bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Brain Networks in Chronic Obstructive Pulmonary Disease: An Electroencephalography Analysis
Authors: Choi Sue In , Kim Jung Bin
Published: July 2021

Background. Limited data are available regarding brain networks in patients with chronic obstructive pulmonary disease (COPD). Here, we investigated brain networks in COPD using graph theoretical analysis of electroencephalography data. Methods. Thirty-eight patients with COPD and 38 healthy controls underwent scalp electroencephalography. We calculated graph measures including average degree, characteristic path length, global efficiency, local efficiency, clustering coefficient, and modularity and compared them between patients and controls. Results. Average degree, global efficiency, local efficiency, and clustering coefficients were lower, while characteristic path length and modularity were higher in patients with COPD than in controls in the alpha band ( P < .05). Significant differences in node degree and global node efficiency between controls and patients were mainly prominent in the medial parieto-central regions in the alpha band. Local efficiency and node clustering coefficients mainly differed in the occipito-parietal regions in the alpha band. We observed no differences in nodal measures in the delta, theta, beta, and gamma bands and no relationships between pulmonary function test parameters and global measures in any frequency bands. Conclusions. The thalamus generates alpha activity and is responsible for controlling respiratory activities to maintain oxygen delivery to tissues in response to chronic hypoxia. We thus speculate that our findings might be related to exposure to chronic hypoxia, implicated in the pathophysiological mechanisms underlying cognitive deficits in patients with COPD. Graph theoretical analysis of resting-state electroencephalography could be considered as a quantitative framework to understand functional networks in COPD.
Micromechanical modelling of the anisotropic creep behaviour of granular medium as a fourth-order fabric tensor
Authors: Wei Wei , Gu Chongshi , Guo Xuyuan , Gu Shuitao
Published: July 2021

The main objective of the present work is to develop a micromechanics approach to predict the macroscopic anisotropic creep behaviour of granular media. To this end, the linear viscoelastic behaviour of the inter-particle interaction at contact is adopted, and the contact distribution is characterized by a fourth-order fabric tensor in the local scale. Then, fourth-order tensor fabric-based micromechanical approaches based on Voigt and Reuss localization assumptions are applied to granular media in the Laplace–Carson space. With help of the inverse Laplace–Carson transformation of these obtained models, the macroscopic anisotropic creep behaviour of granular media submitted to a constant external loading is examined. Finally, the obtained results by specializing the Burgers model into the obtained models are compared with the numerical simulations in the particle flow code (PFC2D) to illustrate the validation and the accuracy of the analytical models for the macroscopic anisotropic creep behaviour of granular media.
Incidence of urinary ketosis and the effect of carbohydrate drink supplementation during fasting for elective caesarean section: Audit
Authors: Bellwood Hannah , Rozdarz Kellie M , Riordan John
Published: July 2021

Elective lower segment caesarean section patients are routinely instructed to fast from food for 6h before surgery, with clear fluids up until 2h before surgery. We conducted an audit examining the true fasting times of mothers undergoing an elective caesarean section and the incidence of urinary ketones before and after introducing a preop carbohydrate drink (Nutricia preOp 400ml) to be administered to all patients at 6am on the day of surgery. We audited 50 patients prior to introducing the preop carbohydrate drink and 54 patients after the introduction of a carbohydrate drink. We found the mean fasting time from last caloric intake was reduced from 13h 35min to 5h 5min after the introduction of a preoperative carbohydrate drink. We found that the incidence of urinary ketones was 40.4% prior to the introduction of a preoperative carbohydrate drink and 38.3% after the introduction of a preop drink (p = 1). If fasting times were limited to under 4h, the incidence of urinary ketones is 10%. Our audit demonstrates that reducing preoperative fasting times is possible and preventing metabolic derangements may be possible, requiring an approach targeted at keeping fasting times to a minimum.
Organ Retention Litigation
Authors: Weedn Victor W.
Published: July 2021

The common practice of retaining organs and tissues after the autopsy dissection is a potential legal liability for forensic pathologists and the offices they work for. In 1988, a coroner and the coroner’s office were successfully sued for corneal procurements without the consent of the next of kin. That led to later lawsuits of forensic pathologists and medical examiner offices over the retention of brains for formalin fixation and neuropathologic examination without consent, although the autopsies were not consent based. National Association of Medical Examiners became involved in this ligation and filed numerous amicus briefs. These later lawsuits were not successful. After caselaw on the subject, such lawsuits have largely abated. Nonetheless, the threat of such lawsuits remains, and statutory language can be promulgated to mitigate the risk.
Rehabilitation of intubated COVID-19 patients in a Singapore regional hospital with early intensive care unit and sustained post-intensive care unit rehabilitation
Authors: Chen Dominic Enhan , Goh Sze Wei , Chan Hiu Nam , Goh Huai Zhi , Ong Sing Yee , Sim Sara , Ho Vui Kian
Published: July 2021

Background

A proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients.

