bluuebunny/crossref_metadata_2025 huggingface dataset:
What are weight bias measures measuring? An evaluation of core measures of weight bias and weight bias internalisation
Authors: Stewart Sarah-Jane F , Ogden Jane
Published: July 2021

Research exploring weight bias and weight bias internalisation (WBI) is grounded upon several core measures. This study aimed to evaluate whether operationalisations of these measures matched their conceptualisations in the literature. Using a ‘closed card-sorting’ methodology, participants sorted items from the most used measures into pre-defined categories, reflecting weight bias and non-weight bias. Findings indicated a high degree of congruence between WBI conceptualisations and operationalisations, however found less congruence between weight bias conceptualisations and operationalisations, with scale-items largely sorted into non-weight bias domains. Recommendations for scale modifications and developments are presented alongside a new amalgamated weight bias scale (AWBS).
Hardiness and attitudes toward professional healthcare services: Implications for healthcare service utilization among Black American adults
Authors: James Drexler
Published: July 2021

This study ( N = 780) examines the indirect effects of hardiness—health locus of control (HLOC), health competence (HC), health value (HV)—on past-year healthcare provider visit via attitudes toward seeking and receiving professional healthcare services (ATSRPHS). Across four health domains (dental, general health, mental, vision), ATSRPHS mediated the indirect effect of (1) HV and (2) internal HLoC on past-year healthcare provider visit. ATSRPHS also mediated the indirect effect of external HLoC on past-year visit to healthcare provider visit for general medical, mental, and vision health. ATSRPHS did not mediate any indirect effect of HC on past-year healthcare provider visit. This research contributes to understanding determinants of healthcare service utilization among Black American adults.
The utility of a dual-phase, dual-energy CT protocol in patients presenting with overt gastrointestinal bleeding
Authors: Mohammadinejad Payam , Kwapisz Lukasz , Fidler Jeff L , Sheedy Shannon P , Heiken Jay P , Khandelwal Ashish , Wells Michael L , Froemming Adam T , Hansel Stephanie L , Lee Yong S , Inoue Akitoshi , Halaweish Ahmed F , McCollough Cynthia H , Bruining David H , Fletcher Joel G
Published: July 2021

Background

Due to their easy accessibility, CT scans have been increasingly used for investigation of gastrointestinal (GI) bleeding.

Purpose

To estimate the performance of a dual-phase, dual-energy (DE) GI bleed CT protocol in patients with overt GI bleeding in clinical practice and examine the added value of portal phase and DE images.

Materials and Methods

Consecutive patients with GI bleeding underwent a two-phase DE GI bleed CT protocol. Two gastroenterologists established the reference standard. Performance was estimated using clinical CT reports. Three GI radiologists rated confidence in GI bleeding in a subset of 62 examinations, evaluating first mixed kV arterial images, then after examining additional portal venous phase images, and finally after additional DE images (virtual non-contrast and virtual monoenergetic 50 keV images).

Results

52 of 176 patients (29.5%) had GI bleeding by the reference standard. The overall sensitivity, specificity, and positive and negative predictive values of the CT GI bleed protocol for detecting GI bleeding were 65.4%, 89.5%, 72.3%, and 86.0%, respectively. In patients with GI bleeding, diagnostic confidence of readers increased after adding portal phase images to arterial phase images ( p = 0.002), without additional benefit from dual energy images. In patients without GI bleeding, confidence in luminal extravasation appropriately decreased after adding portal phase, and subsequently DE images ( p = 0.006, p = 0.018).

Conclusion

A two-phase DE GI bleed CT protocol had high specificity and negative predictive value in clinical practice. Portal venous phase images improved diagnostic confidence in comparison to arterial phase images alone. Dual-energy images further improved radiologist confidence in the absence of bleeding.
Customizing a Program for Older Adults Living with Frailty in Primary Care
Authors: Rasiah Jananee , O’Rourke Tammy , Dompé Brian , Rolfson Darryl , Mansell Beth , Pereira Rachel , Chan Titus , McDonald Karen , Summach Anne
Published: July 2021

Coordination of primary care is essential to improving care delivery within health systems, especially for older adults with increased health/social needs. A program jointly funded by the Canadian Foundation for Healthcare Improvement and Canadian Frailty Network, was implemented in a nurse practitioner-led clinic to address the gap in frailty care for older adults. The clinic was situated within a health and social services organization with a mandate to enhance the quality of life of older adults living in the community. Through this program, a frailty assessment pathway and social/clinical prescriptions were implemented with necessary adaptations as a result of COVID-19.
Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications
Authors: Vatcharavongvan Pasitpon , Puttawanchai Viwat
Published: July 2021

Background

Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription.

Objective

This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs.

Methods

This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs.

Results

Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively).

