bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational Transmission of Parental Adverse Childhood Experiences and Children’s Outcomes: A Scoping Review
Authors: Zhang Lixia , Mersky Joshua P. , Gruber Anne Marie H. , Kim June-Yung
Published: October 2022

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents’ ACEs on children’s outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children’s outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children’s outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018–2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children’s outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children’s outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.
Carbon nanotube to enhancing mechanical properties of three-dimensional woven modified-basalt fiber composites
Authors: Lyu TingTing , Gao Yuan , Zhou Xinghai , Wu Liwei , Lyu Lihua
Published: October 2022

3D woven composites offer various high-performance characteristics and wide applications due to their lightweight, high strength, and good integrity. However, to exploit their structural advantages, it is necessary to improve the interface properties between reinforcement and matrix, and carbon nanotubes with excellent mechanical properties provide a good solution to improve the interface properties of composites. Based on this motivation, the goal of this study is to investigate the impact of multiwalled carbon nanotubes on the tensile and bending properties of basalt fiber through-angle interlocking 3D woven composite, layered-angle interlocking 3D woven composite and orthogonal 3D woven composite. The obtained results indicated that the maximum warp and weft tensile loads of the layered-angle interlocking composites increased by 19.3% and 28.5% from 91,091.3N and 8,409.5N to 9,288.4N and 11,761.4N, respectively. The maximum warp and weft bending loads of 3D orthogonal composites were increased by 26.4% and 19.6% from 566.7N and 635.4N to 770.0N and 790.3N, respectively. O-MWCNTs contain -OH, -COOH and the unsaturated double bond can active functional groups and basalt fiber on the surface of the Si-OH and unsaturated double bonds in the reaction to form epoxy resin covalent bond to improve the interface between the fiber and matrix effect, which solved the key problem of interface outstanding performance of 3D woven modified-basalt fiber composites.
Chitosan nanofibres and polypropylene meltblown substrate based multilayer respiratory filter for byssinosis prevention
Authors: Khawar Muhammd Tauseef , Gong Hugh , Zia Qasim , Nawaz Hafiza Hifza , Li Jiashen
Published: October 2022

Byssinosis is a chronic obstructive pulmonary disease very common in textile cotton workers due to inhalation of fine cotton dust and gram negative bacteria. A three layer composite respiratory filter was developed for Byssinosis prevention by using the combination of polypropylene (PP) based meltblown layers and chitosan nanofibres (CSNF). Filtration efficiency against fine particulates ranges from 100 nm to 2.5 μm and anti-bacterial activity against Pantoea agglomerans were investigated. Chitosan nanofibres were produced by using the electrospinning process and were sandwiched between two PP layers to improve the overall surface area of the filter as well as providing a protective barrier against bacterial pathogens. The filter sample with just 2 hour’s CSNF coating showed more than 99% filtration efficiency with a low pressure drop of 71.6 Pa and a high quality factor value 0.082. The antibacterial performance of CSNF layers achieved up to 91% against the Pantoea agglomerans. Finally, results concluded that the developed respiratory filter can potentially reduce Byssinosis in textile workers.
Clogging performance of micro/nanofibrous laminated composite air filter media
Authors: Calisir Mehmet D , Gungor Melike , Toptas Ali , Donmez Utkay , Kilic Ali , Karabuga Semistan
Published: October 2022

The performance of fibrous filter media relies on factors such as particle capture efficiency, pressure drop and clogging time. Fiber diameter, porosity and packing density are important web-based factors to improve final filtration performance. In this study, composite nonwoven webs were produced using spunbonded, meltblown and electroblown mats to obtain filter media with different fiber diameter, porosity and packing density. Such a layered composite approach caused huge differences in porosity and packing density, which resulted with improved clogging performance. The average fiber diameter was found to be 65 ± 19.4 nm for electroblown layer ( N), while that was 1.17 ± 0.38 μm for meltblown (M) and 17.64 ± 2.65 μm for spunbond (S) layers. NM (nanofiber+meltblown) configuration provided 12–13% lower mean flow pore size, which resulted in faster clogging compared to NS (nanofiber + spunbond) mats. The thicker nanofibrous layer resulted in lower pore size and quality factor. Additionally, the composite samples showed a faster-rising pressure drop than the thick microfibrous mats due to smaller pores that clogged quickly. It was also shown that nanofiber coating causes a linear increase in pressure drop with dust loading, while microfibrous samples exhibited smooth plateau and linear increase after clogging point. Nanofiber layer facilitates cake formation which causes more difficult airflow, and lower dust holding capacity. Among the layered composite mats, the NM configurations were found to be more advantageous due to higher initial filtration efficiency and almost similar dust loading performance.
Decision Support for Flexible Manufacturing Systems: The Evaluation of an Ecological Interface and Principles of Ecological Interface Design
Authors: Bennett Kevin B. , Cravens Dylan G. , Jackson Natalie C. , Edman Christopher
Published: October 2022

