antioxidant-related pathways and iron sequestration pathway followed by activation of ER-resident stress proteins clearly indicate that FKB failed to induce apoptosis in HeLa cells via oxidative stress. This effect implies that the protection of HeLa cells by FKB from H2O2–induced cell death is via neutralization of reactive oxygen species.
Multi-objective mapping of full-mission simulators on heterogeneous distributed multi-processor systems
Authors: Ayari Rabeh , Hafnaoui Imane , Aguiar Alexandra , Gilbert Patricia , Galibois Michel , Rousseau Jean-Pierre , Beltrame Giovanni , Nicolescu Gabriela
Published: July 2016

Full-mission simulators (FMSs) are considered the most critical simulation tool belonging to the flight simulator family. FMSs include a faithful reproduction of fighter aircraft. They are used by armed forces for design, training, and investigation purposes. Due to the criticality of their timing constraints and the high computation cost of the whole simulation, FMSs need to run in a high-performance computing system. Heterogeneous distributed systems are among the leading computing platforms and can guarantee a significant increase in performance by providing a large number of parallel powerful execution resources. One of the most persistent challenges raised by these platforms is the difficulty of finding an optimal mapping of n tasks on m processing elements. The mapping problem is considered a variant of the quadratic assignment problem, in which an exhaustive search cannot be performed. The mapping problem is an NP-hard problem and solving it requires the use of meta-heuristics, and it becomes more challenging when one has to optimize more than one objective with respect to the timing constraints. Multi-objective evolutionary algorithms have proven their efficiency when tackling this problem. Most of the existent works deal with the task mapping by considering either a single objective or homogeneous architectures. Therefore, the main contribution of this paper is a framework based on the model-driven design paradigm allowing us to map a set of intercommunicating real-time tasks making up the FMS model onto the heterogeneous distributed multi-processor system model. We propose a multi-objective approach based on the well-known optimization algorithm “Non-dominated Sorting Genetic Algorithm-II” satisfying the tight timing constraints of the simulation and minimizing makespan, communication cost, and memory consumption simultaneously.
Proposal of a coast-down model including speed-dependent coefficients for the retarding forces
Authors: Baldissera Paolo
Published: July 2016

Coast-down techniques are widely used on bicycles and motorized vehicles in order to estimate retarding forces and respective coefficients. The mathematical model behind coast-down data analysis is usually based on the assumption that both drag and rolling-resistance coefficients do not depend on the vehicle speed. This assumption restricts the model validity to the specifically tested range of speeds and provides averaged values for the force coefficients. In the attempt to overcome this limitation, the proposal of a complete polynomial equation of motion is developed, evaluated and discussed through a human-powered vehicle case study. The analysis points out that the extended model is adequate for experimental data fitting and could potentially provide a more reliable power–speed prediction outside the testing range. However, the expressions included in the model in order to account for speed-dependent coefficients are first approximation with limited capability to represent these complex phenomena. As a consequence, further experimental testing is needed in order to achieve a validation. Advantages and side effects of both the classical and the complete polynomial models are discussed, concluding that the two approaches could be complementary and could answer different needs that specifically depend on the purpose of the coast-down analysis.
Geographical frontiers of gendered violence
Authors: Brickell Katherine , Maddrell Avril
Published: July 2016

This article acts as an introduction to the suite of interventions which aim to generate belated conversation across geography on gendered violences. As such, it brings together and formalizes dialogue convened at the Royal Geographical Society with Institute of British Geographers(IBG) (RGS-IBG) Annual Conference 2013 on the theme of ‘new geographical frontiers’. Organized by the Gender and Feminist Geographies Research Group as part of the ‘100+’ series of events marking the centenary of women’s admission to the RGS-IBG, a plenary panel on gendered violences provided case study insights from the Global North and South on this pressing issue. While far from exhaustive, we explain how the collective of interventions on rape, domestic violence, state-sponsored violence and religious and racial hate crime highlight a multiple set of gendered violences that affect the lives of women and men in different settings.
Herding elephants
Authors: Tyner James
Published: July 2016

In this commentary, I provide critical feedback to a suite of interventions directed toward the geographic study of gendered violence. In furthering this dialogue, I identify three interrelated objects that must be foundational to any geographic study of gendered violence: putting the ‘person’ into interpersonal violence; resituating understandings of home, family, and violence; and the promotion of a denaturalized violence.
Occupational Functionality
Authors: Combs Bryan , Heaton Karen
Published: July 2016

