bluuebunny/crossref_metadata_2025 huggingface dataset:
Satisfacción laboral y el malestar en el trabajo de los guías turísticos. Una aproximación a perspectivas de mejora
Authors: Gismera Tierno Eduardo , Liberal Ormaechea Sheila , Paredes Serrano Cristina
Published: February 2025

Introducción: Las organizaciones empresariales del sector del turismo ofrecen un servicio que pretende ser de alta calidad en tanto en cuanto constituye una pieza fundamental de la balanza de pagos española. Objetivos: El presente estudio pone la atención en la relación guía-turista y explora empíricamente el grado de satisfacción profesional de los guías en su trabajo con la voluntad personal de entablar una relación profesional de calidad con los turistas y el consiguiente efecto sobre la calidad de su misión. Metodología: Los datos han sido recogidos en diversos puntos de la Comunidad de Madrid en los meses de mayo y junio de 2023. A continuación, se ha llevado a cabo un estudio de caso analítico dividiendo las preguntas realizadas según grupos de asuntos en aras a destacar las respuestas más clarificadoras para con el presente estudio. Resultados: El trabajo que se presenta proporciona a la literatura académica y al sector del turismo, tan importante en España, nuevos conocimientos y evidencia empírica sobre un posible enfoque a futuro y, por qué no en el presente, del trabajo en las empresas turísticas. Conclusión: La principal conclusión es la necesaria inclusión del análisis del grado de satisfacción profesional como indicador clave para una mejor gestión y eficacia en el sector turístico español. Los resultados deberían ser una fuente útil de información para los profesionales que buscan implementar mejores sistemas de gestión humana en estas organizaciones.
El color natural en el Pabellón de Barcelona de Mies van der Rohe
Authors: Pesqueira Calvo Carlos
Published: February 2025

Introducción: La construcción del Pabellón de Alemania para la Exposición Universal de Barcelona en 1929, es un manifiesto a la honestidad de los materiales pétreos ligados a la Naturaleza. Un pabellón cuyo objeto expositivo es la materia en su estado primario. Los materiales transformados por el hombre se muestran como mecanismos utilizados para conformar un espacio en que los materiales tradicionales ligados a la naturaleza se muestran sin distorsiones. Metodología: Se realiza un estudio empírico de los diferentes espacios cualificados por la luz y el color y se seleccionan aquellos que aparecen en el Pabellón. Resultados: Podemos identificar varios dispositivos que transforman el color de la luz, provocando que los planos de material natural aparezcan aislados de su entorno, flotando sin referencias. Esos dispositivos espaciales aparecen ligados a los nuevos materiales, y en concreto el vidrio. Discusión y conclusiones: En el espacio interior se consigue controlar la luz mediterránea mediante la interrelación de distintos dispositivos de filtro y difusión. Asi los materiales pueden ofrecer su esplendor bajo una luz difusa y continua. Los dispositivos de reflexión inherentes a la naturaleza de los materiales empleados vuelven infinito el espacio, rompiendo los límites físicos y confundiendo el interior y el exterior.
La adopción del comercio social en la generación Y y Z en México. Un enfoque omnicanal
Authors: Gutiérrez-Leefmans Manuela
Published: February 2025

Introducción: El comercio en redes sociales se disparó en los últimos años y forma parte de la estrategia omnicanal de las empresas. A pesar de ser un fenómeno común a nivel global, hay pocos estudios sobre ello en América Latina. México es la segunda economía de la región con una gran población de jóvenes, lo que la hace una unidad de estudio importante. Metodología: La mayoría de las investigaciones al respecto han realizado estudios cuantitativos. Este estudio es cualitativo, basado en grupos focales. Se combinan técnicas de análisis, como la prueba de chi cuadrada de independencia y el análisis temático. Resultados: Se encuentra que los millennials son los que se inclinan más las compras por redes sociales y se preocupan más por la calidad de los productos, mientras los centennials prefieren la tienda física en ciertas ocasiones y muestran más desconfianza al hacer compras por redes sociales. Discusión: La información en línea es preferida de igual manera por ambos grupos, pues genera confianza. Sin embargo, existe una importante preocupación por la seguridad al hacer transacciones en redes sociales en ambas generaciones. Conclusiones: Es necesario fortalecer la confianza del consumidor por parte de las empresas y a través de políticas públicas.
Manejo y gestión de los residuos sólidos urbanos en la Ciudad de México
Authors: Vargas Rosas Citlalli del Carmen
Published: February 2025