Conclusion

Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.
Exploring the Predictors of Chinese College Students’ Entrepreneurial Intention
Authors: Mensah Isaac Kofi , Zeng Guohua , Luo Chuanyong , Xiao Zhiwu , Lu Mengqiu
Published: July 2021

The development and promotion of entrepreneurial behavior is an important ingredient in developing entrepreneurship ventures. This study examined the factors influencing college students’ intention to engage in entrepreneurial activities. Applying the Theory of Planned Behavior as the theoretical foundation the structural equation modeling technique through Smart PLS 3.0 was used to analyze the hypothesized relationship in this study. The results indicate that all the proposed research hypotheses were statistically supported. Specifically, entrepreneurial attitude, subjective norm, and perceived behavioral control were all significant in determining college students’ entrepreneurial intentions. Furthermore, it was demonstrated that entrepreneurial self-efficacy, entrepreneurial education, and student internship motivation (SIM) were also positive and significant predictors of college students’ entrepreneurial intention. The implications of these findings on the development of entrepreneurial programs and activities that will have a positive influence and encourage students to engage in entrepreneurial activities are discussed.
Mechanisms of Mental-Health Disparities Among Minoritized Groups: How Well Are the Top Journals in Clinical Psychology Representing This Work?
Authors: Adams Leah M. , Miller Adam Bryant
Published: July 2021

It has been known for decades that mental-health disparities exist among minoritized groups, including race, ethnicity, sexual identities, gender identity and expression, ability, and others. Theories and frameworks that incorporate stressors unique to the experiences of minoritized groups, such as the biopsychosocial model of racism and minority-stress model, offer testable mechanisms that may help explain, in part, mental-health disparities. However, research addressing mechanisms of these disparities is still scarce and is not well represented in top clinical psychology journals. In this review, we critically examine the extent to which top-tier clinical psychology journals publish work examining mechanisms of mental-health disparities among minoritized populations. We found that very few studies that address mechanisms of mental-health disparities have been published in top clinical psychology journals. We examine potential reasons for this and discuss recommendations for future research.
Accessing Global Capital Through Remittance: A Route to the Reconfiguration of the Peasant Mode of Production in Rural Eritrea
Authors: Beyan Temesgen Tesfamariam
Published: July 2021

Migration and its resultant remittance have become the two powerful forces of peasant transformation in Eritrea in the last decade. If the former is responsible for uprooting labor from land, the latter is a replacement value to what the labor would have produced from the land. Using qualitative data gathered through an ethnographic fieldwork in the peasant region, this article argues that these two forces—migration and remittance—have resulted in gradual divorce of peasants from their means of production, land, in ways that seemingly appear productive to the peasants, rural–urban migration and a new form of relationship between peasants and state. In general, the outcome of the entire process is the emergence of quasi-peasant society which no more depends on land for survival because remittance has provided them alternative source. Therefore, migration and remittance in Eritrea have not only resulted in massive uprooting of labor from the land, but also heavily reconfigured the peasant mode of production.
Should Leverage Models Employ Time Varying or Time Invariant Firm Factors? An Empirical Analysis of Indian Listed Firms
Authors: Singh Amit Kumar , Bansal Preeti , Haque Moon Moon
Published: July 2021

This study provides a comprehensive analysis of capital structure stability over long horizons for firms listed in India. It covers a period of 28 years from 1992 to 2019, leading to 20,371 firm-year observations to determine the relative significance of cross-firm leverage variation and time-series leverage variation. It also identifies the circumstances and industries when each type of variation emerges stronger. The study employs simple econometric tools along with financial modelling techniques in SPSS and Microsoft Excel. It was found that corporate leverages are sticky and predictable in the short run. Also, with an increase in a firm’s age, leverage stability increases. This study contributes to the existing literature by empirically establishing that leverages can also be persistent at high levels and identifying industries that are persistent at low and high leverages. The results show that persistence at low leverage is a common phenomenon; however, a few industries such as textile, construction, and metals and mining are persistent in their capital structures even at higher levels of leverage.
Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty With a Nonspherical Humeral Head and Inlay Glenoid in Elite Weight Lifters: A Prospective Case Series
Authors: Yalcin Sercan , Scarcella Michael , Everhart Joshua , Samuel Linsen , Miniaci Anthony
Published: July 2021

Background:

Weight lifting after total shoulder arthroplasty (TSA) can place significant stresses on implants that could lead to instability, loosening, and increased wear. A TSA system with nonspherical humeral head resurfacing and inlay glenoid—which improves the biomechanics and thus reduces instability, wear, and potential loosening—may be able to tolerate repetitive loads from weight lifting.

Purpose:

To determine clinical and radiographic outcomes after TSA in weight lifters.

Study Design:

Case series; Level of evidence, 4.

