bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep learning for enhancing wavefield image quality in fast non-contact inspections
Authors: Keshmiri Esfandabadi Yasamin , Bilodeau Maxime , Masson Patrice , De Marchi Luca
Published: September 2019

Ultrasonic wavefield imaging with a non-contact technology can provide detailed information about the health status of an inspected structure. However, high spatial resolution, often necessary for accurate damage quantification, typically demands a long scanning time. In this work, we investigate a novel methodology to acquire high-resolution wavefields with a reduced number of measurement points to minimize the acquisition time. Such methodology is based on the combination of compressive sensing and convolutional neural networks to recover high spatial frequency information from low-resolution images. A data set was built from 652 wavefield images acquired with a laser Doppler vibrometer describing guided ultrasonic wave propagation in eight different structures, with and without various simulated defects. Out of those 652 images, 326 cases without defect and 326 cases with defect were used as a training database for the convolutional neural network. In addition, 273 wavefield images were used as a testing database to validate the proposed methodology. For quantitative evaluation, two image quality metrics were calculated and compared to those achieved with different recovery methods or by training the convolutional neural network with non-wavefield images data set. The results demonstrate the capability of the technique for enhancing image resolution and quality, as well as similarity to the wavefield acquired on the full high-resolution grid of scan points, while reducing the number of measurement points down to 10% of the number of scan points for a full grid.
The Issue Focus of Online and Television Advertising in the 2016 Presidential Campaign
Authors: Franz Michael M. , Franklin Fowler Erika , Ridout Travis , Wang Meredith Yiran
Published: September 2019

Theories of campaign issue emphasis were developed in a pre-digital era. How well do these theories explain spending in the current era, when digital media allow for targeting of specific types of voters? In this research, we compare how the 2016 campaigns, both primary and general election, deployed television advertising with how they deployed online advertising. We suggest that, because online messages are targeted to specific viewer profiles much more than television messages, television ads should be more likely to discuss highly salient issues and valance issues than online ads. To test these ideas, we rely upon data from the Wesleyan Media Project, which tracked all televised political ads that aired in 2016, and our coding of data from Pathmatics, a company that tracks online advertising. We find, contrary to our expectations, that the predictors of issue discussion online and on television are largely similar.
Elevated Levels of TNF-α and Decreased Levels of CD68-Positive Macrophages in Primary Tumor Tissues Are Unfavorable for the Survival of Patients With Nasopharyngeal Carcinoma
Authors: Yu Yahui , Ke Liangru , Xia Wei-Xiong , Xiang Yanqun , Lv Xing , Bu Junguo
Published: September 2019

Due to the critical role of inflammation in nasopharyngeal carcinoma, we aim to investigate the correlation between nasopharyngeal carcinoma prognosis and the levels of tumor necrosis factor α and macrophages for the development of new prognostic models. The levels of tumor necrosis factor-α and CD68-positive macrophages were measured in 111 primary nasopharyngeal carcinoma specimens by immunohistochemistry. Kaplan-Meier analysis showed that, compared with nonelevated tumor necrosis factor-α levels, elevated tumor necrosis factor α levels were correlated with poorer 10-year distant metastasis-free survival (24.5% vs 5.2%, P = .004) and bone metastasis-free survival (17.0% vs 0.0%, P = .001). Multivariate analysis revealed that tumor necrosis factor α level was an independent prognostic factor for distant metastasis-free survival (hazard ratio = 16.765, P = .001), while the level of CD68-positive macrophages was a favorable independent prognostic factor for cancer-specific survival (hazard ratio = 0.481, P = .023) and disease-free survival (hazard ratio = 0.403, P = .010). Additionally, several prognostic models that considered tumor-node-metastasis stage alone or in combination with tumor necrosis factor α and/or CD68-positive macrophage levels were compared by receiver operating characteristic curve analysis. Interestingly, the T_score model, which considered the tumor necrosis factor α level alone, could better predict the distant metastasis-free survival and bone metastasis-free survival, whereas the MT model, which considered the combination of T stage and CD68-positive macrophage level, could better predict the cancer-specific survival and disease-free survival of patients with nasopharyngeal carcinoma. Elevated tumor necrosis factor-α levels and decreased CD68-positive macrophage levels in primary nasopharyngeal carcinoma tissues are unfavorable prognostic indicators in nasopharyngeal carcinoma. The T_score model or the MT model could be better prognostic models than those currently available for nasopharyngeal carcinoma and could be used to select high-risk patients and aid in the design of individualized immunotherapy.
Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment
Authors: Moore de Peralta Arelis , Davis Lauren , Brown Katherine , Fuentes Michelle , Falconer N. Suzanne , Charles Jenneil , Eichinger Michelle
Published: September 2019

Introduction:

Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process.