Introducción: El modelo actual de economía lineal en la gestión de residuos genera acumulación en las ciudades, especialmente en la Ciudad de México, debido a la falta de infraestructura adecuada para implementar la economía circular y la necesidad de la colaboración ciudadana. Metodología: Se realizó un análisis utilizando la epistemología de la complejidad de Rolando García, evaluando el modelo de economía lineal, la economía circular y su aplicabilidad para resolver la acumulación de residuos sólidos urbanos, minimizando el impacto ambiental. Resultados: Los resultados revelaron que, aunque la economía circular ofrece beneficios, también requiere un mayor consumo de recursos como agua, electricidad y combustibles fósiles para sus procesos, lo que afecta la sostenibilidad y el medio ambiente. Además, se identificó la necesidad de nuevos enfoques, equipamiento urbano y regulaciones para facilitar la recolección, procesamiento e industrialización de los residuos. Discusión y Conclusiones: Se concluye que, para implementar efectivamente la economía circular, es fundamental contar con estrategias complementarias, infraestructura adecuada y normatividad para reducir la acumulación de residuos y mejorar la sostenibilidad en las ciudades.
ВИЗНАЧЕННЯ ЕФЕКТИВНОСТІ ОРГАНІЗАЦІЇ ДОРОЖНЬОГО РУХУ В ЗОНІ ЗУПИНКИ БЕЗ МОЖЛИВОСТІ ОБГОНУ ГРОМАДСЬКОГО ТРАНСПОРТУ
Authors: Осетрін М. М. , Тарасюк В. П. , Беспалов Д. О. , Іванець Л. І.
Published: February 2025

У статті проведено аналіз вітчизняної та європейської нормативної бази щодо організації зупинок маршрутного транспорту на вулично-дорожній мережі міста. Створено транспортні моделі для оцінки ефективності зупинок без можливості обгону, враховуючи різні параметри вулично-дорожньої мережі та транспортного руху. Розроблено показник ефективної заповнюваності автобуса для оцінки балансу між економією часу пасажирів і затримками індивідуального транспорту. На основі отриманих даних визначено ефективність організації дорожнього руху в зоні зупинки без можливості обгону та сформовано пропозиції змін до нормативних документів.
Guideline Development
Authors: Rosenbrand Kitty  , Van Croonenborg Joyce  , Wittenberg Jolanda
Published: February 2025

During the last decade many countries have become increasingly interested in the development and use of evidence-based practice guidelines, recognising that guidelines are key tools to improve the quality and appropriateness of health care. They are considered to be the ideal mediator for bridging the gap between the growing stream of research findings and actual clinical practice. Systematic reviews of guideline evaluations have shown that clinical practice guidelines can be an effective means of both changing the process of healthcare delivery and improving outcomes. A review of 59 guideline evaluation studies found that, in all but 4, statistically significant improvements occurred in clinical practice after implementation [17]. A systematic review of 87 studies on the use of guidelines concluded that 81 studies revealed evidence of improved patient outcomes [12]. Evidence-based guidelines are becoming an important and indispensable part of quality healthcare because of their potentials to improve quality and also reduce cost of health-care. Adherence to guidelines and protocols may reduce health-care costs up to a 25% [11]. We will present an overview of the history of guidelinedevelopment and give some widely used definitions of guidelines. Guidelines are developed in a structured and systematic way, this process will be explained later. Also implementation tools necessary to put the guidelines into practice in an active way, will be discussed.
Suggestions for improvement of School Screening for Idiopathic Scoliosis
Authors: Grivas T.B.  , Vasiliadis E.S.  , O'brien J.P.
Published: February 2025

There is skepticism and the worth of school screening for the purposes of health care has been challenged. Numerous reasons are raised by the negativists to abandon these programs, even though the value of school screening is well documented in the literature. The aim of the present study is to update the evidence based recommendations for the improvement of school screening effectiveness, in order to support its continuation. All the relative research papers which originated from our scoliosis school screening program were analyzed. Specific suggestions for a) the organization, b) the optimal age of screening according to the geographical latitude, c) the best examined position, d) the standardization of referrals, e) the follow up of younger referrals with trunk asymmetry and f) the reduction of the financial cost are made. Today there is evidence that the incidence of surgery can significantly be reduced in areas where idiopathic scoliosis can be detected at an early stage through these programs. The introduction of these recommendations to all the existing school screening programs is strongly suggested, to reduce the negative impact they may have on families and on the health system and to improve their effectiveness.
The posterior skeletal thorax: rib-vertebral angle and axial vertebral rotation asymmetries in adolescent idiopathic scoliosis
Authors: Burwell R.G.  , Aujla R.K.  , Freeman B.J.C.  , Dangerfield P.H.  , Cole A.A.  , Kirby A.S.  , Polak F.J.  , Pratt R.K.  , Moulton A.
Published: February 2025

