bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of medication regimen complexity with medication adherence and clinical outcomes in patients with chronic obstructive pulmonary disease: a prospective study
Authors: He Ruoxi , Wang Ye , Ren Xiaoxia , Huang Ke , Lei Jieping , Niu Hongtao , Li Wei , Dong Fen , Li Baicun , Yang Ting , Wang Chen
Published: October 2023

Background:

High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge.

Methods:

Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities.

Results:

Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7−13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52−0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57−0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27−2.11) and readmission (OR, 1.57; 95% CI, 1.17−2.10).

Conclusion:

MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission.

Registration:

ClinicalTrials.gov identifier: NCT02657525.
Generous Pride: The Emotion of Pride in Philippians
Authors: Blois Isaac D.
Published: October 2023

This study draws on the modern psychological distinction between “bad pride” and “good pride” in order to elucidate the apostle Paul’s balanced presentation in Philippians 3 of a version of self-confidence that is negative (i.e., “placing confidence in the flesh”) in contrast with a version of approved boasting into which the believing community is invited (i.e., “boasting in Christ Jesus,” Phil 3:3). Hubristic, or bad, pride connects with a version of social engagement that is inevitably competitive and therefore self-seeking. Through Paul’s own model, as well as through that of Christ himself, such a version of pride is to be rejected by believers. On the other hand, the experience of being in Christ furnishes the opportunity to orient one’s emotion of pride outside of the self, becoming entangled in Christ and his community. Paul uses this good version of pride as a way to safeguard the Philippian community from the potential threat of opponents who would seek to draw them away from Christ and back onto a self-produced version of identity and value.
Diagnostic challenge in a case of foul-smelling vaginal discharge in a newly attained menarche girl
Authors: Tee Vincent , Ng Ca W , Ismail Ahmad A , Che Hashim Noor AH , Afendi Nik R
Published: October 2023

Foul-smelling vaginal discharge in adolescents often stems from infectious origin, foreign body insertion, neoplasm, congenital anomaly, and sexual abuse. Diagnosing the causes of the discharge remains challenging, especially in cases where sexual and reproductive health awareness is relatively low in the population from marginalized ethnographies and socio-cultural backgrounds. Suspicion of sexual abuse must be explored carefully and sensitively. A history of sexual exposure might not be forthcoming in adolescents where premarital sex is frowned upon. The process of eliciting the causation may be a challenge to healthcare professionals, delaying the diagnosis and subsequent management. In rare circumstances, imaging studies may help confirm the origin of the infection, giving insight into the presentation’s aetiology. We describe a case of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome presented with foul-smelling vaginal discharge in a newly attained menarche girl in the North-East region of Peninsular Malaysia. We also discussed the theories and reasons behind the occurrence of such a presentation, along with the diagnostic dilemma in this current case.
Exploring the barriers and facilitators for supporting adolescents with knee pains adherence to mobile health apps: A think-aloud study
Authors: Johansen Simon Kristoffer , Kanstrup Anne Marie , Thomsen Janus Laust , Christensen Mads Norre , Rathleff Michael Skovdal
Published: October 2023

Background

Mobile health (mHealth) applications have the potential to support adolescents’ self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents.

Objective

This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles.

Methods

Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles.

Results

The analysis based on user testing with adolescents with knee pain identified three themes: “user experience and feedback,” “contextual challenges,” and “new features” and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs.

Conclusion

Participants’ motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents’ cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.
Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities
Authors: Camacho David , Bhattacharya Anindita , Moore Kiara , Aranda Maria P , Lukens Ellen P
Published: October 2023

In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.
Childhood Psychological Maltreatment, Mindful Awareness, Self-Transcendence, and Mental Well-Being in Emerging Adults
Authors: Arslan Gökmen , Kabasakal Zekavet , Taş Besra
Published: October 2023

