bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphocyte Oxidative Stress/Genotoxic Effects Are Related to Serum IgG and IgA Levels in Coke Oven Workers
Authors: Gao Meili , Li Yongfei , Zheng Aqun , Xue Xiaochang , Chen Lan , Kong Yu
Published: July 2014

We investigated oxidative stress/genotoxic effects levels, immunoglobulin levels, polycyclic aromatic hydrocarbons (PAHs) levels exposed in 126 coke oven workers and in 78 control subjects, and evaluated the association between oxidative stress/genotoxic effects levels and immunoglobulin levels. Significant differences were observed in biomarkers, including 1-hydroxypyrene levels, employment time, percentages of alcohol drinkers, MDA, 8-OHdG levels, CTL levels and CTM, MN, CA frequency, and IgG, IgA levels between the control and exposed groups. Slightly higher 1-OHP levels in smoking users were observed. For the dose-response relationship of IgG, IgA, IgM, and IgE by 1-OHP, each one percentage increase in urinary 1-OHP generates a 0.109%, 0.472%, 0.051%, and 0.067% decrease in control group and generates a 0.312%, 0.538%, 0.062%, and 0.071% decrease in exposed group, respectively. Except for age, alcohol and smoking status, IgM, and IgE, a significant correlation in urinary 1-OHP and other biomarkers in the total population was observed. Additionally, a significant negative correlation in genotoxic/oxidative damage biomarkers of MDA, 8-OH-dG, CTL levels, and immunoglobins of IgG and IgA levels, especially in coke oven workers, was found. These data suggest that oxidative stress/DNA damage induced by PAHs may play a role in toxic responses for PAHs in immunological functions.
Asynchronous Advanced Encryption Standard Hardware with Random Noise Injection for Improved Side-Channel Attack Resistance
Authors: Kotipalli Siva , Kim Yong-Bin , Choi Minsu
Published: July 2014

This work presents the design, hardware implementation, and performance analysis of novel asynchronous AES (advanced encryption standard) Key Expander and Round Function, which offer increased side-channel attack (SCA) resistance. These designs are based on a delay-insensitive (DI) logic paradigm known as null convention logic (NCL), which supports useful properties for resisting SCAs including dual-rail encoding, clock-free operation, and monotonic transitions. Potential benefits include reduced and more uniform switching activities and reduced signal-to-noise (SNR) ratio. A novel method to further augment NCL AES hardware with random voltage scaling technique is also presented for additional security. Thereby, the proposed components leak significantly less side-channel information than conventional clocked approaches. To quantitatively verify such improvements, functional verification and WASSO (weighted average simultaneous switching output) analysis have been carried out on both conventional synchronous approach and the proposed NCL based approach using Mentor Graphics ModelSim and Xilinx simulation tools. Hardware implementation has been carried out on both designs exploiting a specified side-channel attack standard evaluation FPGA board, called SASEBO-GII, and the corresponding power waveforms for both designs have been collected. Along with the results of software simulations, we have analyzed the collected waveforms to validate the claims related to benefits of the proposed cryptohardware design approach.
Drug Delivery Systems, CNS Protection, and the Blood Brain Barrier
Authors: Upadhyay Ravi Kant
Published: July 2014

Present review highlights various drug delivery systems used for delivery of pharmaceutical agents mainly antibiotics, antineoplastic agents, neuropeptides, and other therapeutic substances through the endothelial capillaries (BBB) for CNS therapeutics. In addition, the use of ultrasound in delivery of therapeutic agents/biomolecules such as proline rich peptides, prodrugs, radiopharmaceuticals, proteins, immunoglobulins, and chimeric peptides to the target sites in deep tissue locations inside tumor sites of brain has been explained. In addition, therapeutic applications of various types of nanoparticles such as chitosan based nanomers, dendrimers, carbon nanotubes, niosomes, beta cyclodextrin carriers, cholesterol mediated cationic solid lipid nanoparticles, colloidal drug carriers, liposomes, and micelles have been discussed with their recent advancements. Emphasis has been given on the need of physiological and therapeutic optimization of existing drug delivery methods and their carriers to deliver therapeutic amount of drug into the brain for treatment of various neurological diseases and disorders. Further, strong recommendations are being made to develop nanosized drug carriers/vehicles and noninvasive therapeutic alternatives of conventional methods for better therapeutics of CNS related diseases. Hence, there is an urgent need to design nontoxic biocompatible drugs and develop noninvasive delivery methods to check posttreatment clinical fatalities in neuropatients which occur due to existing highly toxic invasive drugs and treatment methods.
The Effects of Vitamin E and Omega-3 PUFAs on Endothelial Function among Adolescents with Metabolic Syndrome
Authors: Ahmadi Alireza , Gharipour Mojgan , Arabzadeh Gholamreza , Moin Payam , Hashemipour Mahin , Kelishadi Roya
Published: July 2014