Method:

A binational community–academic partnership adapted the Centers for Disease Control and Prevention’s CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology.

Results:

Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community’s health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels.

Conclusion:

A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.
Social Network Mapping and Functional Recovery Within 6 Months of Ischemic Stroke
Authors: Dhand Amar , Lang Catherine E. , Luke Douglas A. , Kim Angela , Li Karen , McCafferty Liam , Mu Yi , Rosner Bernard , Feske Steven K. , Lee Jin-Moo
Published: September 2019

Objective. Stroke recovery is a multidimensional process influenced by biological and psychosocial factors. To understand the latter, we mapped the social networks of stroke patients, analyzing their changes and effects on physical function at 3 and 6 months after stroke. Methods. We used a quantitative social network assessment tool to map the structure and health habits embedded in patients’ personal social networks. The physical function outcome was determined using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Scale (0-100, mean 50 for US general population). We used mixed-effects models to assess changes in social network metrics. We used multivariable models to test the association between social networks and physical function, independent of demographics, socioeconomic status, clinical characteristics, comorbidities, cognition, and depression. Results. The cohort consisted of 172 patients, with mostly mild motor-predominant stroke (median NIH Stroke Scale of 2) with retention of 149 at 3 months and 139 at 6 months. An average patient’s network over 6 months contracted by 1.25 people and became denser and family oriented. Network composition also became healthier with pruning of ties with people who smoked or did not exercise. The baseline network size, and not density or health habits in the network, was independently associated with 3- and 6-month physical function PROMIS scores. Patients embedded in small kin-based networks reported more negative social interactions. Conclusions. Despite social networks becoming smaller and close-knit after stroke, they also become healthier. Larger baseline social networks are independently associated with better patient-reported physical function after stroke.
An Increase of Excitatory-to-Inhibitory Synaptic Balance in the Contralateral Cortico-Striatal Pathway Underlies Improved Stroke Recovery in BDNF Val66Met SNP Mice
Authors: Qin Luye , Actor-Engel Hannah S. , Woo Moon-Sook , Shakil Faariah , Chen Yi-Wen , Cho Sunghee , Aoki Chiye
Published: September 2019

Despite negative association in cognition and memory, mice harboring Val66Met BDNF SNP (BDNFM/M) exhibit enhanced motor recovery accompanied by elevated excitatory synaptic markers VGLUT1 and VGLUT2 in striatum contralateral to unilateral ischemic stroke. The cortico-striatal pathway is a critical gateway for plasticity of motor/gait function. We hypothesized that enhanced excitability of the cortico-striatal pathway, especially of the contralateral hemisphere, underlies improved motor recovery. To test this hypothesis, we examined the key molecules involving excitatory synaptogenesis: Thrombospondins (TSP1/2) and their neuronal receptor α2δ-1. In WT brains, stroke induced expressions of TSP1/2-mRNA. The contralateral hemisphere of BDNFM/M mice showed heightened TSP2 and α2δ-1 mRNA and protein specifically at 6 months post-stroke. Immunoreactivities of TSPs and α2δ-1 were increased in cortical layers 1/2 of stroked BDNFM/M animals compared with BDNFM/M sham brains at this time. Areal densities of excitatory synapses in cortical layer 1 and striatum were also increased in stroked BDNFM/M brains, relative to stroked WT brains. Notably, the frequency of GABAergic synapses was greatly reduced along distal dendrites in cortical layer 1 in BDNFM/M brains, whether or not stroked, compared with WT brains. There was no effect of genotype or treatment on the density of GABAergic synapses onto striatal medium spiny neurons. The study identified molecular and synaptic substrates in the contralateral hemisphere of BDNFM/M mice, especially in cortical layers 1/2, which indicates selective region-related synaptic plasticity. The study suggests that an increase in excitatory-to-inhibitory synaptic balance along the contralateral cortico-striatal pathway underlies the enhanced functional recovery of BDNFM/M mice.
Bolt loosening detection in a jointed beam using empirical mode decomposition–based nonlinear system identification method
Authors: Xu Chao , Huang Chen-Chen , Zhu Wei-Dong
Published: September 2019