Psychological maltreatment is a severe form of abuse that can have a significant negative impact on an individual’s mental health and well-being. Examining the factors that reduce the negative effects of child maltreatment on the outcomes can, hence, contribute to the development of effective prevention and intervention strategies, providing resources and support for families, early detection, and education for parents and caregivers. The present study aimed to explore the mediating role of mindful awareness and self-transcendence in the association between childhood psychological maltreatment and mental well-being among Turkish emerging adults. The study sample consisted of 422 emerging adults enrolled in a state university in Türkiye (with 65% of female). Participants ranged in age from 18 to 29 years, with a mean age of 20.94 years ( SD = 1.86). The present study found that psychological maltreatment was not only directly associated with lower levels of mindful awareness and self-transcendence, but also indirectly associated with poorer mental well-being through the mediating effects of these variables. The study suggests that childhood psychological maltreatment is a significant risk factor for mental well-being among emerging adults, and highlights the importance of promoting the development of mindful awareness and self-transcendence in preventions and interventions aimed at improving mental well-being. By cultivating these positive psychology states, emerging adults may be better equipped to overcome the negative effects of psychological maltreatment.
Attachment and Breakup Distress: The Mediating Role of Coping Strategies
Authors: Gehl Kristin , Brassard Audrey , Dugal Caroline , Lefebvre Audrey-Ann , Daigneault Isabelle , Francoeur Audrey , Lecomte Tania
Published: October 2023

Breakups are common among emerging adults and are associated with elevated depressive and anxiety symptoms, especially in the presence of attachment insecurities. Previous authors have suggested that inadequate coping strategies might explain this association, yet this has not been examined longitudinally. This study examined the mediating role of five coping strategies (self-help, approach, accommodation, avoidance, self-punishment) in the longitudinal associations between attachment insecurities (anxiety, avoidance) and depressive and anxious symptoms in 196 emerging adults experiencing a romantic breakup. Measures of pre-breakup attachment, post-breakup coping strategies (one-month post-breakup), and depressive and anxiety symptoms (one- and three-month post-breakup) were administered. Results from a longitudinal autoregressive cross-lagged model showed that pre-breakup attachment insecurities were related to higher depressive and anxiety post-breakup symptoms through higher use of self-punishment and lower use of accommodation coping strategies. Findings highlight coping strategies as potential intervention targets to promote the recovery of emerging adults experiencing breakup distress.
Human-Autonomy Teaming Guidelines with a Spacesuit Example
Authors: Matessa Michael , Rohrig Jake
Published: October 2023

With the growing capability of autonomy, there is a growing interest in how humans interact with autonomous systems. This paper shows the development of a human-autonomy teaming (HAT) framework as well as general and specific HAT guidelines. Specific guidelines are made for a spacesuit assistant. Guidelines can be used to aid in the development of concepts of operation, procedures, or interfaces. The HAT framework is based on a crew resource management evaluation system, and so this work shows that a system used to evaluate human teaming can be used to provide general HAT guidelines and to develop specific HAT guidelines. Guidelines that are specific to particular projects help to make more concrete suggestions and can also inform general guidelines.
Gaze Behavior and Mental Workload While Using a Whole-Body Powered Exoskeleton: A Pilot Study
Authors: Upasani Satyajit , Srinivasan Divya
Published: October 2023

The mental demands associated with operating complex whole-body powered exoskeletons are poorly understood. This study aimed to explore the overall workload associated with using a powered wholebody exoskeleton among expert and novice users, as well as the changes in workload resulting from novices adapting to exoskeleton-use over time. We used eye-tracking measures to quantify the differences in workload of six novices and five experts while they performed a levelwalking task, with and without wearing a whole-body powered exoskeleton. We found that only novices’ pupil dilation (PD) increased, while experts showed a greater proportion of downward-directed pathfixations (PF) compared to novices while wearing the exoskeleton. These results indicate that novices’ mental demands were higher, and that experts and novices exhibited distinct visuomotor strategies. Eyetracking measures may potentially be used to detect differences in workload and skill-level associated with using exoskeletons, and also considered as inputs for future adaptive exoskeleton control algorithms.
Unlocking Safer Driving: How Answering Questions Help Takeovers in Partially Automated Driving
Authors: Bai Xiaolu , Feng Jing
Published: October 2023

As vehicle automation increases, drivers' roles shift from active operation to passive monitoring, making it challenging for drivers to effectively take over when automation fails. While a growing body of research focuses on providing assistance to improve driver monitoring behavior and takeover performance, these approaches have been mostly linked to the takeover event. The current study proposes to facilitate drivers' awareness during automated driving by adopting strategies from natural conversations, specifically, asking driver questions while monitoring the vehicle. In this simulated driving study, we investigated how different types of questions affect monitoring behavior and takeover performance with or without takeover notifications. Our preliminary results suggest that the driving-related questions could improve drivers’ takeover performance, especially when the takeover notification is absent.
Do Drivers Require Education After Over-The-Air Adas Updates?
Authors: Mason Justin , Gaspar John , Carney Cher , Kim Jimin , Domeyer Josh , Lenneman John , McGehee Dan
Published: October 2023

