bluuebunny/crossref_metadata_2025 huggingface dataset:
Aramatosides C and D, 2 Previously Undescribed Triterpene Glycosides Isolated From the Roots of Aralia armata
Authors: Chuong Nguyen T. Hong , Thuy Van Do T. , Kim Lien Giang T. , Yen Pham H. , Thuy Hang Dan T. , Nhiem Nguyen X. , Tai Bui H. , Kiem Phan V.
Published: July 2021

The 2 new oleanane-type triterpene glycosides, 23-hydroxyoleanolic acid-[28- O- β-D-glucopyranosyl]-3- O-{ β-D-glucopyranosyl-(1→2)-[ β-D-glucopyranosyl-(1→3)]- β-D-galactopyranoside}, (1) and oleanolic acid-[28- O- β-D-glucopyranosyl]-3- O-{ β-D-glucopyranosyl-(1→2)-[ β-D-glucopyranosyl-(1→3)]- β-D-galactopyranoside} (2) were isolated from the roots of Aralia armata. Their chemical structures were elucidated by using a combination of high resolution electrospray ionization mass spectrometry (HR-ESI-MS), 1 dimensional (1D), and 2 dimensional (2D) nuclear magnetic resonance spectral data, as well as by comparison with the previous literature. Compounds 1 and 2 displayed weak cytotoxic activity toward KB and HepG2 cell lines with IC50 values of 25.1 ± 1.2 and 23.7 ± 0.9 µM (for 1) and 29.5 ± 1.3 and 23.9 ± 0.7 µM (for 2), respectively, compared to that of the positive control compound, ellipticine (IC50: 1.3 ± 0.1 and 1.6 ± 0.1 µM, respectively) in in vitro assay.
Lymphocutaneous spread of Mycobacterium elephantis in an immunocompetent individual: A case report
Authors: Edwards Brett D , Somayaji Ranjani , Fisher Dina , Chia Justin C
Published: July 2021

Mycobacterium elephantis was first described when isolated from an elephant that succumbed to lung abscess. However, despite this namesake, it is not associated with animals and has been described most often as a probable colonizer rather than pathogen in humans with chronic lung disease. In this report, we describe the first case of lymphocutaneous infection from M. elephantis, likely as a result of cutaneous inoculation with contaminated soil. This offers further evidence to its capabilities as a pathogen. We provide a review of the limited prior reports of M. elephantis and outline the available in vitro data on efficacy of various antimycobacterial agents.
Validity of negative bone biopsy in suspicious bone lesions
Authors: Lange Mine B , Petersen Lars J , Nielsen Michael B , Zacho Helle D
Published: July 2021

Background

The presence of malignant cells in bone biopsies is considered gold standard to verify occurrence of cancer, whereas a negative bone biopsy can represent a false negative, with a risk of increasing patient morbidity and mortality and creating misleading conclusions in cancer research. However, a paucity of literature documents the validity of negative bone biopsy as an exclusion criterion for the presence of skeletal malignancies.

Purpose

To investigate the validity of a negative bone biopsy in bone lesions suspicious of malignancy.

Material and Method

A retrospective cohort of 215 consecutive targeted non-malignant skeletal biopsies from 207 patients (43% women, 57% men, median age 64, and range 94) representing suspicious focal bone lesions, collected from January 1, 2011, to July 31, 2013, was followed over a 2-year period to examine any additional biopsy, imaging, and clinical follow-up information to categorize the original biopsy as truly benign, malignant, or equivocal. Standard deviations and 95% confidence intervals were calculated.

Results

210 of 215 biopsies (98%; 95% CI 0.94–0.99) showed to be truly benign 2 years after initial biopsy. Two biopsies were false negatives (1%; 95% CI 0.001–0.03), and three were equivocal (lack of imaging description).

Conclusion

Our study documents negative bone biopsy as a valid criterion for the absence of bone metastasis. Since only 28% had a confirmed diagnosis of prior cancer and not all patients received adequately sensitive imaging, our results might not be applicable to all cancer patients with suspicious bone lesions.
Factor Analysis of the Attitude Toward Parent Involvement Survey With Preservice Teachers
Authors: Nathans Laura , Brown Amber
Published: July 2021