The cognitive systems engineering (CSE)/ecological interface design (EID) approach was applied in developing decision support for the flexible manufacturing system (FMS) work domain. Four interfaces were designed via the factorial application/non-application of direct perception (DP) and direct manipulation (DM). The capability of these interfaces to support performance in a simulated FMS was evaluated using a variety of traditional and novel dependent variables. The ecological interface (with DP, DM and an intact perception-action loop) provided clearly superior decision support (32 favorable significant results) relative to the other three interfaces (a combined total of 28 favorable significant results). The novel dependent variables were very sensitive. The results are interpreted from three different perspectives: traditional EID, the quality of constraint matching between triadic system components and closed-loop, dynamical control systems. The rationale for an expanded theoretical framework which complements, but does not replace, the original principles of CSE/EID is discussed. The potential for both specific interface features and novel dependent variables to generalize to real-world FMS applications is addressed. The expanded theoretical framework is universally relevant for the development of decision making and problem solving support in all computer-mediated work domains.
A Rare Complication of Esophageal Exclusion: Esophageal Mucocele
Authors: Nitz Jonathan A. , Bakhos Charles T. , Petrov Roman V. , Abbas Abbas E.
Published: October 2022

Bipolar esophageal exclusion is a “Hail Mary” procedure for control of leak and persistent mediastinal soilage from esophageal injury. Usually, the esophageal remnant scars down without negative consequences. Esophageal mucocele is a rare complication of bipolar esophageal exclusion. This is a case report of an iatrogenic esophageal transection and the subsequent treatment course. A retrospective chart review of the patient’s medical and surgical history was performed. After a robotic hiatal hernia repair at an outside institution, the patient suffered an esophageal leak and was surgically treated with esophageal exclusion, wide drainage of the mediastinum, and decortication of the resulting empyema. She subsequently underwent retrosternal gastric conduit for esophageal reconstruction 4 months later. Three years after this, she developed a rare complication of esophageal exclusion, a symptomatic esophageal mucocele that required resection.
Researching Local Subjectivities in Contested Contexts: Using Intersecting Methodologies to Understand Large Green-Energy Projects in Kenya
Authors: Shaw Jacqueline , Lind Jeremy
Published: October 2022

This article critically reflects on the use of an ‘intersecting methodologies’ approach to generate understanding of the diverse experiences of people living near contested large green energy projects in Kenya. Local subjectivities are essential to understanding the contestations engendered by these projects, especially in areas that are distant from decision-making and global capital. However, researching residents’ experiences in these settings is challenging due to historical divisions and recent conflict triggered by the projects, and the unequal power relations that exist between stakeholders. We discuss the opportunities and challenges of using intersecting methodologies for research in contested settings, which involved weaving together qualitative, ethnographic, community-based participatory research and participatory video. Challenges included the difficulties of supporting peer researchers in remote places to conduct complex research processes from afar, negotiating the legacies of prior research practices and the knowledge economy, and balancing research sense-making with video production expectations. We argue that interlacing methodologies from different epistemological traditions helps to uncover the various ways that differently positioned local stakeholders ‘see’ large-resource-based investments. It also brought learning from the different epistemologies and viewpoints into conversation, and this created productive tensions to transform understanding of conflict and open pathways to more peaceful relations.
Investigating the leadership styles and national culture of Emirati female school principals
Authors: Al Khatib Soulafa A
Published: October 2022

With the growing expectations from the field of education, increases the importance of effective school leadership. The school proves its effectiveness depending on various factors; the principal's leadership style is the main one. The purpose of this study was to investigate the influence of the female gender and national culture dimensions on the leadership styles of Emirati female school principals, as educational leaders, and the relationships that exist among the different variables. Explanatory sequential mixed method approach was used in two phases for this study. In the first phase, the quantitative data were collected using the Multifactor Leadership Questionnaire (5X-short) survey and the cultural dimensions survey. In the second phase, the researcher conducted semi-structured interviews and qualitative observations. The findings of the study indicated that Emirati female leaders tend to be more transformational in their leadership styles while they still practice transactional leadership to a certain degree. They were found to be more “androgynous” carrying the qualities of both male and female leaders. In addition, the leadership styles and their elements proved to have a significant relationship to national culture dimensions except for management by exception (active). Future research should include a larger sample size and the perspectives of the followers as well. It is important to conduct the study in different organizational contexts not only in schools to confirm the finding that women use “androgynous” style in the United Arab Emirate and beyond.
A curse of knowledge or a curse of uncertainty? Bilingualism, embodiment, and egocentric bias
Authors: Samuel Steven
Published: October 2022

