bluuebunny/crossref_metadata_2025 huggingface dataset:
Lake-Related Cloud Dynamics on the Tibetan Plateau: Spatial Patterns and Interannual Variability
Authors: Rüthrich F. , Reudenbach C. , Thies B. , Bendix J.
Published: August 2015

The scarcity of meteorological observations has hitherto prevented spatially comprehensive and complete assessments on regional and local-scale atmospheric processes such as breeze systems on the Tibetan Plateau (TiP). Because of the high abundance of lakes, the steep topography, and the intense insolation of the TiP, lake breeze and land breeze systems might, however, contribute substantially to the local climatic and hydrological variability. The presented study aims at unveiling the influence of the lake effect over the whole TiP by using a novel high-mountain satellite cloud product, based on Meteosat Indian Ocean Data Coverage (IODC) data from 1999 to 2012, focusing on 70 lake systems larger than 72 km2. Of particular interest are the spatial and interannual variability of lake-related cloud dynamics during boreal summer and autumn. For both seasons, a significant effect of lakes on cloudiness is shown during the early morning. Its mean strength is mainly determined by each basin’s temperature difference between lake and surroundings. For boreal summer the large-scale influences of tropical and extratropical circulation pattern on the interannual variability of the lake effect are also investigated. The results show that the Arctic and North Atlantic Oscillations (AO and NAO) inhibit convective activity above lakes in the northern and central-eastern domain. A positive polarity of the Southern Oscillation index (SOI), in contrast, is in phase with enhanced convective activity. The variability of the Indian summer monsoon circulation does not affect cloud dynamics at more than two locations. Case studies are employed to illustrate interactions between cloud activity and the SOI and NAO. For this purpose satellite data are combined with the modeled 10 km × 10 km High Asia Refined Analysis dataset on a daily basis.
An Initial Assessment of the Surface Reference Technique Applied to Data from the Dual-Frequency Precipitation Radar (DPR) on the GPM Satellite
Authors: Meneghini Robert , Kim Hyokyung , Liao Liang , Jones Jeffrey A. , Kwiatkowski John M.
Published: August 2015

It has long been recognized that path-integrated attenuation (PIA) can be used to improve precipitation estimates from high-frequency weather radar data. One approach that provides an estimate of this quantity from airborne or spaceborne radar data is the surface reference technique (SRT), which uses measurements of the surface cross section in the presence and absence of precipitation. Measurements from the dual-frequency precipitation radar (DPR) on the Global Precipitation Measurement (GPM) satellite afford the first opportunity to test the method for spaceborne radar data at Ka band as well as for the Ku-band–Ka-band combination.

The study begins by reviewing the basis of the single- and dual-frequency SRT. As the performance of the method is closely tied to the behavior of the normalized radar cross section (NRCS or σ0) of the surface, the statistics of σ0 derived from DPR measurements are given as a function of incidence angle and frequency for ocean and land backgrounds over a 1-month period. Several independent estimates of the PIA, formed by means of different surface reference datasets, can be used to test the consistency of the method since, in the absence of error, the estimates should be identical. Along with theoretical considerations, the comparisons provide an initial assessment of the performance of the single- and dual-frequency SRT for the DPR. The study finds that the dual-frequency SRT can provide improvement in the accuracy of path attenuation estimates relative to the single-frequency method, particularly at Ku band.
Herschel Telescopes for Sale
Authors: Hoskin Michael
Published: August 2015

William Herschel supplemented his salary from the King by making reflectors for sale. The most complete statement of what he had to offer is contained in his reply to a letter written on behalf of Catherine the Great of Russia, in which the Empress was said to be interested in buying the largest reflector Herschel could supply.
Al-Asfī’s Description of the Zāwiya Nasiriyya: The Use of Buildings as Astronomical Tools
Authors: Rius-Piniés Mònica , Puig-Aguilar Roser
Published: August 2015

Early Arabic sources report the existence of giant astronomical devices housed inside buildings which were used for observational and computational purposes. Some of them are known to us, but their chronology and their relationship to other well-oriented devices in the Islamic or even in the Latin milieu are yet to be explored in depth. This paper aims to establish whether the zāwiya Nāṣiriyya in Tamegroute (Tamgrūt, in the Drâa valley) described by al-Asfī (seventeenth to eighteenth century) can be considered as part of this tradition.
Claudius Ptolemy? Pseudo-Ptolemy? The Main Source of Moses Almosnino’s Treatise on Astrolabe
Authors: Sheynin Hayim Y.
Published: August 2015