This study involved validating the structure of the Attitude Toward Parent Involvement Survey ( ATPIS). The survey was administered 1,729 times to preservice teachers along with Knowledge assessments at the beginning and end of a course on parent involvement. An exploratory factor analysis was conducted to validate the factors using more sophisticated statistical software. The analysis was conducted to validate the structure of the instrument and compare the factor structure with the factor structure obtained in a previous factor analysis. The main dimensions that the survey evaluated were parent involvement activities initiated by the teacher and parent involvement activities initiated by the parent. It replicated the original three factors and showed a strong fit. Fit statistics supported the three-factor structure in a confirmatory factor analysis. The three factors were Partners in Learning, Teacher-Initiated Activities, and Parent-Initiated Activities. Concurrent and predictive validity were assessed through correlating ATPIS scores and knowledge assessment scores at pre-and posttest. Results yielded limited evidence for concurrent validity at posttest and predictive validity. Current post-Knowledge assessment scores were correlated in four instances with current post-Attitude subscale scores (concurrent validity) and two pre-Attitude subscale scores were correlated with two post-Knowledge assessment subscale scores (predictive validity). The fact that the measure is valid and contains reliable subscales suggests its usefulness for identifying students who would involve parents once they became teachers. The 20-year-old measure needs revision to include family engagement and diversity.
Repatriation as a Human Rights Approach to State Options in Dealing with Returning ISIS Foreign Terrorist Fighters
Authors: Widagdo Setyo , Indrayanti Kadek Wiwik , Saraswati Anak Agung Ayu Nanda
Published: July 2021

Since the territorial defeat of the Islamic State of Iraq and Syria (ISIS), debates and questions on what states should do (individually and or collectively) with foreign terrorist fighters (FTFs) from their countries have become more relevant yet controversial. This article critically investigates whether states of origin have an obligation to repatriate ISIS FTFs under international law as well as what options are available for such countries in dealing with returning ISIS fighters based on a human rights approach. This article also highlights that the current international legal framework is generally moving toward the repatriation of FTFs for the purpose of prosecution and rehabilitation. While states have taken diverse and controversial approaches in dealing with fighters who wish to return, the option to repatriate and fairly prosecute them in their countries of origin is seen as the most comprehensive and preferred approach, not only for the countries of origin but also for the international community as a whole in the long term.
Registered Nurses’ Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey
Authors: El Ghaziri Mazen , Johnson Susan , Purpora Christina , Simons Shellie , Taylor Rosemary
Published: July 2021

Background:

Incivility among workers in the health sector is recognized as an occupational hazard. The COVID-19 outbreak brought sudden and profound changes to many health care settings, many of which have been identified as antecedents to workplace incivility. The purpose of this retrospective study was to explore the experiences of registered nurses with workplace incivility, cyber-incivility, and incivility outside of work during the early phase of the COVID-19 pandemic.

Methods:

This mixed-methods study used convenience sampling. Data were collected from June to September 2020 via an online survey, which consisted of both closed- and open-ended questions. Participants were recruited from national nursing organizations and unions. Data were analyzed using descriptive statistics and thematic analysis for open-ended responses.

Findings:

A total of 526 nurses’ responses were included in the analysis. More than one third experienced greater incivility at work during the COVID-19 outbreak than before the pandemic (37.4%), and almost half (45.7%) said they witnessed more incivility than before the pandemic. Cyber-incivility and incivility outside of work were also issues. Qualitative results indicated that respondents felt they were on edge during this period. Other themes included leadership failure, fractured co-worker relationships, heightened incivility from patients and families, and hostility and ostracism from the general public

Conclusion/Application to practice:

Occupational health nurses, nursing leaders, and staff nurses need to work to restore relations that were fractured by incivility during the pandemic. In the future, improved preparedness, including establishing clear channels of communication, may lessen incivility by decreasing role stress and organizational chaos.
Food Procurement in Post-neoliberal Countries: Examples from South America
Authors: Coca Estevan
Published: July 2021

This article analyzes public food procurement policy as one of the characteristics of post-neoliberalism in South America, whereby food produced by family farmers and peasants is purchased by the state and then donated to low-income people and public-school students. Focusing on Brazil, Ecuador, and Paraguay, the study demonstrates how such experiences partly break the control that large agri-food corporations exert in the food systems of these countries. This occurs because public food procurement has created a new market opportunity for family farmers and peasants and has also functioned as a mechanism to combat hunger and promote democratized access to good food. Moreover, such initiatives can be understood as providing a possibility to re-spatialize food by promoting closer contact between food producers and consumers.
Delayed Anticipatory Muscle Activation in Rotator Cuff Tendinopathy
Authors: Baek Samuel , Ki Se-Young , Chung Seok Won , Lee Seoung-Joon , Cho Young Chang , Oh Kyung-Soo
Published: July 2021

Background:

Previous research investigating rotator cuff (RC) tendinopathy has usually focused on pathoanatomy. The pathologic response to anticipatory postural adjustments (APAs) has not yet been investigated.

Purpose/Hypothesis:

To explore changes in APAs as detected by pre-emptive activation of shoulder muscles during ball catching. It was hypothesized that anticipatory muscle activation (AMA) would be present in the unaffected shoulder but delayed or absent in the affected shoulder in patients with RC tendinopathy.

Study Design:

Controlled laboratory study.

