bluuebunny/crossref_metadata_2025 huggingface dataset:
Austerity measures and municipalities: the case of Denmark
Authors: Mailand Mikkel
Published: July 2014

Danish municipalities have gone through a number of austerity-related government initiatives with consequences for job levels and public services. Moreover, the ‘regulation mechanism’, which ties public sector wages to wage development in the private sector, has worked as an indirect austerity measure leading to a quasi-pay freeze during the public sector collective bargaining rounds in 2011 and 2013. It is difficult, however, to isolate crisis-related consequences from other factors such as demographic development, outsourcing and pre-crisis reform. Social dialogue has played a very limited role in relation to the direct austerity measures, though case studies show that social dialogue at the local level has played a role in the implementation of austerity and restructuring measures. In the education area, working time was removed from the local bargaining agenda after a lock-out and government intervention in the 2013 bargaining round, but beyond this area no major changes in social dialogue institutions have taken place.
Austerity and politically motivated changes – wage bargaining in Hungarian municipal services
Authors: Neumann László , Berki Erzsébet , Edelényi Márk
Published: July 2014

Salaries of public sector employees have been the number one target of austerity measures applied by successive Hungarian governments since 2006, and trade unions have found it difficult to influence government policies. Until 2008 the outcomes of centralized quasi-bargaining somewhat mitigated the harsh measures, but later governments, especially the right-wing one in place since 2010, abandoned such negotiations, implementing labour law reforms that weakened trade union bargaining power and concluding selective agreements solely with representatives of certain strong groups of employees. Social dialogue institutions have become especially weak at sectoral and municipal levels. Though decentralized collective bargaining is common in larger private sector companies, and though the legal regulation is similar in state-/municipality-owned companies, genuine collective bargaining within the latter is very rare. The article presents two case studies (on geriatric care and public transport) highlighting current developments and their impacts on employment relations.
The life and thought of Robert Keith Yorston: An advocate for accounting reform
Authors: Anderson Ray H , Gaffikin Michael JR , Singh Geeta
Published: July 2014

Sir Robert Keith Yorston (1902–1983) was an Australian business educator and practitioner. He was a prolific author whose textbooks were adopted by the professional bodies, technical colleges and universities both in Australia and New Zealand. A large part of Yorston’s career was devoted to the Australian Accountancy College. Yorston was at the forefront of the professional dialogue on the quality of financial reporting in Australia. He also advocated improvements in matters of corporate governance including gender equality and employee reporting. It is argued that many of Yorston’s ideas were ahead of their time, and there is a need for an awareness of his contribution to accounting thought and practice. This article is an acknowledgement of Yorston’s endeavours. It recognizes his contribution to accounting education, the profession and the wider community. In so doing, it traces an important chapter in the history of accounting education and practice in Australia.
Feeling cooperation, being moral
Authors: de Francisco Andrés
Published: July 2014

Is morality a pure rational abstraction or is it rooted in human nature? In this paper I argue for the second option, and I do so in several steps. I first vindicate the cognitive role of emotions. For this, I rely on two contemporary theories of emotions, Martha Nussbaum’s and Antonio Damasio’s, without forgetting the evolutionary approach to emotions. Then I defend a complex model of human behaviour that goes beyond rational choice models and includes, following Gintis, other-regarding orientations and altruistic motivations. Key ingredients of such a complex model are the social emotions involved in human cooperation and reciprocal altruism. Underlying social cooperation is an emotional economy which turns out to be highly informative about the moral nature of social life. I analyse this emotional economy of cooperation and, following Aristotle, I show its moral foundations. Finally, I claim that the set of moral norms and the corresponding emotional responses involved in cooperative behaviour could be reduced to a unique moral principle. Here I draw on the general moral principle – neminem laede; imo omnes, quantum potes, juva – and follow Schopenhauer in his philosophical derivation of the principle of compassion from the emotion.
The role of education in intergenerational social mobility: Problems from empirical research in sociology and some theoretical pointers from economics
Authors: Goldthorpe John H
Published: July 2014

Insofar as research into intergenerational social mobility and its mediation via education has had any theoretical context, this has been provided by the functionalist theory of industrial and post-industrial society. However, the inadequacies of this theory have become increasingly apparent, and rather little appeal to it is now in fact made. Yet no alternative body of theory has emerged. I propose that in developing the micro-level theory that is needed, sociologists could, with advantage, adapt to their own purposes theories originating in the economics of labour markets and, in particular, three theories in some degree deviating from mainstream human capital theory: screening and signalling theory; job competition theory; and incentive-enhancing preference theory. In this way, explanations for findings going contrary to expectations under the functionalist theory can be advanced that can already be provided with some degree of empirical support and that will be readily open to further testing.
Restraining free-riders: The effects of actor types and decision rules in the public goods game
Authors: Sauermann Jan , Glassmann Ulrich
Published: July 2014