Aim. The present study aims to explore the effects of vitamin E and omega-3 on endothelial function indicators among adolescents with metabolic syndrome.Method. In a randomized, double blind, and placebo-controlled trial, 90 young individuals, aged 10 to 18 years, with metabolic syndrome were randomly assigned to receive either vitamin E tablets (400 IU/day) or omega-3 tablets (2.4 gr/day) or placebo. For assessing endothelial functional state, the serum level of vascular endothelial growth factor (VEGF) was measured by ELISA test.Results. The use of omega-3 supplementation for eight weeks led to significant increase in serum HDL level compared with the group treated with vitamin E or placebo group. In this regard, no significant correlations were found between the change in VEGF and baseline levels of other markers including anthropometric indices and serum lipids. Omega-3 could significantly reduce VEGF with the presence of other baseline variables (Beta=-12.55;P=0.012).Conclusion. The administration of omega-3 can effectively improve endothelial function in adolescents with metabolic syndrome by reducing the level of serum VEGF, as a major index for atherosclerosis progression and endothelial destabilization. Omega-3 can be proposed as a VEGF antagonist for improving endothelial function in metabolic syndrome. The clinical implications of our findings should be assessed in future studies.
Murine Aortic Smooth Muscle Cells Acquire, Though Fail to Present Exogenous Protein Antigens on Major Histocompatibility Complex Class II Molecules
Authors: Maddaluno Marcella , MacRitchie Neil , Grassia Gianluca , Ialenti Armando , Butcher John P. , Garside Paul , Brewer James M. , Maffia Pasquale
Published: July 2014

In the present study aortic murine smooth muscle cell (SMC) antigen presentation capacity was evaluated using the Eα-GFP/Y-Ae system to visualize antigen uptake through a GFP tag and tracking of Eαpeptide/MHCII presentation using the Y-Ae Ab. Stimulation with IFN-γ(100 ng/mL) for 72 h caused a significant(P<0.01)increase in the percentage of MHC class II positive SMCs, compared with unstimulated cells. Treatment with Eα-GFP (100 μg/mL) for 48 h induced a significant(P<0.05)increase in the percentage of GFP positive SMCs while it did not affect the percentage of Y-Ae positive cells, being indicative of antigen uptake without its presentation in the context of MHC class II. After IFN-γ-stimulation, ovalbumin- (OVA, 1 mg/mL) or OVA323–339peptide-(0.5 μg/mL) treated SMCs failed to induce OT-II CD4+T cell activation/proliferation; this was also accompanied by a lack of expression of key costimulatory molecules (OX40L, CD40, CD70, and CD86) on SMCs. Finally, OVA-treated SMCs failed to induce DO11.10-GFP hybridoma activation, a process independent of costimulation. Our results demonstrate that while murine primary aortic SMCs express MHC class II and can acquire exogenous antigens, they fail to activate T cells through a failure in antigen presentation and a lack of costimulatory molecule expression.
Preserved Function of Late-Outgrowth Endothelial Cells in Medically Treated Hypertensive Patients Under Well-Controlled Conditions
Authors: Chen Zhi , Herrmann Sandra M.S. , Zhu Xiangyang , Jordan Kyra L. , Gloviczki Monika L. , Lerman Amir , Textor Stephen C. , Lerman Lilach O.
Published: July 2014

Endothelial progenitor cells (EPCs) participate in renal repair, but their number and function may be impaired by exposure to cardiovascular risk factors. The number of circulating EPCs is decreased in essential and renovascular hypertensive patients, but the effects of hypertension on EPC function are incompletely understood. We hypothesized that EPC function was preserved under well-controlled conditions in treated hypertensive patients. Patients with atherosclerotic renal artery stenosis (ARAS; n=22) or essential hypertension (n=24) were studied during controlled sodium intake and antihypertensive regimen. Late-outgrowth EPCs were isolated from the inferior vena cava (IVC) and renal vein blood of ARAS and essential hypertension patients and a peripheral vein of matched normotensive controls (n=18). The angiogenic function of EPCs was assessed in vitro, and multidetector computed tomography was used to measure single-kidney hemodynamics and function in ARAS and essential hypertension patients. Inflammatory biomarkers and EPC homing signal levels and renal release were calculated. Inferior vena cava and renal vein–obtained EPC function were similar in ARAS and essential hypertension patients and comparable to that in normal controls (tube length, 171.86±16.846, 191.09±14.222, 174.925±19.774 μm, respectively). Function of renal vein–obtained EPCs directly correlated with stenotic kidney glomerular filtration rate, EPC homing factors, and anti-inflammatory mediator levels in ARAS patients. Therefore, EPC function was relatively preserved in ARAS patients, although it directly correlated with renal function. Adequate EPC function supports the feasibility of using autologous EPCs as a therapeutic option in essential and renovascular hypertensive patients. Homing signals and inflammatory mediators may potentially regulate EPC angiogenic function.
Time, History, and Philosophy of History
Authors: Mudrovcic María Inés
Published: July 2014