Methods:

This study included 21 RC tendinopathy patients with a mean age of 49.5 years. Patients were required to grab a ball embedded with an electromyography sensor when it dropped on their hand, and surface electromyography signals were recorded from the infraspinatus, upper trapezius, anterior deltoid, and biceps. The trials utilized 2 balls, weighing 200 g and 500 g. Each ball was used in 2 trials, 1 involving a number count preceding the ball drop (predictable) and the other involving a sudden drop (unpredictable). The onsets of AMA between the affected and unaffected limbs were compared.

Results:

Regardless of the experimental condition, significantly delayed AMA onsets were identified in all investigated muscles of the affected side compared with those of the unaffected side, except for the biceps muscle in the 500-g predictable trial. For the infraspinatus, the mean onset time in the 200-g predictable trial was –141.0 ± 60.2 ms on the affected side and –211.9 ± 67.1 ms on the unaffected side ( P < .001); in the 200-g unpredictable trial this value was –139.5 ± 54.9 ms on the affected side and –199.5 ± 56.2 ms on the unaffected side ( P < .001).

Conclusion:

Delayed AMA was observed in the affected shoulder compared with the unaffected shoulder in patients with RC tendinopathy, not only in the RC muscle but also in the periscapular and upper arm muscles. This may indicate that central hypoexcitability is partly responsible.

Clinical Relevance:

The basis for RC tendinopathy treatment should not be limited to the tendon pathoanatomy. Delayed AMA around the shoulder joint could provide insight into potential mechanisms related to the central nervous system.
Cyber-Situational Awarenss in Clinical Trials Using Wearable Device Technology
Authors: Johnson Elizabeth A. , Carrington Jane M.
Published: July 2021

It is estimated 1 in 3 clinical trials utilize a wearable device to gather real-time participant data, including sleep habits, telemetry, and physical activity. While wearable technologies (including smart watches, USBs, and implantable devices) have been revolutionary in their ability to provide a higher precision and accuracy to data acquisition external to the research milieu, there is hesitancy among providers and participants alike given security concerns, perception of cyber-related threats, and meaning attributed to privacy issues. The purpose of this research is to define cyber-situational awareness (CSA) as it pertains to clinical trials, evaluate its current measurement, and describe best practices for research investigators and trial participants to enhance protections in the digital age. This paper reviews integrated elements of CSA within the process of informed consent when wearable devices are implemented for trial procedures.

Evaluation of CSA as part of informed consent allows the research site to support the participant in knowledge gaps surrounding the technology while also providing feedback to the trial sponsor as to technology improvements to enhance usability and wearability of the device.
Etiometry’s T3 Heuristic Evaluation
Authors: Meyeroff Elizabeth , Tremoulet Patrice
Published: July 2021

Five students and a Human Factors Psychology professor participated in a heuristic evaluation of clinical decision support software, called T3, to help improve usability. T3 gathers physiological monitoring data from a variety of sources, e.g. pulse oximeters, electrocardiographs, and ventilators, and uses the data to compute two novel risk indexes. To effectively support clinical decision-making, T3 should present the patient data it collects, as well as the risk indexes that it computes, in an easy to understand interactive display. The evaluation identified 38 potential usability issues, about half of which were deemed ‘not an issue’ or rated as minor. The team developed 11 recommendations for changes to help improve usability of T3. Given the volume and complexity of the information that T3 displays, this is a short list, suggesting relatively good usability. However, none of the evaluators has the clinical training or experience of typical users; it is possible that clinical users would identify additional usability issues.
Psychiatry Transcript Annotation: Process Study and Improvements
Authors: Sridhar Srinivasan , Kazi Nazmul , Kahanda Indika , McCrory Bernadette
Published: July 2021

Background: The demand for psychiatry is increasing each year. Limited research has been performed to improve psychiatrist work experience and reduce daily workload using computational methods. There is currently no validated tool or procedure for the mental health transcript annotation process for generating “gold-standard” data. The purpose of this paper was to determine the annotation process for mental health transcripts and how it can be improved to acquire more reliable results considering human factors elements. Method: Three expert clinicians were recruited in this study to evaluate the transcripts. The clinicians were asked to fully annotate two transcripts. An additional five subjects were recruited randomly (aged between 20-40) for this pilot study, which was divided into two phases, phase 1 (annotation without training) and phase 2 (annotation with training) of five transcripts. Kappa statistics were used to measure the inter-rater reliability and accuracy between subjects. Results: The inter-rater reliability between expert clinicians for two transcripts were 0.26 (CI 0.19 to 0.33) and 0.49 (CI 0.42 to 0.57), respectively. In the pilot testing phases, the mean inter-rater reliability between subjects was higher in phase 2 with training transcript (k= 0.35 (CI 0.052 to 0.625)) than in phase 1 without training transcript (k= 0.29 (CI 0.128 to 0.451)). After training, the accuracy percentage among subjects was significantly higher in transcript A (p=0.04) than transcript B (p=0.10). Conclusion: This study focused on understanding the annotation process for mental health transcripts, which will be applied in training machine learning models. Through this exploratory study, the research found appropriate categorical labels that should be included for transcripts annotation, and the importance of training the subjects. Contributions of this case study will help the psychiatric clinicians and researchers in implementing the recommended data collection process to develop a more accurate artificial intelligence model for fully- or semi-automated transcript annotation.
Simulating the Effects of Anthropometry on the Contralateral Limb of Transtibial Amputees
Authors: Mahajan Ninad , Saravanan Pratima , Menold Jessica
Published: July 2021