The deformity of the ribcage in thoracic adolescent idiopathic scoliosis (AIS) is viewed by most as being secondary to the spinal deformity, though a few consider it primary or involved in curve aggravation. Those who consider it primary ascribe pathogenetic significance to rib-vertebra angle asymmetry. In thoracic AIS, supra-apical rib-vertebra angle differences (RVADs) are reported to be associated with the severity of the Cobb angle. In this paper we attempt to evaluate rib and spinal pathomechanisms in thoracic and thnoracolumbar AIS using spinal radiographs and real-time ultrasound. On the radiographs by costo-vertebral angle asymmetries (rib-vertebral angle differences RVADs, and rib-spinal angle differences RSADs), apical vertebral rotation (AV) and apical vertebral translation (AVT) were measured; and by ultrasound, spine-rib rotation differences (SRRDs) were estimated. RVADs are largest at two and three vertebral levels above the apex where they correlate significantly and positively with Cobb angle and AVT but not AVR. In right thoracic AIS, the cause(s) of the RVA asymmetries is unknown: it may result from trunk muscle imbalance, or from ribs adjusting passively within the constraint of the fourth column of the spine to increasing spinal curvature from whatever cause. Several possible mechanisms may drive axial vertebral rotation including, biplanar spinal asymmetry, relative anterior spinal overgrowth, dorsal shear forces in the presence of normal vertebral axial rotation, asymmetry of rib linear growth, trunk muscle imbalance causing rib-vertebra angle asymmetry weakening the spinal rotation-defending system of bipedal gait, and CNS mechanisms.
Back trunk morphology in 3301 children aged 3–9 years old
Authors: Grivas T.B.  , Vasiliadis E.S.  , Mihasc Maziotou C.  , Triandafyllopoulos G.
Published: February 2025

The present cross sectional study reveals trunk asymmetry (TA) in “normal” Mediterranean juveniles for the first time. The scoliometer readings in both standing and sitting forward bending position (FBP) of 3301 children, (1645 boys, and 1656 girls) aged from 3 to 9 years old were studied. TA was quantified by measuring angle of trunk rotation (ATR) and children were divided in two groups. In group I the ATR was 1° to 6° degrees and in group II≥7°. 71.25% of boys and 73.27% of girls in standing while 81.13% of boys and 80.74% of girls in sitting FBP, were symmetric (ATR=0°). The symmetry difference at standing minus sitting FBP for boys and girls was 9.88% and 7.43% respectively. Severe asymmetry (ATR≥7°) was found in 1.74% of boys and in 1.75% of girls at the standing and in 1.21% and 1.22% at the sitting FBP respectively. Analysing ATR by age it appears that significant TA changes occur between 8–9 years of age for boys and between 6–7 and 8–9 years for girls. The amount of trunk asymmetry in children is the indicator for referral and further orthopaedic assessment. This report provides, for the first time information about the variability of back morphology in “normal” juveniles which is worth knowing when a child is examined for juvenile scoliosis.
Three-dimensional MRI analysis of the skull morphometry in adolescent idiopathic scoliosis girls: A pilot study
Authors: Yeung H.Y.  , Shi L.  , Chu W.C.W.  , Man C.W.  , Cheng T.H.  , Hung V.W.Y.  , Lee K.M.  , Heng P.A.  , Ng B.K.W.  , Cheng J.C.-Y.
Published: February 2025

The parietal bone contour was more prominent while occipital bone contour was significantly smaller in adolescent idiopathic scoliosis (AIS) subjects. AIS also had shorter hypophyseal fossa and longer clivus in the basicranium when compared with normal controls. These observations can be accounted by a mismatch between membranous (calvarium) and endochondral (basicranium) ossification, which affecting the skull and vertebral column as a systemic process of abnormal skeletal growth in AIS. Abnormal skeletal growth in Adolescent Idiopathic Scoliosis (AIS) girls is observed in the vertebral column with a mismatch between endochondral and membranous ossifications. This study sought to investigate whether an abnormal growth pattern also affecting the skull resulting in morphological differences in the calvarium and basicranium between AIS girls and normal controls. The analysis was based on high resolution magnetic resonance imaging (MRI) and computer-assisted morphometric analysis. MRI images of the whole skull were obtained from 28 AIS girls (age 12–18, Cobbs angle >40 degrees) and 18 matched healthy controls. First, the shape of the calvarium (formed by membranous ossification) was assessed by computer-assisted 3D morphometric analysis with shape description. The configuration of basicranium (formed by endochondral ossification and without clear boundary on 3D image) was assessed on the best mid-sagittal image with both linear and angular measurements of the pre-defined anatomical points on the skull base. For the calvarium, the occipital contour was significantly smaller while the left parietal contour was more prominent in AIS subjects (Recursive feature elimination for support vector machine, SVM_RFE). For the basicranium, the length of hypophyseal fossa housing the pituitary gland was significantly shorter in AIS girls (p<0.05) and the length of clivus including the basioccipital synchondrosis was significantly longer in AIS girls (p<0.05). The present study suggests that abnormal skeletal growth is a systemic process in AIS, affecting not only their vertebral columns but also their skulls. These could be accounted by a mismatch between membranous (circumferential growth of vertebral column and calvarium) and endochondral (longitudinal growth of vertebral column and basicranium) ossification. The clinical significance of morphometric changes of the calvarium and basicranium is closely related to whether corresponding changes are present in the underlying cerebral structures.
Normal expression of melatonin receptors (MT1, MT2) in BMSCs from adolescent idiopathic scoliosis patients and its significance
Authors: Li Haibo  , Wang Weijun  , Sun Guangquan  , Cheng Jack Chun-Yiu  , Qiu Yong
Published: February 2025