The ability to adopt others’ perspectives—our “Theory of Mind”—underpins social interaction. Nevertheless, adults are imperfect perspective takers, demonstrating egocentric biases. Here, a series of experiments assessed whether (1) embodying an agent’s physical perspective (working out whether he held something in his left or right hand) or (2) being bilingual, would benefit perspective taking. Participants were shown a scenario in which an agent puts a ball in one of four boxes. When he returns later, the boxes have been rearranged. Participants, who additionally know that the ball is now in a different box, then judge how likely the agent is to look for the ball in each of the four boxes first. In Experiments 1–3 participants were not more likely to judge the agent would look where he last saw it as a function of either factor. In Experiments 4 and 5, one group of participants were told where the ball had been moved to, the other only that the ball had been moved to a different box. In Experiment 4, participants in the latter condition assigned higher probability to the boxes that were never mentioned. In Experiment 5 this was replicated and was driven by monolinguals and those who had received the embodiment condition. These results suggest that egocentric biases may be more likely to arise when participants are more deliberative, such as when making a judgement under uncertainty, and that extrinsic factors such as bilingualism and embodiment may influence perspective attributions under such conditions.
A case of scrofuloderma of the axilla presenting as hidradenitis suppurativa: A case report
Authors: Garon Laurence , Hill Ashley
Published: October 2022

Scrofuloderma is an uncommon cutaneous presentation of tuberculosis. It can be difficult to diagnose, as it can mimic various skin conditions, including hidradenitis suppurativa. We report a case of a 46-year-old female refugee patient with a history of nodules and sinus tracts in the left axilla treated for many years as hidradenitis suppurativa in her home country who was later found to have scrofuloderma. The diagnosis was based on a positive Mycobacterium tuberculosis polymerase chain reaction from an ultrasound-guided aspiration. Further investigation excluded pulmonary tuberculosis. In cases with an atypical presentation of hidradenitis suppurativa, imaging, along with histological and microbiologic examination are warranted to exclude scrofuloderma.
Glioblastoma, IDH-wildtype with leptomeningeal metastasis to Meckel’s cave: A case report
Authors: Murata Toshiki , Matsuda Masazumi , Shinozaki Tetsugaku , Ishiyama Koichi
Published: October 2022

Meckel’s cave or the trigeminal cistern is a subarachnoid space near the apex of the petrous portion of the temporal bone and contains cerebrospinal fluid and the Gasserian ganglion, which divides into the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves. Infectious, inflammatory, congenital, and neoplastic lesions can occur in Meckel’s cave. Leptomeningeal metastasis of glioblastoma (GBM), IDH-wildtype to Meckel’s cave is rare. We encountered a case of leptomeningeal metastasis of GBM to Meckel’s cave in an elderly female patient who presented with pain around her right eye. Magnetic resonance imaging revealed enhancing lesions in the right temporal lobe and cervical spinal cord. The pathological diagnosis of GBM was confirmed after biopsy of the cervical spinal cord lesion, which showed hyperaccumulation of fluorodeoxyglucose (FDG) on FDG-positron emission tomography. This case indicates that metastatic lesions can also occur in Meckel’s cave.
Patient Safety Challenges in the Pandemic: Applying Human Factors Principles to Embed Patient Safety and Experience at the Clinical Front Line
Authors: Chignell Mark , Hall Trevor , Liu Lili , Kastner Monika , Razak Fahad
Published: October 2022

The COVID-19 pandemic has amplified systemic gaps in patient safety, including social frailty for vulnerable populations such as older adults (Briguglio et al., 2020). Public health measures, such as prolonged and frequent lockdowns, restricted access to visitors and support networks and in extreme cases led to confinement within a single room, The negative impact of these restrictions has focused new attention on social frailty, which has hitherto been a somewhat neglected patient safety issue. Since social frailty is a multifaceted construct, it needs to be considered in a variety of settings and from a range of disciplinary perspectives. This practitioner-led panel consisting of an internist, a human factors engineer, an occupational therapist, and an implementation scientist, examines the impact of the pandemic on social interaction, and social frailty amongst older people in three different settings (hospital, long term care home, community). Through a set of case studies, the panelists provided applied experiences and perspectives on the impact of the pandemic on patient safety and on social frailty in particular. The panel covered theory, and real-world application of human factors principles. The question of how to design safety into the healthcare system were also explored. In this paper we review the problem of social frailty, list some brief case studies and discuss possible intervention strategies.
Over Triage: Injury Classification Mistake or Hindsight Bias?
Authors: Simonson Richard J. , Keebler Joseph R. , Fernandez Rosemarie , Lazzara Elizabeth H. , Chaparro Alex
Published: October 2022