In this work, a state-of-art nonlinear system identification method based on empirical mode decomposition is utilized and extended to detect bolt loosening in a jointed beam. This nonlinear system identification method is based on identifying the multi-scale dynamics of the underlying system. Only structural dynamic response signals are needed to construct a reduced-order model to represent the system concerned. It makes the method easy to use in practice. A new bolt loosening identification procedure based on the constructed system nonlinear reduced-order model is proposed. A new damage feature to indicate bolt loosening is presented. Experimental works are carried out to validate the proposed method. The results show that the proposed damage detection method can detect bolt loosening effectively, and the proposed damage feature values increase with the increase of bolt torques. The damage feature calculated from the response solution of the reduced-order model can give robust and sensitive indication of bolt loosening.
Design, kinematics, and statics of a novel wave energy converter with parallel mechanism
Authors: Chen Xiulong , Jiang Deyu
Published: September 2019

In order to design an ocean wave energy generator robot, a novel wave energy converter with parallel mechanism is designed and analyzed. A creative thinking that parallel mechanism can be applied to the wave energy converter is presented and verified during the wave energy using process. The design principles of the wave energy converter are given according to wave motion characteristics. Based on the principles, a novel wave energy converter with 4UPS/UP parallel mechanism is designed, which includes the design of the parallel mechanism, hydraulic cylinders, oil circuit, and converter integration. Then the kinematics model and statics model of the wave energy converter with 4UPS/UP parallel mechanism are derived by MATLAB and ADAMS; with these two methods, we found that the errors of rod length, velocity, and acceleration were 1.13 mm, 0.04 mm/s, and 0.38 mm/s2, respectively. Maximum stress error and maximum constraint moment errors were 1.52 N and 0.57 N·mm. So the correctness of the models is verified. This article can not only provide a reference for other types of parallel mechanisms applied to the wave energy converter, but also provide a theoretical foundation for the experimental prototype and practical application of the wave energy converter.
A 3D model to predict the influence of nanoscale pores or reduced gas pressures on the effective thermal conductivity of cellular porous building materials
Authors: Van De Walle Wouter , Janssen Hans
Published: September 2019

Cellular porous materials are frequently applied in the construction industry, both for structural and insulation purposes. The progressively stringent energy regulations mandate the development of better performing insulation materials. Recently, novel porous materials with nanopores or reduced gas pressures have been shown to possess even lower thermal conductivities because of the Knudsen effect inside their pores. Further understanding of the relation between the pore structure and the effective thermal conductivity is needed to quantify the potential improvement and design new optimized materials. This article presents the extension of a 3D numerical framework simulating the heat transfer at the pore scale. A novel methodology to model the reduced gas-phase conductivity in nanopores or at low gas pressures is presented, accounting for the 3D pore geometry while remaining computationally efficient. Validation with experimental and numerical results from the literature indicates the accuracy of the methodology over the full range of pore sizes and gas pressures. Combined with an analytical model to account for thermal radiation, the framework is applied to predict the thermal conductivity of a nanocellular poly(methyl methacrylate) foam experimentally characterized in the literature. The simulation results show excellent agreement with less than 5% difference with the experimental results, validating the model’s performance. Furthermore, results also indicate the potential improvements when decreasing the pore size from the micrometre to the nanometre range, mounting up to 40% reduction for such high-porosity low-matrix-conductivity materials. Future application of the model could assist the design of advanced materials, properly accounting for the effect of reduced pore sizes and gas pressures.
Influence of early postoperative showering in undressed surgical wound for better clinical outcome
Authors: Jayathilake Anuradha , Jayaweera Jayaweera Arachchige Asela Sampath , Kumbukgolla Wikum Widuranga , Herath Sudheera
Published: September 2019

Surgeons instruct the patients to avoid postoperative bathing and dress the wounds until the sutures are removed. All wounds were sutured at the end of surgery and kept undressed. Participants received a tap water body bath where the water covered the wound after 24h of surgery. The control group were asked not to wet the dressed surgical site until wound inspection on days 3 and 5. The patients were followed up in the surgery clinic on days 14 and 30 after surgery, when age, sex and type of surgery-matched controls’ surgical site infection was significantly high in clean/contaminated and contaminated appendicectomy, breast lump excision, inguinal herniotomy and tendon repair surgeries. In contaminated appendicectomy, clean/contaminated and contaminated herniotomies postsurgical infections other than surgical site infection were significantly low in test groups. Early mobilisation, keeping the surgical wounds moist and providing a clean environment are suitable to minimise the surgical wound and other associated infections.
The Biplanar Effect of the Medial Cuneiform Osteotomy
Authors: Mortimer J. Alexandra , Bouchard Maryse , Acosta Anna , Mosca Vincent
Published: September 2019