Over-the-air (OTA) advanced driver assistance systems (ADAS) updates may require drivers to adjust their mental models to maintain appropriate system use. Based on the magnitude of change to the ADAS, hands-on experience with the updated system may not require consumer education or training. In this study, 96 drivers experienced adaptive cruise control in the NADS-1 and received an OTA update with either pedestrian detection (PD) or traffic jam (TJ). Drivers that experienced PD had a higher confidence in their understanding of PD whereas drivers that experienced TJ, had a better understanding of TJ. However, their confidence was not correlated with their understanding of the system for either TJ or PD. Although hands-on experience with a new system may improve driver’s understanding or confidence in their understanding of the system, consumer education may strengthen the relationship between their understanding and confidence in their understanding of ADAS.
Tactile Displays: The Effects of Location and Intensity on Automated Vehicle Takeover Performance
Authors: Huang Gaojian , Pitts Brandon J.
Published: October 2023

This study investigated the effects of tactile display location and intensity on automated vehicle takeover performance. Twenty participants completed simulated driving tasks in a Level 3 automated vehicle and responded to takeover requests presented at different locations (seat back, seat pan, seat belt, and wrist) with different intensity levels. Results showed that higher intensity tactile displays were associated with faster takeover times, and placing the display on the wrist was correlated with shorter takeover times compared to the seat pan in lower intensity. However, there were no significant effects on maximum resulting jerk. These findings suggest that incorporating tactile displays in automated vehicles as takeover requests is promising, particularly when placed on the wrist and presented at higher intensities. This research contributes to the development of human-machine interfaces that can better assist drivers during takeovers and improve the safety of automated vehicles.
Visual Attention Patterns in Automated and Manual Lane Change Maneuvers
Authors: Noonan T. Zach , Gershon Pnina , Mehler Bruce , Reimer Bryan
Published: October 2023

Tesla auto lane change is a feature which automatically steers the vehicle into an adjacent lane when prompted by the driver. 2,473 naturalistic motorway lane changes were annotated to compare driver eye glance behavior before, during, and after maneuvers performed manually and with automation. Change point detection and glance area prevalence revealed distinct patterns in the drivers’ glance behavior. In manual lane changes drivers had more glances to adjacent lanes and over-the-shoulder prior to and during lane crossing compared to automated lane changes which were associated with fewer glances laterally but more glances to the rearview mirror. These differences were more pronounced in lane changes into the leftmost lane. However, in automated exiting maneuvers, drivers had more preparatory glances to adjacent lanes compared to manual. These behaviors could be related to differences in driver visual attention associated with the use of automation.
Comfort: Beyond HFE to Patient Outcomes and Comfort Zones
Authors: Drury Colin G. , Barnes Catherine Drury
Published: October 2023

Comfort has been a staple of outcome measures in Human Factors / Ergonomics (HFE) for generations. We have theories of comfort and validated measures. But HFE is not alone in studying comfort. Here we review two adjacent applications of comfort: In patient outcomes and in management’s idea of comfort zones. We find some but not much overlap between these three fields and the ability for HFE to learn positive and negative lessons from each.
Nudging to Manage the Spread of COVID-19: Lessons Learned for the Next Pandemic
Authors: Zahed Karim , Demir Mustafa
Published: October 2023

Nudging is a popular low-cost strategy that can be implemented in interventions to influence individuals to perform certain behaviors and implement policies better. With the spread of COVID-19 that began in 2020, several studies attempted to test nudging to influence behaviors that manage the spread. In this article, we report on our review of 21 studies utilizing nudging to improve adherence to various behaviors associated with the management of COVID-19. Findings highlight the overall positive influence of nudging, especially for hesitant individuals, but draw attention to the possibility of messages backfiring when framed negatively. Our results also reflect the importance of customizing the message to the target audience, the behavioral constructs that may influence intention, and the need for researchers to test nudges on actionable behavior in addition to intention to account for the intention-behavior gap.
Creating and Communicating Effective Safety Protocols in Healthcare
Authors: Militello Laura G. , Perry Shawna , Roth Emilie M. , Gurses Ayse P. , Stewart Matthew , Misasi Paul
Published: October 2023

