bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertension Self-Management Perspectives From African American Older Adults
Authors: Moss Karen O. , Still Carolyn H. , Jones Lenette M. , Blackshire Gabrielle , Wright Kathy D.
Published: June 2018

African Americans are disproportionately impacted by hypertension, suffering earlier onset and greater severity of the disease, and premature cardiovascular mortality, than the general population. Managing hypertension is an unending concern for African American older adults. A better understanding of the self-management preferences of this vulnerable population will lead to the enhanced design of culturally acceptable interventions. This descriptive study examined focus group participants’ perspectives on engaging in hypertension self-management activities with the goal of developing a co-created intervention. This study was part of a mixed methods study for which audio- and graphically-recorded focus groups were conducted with community-dwelling African American older adults ( N = 31) diagnosed with hypertension. The majority of the participants were women (87%); the mean age was 72 years ( SD = 7.53). Themes derived from data analyses centered on primary stressors of communication, healthy eating, and sleep related to blood pressure self-management. Based on these, the researchers co-created educational interventions.
Brief Report: Measurement of Young Children’s Engagement and Problem Behavior in Early Childhood Settings
Authors: Prykanowski Debra A. , Martinez Jose R. , Reichow Brian , Conroy Maureen A. , Huang Ke
Published: June 2018

Given the importance of engagement and impact of problem behavior on young children’s behavioral, social, and academic development, these two behaviors are often observed and measured in early childhood settings. The purpose of this brief report is to describe the findings from an examination of the use of multiple direct observation methods to measure engagement and problem behaviors of five children in early childhood settings across two different activity types. Findings from this study support previous research that young children’s engagement and problem behavior differ depending on the type of classroom activity. In addition, the data indicate that behavioral estimates for both engagement and problem behavior obtained using momentary time sampling produced measures of behaviors comparable with those obtained with continuous recording, whereas partial-interval recording consistently overestimated the occurrence of the behaviors compared with continuous recording. Implications of the findings and directions for future research are discussed.
Effect of a rehabilitation program on performance-related musculoskeletal disorders in student and professional orchestral musicians: a randomized controlled trial
Authors: Roos Marianne , Roy Jean-Sébastien
Published: June 2018

Objective:

To explore the feasibility of a rehabilitation program and its effect on the performance-related musculoskeletal symptoms and functional limitations of orchestral musicians.

Design:

Single-blind pilot randomized controlled trial with exercise group and control group.

Setting:

Workplace of professional symphony orchestra and tertiary-level conservatory orchestral musicians.

Participants:

Professional and student orchestral musicians with or without performance-related musculoskeletal disorders.

Interventions:

A rehabilitation program including an educational presentation, an 11-week home exercise program and three supervised exercise sessions, versus no intervention.

Measures:

Feasibility measures included adherence and drop-out rate. The Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM) measured symptom intensity and functional limitations, while the Nordic Musculoskeletal Questionnaire (NMQ) measured symptom prevalence and frequency.

Results:

A total of 30 participants were recruited ( n = 15 per group). Exercise group adherence was 97.7% for the supervised sessions and 89% for the home exercise program. There were no drop-outs. Significant group-time interactions were obtained for both the pain intensity (partial η2 = 0.166; P = 0.025) and pain interference (partial η2 = 0.186; P = 0.017) sections of the MPIIQM. Mean (standard deviation) pain intensity score changes from baseline to 11 weeks were control group: 0.40 (5.04); P = 0.763; partial η2 = 0.007; and exercise group: –4.07 (5.31); P = 0.010; partial η2 = 0.386. For pain interference, mean score changes were control group: 0.20 (9.10); P = 0.933; partial η2 = 0.001; and exercise group: –9.00 (10.73); P = 0.006; partial η2 = 0.430. NMQ analyses revealed no significant interaction ( P > 0.05).

Conclusion:

Results suggest that the studied program is feasible and effective in decreasing the intensity and functional impact of musicians’ symptoms. However, no significant medium-term effect on the prevalence and frequency of symptoms was shown.
Estimating a Preference-Based Single Index Measuring the Quality-of-Life Impact of Self-Management for Diabetes
Authors: Rowen Donna , Labeit Alexander , Stevens Katherine , Elliott Jackie , Mulhern Brendan , Carlton Jill , Basarir Hasan , Brazier John
Published: June 2018