Objective

To describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation.

Methods

Retrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database.

Results

Most patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation.

Conclusion

Early ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients.
Rituximab versus mitoxantrone: comparing effectiveness and safety in advanced relapsing multiple sclerosis
Authors: Zrzavy Tobias , Daniels Esther , Stuka Niklas , Weber Dennis , Winkelmann Alexander , Rauschka Helmut , Hecker Michael , Aboulenein-Djamshidian Fahmy , Meister Stefanie , Leutmezer Fritz , Berger Thomas , Bsteh Gabriel , Zettl Uwe Klaus , Rommer Paulus
Published: July 2021

Background:

Rituximab (RTX), a CD20 depleting agent, is a frequently used off-label treatment for multiple sclerosis (MS), while mitoxantrone (MTX) is approved, albeit rarely used for active relapsing MS (RMS). However, observational data comparing RTX and MTX effectiveness and safety are scarce.

Objective:

We aimed to compare effectiveness and safety of MTX and RTX in patients with active RMS.

Methods:

From combined retrospective clinical data of three MS centers, we selected patients who had received at least one infusion of RTX or MTX and had at least a 6-month clinical follow-up available. Treatment groups were compared by propensity score (PS)-adjusted regression and inverse PS-weighted generalized estimated equation models regarding disability progression, relapse activity, and adverse events (AEs).

Results:

We included 292 RMS patients (mean age 41.8 years, 71.6% female) who received RTX (119 patients, mean age 36.8 years, 74.8% female) or MTX (173 patients mean age 45.3 years, 69.4% female). Using both PS methods, we did not find a significant effect favoring RTX or MTX treatment regarding the probability of disability worsening or relapse occurrence. However, RTX treatment was associated with a significantly lower probability of severe AEs and AEs.

Conclusions:

RTX shows comparable effectiveness but a favorable safety profile compared with MTX in active RMS.
Anal excision of perianal fibroadenoma: Expect the unexpected
Authors: Eberspacher Chiara , Nardi Francesco , Fralleone Lisa , Mascagni Domenico
Published: July 2021

Breast fibroadenomas are a common benign tumour in women that may need to be surgically excised. A mammary-like fibroadenoma can exceptionally be found in the pathological report after an anal polyp removal. A 60-year-old woman presented with huge anal polyp of 25 mm. It was surgically removed transanally. Histologic examination revealed a breast fibroadenoma pattern with glandular structures. Proctologist specialists must be aware that mammary-like tumours are a possible differential diagnosis for anal masses despite their rarity in the literature.
Researching relationality: Reflections on the use of concept cards during in-depth interviews
Authors: Saunders Kristina
Published: July 2021

This article reflects on the use of concept cards during in-depth interviews when researching reproductive decision-making in the context of neoliberalism and postfeminism. As existing literature has shown, card methods are valuable in centring participants’ individual experiences through increased control and inclusion during data collection, and attention has been drawn to their use as an ethically attentive method that can elicit richer, more complex narratives than interviews alone. While these strengths initially led me to consider the cards as an appropriate ‘fit’ with my feminist methodological approach, on reflection, the cards also illuminated the relationality of experiences that my research was concerned with. I view this as occurring in two ways. First, participants’ use of the cards helped to uncover the intertwining of their reproductive decisions with the social and political world, therefore complicating the neoliberal prioritization of the individual. Second, the cards brought the relation between myself and the participants, and between the participants, to the forefront. The reflections in this article therefore offer new insights into what concept cards can achieve, as not only validating individual accounts, but as enhancing the relationality of knowledge production.
Profile of COVID-19 Patients at Zero Delay COVID-19 Ward, in a Tertiary Care Hospital in South India
Authors: Ethirajan Theranirajan , Zahir Hussain S. , Rajendran Karthick , Ramachandran Arunkumar , Natarajan Murugan , Venugopalan Nisha , Elumalai Kathiravan , Annamalai Ganesh , Mathiyalagan Guhan , Panneerselvam Priyadarshini , Pamarthi Jayakrishna , Rajaram Muthukumaran , Anandan Gayathri , Natarajan Gopalakrishnan
Published: July 2021

Introduction:

Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health crisis. During the huge surge in COVID-19 cases, most of the patients arrived at Rajiv Gandhi Government General Hospital, Chennai were severe due to late presentation and also available evidence demonstrated that the delay in treatment is directly associated with increased mortality or poor patient outcome. As an innovative concept, Zero Delay COVID-19 Ward was set up to provide the required critical care for all severe COVID-19 cases. The experience of setting up of such Zero Delay COVID-19 Ward and profile of admitted COVID-19 patients are described in this paper.