Many experiments comparing individual and group behavior find that groups behave more egoistically than individuals. However, most of these studies do not control for the influence of within-group decision-making rules that might have an important impact on group behavior. In this article, we report findings from laboratory experiments comparing individual and group behavior in a public goods game. We find that rather than cooperation levels differing between individuals and groups per se, the intragroup decision-making rule has an influence on the cooperativeness of groups. Groups decide either by majority or unanimity rule. While groups deciding by majority rule reach roughly the same level of cooperation as individuals, groups deciding by unanimity rule contribute significantly lower amounts to the public good.
The Gap Between Perceived and Actual Learning From Group Reflection
Authors: Bolinger Alexander R. , Stanton Julie V.
Published: July 2014

Group reflection is often used as an intervention to facilitate group performance, but reflecting in groups may also affect individual learning. In this article, we compare the effects of individual and group reflection on individuals’ learning in two pairs of decision-making tasks. In two studies, we found that individuals who reflected in groups improved their performance from Task 1 to 2. However, individuals who reflected in groups did not realize greater performance improvements than individuals who reflected alone. Furthermore, individuals who reflected alone perceived that they learned more than individuals who reflected in groups. We discuss the implications of the gap between perceived and actual learning and describe the implications of our findings for group research, as well as recommendations for future research.
Return to Duty After Elective Fasciotomy for Chronic Exertional Compartment Syndrome
Authors: McCallum Jeremy R. , Cook Jay B. , Hines Adam C. , Shaha James S. , Jex Jefferson W. , Orchowski Joseph R.
Published: July 2014

Background:

Civilian literature has reported excellent outcomes after elective fasciotomy for chronic exertional compartment syndrome (CECS). Our study’s purpose was to objectively investigate the functional outcome of fasciotomies performed for CECS in a high demand military population.

Methods:

A retrospective review of all fasciotomies performed for CECS at a single tertiary military medical center was performed. The primary outcome measure was the ability to return to full active duty. Diagnosis, operative technique, and number of compartments addressed were collected and analyzed. Patients were contacted and the visual analog scale (VAS) pain score, functional single assessment numeric evaluation (SANE) score, as well as overall satisfaction were reported. Return to duty status was collected on 70 of 70 (100%) consecutive operative extremities in 46 patients with an average follow-up of 26 months.

Results:

Only 19 patients (41.3%) were able to return to full active duty. Ten patients (21.7%) underwent a medical separation from the military and 17 patients (37%) remained in the military but were on restricted duty secondary to persistent leg pain. Thirty-five of 46 (76%) of the patients were contacted and provided subjective feedback. The average SANE score was 72.3, and there was a mean improvement of 4.4 points in VAS score postoperatively. Overall, 71% of patients were satisfied and would undergo the procedure again. Outcomes were correlated to operative technique, patient rank, and branch of military service.

Conclusion:

Our study showed a return to full military duty in 41% of patients who underwent elective fasciotomy for CECS. Overall 78% of patients remained in the military, which is consistent with previous military literature. Subjective satisfaction rate was 71%. Both the return to activity and subjective outcomes in our study population were substantially lower than reported results in civilian populations.

Level of Evidence:

Level IV, case series.
Quantum and Multidimensional Explanations in a Neurobiological Context of Mind
Authors: Korf Jakob
Published: July 2014

This article examines the possible relevance of physical–mathematical multidimensional or quantum concepts aiming at understanding the (human) mind in a neurobiological context. Some typical features of the quantum and multidimensional concepts are briefly introduced, including entanglement, superposition, holonomic, and quantum field theories. Next, we consider neurobiological principles, such as the brain and its emerging (physical) mind, evolutionary and ontological origins, entropy, syntropy/neg-entropy, causation, and brain energy metabolism. In many biological processes, including biochemical conversions, protein folding, and sensory perception, the ubiquitous involvement of quantum mechanisms is well recognized. Quantum and multidimensional approaches might be expected to help describe and model both brain and mental processes, but an understanding of their direct involvement in mental activity, that is, without mediation by molecular processes, remains elusive. More work has to be done to bridge the gap between current neurobiological and physical–mathematical concepts with their associated quantum–mind theories.
The influence of senior leaders on organisational learning: Insights from the employees’ perspective
Authors: Waddell Alex , Pio Edwina
Published: July 2014