Background. The “foot-CORA” (center of rotation of angulation) method confirms the medial cuneiform as the site of deformity in most forefoot/midfoot deformities and is therefore the ideal location to correct those deformities. It has been consistently observed intraoperatively by the senior author that there is a secondary, unintentional deformity created in the transverse plane when dorsiflexion and plantar flexion osteotomies of the medial cuneiform are performed to correct pronation and supination forefoot deformities, respectively. These effects may not be desirable. This biplanar effect of medial cuneiform osteotomies has been observed but not studied. The purpose of this study was to perform the 4 commonly used medial cuneiform osteotomy techniques on cadaveric feet to demonstrate their biplanar effects. Methods. Four formaldehyde preserved cadaveric feet were used to perform 4 techniques of medial cuneiform osteotomy: dorsiflexion plantar-based opening wedge, plantar flexion dorsal-based opening wedge, dorsiflexion dorsal-based closing wedge, and plantar flexion plantar-based closing wedge. Photographs and fluoroscopy were used to assess the angular changes in the sagittal and transverse planes. Angular measurements were made using OsiriX software on fluoroscopic images. Results. The medial cuneiform opening wedge osteotomies produced midfoot abduction in addition to the desired dorsiflexion and plantar flexion. The medial cuneiform closing wedge osteotomies produced midfoot adduction in addition to the desired dorsiflexion and plantar flexion. Conclusion. We confirm that intentional sagittal uniplanar osteotomies of the medial cuneiform create obligate biplanar effects. This is likely a result of tethering by ligaments and the joint capsules on the lateral border of the medial cuneiform. The obligate transverse plane effect can be used to one’s advantage or result in an undesired effect if not considered during surgical planning and execution. We propose a simple treatment algorithm for selecting the appropriate medial cuneiform osteotomy for forefoot/midfoot deformities.

Levels of Evidence: Level V
Identity and Psychopathology: Bridging Developmental and Clinical Research
Authors: Verschueren Margaux , Claes Laurence , Gandhi Amarendra , Luyckx Koen
Published: September 2019

Research has demonstrated the important impact of identity on psychosocial functioning in both community and clinical populations. The present article aims to identify different mechanisms through which identity may be related to psychopathology. Emphasis is placed on neo-Eriksonian identity models targeting identity mechanisms both at the structural and process levels. With respect to psychopathology, the present article focuses mainly on disturbed eating behaviors and nonsuicidal self-injury, with both behaviors sharing a focus on the body. Emerging research lines are identified, and recent research is discussed as a sample case of how developmental theorizing on identity can yield insights in the emergence and development of psychopathological behaviors. In integrating these research lines, the present article discusses emerging themes originating from the field and provides important avenues for future research and intervention efforts.
Nursing Handovers in Critical Care: A Retrospective Analysis of Information Content and Function
Authors: Patterson Emily S. , McIntire Anne , Beecroft Nicholas , Happ Mary Beth , Moffatt-Bruce Susan D.
Published: September 2019

Translating validated handover protocols from physicians in non-critical care settings to nursing report in critical care is challenging. Our objectives are to identify information content in verbal reports, where information is documented, and the function of non-documented communication. This is a descriptive study of 20 reports describing 27 patients from two medical intensive care units. Analysis involved unique coding of phrases and emergent themes analysis. Information categories included: Identify patient (51.9%); Narrative history (96.3%); Unusual symptoms (88.9%); Response to care (37%); Status of tasks (100%); Expectations of patients and families (55.6%). Information is documented in progress notes, the medication administration record, nursing flowsheets, lab results, orders, and past medical history. Information not typically documented supports providing patient-centered care, sharing clinical judgments, coordinating work, and mentorship. These objectives may guide nursing administrators in tailoring policies and procedures for nursing report to the needs of registered nurses in a critical care setting.
Cognitive Usability Evaluation of Electronic Health Record Systems (CUE-E)
Authors: Pfaff Mark S. , Anganes Amanda , Eris Ozgur , Prior Aileen , Ward Merry , Nebeker Jonathan
Published: September 2019