Methods:

We prospectively enrolled 16 weight lifters (mean ± SD age, 57.2 ± 7.8 years; 15 male) undergoing primary anatomic TSA (n = 17 shoulders, 1 staged bilateral) with nonspherical humeral head resurfacing and inlay glenoid replacement for glenohumeral osteoarthritis between February 2015 and February 2019. Exclusion criteria were rotator cuff deficiency, revision TSA, post-traumatic arthritis, and inflammatory arthritis. Outcome measures included the rate of return to weight lifting, results of patient-reported outcome measures (Penn Shoulder Score, Kerlan-Jobe Orthopaedic Clinic, and 12-Item Veterans RAND Health Survey), radiographic outcomes, and complication rate.

Results:

Follow-up was obtained on all patients at a mean of 38 months (range, 14-63 months). All patients returned to competitive weight lifting at 15.6 ± 6.9 weeks. Compared to the preoperative weight lifting level, at last follow-up patients reported performance at the following level: lighter weight, 1 (6%); same weight, 8 (50%); heavier weight, 7 (44%). Preoperative eccentric posterior glenoid wear was common (71% Walch B2 classification; 12/17), but posterior humeral subluxation improved at follow-up according to the Walch index (mean, 55.5% preoperative vs 48.5% postoperative; P < .001) and contact point ratio (mean, 63.9% preoperative vs 50.1% postoperative; P < .001). Pre- to postoperative improvements were seen in Penn Shoulder Score (44.3 vs 82.6; P < .001), Kerlan-Jobe Orthopaedic Clinic (50.6 vs 91.1; P < .001), and 12-Item Veterans RAND Health Survey physical component score but not mental component score. No signs of radiographic loosening were detected in follow-up images, nor were there any postoperative instability episodes or revision surgeries.

Conclusion:

There were substantial improvements in shoulder function and a high rate of return to weight lifting after TSA with a nonspherical humeral head resurfacing and inlay glenoid component. Radiographically, the humeral head centralized on the glenoid after surgery, and there was no evidence of component loosening at a mean 38-month follow-up.
A Scoping Review of Communication on Social Media - Breast Cancer
Authors: Shetty Nikhil , Yang Ye , Asan Onur
Published: July 2021

Communication on social media enables people to express their views freely and makes them a part of the larger community. Social media is a form of communication that has been adopted in the healthcare sector gradually. Similarly, breast cancer patients also use social media to gain information and support from their providers and fellow cancer survivors. This study presents a scoping review of qualitative and quantitative studies to show different communication themes. The scoping review identified 38 eligible articles. The review identified three themes from the selected articles: raising awareness, social support, and reliability. These themes show the general trends and concerns among breast cancer patients and the use of social media. Future research needs to address these themes to enhance the online patient experience and use social media for health-related activities.
Investigating the Key Persuasive Features for Fitness App Design and Extending the Persuasive System Design Model: A Qualitative Approach
Authors: Oyibo Kiemute
Published: July 2021

Physical inactivity has been recognized as one of the leading risk factors that account for many non-communicable diseases, with the World Health Organization labeling it as the fourth leading risk factor for global mortality. This has led researchers and developers to create fitness apps to support and motivate people to engage in physical activity more regularly. However, there is limited research on how collectivist and individualist users from different social and cultural backgrounds differ in terms of the persuasive features they care about in fitness apps. Having knowledge of the cultural differences will help designers and developers create better fitness apps tailored to the two main types of culture. Hence, we conducted an empirical study to uncover how both cultures differ and the possibility of extending the Persuasive System Design (PSD) model. We found that Primary Task Support (Self-Monitoring and Goal-Setting) is requested more by the individualist group than the collectivist group. On the other hand, Dialog Support (Reminder and Suggestion) is requested more by the collectivist group than the individualist group. Finally, we found that the PSD model can be extended with Goal-Setting and Verbal Persuasion for fitness app design.
Mapping Usability Heuristics to Medical Ethical Principles in Clinical Decision Support Design
Authors: Arnold Tim , Fuller Helen J.A. , Wood Scott D.
Published: July 2021

Human factors professionals voice concerns about the slow and uneven adoption of human-centered design (HCD) principles in healthcare. With good intentions and best efforts, human factors work in healthcare continues, but to understand and to be understood we must share a language that speaks to one another. One way to facilitate this understanding is by bringing attention to how we talk about decision-making approaches in medical ethics and HCD. Both disciplines suggest efforts should be participatory, guided by a set of principles applied thoughtfully, with critical consideration to context and trade-offs. Considering the connections between usability heuristics for design and medical ethical principles may offer a bridge between disciplines and their associated dialects. In this paper, we provide three representations mapping ethical principles to design principles, including usability heuristics: a word tree visualization, narrative passages, and a table format. We believe this mapping demonstrates both that ethical design is inherently human-centric and that human-centered design is ethical design.
Optimizing Electronic Health Records Through Readability
Authors: Ball Rachel V. , Miller Dave B. , Wallace Shaun , Macias Kathlyn Camargo , Ibrahim Mahmoud , Gonzaga Ernesto Robalino , Karasik Olga , Rohlsen-Neal Dekai R. , Barrientos Sarah , Ross Edward A. , Asmar Abdo , Hughes Ashley M. , Hancock Peter A. , Sawyer Ben D.
Published: July 2021