In this paper, I intend to show that different ways of describing, representing or thinking about human affairs presuppose different types of consciousness of temporality. This proposal is embedded in the fruitful concept ‘régimes d’historicités’, which was coined by F. Hartog. Within this context and in regard to historiography and the philosophy of history, I will try to show that these disciplines and concepts, coined by these fields of study, are only possible in a temporal order governed by the future. Within this context, I will examine historiography, understood as the discipline which makes sense of human past and other disciplines, including the analytical or narrativist philosophies of history, which have yielded concepts such as the ‘historical past’, ‘historical consciousnesses’ and ‘historical time’.
Taxonomic corrections to species of Rhyparochromidae (Hemiptera: Heteroptera) described by Carl Peter Thunberg
Authors: KONDOROSY ELŐD , RÉDEI DÁVID , MEJLON HANS
Published: July 2014

Types of Rhyparochromidae (Hemiptera: Heteroptera: Lygaeoidea) species described by Carl Peter Thunberg, deposited in the Museum of Evolution (formerly Zoologiska Institut), Uppsala University, Uppsala, Sweden, were reexamined and the taxonomic and nomenclatural problems that existed among those species discussed and resolved as required. Lectotypes are designated for Cimex caffer Thunberg, 1784, Lygaeus ater Thunberg, 1822, Lygaeus biguttatus Thunberg, 1822, and Pendulinus guttatus Thunberg, 1825. The lectotype of Pendulinus (now Metochus) guttatus is designated as neotype of Pendulinus (now Metochus) uniguttatus Thunberg, 1822; as a result the former name becomes junior objective synonym of the latter. The following taxonomic changes are proposed: Lethaeus ater (Thunberg, 1822), new combination (from Lygaeus); Migdilybs biguttatus (Thunberg, 1822), new combination (from Lygaeus) = Migdilybs furcifer Hesse, 1925, new subjective synonym; Metochus uniguttatus (Thunberg, 1822) = Metochus bengalensis (Dallas, 1852), confirmed subjective synonym = Metochus yeh (Dohrn, 1860), confirmed subjective synonym; Raglius alboacuminatus (Goeze, 1778) = Cimex caffer Thunberg, 1874, confirmed subjective synonym. Lethaeus barberi Slater, 1964 does not belong to Lethaeus Dallas, 1852 but currently it cannot be placed with confidence in any existing genus.
Multi-Index Rain Detection: A New Approach for Regional Rain Area Detection from Remotely Sensed Data
Authors: Upadhyaya Shruti , Ramsankaran R.
Published: July 2014

In this article, a new approach called Multi-Index Rain Detection (MIRD) is suggested for regional rain area detection and was tested for India using Kalpana-1 satellite data. The approach was developed based on the following hypothesis: better results should be obtained for combined indices than an individual index. Different combinations (scenarios) were developed by combining six commonly used rain detection indices using AND and OR logical connectives. For the study region, an optimal rain area detection scenario and optimal threshold values of the indices were found through a statistical multi-decision-making technique called the Technique for Order Preference by Similarity Ideal Solution (TOPSIS). The TOPSIS analysis was carried out based on independent categorical statistics like probability of detection, probability of no detection, and Heidke skill score. It is noteworthy that for the first time in literature, an attempt has been made (through sensitivity analysis) to understand the influence of the proportion of rain/no-rain pixels in the calibration/validation dataset on a few commonly used statistics. Thus, the obtained results have been used to identify the above-mentioned independent categorical statistics. Based on the results obtained and the validation carried out with different independent datasets, scenario 8 (TIRt < 260 K and TIRt − WVt < 19 K, where TIRt and WVt are the brightness temperatures from thermal IR and water vapor, respectively) is found to be an optimal rain detection index. The obtained results also indicate that the texture-based indices [standard deviation and mean of 5 × 5 pixels at time t (mean5)] did not perform well, perhaps because of the coarse resolution of Kalpana-1 data. It is also to be noted that scenario 8 performs much better than the Roca method used in the Indian National Satellite (INSAT) Multispectral Rainfall Algorithm (IMSRA) developed for India.
Negotiating difference: The trope of anak derhaka and ideological endings in Bruneian writings
Authors: Chin Grace Voon Sheong , Haji Mohd Daud Kathrina
Published: July 2014

In a quantitative analysis of themes explored in the creative writing classes at Universiti Brunei Darussalam, it was found that over 60 per cent of all writings dealt with the parent–child relationship, with many dealing specifically with the trope of the anak derhaka, or unfilial child. A closer look at the anak derhaka texts showed that their endings almost invariably showcased a formulaic trajectory that punished the unfilial child and restored family order. This article examines the significance of this recurring trope and its inevitable ending in the context of Brunei Darussalam’s tripartite state ideology and discourse, Malay Islamic Monarchy, consisting of race, religion and political identity. By preserving the continuity of traditional Malay–Muslim worldview, this recurring trope underscores an innate desire, or anxiety, to maintain local identity and cultural values amid the chaos of external, global pressures and events. At the same time, the texts reveal a fascination with difference, or Otherness. This paper will consider how these instances of difference are negotiated, for they reveal moments of tension and ambivalence which appear to undermine the state discourse even as the texts move toward the “correct”, closed endings.
Different Patterns of Drug Use and Barriers to Continuous HIV Care Post-Incarceration
Authors: Swan Holly
Published: July 2014