Gait analysis is a clinically relevant method to assess walking patterns in rehabilitating patients, especially transtibial amputees. Prior work in biomechanics has detailed the impacts of below-the-knee amputation and anthropometric characteristics on patient gait, but little work has been done in the intersection of these fields, particularly with consideration towards the contralateral (intact) limb. This study utilizes OpenSim, a biomechanics simulation package, to investigate the impact of anthropometry on the stresses and response behavior of the hip, knee, and ankle joints in the contralateral limb of transtibial amputees. Musculoskeletal geometry, gait, and ground reaction force data for models were sourced from a healthy subject and appropriately adjusted based on amputation status and anthropometry. Inverse dynamics operations were performed on each model. Results indicate the need for special clinical focus on the ankle of heavier, taller amputees, along with the prescription of appropriate prosthetic componentry with a sufficient range of motion, to prevent long-term joint damage within the lower extremities. Initial data is preliminary, but serves as a foundation for additional simulations and related work in biomechanics simulations.
Usability Study of a Novel Collaborative Health IT in a Pediatric Intensive Care Unit
Authors: Choudhury Avishek , Asan Onur , Scanlon Mathew
Published: July 2021

Non-mandated technologies hold the promise of increasing health care quality by rendering care that is patient-centered, collaborative, and team approach-driven. Large Customizable Interactive Monitor (LCIM), a non-mandated collaborative health information technology (HIT), is a flat panel touch screen monitor that displays validated patient information from the electronic health record (EHR), including vital signs, laboratory results, medications, X-rays, and interventions. The present study conducts semi-structured interviews with 33 parents and 36 providers to address gaps in post-adoption research on collaborative inpatient LCIM in pediatric settings. The study identified 15 usability issues experienced by doctors and patients’ families while using LCIM. The themes were surrounded around data display characteristics, intuition, physical properties, features supporting or opposing the user’s mental model, and technical problems. Filling these gaps produces scientific knowledge about how providers and patients’ family members perceive LCIM technology’s usability.
Design and Development of a Prototype Heads-Up Display: Supporting Context-Aware, Semi-Automated, Hands-Free Medical Documentation
Authors: McGeorge Nicolette M. , Latiff Susan , Muller Christopher , Dong Lucas , Chewning Ceara , Friedson-Trujillo Daniela , Kane Stephanie
Published: July 2021

Military and civilian medical personnel across all echelons of medical care play a critical role in evaluating, caring for, and treating casualties. Accurate medical documentation is critical to effective, coordinated care and positive patient outcomes. We describe our prototype, Context-Aware Procedure Support Tools and User Interfaces for Rapid and Effective Workflows (CAPTURE). Leveraging human factors and usercentered design methods, and advanced artificial intelligence and computer vision capabilities, CAPTURE was designed to enable Tactical Combat Causality Care (TCCC) providers to more efficiently and effectively input critical medical information through hands-free interaction techniques and semiautomated data capture methods. We designed and prototyped a heads-up display that incorporates: multimodal interfaces, including augmented reality-based methods for input and information display to support visual image capture and heads-up interaction; post-care documentation support (e.g., artifacts to support post-care review and documentation); context-aware active and passive data capture methods, specifically natural language interpretation using systemic functional grammars; and computer vision technologies for semi-automated data capture capabilities. During the course of this project we encountered challenges towards effective design which fall into three main categories: (1) challenges related to designing novel multimodal interfaces; (2) technical challenges related to software and hardware development to meet design needs; and (3) challenges as a result of domain characteristics and operational constraints. We discuss how we addressed some of these challenges and provide additional considerations necessary for future research regarding next generation technology design for medical documentation in the field.
A User-Centered Need Analysis of Cancer Patient Navigation — An Intersection of Collaborative Work and Collaborative Health IT
Authors: Zachary Wayne W. , Rogers Courtney C. , McEachin Jennifer , Wilson Donna M. , Cohn Wendy F. , Adams Brooke , Choi Melissa , Lundy Ilene , Valdez Rupa S.
Published: July 2021