Methods:

A total of 4515 laboratory-confirmed COVID-19 patients admitted at Zero Delay COVID-19 Ward was analyzed retrospectively from 7th July to 31st December 2020.

Results:

At the time of admission the frequency of dyspnea was 85.6% among them 99.1% improved after the oxygen therapy and other management at Zero Delay COVID-19 Ward. Of the 4515 COVID-19 individuals, about 1829 (40.5%) had comorbidity, 227 (5%) had died. Multivariable logistic regression analysis, COVID-19 death was more likely to be associated with comorbidity (OR: 18.687; 95% CI: 11.229-31.1) than other variables.

Conclusions:

Comorbidity is an independent high risk factor for mortality of COVID-19 patients. From our observation, it is strongly recommended that effective zero delay covid-19 ward model will help for the prevention of mortality in current/expected waves of COVID-19.
How Early Socioeconomic Adversity Combines With BMI-Linked Genetics to Launch Adverse Developmental Processes Leading to Economic Hardship
Authors: Wickrama Kandauda (K.A.S.) , O’Neal Catherine Walker , Lee Tae Kyoung
Published: July 2021

The present study used a sample of 9,100 youth from The National Longitudinal Study of Adolescent to Adult Health to identify how early socioeconomic adversity and BMI-related genetics combine to influence youth BMI and academic achievement/failure across successive life stages (i.e., adolescence, emerging adulthood, young adulthood), resulting in adverse economic outcomes in young adulthood. The results indicate that early socioeconomic adversity and BMI-related genetics initiate additive, cascading, and cumulative processes through BMI and academic achievement leading to economic hardship after accounting for relevant demographic and contextual variables, including race/ethnicity. Importantly, the BMI-related polygenic score revealed a moderate genetic influence on youth BMI and academic achievement at each life stage. The findings highlight the need to inform longitudinal health and obesity research with molecular genetic information.
An Empirical Examination of Voluntary Development Activities of Employees
Authors: Deosthali Kanchan V. , Johnson Richard D.
Published: July 2021

This study develops and empirically examines a model of voluntary employee self-development behaviours and presents a unique lens for the study of self-development behaviours that integrates the disparate social exchange and motivational models currently applied in the management and training motivation literature. Specifically, the current model utilizes the Theory of Planned Behavior (TPB) as a guiding framework in the combination and expansion of these streams to create an integrated model. This model was validated using a survey of 203 employees. Structural Equation Modelling (SEM) was used to analyse the data. The results indicated support for nine out of eleven theorized relationships in the model, and the new model explained more variance in self-development behaviours (38%) than either lens: the social exchange (8.5%) or the motivational (19%). Thus, the results indicate there is important value in integrating the lenses. Implications for research and practice are also discussed.
Evaluating and Motivating Activation in Long Term Care: Lessons From a Pilot Study
Authors: Jbilou J. , El Bouazaoui A. , Zhang B. , Henry J.L. , McDonald L , Hall T. , Chang R. , Barton D. , Chignell M.H.
Published: July 2021

Older adults living in long-term care facilities typically receive insufficient exercise and have long periods of the day when they are not doing anything other than sitting or lying down, watching television, or ruminating (Wilkinson et al., 2017). We developed an intervention called the Experiential Centivizer, which provides residents with opportunities to use a driving simulator, watch world travel videos, and engage in exercise. We assessed the impact of the intervention on residents of a long-term care home in Fredericton, NB, Canada. In this paper, we report on the results observed and highlight the lessons learned from implementing a technological intervention within a long-term care setting. Practical and research recommendations are also discussed to facilitate future intervention implementation in long-term care.
Morphological Analysis of the Human Lumbar Spine Using Sagittal Magnetic Resonance Imaging
Authors: Wu Ge , Liu Yu , Wen Wen , Zhang Yang , Tang Ruoliang , Gungor Celal , Sesek Richard F.
Published: July 2021