A melatonin deficiency has been suggested being at the source of adolescent idiopathic scoliosis (AIS). However, the relevance of melatonin in the etiopathogenesis of that condition is controversial. There is evidence shows melatonin signaling dysfunction in osteoblast from adolescent idiopathic scoliosis patients. But no study investigates melatonin signaling pathway in BMSCs. To study melatonin receptors (MT1, MT2) expression and to explore its significance in BMSCs from AIS patients. Eighteen AIS patients and ten volunteers were included. From anterior superior iliac spine, the human bone marrow was obtained with anticoagulation by heparine. And the MSCs were isolated by density gradient centrifuge from the mononuclear cells, and then were cultivated and serial subcultivated in vitro. Expression intensity of melatonin receptors(MT1, MT2) of BMSCs from the two groups was detected by RT-PCR. Flow cytometry demonstrated that the expanded mononuclear cells expressed mesenchymal stem cell markers. There was no statistical difference of melatonin receptors expression in BMSCs between AIS group and the controls (P>0.05). Melatonin receptors expression in BMSCs from adolescent idiopathic scoliosis patients is normal, which provides foundation for further study of melatonin signaling pathway in BMSCs.
Thoracic Kyphosis Angle Measurements with ISIS2
Authors: Berryman F.  , Pynsent P.  , Fairbank J.
Published: February 2025

Thoracic kyphosis angle measurements using surface topography with ISIS2 were carried out to estimate the inherent variability in the parameter caused by natural change in the patient's stance, breathing and muscle tension. A mean kyphosis angle of 33.8° (sd 13.4°, range 6°–66°) was measured from repeat tests on 61 patients. The mean difference between the pairs of measurements was −0.02° (sd 3.18°) and the 95% tolerance limits were −7.41° to 7.38°. This variability is lower than the clinically significant change in kyphosis angle reported in the literature. Thus kyphosis angle in ISIS2 is suitable for monitoring progress in kyphotic deformities.
Open Source Electronic Health Record and Patient Data Management System for Intensive Care
Authors: Massaut Jacques  , Reper Pascal
Published: February 2025

Background and objectives: In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components.Methods: The software was designed as a client–server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Results: Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. Conclusion: The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.
Health networks: actors, professional relationships, and controversies
Authors: Artoisenet Caroline  , Roland Michel  , Closon Marie-Christine
Published: February 2025

In recent years international policies have aimed to stimulate the use of information and communication technologies (ICT) in the field of health care. Belgium has also been affected by these developments and, for example, health electronic regional networks (“HNs”) are established. Thanks to a qualitative case study we have explored the implementation of such innovations (HN) to better understand how health professionals collaborate through the HN and how the HN affect their relationships. Within the HNs studied a common good unites the actors: the continuity of care for a better quality of care. However behind this objective of continuity of care other individual motivations emerge. Some controversies need also to be resolved in order to achieve cooperative relationships. HNs have notably to take national developments into account. These developments raise the question of the control of medical knowledge and medical practice. Professional issues, and not only practical changes, are involved in these innovations.
Paper Prototypes for the Detection of Stereotype Violations in (Medical) Device Operation – Are They Good Enough?
Authors: Hallbeck M. Susan  , Koneczny Sonja  , Smith Justine
Published: February 2025

Controls for most technologies, including medical devices, are becoming increasingly complex, difficult to intuitively understand and don't necessarily follow population stereotypes. The resulting delays and errors are unacceptable when seconds can mean the difference between life and death. In this study participants were asked to “control” a system using a paper prototype (color photographs of controls) and then with a higher fidelity prototype of the same physical controls to determine performance differences among ethnicities and genders. No ethnic nor gender differences were found, and the comparison of paper versus higher fidelity prototypes also showed no significant differences. Thus, paper prototypes can be employed as an early device design usability tool to illustrate stereotype violations long before the first physical prototype. This will not only save money in the development and design processes, but also makes sure that even the most complex devices are intuitively understandable and operable for their basic functions.
Teleimmersive Environment for Remote Medical Collaboration
Authors: Kurillo Gregorij  , Bajcsy Ruzena  , Kreylos Oliver  , Rodriguez Rodny
Published: February 2025

We present the work in progress on teleimmersive framework that would allow doctors to collaborate in more natural way by being immersed in the virtual space along with the medical data they could examine and discuss with remotely located colleagues. The system consists of multiple cameras, hand tracking with gesture recognition, and virtual reality system to support volume visualization and 3D interaction with medical data.
EYESi Ophthalmoscope – A Simulator for Indirect Ophthalmoscopic Examinations
Authors: Schuppe Oliver  , Wagner Clemens  , Koch Frank  , Männer Reinhard
Published: February 2025