Cancer care is becoming more complex each year, making the patient’s path to, and through the care continuum confusing and daunting. Patient-navigation programs for cancer patients have grown in recent years, but their navigation support is fragmented in many ways and often incomplete, lessening their effectiveness. Digital tools to support the cancer patient navigator can make them more effective and allow more patients to receive navigation support. A multifaceted analysis of the needs for such tools is presented. The analysis methods include literature review, domain analysis, and qualitative interviews with a sample of ten cancer patient navigators.
Assessing the Ergonomic Design of a New Back Table for Perioperative Nurses
Authors: Thakur Ketan , Kuber Pranav Madhav , Abdollahi Masoud , Wenker David , Kandrikar Mafaaz , Rashedi Ehsan
Published: July 2021

Operating Rooms can be complex and stressful, wherein personnel are required to perform a variety of physically demanding tasks. Among the nursing care, perioperative nurses are more susceptible to musculoskeletal discomfort in low-back, shoulder and neck as they are required to perform an extensive number of demanding tasks before, during and after surgery on the “back table”. To improve the performance and mitigate the risk of injury in perioperative nurses, a new ergonomic design of back table has been developed recently. The purpose of this study was to assess the efficiency of the new table in improving the performance of nurses and reducing their risk of injury in comparison with the traditional table. The study involved 8 participants (4 Male, 4 Female) who performed simulated tasks of lifting/holding/lowering on both tables and finding instruments, similar to the actual work done by perioperative nurses. Our results showed that using the new table, the shoulder moment was reduced by 12%, while based on NASA-TLX scale, mental demand (14%), physical demand (20%), frustration (12%), effort (18%), and performance (15%) all showed reduced values. The outcomes of this study may facilitate reduction in risk of injury in the healthcare domain and may also be beneficial in improving the design of tables, not only in operating rooms but also in industrial environments.
Comparing Traditional and Augmented Reality Training for Identifying Critical Symptoms for Diagnosing Airway Obstruction Cases: A Pilot Study
Authors: Mansour Lauren A. , Sushereba Christen E. , Militello Laura , San Miguel Christopher E. , Patterson Emily S.
Published: July 2021

Recent developments in the portability, flexibility, and affordability of augmented reality technology allow it to address some limitations of current medical training. This pilot study aims to determine whether augmented reality can enhance the detection and identification of subtle cues used to make accurate medical diagnoses. We randomly assigned five participants to a control group, where they received diagnostic training by reading a standard textbook, and an experimental group, where they received diagnostic training by a combination of reading a standard textbook and augmented reality-based training. All participants were tested with a tension pneumothorax scenario, where they listed symptoms and made a diagnosis. We recorded the time until a final diagnosis was made and categorized the diagnosis and symptoms as accurate or inaccurate. A two-tailed t-test was used to assess differences between groups. The experimental group correctly identified more symptoms than the control group (average 12 vs. 5). These results indicate the potential of AR-based training to enhance detection and identification of cues in medical diagnostics.
Comparison of Weighted and Unweighted Task Load Indices for Single-Site Surgery Tasks
Authors: Ma Jiahui , McCrory Bernadette , Claudio David
Published: July 2021

Background: The National Aeronautics and Space Administration Task Load Index (NASA-TLX) a nd Surgery Task Load Index (SURG-TLX) are two subjective workload m easurement instruments. Both instruments provide unweighted andweightedworkload measurements. Weighted TLX m easures have seldomly been used byresearchers typically becauseof its high correlation with unweighted TLX a nd addedexperimentaltime to collect pairwise weightings. Therefore, theaim of thestudy wa s to compare weighted TLX scores with unweighted TLX scores and each’s sensitivity for demographic and experimentalfactors. Methods: Two simulated la paroscopic single site surgery tasks were completedusing four surgicalmethods by 25 participants. Pearson correlations, principle componentanalyses and mixed effect models were used to compare the unweightedandweighted TLXscores across tasks a nd methods. Results: There was a high correlation(r > 0.950, p < 0.001) betweentheunweighted TLXscores and the weighted TLX scores. The weighted TLX scores showed better sensitivity to both demographic and experimental factors for both TLX instruments. Conclusion: The overall weighted NASA-TLX and SURG-TLX scores differed from their respective unweighted scores even with a high correlation. The weighted TLXshowed potentialto better discriminate subjective workloadfor single-site ta sks. Future research is needed to identify and validatea more streamlinedweightingmethodparticularly for complex experimental taskslike single-site surgery.
Health Technology @ Illinois: Innovating for Health
Authors: Holtzclaw-Stone Nicole , Choo-Kang Gabrielle , Robles Granda Marlene , Huq Asif , King Tia , Kumaran Amrutha , Manalil Neva , Rogers Wendy A.
Published: July 2021

This panel provided an overview of the MS Health Technology program and included the experiences of the students in the program. We provided an overview of the simulation spaces on campus that support this unique interdisciplinary professional degree. There is a rapidly growing need for well-trained professionals with skills in software application, hardware engineering, human factors, and user-centered design to create innovative health technologies. The graduates of this program will begin to fulfill the need for well-trained human factors professionals who have a specific focus on health technologies.
The History of Human Factors in Healthcare: From Its Emergence 50 Years Ago to COVID-19
Authors: Mouloua Salim A. , Ball Rachel V. , Ferraro James C. , Mouloua Mustapha
Published: July 2021

