bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Plantar Plate and Surgical Reconstruction Techniques on Static Stability of Lesser Metatarsophalangeal Joints
Authors: Chalayon Ornusa , Chertman Carla , Guss Andrew D. , Saltzman Charles L. , Nickisch Florian , Bachus Kent N.
Published: June 2013

Background:

Disruption of the plantar plate of the lesser metatarsophalangeal (MTP) joints leads to significant instability. Despite the fact that plantar plate disorders are common, the best mode of treatment remains controversial with operative treatments having variable and somewhat unpredictable clinical outcomes.

Methods:

Lesser MTP joints from the second, third, and fourth toes from fresh-frozen cadaver feet were biomechanically tested: (1) intact, (2) with the plantar plate disrupted, and (3) following a Weil osteotomy, a flexor-to-extensor tendon transfer, or a Weil osteotomy with a subsequent flexor-to-extensor tendon transfer with testing in superior subluxation, dorsiflexion, and plantarflexion.

Results:

The plantar plate significantly contributed to stabilizing the sagittal plane of the lesser MTP joints. The flexor-to-extensor tendon transfer significantly stabilized the disrupted lesser MTP joints in both superior subluxation and in dorsiflexion. The flexor-to-extensor tendon transfer following a Weil osteotomy also significantly stabilized the disrupted lesser MTP joints in both superior subluxation and in dorsiflexion.

Conclusions:

In this cadaver-based experiment, disruption of the plantar plate of the lesser MTP joints led to significant instability. After plantar plate disruption, the Weil osteotomy left the joint unstable. The flexor-to-extensor tendon transfer by itself increased the stability of the joint in dorsiflexion, but combined with a Weil osteotomy restored near intact stability against superior subluxation and dorsiflexion forces.

Clinical Relevance:

Surgeons using the Weil osteotomy for plantar plate deficient MTP joints may consider adding a flexor tendon transfer to the procedure. Techniques to repair the torn plantar plate directly are needed.
Comparison of Practice Patterns in Total Ankle Replacement and Ankle Fusion in the United States
Authors: Terrell Rodney D. , Montgomery Scott R. , Pannell William C. , Sandlin Michael I. , Inoue Hirokazu , Wang Jeffrey C. , SooHoo Nelson F.
Published: June 2013

Background:

Although tibiotalar fusion has historically been considered the gold standard treatment for end-stage arthritis of the ankle, the performance of total ankle replacement appears to be gaining favor as improved outcomes have been observed with new implant designs and surgical techniques. The purpose of this study was to compare trends and demographics in the performance of ankle fusion and total ankle replacement in the United States.

Methods:

The Current Procedural Terminology (CPT) codes of patients undergoing ankle fusion and total ankle replacement were searched using the PearlDiver Patient Record Database, a national database of orthopaedic patients. The CPT codes for open ankle arthrodesis (27870), arthroscopic ankle arthrodesis (29899), and total ankle replacement (27700, 27702) were searched for the years 2004 to 2009 to identify relative changes in the performance of ankle fusion and replacement over time.

Results:

The performance of ankle fusion was unchanged during the 6-year study period. In contrast, an increase in total ankle replacement was observed, from 0.63 cases per 10 000 patients searched in 2004 to 0.99 cases per 10 000 patients in 2009 ( P < .05). Both ankle fusion and total ankle replacement were performed most commonly in patients aged 60 to 69 years ( P < .05). Although an even gender distribution was observed in patients undergoing total ankle replacement, open and arthroscopic fusion were more commonly performed in males ( P < .05). With regard to regional distribution, open and arthroscopic fusion were most commonly performed in the western region of the United States, whereas total ankle replacement was performed most frequently in the Midwest ( P < .001).

Conclusions:

In the population studied, the performance of total ankle replacement increased 57% from 2004 to 2009 and was performed equally in male and female patients when compared to ankle fusion, which was more often performed in males and was unchanged with time.

Level of Evidence:

Level IV, cross-sectional study.
The active unbalanced vibration compensation of the flexible switched reluctance motorized spindle
Authors: Qiao Xiaoli , Zhu Changsheng
Published: June 2013

An active unbalanced vibration compensation scheme with built-in force actuator for a flexible switched reluctance motorized spindle (SRMS) is proposed. The force actuator is a set of windings, which are wound on the stator pole of the switched reluctance motor (SRM). The equivalent unbalance identification method is proposed to indentify online the unbalanced vibration caused by the grinding wheel’s mass imbalance. The equivalent reference unbalance compensation signal is produced by the identification method, which is used to obtain the compensation current of a force actuator, so a controlled, non-contact electromagnetic compensation force on the rotor of the SRMS is produced by the force actuator to compensate the actively unbalanced vibration of the flexible SRMS. The dynamic flexible SRMS is modeled by means of finite element method (FEM). The inductance of main and control windings, the coefficients of the compensation and the unbalanced magnetic pull force are identified by the FEM, and then the active unbalanced vibration compensation scheme for the flexible SRMS is designed in Matlab, in which inductance of main and control windings, the coefficients of the compensation and unbalanced magnetic pull force are obtained by the Look-up table method. The results show that the proposed active unbalanced force compensation scheme has an obvious compensation effect and the coefficients indentified by the FEM have been closer to an actual effect on compensating the unbalanced vibration of the flexible SRMS.
Robust stabilization of fractional-order chaotic systems with linear controllers: LMI-based sufficient conditions
Authors: Faieghi Mohammad Reza , Kuntanapreeda Suwat , Delavari Hadi , Baleanu Dumitru
Published: June 2013