Occupational health nursing has evolved since the late 19th century and, with the inclusion of advanced practice nursing, has become essential to the health and safety of workers. A key component of the knowledge required of advanced practice occupational health nurses is an understanding of what it means for workers to be fit for duty. The definition or concept of being fit for duty varies depending on the point-of-view of the health care provider. Health care providers across all professions must have a consistent understanding of what it means to be fit for duty. Literature shows that professions and specialties that often collaborate have varying ideas about what it means to be fit for duty. These differences highlight the need for a consistent concept that can be used across professions, is holistic, and incorporates other concepts critical to all points of view. To better understand fit for duty, a concept analysis, using the Walker and Avant framework, focused on the concept of occupational functionality (OF). Occupational functionality is best defined as the qualities of being suited to serve an occupational purpose efficiently and effectively within the physical, occupational, environmental, and psychological demands of a unique work setting. This concept analysis offers an initial step in understanding fit for duty and gives health care providers a concept that can be used across disciplines.
Design Issues of the Existing Radiotherapy Segmentation Software
Authors: Ramkumar Anjana , Song Yu , Niessen Wiro J. , Stappers Pieter Jan
Published: July 2016

Findings from previous literatures, ethnography studies and interviews showed that radiotherapy contouring interfaces are very complex, requiring many human-computer interactions (HCI). In this paper we used observational, heuristic evaluation, think aloud and NASA-TLX methods to 1) analyse the workflow of radiotherapy segmentation systems; 2) discover possible usability and HCI design issues of current segmentation systems in order to identify the requirements for future interface design; and 3) explore the abilities and limitations of various evaluation methods. From the results it can be seen that observational and think aloud methods were very useful in identifying the workflow of different systems. The heuristic evaluation method uncovered more general usability issues with the interface design. The think aloud method identified more HCI issues compared to general usability issues. From the NASA-TLX, it can be seen that the workload level of system C is higher in almost all the categories. Using the four different methods this study identified several usability and HCI issues and have proposed seven main requirements which might be considered in our future studies.
A Human Factors Approach to Building High-Performance Multi- Professional Cardiac Arrest Teams
Authors: Hinski Sandra , Cooke Nancy J. , McNeese Nathan , Sen Ayan , Patel Bhavesh
Published: July 2016

Background: The American Heart Association (AHA) estimates that annually there are approximately 200,000 in-hospital cardiac arrests (IHCA). Hospitals have implemented multidisciplinary teams trained in advanced cardiac life support (ACLS) to provide care during these events. Outcome measures of these team’s effectiveness are typically mortality rates at discharge and reduction of unplanned cardiac arrest occurring outside of the ICU. Neither is a sensitive measure of team effectiveness. Methods: Using a retrospective analysis of 10 simulated code blue events we developed a metric of team effectiveness for code blue teams that also identifies specific teamwork weaknesses. Results: The new ASU-Mayo metric was highly correlated with Mayo high performance team scale (MHPTS) (r (6) = .71), team emergency assessment measure (TEAM) (r (6) = .84), and the observational skill-based assessment tool for resuscitation (OSCAR) (r (6) = .89) metrics as well as the ratings of the subject matter experts (r (6) = .88). Conclusions: We developed a team performance metric that allows for the identification of performance gaps therefore, can allow for targeted intervention with the intention of providing trainees richer feedback on performance. Also, it will generate quantitative assessments of the value of mock code exercises and can be used to evaluate interventions. Our understanding of teamwork during a simulated code blue event was also enhanced.
Evaluation of Ergonomically Redesigned Paramedic Bags – A Usability Study
Authors: Bitan Yuval , Ramey Scott , Philp Giselle , Milgram Paul
Published: July 2016

Motivated by the premise that well designed paramedic response bags can improve paramedics’ performance and patient safety, our objectives in this study were to evaluate performance and preferences when comparing traditional response bags with new ergonomically designed bags. A usability study based on two emergency scenarios was carried out, using 17 active duty paramedic teams as participants. Although most of the objective performance results were not statistically significant, the subjective results showed a clear preference for the new bags.
The Learning Health-System
Authors: Roth Michael G. , Rubin Joshua C. , Omollo Kathleen , Friedman Charles P. , Seagull F. Jacob
Published: July 2016

The concept of a “Learning Health System” (LHS) is emerging as a new paradigm in healthcare. We present an overview of LHS functions and concepts, then an analysis of the ways in which Human Factors (HF) can contribute to and benefit from LHS. Successful implementation of an LHS will require the engagement of the HF community, and to this end the HF community will benefit from understanding the LHS. In order to effectively contribute, HF professionals must understand the complexities of the LHS, as well as the leverage points on which HF professionals can act.
Handoff Research
Authors: Riesenberg Lee Ann , Davis Robyn , O’Hagan Emma
Published: July 2016