Advances in medical technologies and training have been met by universal challenges in safety, efficiency, and effectiveness. The drastic growth and variegation of Healthcare as a field demands greater optimization of medical resources by Human Factors professionals. This study aimed to qualitatively evaluate the entire field of Medical Human Factors since its inception, comprising 1,251 articles across two discipline-specific conferences through keywords related to Healthcare. We analyzed trends in the Human Factors and Ergonomics Proceedings (HFES) from 1974 to 2020 and in the Proceedings of the International Symposium on Human Factors in Health Care (HCS) from 2013 to 2020. Results were tabulated, analyzed, and graphed based on their authorial affiliations, funding agencies, countries of research, as well as general content areas and more specific domains over time. Our analyses indicated that Healthcare research has grown exponentially in the past five decades, with 75% of relevant proceedings papers produced since 2010. Gaps in Healthcare literature, directions for future research, and emerging issues related to technologies and training are discussed as well.
Crash Cart Usability: A Method in Simulation & Iterative Design
Authors: Jesso Matthew N. , Peng Yuhao , Anderson Amanda
Published: July 2021

Prior to implementation, front line clinical staff assessed a new crash cart in a simulated environment.

The contents of the cart were assessed during a simulated code on a number of metrics; time on task, number of physical interactions, errors, as well as qualitative feedback from participants. These metrics helped researchers redesign the cart contents to improve visibility and organization of supplies. Using an iterative design cycle, the redesign cart and contents showed a reduction in time on task, physical interactions, and errors for most scenarios.
Foundational Analysis to Support Simulation Training System Design
Authors: Sushereba Christen E. , Militello Laura G. , Patterson Emily S. , Wolf Steve , Smith Oliver , San Miguel Christopher
Published: July 2021

Simulation-based training systems should be tailored to the actual work environment of the envisioned audience of learners. After building an augmented reality-based training system for combat medics, we began to explore strategies for adapting the training to medical students. While people who provide medical care on the battlefield and people who practice medicine in a hospital need to know how to treat traumatic injuries, there are vast differences in how they are trained. Foundational research into the work environment has implications for training design, especially with regards to training content and delivery.
Low-Cost Haptic Force Needle Insertion Simulator With Advanced Personalized Learning System
Authors: Peng Aoran , Ostrander John , Radwan Noriana , Starkey Elizabeth , Miller Scarlett , Moore Jason
Published: July 2021

Although needle insertion remains a crucial part of medicine practice, there still exists a gap between theoretical knowledge and real-world practice with live patients. To help bridge this gap, the Low-Cost Needle Insertion Simulator, or the LCNIS, is developed to assist students in gaining more confidence through simulated practice. It does so first through its physical design, which include a physical needle insertion device that can give the feeling of puncturing through multiple layers of human flesh. Its user-interface then provides a variety of simulation options as well as performance feedback that can aid in the improvement of student skills. With these key features, the LCNIS hopes to give students a cheap and yet realistic way of practicing needle insertion without the stress and pressure associated with performing on patients. This study hopes to (1) learn about the current needle insertion education as well as gather feedback on the LCNIS prototype, and (2) use this information to construct a more effective user interface for the LCNIS.
Applying Human Factors Methods to Improve Healthcare Risk Management Tools
Authors: Bañez Carleene , Carruthers Jodi , Gelmi Stefano , Kraft Arlene , Gaulton Catherine , Hall Trevor
Published: July 2021

The Healthcare Insurance Reciprocal of Canada (HIROC) is a not-for-profit medical malpractice insurance reciprocal that has a vision of partnering to create the safest healthcare system. Each year, patients die from preventable patient safety incidents in Canada. A proactive focus on risk management and embedding safety into healthcare systems is key to improving patient safety. HIROC conducted semi-structured interviews to help identify usability areas of interest for two primary risk management tools: The Risk Assessment Checklist and the Risk Register. A total of 16 participants from HIROC Subscribers, all with experience in risk management, quality improvement or patient safety, volunteered to partake in the semi-structured interviews. A thematic analysis of the data collected informed usability improvements. For the Risk Assessment Checklist, participants indicated that the tool is informative as it helps create risk management awareness across their organizations. Participants found the Risk Assessment Checklist interface easy to use and are pleased that submitting their self-assessments is a streamlined process. For the Risk Register, participants reported that the tool is simple and easy to use. Specifically, they find value in having an electronic system that keeps them organized and provides a way for them to track and trend their progress. Participants identified some usability concerns that the research team addressed with proposed design reflections informed by Jakob’s Ten Usability Heuristics (Nielsen, 1994).
Standardizing Crash Carts Using Collaborative Design Methods And Usability Testing
Authors: Jamil Melinda , Congenie Kari , Bartjen Linda , Hoffman Paul
Published: July 2021