Individuals with a drug use history often experience drug use relapse when they are released from incarceration. This article explores the processes by which a sample of adults experienced relapse post-incarceration and consequently experienced HIV treatment interruption. Data are from in-depth interviews with 25 formerly incarcerated HIV-positive adults who have a self-reported history of drug use. Findings reveal that each participant relapsed post-incarceration. Some participants relapsed immediately after release; others remained drug free until something “triggered” a relapse. Once a participant relapsed, factors that contributed to HIV treatment interruption included re-incarceration, a lack of concern for HIV care, and the overlap of symptoms between addiction and HIV infection. The relationship between drug use and HIV treatment interruption was exacerbated when the participant reported also having a mental health disorder. Cessation of drug use facilitated HIV treatment engagement for participants. The implications of these findings for policy and practice are discussed.
A Markan “Context” Kingdom? Examining Biblical and Social Models in Spatial Interpretation
Authors: Wenell Karen
Published: July 2014

This article argues for the Kingdom of God as a central spatial concept to Mark's Gospel, but one that ought to be understood “without context.” For this, Bruno Latour's critique of “context” and “the social” is employed in order to challenge the usefulness of both biblical models of space and social scientific models for interpretation, and to investigate what is new in the Kingdom's construction as a space. The article engages with Esler and Horrell's 2000 debate in JSNT over social scientific methodologies, with the ultimate goal of moving from an understanding of what is social about the Kingdom as explanans—an explaining element—to explanandum—what needs to be explained.
Terrorizing Violence and the Iraq War
Authors: Bonds Eric
Published: July 2014

The extent to which global humanitarian norms can matter in terms of nation-state behavior is a much-debated topic among those who study the international order. This article argues that even long-standing and deeply held norms outlawing the targeting of civilians in war have not stopped the United States from regularly using such violence. In particular, this article examines two instances of what is described as terrorizing violence—targeting civilians in order to create fear or cause intimidation—in the Long Iraq War: the sanctions regime from 1990 to 2002 and the U.S. counterinsurgency strategy used after the 2003 invasion. These cases demonstrate the need for a theoretical perspective that places humanitarian norms within a larger cost–benefit analysis war makers use when considering the deployment of violence. U.S. officials make decisions about war and peace in an economy of political risk. They may choose to undertake policies that violate humanitarian norms when they believe that there could be gains, provided that the potential losses can be kept low if such violence is carried out indirectly or through other less discernible means. Social scientists have important work to do in terms of calling attention to terrorizing violence and bringing it into the light.
What Are They Thinking? The Moral Judgment of Children With Emotional and Behavioral Disorders
Authors: Hardman Elizabeth L.
Published: July 2014

This study was conducted to describe the moral judgment of 12 third- through fifth-grade children with and without emotional and behavioral disorders (EBD) and to explore how feelings affected their thought processes. Data were gathered via three individually conducted moral dilemma interviews with each child participant. These procedures produced 2,107 moral judgments that were coded and submitted to an analysis using case study research methodology. The results showed that 10 of the children voiced an egocentric moral orientation and that only 2 voiced a developmentally typical cooperative moral orientation. The children also described how caring, just relationships engendered feelings of happiness and love and inspired a sense of moral autonomy while harsh, unjust relationships fueled feelings of anger, sadness, and fear and led to prescriptions of disobedience and retaliation. The implications of the results are discussed with respect to the importance of children’s experiences in inclusive classroom communities.
Looking Beyond the Illness
Authors: Barnao Mary , Ward Tony , Casey Sharon
Published: July 2014

The aim of this qualitative study was to explore perspectives on rehabilitation of those detained in a New Zealand forensic hospital setting. Twenty forensic service users participated in individual interviews, which were audio-taped, transcribed verbatim, and subjected to thematic analysis. The analysis identified seven themes that were broadly categorized into those that concerned the rehabilitation context (external) and those that more directly reflected the forensic service user’s personal experience (internal). External themes highlighted a person-centered approach, the nature of relationships with staff, consistency of care, and awareness of the rehabilitation pathway. Internal themes related to forensic service users’ self-evaluations, agency, and coping strategies. These findings are discussed within the broader context in which rehabilitation took place.
Response to Ruth Armstrong
Authors: Winter Tim
Published: July 2014

The growth in Muslim chaplaincy provision in UK prisons disguises a paucity of resources, particularly in the area of offender rehabilitation. Islam’s distinctive approach to antisocial behaviour, repentance and forgiveness needs to be better known among social administrators, particularly in the probation service.
A better confidence interval for the sensitivity at a fixed level of specificity for diagnostic tests with continuous endpoints
Authors: Shan Guogen
Published: July 2014