This paper is concerned with the problem of robust state feedback controller design to suppress fractional-order chaotic systems. A general class of fractional-order chaotic systems is considered and it is assumed that the systems’ equations depend on bounded uncertain parameters. We transform the chaotic system equations into linear interval systems, and a sufficient stabilizability condition is derived in terms of linear matrix inequality (LMI). Then, an appropriate feedback gain is introduced to bring the chaotic states to the origin. Such design will result in a simple but effective controller. Several numerical simulations have been carried out to verify the effectiveness of the theoretic results.
Low-frequency dynamics of an electrorheological fluid in squeeze and shear modes. Part II: modeling and identification
Authors: Bauer Jens , Dohnal Fadi , Norrick Nicklas
Published: June 2013

Electrorheological fluids (ERFs) offer rapid control of damping using very low power requirements. Different models have been proposed to simulate the hysteresis phenomenon of ERFs. A modular test facility was designed to perform measurements of a specific electrorheological fluid in squeeze and shear modes in Part I. Based on these measurement cycles, material models for squeeze and shear modes are proposed and corresponding model parameters are identified within this parameter space. The fitted models are benchmarked against the measurement data and are capable of resembling the fluid’s dynamic properties at harmonic excitation, including transitions between Bingham-like and visco-elastic material behavior. Once model parameters are identified, the dynamics of an ERF are resembled excellently by phenomenological models. However, clear trends within the parameter space cannot be stated for all model parameters which prevents the derivation of analytical statements for the model parameters. Since the identification of model parameters is not transferable, a new adaptation is necessary for every application. Nevertheless, the presented procedure can be applied directly in these cases and is robust.
Optimization of the dynamic properties of the ladder track system to control rail vibration using the multipoint approximation method
Authors: Yan Zi-Quan , Markine Valéri , Gu Ai-Jun , Liang Qing-Huai
Published: June 2013

The combination model of the vehicle and ladder track system that accounts for the wheel–rail interface has been developed to analyze the wheelset and ladder track vibration characteristics in the frequency and time domains. In the wheel–rail interface, the vertical contact is represented by contact stiffness derived from the Hertz theory of normal elastic contact, and lateral contact is idealized by linear contact used Kalker linear rolling contact theory. The considerable noise and vibration frequency of the ladder track is determined by experimental investigation results. Then the effect of the most significant ladder track parameters on the track vibration is analyzed in time domain using the vehicle–track coupling model. Based on the results of the parametric study, an optimization of the mechanical properties of the ladder track to reduce the track vibrations is performed using the multipoint approximation method. The results of the optimization are presented and discussed.
Magneto-thermoelastic response of an infinite functionally graded cylinder using the finite element method
Authors: Zenkour Ashraf M , Abbas Ibrahim A
Published: June 2013

In this article, the magneto-thermo analysis problem of an infinite functionally graded (FG) hollow cylinder is studied. The radial displacement, mechanical stresses and temperature, as well as the electromagnetic stress, are all investigated along the radial direction of the infinite cylinder. Material properties are assumed to be graded in the radial direction according to a novel power-law distribution in terms of the volume fractions of the metal and ceramic constituents. The inner surface of the FG cylinder is pure metal, whereas the outer surface is pure ceramic. The equations of motion and the heat-conduction equation are used to derive the governing second-order differential equations. A finite element scheme is presented for the numerical purpose. The system of differential equations is solved numerically and some plots for displacement, radial and electromagnetic stresses, and temperature are presented.
Modal testing and finite element model calibration of in-filled reinforce concrete frames
Authors: Arslan Mehmet E , Durmuş Ahmet
Published: June 2013