Creating and communicating effective safety protocols is important to the well-being of healthcare workers, patients, and all who interact with health systems. Although protocols have been used to support healthcare teams in providing care for decades, there is limited consensus about what constitutes an effective protocol (Myburgh, 2008). In fact, there is considerable ambiguity about what constitutes a protocol versus a policy versus a guideline versus a standard operating procedure. This panel uses the term protocol as an umbrella term to represent a range of strategies used to mandate and/or guide personnel in implementing safe practices. Panelists will discuss their perspectives and latest research characterizing challenges to effective safety protocols, as well as future directions for improving protocols in healthcare.
Towards Directive Driving Automation: Nudging Driver’s Away From Overriding Using Social Norms
Authors: Lee Joonbum , Kim Boyoung , Rheem Hansol , Kamaraj Amudha V. , Kim Sooyeon , Domeyer Joshua E. , Lee John D. , Toyoda Heishiro
Published: October 2023

We propose the concept of directive driving automation that positively influences drivers’ intentions to achieve shared goals. As a step toward directive driving automation, this survey study explored how social norms can persuade drivers to continue using driving automation. We tested social norm messages using a 2x2x2x2 factorial within-subject design: norm type (descriptive vs. injunctive), explanation (absent vs. present), spatial scale (local vs. global), and outcome criticality (safety-critical vs. non-safety-critical). The results suggest that framing messages as descriptive norms and providing explanations relevant to the driver can encourage them to continue using automation, especially with safety-critical outcomes. This study highlights the importance of considering message characteristics in persuasive interventions to promote the safe use of driving automation.
Environmental Sustainability, Electronics, and Ergonomics: A Tale of Two Continents
Authors: Acquah Augustine A. , Martin Bernard J. , Maguire Amrita S. , D’Souza Clive
Published: October 2023

What does the overdependence on electronic and electrical appliances in the US have to do with migrant workers in West Africa? What is the relevance and role of Human Factors and Ergonomics (HF/E) research and practice in this context? This discussion panel will: (i) explore the nexus between electrical and electronic appliance waste (e-waste) – of which the US and other developed countries are a major contributor – and the disproportionate environmental and occupational health burden placed on emerging countries such as Ghana, and (ii) examine how corporations are responding by intentional paradigm shifts in sustainability, circularity, supply chain transparency, and product life-cycle management spanning raw material sourcing to recycling and reuse. This panel will be a social impact discussion hosted by the HFES Environmental Design Technical Group in collaboration with the HFES Sustainability Task Force and the IEA Technical Committee on Informal Work, with panelists from academia and industry.
Investigating The Perseverance and Bias Blind Spot Relationship
Authors: Davidson Jordan A. , Drews Frank
Published: October 2023

Although cognitive bias is easily detectable in the judgments and decision making of other people, we often fail to see its influence in our own thoughts and behavior. This “bias blind spot” is present in most individuals, but its magnitude differs from person to person. To better understand individual differences in susceptibility, we examined the relationship between bias blind spot and perseverance. To measure perseverance, participants were asked to complete as many easy or difficult mazes as they were able to do. Bias blind spot was measured using a validated scale developed by Scopelliti et al. (2015). Bias blind spot susceptibility was compared to time spent on the mazes and number of mazes completed. ANCOVA results revealed a significant finding between bias blind spot and measures of perseverance on difficult mazes, suggesting a relationship exists for bias blind spot and perseverance on challenging tasks. A second study will measure differences in perseverant behavior when feedback is introduced that compares the participant’s number of mazes completed to the average number completed by peers.
Worker and Work-Related Factors Influence on Musculoskeletal Symptoms among Veterinary Surgeons
Authors: Villarreal Ryan Thomas , Kim Sun Young , Yu Denny
Published: October 2023

Current literature on surgeons in human medicine provides evidence that surgeons often work in awkward positions for extended periods of time, suggesting there are significant physical ergonomic risk factors associated with the work demands of the role. These risk factors are likely also present in surgical work in veterinary medicine. In this study, 212 members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all 10 regions, reported pain increased significantly from before to after a typical day of surgery. Worker factors that were shown to be related to reported pain include gender, weight, age, and years performing surgery. Among work factors investigated, number of procedures, practice focus, and proportion of minimally invasive surgery were shown to influence reported pain. Our findings confirm that musculoskeletal symptoms are commonly experienced by veterinary surgeons.
Conceptualizing a Socio-technical Model for Evaluating AI-driven Technology
Authors: Weger Kristin , Yeazitzis Taylor
Published: October 2023