For a diagnostic test with continuous measurement, it is often important to construct confidence intervals for the sensitivity at a fixed level of specificity. Bootstrap-based confidence intervals were shown to have good performance as compared to others, and the one by Zhou and Qin (2005) was recommended as the best existing confidence interval, named the BTII interval. We propose two new confidence intervals based on the profile variance method and conduct extensive simulation studies to compare the proposed intervals and the BTII intervals under a wide range of conditions. An example from a medical study on severe head trauma is used to illustrate application of the new intervals. The new proposed intervals generally have better performance than the BTII interval.
Trends in the Turn to Affect
Authors: Wetherell Margaret
Published: July 2014

This article explores the psychological logics underpinning key perspectives in the ‘turn to affect’. Research on affect raises questions about the categorization of affective states, affective meaning-making, and the processes involved in the transmission of affect. I argue that current approaches risk depopulating affecting scenes, mystifying affective contagion, and authorizing questionable psychobiological arguments. I engage with the work of Sedgwick and Frank, Thrift, and Ahmed to explore these points and suggest that the concept of affective practice offers a more promising social psychological grounding. Notions of affective practice are more commensurate with trends in contemporary psychobiology, explain the limits on affective contagion, and emphasize relationality and negotiation, attentive to the flow of affecting episodes. A practice approach positions affect as a dynamic process, emergent from a polyphony of intersections and feedbacks, working across body states, registrations and categorizations, entangled with cultural meaning-making, and integrated with material and natural processes, social situations and social relationships.
Networked privacy: How teenagers negotiate context in social media
Authors: Marwick Alice E , boyd danah
Published: July 2014

While much attention is given to young people’s online privacy practices on sites like Facebook, current theories of privacy fail to account for the ways in which social media alter practices of information-sharing and visibility. Traditional models of privacy are individualistic, but the realities of privacy reflect the location of individuals in contexts and networks. The affordances of social technologies, which enable people to share information about others, further preclude individual control over privacy. Despite this, social media technologies primarily follow technical models of privacy that presume individual information control. We argue that the dynamics of sites like Facebook have forced teens to alter their conceptions of privacy to account for the networked nature of social media. Drawing on their practices and experiences, we offer a model of networked privacy to explain how privacy is achieved in networked publics.
Facebook’s mobile career
Authors: Goggin Gerard
Published: July 2014

At the end of its first decade, Facebook’s identity, popularity and characteristics are shaped in important ways by its becoming a form of mobile media. This article seeks to explore and understand Facebook as the important force in mobile media and communication it now is. It draws upon and combines perspectives from technology production, design and economy, as well as user adoption, consumption, practices, affect, emotion and resistance. This article discusses the beginnings of mobile Facebook and the early adoption of mobile Facebook associated with the rise of smartphones. The second part of the article explores Facebook’s integration with photography (with Instagram) and social games (such as Zynga’s Farmville). This article argues that Facebook’s mobile career is an accomplishment that has distinctively melded evolving affordances, everyday use across a wide range of settings, as well as political economies, corporate strategy and design.
Analyzing Campaign Contributions in Context
Authors: Lowry Robert C.
Published: July 2014

Political campaign contributions are not made in a vacuum. Rather, contributions from individuals are affected by the political and legal environment experienced by potential donors. I study itemized contributions to candidates, parties, and political action committees (PACs) aggregated by congressional district for 1994-2006. The timing and competitiveness of presidential, congressional, and even state elections affect the expected benefits and opportunity costs of contributing to all types of committees, and this is reflected in the amounts contributed through different channels. Political party committees raising hard money contributions relied more on districts with high per capita income, education attainment, and urbanization after the Bipartisan Campaign Reform Act (BCRA) than before, but were still less dependent on these districts than soft money committees before the BCRA. Overall, the BCRA led to less reliance on districts with high socioeconomic status as sources of itemized contributions to committees regulated by the Federal Election Commission.
Imperatives in voice-overs in British TV commercials: ‘Get this, buy that, taste the other’
Authors: Pennock-Speck Barry , Fuster-Márquez Miguel
Published: July 2014

Television commercials are often thought of as bothersome multimedia artefacts that by their very existence spoil our viewing pleasure at regular intervals. Not only that, but they seem to have the habit of ordering us around. This aspect of TV ads has often been commented on by experts and laypersons alike. Therefore, we decided to tackle this issue and look at the prototypical expression of directives, that is, imperatives in voice-overs in television commercials. To this end we have carried out an empirical analysis of imperatives in voice-overs in the MATVA corpus (Multimodal Analysis of TV Ads) which contains transcriptions of nearly 800 voice-overs in British TV ads recorded on six days during 2009, 2010 and 2011. We provide an exhaustive quantitative and qualitative profile of imperatives in contemporary TV advertising. This includes information on the distribution of imperatives, the most common verbs in imperative clauses, and their discourse function. We are also able to show conclusively that the directive force of imperatives in TV ads is more akin to advice or recommendation than commands, and explain from a discourse-pragmatic perspective why this is so.
Evaluation and Management of Patellar Instability in Pediatric and Adolescent Athletes
Authors: Khormaee Sariah , Kramer Dennis E. , Yen Yi-Meng , Heyworth Benton E.
Published: July 2014

Context:

The rising popularity and intensity of youth sports has increased the incidence of patellar dislocation. These sports-related injuries may be associated with significant morbidity in the pediatric population. Treatment requires understanding and attention to the unique challenges in the skeletally immature patient.