We present a training simulator for indirect ophthalmoscopy. An optical tracking system is used to reconstruct the position of a lens mockup and a model of the patient's face. Refraction and illumination are computed in real-time and displayed on a head-mounted display using augmented reality. A case database completes the training system which allows to practise the examination and to study clinical patterns.
A Survey of Simulators for Palpation Training
Authors: Zhang Yan  , Phillips Roger  , Ward James  , Pisharody Sandhya
Published: February 2025

Palpation is a widely used diagnostic method in medical practice. The sensitivity of palpation is highly dependent upon the skill of clinicians, which is often difficult to master. There is a need of simulators in palpation training. This paper summarizes important work and the latest achievements in simulation for palpation training. Three types of simulators; physical models, Virtual Reality (VR) based simulations, and hybrid (computerized and physical) simulators, are surveyed. Comparisons among different kinds of simulators are presented.
Advanced Finite Element Mesh Model of Female SUI Research During Physical and Daily Acitivities
Authors: Zhang Yingchun  , Sweet Robert M.  , Metzger Gregory J.  , Burke Daniel  , Erdman Arthur G.  , Timm Gerald W.
Published: February 2025

With a goal towards dynamic subject-specific mechanical characterization of the etiology of stress urinary incontinence (SUI) in females during physical or daily activities, a finite element (FE) mesh model generation procedure has been developed to build the subject-specific FE model of the female pelvis from multiple high resolution magnetic resonance (MR) acquisitions with varying contrasts. The advanced female pelvis FE model was developed by using this procedure which consisted of over 35 anatomical parts including: 10 pelvic muscles, 10 pelvic ligaments, 6 pelvic bones, skin, fat tissue, bladder, urethra, uterus, vagina, colon, rectum, anus etc. basically all the major parts of the female pelvis. This comprehensive pelvis model is ready to be used to characterize relative relationships and structures during the physical activities that elicit SUI during activities of daily living.
Characterization of a Pneumatic Balloon Actuator for Use in Refreshable Braille Displays
Authors: Fan Richard E.  , Feinman Adam M.  , Wottawa Christopher  , King Chih-Hung  , Franco Miguel L.  , Dutson Erik P.  , Grundfest Warren S.  , Culjat Martin O.
Published: February 2025

Many existing refreshable Braille display technologies are costly or lack robust performance. A process has been developed to fabricate consistent and reliable pneumatic balloon actuators at low material cost, using a novel manufacturing process. This technique has been adapted for use in refreshable Braille displays that feature low power consumption, ease of manufacture and small form factor. A prototype refreshable cell, conforming to American Braille standards, was developed and tested. The cell was fabricated from molded PDMS to form balloon actuators with a spin-coated silicone film, and fast pneumatic driving elements and an electronic control system were developed to drive the Braille dots. Perceptual testing was performed to determine the feasibility of the approach using a single blind human subject. The subject was able to detect randomized Braille letters rapidly generated by the actuator with 100% character detection accuracy.
National Health Information Management/Information Technology Strategies in Hong Kong, Taiwan and Singapore
Authors: Zhu Julia Yinxin  , Protti Denis J.
Published: February 2025

A national health information management/information technology (IM/IT) strategy is crucially important for a country in planning and implementing healthcare priorities. However, little comparative research has been performed in this area, especially in Asian countries. This paper reviews, assesses and compares the healthcare systems, as well as the national health IM/IT initiatives and strategies in Hong Kong, Taiwan and Singapore. Although the proportion of public and private health services, IT infrastructure development, and government involvement in these three jurisdictions are different, they experience similar challenges with limited resources. By outlining the approaches being taken in the three Asian jurisdictions, this paper provides comparison, evaluation and insights that may be useful to other jurisdictions.
Anemia Analyzer: Algorithm and Reflex Testing in Clinical Practice Leading to Efficiency and Cost Savings
Authors: Haq Samir M.
Published: February 2025

Anemia is a common disease affecting about 3.5 million people in the United States. In present day clinical practice, a clinician makes a diagnosis of anemia based on low hemoglobin levels discovered during a complete blood count (CBC) test. If the etiology of the anemia is not readily apparent, the clinician orders additional testing to discover the cause of the anemia. Which tests are ordered, in what order these tests are run, and how the information gathered from the tests is used is based primarily on the individual physician's knowledge and expertise. Using this system to determine the cause of anemia is not only labor and resource intensive but it carries a potential for morbidity and an occasional mortality. Utilizing previously published data, we created an algorithmic approach to analyze the cause of anemia in the majority of cases. The algorithm accepts as input three parameters from a CBC test: (1) mean corpuscular volume, (2) red cell distribution width, and (3) reticulocyte count. With these three parameters, the algorithm generates a probable etiology of the anemia. Additionally, the algorithm will automatically order reflex tests needed to confirm the diagnosis. These reflex tests can be modified depending on the policies of the institution using the algorithm, as different institutions may order different tests based on availability and costs. This is a simple algorithm that could be integrated into the CBC test output. When a low hemoglobin level is found, the algorithm suggests the probable etiology and orders reflex tests if they are desired. Such an approach would not only provide cost efficiency and time savings but would also elevate the level of every clinician ordering a CBC to that of an expert hematologist.
Scenario-based Testing of Health Information Systems (HIS) in Electronic and Hybrid Environments
Authors: Borycki Elizabeth M.  , Kushniruk Andre W.
Published: February 2025