Medical professionals engage in an enormous and ever-increasing amount of reading in Electronic Health Records (EHRs), which may have adverse impacts on patient care. Personalized readability formats (PRFs) may help to accelerate reading these records, without training, and without adversely affecting comprehension in this critical task. Using History of Present Illness (HPI) reports written by physicians, we investigated how personalized fonts impacted medical text reading speed and comprehension. Crowd-workers without medical training read a set of eighth-grade level passages in six common fonts to determine their fastest and slowest fonts, which were then used to display a set of HPI reports and accompanying comprehension questions. Results showed that PRFs accelerated reading of medical passages by 15% while maintaining comprehension. This finding suggests that individualized information design like PRFs, and specifically font optimization, may be a straightforward way to optimize EHRs through readability. We see a future in which PRFs may help physicians in reading medical information, and look toward future studies investigating PRF impacts on medical professionals’ EHR reading.
Using Simulated Handover to Assess Team-Based Competencies in a Virtual Environment
Authors: Sadighi Mozhdeh , Lazzara Elizabeth H. , Michael Meghan , Hernandez Jessica , Chan Chrissy , Shields Ian H. , Preble Richard , Phelps Mary E. , Tannenbaum Scott , Greilich Philip
Published: July 2021

We utilized simulated patient scenarios in a virtual environment to improve students’ communication skills during handovers. To determine how students performed during the scenarios, we assessed several behaviors: structured communication, closed-loop communication, and asking clarification questions. Results revealed that the students’ performance was stronger in the first area (structure communication) and weaker in the second (closed-loop communication) and third (asking clarifying questions) areas.
Synergy: Development of an Interdisciplinary Curriculum for Clinical Learners and Design Students
Authors: Park Hannah , Lesselroth Blake
Published: July 2021

The complexity of problems in Health design demands trans-disciplinary efforts to be addressed and resolved. However, very few curricula in medical education involve collaboration with non-medical disciplines. The gaps between disciplines emerge as barriers to find innovative resolution in healthcare. The faculty members from the Department of Design and Department of Internal Medicine have been seeking ways to break discipline-centered silos and innovate educational modules for future clinicians and designers. The presentation will overview pedagogical strategies for co-education between medicine and design, institutional barriers that learners should aware of for co-education, and outcomes of the three collaboration projects.
Evaluating Psychosocial Support Provided by an Augmented Reality Device for Children With Type 1 Diabetes
Authors: Ullman Daniel , Phillips Elizabeth , Aladia Salomi , Haas Peter , Fowler Halle S. , Iqbal Iman S. , Mi Kaitlyn L. , Riches Isabel W. , Omori Maya , Malle Bertram F.
Published: July 2021

Type 1 diabetes (T1D), previously known as juvenile diabetes, has a large impact on everyday life and can pose a number of challenges for both children and their parents. A patient-centered design company, Sproutel, has designed and developed Jerry the Bear®—an interactive augmented reality (AR) stuffed animal toy bear designed to provide children with T1D with comfort and education about their diabetes management through play. We evaluated the AR device in a research study that involved participation over the course of approximately two weeks; the overall research project spanned three years and involved a variety of partners. We investigated whether Jerry the Bear offered psychosocial support to children with T1D and their parents and whether a new prototype version (equipped with audio feedback) offered any additional benefits. We conducted two versions of the study—a lab study ( n = 11) and a remote study without any in-person component ( n = 14). We found two major takeaways: (1) The results from the remote study closely paralleled the more time- and effort-intensive lab study, pointing to a promising avenue of research for hard-to-reach populations. (2) Jerry the Bear had a positive impact on children with T1D and their parents in almost all cases—in some the impact was more neutral, but never markedly negative. We did not find evidence for a consistent preference between the current Jerry the Bear and the new prototype. We also discuss the challenges of conducting rigorous research in highly specific target populations.
Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods
Authors: Attef Maryam , Cloutier Mireille , Gillespie Meredith , Trudel Chantal , Boycott Kym
Published: July 2021

This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.
Symbiotic Design Application in Healthcare: Preventing Hospital Acquired Infections
Authors: Li Mengyun , Morey Dane A. , Rayo Michael F.
Published: July 2021