Patient triage is a critical stage in providing patients with the appropriate level of care required. Multiple metrics are considered in determining appropriate triage at the time of assessment. Due to the complexity of healthcare intervention, patients are often under- or over-triaged. Initiatives to reduce incorrect triages have been developed and implemented. These initiatives, however, may be based on hindsight bias and subsequently result in inaccurate assessments of triage accuracy and lead to improper triage-based education initiatives. This submission proposes the application of the SEIPS framework as a method of mitigating challenges introduced in the triage accuracy assessments due to this potential hindsight bias.
Team Coordination Dynamics Measurement in Enroute Care Training: Defining Requirements and Usability Study
Authors: Winner Jennifer , King Jayde , Gorman Jamie , Grimm David
Published: October 2022

Prior research indicates a need for objective and reliable measures of team communication and coordination. This need rings true for United States Air Force (USAF) teams, whose instructors heavily employ subjective evaluations within fast-paced training. Instructors must observe a multitude of teams and their communications, leaving room for varied evaluations and missed opportunities for feedback. Recent studies have advanced and tested team coordination measures based on dynamical systems theory, yielding results that illustrate the relationship between team communication flow and performance. This work leverages those measures and applies them in the context of USAF medical training. In this study, we assess the usability of a Team Dynamics Measurement System prototype. Users (n = 4) completed 15 tasks and evaluated system usability, perceived mental effort, system satisfaction, and task difficulty. Results indicate marginally acceptable overall system usability. These results helped identify essential interface modifications for future iterations. Future work and use cases for instructor support are discussed.
Performance Based Evaluation of Cricothyroidotomy Simulators for Training
Authors: Bliss James P. , Etherton Kent C. , Hodge Douglas , Winner Jennifer
Published: October 2022

The U.S. military has become increasingly reliant on simulators to train combat medical personnel. Human patient simulators that exist for training medical procedures represent task elements with varying degrees of fidelity. The goal of this research was to evaluate the functional fidelity of two commonly used simulators to train surgical cricothyroidotomy to experienced participants. Following a task analysis informed by experts, we collected performance training and test data from 14 experienced trainees. Each participant performed surgical cricothyroidotomies on porcine tracheas before and after five training sessions using one of two simulators. Comparisons of procedure completion times and errors showed development of task mastery by members of both training groups. Analyses of transfer of training from the final training session to the porcine posttest suggested that experienced participants were sensitive to differences between the training simulators and conditions of the posttest. Implications are presented as they relate to the use of simulation technologies for training cricothyroidotomy and the application of a standard method for fidelity assessment.
From Reactive to Proactive Safety: Joint Activity Monitoring for Infection Prevention
Authors: Morey Dane A. , Rayo Michael F. , Li Mengyun
Published: October 2022

Despite the promise of a proactive approach to safety, a lack of resources and tangible measures have limited its implementation in organizations. We are exploring Joint Activity Monitoring (JAM) as one key component of a proactive safety program within the domain of infection prevention. However, despite a conceptual alignment to the requirements of a proactive monitoring capability, our experiences instrumenting daily work tools with the capabilities to support continuous, unobtrusive, real-time monitoring have revealed additional organizational and technological requirements. In this paper, we describe our strategies and challenges in developing this capability and discuss implications for supporting successful proactive safety implementations.
Design of a Decision Support Based Mobile Application for Mental Health Crisis
Authors: Johnson Amanda J. , Bisantz Ann , Reynolds Amy L. , Meier Scott T.
Published: October 2022

Mental health concerns are one of the most significant issues facing our world today. Many solutions are being researched and developed to address the issues associated with mental health. Often these solutions are designed without incorporating the user into the research or development process, resulting in applications that are not useful, usable, or engaging. The following research focused on incorporating this population into the process of developing a mobile application for use during mental health crises.
The Final Inch: What Pop-Up COVID Testing Tells Us about Community Engagement
Authors: Della Vella Dante , Rayo Michael F.
Published: October 2022

The COVID-19 pandemic has highlighted the need for increased and more dynamic access to healthcare resources. It has also revealed a novel complication to the effective delivery of health resources to communities, which we call the final inch problem. In our recent COVID-19 pop-up testing work with Columbus Public Health and the Ohio National Guard, we have observed that, even when a healthcare-related service is transported directly to community members, it is not a given that they will use that service. We argue that crossing this final inch will require us to reframe public health initiatives through the lens of joint activity: a partnership between healthcare institutions and the public. Our work focuses on three questions. How do we engage with the public and foster common ground between people and our healthcare providers? As part of this, how can we work with the community to determine where to dynamically direct our resources on a given day? Finally, when we show up at the “right” place, will the community join us? Our recent work creating and deploying the Flexible Algorithmic, Adaptive Surveillance Testing (FAAST) has generated promising insights to answer these questions. Throughout our initial tests, we observed a continuous increase in community participation as well as increased positivity through multiple iterations of the program. We consistently overrepresented traditionally underserved minority groups in all testing locations as well. Insights for convincing communities to participate in pop-up testing may yield repeatable, generalizable strategies by which public health officials and healthcare providers may cross the final inch. Through establishing and nurturing reliable community relationships, public health institutions working in partnership with their constituent communities can proactively monitor the health of their communities, thereby facilitating a more resilient response to emerging threats.
Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery
Authors: Evangelista Jeunice Vianca , Li Cherryl , Ng Kimberley-Dale Rebecca , Fan Mark , Trbovich Patricia
Published: October 2022