In the late 1960s, the author discovered an unknown Judeo-Spanish treatise on the astrolabe among the Hebrew manuscripts in the Russian National Library. He identified it as the Treatise on the Astrolabe (1560) by Moses Almosnino of Salonica. In the treatise, Almosnino alleged more than once that Ptolemy’s Canons was his source for both the contents and the form of it. The researcher established that Almosnino’s insistence on Ptolemy as his source is questionable. However, the search for the true source took quite a long time. Finally, the genuine source is identified as the Kitāb al-ʻamal bi-asṭurlāb (The Book of the use of the astrolabe) by the Andaluzian Arab astronomer Abū-l-Qāsim Aḥmad Ibn al-Ṣaffār (d. 1035). This article also explains why Almosnino ascribed his source to Ptolemy.
Examining the Positivity Effect in Autobiographical Memory Across Adulthood
Authors: Siedlecki Karen L. , Hicks Stephanie , Kornhauser Zachary G. C.
Published: August 2015

The positivity effect in memory is characterized by enhanced memory for emotionally positive information or decreased memory for emotionally negative information with increased age. The goals of the current study were to (a) examine the positivity effect in autobiographical memory using instructions that limited experimental constraints, (b) examine the relationship between memory valence and subjective well-being, and (c) examine the relationship between age and other memory characteristics across adulthood. In the current study, 281 individuals between the ages of 18 and 94 ( Mage = 53.14, SD = 17.04) completed a modified Memory Experiences Questionnaire using online survey methods. Participants answered questions about emotional valence and other phenomenological characteristics regarding two memories, including any specific memory of their choosing and a personally meaningful memory. Results indicated that memory valence was unrelated to age, thus failing to provide evidence for the positivity effect. However, memory valence was found to be a significant predictor of life satisfaction. Age moderated the relationship between memory valence and subjective well-being but did so differently across the two memories. Age was also associated with increased vividness, coherence, sensory detail, time clarity, and a first-person perspective for the personally meaningful memory.
Perceptions of Successful Aging
Authors: Kelly Gina Aalgaard , Lazarus Jennie
Published: August 2015

This study explored the perceptions of successful aging from intergenerational perspectives. A total of 66 participants were interviewed from three different generations including college students, parents, and grandparents. After qualitative data collection and analyses were used, five conceptual categories emerged from the data that related to perceptions of successful aging. The five concepts include wisdom, health, financial stability, staying active, and well-being. Conceptual categories emerged from the participants of different generations, and some were interconnected across generations. Each category is representative of major thematic patterns. Well-being was the primary concept which emerged because all three generations perceived and explicitly discussed well-being as the most valued aspect of successful aging. Previous successful aging research informed the use of a bio-psycho-social theoretical lens to frame the study findings and discussion.
Passing the buck without the bucks: Some reflections on fiscal decentralisation and the Business Rate Retention Scheme in England
Authors: Muldoon-Smith Kevin , Greenhalgh Paul
Published: August 2015

In an era of continuing Local Government austerity and enhanced urban financialisation, Local Government in England is increasingly reliant upon decentralised methods of urban finance (typically based on ‘new economic growth’ extracted from non-residential property development) to fund public services, economic development and urban regeneration. Opportunities for greater territorial governance and economic development often frame fiscal decentralisation, yet, critical appraisals of this agenda are less common. Reflecting upon this issue, this paper critically appraises the underlying method of ‘localist’ finance in England, the Business Rate Retention Scheme. In doing so, it describes a picture of geographical variegation in England, one that suggests that the Business Rate Retention Scheme could lead to splintered urban development, based on the necessity (and underlying viability) for new development. The paper concludes that a minority of ‘premium locations’, characterised by buoyant property market characteristics, could outperform more numerous ‘stranded’ and ‘redundant locations’. The result is that those areas most in need of investment, that exhibit some kind of market failure and geographical disadvantage, could be less able to generate new development in order to fund the Business Rate Retention Scheme. Under these conditions, rather than correcting incidences of spatial inequality, fiscal decentralisation could further polarise uneven development.
Creating the north from the sum of its parts? Research questions to assess the Northern Powerhouse
Authors: Nurse Alexander
Published: August 2015

In late 2014, Chancellor George Osborne announced ambitious plans for the creation of a ‘Northern Powerhouse’ which would see cities taking control over a greater number of functions in exchange for installing new democratic arrangements. This paper explores those plans and in doing so outlines a number of questions that will be of interest to researchers. This focuses on a number of issues including the ability to develop coherent regional success by fostering city region level development, the governance model of a directly elected executive mayor and how this will work on a practical basis, and the city-level democratisation of key services including health provision.
Parasocial Compensation Hypothesis
Authors: Madison T. Phillip , Porter Lance V. , Greule Al
Published: August 2015