In this study, modal testing and finite element model calibration of in-filled reinforced concrete (RC) frames are studied. For this purpose a full-scaled, one bay and one-story RC frame is produced and tested for plane and brick in-filled conditions. Dynamic characteristics, such as natural frequencies, mode shapes and damping ratios, of plane and in-filled RC frames are determined using the Operational Modal Analyses method under ambient vibration. The RC frame is vibrated by natural excitations with small-impact effects and the response signals are measured using sensitive accelerometers during ambient vibration tests. Measurements of time-frequency range and effective mode number are determined by considering similar studies and literature. To obtain experimental dynamic characteristics, enhanced frequency domain decomposition and stochastic subspace identification methods are employed. Analytical modal analysis is performed on a two-dimensional finite element model of the frames using SAP2000 software to provide analytical frequencies and mode shapes. The results of ambient vibration tests show that dynamic characteristics change significantly depending on the existence of an in-fill wall. The first five natural frequencies are obtained experimentally between 16.64 and 179.20 Hz, and 63.56 and 226.12 Hz for plane and brick in-filled, respectively. Dynamic characteristics obtained by analytical and experimental methods are compared with each other and the finite element model of the frames is updated by changing some uncertain modeling parameters, such as material properties and boundary conditions, to reduce the differences between the results. At the end of the study, maximum differences in the natural frequencies are reduced on average from 39% to 8% and a good agreement is found between analytical and experimental dynamic characteristics after finite element model updating. This result shows the importance of finite element model updating to reflect the current behavior of the structures. In addition, it is seen that material properties are more effective parameters in the finite element model updating of the plane frame. However, for the brick in-filled frame, changes in boundary conditions determine the model updating process.
Variable stiffness type magnetic vibration absorber to control the vibration of beam structure
Authors: Sayyad FB , Gadhave ND
Published: June 2013

Vibration absorbers are frequently used to control and minimize excess vibration in structural systems. Dynamic vibration absorbers are used to reduce undesirable vibration in many applications such as pumps, gas turbines, engines, bridges, electrical generators, etc. To reduce the vibration of the system, the frequency of the absorber should be equal to the excitation frequency. The aim of this paper is to investigate the use of a variable stiffness type magnetic vibration absorber to control the vibration of beam structure. This study will aim to develop variable stiffness of a magnetic vibration absorber to adapt to the change in a vibratory system; its stiffness can be varied by changing the distance between magnets. The absorber system is mounted on a cantilever beam acting as primary system. The objective is to suppress the vibration of the primary system subjected to a harmonic excitation whose frequencies vary. This can be achieved by varying the stiffness by changing the distance between the magnets. The advantage of a magnetic vibration absorber is that it can be easily tuned to the excitation frequency, so it can be used to reduce the vibration of a system subjected to variable excitation frequency.
Identification of dissipation of a Hertzian contact from free vibration investigations
Authors: Xiao Huifang , Ferguson NS , Shao Yimin
Published: June 2013

The nonlinear oscillatory motion of an elastic sphere in contact with a rigid flat surface to different loads is clearly dominated by the damping mechanism of the system. However, the damping power law is unable to be identified using the decrement method due to the almost identical free vibration responses. In this paper, a procedure which allows identification of the nonlinear viscous damping from the free response data is presented. The procedure is based on the figure relating the damping restoring force and the velocity which is distinguishable for different damping laws. A dynamic experiment is described, and from the free vibration data obtained the damping restoring forces are extracted for spheres with different materials being steel and low density polyethylene (LDPE). Subsequently, based on the models and observations the characteristics of the damping law are estimated. The results show that a linear viscous damping model is a good representation for the steel sphere contact, which confirms earlier studies; whilst the LDPE sphere contact follows a nonlinear power law for the viscous damping function, which is newly obtained. The validity and accuracy of the proposed method are supported by the good agreement between numerical results and experimental results.
Effects of encapsulation on the viability of potential probiotic Lactobacillus plantarum exposed to high acidity condition and presence of bile salts
Authors: Tee WF , Nazaruddin R , Tan YN , Ayob MK
Published: June 2013

This study investigated the survival of encapsulated potential probiotic Lactobacillus plantarum which isolated from fermented cocoa beans. κ-Carrageenan was used to encapsulate the probiotic. Encapsulation techniques such as emulsification, freeze-drying or extrusion were adopted to encapsulate the probiotic. Freeze-drying and extrusion methods showed higher ( p < 0.05) efficiency (89.48 ± 3.21 and 92.26 ± 1.45%, respectively) in encapsulating the probiotic compared to the emulsification method (82.19 ± 0.71% efficiency). Freeze-dried encapsulated probiotic L. plantarum was selected for further survival analysis as greater amount of beads were produced compared to the extrusion method. Freeze-dried probiotic was found to have significantly ( p < 0.05) higher tolerance to acid at pH 2 with higher survival percentage compared to non-encapsulated probiotic. However, freeze-drying encapsulation was proven not to enhance the resistance of the probiotic to bile salt as evidenced by the one log colony reduction as for the non-encapsulated probiotic. Further modification of freeze-drying encapsulation technique is needed to enhance the survival of the encapsulated potential probiotic L. plantarum toward bile salt in the future.
Specific phenolic compounds and sensory properties of a new dealcoholized red wine with pomegranate (Punica granatum L.) extract
Authors: Tárrega Maria Amparo , Varela Paula , Fromentin Emilie , Feuillère Nicolas , Issaly Nicolas , Roller Marc , Sanz-Buenhombre Marisa , Villanueva Sonia , Moro Carlos , Guadarrama Alberto , Fiszman Susana
Published: June 2013