The Surgical Safety Checklist (SSCL) is a widely implemented intervention; however, limited studies have explored system factors that impact adherence to proper checklist completion. Using an audio-visual recording technology called the Operating Room Blackbox (ORBB), the goal of this study was to characterize the level of checklist completion and identify work system factors that impact the use of the SSCL in general laparoscopic surgery. Thirty-six cases captured by the ORBB in a hospital in Toronto, Ontario were reviewed using an SSCL audit tool to collect data on item-level adherence. The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was applied to the observation notes from the ORBB recordings to identify work system factors influencing checklist use. On average, across all 36 cases, 8 of the 29 checklist items were completed (30.1%), with debriefing being completed most frequently of the 3 checklist sections. Of the 29 checklist items, commonly completed items were: patient concerns addressed, surgical counts complete, and procedure name, while items in the timeout section were completed the least. Notably, factors related to person (e.g., confirmation of patient information amongst surgical team) and tools and technology (e.g., use of checklist in combination with patient chart) were identified as facilitators to checklist use, while factors relating to tasks (e.g., redundancy of checklist items with existing workflow), tools and technology (e.g., some checklist items not applicable to some procedures), organization (e.g, timing of checklist items and absence of team member), and internal environment (e.g., music volume in the OR) were identified as potential barriers to checklist use. By understanding how system factors contribute to checklist use and item-level adherence, we can identify ways to improve the checklist to meet the needs of the OR team and enhance integration of the SSCL into existing workflows.
COVID-19 Vaccination Clinic Success: An Interdisciplinary Application of Simulation and Modeling
Authors: Toscos Tammy , Cornet Victor P. , Charles Michelle , Cumbee Erica , Gabet Charlotte , Massing Ethel , Stienecker (Roger) Scott
Published: October 2022

This paper shares a case study of a rapid cycle of process improvement, physical simulation, and simulation software development to stand up a mass COVID-19 vaccination site. The resulting standard work, clinic setup and simulation software tool were designed and implemented by an interdisciplinary team at a moderate size not-for-profit health system. This unique example of a simulation and modeling implementation led to a high throughput vaccination clinic with an outstanding patient experience.
In the Face of New Challenges; Effective Human Factors Engineering for Software as Medical Device Products
Authors: Groenborg Trine
Published: October 2022

This paper tackles challenges facing human factors professionals when transitioning into working with Software as Medical Device products. Specifically, it outlines the challenges Novo Nordisk A/S has faced when it comes to applying human factors considerations when developing Software as Medical Device products and ensuring regulatory compliance. It showcases the efforts Novo Nordisk A/S has implemented to meet these challenges and conclude on the learnings Novo Nordisk A/S has had with the proposed solutions.
Developing Representations to Support Clinical Decision Making: Insights from Work Analysis
Authors: Flach John M.
Published: October 2022

Principles of Work Domain Analysis (WDA) and Ecological Interface Design (EID) are illustrated using the example of a graphical interface designed to support clinical decision making with respect to cardiovascular health. Multiple iterations of the graphical interface will be presented that show the iterative analysis and design process and the logic of mapping meaningful dimensions into a representation that helps healthcare professionals to understand a complex biological system.
Impact of Health Informatics on Patients’ Perception of Health Care Services: Trends over Time of Health Information Technology Use
Authors: Elkefi Safa , Asan Onur , Do Thy
Published: October 2022

Despite the increase in the availability of online technology, the trend of patients’ adoption of health information technology is not yet clear. This study aims to track the temporal evolution of technology adoption among patients. It focuses on studying the impact of technology use on health care services perspective using the self-efficacy theory. We conducted analysis to evaluate trends over time using Nationally representative data. We found that the more people use technology over time, the less effective they perceive health care services. Their use of technology consists of seeking more information online and communicating more with health care providers. Efforts need to be made in order to guide the use of technology as a complement to clinical health care services to ensure a supervision of health behaviors and a framing of health pathway. Future studies should look at the possible designs and concepts that may provide a suitable solution that both satisfy patients and providers’ needs involving technology but keeping traditional health services respectable.
Unmet Employment Related Needs of Metastatic Breast Cancer Survivors: A Work System Analysis
Authors: Salwei Megan E. , Sesto Mary E. , Tevaarwerk Amye , Carroll Cibele B.
Published: October 2022