In America, socializing with friends has become a functional alternative to watching television. Such a drastic change in how we spend free time demands a closer look at media effects. The study at hand invokes intrapersonal communication research and parasocial interactions and relationships from the media effects literature, synthesizing a new line of research in the process. We ask, “What functions and characteristics of parasociability predict parasocial compensation for real-life interaction?” To explore this question, we combined data based on respondent identification numbers from two larger surveys that measured functions and characteristics of parasocial. An ordinary least squares regression with compensation as the focal variable revealed that parasocial thinking, when functioning as internal rehearsal and self-understanding, and when characterized by variety and self-dominance, predicts parasociability as compensation for human interaction. Retroactive parasocial thinking negatively predicted compensation. The bottom line is this: Under certain circumstances, people choose parasocial relationships over real-life relationships. These findings support the continuing push to explore parasocial relationships as an imaginative force rather than as simple by-products of media exposure.
India’s Military: Evolution, Modernisation and Transformation
Authors: Ganguly Rajat
Published: August 2015

The Indian military is the world’s fourth largest after the US, Russia and China. In the immediate aftermath of India’s independence from British rule, however, it was hard to imagine that in the span of six decades, a poverty-stricken, fragmented and deeply traumatised country would emerge as a military powerhouse. How and why has this transformation taken place? Has India’s growing military prowess resulted in a more robust and adventurist foreign policy, particularly within the South Asian region? What does India’s rapid military transformation, particularly the Indian Navy, in the twenty-first century say about India’s perception of threats to national security? In this article, I argue that the Indian military’s expansion and modernisation has happened in phases, mainly as a reaction to threatening developments within the surrounding region, the evolving global strategic environment and the perceptions and decisions taken by India’s political elites. I argue, further, that as India’s military prowess and self-confidence have grown, Indian leaders have at times felt tempted to flex the military muscles, particularly in low-intensity regional conflicts, but not always with expected results. I conclude that in the twenty-first century, the Indian military, particularly the Indian Navy, is undergoing rapid expansion and transformation. This suggests that in addition to threats coming across the western and northern land borders with Pakistan and China respectively, India’s security planners envisage a growing threat to national security emanating from the deep waters of the Bay of Bengal, the Arabian Sea and the Indian Ocean.
International Trade in Health Care Services: Prospects and Challenges for India
Authors: Bhat T.P.
Published: August 2015

In the last two decades, international trade in health care services has expanded under the GATS. It has acquired new dimensions with the application of advanced information and communication technology and cross-border mobility. India is a participant in the GATS and has made binding commitments to minimise trade barriers. Under GATS, trade liberalisation is effected through four modes: mode 1 represents cross-border supply; mode 2, consumption abroad; mode 3, commercial presence; and mode 4, presence of natural persons. Though all modes are not totally free and are subject to restrictions, India enjoys certain distinct advantages, especially under modes 2 and 4. India has emerged as a hub for clinical research, has established superiority in IT-enabled and back-end services and has built a reputation in offering an array of specialised medical and surgical interventions at affordable prices, which have boosted medical tourism. The global health care market is highly competitive; therefore, there is a need for suitable export strategies to effectively tap into the potential of the individual markets.
Islamic Movements Engaging with Democracy: Front Islamique Du Salut (FIS) and the Democratic Experiment in Algeria
Authors: Sebastian N.
Published: August 2015

The recent political developments in the Arab world, in general, and in the North African states like Tunisia, Egypt and Libya, in particular, develop new enthusiasm on the interaction between Islam/Islamism/Islamic movements and democracy; especially with the institutions and practices of western liberal democracy. Islamist groups have become a critical factor in the larger politics of those states and the central focus of any serious debate on political liberalisation and democratisation in the Arab world. The 1990s witnessed a revival of Islamism in the political sphere through the increasing participation of Islamists in elections and the democratic process. It has raised some new debates on the fundamental question of the compatibility of Islam and democracy. Such debates, at times, challenged the dominant western pre-supposition that Islam and democracy are incompatible. It has become crucial in the widely discussed ‘post September 11’ global context where many groups in the west project Islamism and Islamic movements as the biggest threat to modern liberal–democratic states. The Algerian experiment with democracy in the late 1980s, which this article discusses in detail, was the first such experiment in the Arab world where Islamists actively participated in a liberal democratic election process. The developments that had taken place after the victory of Islamists in this election were crucial in framing an Islamist approach to democracy thereafter.
Book Review: Frenz, Margaret, Community, Memory, and Migration in a Globalizing World. The Goan Experience, c. 1890–1980
Authors: Rothermund Dietmar
Published: August 2015

Margaret Frenz, Community, Memory, and Migration in a Globalizing World. The Goan Experience, c. 1890–1980 (New Delhi: Oxford University Press, 2014). Pp. 380, Price ₹995.
Book Review: Harsh, V.P., India’s Afghan Muddle: A Lost Opportunity
Authors: Joshi Nirmala
Published: August 2015

Harsh, V.P., India’s Afghan Muddle: A Lost Opportunity (New Delhi: Harper Collins Publishers, 2014). Pp. XI + 192, Price ₹450.
Book Review: Thakur, Atul Kumar (Ed.), India since 1947: Looking Back at a Modern Nation
Authors: Chaturvedy Rajeev Ranjan
Published: August 2015