Any clinical decision support (CDS) design project integrating computational technologies with clinician workflows will require the merging of multiple perspectives and fields of expertise in multidisciplinary teams. Much like the tools these teams aim to create, the team itself will need to continuously build, monitor, and repair a mutually beneficial relationship between each of its members. From our experience during the early development stages of an AI-enabled CDS tool for hospital-acquired infection (HAI) prevention, we abstract three central tenets of a symbiotic design process we have found to be vital for aligning goals, priorities, mental models, and techniques among a multidisciplinary team: (1) recurrent bottom-up feedback, (2) continual model (re-)alignment, and (3) openness to co-direction. With regards to these tenets, we discuss the successes and challenges our team has faced during the symbiotic design process through a series of vignettes and how these experiences coalescing diverse human design teams can influence the design of human-machine teams.
Incorporating Human Factors Into a Healthcare System’s COVID-19 Communication Strategy
Authors: Butler Rebecca L. , Hoobler Ann Katherine , Stein Lucy C. , Hoenig Erica S. , Lee Laura M. , Kellogg Kathryn M.
Published: July 2021

The COVID-19 era has been an age of change for healthcare systems worldwide. At the beginning of the pandemic in particular, there was a huge need to rapidly communicate new and constantly changing information with critical safety implications. Previously successful communication strategies were not adequate for this unprecedented challenge. At MedStar Health, the Quality & Safety team led a unique partnership between human factors experts, clinical teams, and the communications department to develop a three-pronged strategy for effective communication during the pandemic. This strategy incorporated the following components: 1) Using human factors and usability concepts to distill complex clinical information into easy-to-understand infographics for frontline associates; 2) Creating regular, succinct messaging to distribute the information and provide frequent updates throughout the healthcare system; and 3) Designing and maintaining a usable webpage where associates could access up-to-date information relevant to their specialty at any time, on or off the hospital network. This strategy, which was dynamic and adapted to user feedback, was supported by associates as a streamlined method for communicating important information throughout the pandemic.
Multi-Faceted Ergonomics Assessment in Medical Device Manufacturing: A Case Study
Authors: Saliu Bukola , McCrory Bernadette
Published: July 2021

Background: According to the National Safety Council and the Bureau of Labor Statistics there were over 4,000 preventable injury related deaths. The Occupational Health and Safety Administration emphasizes that safety cultures should consist of shared beliefs, practices, and attitudes that exist at an establishment. The purpose of this industry-sponsored research project was to assist a medical manufacturing facility with safety program OSHA compliance. Method: Job Safety Analysis (JSA), also ca lled job hazard analysis, and facility inspections were used to identify hazards focused on the worker, task, tools, and the work environment. Results: Areas with high hazard scores according to the JSA were a ssigned to supervisors and the research team to provide immediate process and environment changes. Conclusion: JSA is a great tool to identify safety hazards on a job site though job functions. This will prevent injuries and a llow even small companies to remain compliant with federal regulations. Creating an atmosphere from top to bottom with a culture of safety responsibility andownership can promote a safe and productive environment.
Usability Testing of Ultrasonic Surgical System for Lower Eyelid Fat Removal
Authors: Choi JeongUk , Park SangEun , Jang Wonseuk
Published: July 2021

This study shows the method and result on usability testing of ultrasonic surgical system for general liposuction & lower eyelid surgery. The purpose of the study is to validate whether UI risk mitigation controls are properly established and collected any opinions about the device. The quantitative data(task completion rate, the number of use error occurred, user satisfaction score) and qualitative data(subjective opinions via follow-up question) were collected. Due to simple how to use, few use errors were occurred. But the result from analyzing subjective data was different, several potential harms causing from the user interface were expected. These test results could help medical device designers to understand human factor considerations.
Using Visual Aids to Supplement Medical Instructions, Health Education, and Medical Device Instructions
Authors: Lee Katherine , Nathan-Roberts Dan
Published: July 2021

Objective:

To review the effects of visual aids on adherence, comprehension, and recall when used to supplement written or spoken information in medical instructions, health education, and medical device instructions and the effects on patients with low literacy levels.

Method:

Review of studies from medical instructions, health education, and medical device instructions to measure adherence, comprehension, and recall of written or spoken instructions, with or without visual aids.

Results:

The addition of visual aids to written or spoken instructions can positively impact adherence, comprehension, and recall, which can lead to better patient outcomes. Simpler, larger, quantitative, regional, and reinforcing visual aids provided the largest improvements, especially with patients with low literacy.
Implications for the Physical Design of the Postnatal Care Unit from a Targeted Analysis of Issues With Accessing the Bathroom at Night in the Acute Setting: A Secondary Analysis
Authors: Chirumamilla Varshita , Gerard Joseph M. , Sweeney Alison E. , Tully Kristin P. , Stuebe Alison M. , Patterson Emily S.
Published: July 2021