Metastatic breast cancer (MBC) is incurable breast cancer (i.e., stage IV) affecting approximately 165,000 women in the US, some of whom will live for years with MBC. Survivors living with MBC frequently experience functional impairments and sickness relating to treatment and their disease progression. Unlike “curable” cancers, MBC survivors are likely to deal with ongoing and/or evolving impairments due to cancer and cancer treatment until end of life, which presents challenges to work and employment. Little is known about the work-related needs of MBC survivors and the factors that impact individual survivors’ decisions to stay-or-leave work. The objective of this study is to understand the work system barriers and facilitators facing MBC survivors who were working at the time of MBC diagnosis. We conducted a survey of MBC survivors as a part of a larger research project to explore the importance of work and work-related decisions in this population. We conducted a secondary, deductive content analysis of a free-text response survey question guided by the Work System model. We identified a total of 77 excerpts, grouped into 12 barriers and 5 facilitators from survey responses of 133 MBC survivors. The person work system element resulted in the most barriers and facilitators, with numerous barriers relating to a lack of information available for MBC survivors. We only identified one excerpt relating to the technology work system element. Given the rapidly growing capabilities of technologies, there is a missed opportunity to design technologies that can support MBC survivors. The increased use of dedicated personnel (e.g., social work, navigators or financial counselors) and the development of patient-facing health IT may better support the unique needs of MBC survivors.
Understanding Work-Related Injury Risk Among Rural Rehabilitation Clinicians
Authors: Ma Jiahui , Fitzgerald Macy , Kittelman Sage , McCrory Bernadette
Published: October 2022

Background: Rehabilitation clinicians have a high risk of occupational injury. Work-related musculoskeletal disorders (WMSDs) are one of the most frequent injuries for rehabilitation clinicians due to repeated heavy lifting and other forceful tasks. The primary objective of this study was to identify factors that caused or contributed to WMSDs for clinicians specifically working in rehabilitation settings (e.g., acute care, inpatient rehabilitation, long-term care, outpatient therapy). Methods: An, in person, proctored questionnaire was conducted of physical therapists (PTs), occupational therapists (OTs) and therapy assistants working at a rural community hospital. Information on general workload, work-related pain or discomfort, patient handling, and clinical experience were gathered using both a scripted interview questionnaire and a semi-scripted post-interview discussion. The questionnaire was analyzed using both descriptive and inferential statistical methods to determine the 1-year prevalence of WMSDs and factors associated with WMSDs and use of safe patient handling techniques. Results: Respondents (n=27) included 18 PTs, 6 OTs and 3 therapy assistants. On average, rehabilitation clinicians spent over eight hours per day delivering “hands-on” care to patients. During a typical workday, therapists spent more than 20% performing heavy lifting, physically fatiguing tasks, or were in a static or awkward posture. Bending or twisting, repetitive tasks, and kneeling or squatting were each performed 30% or more of a typical workday, especially bending or twisting (38%). More than half (63%) suffered musculoskeletal pain/discomfort during the past year. Inadequate lifting devices were reported to be available in the working environment. A negative association was observed between the availability of multiple lifting devices and WMSDS (p-values<0.05). Less than a third of clinicians (31.5%) reported complete confidence to use mechanical lifting devices during rehabilitation activities. Conclusion: Rehabilitation clinicians are at higher risk for WMSDs due to patient handling tasks. More ongoing training must be provided to ensure clinicians have confidence to use the technologies available for rehabilitation tasks. However, additional research is still needed to understand the causal factors of WMSDs related to patient handling, particularly for rural care settings that lack access to technology and adequate staffing.
Mobile Health App Privacy Policies: What Patients Want vs. Understand
Authors: Siberry Vikram , Ratwani Raj , Wesley Deliya
Published: October 2022

Mobile health applications (apps) are increasingly serving as supplement tools to provider-delivered care in various clinical scenarios. This pilot study explored the relationship between readability of in-app privacy policies and patient comprehension of the policy as well as patient preferences regarding data sharing practices and policy content. Based on interviews with individuals with experience and expertise understanding privacy policies (N=5), a list of important patient-relevant content details was generated for each of the two policies used in the study. Patients (N = 5) then determined important content details from their perspective in the same two policies and answered general questions regarding preferences for personal data sharing. The two app policies differed in length and reading difficulty, yet patients only identified 40% of expert-derived content details in each policy. Patients expressed clear preferences for types and purposes of their data being used by apps and method for privacy policy update notification.
Speech Recognition and Listening Effort of Meaningful Sentences Using Synthetic Speech
Authors: Ibelings Saskia , Brand Thomas , Holube Inga
Published: October 2022