Thakur, Atul Kumar (Ed.), India since 1947: Looking Back at a Modern Nation (New Delhi: Niyogi Books, 2013). Pp. 340, Price ₹395.
Book Review: Bajpai, Kanti P, Saira Basit and V. Krishnappa, India’s Grand Strategy: History, Theory, Cases
Authors: Bhattarai Chandra Moni , Verma Raj Kumar
Published: August 2015

Bajpai, Kanti P, Saira Basit and V. Krishnappa, India’s Grand Strategy: History, Theory, Cases (New Delhi: Routledge, 2014). Pp. 569, Price ₹1295.
A Clinical Translation of the Article Titled, “The Utility of Magnetic Resonance Spectroscopy for Understanding Substance Use Disorders: A Systematic Review of the Literature”
Authors: Finnell Deborah S.
Published: August 2015

BACKGROUND: While magnetic resonance spectroscopy (MRS) is a technique used in research related to substance use, MRS may be less familiar to practitioners. METHOD: This is a clinical translation of a systematic review by Hellem and Shi (this issue of JAPNA). The article provides an overview of the MRS technique and neurometabolites that are commonly studied with MRS in the human brain. The methods and results are presented for the systemic review of MRS studies among adults and focus on alcohol, methamphetamine, MDMA, cocaine, opiates/opioids, marijuana, and nicotine. RESULTS: Thirty-six studies were included in the review of literature. Substance-specific studies indicated inconsistencies with respect to alterations in brain chemistry. A consistent finding across substances (alcohol, methamphetamine, and nicotine) was the decrease of two metabolites ( N-acetylaspartate and choline). CONCULSION: MRS offers the possibility of identifying brain biomarkers for disease and evaluating treatment response. Needed are studies employing standardized protocols for data acquisition and reporting.
Physicochemical properties and structural characteristics of whole grain Oryza sativa L. with different treatments
Authors: Albarracín Micaela , Talens Pau , Martínez-Navarrete Nuria , González Rolando J , Drago Silvina R
Published: August 2015

Physicochemical properties and structural characteristics of whole rice flours with different treatments (soaking, germination and extrusion cooking) were studied. Water solubility, water absorption, crystallinity, adsorption isotherms (BET and GAB models), and glass transition temperature of the samples were determined. Water solubility and water absorption were enhanced by extrusion cooking process (3.17–4.98 vs. 24.1–53.76 g/100 g and 2.77–3.05 vs. 4.46–7.04 ml/g, respectively), but crystallinity was decreased (30–33 vs. 4–16%). Adsorption isotherms showed that extruded samples exhibited higher equilibrium moisture content as compared with their corresponding non-extruded samples (5.0–19.2 vs. 4.0–16.1 g water/g solids). There were no changes in glass transition temperature values in the studied moisture range (3.8–16 g/100 g). These results allow the correct use of whole rice flours with different treatments in foods and also contributed to the knowledge of stabilization of the products.
Enhancing the contribution of research to health care policy-making: a case study of the Dutch Health Care Performance Report
Authors: Hegger Ingrid , Marks Lisanne K , Janssen Susan WJ , Schuit Albertine J , van Oers Hans AM
Published: August 2015

Objectives

The Dutch Health Care Performance Report, issued by the National Institute of Public Health and the Environment, aims to monitor health care performance in The Netherlands. Both the National Institute and the Ministry of Health wish to increase the contribution of the Report to health care policy-making. Our aim was to identify ways to achieve that.

Method

We used contribution mapping as a theoretical framework that recognizes alignment of research as crucial to managing contributions to policy-making. To investigate which areas need alignment efforts by researchers and/or policy-makers, we interviewed National Institute researchers and policy-makers from the Ministry of Health and assessed the process for developing the 2010 Report.

Results

We identified six areas where alignment is specifically relevant for enhancing the contributions of future versions of the Dutch Health Care Performance Report: well-balanced information for different ministerial directorates; backstage work; double role actors; reports of other knowledge institutes; data collection/generation and presentation forms.