The pomegranate ( Punica granatum L.) fruit has a long history of human consumption and possesses notable antioxidant and cardiovascular properties. This work evaluated the feasibility to provide a new functional beverage based on a dealcoholized red wine matrix supplemented by a pomegranate extract. The potential bioactive compounds in the pomegranate extract, punicalagin A and B and ellagic acid, were analyzed during the downstream process in order to evaluate the functional dose in the final beverage. The addition of pomegranate extract to the dealcoholized red wine resulted in a product with more intense yeast odor, acidity, yeast flavor, and astringency and with a less intense berry flavor. Consumer acceptance of the product was also investigated and the results revealed the existence of a niche of consumers willing to consume dealcoholized wine enriched with pomegranate extract. After tasting, 50% and 40% of those consumers initially interested by this product concept declared to be interested to purchase the control sample and the functional beverage, respectively. The daily consumption of two servings of 250 mL of this new pomegranate-enriched dealcoholized wine provides 82 mg of total ellagitannins, corresponding to the sum of punicalagin A and B and ellagic acid.
Assessment Administration and Performance during the Great Recession
Authors: Propheter Geoffrey
Published: June 2013

This study explores the performance of assessment administration during the Great Recession using a panel of Washington state counties from 2006 to 2011. The housing bust is treated as a productivity shock to the assessment process. Due to rapidly changing environmental conditions and declining assessor resources, assessment performance, as measured by the residential coefficient of dispersion, is predicted to suffer. Only the former condition is found to impact residential assessment uniformity, however. The results suggest that the increased task complexity in an environment of falling home prices gives homeowners experiencing wide swings in market value de facto assessment relief. In order to maintain high levels of performance during poor economic conditions, a number of policy alternatives are proposed.
Grazing the State and Local Fiscal Commons
Authors: Lipford Jody W. , Yandle Bruce
Published: June 2013

The literature on the tragedy of the commons is voluminous, and application to the fiscal commons is well established. In this article, we extend this application by examining the effects of the distribution of state and local governments’ tax liability on budgetary outcomes. Different tax structures yield vastly different contributions from members of the polity, but all members may influence the draw from the fiscal commons through the political process. We find that when the tax burden is heavier for taxpayers at the top of the income distribution and lighter for taxpayers at the bottom of the income distribution, state and local government expenditures grow, and governments spend more on social welfare. However, we do not find a link between the distribution of tax liability and debt.
Legislating language in the name of national unity
Authors: Brown Donathan
Published: June 2013

Concerns over demographic shifts continue to result in legislative disputes at all levels of government. These conflicts, whether challenging the creation of congressional districts that attempt to “dilute minority votes” or legislative attempts at defining and implementing “official language” laws, continue to arise in areas experiencing Latino population growth. Since the 2004 release of statistics by the United States Census Bureau, which indicated that Latinos are overtaking African Americans to become the largest and fastest growing “minority group” in the United States, much legislative attention has focused upon the socio-economic and political absorption of Latinos. Although proponents of the Oklahoma State Ballot Question 751, the English is the Official Language of Oklahoma Act, argued that the supposed policy necessity of an official language law was measured without attention to race, this essay argues otherwise. In what follows, I argue the existence of a forged rhetorical correlation between shifting racial demographics and the insisted demand for more official language policies. To illustrate this claim, the arguments sought in support of the United States most recent English-only measure, Oklahoma State Ballot Question 751, will be analyzed.
Tackling disability-based discrimination in international and European law
Authors: Maučec Gregor
Published: June 2013

Discrimination against people with disabilities remains one of the greatest human rights issues of our time. This article represents a critical overview of international, and in particular European, human rights and of the non-discrimination frameworks relevant and applicable to the unequal treatment of persons with disabilities in order to ascertain whether these norms provide for adequate legal, policy and institutional bases for dealing with discrimination on the grounds of disability. Having considered the contents and scope of relevant international human rights and non-discrimination provisions, the author turns to the questions of how these provisions might be exercised, who the rights holders and duty bearers would be and what the challenges of balancing different rights and needs are. The article also includes the definition of the concept of disability in the context of non-discrimination law and examines the dimensions of disability discrimination as defined in international and EU law. The author concludes that international, and especially modern EU, non-discrimination law establishes a wide and inclusive legal framework for dealing with disability discrimination. However, the actual scope of the realisation of international and European legal standards on disability discrimination in each state will depend on the consistency and effectiveness of their national implementation and on the manner of putting them into practice.
The air from outside: Getting to know the world through air practices
Authors: Hauge Bettina
Published: June 2013