Socio-technical models have been developed to address challenges inherent to complex systems. The goal of this paper was to conceptualize a comprehensive socio-technical model, integrating technological and measurement-based dimensions of AI technology with socio-technical dimensions. This model addresses current limitations in operationalizing AI-driven technology interventions in complex adaptive environments. Building off of previous models, eight dimensions were identified to account for factors influencing the success of AI-driven technology interventions in complex, adaptive organizations, including hardware and software; content; user interface; people; workflow and communication; organizational policies, procedure, and culture; external rules, regulations, and forces; and measurement and monitoring. This model provides new avenues of thinking regarding socio-technical dimensions for adopting AI-driven technology by organizations and how these can be accounted for in AI-driven technology interventions and research.
Factors Associated with Stopping to Rest During Long Night-Time Simulated Drives
Authors: Gaspar John G. , Carney Cher , Tefft Brian C. , Horrey William J.
Published: October 2023

Driver drowsiness contributes to substantial numbers of motor vehicle crashes, injuries, and deaths. Previ-ous research has shown that taking a nap and consuming caffeine can temporarily mitigate drowsiness and enable continued safe driving. The current study sought to investigate what factors influenced drowsy drivers’ decisions regarding whether to take breaks versus continue driving. Ninety drivers completed a 150-mile highway drive in a driving simulator, beginning at 11pm or 2:30am, after a day of partial sleep restriction. Drivers were given the opportunity to stop, rest, and obtain caffeinated beverages at simulated rest areas throughout the drive. To replicate drivers’ motivation to reach their destination safely but also quickly, drivers were told that they would be paid more for completing the simulated drive faster but would forfeit their payment if they crashed. Self-reported subjective drowsiness was significantly associated with break-taking decisions for breaks that were attributed to drowsiness; however, even at the highest levels of drowsiness, most drivers bypassed simulated rest areas without stopping. Results underscore the need to educate and/or motivate drivers to respond sooner to warning signs of drowsiness.
Co-Design with Patients for Improving Patient Safety: Strategies, Barriers and pitfalls
Authors: Xiao Yan , Miller Kristen , Werner Nicole , Smith Kelly , Hendrix Noah , Hemmelgarn Carole
Published: October 2023

What happens when “frontline” workers are patients and family members performing health-related tasks? As more and more complex healthcare tasks are performed by patients and family members, and more emphasis is placed on patient- and family-centered care, strategies are needed to engage patients and family members in co-design “work systems” and patient-professional collaborative work. Human factors professionals are well-equipped to apply participatory ergonomics to patient and collaborative tasks. However, there are a number of barriers and pitfalls in engaging patients in design. Moving from tokenism to meaningful engagement in research requires patience, constant reflection, and a commitment to codesign. Our panel will explore the continuum of engagement and strategies to move from tokenism to partnership to cocreation in patient safety research, ranging from ambulatory medication safety to diagnosis in the emergency department. Strategies and barriers are presented as a starting point to discuss how to achieve effective work system designs.
Reliability Analysis of Task Performance and Subjective Measures for Assessment of Occupational Exoskeletons
Authors: Noll Alexander , Nussbaum Maury A. , Kim Sunwook , Park Hanjun
Published: October 2023

Use of occupational exoskeletons (EXOs), an emerging intervention, has attracted great interest from various industries. To facilitate their industry adoption, emphasis has been placed on the standardization of EXO assessment, but little effort has been made to improve experimental efficiency and effectiveness. Therefore, we investigated the within-session reliability of task performance (completion time) and subjective outcome measures when using arm- and back-support EXOs during donning/doffing and cart pushing/pulling tasks. Twenty-four participants replicated 10 trials of these tasks in each of two sessions, with each participant randomly assigned to one of two EXO groups. Within-session reliability increased with the number of trials and in Session 2 (vs. Session 1). Many outcome measures achieved excellent reliability, though the number of trials required for this varied across outcome measures, tasks, and EXO types. These findings can assist in the efficient design of future studies to assess the effects of EXO use.
Human-AI teams in complex military operations: Soldiers’ perception of intelligent AI agents as teammates in human-AI teams
Authors: Sawant Sarvesh , Brady Camden , Mallick Rohit , McNeese Nathan , Chalil Madathil Kapil , Bertrand Jeffrey
Published: October 2023