In the current century, organisations are facing unprecedented changes in their working environments. In order to remain viable, organisations must learn to adapt to the changes they face. We investigate the influence of senior leaders on organisational learning from the employees’ perspective. Data were based upon qualitative research utilising a case study of a New Zealand–operated information technology company. By employing an explorative, exploitative and transformative organisational learning framework, and a transactional and transformational model of leadership, the findings contribute empirically to the limited body of research surrounding how senior leaders influence organisational learning. In particular, the findings illustrate the way in which senior leaders employed a transformational leadership approach during explorative and transformative learning, while adopting a transactional leadership style during exploitative learning. Also compelling were participants’ comments highlighting how senior leaders had employees emotionally connect and test business ideas and assumptions throughout the learning process.
Rapid Home HIV Testing
Authors: Banda Jonathan
Published: July 2014

This article examines the home rapid HIV test as a new practice of US biocitizenship. Via an analysis of discourse surrounding self-diagnostics, I conclude that while home HIV tests appear to expand consumer rights, they are in fact the vanguard of a new form of self-testing that carries a moral urgency to protect one’s own body and to manage societal risk. In addition, these tests extend biomedical authority into the private domain, while appearing to do the exact opposite. Furthermore, access to these tests may be stratified, contradicting the intent expressed by the manufacturer to reach populations in need of it most and reinforcing stigma against them. Lastly, diagnostics such as the rapid home HIV test represent new obligations for surveillance of one’s own health and that of others. The new public health effort to test the population at large has given rise to a new ‘risky’ population: the untested bodies.
From Disfigurement to Facial Transplant
Authors: Le Breton David
Published: July 2014

The face embodies for the individual the sense of identity, that is to say, precisely the place where someone recognizes himself and where others recognize him. From the outset the face is meaning, translating in a living and enigmatic form the absoluteness yet minuteness of individual difference. Any alteration to the face puts at stake the sense of identity. Disfigurement destroys the sense of identity of an individual who can no longer recognize himself or be recognized by others. Disfigurement places a mask on the face. The goal of a facial transplant consists of restoring an individual’s place in the world and reviving his taste for life, returning to him his ‘human shape’. Facial transplants raise essential anthropological questions such as ‘Who am I?’ and ‘To whom belongs this face that henceforth is mine?’
Material Feminism, Obesity Science and the Limits of Discursive Critique
Authors: Warin Megan
Published: July 2014

This article explores a theoretical legacy that underpins the ways in which many social scientists come to know and understand obesity. In attempting to distance itself from essentialist discourses, it is not surprising that this literature focuses on the discursive construction of fat bodies rather than the materiality or agency of bodily matter. Ironically, in developing arguments that only critique representations of obesity or fat bodies, social science scholars have maintained and reproduced a central dichotomy of Cartesian thinking – that between social construction and biology. In this article I examine the limitations of social constructionist arguments in obesity/critical fat studies and the implications for ignoring materiality. Through bringing together the theoretical insights of material feminism and obesity science’s attention to maternal nutrition and the fetal origins hypothesis, this article moves beyond the current philosophical impasse, and repositions biological and social constructionist approaches to obesity not as mutually exclusive, but as one of constant interplay and connectedness.
Informal Surrogacy in China
Authors: Yang Jie
Published: July 2014

Rather than being a form of explicitly commodified reproduction, informal surrogacy is practiced (and interpreted) in a working-class community in Beijing as part of local affective life, viewed in terms of gifting, favors, filial piety, and family concerns. Through this practice a particular form of biopower, articulated in affective terms, limits some women to serving as instruments of reproduction. Unlike the common western assumption of a physical body as separate from the experiencing subject, the Chinese body has a subjective, experiential dimension. This subjective body harbors an agency with the potential to transform the power exercised on it and to impact the circumstances of the surrogate’s life. I contextualize such agency in the analysis of the ambivalence of these women toward surrogacy and the violence of local kinship systems. Through analyzing how surrogates use their bodies to transform codes, forces and reform the self, the article suggests that informal surrogacy interacts and shapes local affective and political economies.
Multi-layered mesh generation and user subroutine development based on an Eulerian–Eulerian approach for soot filtration visualization in a three-dimensional particulate filter model
Authors: Lee Hoon , Lee Kyeong O
Published: July 2014

A three-dimensional model is developed for computational fluid dynamics analysis of soot filtration processes in a wall flow–type particulate filter based on an Eulerian–Eulerian numerical approach. The primary objective of this study is to accurately capture the local values of filtration parameters, such as volume porosity, collection efficiency, and soot mass deposited, through isotropically discretized computational grids within the multi-layered porous wall regions. Most commercial computational fluid dynamics codes do not have the ability to generate structured mesh with ordered cell index or allow expressing mathematical recursive operation or handling time array through defined user field functions. For these reasons, it is difficult to utilize the code in situations where complex algorithms and mathematical treatments are required. Therefore, custom-build user subroutines, written with C++ programming language, are developed and integrated with the model to calculate localized soot mass distributions in each layer of porous wall. New recursive and computationally efficient algorithms are developed utilizing the functional attributes of the computational fluid dynamics code and coupled with the modified unit collector mechanism in order to obtain temporal and local filtration efficiency. Simulations enabled quantitative visualization of the detailed filtration processes along the filter wall and channel, including the time evolution of filtration parameters, which is difficult to detect experimentally. The model revealed correlations between wall flow pattern and rearrangement behaviors of filtration parameters and provided insights into the soot cake layer profiles with respect to both the length and the width of the channel.
Managed Care and the Dissemination of Robotic Prostatectomy
Authors: Zhang Yun , Hollenbeck Brent K. , Schroeck Florian R. , Jacobs Bruce L.
Published: July 2014