Evidence Acquisition:

PubMed searches spanning 1970-2013.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Although nonoperative approaches are most often suitable for first-time patellar dislocations, surgical treatment is recommended for acute fixation of displaced osteochondral fractures sustained during primary instability and for patellar realignment in the setting of recurrent instability. While a variety of procedures can prevent recurrence, the risk of complications is not minimal.

Conclusion:

Patellar stabilization and realignment procedures in skeletally immature patients with recurrent patellar dislocation can effectively treat patellar instability without untoward effects on growth if careful surgical planning incorporates protection of growth parameters in the skeletally immature athlete.
Diagnosing Femoroacetabular Impingement From Plain Radiographs
Authors: Ayeni Olufemi R. , Chan Kevin , Whelan Daniel B. , Gandhi Rajiv , Williams Dale , Harish Srinivasan , Choudur Hema , Chiavaras Mary M. , Karlsson Jon , Bhandari Mohit
Published: July 2014

Background:

A diagnosis of femoroacetabular impingement (FAI) requires careful history and physical examination, as well as an accurate and reliable radiologic evaluation using plain radiographs as a screening modality. Radiographic markers in the diagnosis of FAI are numerous and not fully validated. In particular, reliability in their assessment across health care providers is unclear.

Purpose:

To determine inter- and intraobserver reliability between orthopaedic surgeons and musculoskeletal radiologists.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Six physicians (3 orthopaedic surgeons, 3 musculoskeletal radiologists) independently evaluated a broad spectrum of FAI pathologies across 51 hip radiographs on 2 occasions separated by at least 4 weeks. Reviewers used 8 common criteria to diagnose FAI, including (1) pistol-grip deformity, (2) size of alpha angle, (3) femoral head-neck offset, (4) posterior wall sign abnormality, (5) ischial spine sign abnormality, (6) coxa profunda abnormality, (7) crossover sign abnormality, and (8) acetabular protrusion. Agreement was calculated using the intraclass correlation coefficient (ICC).

Results:

When establishing an FAI diagnosis, there was poor interobserver reliability between the surgeons and radiologists (ICC batch 1 = 0.33; ICC batch 2 = 0.15). In contrast, there was higher interobserver reliability within each specialty, ranging from fair to good (surgeons: ICC batch 1 = 0.72; ICC batch 2 = 0.70 vs radiologists: ICC batch 1 = 0.59; ICC batch 2 = 0.74). Orthopaedic surgeons had the highest interobserver reliability when identifying pistol-grip deformities (ICC = 0.81) or abnormal alpha angles (ICC = 0.81). Similarly, radiologists had the highest agreement for detecting pistol-grip deformities (ICC = 0.75).

Conclusion:

These results suggest that surgeons and radiologists agree among themselves, but there is a need to improve the reliability of radiographic interpretations for FAI between the 2 specialties. The observed degree of low reliability may ultimately lead to missed, delayed, or inappropriate treatments for patients with symptomatic FAI.
Activity Monitoring Technologies and Older Adult Users
Authors: Preusse Kimberly C. , Mitzner Tracy L. , Fausset Cara B. , Rogers Wendy A.
Published: July 2014

Older adults may benefit from using activity monitoring technologies to support health and wellness management. However, adoption of such technologies is contingent upon ease of use considerations. Age-related changes in cognitive and physical capabilities impact usability. Heuristic evaluation of two such technologies revealed important ease of use design issues that may be particularly problematic for this user group. Case studies of four older adults’ usage experiences over a two-week period revealed additional usability challenges. Human factors involvement in product development should address these issues to enable older adults to use these potentially beneficial technologies.
The Influence of Computer Experience and Screen Size on Use Performance and Perceptions of a Tablet-Based Chronic Illness Self-Management System for Older Adults
Authors: Tao D. , Or C. K. L. , Li K.
Published: July 2014

A usability study of a tablet-based chronic illness self-management system was conducted to evaluate the system’s usability and to examine the effects of screen size and computer experience on use performance and perceptions of the system. A two-factor, between-subjects design was implemented, in which 40 older adults aged from 55 to 88 years were equally assigned to two screen size groups and required to perform a set of self-management tasks. The results showed that screen size had no effect on either the use performance or perceptions of the system, and that computer experience had significant effects on the former but no effect on the latter. Older adults without computer experience tended to perceive the large tablet screen system as more useful. This study verified the usability of the tablet-based self-management system with older adults. Its findings suggest the need to determine an optimal screen size for consumer health information technologies, and highlight the importance of computer experience in usability studies. Future studies may address its limitations.
Human Factors and Usability in Mobile Health Design – Factors for Sustained Patient Engagement in Diabetes Care
Authors: Goldwater Jason C.
Published: July 2014