Military decision-making frequently involves complex problems in non-routine situations with minimal rule-based or automated solutions. As human information processing capabilities are limited, processing the required scale of information increases the decision-makers’ workload, impacting their situational awareness and affecting the quality of soldiers’ decisions. This study uses a route clearance task as a use-case scenario to understand the issues in team-level decision-making in military tasks, the challenges in successfully completing the mission, and the demands placed on AI teammates when working in a human-AI team. We interviewed eight subject matter experts with prior experience in route clearance operations. The themes generated by analyzing the interview transcripts provide insights into soldiers’ perceptions of AI teammates as well as recommendations for successfully integrating human-AI teams in military settings.
Enhance Auditory Experience by Identifying User Needs and Classifying User Types While Driving Electric Vehicles
Authors: Song Yein , Lee Jane , Wang Cai , Yun Myung Hwan
Published: October 2023

The auditory experience of driving electric vehicles (EVs) has been studied as a means of conveying vehicle status information and improving user satisfaction. However, the driving experience and user preferences may vary depending on the driving context, including user characteristics. Thus, this study aims to 1) classify users based on their characteristics and 2) investigate their auditory experience preferences while driving EVs. For this purpose, 40 participants conducted questionnaires about their characteristics and performed a think-aloud task while driving 15.6 km in real EVs. As a result, three user characteristics and two user types were identified using factor analysis and K-means clustering, respectively. Text-formed think-aloud data were analyzed through network analysis to obtain insights for designing usercentered driving sound for EVs. These findings can contribute to the strategic management of EV sound design.
Multi-Functional Glasses for the Blind and Visually Impaired: Design and Development
Authors: Bastola Ashish , Atik Enam Md , Bastola Ananta , Gluck Aaron , Brinkley Julian
Published: October 2023

This paper presents the design of a glasses system for the blind and visually impaired that incorporates various technologies to enhance their daily living experience. The glasses are equipped with a speaker and haptic feedback, allowing users to receive audible and tactile notifications about their surroundings. We also implemented image understanding for identifying multiple unique objects, people, and environmental obstacles. Additionally, the glasses can read signs and printed materials via text recognition technology. Finally, the glasses incorporate navigation tools, helping users to find their way in unfamiliar environments. The system has the potential to significantly improve the independence and quality of life of those with visual impairments, as it could be a valuable assistive technology tool for a wide range of applications.
Human-Centered Design: A Haptic Robotic-Based Leader-Follower Driving Training System to Improve Driving Skills and Enhance Safety
Authors: Lammert Keegan , Huang Gaojian , Etu Egbe-Etu , Quientero David , Jiang Lin
Published: October 2023

This study presents the design and implementation of a human-centered wearable robotic glove for driving training using a lead-follower control methodology and haptic stimuli. The glove captures and analyses biometric signals, including piezoelectric sensors on fingers, Electromyography (EMG) for muscle strength, and inertial measurement unit (IMU) for hand position, to monitor hand and forearm behaviour during operation. Real-time motor controllers generate guidance cues for leader-follower gloves based on feedback from sensors, which are wirelessly communicated through the ESP-Now WIFI protocol. An experimental test was conducted to evaluate the effectiveness of the haptic cues on hand pressure and motion. 2-way ANOVA statistical analysis is used to measure the significance of the relevance between haptic cues and driving training outcomes. While haptic cues did not affect hand trajectory, they have statistical significance to driving outcomes. The proposed system has the potential to enhance driving safety training and improve performance.
System Theoretic Process Analysis for Identification of Sources of Mode Confusion
Authors: Bishop Brittany E. , Harrington Polly M. , Rose Rodrigo L. , Leveson Nancy G.
Published: October 2023

As systems grow increasingly complex, the likelihood of mode confusion regarding automation and system processes also increases. Mode confusion stems from inaccurate mental models that lead operators to execute inappropriate control actions that result in losses. System Theoretic Process Analysis (STPA) is a holistic risk analysis method that examines the emergent properties of complex systems with interacting components. Such components may include humans, software, organizations, safety culture, and more. By allowing users to clearly understand controllers’ process models, STPA provides a methodology to identify sources of mode confusion and generate requirements to eliminate them. This paper presents an approach to conducting STPA that is tailored to issues of mode confusion in systems with interactions between human and automated controllers. Additionally, an example STPA is applied to the Boeing 777 autopilot system to illustrate how inappropriate feedback and mode confusion can be identified and prevented in complex systems.
A Network Analysis Approach to Quantifying Changes in ADAS from Over-the-Air Updates
Authors: Gaspar John G. , Carney Cher , Mason Justin , McGehee Daniel V. , Domeyer Joshua , Lenneman John
Published: October 2023