Sagittal morphological dimensions of the human lower lumbar structures are critical inputs for the comprehensive biomechanical modeling of spinal motions and the risk assessment of work-related low back pain. In this new quantitative exploration of sagittal morphology across the lower lumbar region (i.e., from L3/L4 to L5/S1), intervertebral disc (IVD) height, vertebral body (VB) height, endplate concavity was measured from two samples of subjects, including 1) archived medical records (AMR) collected from 57 patients and 2) 43 asymptomatic subjects with no history of low back pain (ASYM), independently by four individuals on a monthly basis. First, the current study achieved good inter- and intra-rater reliabilities. In addition, the current results also revealed that AMR sample had greater anterior-to-posterior vertebral body height ratio in vertebra L3 and L5. On the other hand, ASYM sample had significantly greater endplate concavity.
Household and Population-Level Behavioural Changes Due to COVID-19 Pandemic: A Smart Thermostat Based Comparative Data Analysis
Authors: Sahu Kirti Sundar , Oetomo Arlene , Jalali Niloofar , Morita Plinio P.
Published: July 2021

The World Health Organization declared the coronavirus outbreak as a pandemic on March 11, 2020. To inhibit the spread of COVID-19, governments around the globe, including Canada, have implemented physical distancing and lockdown measures, including a work-from-home policy. Canada in 2020 has developed a 24-Hour Movement Guideline for all ages laying guidance on the ideal amount of physical activity, sedentary behaviour, and sleep (PASS) for an individual in a day. The purpose of this study was to investigate changes on the household and population-level in lifestyle behaviours (PASS) and time spent indoors at the household level, following the implementation of physical distancing protocols and stay-at-home guidelines. For this study, we used 2019 and 2020 data from ecobee, a Canadian smart Wi-Fi thermostat company, through the Donate Your Data (DYD) program. Using motion sensors data, we quantified the amount of sleep by using the absence of movement, and similarly, increased sensor activation to show a longer duration of household occupancy. The key findings of this study were; during the COVID-19 pandemic, overall household-level activity increased significantly compared to pre-pandemic times, there was no significant difference between household-level behaviours between weekdays and weekends during the pandemic, average sleep duration has not changed, but the pattern of sleep behaviour significantly changed, specifically, bedtime and wake up time delayed, indoor time spent has been increased and outdoor time significantly reduced. Our data analysis shows the feasibility of using big data to monitor the impact of the COVID-19 pandemic on the household and population-level behaviours and patterns of change.
Can Cognitive Assessment Games Save Us From Cognitive Decline?
Authors: Chignell M.H. , Morton J.B. , Kastner M. , Lee J.S.
Published: July 2021

Loss of cognitive potential is one of the greatest impediments to human wellbeing and productivity. Our healthcare system does a poor job of managing cognitive development and cognitive decline because it measures cognitive status relatively infrequently and in the limited times when cognitive measures are taken, the instruments used tend to be blunt. In the panel that we presented at HCS 2021 we examined the potential for cognitive assessment games to provide more frequent cognitive assessment. We reported on the use of a cognitive assessment game to screen for delirium risk in emergency patients, and the development of a suite of assessment games that can assess executive functions and other cognitive abilities in both young and old. We conclude with a discussion of knowledge translation and implementation science strategies for incorporating game-based cognitive assessment into healthcare practice.
Lessons Learned From Developing a MCI Virtual Empowerment Program?
Authors: Bradley Fain W. , Nare Megan , Doiron Matthew , Farmer Sarah , Johnson Jeremy , Laforce Salimah , Ramesh Aparna , Rodriguez Amy , Vickers Kayci , Zubatiy Tamara , Mynatt Elizabeth
Published: July 2021

In the Spring of 2020, COVID-19 closures and safe distancing orders required healthcare programs across the US to cease in-person treatment. This paper presents a case study of rapidly pivoting a novel, 12-month comprehensive clinical lifestyle program combining education, occupational therapy, cognitive training, and social interaction to an online application-based education program. The focus of the program is empowerment research for people newly diagnosed with mild cognitive impairment (MCI) and their care partners, and is conducted by the Emory Brain Health Center. Georgia Tech developed an education application (named MyCEP) for use with our MCI and care partner population combining off-the-shelf services and customized user interfaces. We used an iterative design and development process, testing our application with our end users and our treatment providers, and made updates based on our discovery of the need for new capabilities and requirements. We present the discovery of emergent practices by family members and healthcare providers to meet the new requirements for successful virtual engagement.
Developing an Evidence-Based Clinical Decision-Support System to Enhance Prosthetic Prescription
Authors: Saravanan Pratima , Menold Jessica
Published: July 2021