Conclusion

The contribution of health care performance reporting to policy-making is complex and requires continuous alignment efforts between researchers and policy-makers. These efforts should form an inseparable part of health care performance reporting and although this demands considerable resources, it is worth considering since it may pay back in better contributions to policy-making.
Multi-length-scale derivation of the room-temperature material constitutive model for SiC/SiC ceramic-matrix composites
Authors: Grujicic M , Snipes JS , Galgalikar R , Yavari R , Avuthu V , Ramaswami S
Published: August 2015

In the present work, multi-length-scale physical and numerical analyses are used to derive a SiC/SiC ceramic matrix composite (CMC) material model suitable for use in a general room-temperature, finite element-based, structural/damage analysis of gas turbine engine components. Due to its multi-length-scale character, the material model incorporates the effects of fiber/tow (e.g. the volume fraction of the filaments, thickness of the filament coatings, decohesion properties of the coating/matrix interfaces, quality, as quantified by the Weibull distribution parameters, of the filament, coating, and matrix materials, etc.) and ply/lamina (e.g. the 0°/90° cross-ply vs. plain-weave architectures, the extent of tow crimping in the case of the plain-weave plies, cohesive properties of the inter-ply boundaries, etc.) length-scale microstructural/architectural parameters on the mechanical response of the CMCs. To identify and quantify the contribution of the aforementioned parameters on the material response, detailed numerical procedures involving the representative volume elements and the virtual mechanical tests are developed and utilized. The resulting homogenized turbine-engine component-level material model is next integrated into a user-material subroutine and used, in conjunction with a commercial finite element program, to analyze the foreign object damage experienced by a toboggan-shaped turbine shroud segment. The results obtained clearly revealed the role different fiber/tow and ply/lamina microstructural parameters play in the structural/damage response of the gas-turbine CMC components.
Improving the Ergonomics of Cognitive Assessment with Serious Games
Authors: Tong Tiffany , Yeung Joanna , Sandrakumar Janahan , Chignell Mark , Tierney Mary C. , Lee Jacques
Published: August 2015

Current cognitive testing methods in the elderly rely on clinical assessments, which are time consuming, costly, and require highly trained staff (Kueider, Parisi, Gross, & Rebok, 2012). We are developing a serious game with the goal of improving the ergonomics of cognition assessment. Instead of pencil and paper, or a computer, we are using touch-based tablets in order to provide a highly mobile and usable form of cognitive assessment. We are currently conducting usability studies on elderly adults in different healthcare environments to evaluate the technology. This paper presents work on customizing the game for use by elderly adults in a hospital emergency department (ED) and it will discuss some of the results obtained thus far, focusing on the usability of the game for this clinical population. In addition to usability results we will also report on the validity of the game in terms of how well it agrees with existing methods of cognitive assessment that are used in the ED.
The Role of Human Factors in Requirements Engineering in Health Care: A Case Study in the Brazilianhealth Care System
Authors: Jatobá Alessandro , Da Cunha Amauri M. , Burns Catherine M. , Vidal Mario Cesar R. , De Carvalho Paulo Victor R.
Published: August 2015

In this paper we propose an approach for the enhancement of software requirements specifications by combining human factors and requirements engineering concepts. The approach we propose uses cognitive engineering methods to increase understanding about how professionals perform complex work, taking into account the cognitive effort made by workers. We employed the suggested the approach in the context of a primary health care facility in Brazil to demonstrate that including human factors models improved the understanding of context, decision making and informal knowledge, enhancing software requirements specifications. Our results point out that a richer set of requirements was obtained, increasing the reliability of requirements specifications, enabling the design of better information technology to support work in the primary health care facility.
Establishing a Human Factors and Usability Center for Medical Devices in Brazil
Authors: Almeida Ana P. S. S. , Trbovich Patricia , Pinkney Sonia , Ferreira Filho José A. , Muller Egon L. , Almeida Rodrigo M. A. , Custodio Renata A. R. , Mellol Carlos H. P.
Published: August 2015

This paper describes the main goals, motivation and challenges in developing Human Factors and Usability Engineering expertise to be applied to medical devices at a University in Brazil. With the advancement of medical instrumentation, it was necessary to develop studies to evaluate the variables that could affect the ability of people to use medical equipment properly. Advantages of using technological innovations in health care settings have been widely touted. However, many technologies designed to support patient treatment and diagnosis have been abandoned due to problems in their use and design. This has resulted in patient and user safety risks, an increase in healthcare complexity and dissatisfaction by end users. In Brazil, there is a lack in specialized centers that could investigate these problems. Also, there is a lack of knowledge of human factors methods that could help understand the causes of use errors and inform the medical device design process. Creating a Usability and Human Factors Lab for Medical Devices (and team) may increase health care safety by supporting usability studies on equipment while also educating and training students; this would benefit Brazilian industries, health care institutions and government agencies.
Barriers to Information Access in Electronic Health Records during Initial Patient Visits: A Qualitative Study
Authors: Doberne Julie W. , Kakaday Roheet , Redd Travis K. , Eriksson Carl O. , Yackel Thomas R. , Marquard Jenna , Gold Jeffrey A. , Mohan Vishnu , Ash Joan S. , Chiang Michael F.
Published: August 2015