Objective. Self-management is becoming increasingly important in diabetes but is neglected in conventional preference-based measures. The objective of this paper was to generate health state utility values for a novel classification system measuring the quality-of-life impact of self-management for diabetes, which can be used to generate quality-adjusted life years (QALYs). Methods. A large online survey was conducted using a discrete choice experiment (DCE), with duration as an additional attribute, on members of the UK general population ( n = 1,493) to elicit values for health (social limitations, mood, vitality, hypoglycaemia) and non-health (stress, hassle, control, support) aspects of self-management in diabetes. The data were modelled using a conditional fixed-effects logit model and utility estimates were anchored on the one to zero (full health to dead) scale. Results. The model produced significant and consistent coefficients, with one logical inconsistency and 3 insignificant coefficients for the milder levels of some attributes. The anchored utilities ranged from 1 for the best state to −0.029 for the worst state (meaning worse than dead) defined by the classification system. Conclusion. The results presented here can potentially be used to generate utility values capturing the day to day impact of interventions in diabetes on both health and self-management. These utility values can potentially be used to generate QALYs for economic models of the cost-effectiveness of interventions in diabetes.
A Non-Dominated Sorting Genetic Algorithm Approach for Optimization of Multi-Objective Airport Gate Assignment Problem
Authors: Mokhtarimousavi Seyedmirsajad , Talebi Danial , Asgari Hamidreza
Published: June 2018

Gate assignment problems (GAP) are one of the most substantial issues in airport operation. The ever-increasing demand producing high occupancy rates of gates, the potential financial loss from imbalances between supply and demand in congested airports, and the limited scope for expanding facilities present challenges that require an advanced methodology for optimal supply allocation. In principle, tackling GAP involves seeking to maintain an airport’s maximum capacity through the best possible allocation of resources (gates). There are a wide range of dependent and independent resources and limitations involved in the problem, adding to the complexity of GAP from both theoretical and practical perspectives. In this study, GAP is extended and mathematically formulated as a three-objective problem, taking into account all resources and restrictions, which can be directly linked to airport authorities’ multiple criteria decision-making processes. The preliminary goal of multi-objective formulation is to consider a wider scope, in which a higher number of objectives are simultaneously optimized, and thus to increase the practical efficiency of the final solution. The problem is solved by applying the second version of Non-dominated Sorting Genetic Algorithm (NSGA-II) as a parallel evolutionary optimization algorithm. Results illustrate that the proposed mathematical model could address most of the major criteria in the decision-making process in airport management in terms of passenger walking distances, robustness, and traditional costs. Moreover, the proposed solution approach shows promise in finding acceptable and plausible solutions compared with other multi-objective algorithms (BAT, PSO, ACO, and ABC).
Nurse Practitioners as Disruptive Innovators in Palliative Medicine
Authors: Opitz Samantha E. , Hebert Randy S.
Published: June 2018

As the population ages, the corresponding rise in people living with life-limiting illnesses will lead to a greater need for clinician experts in palliative medicine. There are not enough physicians available to care for the growing number of patients, however. We believe that nurse practitioners are well positioned to meet this demand. In this paper, we will use the concept of disruptive innovations to provide support for our belief that nurse practitioners can, and should, take a larger role in palliative medicine. First, we will describe how 2 general types of business models—solution shops and value-adding processes—can be applied to health care in general and palliative medicine specifically. Second, we will describe the concept of disruptive innovations. Finally, we will use these business models to explain how nurse practitioners are particularly well suited to disrupt the current business model of palliative medicine, thereby allowing more patients with life-limiting illness to receive the high-quality care they need.
Making the invisible visible? Everyday lived experiences of ‘seeing’ and categorizing children’s well-being within a Danish kindergarten
Authors: Houmøller Kathrin
Published: June 2018

This article explores how pedagogues assess and categorize children’s well-being in the everyday life of a kindergarten caring for a large number of children considered socially vulnerable. Based on ethnographic fieldwork, the article focuses on a newly implemented well-being assessment tool oriented towards making all children’s needs visible through the pedagogues’ regular colour-categorizations of their state of well-being. The article problematizes this ambition and proposes that some children are rendered invisible in the process of categorizing. It is argued that the categorizations are more reflective of the structural conditions of the kindergarten and a gauged sense of urgency.
The resonant valley suppression of a hydraulic shaking table by using adaptive spectral line enhancer
Authors: Wang Tao , Song Jinchun
Published: June 2018

As an electro-hydraulic servo shaking table takes on an elastic load in a vibration test of a 2-mass dynamic system, a mutual coupling effect is exerted between the shaking table and the specimen, which will form a resonant system to weaken the dynamic characteristics of the system. As required by the system bandwidth, the resonant system contains a resonance valley and a resonance peak, and its amplitude commonly surmounts the stability range of the system’s acceleration amplitude. In this article, the resonance phenomenon is analyzed, and the structure and the parameters of the three-state controller are designed on the basis of a pole assignment system. The adaptive spectral line enhancer is adopted to suppress the resonant valley, and the power spectrum is analyzed to experimentally verify that it exerts an anti-resonance effect.
North-south patterning of millet agriculture on the Loess Plateau: Late Neolithic adaptations to water stress, NW China
Authors: Sheng Pengfei , Shang Xue , Sun Zhouyong , Yang Liping , Guo Xiaoning , Jones Martin K
Published: June 2018