With the rapid increase in the global amputee population, there is a clear need to assist amputee care providers with their decision-making during the prosthetic prescription process. To achieve this, an evidence-based decision support system that encompasses existing literature, current decision-making strategies employed by amputee care providers and patient-specific factors is proposed. Based on an extensive literature review combined with natural language processing and expert survey, the factors influencing the current decision-making of amputee care providers in prosthetic prescription were identified. Following that, the decision-making strategies employed by expert and novice prosthetists were captured and analyzed. Finally, a fundamental understanding of the effect gait analysis has on the decision-making strategies of prosthetists was studied. Findings from this work lay the foundation for developing a real-time decision support system integrated with a portable gait analysis tool to enhance prescription processes. This is critical in the low-income countries where there is a scarcity of amputee care providers and resources for an appropriate prescription.
Development of a New Reusable and User-Centric General-Use Mask for Averting Respirator Supply Crisis in the Healthcare Sector
Authors: Uniyal Aishwarya , Kuber Pranav Madhav , Lobos Alex , Magyar Mindy , Rashedi Ehsan
Published: July 2021

Healthcare workforce implements general-use masks for low and/or moderate barrier protection in sterile environments. However, these masks are often unavailable in pandemic situations due to a strain on supply/demand logistics. In such cases, establishing development of respiratory protection within the organization may be beneficial. Our work presents one such novel method of designing customized masks by considering facial anthropometrics of the specific sample population. In fact, such a design may provide a more efficient fit with the users as compared to currently available masks, which are often designed for a much wider range of people. The protocol followed a fast-paced method of obtaining facial data (~2.8 mins/participant), and a data-driven approach for extracting design profiles. We have demonstrated the same through a pilot study, which involved recruiting a group of 7 participants with ethnic and gender variation. A total of 7 landmarks representing zygomatic process of the temporal, angle of mandible, zygomatic arch, nasal-maxillary region, and apex of nose, mid-lips and the chin were selected. Analysis included determining closest, mid-points, and farthest points for each landmark among the entire datasets. Results indicated that the landmarks: Apex of Nose, Midlips and Chin represented a straight-line path with a lateral shift of ~4.58 inches between the closest and farthest dimensions from the nose point, based on which the facepiece was designed. Meanwhile, geometric transformations consisting of several construction lines and bisectors were used along with obtained data from zygomatic arch, process of temporal, and angle of mandible landmarks to determine the contours of the straps for securing the mask. Our design addresses common issues in masks like discomfort around the ear, humidity, and reuse, by provision of a novel mounting method, fabric-based materials, and sleeve for replacement of filters, respectively. The proposed concept of the mask and the methods followed could also be applied in broader applications including manufacturing/construction and also daily-life activities besides hospital environments.
Examining the Influence of Power Distance on Psychological Safety Within Healthcare Teams
Authors: Krishnakumar Divya , Caskey Rachel , Hughes Ashley M.
Published: July 2021

Cultivating good teamwork practices within healthcare teams is important for providing effective patient care and preventing adverse health outcomes. Psychological safety is one factor which is instrumental in developing a positive team environment, which fosters effective teamwork. The historically hierarchical nature of healthcare ascribes status to individuals based on profession, and this power differential is a contributing factor to a team member’s psychological safety. This study seeks to identify relationships between cultural backgrounds and teamwork in healthcare through examining how power distance influences psychological safety within healthcare teams. A cross-sectional questionnaire containing the Psychological Safety Scale and the Personal Cultural Orientation Scale was fielded to sets of Internal medicine teams working in a health system located in the Midwest region of the United States ( n=17). Levels of power-distance and psychological safety were similar amongst leaders and their team members. Upon comparison, there was no correlation found between power distance and psychological safety. Moderate to significant correlations were found between other deep cultural constructs.
Towards Reducing Risk of Injury in Nursing: Design and Analysis of a New Passive Exoskeleton for Torso Twist Assist
Authors: Kuber Pranav Madhav , Rashedi Ehsan
Published: July 2021