This article evolves around air: how we experience air, become knowledgeable about our environment through air and include sociality in our actions relating to air. Based on a qualitative study in Denmark about how people use air from the outside and let it into their homes, the article investigates the relation between the air we breathe and learn from and the air we ‘perform’, such as airing our homes. The study indicates patterns of use that reflect on air as a vital element in our being-in-the-world as well as being socially and bodily significant for shaping our everyday life. The article begins by showing air as an integrative practice with three dimensions: functional, bodily/sensory and social. It is shown how knowledge of the environment is constructed in the process of ‘practising’ air, how this knowledge is transferred into a sense of being-in-the-world and how emotions are part of this becoming.
The meanings of red envelopes: Promises and lies at a Singaporean Chinese funeral
Authors: Toulson Ruth E
Published: June 2013

This article begins with a puzzle. Why do red envelopes appear at Singaporean Chinese funerals? Specifically, why are payments to corpse-handlers, coffin-carriers and gravediggers wrapped in red, when the work they do is described as being ‘white through and through’? Conventionally, red is the colour of auspicious occasions, hence it is the colour of a traditional wedding dress, while white is the colour of death, of the shroud and of mourning wreaths. In this article, the author suggests that the meanings of colours might actually be more complex than previous scholarship has suggested. By following this exchange of red envelopes, paying careful attention to the shifting meanings given to red, she reveals the complex, otherwise unarticulated, nature of the relationships made visible via their transfer. She follows Keane’s suggestion that attaching meaning to material takes considerable social work in order to clarify the meanings an object in exchange should carry.
Domesticating and democratizing science: A geography of do-it-yourself biology
Authors: Meyer Morgan
Published: June 2013

By turning private homes and community spaces into sites where biological experimentation can be carried out, do-it-yourself biology promises a democratization of science. This democratization is based upon material processes: efforts to increase the affordability, accessibility and mutability of scientific equipment can be observed. In particular, do-it-yourself biology relies on ‘creative workarounds’ around objects (to transform and combine them in novel ways) and institutions (to circumvent established university–industry business linkages). By tinkering with objects and sharing knowledge via various communicative devices – websites, blogs, wikis, forums, videos – do-it-yourself biologists aim to create a new, collective and open economy of scientific equipment and render biology more accessible to citizens. A distinct form of individuality is constituted by providing people with access, transforming them into active makers of science, making their bodies/ailments more knowable and demonstrating that one can do it oneself. Do-it-yourself biology thus offers a site for exploring the ethics, boundaries and new forms of sociability for biology.
The qualities of fat: Bodies, history, and materiality
Authors: Forth Christopher E
Published: June 2013

This article proposes that, at various historical moments, stereotypes about fat people as being corrupt, weak, and stupid have been complemented and perhaps even informed by perceptions of fat as a material substance with definite properties and qualities. In an effort to understand the formation and longevity of these three longstanding stereotypes this article submits that the material properties of fat – particularly its unctuousness, softness, and insensateness – have played important roles in motivating some of the responses this substance has generated both with reference to human bodies and their material worlds. Due to the conceptual slipperiness of ‘fat’ in its various forms (whether ‘frozen’ as a solid or liquefied as oil or grease), this analysis uses examples from ancient Greek, Roman and Hebrew texts to track the ways in which this substance has been perceived across these registers, revealing the surprisingly mercurial and ambiguous ways in which ‘fat’ has been understood culturally.
Attitude and flexibility are the most important work place factors for working parents’ mental wellbeing, stress, and work engagement
Authors: Eek Frida , Axmon Anna
Published: June 2013

Aims: The need to combine active employment and parenthood is a reality for many parents today. Knowing more about which work place factors are associated with better or worse health could help employers to form a work environment that provides optimal conditions to maintain or increase health and work engagement in this group. The aim of this study was to explore possible associations between different subjective and objective work factors and benefits, and a range of outcome variables such as stress, symptom report, wellbeing, work-related fatigue, work engagement, and work–family conflict among working mothers and fathers with small children. Methods: Cross-sectional analyses of associations between work place factors categorised into three different dimensions; flexibility, benefits, and attitude and the outcome measures were performed, including questionnaire responses from 1562 working parents. Results: The results showed that work place factors related to flexibility and, especially among women, attitude to parenthood appear to have the strongest effect on working parents’ subjective stress and wellbeing, while benefits appear to have less impact. Except regarding factors related to attitudes at the work place, most associations were similar among men and women. Conclusions: Most likely, different factors are better suited or more important for some individuals than others depending on their total work, as well as family situation and also depending on individual factors such as personality and priorities. A positive attitude towards parenthood and a flexible work situation seem, however, beneficial for the general wellbeing and work engagement among working parents.
Kevin Rudd, celebrity and audience democracy in Australia
Authors: Wilson Jason
Published: June 2013