Objective. Robotic prostatectomy has rapidly disseminated over the past decade. How managed care, thought by many to be a barrier to new technology, influences the dissemination of robotics is unknown. We sought to better understand the relationship between a market’s managed-care penetration and the dissemination of robotic prostatectomy. Methods. We used SEER-Medicare data from 2003 through 2007 to identify men ≥66 years of age treated with radical prostatectomy for prostate cancer. We categorized Health Service Areas (HSAs) according to the degree of managed-care penetration (ie, low vs high). We assessed adoption of robotic prostatectomy and utilization among adopting HSAs using Cox proportional-hazards and Poisson regression models, respectively. Results. Compared with markets with little managed care, highly penetrated markets had more racial diversity (24% vs 15% nonwhite, P < .01), higher population densities (1987 vs 422 people/square mile, P < .01), and higher median incomes ($49 374 vs $36 236, P < .01). Robotic prostatectomy adoption and utilization increased over time in both HSA categories. Compared with low managed-care markets, those with high managed care adopted robotic prostatectomy more rapidly (eg, probability 0.37 [low] vs 0.52 [high] in 2007; P < .01). However, the postadoption utilization of robotic prostatectomy was constrained in these highly penetrated markets (eg, probability 0.66 [low] vs 0.52 [high] in 2007; P < .01). Conclusions. High managed-care penetration was associated with more rapid robotic prostatectomy adoption. However, once adopted, utilization increased more slowly in these markets. Understanding this paradox is important as more technologies are unveiled in an increasingly cost-conscious health care environment.
Video Processing to Locate the Tooltip Position in Surgical Eye–Hand Coordination Tasks
Authors: Jiang Xianta , Zheng Bin , Atkins M. Stella
Published: July 2014

Introduction. Trajectories of surgical instruments in laparoscopic surgery contain rich information about surgeons’ performance. In a simulation environment, instrument trajectories can be taken by motion sensors attached to the instruments. This method is not accepted by surgeons working in the operating room due to safety concerns. In this study, a novel approach of acquiring instrument trajectories from surgical videos is reported. Methods. A total of 12 surgical videos were obtained for this study. The videos were captured during simulated laparoscopic procedures where subjects were required to pick up and transport an object over 3 different targets using a laparoscopic grasper. An algorithm was developed to allow the computer to identify the tip of the grasper on each frame of video, and then compute the trajectories of grasper movement. Results. The newly developed algorithm successfully identified tool trajectories from all 12 surgical videos. To validate the accuracy of this algorithm, the location of the tooltip in these videos were also manually labeled. The rate of accurate matching between these 2 methods was 98.4% of all video frames. Discussion. Identifying tool movement from surgical videos creates an effective way to track instrument trajectories. This builds up the foundation for assessing psychomotor performance of surgeons in the operating room without jeopardizing patient safety.
Rigid, Variable-View Endoscope in Neurosurgery
Authors: Ebner Florian H. , Roser Florian , Roder Constantin , Tatagiba Marcos , Schuhmann Martin U.
Published: July 2014

Introduction. The endoscope became a highly valued visualization tool in neurosurgery. However, technical limitations caused by the rigidity of current standard endoscopes significantly decrease ergonomy in transcranial neurosurgery. Further technological developments will aid enlarging the surgical applicability. Objective. To evaluate the intraoperative features of a rigid variable-view endoscope in neurosurgery. Methods. We assessed a 4 mm rigid rod lens endoscope (EndoCAMeleon, Karl Storz, Tuttlingen, Germany) in the intraoperative setting. The device offers a variable angle of view from 15° to 90° in one plane. The endoscope was used in 3 cases (aneurysm clipping, vestibular schwannoma surgery, endoscopic third ventriculostomy) for inspection. Results. Direct insertion of the device through the craniotomy/burr hole with the lowest angled view (15°) was always possible. Neurovascular structures crossing the access route could be visualized and avoided. This allowed a targeted positioning of the endoscope’s tip in the operating field. Once the target point was reached, viewing direction was changed in one plane from 15° to 90° according to anatomic demands. As the endoscope’s tip does not move while the lens is rotated, surrounding neurovascular structures are not at risk to be injured. However, turning of the lens-controlling wheel in proximity to delicate structures may be inconvenient. Conclusion. The rigid, variable-view endoscope has the potential to become an appreciated visualization tool in neuroendoscopy. The steerable lens enables a tremendous expansion of the visual field, resulting in higher efficiency for surgeons and increased safety for patients.
Effects of new formulation strategy on life cycle management in the US pharmaceutical industry
Authors: Daidoji Kengo , Yasukawa Satoshi , Kano Shingo
Published: July 2014