Handoffs, or the transfer of patient care from one provider to another, are a complex task which can both contribute to and prevent medical errors. In this article, we review three topics that illustrate what is good, bad, and ugly about the current state of handoff research. First, we examine the good, the increase both in quantity and variety of research into patient handoffs over the past 30 years. Second, we discuss what is lacking, funding for handoff research. Finally we review one of the most troubling aspects of handoffs, the general lack of education and training for medical students, residents, and nursing students, to prepare them to manage handoffs as health care providers.
Modeling Patient-Centered Cognitive Work for High-Value Care Goals
Authors: Furniss Stephanie K. , Burton Matthew M. , Larson David W. , Kaufman David R.
Published: July 2016

Patient-centered cognitive support has been shown to be critically important to facilitate the effective use of health information technologies (HIT). There is a well-documented need to better understand HIT-mediated clinical workflow. Current technologies can burden clinicians’ cognitive resources, which is associated with patient safety risks and medical errors. We sought to employ a distributed cognition approach to examine how information flows across the activity system to support clinicians’ problem-solving. Specifically, we studied the propagation of representational states across media, conversations, actors and time in the coordination of patient-care processes. We examined multiple instances of work and information flow in a real-world setting, revealing problems in information flow: a) use of paper artifacts has limitations to facilitating coordination of care, b) clinicians challenged in developing shared awareness, c) responsibility of representing patient states is distributed across documents, d) clinical reasoning that informed care plans was absent from documents. Findings surface a challenge to automated monitoring of care goals; much of the information is present only in clinicians’ minds and in informal documents.
Human Factors and Health-Care Professionals Collaboration to Reduce Alarm Fatigue in ICU Settings at a Large Academic Medical Center
Authors: Mayer Celeste , Mauney Jennifer , Barnes Janey , Addison Ashley , Dicus Andrea K. , Hanlin Ryan , Hsieh Kelsy B. , Soares Sharmila , White Brittany L.
Published: July 2016

Key stakeholders across healthcare’s complex socio-technical environment have been called by the Joint Commission to take part in the shared responsibility to improve alarm safety. This project demonstrated the value added from applying Human Factors principles to a process supporting the safety of patients and the work of health-care providers by reducing the non-actionable alarms in 4 in-patient care units. An Alarm Safety Quality Improvement project is described with specific objectives, methods and results.

Results from this project demonstrated an iterative process which provided data and empowerment to the team. The data provided the unit leaders new actionable information and targeted intervention planning with associated meaningful measurements. The process has empowered units to tackle alarm fatigue with the necessary knowledge, tools, and support. The four in-patient care units that have completed this process saw a combined average weekly decrease of 14,000 alarms.
Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care
Authors: O’Malley Ann S. , Collins Anna , Contreary Kara , Rich Eugene C.
Published: July 2016

Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers. Methods: We used Choosing Wisely® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions. Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendations. Physicians’ communication skills were the most commonly mentioned facilitator. Practice site, organization, and hospital system barriers included measures of emergency department throughput, the order in which test options are listed in electronic health records (EHR), lack of relevant decision support in EHRs, and payment incentives that maximize billing and encourage procedures rather than medical management or counseling patients on behavior change. Factors from different levels interacted to undermine evidence-based care. Most physicians received billing feedback, but quality metrics on evidence-based service use were nonexistent for the four decisions in this study. Conclusions and Implications: Additional research and quality improvement may help to modify delivery systems to overcome barriers at multiple levels. Enhancing provider communication skills, improving decision support in EHRs, modifying workflows, and refining the design and interpretation of some quality metrics would help, particularly if combined with concurrent payment reform to realign financial incentives across stakeholders.
Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut
Authors: Kakihana Kazuhiko , Fujioka Yuki , Suda Wataru , Najima Yuho , Kuwata Go , Sasajima Satoshi , Mimura Iyo , Morita Hidetoshi , Sugiyama Daisuke , Nishikawa Hiroyoshi , Hattori Masahira , Hino Yutaro , Ikegawa Shuntaro , Yamamoto Keita , Toya Takashi , Doki Noriko , Koizumi Koichi , Honda Kenya , Ohashi Kazuteru
Published: July 2016

Key Points

FMT was safely performed in SCT patients, with 3 complete responses and 1 partial response. Temporal microbiota dynamics seem linked to gut condition and effector regulatory T cells also increased during response to FMT.
Superior absorption and retention properties of foam-film silver dressing versus other commercially available silver dressing
Authors: Lee Seung Moon , Park Il Kyu , Kim Yong Soo , Kim Hyun Jung , Moon Hanlim , Mueller Stefan , Arumugam Harsha , Jeong Young-IL
Published: July 2016

Background

The aim of this study is to investigate the physicochemical and structural properties of Medifoam®Silver and to compare with other commercially available silver-containing polyurethane (PU) foam dressing in vitro.