Water availability and climatic conditions profoundly control agricultural systems in different spatial-temporal conditions. Using new results of archaeobotanical research on the north Loess Plateau and extant macro-botanical data recovered from the eastern part of the north-south Loess Plateau, we investigated the ancient cropping patterns of different agrarian communities living in the marginal area of the East Asian monsoonal climatic zone. It indicated that the common millet ( Panicum miliaceum)–based cropping pattern was dominant in the north Loess Plateau during around 3000–1800 cal. BC. However, there is a preference for foxtail millet ( Setaria italica)–based farming combined with a certain amount of rice ( Oryza sativa) cultivation by the archaeological humans on the south of the Loess Plateau during the same periods. We infer the diverse ways of crop management selected by late Neolithic human beings adapting to various water stress that probably underpinned different developmental trajectories of ancient civilizations on the Loess Plateau during mid-late Holocene.
Treating lupus patients with antimalarials: analysis of safety profile in a single-center cohort
Authors: Spinelli F R , Moscarelli E , Ceccarelli F , Miranda F , Perricone C , Truglia S , Garufi C , Massaro L , Morello F , Alessandri C , Valesini G , Conti F
Published: June 2018

This longitudinal retrospective study aims at describing the safety profile and the reasons for discontinuation of antimalarials in patients with systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE), focusing on ocular toxicity. We analyzed the clinical data of 845 SLE and DLE patients; 59% of them were taking antimalarials: 1.4% chloroquine (CQ), 88.5% hydroxychloroquine (HCQ) and 10.1% both. The mean therapy duration was 82.5 ± 77.4 months. At least one side effect was reported by 19.4% of patients, leading to temporary or permanent withdrawal in 9.1% and 10.3% of cases, respectively; 19.3% of patients experienced side effects with HCQ and 8.6% with CQ. In 55.1% of cases, the adverse event was mild or moderate. Ophthalmological alterations were reported by 8.5% but were confirmed by the ophthalmological examination in 5.5% of cases. Retinal alterations were associated with age, disease duration and duration of the antimalarial therapy, but not to drug dose and comorbidities or lupus nephritis. This is the largest monocentric longitudinal study confirming the good safety profile of antimalarials in DLE and SLE patients. The main adverse events during the therapy were mild or moderate, but maculopathy—reported in a low percentage of patients—remains the main cause of treatment withdrawal.
Syncope caused by complete heart block and ventricular arrhythmia as early manifestation of systemic lupus erythematosus in a pregnant patient: a case report
Authors: Lo C H , Wei J C C , Tsai C F , Li L C , Huang S W , Su C H
Published: June 2018

Systemic lupus erythematosus (SLE) can affect all heart structures including the conduction system, with either reversible or permanent derangement. However, only a few cases of adult SLE and complete atrioventricular (AV) block have been reported. We describe a young pregnant woman who initially presented with complete AV block on electrocardiography before the diagnosis of SLE. Syncope subsequently developed during the postpartum period due to frequent nonsustained polymorphic ventricular tachycardia, suggesting lupus myocarditis. The ventricular arrhythmia was successfully treated by intravenous corticosteroids, lidocaine and implantation of a permanent pacemaker. This may represent the first report of complete AV block with polymorphic ventricular tachycardia, which was identified before the other clinical features of SLE fully manifested. SLE should be considered if a patient presents with complete AV block without other clinical features. It may warn for early diagnosis and appropriate treatment of SLE including lupus-related heart disease.
The Flaws and Future of Islet Volume Measurements
Authors: Huang Han-Hung , Harrington Stephen , Stehno-Bittel Lisa
Published: June 2018

When working with isolated islet preparations, measuring the volume of tissue is not a trivial matter. Islets come in a large range of sizes and are often contaminated with exocrine tissue. Many factors complicate the procedure, and yet knowledge of the islet volume is essential for predicting the success of an islet transplant or comparing experimental groups in the laboratory. In 1990, Ricordi presented the islet equivalency (IEQ), defined as one IEQ equaling a single spherical islet of 150 μm in diameter. The method for estimating IEQ was developed by visualizing islets in a microscope, estimating their diameter in 50 μm categories and calculating a total volume for the preparation. Shortly after its introduction, the IEQ was adopted as the standard method for islet volume measurements. It has helped to advance research in the field by providing a useful tool improving the reproducibility of islet research and eventually the success of clinical islet transplants. However, the accuracy of the IEQ method has been questioned for years and many alternatives have been proposed, but none have been able to replace the widespread use of the IEQ. This article reviews the history of the IEQ, and discusses the benefits and failings of the measurement. A thorough evaluation of alternatives for estimating islet volume is provided along with the steps needed to uniformly move to an improved method of islet volume estimation. The lessons learned from islet researchers may serve as a guide for other fields of regenerative medicine as cell clusters become a more attractive therapeutic option.
Teaching Evidence-Based Practice Using Cases in Social Work Education
Authors: Drisko James , Grady Melissa D.
Published: June 2018