This research discusses the role of new formulation strategies on life cycle management in the US pharmaceutical industry and evaluates its effect on the market life of existing drug products. We constructed a method to quantitatively measure the life cycle extension period of new formulation pharmaceuticals, including censored cases, wherein the generic drug has not yet been approved and the innovator drug is surviving in the market. We employed 180 new formulation approvals for which Abbreviated New Drug Application approvals were granted for new molecular entities. We undertook a comprehensive and quantitative analysis of how long these new formulation pharmaceuticals are able to prevent the entry of generic pharmaceuticals into the US market after the end of the regulatory exclusivity period. The results showed that among the oral formulations, dosage forms that require advanced manufacturing technology, such as “Extended/Delayed Release,” have significantly extended the life cycle extension period over the past 20 years. In addition, the acquisition of formulation-related patents protecting products was observed to extend the life cycle extension period significantly. These research outcomes can help business strategists in the pharmaceutical industry to take advantage of already marketed new molecular entities as part of the life cycle management strategy and can help generic drug companies adapt to the strategies of innovator drug companies.
Novel Insulin Delivery Profiles for Mixed Meals for Sensor-Augmented Pump and Closed-Loop Artificial Pancreas Therapy for Type 1 Diabetes Mellitus
Authors: Srinivasan Asavari , Lee Joon Bok , Dassau Eyal , Doyle Francis J.
Published: July 2014

Background:

Maintaining euglycemia for people with type 1 diabetes is highly challenging, and variations in glucose absorption rates with meal composition require meal type specific insulin delivery profiles for optimal blood glucose control. Traditional basal/bolus therapy is not fully optimized for meals of varied fat contents. Thus, regimens for low- and high-fat meals were developed to improve current insulin pump therapy.

Method:

Simulations of meals with varied fat content demonstrably replicated published data. Subsequently, an insulin profile library with optimized delivery regimens under open and closed loop for various meal compositions was constructed using particle swarm optimization.

Results:

Calculations showed that the optimal basal bolus insulin profiles for low-fat meals comprise a normal bolus or a short wave. The preferred delivery for high-fat meals is typically biphasic, but can extend to multiple phases depending on meal characteristics. Results also revealed that patients that are highly sensitive to insulin could benefit from biphasic deliveries. Preliminary investigations of the optimal closed-loop regimens also display bi- or multiphasic patterns for high-fat meals.

Conclusions:

The novel insulin delivery profiles present new waveforms that provide better control of postprandial glucose excursions than existing schemes. Furthermore, the proposed novel regimens are also more or similarly robust to uncertainties in meal parameter estimates, with the closed-loop schemes demonstrating superior performance and robustness.
Fault Detection and Safety in Closed-Loop Artificial Pancreas Systems
Authors: Bequette B. Wayne
Published: July 2014

Continuous subcutaneous insulin infusion pumps and continuous glucose monitors enable individuals with type 1 diabetes to achieve tighter blood glucose control and are critical components in a closed-loop artificial pancreas. Insulin infusion sets can fail and continuous glucose monitor sensor signals can suffer from a variety of anomalies, including signal dropout and pressure-induced sensor attenuations. In addition to hardware-based failures, software and human-induced errors can cause safety-related problems. Techniques for fault detection, safety analyses, and remote monitoring techniques that have been applied in other industries and applications, such as chemical process plants and commercial aircraft, are discussed and placed in the context of a closed-loop artificial pancreas.
Integrated clinical coding in urology – a novel way of working
Authors: Misra S , Chetwood A , Dixon G , Coker C , Thomas P
Published: July 2014

Objectives:

The objective of this article is to report a completed cycle of audit of coding co-morbidities for bladder outlet surgery. We also present a novel way of working to achieve better accuracy in capturing admitted patient care data and coding in urology.

Materials and methods:

We undertook a retrospective case note and coding review of all bladder outlet surgeries performed in a single month. After initiating several measures to improve data recording and capture, we re-audited our results prospectively and analysed the results.

Results:

The initial accuracy of coding co-morbidities was 73%. This improved to 100% at re-audit. However, we found that procedure coding errors remained. We have devised a novel working model to improve all coding issues related to urology.