Nursing is among the most physically challenging occupations and involves intensive lifting activities often including twisting of torso while performing tasks such as patient handling. Frequent and repetitive twisting of the body is known to induce large demands on the musculature, which may lead to MSD with direct and indirect costs to the hospital governance. One solution proposed through this article includes an exoskeleton specifically designed to assist in twisting movements of the trunk. This involves a double-actuator fully passive system that assists in rotation of the torso with the help of mechanical springs and cable modules. Our study provides a conceptual design of the mechanism, and a preliminary analysis using the concepts of kinematics, dynamics, usability, wearability, and freedom of movement. Results show that the mechanism could offer freedom of rotation for the wearer’s torso up to 52, 25 and 22 degrees (with stationary hip joint) along the transverse, sagittal and coronal planes, respectively. Moreover, similar force generation (up to 80N) was obtained in both actuators for same rotation on transverse plane in both directions for a combination of spring stiffness (0.5 – 1 N/mm) and damping (0.1 - 0.5 N-sec/mm) parameters. Our proposed design could also be integrated to the current exoskeletons in the form of a module and could be beneficial in more general work settings.
Vigilance in Cardiac Telemetry Monitoring: Performance Outcomes and Effects on Operators’ Cognitive and Affective States
Authors: Nare Matthew T. , Hancock Gabriella M.
Published: July 2021

Healthcare represents an industry where any errors have the potential to lead to significant consequences such as unintended patient injury or death. Teams of healthcare professionals work together to complete patient care activities across several hospital environments including operating rooms, trauma centers, and care floors. While most healthcare tasks are patient-facing, some tasks such as cardiac telemetry monitoring occur without much patient interaction. Even so, cardiac telemetry monitoring represents a task where errors result in patient harm or death. The purpose of this study was to investigate the vigilance decrement using a healthcare visual search task based on cardiac telemetry monitoring. Results of this study were viewed through the lens of resource theory of vigilance. Findings from this study include a decrease in correct detections and false alarms with increased workload which supports previous vigilance decrement research as well providing directions for future research.
Creating a Safer Patient Room Environment: The Contribution of Patient Bed Height
Authors: Taylor Dorothy , Morse Janice , Merryweather Andrew
Published: July 2021

Elderly patient falls are expensive and may cause serious harm. Studies have identified the sit-to-stand-and-walk (STSW) task as the task where the greatest number of elderly patient falls occur. There is a great need to identify the particular movement and environmental conditions that lead to these elderly patient falls. This study begins to address this gap by evaluating the elderly patient during self-selected hospital bed egress. Using an observed fall risk episode (FRE) as a fall proxy, statistically significant parameters were identified which include bed height, pausing prior to initiating gait, level of fall risk, and Stand phase. Low bed height was identified as the least safe bed height. Patient-specific bed height (PSBH) using the patient’s lower leg length (LLL) is recommended. In addition, suggested guidelines are presented for clinical application in setting PSBH without measuring the patient’s LLL.
Virtual Observation: Conducting Contextual Inquiry Remotely
Authors: Donnelly Tom , Rahman-Vyas Hiba , Mandelbaum Jason , Hatch Michelle , Bhattacharya Binita
Published: July 2021

This past year, there have been challenges conducting research in person due to the COVID-19 pandemic. While many types of projects have been successfully converted to virtual approaches with relative ease, observational research and hands-on work with medical devices and technology have proven to be more difficult. In this article we will discuss: (1) Traditional observational research approaches; (2) Pros and cons of three virtual observational approaches; (3) Two case studies: Home Health Infusions and Preparing/Administering Intravenous (IV) Chemotherapy; (4) and Considerations for going virtual. In our conclusion, we reflect on the need for observational research, point out the strengths of conducting research in phases, and provide tips for success.
Maternal Mortality Litigation Review
Authors: Kothari Sanjana , Patterson Emily S.
Published: July 2021

Obstetrics and gynecology is considered one of the most litigious medical specialties; medical negligence and malpractice lawsuits are frequently filed to seek damages for improper medical care during childbirth. In fact, several studies have shown that a much greater percentage of maternal injury claims result in settlements or judgments as compared to other specialties. A considerable number of these claims can be linked to postpartum hemorrhage, or excessive bleeding following vaginal birth or cesarean delivery. This study aims to identify cases where postpartum hemorrhage contributed to maternal morbidity or mortality and led to a lawsuit. A review of litigation surrounding this topic was conducted using the Nexis Uni database from January 2011 to December 2020. Inclusion criteria consisted of maternal mortality cases due to postpartum hemorrhage, which discussed legal causes like medical negligence or obstetric violence. Evaluation of the litigation search results demonstrated various elements most associated with postpartum hemorrhage-related maternal injury litigation. Understanding challenges which arise most frequently in postnatal care settings will be useful in improving maternal health outcomes.
Learning From Root Cause Analysis (RCA) Actions That Use Standardization to Address Patient Safety Concerns
Authors: Fuller Helen J.A. , Arnold Tim , Bagian Tandi M.
Published: July 2021