This article details an approach to teaching the evidence-based practice (EBP) process using clinical case examples. This approach can also be used by classrooms educators, field instructors, supervisors in agencies, and agency leaders to enhance use of the EBP process in practice. We present an overview of EBP and the two main approaches to teaching it in social work. Next, we share a clinical case and classroom-based examples to teach the steps of doing EBP in practice. Feedback from students regarding their experiences of learning EBP is also detailed. In addition, we discuss challenges and opportunities this process offers students and instructors, supervisors, and administrators. The use of cases reveals the complexity of client needs, the merits and limitations of available research results, the complexity of evaluating research results, and the challenges of collaboratively developing a treatment plan.
“We Know for a Fact”: Dyslexia Interventionists and the Power of Authoritative Discourse
Authors: Worthy Jo , Svrcek Natalie , Daly-Lesch Annie , Tily Susan
Published: June 2018

Although researchers have studied dyslexia for over a century, there is still much debate about how dyslexia differs from other reading difficulties and how to support students labeled dyslexic. Nevertheless, dyslexia policy and practice are steeped in authoritative discourse that speaks of a definitive definition, unique characteristics, and prescribed intervention programs that are not well supported by research. In Texas, and increasingly in other states, only educators trained in these programs are considered qualified to provide intervention for students identified as dyslexic. In contrast to earlier research, which found that the word dyslexia decreased teachers’ confidence and feelings of self-efficacy, the dyslexia interventionists we interviewed expressed a high degree of confidence and certainty about dyslexia and the interventions they used. Bakhtin’s notion of authoritative and internally persuasive discourse helped us think about the reasons for these findings and how to initiate a broader and more inclusive conversation about dyslexia.
Regulation 1231/2010 on the inclusion of third-country nationals in EU social security coordination
Authors: Cornelissen Rob
Published: June 2018

The EU regulations on the coordination of social security systems provide a high standard of protection for people moving within the EU. For a long time, third-country national workers have been excluded from this protection. This article shows that the explanation for this exclusion is to be found in the legal basis of the EU regulations. This article also demonstrates how developments in primary law in the last two decades have paved the way for the extension of the EU regulations to third-country nationals. Regulation 1231/2010 offers third-country nationals, in the field of social security, the same protection as EU citizens moving within the EU. However, this extension is subject to two conditions. For this reason, a considerable number of third-country nationals working in a Member State do not benefit from equal treatment as nationals of the host State. The article clarifies why Regulation 1231/2010 does not apply in Norway, Iceland, Liechtenstein, Switzerland and Denmark. Attention is paid to a number of challenges and open questions, such as the special position of the UK and the relationship between Regulation 1231/2010 and bilateral agreements concluded between a Member State and a third country.
A uniform initialization Gaussian mixture model–based guided wave–hidden Markov model with stable damage evaluation performance
Authors: Yuan Shenfang , Zhang Jinjin , Chen Jian , Qiu Lei , Yang Weibo
Published: June 2018

During practical applications, the time-varying service conditions usually lead to difficulties in properly interpreting structural health monitoring signals. The guided wave–hidden Markov model–based damage evaluation method is a promising approach to address the uncertainties caused by the time-varying service condition. However, researches that have been performed to date are not comprehensive. Most of these research studies did not introduce serious time-varying factors, such as those that exist in reality, and hidden Markov model was applied directly without deep consideration of the performance improvement of hidden Markov model itself. In this article, the training stability problem when constructing the guided wave–hidden Markov model initialized by usually adopted k-means clustering method and its influence to damage evaluation were researched first by applying it to fatigue crack propagation evaluation of an attachment lug. After illustrating the problem of stability induced by k-means clustering, a novel uniform initialization Gaussian mixture model–based guided wave–hidden Markov model was proposed that provides steady and reliable construction of the guided wave–hidden Markov model. The advantage of the proposed method is demonstrated by lug fatigue crack propagation evaluation experiments.
Assessing Teacher Usability of Written Expression Curriculum-Based Measurement
Authors: Payan Anita M. , Keller-Margulis Milena , Burridge Andrea B. , McQuillin Samuel D. , Hassett Kristen S.
Published: June 2018