The degree of health care resource consumption within the United States is significant, even with the passage of the Patient Protection and Affordable Care Act (PPACA), with annual expenditures expected to reach 14% of the US gross domestic product by 2016. This suggests the need for population-level solutions that cover the spectrum of both clinical and non-clinical care for the primary prevention of chronic disease, in particular diabetes, which affects over eight percent of the population and costs over $100 billion annually. Over the past decade, there have been an abundance of technological solutions that provide the potential of mitigating the risk issues associated with diabetes and improving self-management practices. One such technology in particular is emerging that may become very important to the delivery of health care: mobile phones. In 2012, a study undertook a comprehensive assessment of the use of mobile health (mHealth) in the management and treatment of diabetes. This study encompassed the review of over 514 articles, as well as series of key informant interviews and site visits, to determine the effectiveness and utility of mHealth in managing and treating diabetes. The research suggested that the usability of mHealth applications could be understood and assessed according to four major factors: user-friendliness, user design, user satisfaction and user confidence. The first two primarily deal with the type of technology and the design of the interface. The last two concern user perception and are crucial in appropriately evaluating how well the application meets a patient’s expectations, which is a critical component of both quality of care and patient outcomes.
Observed Usage Errors during Meaningful Use Stage 2 Safety-Enhanced Design Summative Testing
Authors: Furlough Caleb , Barnes Janey , Mauney Jennifer , Belk Alisha , Blanchard Laura , Brooks Teri , Brown Megan , Glasscock Naomi , Gross Merryl , Hunt Ellie , Mehranian Hasmik
Published: July 2014

This report presents data from summative usability tests conducted by User-View on behalf of multiple vendors as part of MU2 certification. The objective is to present findings related to performance metrics and use errors associated with each prioritized certification criteria, shine the light on EHR effectiveness, and contribute to ongoing discussions of EHR usability.
Ad hoc signage in a new hospital- a useful social tool and cognitive artifact
Authors: Nunnally Mark E. , Bitan Yuval
Published: July 2014

Introduction:

High-stakes industries, such as healthcare, are complex systems prone to influence by various constraining factors. Expert practitioners in these domains work at the “sharp end” of these constraints and must reconcile limitations in the context of operations. When a major constraining factor is changed abruptly, it can induce a rapid sequence of adaptations. We observed the cognitive artifacts of post hoc signage, posted inside the space of the operating rooms of a new hospital facility, to help identify the way clinicians adapt to a new physical plant.

Methods:

In the first six months of operation of a new hospital facility, a clinician (MN) photographed signage posted on the operatory floor of the hospital. The photographs were classified into general categories to uncover the sorts of adaptive behaviors they represented.

Results:

We identified 28 signs that fit into four categories: way finding (7); appropriation and item localization (6); equipment activation, instruction and upkeep (9); and malfunction or breakage (6). Way finding and equipment activation, instruction and upkeep signs appeared earlier, and malfunction signs appeared later over the course of observation.

Discussion:

The physical layout of a building is a concrete example of operational constraints influencing clinical behavior (“sharp end”). Clinicians adapt to several needs when faced with a new workspace. Way finding and operational instructions are important components of this adaptation, but so too is resource appropriation. Physical failings of equipment become evident during operations, and the signage suggests that communicating these failures visually is important. The signs show the way clinicians adapt to constraints, effectively documenting the deficiencies in the interface between the physical structure and the people who work there. They are useful to direct research into new, helpful signage and also to signal the “brittle” aspects of the workplace. They should be celebrated as opportunities for improvement.
Using the DIAL-F Systems Model as the Conceptual Framework for an Audit of In-Patient Falls Risk Management
Authors: Hignett Sue , Youde Jane , Reid James
Published: July 2014

Most interventions for managing (reducing) the risks associated with in-patient falls have used a clinical approach to address underlying frailty and illness (physical and mental) with drugs, technology and therapy. This paper reports the results of a two stage audit on in-patient falls risk management at two teaching hospitals in the UK in July 2013 using the DIAL-F systems model as a Human Factors/Ergonomics (HFE) conceptual framework to explore patient engagement with falls risk management. Some safety critical system misalignments were found, and it is suggested that a future HFE intervention might include addressing the problems of (1) reach distances to walking aids and (2) obstacles in the bedside area for patients needing mobility assistance.
The Impact of Computerized Decision Support on the Ability to Supervise Resident Physician Sign-Outs
Authors: Mount-Campbell Austin F. , Weiss Chad A. , Andonian Nicole , Duchon Andrew , O’Brien James , Patterson Emily S.
Published: July 2014