Electronic Health Records (EHRs) have been shown to markedly alter clinical workflows and are associated with lower professional satisfaction scores among providers post-implementation. In light of these issues, questions exist regarding what barriers currently exist in EHRs to adequately meet the workflow needs of providers. The objective of this study was to describe what physicians perceive to be the current barriers to information gathering and overall workflow when using electronic health records (EHRs) to evaluate new patients. A web-based national survey was distributed to practicing physicians in primary care, general internal medicine, medicine subspecialties, general surgery, surgery subspecialties, general pediatrics, and pediatrics subspecialties from June to September 2014. Prominent themes pertaining to information gathering and overall workflow in the EHR were identified from narrative survey responses using constant comparison and axial coding to arrive at a grounded theory. Narrative responses from 327 physicians were obtained and analyzed from a total of 1385 respondents (24%). Major identified themes included: 1) Physicians struggle with unintuitive workflows and negative time impact; 2) EHR documentation was excessive and often of poor clinical value; 3) Provider-provider communication is negatively impacted by EHR challenges; and 4) Frustration with EHRs led to mistrust of vendors and clinical administration responsible for building and selecting the EHR software. Barriers such as inefficient workflows, increased time demands, and inconsistent documentation practices exist in EHRs that prevent ideal information gathering when evaluating a new patient. Results from this study could provide insights into new EHR interface redesign and development, and into new physician EHR training opportunities.
A Cognitive Analysis of Informatics Patient Safety Issues Reported Within the Veterans Health Administration
Authors: Chapman Roger J. , Taylor Lesley
Published: August 2015

The goal of the Veterans Health Administration (VHA) Informatics Patient Safety program (IPS) is to improve the safety of Health Information Technology (HIT) products. To support the analysis of patient safety issues, a set of categories was developed for Human-HIT interaction errors that can occur as users conduct their work (Chapman, Taylor, and Wood, 2012). Here we describe the categorization of 97 patient safety issues reported to IPS between October 1st 2013 and September 30th 2014. We highlight: (1) how categorization can contribute to the risk assessment process, (2) which error types were most frequently found, and (3) how these results suggest the categories and our issue analysis process can be refined.
The Human Factors of Continuous Subcutaneous Insulin Infusion: Modeling Insulin Pump Use Issues
Authors: Fuller Helen J.A. , Sillars Dawn M. , Arnold Timothy J. , Paull Douglas E. , Bagian Tandi M. , Williams Linda C. , Hemphill Robin R.
Published: August 2015

Continuous subcutaneous insulin infusion (CSII) devices are commonly used in the treatment of patients with diabetes mellitus. These devices release basal doses of insulin and can be used to deliver boluses of insulin when needed. Use errors involving CSII devices may have serious consequences: an overdose of insulin can result in hypoglycemia and even death, while too little insulin may result in diabetic ketoacidosis and coma. A targeted search of the database of adverse events in the Veterans Health Administration yielded information about patient safety incidents involving CSII devices, including the location and type of error. A model of CSII therapy that includes relevant characteristics of the user, use environment, and task was developed and used to explore potential error modes. By examining adverse events associated with CSII device use and by considering other potential error modes, it may be possible to redesign devices, treatment plans, hospital policy and procedures to minimize the risk of patient harm.
Human Factors Considerations in the Design of Falls Prevention Technologies for Nursing Homes: A Case Study
Authors: Li Huiyang , Ali Haneen
Published: August 2015

Falls occur frequently and repeatedly among nursing home residents and cause about 1800 deaths each year. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion. Although auto-alert systems have been developed to detect and report falls of the elderly in the community, fewer were developed for the nursing home setting and are not suited for this setting due to the unique challenges in nursing homes. This paper analyzes the human factors challenges in falls prevention in nursing homes through interviews, observations, and work analysis. Implications and guidelines for developing fall prevention technologies for nursing homes are discussed.
A Human Factors Approach for Root Cause Analysis: A Case of Duplicate Medical Record Number
Authors: Khunlertkit Adjhaporn , Paine Lori
Published: August 2015

Health care organizations have deployed the root cause analysis (RCA) method to identify factors that could have contributed to the event. An organization that appropriately takes a system approach when conducting an RCA, often discovers system issues that, if mitigated, could prevent future recurrences. Our study examined how a human factors framework could be deployed for an RCA to identify system factors associated with duplicate medical record creations. We used mixed method data collection and analysis with the Systems Engineering Initiative for Patient Safety (SEIPS) framework to guide our RCA. Results of our RCA revealed multiple system factors contributing to duplicate record creations, some of which included interactions between patients and registrars, poor system usability, poor working environment, lack of team support, and inadequate training. Changes made to the work system, based on our findings, could prevent medical record duplication in the future.
Developing a Better Clinical Alert System in EHRs
Authors: Mauney Jennifer , Furlough Caleb , Barnes Janey
Published: August 2015