Researchers have identified sources of technology-induced errors involving health information systems (HIS) across the software development lifecycle. In this paper the authors review approaches to identifying technology-induced error and describe, compare and contrast the advantages and disadvantages of using predictive and post-implementation methodologies to identify technology-induced error. Following this, the authors focus upon clinical simulations using scenario-based testing as a methodology for diagnosing technology-induced errors to assess HIS ability to respond to the stresses and strains of health professionals using such systems in real-world clinical settings.
Getting to 100%: A Framework to Define and Reach Target Order Entry Rates
Authors: Pattullo Andy  , Jamieson Peter  , Kraft Scott  , Robert Jill  , Ross Sheri  , Abelseth Greg  , Rosenal Tom
Published: February 2025

Following a detailed review of orders entered into a clinical information system, we propose a framework to define computerized physician order entry types and a more useful formula for calculating order entry rate.
Integrating Evidence-Based Interventions into Client Care Plans
Authors: Doran Diane  , Carryer Jennifer  , Paterson Jane  , Goering Paula  , Nagle Lynn  , Kushniruk Andre  , Bajnok Irmajean  , Clark Carrie  , Srivastava Rani
Published: February 2025

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory – Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.
Virtual Reality Rehabilitation of Spatial Abilities after Brain Damage
Authors: Koenig Sebastian T.  , Crucian Gregory P.  , Dalrymple-Alford John C.  , Dünser Andreas
Published: February 2025

Current rehabilitation of navigation and spatial orientation ability after brain damage is generally focused on training within the rehabilitation hospital or the patient's home as part of common physio- and occupational therapy sessions. To further promote generalization of gained abilities and to quantify functional improvements, this project aims at developing a Virtual Reality (VR) application that can be used for training and assessment of spatial orientation and navigation skills in brain-damaged patients. The training is administered after the standard hospital rehabilitation training is completed. Additionally, the program will be used as an assessment tool to quantify the participants' wayfinding performance. The data will be compared with real-world navigation performance in tasks of similar complexity to evaluate real-world transfer of the VR training. Currently, the application is under development and basic functionality and data acquisition are being implemented.
The Receptiveness of Stress Management Techniques by Military Personnel
Authors: Stetz Melba C.  , Bouchard Stéphane  , Wiederhold Brenda K.  , Riva Giuseppe  , Folen Raymond A.
Published: February 2025

Many military service members suffer from stress. Sixty Soldiers participated in a study designed to test receptivity to stress management techniques. Preliminary analyses of surveys and a focus group suggested that participants not only liked practicing relaxation techniques but would also continue practicing these after completion of the present study.
EEG, HRV and Psychological Correlates while Playing Bejeweled II: A Randomized Controlled Study
Authors: Russoniello Carmen V.  , O'Brien Kevin  , Parks Jennifer M.
Published: February 2025

Stress related medical disorders such as cardiovascular disease, diabetes, depression, and anxiety are serious medical issues that can cause disability and death. Interventions to prevent their development and exacerbation are needed. Casual video games (CVGs) are fun, easy to play, spontaneous and tremendously popular. People report that they play these games because they decrease their stress and improve their mood. This study tested this theory by comparing people playing Bejeweled II a popular CVG with control subjects measured under similar conditions. Electroencephalographic (EEG) changes after playing Bejeweled II were consistent with increased mood and corroborated with similar findings on psychological reports. Moreover, heart rate variability (HRV) changes consistent with autonomic nervous system relaxation or decreased physical stress were also recorded. It is concluded, therefore, that playing a CVG like Bejeweled II can increase mood and decrease stress. These finding have broad implications and include the potential development of prescriptive interventions using Bejeweled II to prevent and treat stress related medical disorders. Finally, these findings demonstrate a method using EEG, HRV and psychological correlates to understand the psychophysiological or cybernetic interconnection between participant and video game.
Semantic and Gender Priming in Frontotemporal Dementia
Authors: Repetto Claudia  , Manenti Rosa  , Cappa Stefano  , Miniussi Carlo  , Riva Giuseppe
Published: February 2025

Modifications of language processing can be observed both in normal aging and in the most common forms of degenerative dementia, such as Alzheimer's disease and the spectrum of frontotemporal dementias. The present experiment tests at the same time semantic and syntactic aspects of language processing in patients with frontotemporal dementia, using an online paradigm that allows researchers to evaluate the real linguistic competence of the patients.
Designing an Ecological and Adaptable Virtual Task in the Context of Executive Functions
Authors: Klinger Evelyne  , Cao Xue  , Douguet Anne-Sophie  , Fuchs Philippe
Published: February 2025