Conclusion:

It is possible to improve accuracy of coding by educating clinicians working alongside our integrated model of a team of a clinician with an interest in coding with coding and finance personnel.
External Fixation Versus Open Reduction With Locked Volar Plating for Geriatric Distal Radius Fractures
Authors: Lee Daniel J. , Elfar John C.
Published: July 2014

The optimal management of displaced dorsal radius fractures (DRFs) in older patients remains an issue of debate. Bridging external fixation is a well-accepted treatment modality for severely comminuted DRFs, while open reduction and internal fixation with locked volar plating has emerged as a promising alternative in recent years. The current body of randomized trials supports the trend toward locked volar plating, as it allows for quicker improvement in subjective and functional outcomes. There is no clear evidence to suggest that one technique carries significantly less complications than the other. Locked volar plating should be considered in patients for whom an accelerated functional recovery would be advantageous. Otherwise, both external fixation and locked volar plating provide good long-term clinical outcomes.
Teaching for Action Competence
Authors: Hedefalk Maria , Almqvist Jonas , Lidar Malena
Published: July 2014

The focus of this article is to explore preschool children’s possibilities to learn to act for sustainable development. The purpose is to describe and analyze which actions are privileged when children participate in preschool activities. Analyses of video recordings of everyday preschool activities show how children experience activities where they critically discuss and make value judgments about actions. The results of the analyses also show how different actions become relevant in different practices. Furthermore, comparisons are made between the preschool practices and three teaching principles within education for sustainable development (ESD). In ESD, action competence is the ability to critically make value judgments about different alternative ways to act for a sustainable future. The result shows how children make value judgments in situations where facts are not sufficient for solving a problem.
Street Harassment
Authors: Dhillon Megha , Bakaya Suparna
Published: July 2014

This study attempted to understand street harassment as experienced by young women in Delhi. Interviews were conducted with 20 women between the ages of 18 and 30 years to understand the nature of harassment they faced, its perceived consequences, their ways of coping with it, and the changes they felt were needed for them to feel safer. Findings revealed that harassment occurred most often in crowded spots and in broad daylight. High levels of harassment were attributed to factors like prevalent attitudes toward women and weak implementation of laws. Participants saw their lives as being restricted in several ways by the harassment. The police was seen as apathetic, and women took on themselves the responsibility for staying safe. Sometimes, women chose to defend themselves by moving away from harassers rather than confronting them due to fear of escalation. However, several participants felt that staying quiet allowed the perpetuation of harassment. The major change that women sought was more effective police functioning.
Ecological Interface Design for Knee and Hip Automatic Physiotherapy Assistant and Rehabilitation System
Authors: Li Yeti , Burns Catherine M. , Kulić Dana
Published: July 2014

In this paper, we report on a recent interface design and evaluation process for a new knee and hip automatic physiotherapy assistant and rehabilitation system (ARS). Interface design was concurrent with the development of ARS. The ARS has the potential to improve the automation of rehabilitation treatments, by providing quantitative measures of a patient’s motion. However, the complexity of rehabilitation information available to the therapist has increased with this additional information. We applied Ecological Interface Design (EID) to understand the domain of physiotherapy and the role of the automation. Results of a Work Domain Analysis (WDA) revealed new functions and constraints in rehabilitation now accessible through the ARS, and provided the design requirements for interface design. A novel interface was designed which is currently undergoing evaluation to see if it improves the quality and experience of physiotherapy. This study provides an example of the advantages of using EID at the early phase of design, and how to apply EID to a system of increasing automaticity.
User Perception of Data and Medical Record Personalities
Authors: St-Maurice Justin , Burns Catherine M.
Published: July 2014

Data quality is an important and costly topic in modern society, and data quality and contextual data quality are important components of the human-computer relationship. As a long-term design imperative, the user interface needs to be improved to support better data quality. To design for better data quality, this exploratory study characterizes physicians’ opinions on their own data and the data produced by their colleagues. Through a regional survey and semi-structured interviews, the issue of data style and medical record personality was a dominant theme. A record’s personality impacts an individual user’s willingness to accept the data it contains. Future work will incorporate these results into modeling the data quality problem with cognitive work analysis, and will explore design elements to support the design for better data quality.
Designing Serious Games for Cognitive Assessment of the Elderly
Authors: Tong Tiffany , Chignell Mark , Lam Phil , Tierney Mary C. , Lee Jacques
Published: July 2014