Standardization has obvious benefits, but standardization also has clear risks. This paper grew out of an ongoing discussion of how we are standardizing in healthcare today, with a goal of looking to the future for possible improvements. We continue this dialog by describing Root Cause Analysis (RCA) actions involving standardization with hopes of promoting inquiry into the nuances of standardization in different contexts. Studies are needed to understand the benefits and risks of standardization, locally and nationally, as well as the different interpretations of the term “standardization.” These in turn can inform the development of decision support and systems or guidance for facilitating responsible and safe standardization in healthcare. Approaching standardization thoughtfully, not as a blanket solution, but instead as a potential instrument that must be studied, tailored, and cautiously applied could be the next standard we seek.
Using Incident Reports to Advance Patient Safety and System Resilience in Radiation Oncology Treatment Planning
Authors: DiCostanzo Dominic J. , Patterson Emily S.
Published: July 2021

We used incident reports to improve treatment planning in radiation oncology to advance patient safety. First, a cluster of related reports enabled discovery of communication issues for setup instructions stemming from a text box with a limited character size. A redesigned process used structured data and image formats to reduce the proportion of inaccurate setup instructions. An upward trend in inaccurate setup instructions identified that some rotating staff were unaware of which equipment to use. Implementing default disease site setups ensured that when a patient was to commence treatment for a specific disease site, it was known which immobilizing equipment should be utilized as the basis before customization. Second, inappropriate plans were identified for proactive improvement. The process resilience was enhanced with targeted validations of generated treatment plans. The automated checks incorporated data automatically pulled from the electronic health record. Useful methods included clustering reports into categories to proactively see patterns in reported issues, collaborating with clinical experts from different perspectives, surveillance monitoring to identify new risks as conditions change, improving communications across disciplines through health information technology, and increasing system resilience with targeted validation of known gaps and variation in plans. The implementation of ILS frameworks, careful review of events and categorization, which culminate with interventions targeting the most frequent or highest severity incidents reported, increased patient safety within our department.
Rapid Prospective Risk Assessment of Mobile Products in Healthcare
Authors: Kabel Margo , Arnold Tim , Daum Marian
Published: July 2021

There is much hope and hype surrounding the development of innovative technologies, but are we as motivated and effective in assessing the potential risks of these technologies? It is prudent to assess and mitigate risks prior to deploying a new product or process, but how often is a risk assessment performed when new functionality or changes are proposed? This paper describes a rapid, Agile approach for intermittent risk assessment and surveillance when there are substantial changes to systems and their context of use. Fault Tree Analysis and Failure Mode and Effect Analysis were used as models in a customized approach to assess for risk and potential hazards of added functionality and changes to mobile products after initial deployment. We also describe benefits and challenges. A rapid risk assessment could also be used as an initial assessment in situations where the software development cycle is not amenable to a more time-consuming approach to risk assessment. A lesson learned in preparing to rapidly assess for risks is to consider several or some combination of approaches.
Spending More or Spending Less? Institutional Expenditures and Staffing in the Free-College Era
Authors: Odle Taylor K. , Monday Alex B.
Published: July 2021

While research has documented outcomes for students served by promise programs, few studies have considered the behavior of institutions themselves in the promise era. A new source of revenue combined with larger and more diverse cohorts is likely to motivate changes in spending and staffing—decisions instrumental to student access and success. We employ complementary difference-in-differences and synthetic control strategies to estimate impacts of the first statewide promise program on these two outcomes. Findings suggest institutions diverted expenditures away from instruction, academic support, and institutional support toward greater institutional grant awards. We find no meaningful impact on staffing levels. While some institutional actions may further support the access and success goals of promise programs, the diversity of programs across the nation suggests not all may follow suit. This study should inform policy makers considering the full extent of outcomes of free-college programs and invigorate further research on institutional responses.
Book review: Peter Lehr. 2020. Militant Buddhism: The Rise of Religious Violence in Sri Lanka, Myanmar and Thailand
Authors: Shaffer Ryan
Published: July 2021

Peter Lehr. 2020. Militant Buddhism: The Rise of Religious Violence in Sri Lanka, Myanmar and Thailand, Palgrave Macmillan, vi + 306 pp. ISBN: 9783030035167.
Patient Experience on a Hospital Oncology Service Before and After Implementation of a No-Visitor Policy During COVID-19
Authors: Bolton Kenyon C. , Lawler Michael , Hauptman Jennifer , Madden Marissa , DeVoe Stephen G. , Kennedy Amanda G. , Tomkins Bradley J. , Hodde Naomi M.
Published: July 2021