National test data indicate that some students do not perform well in writing, suggesting a need to identify students at risk for poor performance. Research supports Written Expression Curriculum-Based Measurement (WE-CBM) as an indicator of writing proficiency, but it is less commonly used in practice. This study examined the usability of WE-CBM compared with Reading Curriculum-Based Measurement (R-CBM). Participants included 162 teachers who were given examples of WE-CBM and R-CBM and then completed a usability measure for both curriculum-based measurement (CBM) types. Teachers not only rated WE-CBM as usable but also rated R-CBM significantly higher in usability, with no significant differences in acceptability. Practical implications that may inform modifications to WE-CBM are discussed.
Areca nut trade, globalisation and its health impact: perspectives from India and South-east Asia
Authors: Arora Shelly , Squier Christopher
Published: June 2018

Aim:

Areca nut (AN) is consumed globally by 600 million people, and 10%–20% of the world population uses betel quid, a preparation containing areca nut. India and other South-east Asian countries are the largest consumers of AN in the world. The aim of this article is to review the economic impact and oral health effects of the consumption of AN. It will also discuss the role of dentists and auxiliary healthcare providers for increasing public awareness and the need for a strong public health policy.

Method:

To address the concerned area, PubMed, Scopus and Google Scholar databases were explored from the year 1965 until 2017. Studies focusing on various aspects of AN only, and articles published in English were included. Anecdotal reports, case reports and unpublished data were excluded.

Results and discussion:

This narrative review suggests India is the world’s largest producer of AN along with the largest AN consuming population followed by other South-east Asian countries. AN chewing causes oral submucous fibrosis (OSF) and it is most commonly observed in people of India and South-east Asia. AN use is associated with various social and unsocial aspects. Dentists and dental auxiliaries can increase the knowledge and awareness of a health issue (OSF) among the target audience as well as the detrimental effects of AN chewing.

Conclusion:

There is a need for more aggressive public health measures and dentists and dental auxiliaries should be employed to bring awareness to the general public regarding AN use.
Establishing a local coalition for addressing social determinants of hypertension in Quibdó (Colombia): a description and reflection on the process
Authors: Lucumí Diego I. , Schulz Amy J. , Torres-Gil Jorge E. , Gonzales Lenin , Ramírez Kielvis
Published: June 2018

One-fourth of the adult population of Colombia is estimated to have hypertension. However, there has been relatively little attention to participatory approaches that address the social determinants of hypertension at the local level in Colombia. Early stages of a coalition for addressing hypertension in Quibdó (Colombia) included a stakeholder analysis and engagement of local organizations. This was followed by defining mutual goals, agreement of rules for decision making, and refining a shared vision. Based on a unified understanding of factors influencing hypertension risk, 12 organizations joined the local coalition. They developed an action plan for preventing hypertension and eliminating social disparities in its distribution. Lessons learned during this process suggest that, in marginalized urban areas of middle- and low-income countries, particular attention should be paid, at early implementation stages of coalition, to context specific challenges and opportunities, coalition membership and structure, reframing health, and strengthening capacity.
A typology of mobile messaging’s disconnective affordances
Authors: Mannell Kate
Published: June 2018

Mobile messaging is typically understood as a medium that connects people. This article argues that to better understand mobile messaging we must also attend to its disconnective affordances—the opportunities for disconnection facilitated by the material properties of messaging platforms and mobile devices. Drawing on interview research into the mobile messaging practices of 24 young people, this article proposes a typology of five disconnective affordances that participants used to manage and limit their connections to friends and family, and to mobile devices and platforms. In highlighting these affordances, this article enables a better understanding of how people manage and limit availability to and through mobile messaging, actions that are increasingly necessary as mobile communication becomes ever more deeply embedded in daily life. In doing so, this article also demonstrates the value of key developments in the theorisation of affordances by applying newly developed terms and concepts to an empirical example.
Giving depth to the surface: An exercise in the Gaia-graphy of critical zones
Authors: Arènes Alexandra , Latour Bruno , Gaillardet Jérôme
Published: June 2018

Foregrounding the importance of soil and more generally the surface of the Earth – what is now often called the critical zone (CZ) – remains very difficult as long as the usual planetary view, familiar since the scientific revolution, is maintained. In this joint effort coauthored by a landscape architect, a historian of science and a geochemist, we propose what is called in history of drawing an anamorphosis, that is, a distorsion of image made through an instrument or a change in perspective. Such anamorphosis allows us to shift from a planetary vision of sites located in the geographic grid, to a representation of events located in what we call a Gaia-graphic view. We claim that such a view is much better suited to situate the new actors of the Anthropocene because it brings pride of place to the CZ.
Stearoyl coenzyme A desaturase
Authors: Abraham Marin , Sowmya SV , Rao Roopa S , Haragannavar Vanishri C , Patil Shankargouda , Augustine Dominic , Nambiar Shwetha
Published: June 2018

Background:

Oral cancer is a major public health problem in many parts of South Asia and ranking third among the cancer types in India. Numerous diagnostic, prognostic and metastatic biomarkers have been employed till date to assess various carcinomas. Stearoyl coenzyme A desaturase (SCD) is one such recently introduced biomarker that regulates key cell cycle events in normal cells and during carcinogenesis in neoplastic cells. Although SCD has been used to analyze the prognosis of breast and renal cell carcinomas, its role in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) remains unexplored. Therefore, there is a need to analyze the role of SCD in OED and OSCC to predict their biologic behaviour.