Methods

Surface and cross-section of four polyurethane foam dressings were assessed with field-emission scanning electron microscope. Thickness, density, tensile strength, elongation, absorption rate, absorption/retention capacity and water-vapor transmission (WVT) were measured to compare physical properties of various dressing materials.

Results

Among four tested dressings, Medifoam®Silver has relatively uniform and smallest pore size in both surface and cross-section. In comparison of absorption properties with other dressing materials, Medifoam®Silver has rapid absorption rate, good absorption/retention capacity and good WVT value.

Conclusions

The data further suggests that Medifoam®Silver is a promising candidate for wound healing management.
Obesity As a Risk Factor for Anthracyclines and Trastuzumab Cardiotoxicity in Breast Cancer: A Systematic Review and Meta-Analysis
Authors: Guenancia Charles , Lefebvre Annick , Cardinale Daniela , Yu Anthony F. , Ladoire Sylvain , Ghiringhelli François , Zeller Marianne , Rochette Luc , Cottin Yves , Vergely Catherine
Published: July 2016

Purpose

Patients with metabolic syndrome have a greater risk of cardiovascular disease, although their susceptibility to chemotherapy-induced cardiac disease is not well documented. The aim of this meta-analysis was to assess associations between obesity or being overweight and cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab in patients with breast cancer.

Methods

We performed a random-effects analysis and a network meta-analysis and assessed publication bias. We included 15 studies and 8,745 patients with breast cancers who were treated with anthracyclines and sequential anthracyclines and trastuzumab.

Results

Combination of obesity and being overweight was significantly associated with a greater risk of developing cardiotoxicity after anthracyclines and a sequential anthracyclines and trastuzumab regimen in patients with breast cancer. Pooled odds ratio for cardiotoxicity was 1.38 (95% CI, 1.06 to 1.80; I2= 43%; N = 8,745) for overweight or obesity (body mass index > 25 kg/m2), 1.47 (95% CI, 0.95 to 2.28; I2= 47%; n = 2,615) for obesity, and 1.15 (95% CI, 0.83 to 1.58; I2= 27%; n = 2,708) for overweight. Associations were independent of study design, year of publication, drug regimen (anthracyclines alone v sequential anthracyclines and trastuzumab), or definitions of cardiotoxicity and of overweight or obesity. There was no evidence of publication bias; however, we could not separate the contributions of obesity-related cardiovascular risk factors, such as diabetes and hypertension, from that of obesity itself in this largely unadjusted analysis.

Conclusion

Our findings in a largely unadjusted analysis suggest that overweight and obesity are risk factors for cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab.
Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review
Authors: Baik Sharon H. , Gallo Linda C. , Wells Kristen J.
Published: July 2016

Purpose

Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer.

Methods

The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies.

Results

Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes.

Conclusion

This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment.
Reciprocal Feedback Between miR-181a and E2/ERα in Myometrium Enhances Inflammation Leading to Labor
Authors: Gao Lu , Wang Gang , Liu Wei-Na , Kinser Holly , Franco Hector L. , Mendelson Carole R.
Published: July 2016

Context:

The initiation of term and preterm labor is associated with an up-regulated inflammatory response in myometrium; however, the underlying signaling pathways remain incompletely defined.

Objective:

To define the regulatory mechanisms that mediate the increased myometrial inflammatory response leading to labor, we investigated the roles of microRNAs (miRNA/miR).

Design and Setting:

Human myometrial tissues, isolated smooth muscle cells, and animal models were used to study miR-181a regulation of uterine inflammatory pathways and contractility.

Patients:

Myometrial tissues from 15 term pregnant women undergoing elective cesarean section (not in labor) and 10 term pregnant women undergoing emergency cesarean section (in labor) were used.

Results:

Expression of the highly conserved microRNA, miR-181a, was significantly decreased in mouse and human myometrium during late gestation. By contrast, the putative miR-181a targets, TNF-α, and estrogen receptor (ER)-α, and the validated target, c-Fos, key factors in the inflammatory response leading to parturition, were coordinately up-regulated. In studies using human myometrial cells, overexpression of miR-181a mimics repressed basal as well as IL-1β-induced TNF-α, C-C motif chemokine ligand 2 and 8 expression, whereas the expression of the antiinflammatory cytokine, IL-10, was increased. Overexpression of miR-181a dramatically inhibited both spontaneous and IL-1β-induced contraction of human myometrial cells. Notably, miR-181a directly targeted ERα and decreased its expression, whereas estradiol-17β reciprocally inhibited expression of mature miR-181a in myometrial cells.

Conclusions:

Thus, increased estradiol-17β/ERα signaling in myometrium near term inhibits miR-181a, resulting in a further increase in ERα and proinflammatory signaling. This escalating feedback loop provides novel targets and therapeutic strategies for the prevention of preterm labor and its consequences.