Currently, many alert systems designed for EHRs can negatively affect providers' ability to prescribe appropriately and thus, are also affecting patient safety. This is due to the design of the alerts and the overwhelming number of alerts presented. There is a wealth of information in the human factors literature on the design and use of alerts but that information is either not known or has not been implemented in the design of EHRs. This paper will bring that literature to light, and demonstrate how to implement the recommendations to develop not only a better system for handling alerts in EHRs, but better CPOE (Computerized Provider Order Entry) as well. Serious usability issues with medication-based alerts displayed on EHRs were found after reviewing the data from the Meaningful Use 2 (MU2) Usability reports linked to the ONC CHPL website. The types of alert system issues found within the MU2 Usability reports and across various EHR vendors as well as human factors research that specifies how to deal with these issues will be described in this paper. In addition, recommendations for the design of medication-based alerts will be presented.
Usability Analysis and Redesign of Infusion Pump User Interface
Authors: Ali Haneen , Li Huiyang , Lisboa Piterson
Published: August 2015

Infusion pump is a vital medical device used to continually deliver medications or fluids to the patient's body in a controlled manner. This device is capable of delivering predetermined amounts of fluids and may be used to deliver nutrients, blood, or medications, such as antibiotics, pain medications, and chemotherapeutic. However, due to poorly designed user interface, misuses can be prevalent and might lead to serious medical errors, such as dosing errors. The aim of this research is to (1) identify usability problems of infusion pumps commonly used in oncology clinics and other outpatient settings through interviews and heuristic evaluation; (2) propose new designs to address the problems and eventually improve performance. During a heuristic evaluation, three major violations of human factors design principles were identified: (1) lack of feedback about the patient and the patient condition? Not sure if this is a violation; (2) poor flexibility and efficiency of use; (3) the position of start/stop button can limit the control over the task. We proposed a new interface design to overcome these issues.
Inter-professional Human Factors Education: Democratizing Safety and Quality
Authors: Seagull F. Jacob , Greenberg Grant M.
Published: August 2015

A key strategy for improving healthcare outcomes is the development of a sufficient number of health care professionals at both the front line and in leadership positions who partner with human factors experts to promulgate the lessons of patient safety and quality improvement (PS/QI). The complexity of healthcare systems necessitates effective collaboration to achieve gains in PS/QI. A “Patient Safety and Quality Leadership” (PASQUAL) Scholars program was developed at the University of Michigan to provide clinicians with a theoretical and practical underpinning of human factors, QI, and PS knowledge. The scholars program's curriculum has been developed and refined to create clinical leaders who can work together with human factors professionals to have a significant impact on healthcare outcomes. The PASQUAL Scholars curriculum provides a concrete, time-tested blueprint for a successful program to improve safety and quality, and provide a human infrastructure of partners in human factors efforts.
Best Practices for Analyzing EMRs Used in Non-Traditional Settings
Authors: Smith Melissa A. , Blumberg Eric J.
Published: August 2015

The research presented in this paper focuses on best practice analyses for a non-traditional electronic medical record (EMR) application. CampDoc, an electronic medical records system specifically designed for day and overnight camps as well as small care facilities (e.g. daycare centers) was examined. Over 12, 000 camps operate in America, looking after 11, 000, 000 people each year making them a unique application for EMRs (American Camping Association, 2012). The analysts' goals were to improve upon the user experience within CampDoc by increasing the ease of use and the clarity of content via human factors techniques. Specific emphasis was placed on understanding and designing for users who might not possess medical training and identifying how medicine is practiced in non-traditional medical settings.
A Framework for Rebuilding Trust in Social Automation Across Health-Care Domains
Authors: Marinaccio Kaitlyn , Kohn Spencer , Parasuraman Raja , De Visser Ewart J.
Published: August 2015

This paper reviews current human-automation trust and trust repair literature as it applies to health-care systems. In addition, we examine the increased use and relevance of social agents, such as robots and virtual agents, within the medical field and consider the importance of using social agents in this particular domain. Furthermore, we examine strategies for trust repair following errors in health-care settings, and provide a conceptual framework for repairing trust with social automation. Most literature to date stems from a human-human perspective, and we hope to extend this work to the field of social automation. If these strategies are effective, humanautomation systems in health-care can maintain appropriate levels of trust, ensuring effective and efficient long-term collaborations in critical work areas.
Using Formal Task Analytic Models to Support User Manual Development: An LVAD Case Study
Authors: Abbate Andrew J. , Throckmorton Amy L. , Bass Ellen J.
Published: August 2015

Thousands of medical devices are employed to diagnose and treat human health problems each day. These devices can be complicated to use, maintain, and troubleshoot when alarm conditions occur. Patients often turn to the provided instructions for use (IFUs) for step-by-step guidance in alarm mitigation. Despite standards and guidance provided by standardization organizations and regulatory agencies to support user manual usability, inadequate IFUs may be contributing to adverse events. To address potential limitations of currently employed user manual design methods, we present a model-based approach to support user manual development. Our approach leverages formal task modeling, finite state automata, linear temporal logic (LTL) and symbolic model checking, all of which contribute individually and additively to our analysis. We demonstrate the value of our approach using a case study of a left ventricular assist device (LVAD) and a set of troubleshooting instructions from its patient handbook.
Positive selection in development and growth rate regulation genes involved in species divergence of the genus Radix
Authors: Feldmeyer Barbara , Greshake Bastian , Funke Elisabeth , Ebersberger Ingo , Pfenninger Markus
Published: August 2015