Advanced driver assistance systems are changing the way that drivers interact with vehicles and may benefit from changes to consumer education that aim to improve the driver’s understanding of changes to their role. System updates will increasingly be applied over the air, which may lead to confusion about system capabilities if there is a substantial change, and there is a need to understand when changes need additional education. This paper uses a network analysis to quantify the change in driver assistance systems and also extends the approach to include a human user in the network. This paper describes the approach and presents an example comparing two adaptive cruise control systems, before and after an update. The network analysis quantified the connections within the network, with components of the driving assistance systems showing different connection strength with an increase in complexity of the system and with the addition of the user as a node in the network. The network analysis approach may be a useful tool for determining when additional consumer education is necessary for advanced driver assistance systems updates.
Human Factors/Ergonomics Contributions to an Equitable Personal Protective Equipment Protections Strategy
Authors: Dempsey Patrick G.
Published: October 2023

The National Institute for Occupational Safety and Health (NIOSH) is developing a National Strategy for Equitable Personal Protective Equipment Protections for All U.S. Workers. This paper describes several formative components of the strategy that have been completed and are ongoing. These efforts clearly indicate the need for human factors/ergonomics (HF/E) contributions to overcome current limitations and barriers to equitable PPE protection for some workers. Fundamental ergonomics approaches are needed to contribute to more equitable PPE protections for all members of the workforce for whom PPE is required. This will ensure that all workers that require PPE are adequately protected from hazards while minimizing negative consequences (e.g., discomfort, reduced perceptual capabilities, performance decrements) while also allowing workers to safely and comfortably work as productively as when not wearing PPE.
Development of a VR Head-mounted Display Strap Modification for Use by Individuals with a Cochlear Implant
Authors: Gluck Aaron , Golba Emily , Brinkley Julian
Published: October 2023

Virtual reality (VR) continues to revolutionize how people work, play, and socialize. Even with new VR systems released regularly, VR hardware can still be inaccessible to many, especially people with disabilities. While researching VR accessibility barriers for older adults, we discovered that the Meta Quest 2 VR head-mounted display (HMD) does not allow for a person with a cochlear implant to wear both simultaneously. This inaccessibility is due to the cochlear implant being surgically implanted along the path of the HMD strap. To increase VR accessibility for individuals with a cochlear implant, we designed, developed, and tested a 3D-printed HMD strap modification that supports wearing both a VR HMD and a cochlear implant. This work illustrates that small, simple modifications can significantly increase the accessibility of VR system hardware for people with disabilities.
Forklift Driving Performance of Novices with Repeated VR-based Training
Authors: Islam Md Shafiqul , Jamshid Nezhad Zahabi Saman , Kim Sunwook , Lau Nathan , Nussbaum Maury A. , Lim Sol
Published: October 2023

Virtual reality (VR) has emerged as a promising tool for training novice forklift drivers, but temporal patterns of such improvements are largely unknown. We trained 19 novice participants using an order-picker VR simulator on a selected driving lesson. In two sessions, participant driving performance was assessed using task completion time and kinematics of the head, shoulder, and lumbar spine via inertial measurement units (IMUs). Completion time and head flexion/movement decreased significantly (up to 22.4% and 31.5%, respectively). The observed changes in head motion (flexion/extension) indicate an initial adjustment period to prepare a mental model of the driving task and the control panel, which was also adapted over repeated trials. One implication of our results is that reduced head flexion/extension could be used as an indication of a novice driver’s improved skill during the early stages of training, in terms of familiarizing themselves with vehicle control and the vehicle control panel.
Driving In Mixed Traffic: Will Increased Penetration Rates of Automated Vehicles Change Driver Behaviors?
Authors: Ma Zheng , Zhang Yiqi
Published: October 2023