Attending physicians need to supervise resident physician sign-outs in order to ensure patient safety. In one survey study, 59% of resident physicians reported at least one case of harm to one of their patients due to communication issues during sign-outs in their last rotation. In prior research, we identified ‘best practices’ for sign-outs used by attending physicians. For the outgoing physician, communication strategies improve the informativeness, structure, and coverage of the information. For the incoming physician, communication strategies focus on minimizing interruptions, active listening, and assertively questioning the accuracy of contentious decisions. These may include diagnoses, treatment plans, and prognoses. Real-time monitoring of four teams of resident physicians conducting sign-outs simultaneously is extremely difficult for attending physicians without computerized decision support. In this study, we examined the impact of providing automated highlights of sign-out transcripts on the ability to judge the quality of the sign-out. A between-subject design was employed to compare performance with a system displaying four transcripts of sign-outs simultaneously vs. one with the automated highlights on the transcripts. Study participants were 16 fourth-year medical students. Hypothesized benefits of the computerized support on performance and efficiency were not detected. One explanation is that the participants did not understand or agree with the best practice communication strategies, which were used in the design of the highlighted information. Nevertheless, study participants without the computerized support were more likely to judge the supervisory task as not able to be performed safely (p<0.05). All study participants reported that they would be more comfortable performing the task if they were already familiar with the patients (p<0.05). Implications of the study findings include design revisions to the computerized support and the need to provide training on best practices for software assisted sign-outs.
Comparison of Heuristic Evaluation and Think Aloud Methods
Authors: Ramkumar Anjana , Song Yu , Varga Edit , Niessen Wiro J. , Laprie Anne , Rowland Ben , Freudenthal Adinda
Published: July 2014

During the radiotherapy planning process patient’s medical images are used to determine the optimum configuration of radiation beams for their cancer treatment. The primary aim of radiotherapy planning is to maximize radiation dose to the patient’s tumour while sparing their normal tissues. To achieve this, the boundary of the tumour needs to be accurately identified in the treatment planning process, especially in the step of target volume delineation. Clinically, tumour delineation is performed by physicians, either manually or using semi-automatic/automatic software based on the patient’s CT, PET and/or MRI images. In addition to the expertise of the physician and choices of segmentation algorithms, the usability of the software also plays an important role in the tumour delineation process. In this paper, the usability of the IPLAN® contouring software was evaluated. First, two evaluators assessed the software according to the heuristic evaluation method. Then three physicians evaluated the same system using the think aloud method. The outcomes of the experiments revealed different insights of the system. With the think aloud method, it was easier to identify end users’ preferences regarding both software interface and hardware input tools. On the other hand, the heuristic evaluation method uncovered more specific issues with the interface. Besides, this method was able to explore more details regarding individual functionalities on the interface. Based on the comparison of the outcomes of both methods, it is suggested that in the process of improving usability of the contouring interface, the think aloud method can be applied to explore preferences of the user. The heuristic evaluation can be applied in designing the details of the interface.
Closing the Loop
Authors: Karn Keith , Rieger Kathryn , Bergman Eric , Hallbert Bruce , Gellatly Andrew W. , Harris Steve
Published: July 2014

There has been considerable study and discussion regarding the appropriate role of the human operator in automated systems. Closed-loop systems are commonplace in manufacturing, power plant control, and aircraft control, and there is a growing body of research and public discussion related to automobile control. Closed-loop systems are less common in healthcare with some notable exceptions. The Artificial Pancreas Project is an example of a medical technology where system designers are facing difficult decisions related to removing the human from the control loop. This panel presented an opportunity for open, professional discussion on such closed-loop systems in healthcare that included subject matter experts not only from healthcare human factors, but also from the nuclear, automotive, and aviation human factors domains.
Creating Biofidelic Phantom Anatomies of the Colorectal Region for Innovations in Colorectal Surgery
Authors: White Eoin , McMahon Muireann , Walsh Michael , Coffey J. Calvin , O’Sullivan Leonard
Published: July 2014

The aim of this research was to develop a replicated colorectal region for use in laparoscopic instrument innovation.Testing of both surgical skills and laparoscopic surgical instruments takes place in a controlled lab setting. Cadaverous tissue or laparoscopic simulators are the tools of choice for skill testing.However, in the instance of colorectal surgery, porcine intestines remain the gold standard for laparoscopic testing(Lamata et al. 2004). There exists data in current literature which discuss the use of anatomical simulators (also known as simulator boxes) for both researching surgical methods, and testing laparoscopic instruments. There is little focus in the literature on the materials used to create surrogate environments which mimic those of the real world. Simulator boxes exist, and are of high fidelity, but can be quite cumbersome, with some being left in storage areas indefinitely, with some remaining inaccessible for many centers around the world. There are also many peripheral devices which need to accompany these simulators, such as laparoscopes and external monitoring equipment for recording and review. As they are highly specialized pieces of research equipment, in the majority of cases, they are not designed to be portable or readily reconfigurable. These limitations make high end laparoscopic simulators inappropriate choices for early stage HFE (Human Factors Engineering) studies.The authors propose the creation of a laparoscopic simulator which contains anatomically accurate, 3D printed colorectal sections for use in both surgical training and instrument innovation. The colon is modeled from high quality CT data in DICOM format, using the Material Mimics Innovation Suite (Materialise, 2013). By creating virtual models of the internal anatomical structure of the colorectal region, it allows for a more accurate depiction of the anatomy encountered in a surgical setting. A maximum level of realism is required for a simulator to be effective(Lamata et al. 2004).The future application of this work lies in the validation of the 3D printed anatomy which will lead to innovation of new instruments or approaches to laparoscopic surgery.