Speech-recognition tests are an important component of audiology. However, the development of such tests can be time consuming. The aim of this study was to investigate whether a Text-To-Speech (TTS) system can reduce the cost of development, and whether comparable results can be achieved in terms of speech recognition and listening effort. For this, the everyday sentences of the German Göttingen sentence test were synthesized for both a female and a male speaker using a TTS system. In a preliminary study, this system was rated as good, but worse than the natural reference. Due to the Covid-19 pandemic, the measurements took place online. Each set of speech material was presented at three fixed signal-to-noise ratios. The participants’ responses were recorded and analyzed offline. Compared to the natural speech, the adjusted psychometric functions for the synthetic speech, independent of the speaker, resulted in an improvement of the speech-recognition threshold (SRT) by approximately 1.2 dB. The slopes, which were independent of the speaker, were about 15 percentage points per dB. The time periods between the end of the stimulus presentation and the beginning of the verbal response (verbal response time) were comparable for all speakers, suggesting no difference in listening effort. The SRT values obtained in the online measurement for the natural speech were comparable to published data. In summary, the time and effort for the development of speech-recognition tests may be significantly reduced by using a TTS system. This finding provides the opportunity to develop new speech tests with a large amount of speech material.
mTOR inhibition attenuates cTfh cell dysregulation and chronic T-cell activation in multilineage immune cytopenias
Authors: Kumar Deepak , Nguyen Thinh H. , Bennett Carolyn M. , Prince Chengyu , Lucas Laura , Park Sunita , Lawrence Taylor , Chappelle Karin , Ishaq Mariam , Waller Edmund K. , Prahalad Sampath , Briones Michael , Chandrakasan Shanmuganathan
Published: October 2022

mTOR inhibitors such as sirolimus are increasingly used in the management of multilineage immune cytopenia (m-IC) in children. Although sirolimus is effective in improving IC, it is unclear how sirolimus affects the broader immune dysregulation associated with m-IC. We profiled T- and B-cell subsets longitudinally and measured cytokines and chemokines before and after sirolimus treatment. Eleven of the 12 patients with m-IC who tolerated sirolimus were followed for a median duration of 17 months. All patients had an improvement in IC, and sirolimus therapy did not result in significant decreases in T-, B- and NK-cell numbers. However, the expansion and activation of circulating T follicular helper and the Th1 bias noted before the initiation of sirolimus were significantly decreased. Features of chronic T-cell activation and exhaustion within effector memory compartments of CD4+ and CD8+ T cells decreased with sirolimus therapy. Corresponding to these changes, plasma levels of CXCL9 and CXCL10 also decreased. Interestingly, no significant improvement in the proportion of class-switched memory B cells or frequencies of CD4+ naive T cells were noted. Longer follow-up and additional studies are needed to validate these findings and evaluate the effect of sirolimus on B-cell maturation.
Multiple COVID-19 vaccine doses in CLL and MBL improve immune responses with progressive and high seroconversion
Authors: Shen Yandong , Freeman Jane A. , Holland Juliette , Naidu Kartik , Solterbeck Ann , Van Bilsen Nenna , Downe Paul , Kerridge Ian , Wallman Lucinda , Akerman Anouschka , Aggarwal Anupriya , Milogiannakis Vanessa , Martins Costa Gomes Gabriela , Doyle Chloe M. , Sandgren Kerrie J. , Turville Stuart , Cunningham Anthony L. , Mulligan Stephen P.
Published: October 2022

Patients with chronic lymphocytic leukemia (CLL) or monoclonal B-lymphocytosis (MBL) have impaired response to COVID-19 vaccination. A total of 258 patients (215 with CLL and 43 with MBL) had antispike antibody levels evaluable for statistical analysis. The overall seroconversion rate in patients with CLL was 94.2% (antispike antibodies ≥50 AU/mL) and 100% in patients with MBL after multiple vaccine doses. After 3 doses (post-D3) in 167 patients with CLL, 73.7% were seropositive, 17.4% had antispike antibody levels between 50 and 999 AU/mL, and 56.3% had antispike antibody levels ≥1000 AU/mL, with a median rise from 144.6 to 1800.7 AU/mL. Of patients who were seronegative post-D2, 39.7% seroconverted post-D3. For those who then remained seronegative after their previous dose, seroconversion occurred in 40.6% post-D4, 46.2% post-D5, 16.7% post-D6, and 0% after D7 or D8. After seroconversion, most had a progressive increase in antispike antibody levels. Neutralization was associated with higher antispike antibody levels, more vaccine doses, and earlier severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants; neutralizing antibody against early clade D614G was detected in 65.3%, against Delta in 52.0%, and against Omicron in 36.5%. SARS-CoV-2–specific T-cell production of interferon γ and interleukin 2 occurred in 73.9% and 60.9%, respectively, of 23 patients tested. After multiple vaccine doses, by multivariate analysis, immunoglobulin M ≥0.53 g/L, immunoglobulin subclass G3 ≥0.22 g/L and absence of current CLL therapy were independent predictors of positive serological responses. Multiple sequential COVID-19 vaccination significantly increased seroconversion and antispike antibody levels in patients with CLL or MBL.
MAP kinase activating death domain deficiency is a novel cause of impaired lymphocyte cytotoxicity
Authors: Schütze Kerstin , Groß Miriam , Cornils Kerstin , Wustrau Katharina , Schneppenheim Sonja , Lenhartz Henning , Korenke G. Christoph , Janka Gritta , Ledig Svea , Müller Ingo , Ehl Stephan , Lehmberg Kai
Published: October 2022