Automated Vehicle (AV) technology has been developed with the goal of reducing injuries, improving mobility, and relieving drivers of driving responsibilities. However, achieving the expected benefits of AVs may require a high market penetration of these vehicles, which is not feasible in the near future. Consequently, a mixed traffic where human-driven vehicles (HVs) share the roads with AVs is expected. Despite the growing prevalence of AVs, few studies have focused on driver performance during HV-AV interactions. This study investigates the impact of driving styles and AV penetration rates on drivers’ decision-making in mixed traffic. The results indicate that aggressive and moderate drivers may behave more aggressively and take advantage of AVs as the AV penetration increases. These findings provide valuable insights into the understanding of human drivers’ decision-making processes and responses to HV-AV interactions in mixed traffic.
All Human Versus Human-Robot Teaming: Measuring Neurophysiological Synchrony, Team Performance, and Trust during Search and Rescue
Authors: Yadav Aakash , Ghosh Patralika , Rawashdeh Malik , Lee Diane , Bolf Thomas , Mehta Ranjana K.
Published: October 2023

This study used a multiplayer virtual environment simulating search and rescue to examine teaming behaviors and trust networks in two teaming conditions using the Wizard of Oz approach: (1) an all-human team (three humans) and (2) a human-robot team (two humans, one simulated quadruped robot). Neural, physiological, and subjective responses of trust and workload at the individual and team (e.g., neurophysiological synchrony) levels, along with task performance, were measured. We observed better task performance in human-robot teams and associated higher neural synchrony, but lower trust in the team and the robot agent. Trust between the human dyads remained intact. These findings provide insights into comparing the neural bases of complex and social interactions in all-human versus human-autonomy teams.
Black Adolescent Females’ Perceptions of PrEP for HIV Risk Reduction
Authors: Budge Mariana , Opara Ijeoma , Weser Veronica U. , Sands Brandon E. , Hieftje Kimberly D.
Published: October 2023

Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is approved for use in adolescents, though uptake remains low. Black adolescent females experience higher rates of HIV transmission compared to adolescent females of other racial/ethnic groups. Increasing PrEP awareness and education among this population may be an effective strategy to mitigate disparities in HIV transmission among Black adolescent females. Twenty-seven Black adolescent females participated in focus groups which were coded using the constant comparative method of qualitative analysis to identify major themes: (1) PrEP is not commonly framed as an HIV prevention strategy for heterosexual Black adolescent females, (2) PrEP use among peers is perceived as mostly positive, (3) Adoption of PrEP among Black adolescent females is impeded by perceived barriers such as stigma, negative side effects, and adherence concerns. These findings may inform the development of targeted culturally tailored marketing and educational campaigns centered on Black heterosexual adolescent females to increase PrEP awareness and uptake in this population disproportionately affected by HIV.
Outcomes After Double-Layer Repair Versus En Masse Repair for Delaminated Rotator Cuff Injury: A Systematic Review and Meta-analysis
Authors: Quan Xiaolin , Wu Jiangping , Liu Zhibo , Li Xiangwei , Xiao Yujia , Shu Han , Zhou Anpei , Wang Ting , Nie Mao
Published: October 2023

Background:

Delamination of rotator cuff tears during arthroscopic shoulder surgery has an incidence of 38% to 92%. Double-layer (DL) repair and en masse (EM) repair are most commonly used in this situation.

Purpose:

To compare the clinical results of the DL versus EM repair techniques for delaminated rotator cuff tears using a meta-analysis.

Study Design:

Systematic review; level of evidence, 3.

Methods:

We identified relevant studies comparing the clinical results of DL and EM repair for delaminated rotator cuff injuries in the PubMed, Embase, and Cochrane databases after the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The primary outcomes were the Constant score and retear rate. Additionally, we compared other postoperative shoulder functional scores, shoulder range of motion, and visual analog scale (VAS) pain scores between the 2 suture methods using a meta-analysis. The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes.

Results:

Of the 197 studies initially identified, 6 studies were included in this analysis. There were significant differences in the Constant score (MD, 8.64 [95% CI, 4.47 to 12.8]; P < .05) and external rotation (MD, 5.10 [95% CI, 2.63 to 7.56]; P < .05) between the 2 techniques, with DL repair having superior outcomes. No significant differences were observed between the 2 techniques in forward flexion (MD, 0.62 [95% CI, –1.18 to 2.43]; P = .50), VAS pain (MD, –0.03 [95% CI, –0.34 to 0.27]; P = .84), or retear rate (OR, 0.73 [95% CI, 0.37 to 1.41]; P = .35).

Conclusion:

Results of this review and meta-analysis suggest that DL repair was more beneficial than EM repair in terms of the Constant score and shoulder external rotation in patients with delaminated rotator cuff injuries.