Kevin Rudd’s political ascendancy moved celebrity personae and celebrity media closer to the central terrain of Australian politics. This tended to diminish the authority of political journalists, and presented a directed challenge to the power of bureaucrats and activists in the Australian Labor Party (ALP). Rudd’s engagement with celebrity culture, and his instantiation of ‘audience democracy’ can be understood in the context of Australia’s ‘post-broadcast democracy’, the competitive, co-adaptive dynamic between political actors and journalists, and the increasing celebritisation of contemporary culture. In responding to Rudd’s strategies, political journalists resorted to the ‘scourging’ tactics familiar from celebrity journalism. Rudd’s brief Prime Ministership raises questions about the future of politics and journalism in celebritising, post-broadcast democracies, that have global ramifications.
A Standardized Approach to the Fugl-Meyer Assessment and Its Implications for Clinical Trials
Authors: See Jill , Dodakian Lucy , Chou Cathy , Chan Vicky , McKenzie Alison , Reinkensmeyer David J. , Cramer Steven C.
Published: June 2013

Background. Standardizing scoring reduces variability and increases accuracy. A detailed scoring and training method for the Fugl-Meyer motor assessment (FMA) is described and assessed, and implications for clinical trials considered. Methods. A standardized FMA scoring approach and training materials were assembled, including a manual, scoring sheets, and instructional video plus patient videos. Performance of this approach was evaluated for the upper extremity portion. Results. Inter- and intrarater reliability in 31 patients were excellent (intraclass correlation coefficient = 0.98-0.99), validity was excellent ( r = 0.74-0.93, P < .0001), and minimal detectable change was low (3.2 points). Training required 1.5 hours and significantly reduced error and variance among 50 students, with arm FMA scores deviating from the answer key by 3.8 ± 6.2 points pretraining versus 0.9 ± 4.9 points posttraining. The current approach was implemented without incident into training for a phase II trial. Among 66 patients treated with robotic therapy, change in FMA was smaller ( P ≤ .01) at the high and low ends of baseline FMA scores. Conclusions. Training with the current method improved accuracy, and reduced variance, of FMA scoring; the 20% FMA variance reduction with training would decrease sample size requirements from 137 to 88 in a theoretical trial aiming to detect a 7-point FMA difference. Minimal detectable change was much smaller than FMA minimal clinically important difference. The variation in FMA gains in relation to baseline FMA suggests that future trials consider a sliding outcome approach when FMA is an outcome measure. The current training approach may be useful for assessing motor outcomes in restorative stroke trials.
Lifestyle Approach for Increasing Physical Activity in Youth
Authors: Johnston Craig A. , Papaioannou Maria A.
Published: June 2013

Although physical activity (PA) provides children with various health benefits, many children do not engage in regular PA. Health care professionals can effectively encourage children and their families to participate in more PA through lifestyle changes. The strategies that clinicians can employ to promote PA are discussed in this article.
A Career and Development Framework for Infection Prevention and Control nurses
Authors: Freeman Sarah , Gray Denise
Published: June 2013

To support Infection Prevention Services in Scotland, NHS Education for Scotland developed a Career and Development Framework for Infection Prevention and Control Nurses (IPCN). This was structured using the Post Registration Career Development Framework developed by NHS Education for Scotland ( http://www.careerframework.nes.scot.nhs.uk/ ) which is based on the Career Framework for Health developed by Skills for Health 2006). This development was facilitated by NHS Education for Scotland in partnership with practitioners and educationalists, and it is supported by the Scottish government. This paper will discuss the benefits of the Career and Development Framework for IPCN, for those working or who aspire to work in infection prevention and control, managers and educationalist in NHS and non-NHS settings. The strategy for implementation in NHS boards will also be discussed.
Is State-Mandated Redesign an Effective and Sustainable Solution?
Authors: Young Michelle D.
Published: June 2013

There is a pervasive and ongoing perception that leadership preparation is a problem. Important questions remain about the intentions, capacity, and impact of state departments of education engaged in leadership preparation program redesign. In this essay, I take up several issues concerning this state policy work, including whether a one size fits all approach to redesign is appropriate, whether the approaches taken by states have had the intended impact on preparation and leadership practice, and whether state departments of education have the capacity to shoulder the responsibility of translating and implementing policy as well as supporting preparation program redesign.
Transformation of a Silent Adrencorticotrophic Pituitary Tumor Into Central Nervous System Melanoma
Authors: Miller Brandon A. , Tanaka Tomoko , Ioachimescu Adriana G. , Vincentelli Cristina , Appin Christina L. , Oyesiku Nelson M.
Published: June 2013