Most hereditary forms of hemophagocytic lymphohistiocytosis (HLH) are caused by defects of cytotoxicity, including the vesicle trafficking disorder Griscelli syndrome type 2 (GS2, RAB27A deficiency). Deficiency of the mitogen-activated protein kinase activating death domain protein (MADD) results in a protean syndrome with neurological and endocrinological involvement. MADD acts as a guanine nucleotide exchange factor for small guanosine triphosphatases, including RAB27A. A homozygous splice site mutation in MADD was identified in a female infant with syndromic features, secretory diarrhea, and features of HLH. Aberrant splicing caused by this mutation leads to an in-frame deletion of 30 base pairs and favors other aberrant variants. Patient natural killer (NK) cells and cytotoxic T cells showed a severe degranulation defect leading to absent perforin-mediated cytotoxicity. Platelets displayed defective adenosine triphosphate secretion, similar to that in GS2. To prove causality, we introduced a CRISPR/Cas9-based MADD knockout in the NK cell line NK-92mi. MADD-deficient NK-92mi cells showed a degranulation defect and impaired cytotoxicity similar to that of the patient. The defect of cytotoxicity was confirmed in another patient with MADD deficiency. In conclusion, RAB27A-interacting MADD is involved in vesicle release by cytotoxic cells and platelets. MADD deficiency causes a degranulation defect and represents a novel disease predisposing to an HLH phenotype.
Detecting protein complexes with multiple properties by an adaptive harmony search algorithm
Authors: Wang Rongquan , Wang Caixia , Ma Huimin
Published: October 2022

Background

Accurate identification of protein complexes in protein-protein interaction (PPI) networks is crucial for understanding the principles of cellular organization. Most computational methods ignore the fact that proteins in a protein complex have a functional similarity and are co-localized and co-expressed at the same place and time, respectively. Meanwhile, the parameters of the current methods are specified by users, so these methods cannot effectively deal with different input PPI networks.

Result

To address these issues, this study proposes a new method called MP-AHSA to detect protein complexes with Multiple Properties (MP), and an Adaptation Harmony Search Algorithm is developed to optimize the parameters of the MP algorithm. First, a weighted PPI network is constructed using functional annotations, and multiple biological properties and the Markov cluster algorithm (MCL) are used to mine protein complex cores. Then, a fitness function is defined, and a protein complex forming strategy is designed to detect attachment proteins and form protein complexes. Next, a protein complex filtering strategy is formulated to filter out the protein complexes. Finally, an adaptation harmony search algorithm is developed to determine the MP algorithm’s parameters automatically.

Conclusions

Experimental results show that the proposed MP-AHSA method outperforms 14 state-of-the-art methods for identifying protein complexes. Also, the functional enrichment analyses reveal that the protein complexes identified by the MP-AHSA algorithm have significant biological relevance.
Identification of inflammatory-related gene signatures to predict prognosis of endometrial carcinoma
Authors: Chen Linlin , Zhu Guang , Liu Yanbo , Shao Yupei , Pan Bing , Zheng Jianhong
Published: October 2022

Little is known about the prognostic risk factors of endometrial cancer. Therefore, finding effective prognostic factors of endometrial cancer is the vital for clinical theranostic. In this study, we constructed an inflammatory-related risk assessment model based on TCGA database to predict prognosis of endometrial cancer. We screened inflammatory genes by differential expression and prognostic correlation, and constructed a prognostic model using LASSO regression analysis. We fully utilized bioinformatics tools, including ROC curve, Kaplan–Meier analysis, univariate and multivariate Cox regression analysis and in vitro experiments to verify the accuracy of the prognostic model. Finally, we further analyzed the characteristics of tumor microenvironment and drug sensitivity of these inflammatory genes. The higher the score of the endometrial cancer risk model we constructed, the worse the prognosis, which can effectively provide decision-making help for clinical endometrial diagnosis and treatment.