Objectives:

To assess the expression levels of SCD in OED and OSCC samples and correlate them with normal oral mucosa (NOM) to determine their prognostic potential.

Methodology:

Fifty five tissue samples of OED (20), OSCC (20) and NOM (15) was subjected to immunohistochemistry using SCD. Clinical details and follow-up data (3 years) were recorded. Clinical and histopathological parameters were statistically analyzed using descriptive statistics, univariate and multivariate analyses, Kruskal–Wallis analysis of variance test and Mann–Whitney U tests.

Results:

Descriptive analysis on OED and NOM showed a statistically significant difference in age between OED and NOM ( p = 0.002). Univariate analysis of OSCC cases by log-rank test revealed significant results in the usage of smoked and smokeless tobacco and clinical staging of OSCC ( p = 0.044). Significantly increased SCD expression was identified with poor survival rate ( p = 0.028). However, multivariate analysis of OSCC was statistically insignificant ( p = 1.00). A significantly increased SCD expression was observed in OED and OSCC when compared to NOM ( p = 0.001). The expression of SCD was significantly high in OSCC when compared to OED ( p = 0.029). Although an increased expression of SCD was appreciated in higher grades of OED and poorly differentiated squamous cell carcinoma, a statistical significance was not achieved ( p = 0.546 and 0.388, respectively).

Conclusion:

The expression of SCD in OED was higher than NOM suggesting changes in cell cycle control in OED. An enhanced expression of SCD was identified in OSCC when compared to OED. Correlating the SCD expression with survival rate in OSCC patients revealed an increased SCD expression with diminished survival rate, indicating that SCD may be used to predict prognosis. However, the role of SCD in assessing the prognostic potential within the grades of OED and OSCC requires future research.
A needle in a haystack: Endoscopic removal of a foreign body from the infratemporal fossa
Authors: Ioanidis Khrystyna , Rotenberg Brian
Published: June 2018

Background

This report presented the case of a difficult-to-remove needle foreign body. The patient had a dental procedure in which a 30-gauge needle was lost in the gingival buccal sulcus. Several attempts at removal were unsuccessful. The patient presented to the otolaryngology clinic with trismus, pain with mastication, intermittent right otalgia, and numbness of the right cheek.

Methods

The needle was finally localized in the infratemporal fossa and removed by using image guidance technology.

Results

This case demonstrated an approach to a difficult-to-locate foreign body removal and the importance of intraoperative imaging in foreign body localization.

Conclusion

Foreign bodies of the infratemporal fossa and posterior orbit are better removed via endoscopic than open technique.
Comparison of Tissue Loading Before and After the Creation of a Continuous Density Gradient in Porcine Islet Purification
Authors: Miyagi-Shiohira Chika , Nakashima Yoshiki , Ebi Nana , Hamada Eri , Tamaki Yoshihito , Kuwae Kazuho , Kobayashi Naoya , Saitoh Issei , Watanabe Masami , Kinjo Takao , Noguchi Hirofumi
Published: June 2018

The purification step is one of the most important and difficult procedures in islet isolation for pancreatic islet transplantation. We previously reported that a purification method using large plastic bottles effectively achieved a high yield of islets from the porcine pancreas. In this study, we evaluated the impact of the timing of tissue loading on porcine islet purification using large plastic bottles. One method involved loading digested tissue after creating a continuous density gradient (tissue after gradient [TAG]). The other method involved loading digested tissue before creating a continuous density gradient (tissue before gradient [TBG]). There were no significant differences between TAG and TBG in terms of the islet yield, rates of viability and purity, score, and in the stimulation index after purification. Furthermore, there were no marked differences in the attainability or suitability of post-transplantation normoglycemia. Our study shows the equivalency of these two methods of islet purification.
Comparison of isometric triceps brachii force measurement in different elbow positions
Authors: Prkić Ante , Viveen Jetske , The Bertram , van Bergen Christiaan JA , Koenraadt Koen LM , Eygendaal Denise
Published: June 2018

Purpose:

Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach–based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm.

Methods:

Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test–retest reliability using intraclass correlation.

Results:

We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2–6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted.