Hospital visitor restriction policies prompted by Coronavirus Disease 2019 (COVID-19) may lead to a less comfortable or informed inpatient experience for oncology patients admitted for non-COVID-19 conditions. We surveyed oncology inpatients before (n = 47) and after (n = 65) implementation of a no-visitor policy using a validated questionnaire to measure patient experience. Results revealed no significant difference in the percentage of patients reporting “no problems” ( P < .05) in all questions. Patient experience was not adversely impacted by visitor restrictions enacted in response to COVID-19 on an oncology service, as measured by a questionnaire capturing common concerns among inpatients.
Inequality and Inequity in the Use of Oral Health Services in Australian Adults
Authors: Ju X. , Do L.G. , Brennan D.S. , Luzzi L. , Jamieson L.M.
Published: July 2021

Objective:

Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults.

Methods:

Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual’s self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity.

Results:

A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro–low education and pro–poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income.

Conclusion:

The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults.

Knowledge Transfer Statement:

The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.
Generating a Future Vision of Patient Safety: A Pilot Program to Test the Integration of Certified Professional in Patient Safety™ Curriculum into Undergraduate Medical Education
Authors: Gelinas Lillee S , Reynolds Conner D , Lindsley Joshua , Lieto Janet
Published: July 2021

Preventable healthcare-associated harm results in significant morbidity and mortality in the United States, costing nearly 400 000 patient lives annually. The Institute for Healthcare Improvement provides high-quality educational resources tailored for working healthcare professionals. One such resource is the Certified Professional in Patient Safety (CPPS™) review course, which equips professionals with advanced proficiency in 5 core patient safety domains. The CPPS™ certification is the only interprofessional, patient safety science credential recognized worldwide. In 2010, the Lucian Leape Institute at the National Patient Safety Foundation described the critical need for medical students to participate in patient safety solutions as well. However, equivalent patient safety credentialing remains challenging for students in the preclinical and clinical stages of training to obtain. To address this growing dilemma, the Texas College of Osteopathic Medicine (TCOM) piloted the first-of-its-kind CPPS™ course with 10 medical students to test a novel, academic-level approach to patient safety curriculum. Medical students showed large gains in performance on the post-test (83.18% ± 26.12%) compared to the pre-test (46.46% ± 27.18%) ( P < .001, η2 p = .368), representing increased knowledge across all learning domains. On the national certification examination, students had a 90% first-time pass rate, exceeding the current national average of 70% for first-time examinees. In satisfaction surveys, students expressed the value of pilot curriculum for their medical training, the importance of similar Patient Safety Education and CPPS certification for all medical students, their confidence as future healthcare change agents. Content analysis of open response questions revealed 3 key areas of strength and opportunity for guiding future iterations of the course. This pilot generates a future vision of patient safety, equipping students with critical knowledge to systematically improve healthcare quality.
Book review: Aakash Singh Rathore, Ambedkar’s Preamble: A Secret History of the Constitution of India
Authors: Gaur Ratika
Published: July 2021

Aakash Singh Rathore, Ambedkar’s Preamble: A Secret History of the Constitution of India. Haryana: Vintage, Penguin Random House, 2020. xlviii + 236 pp., ₹599. ISBN 978–0–670–09324–3.
On microstructural and mechanical properties of 21-4-N nitronic steel joint developed using microwave energy
Authors: Bhandari Shivani , Gupta Shivani , Mishra Radha Raman , Sharma Apurbba Kumar , Arora Navneet
Published: July 2021

In the current experimental work, an effort has been made to explore the feasibility of fusion joints of 21-4-N nitronic steel employing microwave heating. These fusion joints were developed inside a domestic microwave applicator operating at 900 W. Microwave energy was used to fabricate the joints in hybrid heating mode by converting electromagnetic energy into heat at 2.45 GHz. Charcoal and SiC plates were used as susceptor and separator, respectively, and nickel powder was used as the interface material. The developed joints were characterized for their microstructural and mechanical properties. The microstructures indicate a complete fusion of nickel interfacing powder with the faying surfaces. XRD results show the formation of metallic nitrides and carbide phases (Cr2N, Fe3N, and Fe2C) and the FeNi phase at the weld zone. Furthermore, the observed average tensile strength of the fusion joints was approximately 61% of base metal. The reduction in the stress and elongation compared to the base metal were 38.67% and 12.68%, respectively. The average microhardness of the microwave joints was monitored as 407 ± 69.27 HV. The results indicate the feasibility of fusion joints of nitronic steel using microwave energy.