Crash carts are mobile containers of medications and supplies used to resuscitate patients in emergencies within health care facilities. Contents and organization of carts often differ across hospitals and even departments within the same hospital. To support our team members in emergencies across our multi-hospital system, we created a system safety initiative to standardize and optimally organize adult crash carts. Our team established a three-phase user-centered research and design approach. First, we facilitated a collaborative design workshop with front line stakeholders to develop an initial cart organization. Second, 59 clinicians across 8 departments interacted with a cart mock-up and provided feedback. Finally, 18 clinicians participated in usability testing of the updated cart in 3 separate full simulations of realistic patient emergencies including an airway emergency (anaphylaxis), cardiac arrest (ventricular fibrillation), and sepsis using manikins. Observations and feedback from all three research phases contributed to a final medical supply list and crash cart design for our hospital system. This work also provides guidance for using co-design methods and usability testing within hospital environments.
Human Factors Testing Sample Size Requirements: Is it Time to Reevaluate?
Authors: Esteve Savannah , Forkey Denise , Clark Shannon
Published: July 2021

According to the 2016 FDA Human Factors Guidance, Human Factors Validation Testing should include a minimum of 15 test participants from each intended user group for simulated use Human Factors Validation Testing, but there is not specific guidance on sample sizes for studies focused on labeling comprehension. This sample size for labeling comprehension testing has been debated, as some experts suggest that fewer than 15 test participants may be acceptable to achieve similar results. The authors collected data from multiple labeling comprehension studies, to investigate the optimal number of test participants necessary to uncover all use errors specifically when evaluating comprehension and understandability of written instructions, i.e., labeling. While smaller sample sizes may be able to detect most common usability problems, UserWise recommends further investigation of usability study data considering device complexity, user groups, and prior experience level of users to aid the determination of the optimal sample size for adequacy of labeling assessments.
Improving Elderly Patient Care Coordination by Focusing on Outpatient Providers’ Needs
Authors: Tremoulet Patrice , Kurtz Jon Tyler , Stroka Ryan
Published: July 2021

Outpatient providers rely upon discharge summaries to obtain the clinical information about patients recently discharged from acute care settings. This information is needed to coordinate care for those patients, and currently there is a great deal of variability in the content, format, and organization of discharge summaries supplied by acute care providers in the United States. Prior research has identified the information that outpatient providers who care for elderly patients would like to be able to find in discharge summaries, but has not addressed how those providers would like this data to be presented. To gain insight into how to best convey clinical information about recently discharged elderly patients, eleven outpatient physicians participated in interviews and completed a card sorting task.
Assessing Surgical Teamwork Competencies During Moments of Uncertainty Using OR Black Box
Authors: Incze Taylor , Pinkney Sonia , Fan Mark , Trbovich Patricia
Published: July 2021

Teamwork is an essential aspect to maintaining high-quality healthcare. This is especially true during times of uncertainty, when collaborative problem solving is necessary for clinical teams to adapt and deliver safe and effective care. We conducted a prospective observational study using audio/visual analysis captured by OR Black Box. Human factors experts transcribed and coded the videos using an evidence-based teamwork framework, specific to healthcare. We identified teamwork competencies that were either present or absent during moments of uncertainty in the operating room. Four main team roles (nurses, anesthesiologists, surgeons and trainees) were studied. We identified 3539 instances of teamwork, during 180 hours of surgical observation, and categorized them into 7 competencies. Team leadership was expressed significantly more often by surgeons compared to other team members whereas backup behaviour was expressed significantly more by nurses. Understanding how each team role uniquely contributes to teamwork can help develop specific and actionable teamwork interventions, which could ultimately lead to increased safety in the OR.
Focusing the Safety Spotlight: How Safety Intelligence Can Inform Systemic Patient Safety Initiatives
Authors: Soung Yee Anthony , Hall Trevor , Herlihey Tracey , Jeon Jennifer , Trbovich Patricia , Gelmi Stefano
Published: July 2021

This panel discussion at the 2021 Human Factors and Ergonomics Society (HFES) Healthcare Symposium (HCS) touched upon several topics related to actioning safety intelligence to improve patient safety. The panel had representation from both Canada and England across a broad range of human factors expertise in healthcare: from the perspective of academic research, operational hospital work, patient safety incident investigation and national healthcare policy, and a nationwide healthcare liability insurer. The panelists began with defining safety intelligence and distinguishing between safety intelligence and safety wisdom. The panel provided an engaging and insightful discussion on several topics including data collection, analysis and actioning upon the insights gained. In addition, the panel discussed strategies for demonstrating value in improving patient safety, and emphasised the importance of aligning one’s work with existing initiatives in the organisation, as well as the importance of collaborating with various stakeholders across the system to affect meaningful change.
Trends of Non-Fatal HEMS Accident-Related Injuries
Authors: Simonson Richard J. , Keebler Joseph R. , Chaparro Alex
Published: July 2021