Conclusion:

The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed.
Distributed Cognition for Improving Cancer Care Coordination
Authors: Hazlehurst Brian , Randhawa Gurvaneet , Gorman Paul N. , Xiao Yan
Published: June 2018

Our health care system uses sophisticated cancer therapies, treatment technologies and facilities, and has dedicated and talented cancer specialists. Effective use of these innovations requires coordination of many diffuse components. For example, transitions between steps of care involve multiple actors and institutions, with distinct sets of information, procedures, policies, practices and knowledge. As Taplin and Rodgers note (2010:108), “[i]t takes the entire care process to achieve optimal cancer care. Screening is of no value without a diagnosis, and diagnosis does not improve outcome without access to comprehensive and effective treatment. This seems obvious but the care process is not studied that way.” In cancer care, coordinating across the many providers and with the patient and family members, is challenging. A human factors and systems-based approach to improving that coordination has potential to improve patient outcomes.
Making Human Factors Affordable for Medical Device and Global Health Startups
Authors: Johansen Elizabeth
Published: June 2018

Including human factors during medical device development leads to better outcomes as recognized by the U.S. Food and Drug Administration (FDA) and the International Electrotechnical Commission (IEC). Startup companies have historically been a major source of medical device innovation. However, many startups are unaware of the field of human factors or do not know the value it can bring in creating safe and effective medical devices that are well-adopted in the market. In this paper, there are four ideas for including human factors during medical device development at startups: demonstrating the value of human factors to startups; collaborating on early funding proposals; delivering value on multiple levels simultaneously; and using resources creatively and judicially. These ideas are illustrated in 3 case studies.
Planning Human Factors Engineering for Development of Implantable Medical Devices
Authors: Jensen Maria Lund , Coates Jayme
Published: June 2018

Development of implantable medical devices is becoming increasingly interesting for manufacturers, but identifying the right Human Factors Engineering (HFE) approach to ensure safe use and effectiveness is challenging. Most active implantable devices are highly complex; they are built on extremely advanced, compact technology, often comprise systems of several device elements and accessories, and they span various types of user interfaces which must facilitate diverse interaction performed by several different user groups throughout the lifetime of the device. Furthermore, since treatment with implantable devices is often vital and by definition involves surgical procedures, potential risks related to use error can be severe.

A systematic mapping of Product System Elements and Life Cycle Stages can help early identification of Use Cases, and for example user groups and high-level use risks, to be accounted for via HFE throughout development to optimize Human Factors processes and patient outcomes. This paper presents a concrete matrix tool which can facilitate an early systematic approach to planning and frontloading of Human Factors Engineering activities in complex medical device development.
Clinical Actual Use Human Factors Testing
Authors: Clark Shannon , Forkey P.E., Denise
Published: June 2018

Due to perceived cost and time savings, medical device and combination product manufacturers frequently consider the option to combine human factors testing with clinical studies. There are some scenarios in which human factors and clinical testing of medical products can be combined to save time and resources. While guidance documents published by the Food and Drug Administration (FDA) emphasize that most human factors validation testing can fully evaluate use-related safety via simulated use usability testing, there are some cases in which clinical actual use usability testing is needed to fully evaluate use-related safety. This paper suggests synergies between clinical testing and human factors testing, presents challenges faced by human factors practitioners when the two types of testing are combined, and offers best practice recommendations to maximize the chance of successfully evaluating the human factors endpoints.
How Nurses Identify Hospitalized Patients on Their Personal Notes: Findings From Analyzing ‘Brains’ Headers with Multiple Raters
Authors: Sarkhel Ritesh , Socha Jacob J. , Mount-Campbell Austin , Moffatt-Bruce Susan , Fernandez Simon , Patel Kashvi , Nandi Arnab , Patterson Emily S.
Published: June 2018

The overarching objective of this research is to reduce the burden of documentation in electronic health records by registered nurses in hospitals. Registered nurses have consistently reported that e-documentation is a concern with the introduction of electronic health records. As a result, many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, we can begin to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding is that nurses use room number as the primary patient identifier in the hospital setting, not the patient’s last name. In addition, the last name, gender, and age are sufficiently important identifiers that they are frequently recorded at the top of handwritten notes. Clearly distinguishable field labels and values are helpful in quickly scanning the identifier for identifying information. A web based annotator was designed as a first step towards machine learning approaches to recognize handwritten or printed data on paper sheets in future research.
It’s Like Scanning the Spoon: Problems and Interventions in Insulin Pen Safety
Authors: Regli Susan Harkness , Ho Suzanna , Yoho Margaret , Lorincz Ilona , Stamm Rebecca , Hibbs Melissa , Kornet Terese
Published: June 2018

This paper describes a multifaceted patient safety project undertaken to address the complex medication safety issues of single-patient insulin pens in the hospital setting. The project makes the following contributions: a) provides observation- and data-based insight into root causes for the wrong pen/wrong patient problem; b) provides multiple solutions that can work together to significantly reduce the incidence of insulin pen-related safety events; c) shows how Quality and Safety methodologies can work hand-in-hand with human factors and human computer interaction methodologies to produce richer, more in depth results, and d) confirm expert recommendations for best practices that can reduce risks.
Selecting, evaluating, and translating psychophysiological measures into clinical settings: From lab to practice
Authors: Kennedy Lauren , Lau Nathan , Pappada Scott , Parker Sarah Henrickson
Published: June 2018