Brain damage is a major cause of disability that often leads to deficits in Executive Functions (EF) with dramatic consequences on activities of daily living. While rehabilitation approaches of the dysexecutive syndrome are still limited, Virtual Reality (VR) has shown its potential to propose innovative intervention strategies based on ecologically valid functional tasks. The purpose of this paper is to present the design process of the Therapeutic Virtual Kitchen (TVK) in which ecological and adaptable virtual tasks may be configured by the therapists for patients' assessment and rehabilitation. The outcomes of a preliminary test of feasibility among members of our laboratory and Kerpape Rehabilitation Center are reported and discussed.
A New Protocol Test For Physical Activity Research In Obese Children (Etiobe Project)
Authors: Guixeres Jaime  , Zaragozá Irene  , Alcañiz Mariano  , Gomis-Tena Julio  , Cebolla Ausiàs
Published: February 2025

A new protocol is presented to validate TIPS (portable physiological monitoring device designed by I3BH that can get respiration, ecg and activity of the patient) for physical habits detection. Physiological and activity parameters and data from questionnaires have been acquired from a group of obese & non-obese children (n=20). Children completed activities from sedentary level to vigorous level. Preliminary results show variability on the response of children's effort and feasibility of TIPS platform as an ambulatory tool.
The SNaP Framework: A VR Tool for Assessing Spatial Navigation
Authors: Annett Michelle  , Bischof Walter F.
Published: February 2025

Recent work in psychology has leveraged the power of Virtual Reality (VR) to study the deterioration of navigation abilities in the elderly. Much of this research has focused on determining the behavioral measurements and paradigms appropriate for such diagnoses. We present a system, the Spatial Navigation Paradigm (SNaP) framework, which can be used to implement a battery of spatial navigation paradigms. This framework integrates a popular VR environment development platform with an extensible representation medium to allow for the precise control of paradigms, the switching between input and output devices, and the recording of accurate behavioral measurements. A preliminary study of the framework indicates that novice and expert VR users are able to quickly and easily specify and deploy experiments and that expert VR users can easily modify and extend existing paradigm implementations.
High Resolution 3D Models for the Teaching of American Sign Language
Authors: Odor Alberto
Published: February 2025

Millions of Americans in all age groups are affected by deafness and impaired hearing. They communicate with others using the American Sign Language (ASL). Teaching is tutorial (person-to-person) or with limited video content. We believe that high resolution 3D models and their animations can be used to effectively teach the ASL, with the following advantages over the traditional teaching approach: a) signing can be played at varying speeds and as many times as necessary, b) being 3-D constructs, models can be viewed from diverse angles, c) signing can be applied to different characters (male, female, child, elderly, etc.), d) special editing like close-ups, picture-in-picture, and phantom movements, can make learning easier, and e) clothing, surrounding environment and lighting conditions can be varied to present the student to less than ideal situations.
Robot therapy for stroke survivors: proprioceptive training and regulation of assistance
Authors: Sanguineti Vittorio  , Casadio Maura  , Vergaro Elena  , Squeri Valentina  , Giannoni Psiche  , Morasso Pietro G.
Published: February 2025

Robot therapy seems promising with stroke survivors, but it is unclear which exercises are most effective, and whether other pathologies may benefit from this technique. In general, exercises should exploit the adaptive nature of the nervous system, even in chronic patients. Ideally, exercise should involve multiple sensory modalities and, to promote active subject participation, the level of assistance should be kept to a minimum. Moreover, exercises should be tailored to the different degrees of impairment, and should adapt to changing performance. To this end, we designed three tasks: (i) a hitting task, aimed at improving the ability to perform extension movements; (ii) a tracking task, aimed at improving visuo-motor control; and (iii) a bimanual task, aimed at fostering inter-limb coordination. All exercises are conducted on a planar manipulandum with two degrees of freedom, and involve alternating blocks of exercises performed with and without vision. The degree of assistance is kept to a minimum, and adjusted to the changing subject's performance. All three exercises were tested on chronic stroke survivors with different levels of impairment. During the course of each exercise, movements became faster, smoother, more precise, and required decreasing levels of assistive force. These results point to the potential benefit of that assist-as-needed training with a proprioceptive component in a variety of clinical conditions.
Benchmarking by the RAFAELA Patient Classification System – a Descriptive Study of Optimal Nursing Intensity Levels
Authors: Fagerström Lisbeth
Published: February 2025