We conducted an investigation into non-fatal helicopter emergency medical service accidents from January 26, 1991 to April 26, 2018 via the National Transportation Safety Board aviation accident database. Over this 28-year timeframe 247 accidents results in 251 fatalities and 179 non-fatal injuries. Exploratory analysis of the data indicate that more non-fatal injuries occurred in September compared to any other month during the study timeframe. Exploratory correlational analysis via elastic net logistic regression concluded that no linear relationship of NTSB accident database data provide insights into what factors are correlated with an increased likelihood of non-fatal injuries. Further, no linear relationships of available variables provide insights into the increased number of non-fatal injuries in September during this investigation’s timeframe. Future research should identify if these null results are due to a true lack or no relationship between available data and non-fatal injuries or if these results are due to inaccessibility to relevant data.
The Patient in Patient Safety: Contemporary Issues, From COVID-19 to Citizen Science
Authors: Papautsky Elizabeth Lerner , Holden Richard J. , Valdez Rupa S. , Hill Jordan , Brown Janetta
Published: July 2021

In the 4th panel on the topic of The Patient in Patient Safety, we highlighted topics of current relevance and facilitated a reflection session. The objective was to highlight the ways in which the COVID-19 pandemic has impacted patient ergonomics research and work, with particular focus on safety. After a topic overview, panelists presented their work on overcoming challenges to human subjects research created by the suspension of face-to-face activities during the COVID-19 pandemic. A facilitated reflection and brainstorming session using Miro followed. We used questions to elicit examples of patient and caregiver roles in safety during the pandemic and research strategies and challenges. These questions were also distributed on social media prior to the event. The panel served as an opportunity to share lessons learned.
Mindful Hand Hygiene and Self-Guided Training Using a Mobile Phone App
Authors: Cahill Joan , Kay Alison , Howard Vivienne , Mulcahy Ber , Forde Mary , George Siji , Lacey Gerard , Harte Richie , Reilly Frank O , Nolan Rachel , Fitzpatrick Fidelma , Ziampra Eva
Published: July 2021

This paper presents a preliminary concept for a ‘Mobile Phone App’ providing training in mindful hand hygiene integrated with the WHO hand hygiene protocol. A range of human factors action research methods were used to specify the preliminary concept. This includes stakeholder interviews, workshops, and participatory co-design/evaluation sessions. Mindfulness enables HCW to focus on the correct procedure for HH, along with addressing the need for self-care. The proposed Mobile Phone App enables training in mindful HH, from home. Mindful HH training forms parts of a wider learner journey which includes addressing self-care and training in PPE donning and doffing. Mindfulness is an inexpensive strategy to reduce stress and improve the quality of the working lives of healthcare workers. However, it is not a substitute for professional counselling services.
Book review: Donald K. Emmerson (Ed.). 2020., The Deer and the Dragon: Southeast Asia and China in the 21st Century
Authors: Marston Hunter S.
Published: July 2021

Donald K. Emmerson (Ed.). 2020., The Deer and the Dragon: Southeast Asia and China in the 21st Century. Brookings Institution Press. 386 pp. ISBN: 9781931368537.
China’s Maritime Ambition, Security Dilemma and Lack of Multilateral Framework
Authors: Lee Ji-Yong
Published: July 2021

The security environment of the South China Sea has been disrupted as China strengthens its efforts at maritime ambition. The recent security situation in the Asia-Pacific, particularly the South China Sea, is characterised by arms building and balancing against China. It raises the possibility of conflict. For securing stability and peace, it is time to bring multilateralism back in, since a multilateral security framework contributes to taking the edge off power politics. However, there is no reliable multilateral framework to deal with the declining maritime security environment. This article highlights the lack of a multilateral framework and suggests an eclectic approach to multilateralism for securing the Asia-Pacific maritime order.
Book review: Altaf Hussain Para. 2019. The Making of Modern Kashmir: Sheikh Abdullah and the Politics of the State
Authors: Kaul Ayushya
Published: July 2021

Altaf Hussain Para. 2019. The Making of Modern Kashmir: Sheikh Abdullah and the Politics of the State. Routledge. x + 309 pp. ISBN: 978-0-367-32207-6.
Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study
Authors: Luca Corina Elena , Cavicchioli Andrea , Bianchi Monica
Published: July 2021

Introduction

Patient advocacy, acting on behalf of patients’ unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers’ decisions about patients’ clinical proceedings, in which patients’ involvement in making those decisions is either doubtful or absent.

Objectives

The aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients.

Methods

The methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis.

Results

Nurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients’ family’s attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams’ lack of consideration of nurses’ opinions.

Conclusion

This research highlighted nurses’ need for advocacy to promote patients’ rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals’ work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families’ active involvement.