Silent adrenocorticotrophic pituitary adenomas are nonfunctioning pituitary adenomas that express adrenocorticotrophic hormone (ACTH) but do not cause the clinical or laboratory features of hypercortisolemia. Primary central nervous system (CNS) melanoma is well documented, but rarely originates in the sellar region or pituitary gland. Here we report transformation of an aggressive silent adrenocorticotrophic pituitary adenoma that transformed into CNS melanoma and review other presentations of pituitary melanoma. A 37-year-old woman initially presented with apoplexy and an invasive nonfunctioning pituitary macroadenoma for which she underwent transphenoidal surgery. The patient underwent 3 subsequent surgeries as the tumor continued to progress. Pathology from the first 3 operations showed pituitary adenoma or carcinoma. Pathology from the final surgery showed melanoma and the magnetic resonance imaging characteristics of the tumor had changed to become consistent with CNS melanoma. Dermatologic and ophthalmologic examinations did not identify cutaneous or ocular melanoma. The patient’s disease progressed despite aggressive surgical, medical and radiologic treatment. To our knowledge, this is the first report demonstrating transformation of a primary pituitary tumor into melanoma. The mechanism of tumor transformation is unclear, but it is possible that a mutation in the original ACTH-producing tumor lead to increased cleavage of pro-opiomelanocortin or ACTH into α-melanocyte-stimulating hormone, which in turn stimulated the expression of microopthalmia transcription factor, leading to melanocytic phenotype transformation.
Characterizing Levels of Health IT System Interoperability based on How it Affects the Work of the Users
Authors: Guarrera Theresa K. , McGeorge Nicolette M. , Ancker Jessica S. , Hegde Sudeep , Zhou Yuan , Lin Li , Crane Peter W. , Fairbanks Rollin J. , Kaushal Rainu , Bisantz Ann M.
Published: June 2013

After comparing existing interoperability frameworks that describe information exchange among health IT systems and other non-medical domains, we propose a new framework for classification based on work as experienced by frontline healthcare workers. Seven user-centric interoperability levels are proposed.
Designing Case Studies for Evaluating an Inventory Management Product Using RFID Technology for Medical Testing Laboratories
Authors: Elson Ila J.
Published: June 2013

Radio Frequency Identification (RFID) is a technology that can be applied to the inventory management of reagents in medical testing laboratories throughout the world. This paper focuses on the case study methodology chosen to better understand the effectiveness and safety of prototype hardware and software and the usefulness of this new technology in laboratories. Study objectives and metrics are presented first. Then the case study approach is explained along with the logic for selecting a case, the generalization of the results and the benefits of the method. Human Factors practitioners and consultants in the healthcare information technology industry will find this information useful in designing case study research of new products for their clients.
Improving Patient Safety through User-Centered Healthcare Background Check System Design
Authors: Swierenga Sarah J. , Abujarad Fuad , Dennis Toni A. , Post Lori A.
Published: June 2013

The Michigan Workforce Background Check (MWBC) system is a cost-effective, usable web application for conducting employability screenings for healthcare workers in long-term care settings. This system is an exemplar for demonstrating how a user-centered design process facilitated the flow of critical information, improved applicant data accuracy, and improved patient safety by eliminating access by known abusers and criminals to vulnerable adults in long-term care settings. The redesigned system 1) increases the efficiency in the background check process, 2) collects more accurate and comprehensive applicant data, and 3) ultimately improves patient safety by quickly identifying unfit workers.
A Data Collection Framework for Care Coordination and Clinical Communications About Patients (CAPs)
Authors: Zachary Wayne , Maulitz Russell , Iverson Elissa , Onyekwelu Chioma , Risler Zachary , Zenel Lauren
Published: June 2013

Care coordination unfolds through communications about specific patients between clinicians in the context of a specific illness episode. This is a largely informal process that is also ephemeral, in that it leaves little or no permanent documentary record. Recent research has identified care coordination and communication about patients as a potential solution for improving care for chronic illnesses while reducing health care costs and increasing accountability, and as vehicle for reducing medical errors. However, relatively few empirical data exist on the communications about patients that comprise care coordination, possibly due to the methodological difficulty in gathering such data. A theory-based and empirically refined method for representing and collecting data on CAPs is presented.
Eye-Tracking and Retrospective Verbal Protocol to Support Information Systems Design
Authors: Wright Melanie C. , Dunbar Sherry , Moretti Eugene W , Schroeder Rebecca A , Taekman Jeffrey , Segall Noa
Published: June 2013

As capabilities for storing and sharing electronic health data expand, it becomes increasingly important to classify, prioritize, and contextually link patient health data. Providers using electronic health records (EHR) complain that it is difficult for them to rapidly find information they need and that key information can be missed. Unfortunately, phases of human-centered design that support defining information needs and developing an understanding of the work environment are sometimes shortchanged. We present a knowledge elicitation approach for the purposes of supporting EHR design that combines the rich contextual data gained through recording information use activities during actual patient care followed by retrospective verbal protocol interviews of the provider as they watch and listen to playback of their information use activities. As a means of analyzing qualitative data collected through techniques such as these, we apply grounded theory based content analysis techniques. The goal of our research is the development of principles to support better organization and prioritization in the presentation of electronic health data. As a secondary objective, we also seek to identify criteria that, with computational algorithms, may be used to prioritize specific data in context to support intelligent contextualized information display. In this paper, we present details of our methods (data collection and analyses), preliminary findings that have resulted from these efforts, and specific advantages and disadvantages to our approach.
Moving Beyond the Content
Authors: Polander Emily , Bullemer Beth , Shalin Valerie L.
Published: June 2013