The overall aim of the RAFAELA system is that the personnel resources should be in balance with the patients' caring needs, i.e. when the nursing intensity per nurse is on the optimal level of the unit. The RAFAELA system consists of three parts: the OPCq (Oulu Patient Classification Qualisan) instrument for measuring the nursing intensity, registration of the daily nursing resources and the PAONCIL (Professional Assessment of Optimal Nursing Care Intensity Level) method. The aim of this paper is (1) to describe the structure of benchmarking with the RAFAELA system and (2) to present comparisons of optimal nursing intensity levels in Finnish hospitals by using data from RAFAELA benchmarking reports in 2001. Totally 86 wards from 14 different hospitals in Finland took part in the study, the optimal nursing intensity had been decided for 53 wards. Data was analyzed using descriptive statistics. The average workload was on adult wards 25.2 NCI points per nurse. The optimal NCI was exceeded during 48% of the days and under during 22% of the days. An imbalance between nursing intensity and personnel resources clearly affects the care quality and the results. Benchmarking with the RAFAELA system provides nurse managers with many opportunities in their decision processes in human resource management.
“When Quality and Computers Meet” – Construction of a Computerized Nursing Quality Indicators' Scale for Departmental Self-Monitoring and Improvement of Quality of Care
Authors: Cohen Rachel  , Fish Miri  , Peri Henia  , Niv Galia  , Kedem Koby  , Nir Eli  , Kagan Ilya
Published: February 2025

In recent years, computerized information systems have become one of the most important tools for promoting, developing and supporting quality improvement in healthcare. The unique contribution of these systems is related to the collection, storage and analysis of data as well as user-friendly and sophisticated access to end-users. Israel's nursing system has yet to fully implement the use of these systems in order to facilitate systematic measurement and improvement of nursing care quality.
Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls
Authors: Hurley Ann C.  , Dykes Patricia C.  , Carroll Diane L.  , Dykes John S.  , Middleton Blackford
Published: February 2025

This paper reports on the development and validation of a set of icons designed to communicate fall risk status and tailored interventions to prevent patient falls in hospitals. The icons will populate a fall prevention toolkit to provide actionable alerts to nurses, nursing assistants, and other interdisciplinary health care team members and educational materials for patients and families in acute hospital settings.
An IT Innovation for Individualizing Care: Success with Clinicians Leading the Way
Authors: Hook Mary L.  , Burke Laura J.  , Murphy Judy
Published: February 2025

In 2004, the Knowledge-based Nursing Initiative (KBNI) began as a partnership between a university-based college of nursing, an informatics vendor, and a large, integrated health care system. The goal was to develop a process for translating evidence into actionable recommendations, embedding the recommendations into the computerized decision support and documentation systems, and supporting nurses' use of the nursing process to individualize care. This paper will describe the essential administrative, information technology (IT), educational and clinical support activities that were used to deploy this innovation into the electronic health record (EHR) and workflow of nurses on two acute care medical pilot units in July of 2008. The project supported every nurse to document their evidenced-based practice with each patient contact and populate the EHR database with rich, nursing sensitive, retrievable data for quality improvement and research. The results included verifying data reliability and validity, evaluating go-live preparation, and summarizing the qualitative and quantitative findings. Two critical factors that made this implementation a success were that the project had a transformational vision and that it was led by the clinical team and strongly supported by the IT team. The lessons learned in the adoption phase will be diffused to the rest of the health care system and beyond.
Documentation of Pain Management with TT- 2000+ in May 2008 Viewed from Clinical Nursing Practice
Authors: Asteljoki Sara  , Kesänen Jukka  , Pykälämäki Helena  , Korpela Sini-Vuokko  , Montin Liisa
Published: February 2025

Background: Electronic Patient Record (EPR) TT- 2000+ was implemented in Hospital Orton in January 2008. The software TT 2000+ was implemented in 2005. TT- 2000+ enables structured and specifically defined documentation in clinical nursing practice. Objectives: To describe the use of pain management documentation into TT- 2000+ and how the results can be implemented into clinical nursing practice. Can the results be used in development of clinical nursing practice? How does the evaluation of pain reflect into the number of documentation? Methods: The data were obtained from documentations made in May 2008 from patient groups that had undergone total hip arthroplasty and total knee arthroplasty. Results: The number of total hip arthroplasty patients was 60 and total knee arthroplasty patients 51. The total number of pain documentations with the group of THA's was 992 and with TKA's 913. Discussion: Due to the circumstances in May 2008, the numbers of documentation into the TT- 2000+ are inadequate. Therefore, the documentation needs further research within a longer period of time. Undefined and unified way of maintaining and recording should be considered in processing information in clinical practice.
Frequency and Types of Alerts for Antibiotic Prescribing in a Neonatal ICU
Authors: Sheehan Barbara  , Chused Amy  , Graham III Phillip L.  , Stetson Peter  , Currie Leanne
Published: February 2025

Sepsis in neonates is a significant problem that carries with it severe morbidity and mortality. Managing antibiotics in this population is therefore an important issue. We studied clinical alerts currently in place to support antibiotic prescribing in a neonatal intensive care unit in order to ensure that appropriate information is being provided in a way that is consistent with current recommendations. Data were obtained from our alerts tracking database. Alerts were described according to triggering orders and clinician recipients. We found that alerts most commonly associated with antibiotics are providing critical information regarding lab results and patient factors necessary in preventing adverse effects of these drugs. Clinician recipients of alerts are those responsible for entering orders and the information is being provided at the point of care.