Assessing hospital environment conditions is necessary for healthcare providers and patients to coordinate safe care. The aims of this research included: a) identifying patterns in hospital visit feedback transcripts regarding bathroom doors and lights in the hospital room and b) interpreting the results to make recommendations for more enabling clinical environments. The methods used by the research team included organizing transcript data, assigning codes, and conducting an interrater reliability test to assess codebook efficacy. Finally, working with maternal and infant mortality experts, recommendations for the hospital were developed. We identified four possible interventions to address barriers: a) implement low-height, dimmable lighting along the base of the patient room, b) provide personal lights, such as penlights, to staff for nighttime assessments, c) install and improve on existing grab bars in patient room bathrooms and d) replace the standard patient room bathroom door with a different kind of auditory/visual privacy barrier.
Multi-Component Design of a Mobile Rehabilitation Application for Remote Monitoring of Patients
Authors: Bernard Shai , Daristotle Nick , Demises Yealshaday , Hearn Jesse , Malkastian Kohar , Moorhead Matt , Murph Imani , Oweida Phil , Taefi Naghmeh , Vaughn-Cooke Monifa , McLaughlin Anne , Kontson Kimberly
Published: July 2021

This paper a will provide background and research outcomes for a student-led multi-University motion capture design project with the FDA Human Device Interaction Lab. This research project spawned from the FDA’s interest in studying mobile Apps used to collect information about a rehabilitation patient’s function outside of a laboratory setting. This is particularly important from a research perspective as it allows knowledge to be gathered about the reliability, safety, and efficacy of such devices, which can later inform human factors guidelines and regulatory oversight. While there is a wide range of applications for remote monitoring of patient function, this project focuses specifically on wearables used to track rehabilitative progress of individuals suffering from upper or lower limb impairment. These wearables may also be used to assess the efficacy of a new assistive technology intended to restore or augment function. The interdisciplinary student teams applied human-centered design principles to develop and prototype hardware and software components for a rotatable body-worn mobile device holder to remotely track rehabilitation progress. The design process and outcomes are presented along with insights on further development of system components.
Can We Use Design Approaches to Increase Comfort and Reduce Suffering at End-of-Life: A Focused Literature Review
Authors: Schwellnus Meg , Trudel Chantal , Orosz Zsofia
Published: July 2021

End-of-life (EoL) care is often a difficult period for all involved: the person who is dying, their family and friends, and care providers. A review and analysis of literature on design for end-of-life care led to identifying common themes that may influence end-of-life experience, design categories which aim to support EoL care, and continuing challenges that may undermine EoL experience. An additional review researched impacts of the COVID-19 pandemic on EoL experiences. The results of both reviews are presented here, as well as some suggestions for future directions in EoL design.
Telemedicine Security: Challenges and Solutions
Authors: Fausett Crystal M. , Christovich Megan P. , Parker Jarod M. , Baker John M. , Keebler Joseph R.
Published: July 2021

The proliferation of telemedicine spurred by the COVID-19 pandemic has come with a variety of human factors challenges. Such challenges include mitigating potential risks associated with the quick transition to virtual care. We identify challenges and solutions related to telemedicine security, and analyze our results using Schlarman’s People, Policy, Technology framework (2001). Our systematic literature review synthesizes gray literature (white papers, news articles, and blog posts) in addition to formal (published) literature. This methodology closes the gap between academic research and professional practice and aids in providing timely, practical insights related to cybersecurity and safety in virtual care environments. As the transition from traditional care continues to develop, we seek to better understand emerging vulnerabilities, identify crucial cyber hygiene practices, and provide insights on how to improve the safety of patient data in virtual care. Telemedicine is here to stay, and lessons learned from the pandemic are likely to remain useful.
Prevalence of Surgical Flow Disruptions Across Intra-operative High- and Low-Workload Phases in Cardiac Surgery
Authors: Kennedy-Metz Lauren R. , Dias Roger D. , Phillips Annette M. , Shapeton Alexander , Zorca Suzana , Leissner Kay B. , Zenati Marco A.
Published: July 2021

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to be explored. Recent evidence suggests that preventable surgical errors often have a cognitive basis, warranting investigation into the association between SFDs and workload. This study aimed to characterize SFDs according to auditory and cognitive domains and further to compare the frequency and nature of SFDs within periods of high team cognitive workload and low team cognitive workload. Overall, the presence of cognitive distractions was associated more with high team cognitive workload states, while the frequency of auditory distractions was significantly higher during periods of low team cognitive workload states. Future work should consider the types, frequency, and sources of SFDs as well as their impact on surgical procedures and outcomes in order to devise appropriate methods to mitigate or manage potential disruptions to surgical workflow.
Social Media Influencer Effects on CSR Communication: The Role of Influencer Leadership in Opinion and Taste
Authors: Cheng Yang , Hung-Baesecke Chun-Ju Flora , Chen Yi-Ru Regina
Published: July 2021