Background

Life history traits like developmental time, age and size at maturity are directly related to fitness in all organisms and play a major role in adaptive evolution and speciation processes. Comparative genomic or transcriptomic approaches to identify positively selected genes involved in species divergence can help to generate hypotheses on the driving forces behind speciation. Here we use a bottom-up approach to investigate this hypothesis by comparative analysis of orthologous transcripts of four closely related EuropeanRadixspecies.

Results

Snails of the genusRadixoccupy species specific distribution ranges with distinct climatic niches, indicating a potential for natural selection driven speciation based on ecological niche differentiation. We then inferred phylogenetic relationships among the fourRadixspecies based on whole mt-genomes plus 23 nuclear loci. Three different tests to infer selection and changes in amino acid properties yielded a total of 134 genes with signatures of positive selection. The majority of these genes belonged to the functional gene ontology categories “reproduction” and “genitalia” with an overrepresentation of the functions “development” and “growth rate”.

Conclusions

We show here thatRadixspecies divergence may be primarily enforced by selection on life history traits such as (larval-) development and growth rate. We thus hypothesise that life history differences may confer advantages under the according climate regimes, e.g., species occupying warmer and dryer habitats might have a fitness advantage with fast developing susceptible life stages, which are more tolerant to habitat desiccation.
Within-host evolution decreases virulence in an opportunistic bacterial pathogen
Authors: Mikonranta Lauri , Mappes Johanna , Laakso Jouni , Ketola Tarmo
Published: August 2015

Background

Pathogens evolve in a close antagonistic relationship with their hosts. The conventional theory proposes that evolution of virulence is highly dependent on the efficiency of direct host-to-host transmission. Many opportunistic pathogens, however, are not strictly dependent on the hosts due to their ability to reproduce in the free-living environment. Therefore it is likely that conflicting selection pressures for growth and survival outside versus within the host, rather than transmission potential, shape the evolution of virulence in opportunists. We tested the role of within-host selection in evolution of virulence by letting a pathogen Serratia marcescens db11 sequentially infect Drosophila melanogaster hosts and then compared the virulence to strains that evolved only in the outside-host environment.

Results

We found that the pathogen adapted to both Drosophila melanogaster host and novel outside-host environment, leading to rapid evolutionary changes in the bacterial life-history traits including motility, in vitro growth rate, biomass yield, and secretion of extracellular proteases. Most significantly, selection within the host led to decreased virulence without decreased bacterial load while the selection lines in the outside-host environment maintained the same level of virulence with ancestral bacteria.

Conclusions

This experimental evidence supports the idea that increased virulence is not an inevitable consequence of within-host adaptation even when the epidemiological restrictions are removed. Evolution of attenuated virulence could occur because of immune evasion within the host. Alternatively, rapid fluctuation between outside-host and within-host environments, which is typical for the life cycle of opportunistic bacterial pathogens, could lead to trade-offs that lower pathogen virulence.
Determinants of footwear difficulties in people with plantar heel pain
Authors: Sullivan Justin , Pappas Evangelos , Adams Roger , Crosbie Jack , Burns Joshua
Published: August 2015

Background

Plantar heel pain is a common foot disorder aggravated by weight‐bearing activity. Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear‐related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear‐related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice.

Methods

The footwear domain of the Foot Health Status Questionnaire (FHSQ) was assessed in 192 people with plantar heel pain and 69 asymptomatic controls. The plantar heel pain group was also assessed on a variety of measures including: foot posture, foot strength and flexibility, pedobarography and pain level. A univariate analysis of covariance, with age as the covariate, was used to compare the heel pain and control groups on the FHSQ footwear domain score. A multiple regression model was then constructed to investigate factors associated with footwear scores among participants with plantar heel pain.

Results

When compared to asymptomatic participants, people with plantar heel pain reported lower FHSQ footwear domain scores (mean difference −24.4; p < 0.001; 95 % CI: −32.0 to −17.0). In the participants with heel pain, footwear scores were associated with maximum force beneath the postero‐lateral heel during barefoot walking, toe flexor strength and gender.

Conclusions

People with plantar heel pain experience difficulty with footwear comfort, fit and choice. Reduced heel loading during barefoot walking, toe flexor weakness and female gender are all independently associated with reports of footwear difficulties in people with heel pain. Increased focus, in both clinical and research settings, is needed to address footwear‐related issues in people with plantar heel pain.