The under-diagnosis of cognitive impairments can lead to increased economic burden, hospitalization, and even death (Inouye, Bogardus, Baker, Leo-Summers, & Cooney, 2000). Many of the current cognitive tests have been developed to diagnose specific conditions. However, there is a lack of cognitive tools to assess transitory conditions that occur between normal cognition and cognitive failure such as delirium. In this paper, we discuss the development of a serious game for cognitive assessment of the elderly that can address this gap. We introduce the whack-a-mole game that we have developed and present initial findings concerning its usability and validity in university and elderly populations. We conclude by discussing the role of human factors engineering, and associated design methodologies, in developing serious games of this type.
Using Cognitive Work Analysis and a Persuasive Design Approach to Create Effective Blood Pressure Management Systems
Authors: Rezai Leila S. , Burns Catherine M.
Published: July 2014

When developing patient self-management applications, designs must motivate patients to engage with the intervention so as to increase their medical adherence. This paper hypothesizes that for the analysis and design of these technologies, a Cognitive Work Analysis (CWA) approach would benefit from the additional insight provided by a Persuasive Design (PD) framework. The results of this combined approach are shown to be valuable in informing an Ecological Interface Design (EID) of self-management systems. Benefits come in two ways: First, by improving patients’ understanding of their disease and how to manage it, and second by increasing their motivation to self-monitor. The next step of this research will be to devise a set of design guidelines that can be used to create effective patient self-management systems.
Identification of EMR Hardware and Space Design Requirements using Human Factors Analyses
Authors: Campbell Catherine , Kramer Chelsea , Kelsey Shelley , King W. James
Published: July 2014

Electronic Medical Records (EMR) are being implemented globally in the hope of improving patient care, provider coordination, documentation accuracy, and information availability. Numerous factors impact successful EMR implementation including usability, accessibility and unique characteristics of the sociotechnical system within which it will be used. This paper describes the application of human factors methods to support effective EMR implementation at one pediatric hospital. The focus is on the problem of hardware selection and placement – a topic that has not received much attention in the literature to date. The requirements gathering process for two outpatient clinics included a task and gap analysis of current clinic workflows that led to the identification of specific hardware and design recommendations supporting future EMR workflows. Lessons learned post-implementation and requirements associated with hospital wide practices were extrapolated to generate guiding principles that apply to EMR implementation in other outpatient clinics.
Usability evaluation and assessment of a novel emergency department IT system developed using a cognitive systems engineering approach
Authors: Clark Lindsey N. , Guarrera Theresa K. , McGeorge Nicolette M. , Hettinger A. Zachary , Hernandez Angelica , LaVergne David T. , Benda Natalie C. , Perry Shawna J. , Wears Robert L. , Fairbanks Rollin J. , Bisantz Ann M.
Published: July 2014

This paper presents the results of a usability evaluation conducted of an electronic Emergency Department information system (EDIS) prototype that was designed using a cognitive system engineering (CSE) approach. Participants were asked to complete tasks using the EDIS prototype, while thinking aloud about their interactions with the displays. Participants also completed subjective assessments of the system that related to 1) cognitive performance support objectives, 2) usability, usefulness, and frequency of system use, and 3) qualitative feedback. Mean scores were calculated for cognitive performance support objectives as well as usability, usefulness, and frequency of use for each display. Mean scores for all cognitive performance support objectives were six or higher. The mean usability score was five or higher, and the mean usefulness score was six or higher. Displays that provided information on individual patient status had the highest scores. Results from this evaluation regarding positive ratings for the cognitive support objectives provide evidence that CSE design methods can be used to understand the goals and objectives of medical work domains.
A Macroergonomic Usability Evaluation of Pre-filled Medication Syringes
Authors: Yang Yushi , Rivera A. Joy , Fortier Christopher , Abernathy James
Published: July 2014

Anesthesia providers experience high workload in the Operating Room (OR) environment due to the complex process of the self-filled medication syringes (SFS) medication preparation and administration. Improvements have been continuously made in order to ensure the safety of anesthesia medication management processes. One proposed way is to replace SFS with pre-filled medication syringes (PFS). This implementation is still in its infancy, therefore, there are opportunities to improve the design of PFS and facilitate their compatibility within the overall work system. This research took a macroergonomic perspective to examine the interactions end-users’ have with PFS within the working context. The purpose was to identify PFS’ usability problems and their potential effects on the anesthesia medication management process. Two human factors engineers conducted 27-hours of observation. Data was aggregated into three storyboard-style scenarios that described the prominent system vulnerabilities that exist when PFS are used. Based on the scenarios, design recommendations were proposed that enhance medication management safety and efficiency of workflow. It is concluded that while PFS are considerably more beneficial with respect to patient safety and providers’ workflow, they may introduce new unintended complications that need to be addressed.
Designing Impactful Human Factors Research Programs in Healthcare
Authors: Fan Mark , Pinkney Sonia , Cassano-Piché Andrea , White Rachel , Trbovich Patricia , Easty Anthony
Published: July 2014