With the prevalence of social media usage among consumers, brands have increasingly utilized paid social media influencer (SMI) endorsements in their corporate social responsibility (CSR) communication. However, how such practice generates positive consumer responses is not well understood. Drawing from signaling theory, social learning theory, and social identity theory, a structural equation model analysis was conducted to test our hypotheses and proposed model based on the survey data from 592 U.S. consumers. The research results suggest that a brand’s CSR initiatives, when endorsed by SMIs who are perceived as social media leaders in opinion and taste, directly enhance consumers’ CSR communication engagement about the initiatives and do so indirectly via the consumers’ reduced CSR skepticism. Reduced CSR skepticism and enhanced CSR communication engagement ultimately lead to the consumers’ brand loyalty, brand preference, and price premium. The study has implications for CSR advertising/social-mediated communication, SMI leadership, and SMI endorsement effects.
Book review: Luca Anceschi. (2020). Analyzing Kazakhstan’s Foreign Policy: Regime Neo-Eurasianism in the Nazarbayev Era
Authors: Sim Li-Chen
Published: July 2021

Luca Anceschi. (2020). Analyzing Kazakhstan’s Foreign Policy: Regime Neo-Eurasianism in the Nazarbayev Era. Routledge. 208 pp. ISBN: 9780415711432.
Rethinking Telerehabilitation: Attitudes of Physical Therapists and Patients
Authors: Saaei Fereshteh , Klappa Susan G
Published: July 2021

COVID-19 has accelerated the adoption of telehealth among various specialties, including rehabilitation. The fast-paced implementation of telerehabilitation has laid bare its challenges, providing an opportunity for innovation in order to enhance the experience of remote care. The purpose of this study sought to understand the attitudes toward telerehabilitation from physical therapist (PT) and patient perspectives. Two surveys administered to PTs, and the general patient population explored beliefs regarding telerehabilitation. There were a total of 289 participant responses in this study. There were 228 PT respondents and 61 patients who responded to the patient survey. Qualitative results describe current attitudes toward telerehabilitation. Results indicated both groups were receptive to virtual therapy sessions; however, some challenges were also reported. Current challenges and trends in utilizing telerehabilitation are further discussed.
Privacy, or the Lack Thereof, and Its Implications for Dignity in Mobile COVID-19 Testing
Authors: Neely Jennifer , Eddins Amani , Lesure Naomi , Dee Danielle , Real Raquel , Singer Rebecca , Crooks Natasha , Singer Randi B.
Published: July 2021

Introduction

Chicago’s COVID-19 Rapid Response Team (CRRT) is a decentralized, interprofessional group of nurses, residents, students, and faculty who provide free COVID-19 testing for those living or working in congregate settings (i.e., shelters, long term care facilities, prisons and encampments) due to their increased risk. Individuals within these vulnerable populations regularly experience stigma, a lack of privacy, and healthcare discrimination as they are often in low-income and underserved communities. The CRRT tests in settings that are necessarily large (cafeterias, meeting areas, gymnasiums, recreation rooms), and provide little physical privacy. Regardless of patient circumstances, respecting patient dignity is a professional standard of care, and patient privacy is consistent with that standard.

Methods

Guided by trauma-informed care techniques, emancipatory nursing practice, and cultural safety methodology, student members of the CRRT initiated a project focused on expanding physical privacy protection for those undergoing COVID-19 testing.

Conclusion

Though the introduction of a portable privacy screen started as an initiative to safeguard the dignity for underserved populations, this call to action implores current and future health care providers to prioritize the ethical treatment of those most vulnerable by advocating for patient dignity and privacy.
Genome-wide DNA methylation pattern in systemic sclerosis microvascular endothelial cells: Identification of epigenetically affected key genes and pathways
Authors: Nada Shadia , Kahaleh Bashar , Altorok Nezam
Published: July 2021

Background:

The etiology of systemic sclerosis is not clear, but there is evidence suggesting a critical role for epigenetic alterations in disease pathogenesis and clinical expression. We sought, in this study, to characterize the genome-wide DNA methylation signature in systemic sclerosis microvascular endothelial cells.

Methods:

We performed a genome-wide DNA methylation study in microvascular endothelial cells derived from seven diffuse cutaneous systemic sclerosis patients compared to seven age-, sex-, and ethnicity-matched healthy controls. We paired matched samples on Illumina HumanMethylation450 (three diffuse cutaneous systemic sclerosis microvascular endothelial cells and three controls), and reproduced the results in an independent set of matched patient and controls using Illumina Infinium MethylationEPIC (four diffuse cutaneous systemic sclerosis patients and four controls) to identify differentially methylated genes.