Physiological data collection methods are unobtrusive, passive, continuous, and objective. The information afforded by sensors collecting physiological data can be transformed to represent operator performance estimates and stress state visualizations in real time. This technology is conducive to healthcare settings, creating the potential to inform healthcare operators of their current performance and physiological statuses. Despite the broad and pervasive utility of sensor technology, its applications in healthcare are underutilized and misunderstood. This is likely due to the combination of a lack of understanding of the full capabilities of sensor technology, a scarcity of demonstrated uses in healthcare, and an uncertainty surrounding translation and implementation into practice. Implementing findings from providers’ physiological data can be met with challenges, especially in the healthcare setting. Clinicians are most frequently concerned with patient care, and may not always recognize the importance of their own physiological state. While transitioning sensor technology from personal monitoring purposes to a data collection tool can be challenging, passive data collection via sensor technology may have significant value for learners and experienced practitioners. The goals of this paper are to: 1. raise awareness of sensor technology and its utility in clinical settings; 2. provide empirical examples of how to use sensor technology to answer basic and applied questions pertaining to clinical workflow; and 3. exemplify scalability and translatability of findings from sensor technology studies in clinical settings.
Mobile Technology to Assess Balance During Sit to Stand Manuever Among Older Adults at Risk for Falling
Authors: Gray-Miceli Deanna , Craelius William , Li Kang
Published: June 2018

Older adults over age 65 are susceptible to loss of balance for a variety of reasons including drops in blood pressure with standing (orthostatic hypotension [OH]; Gray-Miceli, Ratcliffe, Thomasson, Quigley, Li & Craelius, 2016). OH is a treatable condition, and cause of falls if detected. Nearly 50% of the 1.43 million older adults in long-term care experience falls (National Center for Injury Prevention and Control, 2017). Falls often occur among older adults in long term care during periods of transitioning, where older adults are susceptible to loss of balance and increased risk to fall. As found in our prior work, older adults with OH may not always experience classic dizziness symptoms that may accompany OH (Gray-Miceli, Ratcliffe, Liu, Wantland & Johnson, 2012; Gray). To better understand this phenomenon, our project adapted a cellphone as an inertial measurement unit attached to the person’s center of mass to determine body sway. The objective of this pilot study was to determine if a relationship was observable during the sit to stand maneuver (StS) while older adults wore a Smartphone measuring three dimensions of motion among older adults who had evidenced of symptoms or OH. A sample of four older adults from a rehabilitation facility who were 65 years of age, receiving physical therapy at the time of testing, were cognitively intact, able to perform the StS maneuver and had no active cancer, fractures or serious injuries were recruited and enrolled. Oh determinations, pulse rate and symptoms of dizziness were elicited during a 30 second StS maneuver. In Patient A and Patient B we present the Z-axis and X-axis of front acceleration and patterns of motion side by side for case comparison while highlighting clinical findings. In Patient B, a greater degree of sway at the start of the StS maneuver is noted. Patient B’s blood pressure also dropped 33 mmHg and there were symptoms of dizziness. Drops in mean arterial blood pressure were greater among those with symptomatic OH. Limitations of this pilot include noise, selection of filters and time stamping of the data. Project aims are to help clinicians prevent falls by further assessing symptoms among elders who suffer from LOB and OH.
Development of Virtual Simulations for Medical Team Training: An Evaluation of Key Features
Authors: Howe Jessica , Puthumana Joseph , Hoffman Daniel , Kowalski Rebecca , Weldon Danielle , Miller Kristen , Weyhrauch Peter , Niehaus James , Bauchwitz Benjamin , McDermott Ashley , Ratwani Raj
Published: June 2018

Medical team training (MTT) conducted in a virtual environment fosters growth in cognitive, technical, and clinical aptitudes while offering advantages of flexibility, cost, and ease of scheduling over traditional high- fidelity simulations. Growing technology facilitates innovations to improve the ability to emulate roles, rules, resources, and fidelity. Our objective was to evaluate elements of key features that inform technical specifications for virtual simulations. A narrative review included 27 articles as relevant to elaborate on five key features identified as critical to development of virtual environments for MTT: automated assessment, task fidelity, interface modality, virtual teammates, and adaptability. Designers continue to improve the technology of virtual reality to create better and more enhanced training modules. We must better understand how variances in simulation features impacts performance outcomes and learned behavior. Future research can more deeply examine features beyond the five reviewed here to guide development of effective, cost-efficient virtual simulations for MTT.