Several human factors (HF) research studies conducted by HumanEra, our research team, generated interest from the healthcare community and appeared to have strong impact on clinical practice. We believe these studies demonstrated valuable characteristics that could support HF professionals devise research programs that translate findings into clinical practice more effectively, and thereby improve patient safety. Three characteristics were identified, including 1) sustained project funding from an organization with broad jurisdictional responsibilities so that the research has broader system applicability, 2) the presence of a multidisciplinary advisory group to validate findings and engage key stakeholders to later champion the study findings into the healthcare system and 3) the use of multiple methods that build toward implementation efforts. Our studies have resulted in guidance, and other tools, for stakeholders across the healthcare system, including national regulatory organizations, manufacturers, healthcare institutions, clinical educators, clinicians and patients. They have also spurred major areas of ongoing work and funding for our team. We believe that the tendency for our work to trigger additional studies of this type is because funders recognize that proactive and exploratory risk assessment has tremendous value in preventing or reducing patient harm and associated downstream costs. We hope other teams will be able to utilize our experiences to enhance their research efforts and build the profile of HF in healthcare to further support this work.
A Quantitative Situational Awareness Model of Pilot
Authors: Shuang Liu , Xiaoru Wanyan , Damin Zhuang
Published: July 2014

The pilot’s situational awareness (SA) mainly depends on the perception, understanding and prediction of the information obtained from the man-machine display interface, therefore there is an intrinsic link between the display interface design and the level of pilot’s SA. A quantitative SA model, which considers the influence of information importance on SA, the characteristics of human cognition and the Bayesian conditional probability theory, was proposed based on the attention allocation model built previously. This model was expected to be used to predict the pilot’s SA levels under different task conditions. In order to verify the validity of the SA model, 20 volunteers were recruited to perform the instrument supervision tasks in four kinds of task, at the same time, Situation Awareness Global Assessment Technique (SAGTA), 3-dimensional Situational Awareness Rating Technique (3-D SART), and eye movement measurement were adopted for the evaluation of SAs. The experimental results reveal that, the SAGAT is the most effective approach to measure the level 2 SA, showing that the correct rate of SAGAT has the most similar changing trend with the task performance, and the SA model is validated since the changing trend of SA predicted by the model is highly correlated with the measurement indices.
Ending the Vicious Cycle of Patient Falls…
Authors: Wolf Laurie , Costantinou Eileen , Hignett Sue
Published: July 2014

Over the past two years Barnes-Jewish Hospital has used Lean and Six Sigma methodologies in process improvement projects to prevent inpatient falls and falls with injury. These intensive programs have validated that falls are a multifaceted, complex problem that need constant vigilance and continuous improvement to sustain patient safety. Falls that result in serious injury can be life-changing for patients and families as well as impact the caregivers with potentially severe financial and health consequences. Trends in fall rates after completion of two Case Studies show that while decreasing the number of falls continue to be a challenge; the severity of injury from a fall can be reduced with patient and staff collaboration.
Work Domain Analysis Applied to Medical Diagnosis
Authors: Nystrom Daniel , Williams Linda , Paull Douglas , Graber Mark
Published: July 2014

Few studies have described the cognitive components that characterize the diagnostic process. This article illustrates the use of work domain analysis to create a functional depiction of diagnosis. The resulting abstraction-decomposition space clarifies the medical diagnostician’s work domain and provides a glimpse into the fundamental cognitive features of diagnosis. To facilitate comprehension of the abstraction-decomposition space’s portrayal of diagnosis, features of a generalized depiction of diagnosis and the abstraction-decomposition space were graphically coded to communicate areas of similarity. Limitations, suggestions for future work, and future applications of this work to reduce diagnostic error are provided.
Integrating Electronic Health Records into Clinical Workflow
Authors: Lowry Svetlana Z. , Ramaiah Mala , Patterson Emily S. , Brick David , Gurses Ayse P. , Ozok Ant , Simmons Debora , Gibbons Michael C.
Published: July 2014

Issues with workflow integration have contributed to slow rates of EHR adoption in ambulatory outpatient care settings. In response to workflow integration challenges with EHRs, clinicians often develop workarounds to complete clinical tasks in ways other than were intended by system designers. Based on the insights generated during collegial discussions with physician Subject Matter Experts (SMEs) and three interdisciplinary team meetings with clinical and human factors experts, we created process map visualizations. A wide range of opportunities to improve workflow through enhanced functionality with the EHR were identified. Targeted recommendations for EHR developers and ambulatory (outpatient) care centers are proposed to increase efficiency, allow for better eye contact between the physician and patient, improve physician’s information workflow, and reduce alert fatigue. These recommendations provide a first step in moving from a billing-centered perspective to a clinician-centered perspective.