Results:

We identified 71,353 differentially methylated CpG sites in systemic sclerosis microvascular endothelial cells using Infinium MethylationEPIC microarray in the first group (0.081% of representative probes) and 33,170 CpG sites in the second group using HumanMethylation450 microarray (0.073% of representative probes) in diffuse cutaneous systemic sclerosis microvascular endothelial cells. Among the two groups of subjects, we identified differential methylation of 2455 CpG sites, representing 1301 genes. Most of the differentially methylated CpG sites were hypermethylated (1625 CpG), corresponding to 910 genes. Common hypermethylated genes in systemic sclerosis microvascular endothelial cells include NOS1, DNMT3A, DNMT3B, HDAC4, and ANGPT2. We also identified hypomethylation of IL17RA, CTNNA3, ICAM2, and SDK1 in systemic sclerosis microvascular endothelial cells. Furthermore, we demonstrate significant inverse correlation between DNA methylation status and gene expression in the majority of genes evaluated. Gene ontology analysis of hypermethylated genes demonstrated enrichment of genes involved in angiogenesis ( p = 0.0006). Pathway analysis of hypomethylated genes includes genes involved in vascular smooth muscle contraction ( p = 0.014) and adherens junctions ( p = 0.013).

Conclusion:

Our data suggest the presence of significant genome-wide DNA methylation aberrancies in systemic sclerosis microvascular endothelial cells, and identify novel affected genes and pathways in systemic sclerosis microvascular endothelial cells.
Resistance to Bruton tyrosine kinase inhibitors: the Achilles heel of their success story in lymphoid malignancies
Authors: Stephens Deborah M. , Byrd John C.
Published: July 2021

Bruton tyrosine kinase inhibitors (BTKi) have significantly changed the treatment landscape for patients with B-cell malignancies, including chronic lymphocytic leukemia, Waldenstrom macroglobulinemia, mantle cell lymphoma, and marginal zone lymphoma. Unfortunately, patients with BTKi-resistant disease have shortened survival. Clinical and molecular risk factors, such as number of prior therapies and presence of TP53 mutations, can be used to predict patients at the highest risk of developing BTKi resistance. Many mechanisms of BTKi resistance have been reported with mutations in BTK and phospholipase C γ2 supported with the most data. The introduction of venetoclax has lengthened the survival of patients with BTKi-resistant disease. Ongoing clinical trials with promising treatment modalities, such as next-generation BTKi and chimeric antigen receptor T-cell therapy, have reported promising efficacy in patients with BTKi-resistant disease. Continued research focusing on resistance mechanisms and methods of how to circumvent resistance is needed to further prolong the survival of patients with BTKi-resistant B-cell malignancies.
Comparisons within the Rice GA 2-Oxidase Gene Family Revealed Three Dominant Paralogs and a Functional Attenuated Gene that Led to the Identification of Four Amino Acid Variants Associated with GA Deactivation Capability
Authors: Hsieh Kun-Ting , Chen Yi-Ting , Hu Ting-Jen , Lin Shih-Min , Hsieh Chih-Hung , Liu Su-Hui , Shiue Shiau-Yu , Lo Shuen-Fang , Wang I-Wen , Tseng Ching-Shan , Chen Liang-Jwu
Published: July 2021

Background

GA 2-oxidases (GA2oxs) are involved in regulating GA homeostasis in plants by inactivating bioactive GAs through 2β-hydroxylation. Rice GA2oxs are encoded by a family of 10 genes; some of them have been characterized, but no comprehensive comparisons for all these genes have been conducted.

Results

Rice plants with nine functional GA2oxs were demonstrated in the present study, and these genes not only were differentially expressed but also revealed various capabilities for GA deactivation based on their height-reducing effects in transgenic plants. Compared to that of wild-type plants, the relative plant height (RPH) of transgenic plants was scored to estimate their reducing effects, and 8.3% to 59.5% RPH was observed. Phylogenetic analysis of class I GA2ox genes revealed two functionally distinct clades in the Poaceae. The OsGA2ox3, 4, and 8 genes belonging to clade A showed the most severe effect (8.3% to 8.7% RPH) on plant height reduction, whereas the OsGA2ox7 gene belonging to clade B showed the least severe effect (59.5% RPH). The clade A OsGA2ox3 gene contained two conserved C186/C194 amino acids that were crucial for enzymatic activity. In the present study, these amino acids were replaced with OsGA2ox7-conserved arginine (C186R) and proline (C194P), respectively, or simultaneously (C186R/C194P) to demonstrate their importance in planta. Another two amino acids, Q220 and Y274, conserved in OsGA2ox3 were substituted with glutamic acid (E) and phenylalanine (F), respectively, or simultaneously to show their significance in planta. In addition, through sequence divergence, RNA expression profile and GA deactivation capability analyses, we proposed that OsGA2ox1, OsGA2ox3 and OsGA2ox6 function as the predominant paralogs in each of their respective classes.

Conclusions

This study demonstrates rice has nine functional GA2oxs and the class I GA2ox genes are divided into two functionally distinct clades. Among them, the OsGA2ox7 of clade B is a functional attenuated gene and the OsGA2ox1, OsGA2ox3 and OsGA2ox6 are the three predominant paralogs in the family.