The purpose of this study is to examine lay individuals’ gaps in understanding and misconceptions surrounding hypertension for more fundamental issues with reasoning about complexity. We coded for issues with complexity thinking in 100 posts from the online hypertension discussion forums, Ehealth.com and BPlog.com . Complementing the findings on novice and expert reasoning in the learning sciences literature, we identified four major issues with complexity thinking: Oversimplification of contributing factors, simple linear thinking, static reasoning, and discrete boundary thinking. We conclude with practical implications for these findings and suggestions for future research.
Integration of Cognitive Modeling into the Evaluation of Electronic Health Records
Authors: Berg Leif P. , Mahnke Andrea , Moritz Robert
Published: June 2013

Previous research has consistently cited the importance of a usable interface in the successful adoption of the electronic health record (EHR). Among the most time intensive EHR activities is Computerized Physician Order Entry (CPOE) a method of creating and modifying orders through an electronic interface. The Marshfield Clinic, a non-profit, regional health care organization in Wisconsin, is in the process of implementing a new CPOE system. As a part of early evaluation, cognitive and behavioral modeling was coupled with formative usability testing to better understand the potential use of a new CPOE design. Participants consisted of 11 medical residents. Results suggest that participants were able to complete the majority of task scenarios in less than 20 seconds per task. Additionally, the integration of a cognitive and behavioral tool provided new evaluation information to help aid in future design efforts.
Better Pairing of Providers and Tools
Authors: Guarrera Theresa , McGeorge Nicolette , Stephens Robert , Hettinger A. Zachary , Clark Lindsey , Hernandez Angelica , LaVergne David , Lewis Vicki , Lin Li , Perry Shawna , Wears Robert , Fairbanks Rollin , Bisantz Ann
Published: June 2013

Health IT systems are often designed without a sufficient understanding of the clinical activities they are intended to support; thus desired benefits in quality of care, safety, and efficiency may not accrue. We present the second part of a multi-phase study which utilizes cognitive systems engineering (CSE) methods to design and test novel user interfaces for a hospital emergency department (ED) information system. Using the work domain analysis results from phase one, display components were developed for a system which can better support work activities and information needs of ED clinicians and staff.
Rapid Ethnography – The Study of Behavior, Communication, and Context in Cosmetic Surgery Consultations and the Design of a New Medical Device
Authors: Koester Thomas , Rangstrup Betina , Nibe Malene T. , Schøler Tille V.
Published: June 2013

Ethnographic research methods are increasingly popular within the general field of Human Factors, usability, user experience and design. Through a case story from the development and design of a medical device called 3D Surgery – a decision aid to be used in surgeon-patient consultations for cosmetic breast surgery – the presentation exemplifies the value and efficiency of the use of rapid ethnography used as stand-alone method and in combination with other methods. The case study describes an iterative approach encompassing continuous adjustment of method repertoire as well as continuous adjustment of use of analytical tools through which insights into the specific context of use are built. The case study further illustrates how the pre-surgery consultation and decision making process of the patient can be analyzed, and how the knowledge acquired can be transferred into design criteria for the 3D Surgery System.
Evaluation Of Human Errors And Malfunctions For Minimal Invasive Surgeries In Conventional and Integrated OR Solutions
Authors: Von Saucken A - M , Prümper J , Kraft M
Published: June 2013

This German Research Foundation project aims to investigate the human-machine interaction of the operating theatre as a work system and from the results deduce measures and, using consolidated medical devices as an example, develop design guidelines for a prospective development of complex integrated technical systems.
Optimizing Resident Care in Assisted Living Communities
Authors: McBride Sara E. , Rogers Wendy A.
Published: June 2013

A primary goal of assisted living communities is to help residents maintain their health and wellbeing. One method by which this is accomplished is that caregivers continually monitor residents for cues that might signal problems or concerns, and then respond appropriately. The critical role of knowledge in caregiving has been recognized in the literature, but the existent research has demonstrated that those who provide care directly to assisted living residents may be lacking critical facets of knowledge. Although psychological science has recognized the value of comparing novices to experts for the purposes of understanding and training skill development (e.g., Chi, 2006; Rogers, Maurer, Salas, & Fisk, 1997), the literature in this area has not examined caregiving as a function of expertise or experience. Therefore, we contend that a research priority should be to investigate the cognitive processes involved in detecting resident issues, including problem detection (i.e., using cues to make a judgment about whether there is a need to be concerned), and decision making (i.e., responding in some form to resolve concerns).