This project’s purpose was to develop cognitively-focused usability evaluation methods for electronic health records (EHRs). This research involved developing a conceptual framework for evaluating EHR usability in terms of clinical cognition and operationalizing the framework in the form of two novel EHR usability evaluation methods. The two evaluation methods - one observational and one lab-based - are described in a suite of protocol materials and recommendations for EHR evaluation and design. This resulting body of work is referred to as CUE-E: Cognitive Usability Evaluation - EHR. This paper describes the process behind the development of the CUE-E evaluation methods, summarizes the use of both, and discusses directions for future work. The two CUE-E evaluation methods are currently ready for pilot applications to assess their reliability and validity and identify opportunities for further improvement.
Mixed Reality in Medical Education: A Narrative Literature Review
Authors: Barrie Michael , Socha Jacob J. , Mansour Lauren , Patterson Emily S.
Published: September 2019

There is growing interest in using immersive technology, which includes augmented, virtual, and mixed reality, in medical education. We conducted a narrative literature review to identify elements to consider when using immersive technologies in medical education. Our search revealed clusters of key articles for different applications that point to four categories of elements to consider. We recommend matching learning objectives with choices aligned with these elements for the purchase, implementation, and use of immersive technologies with individuals and groups of medical students.
Towards the Design of a Smart Glasses Application for MICU Decision-Support: Assessing the Human Factors Impact of Data Portability & Accessibility
Authors: Faiola Anthony , Belkacem Ilyasse , Bergey Dani , Pecci Isabelle , Martin Benoit
Published: September 2019

The focus of this research is to develop and test a new smart glasses application for use in the medical intensive care unit (MICU) to support workflow, patient care, and overall clinical decision-making. The application prototype, mCARE glass, provides clinicians mobility, portability, and hands-free access to real-time patient electronic medical records and bedside data on demand. Five MICU physician volunteers participated in a study consisting of two parts: 1) a usability test with two tasks, and 2) an interview. Part one included usability testing with the use of the tracking pad, followed by the NASA Task Load Index Test and System Usability Scale test. Our findings suggest that mCARE glass has the potential to enhance clinical workflow in the ICU, and that besides providing easy access to patient data, it would improve patient monitoring and surveillance. Participants concurred that for mCARE glass to optimize clinical workflow, it must be well-integrated into one’s daily work as part of decision-making and observation.
How mHealth Apps with Higher Usability Effects on Patients with Breast Cancer?
Authors: Ebnali Mahdi , Shah Mousgan , Mazloumi Adel
Published: September 2019

Background and Method:

This study compared the effects of self-management mHealth (mobile health) apps and conventional intervention (brochure) on the quality of life (QoL) and exercise engagement of patients with breast cancer. Moreover, the current research aimed to investigate how usability improvement in mHealth leads to increased exercise engagement and QoL. To select apps with different level of usability, a heuristic usability testing using was conducted. Three apps with varying scores of usability - low, average, and high- were selected to enter in a randomized control trial (RCT) experiment. We formed 4 groups of intervention including the app with the highest usability (App5), the app with average usability (App4), the app with the lowest usability (App3), and the brochure. In each group, 5 patients, randomly selected from 20 patients, entered to the experiment and started to use the assigned mHealth app for 6 weeks.

Results:

The results showed that QoL scores were significantly higher for all participants in app groups compared to the broacher group. Further analysis of the results showed that the patients in App5 group reported higher QoL compared to patients in App4, App3, and brochure groups. In addition, patients in App5 and App4 groups reported more engagement in physical activities. Self-reported engagement in exercise data was not wholly consistent with engagement data logged by phones. Usability evaluation of apps from the patients’ perspective showed that, similar to heuristic usability, the patients rated App5 with higher usability score. The correlation analysis showed that user usability score was positively correlated with heuristic usability score. Moreover, other correlation analysis revealed that patients who rated the app with higher usability score, reported more commitment to physical activities. These results may imply that, compared to conventional intervention (brochure), mHealth apps engaged the patients in physical activities with a higher degree, and consequently improved their QoL.
Patient-centered Design Grounded in User and Clinical Realities: Towards Valid Digital Health
Authors: Cornet Victor P. , Daley Carly , Bolchini Davide , Toscos Tammy , Mirro Michael J. , Holden Richard J.
Published: September 2019

Valid design of patient-centered digital health or health information technology (IT) systems is based on a thorough and accurate understanding of both “user reality” and “clinical reality.” Type 1 Design Error (User-Reality Error) occurs when designers do not accommodate user characteristics, tasks, context of use, needs, or preferences. Type 2 Design Error (Clinical-Reality Error) occurs when designers do not accommodate the clinical reality, including biomedical knowledge, clinical workflows, and organizational requirements. Both types of errors can invalidate the design, leading to products being rejected by patient end-users or their healthcare delivery systems, product non-use or inappropriate use, and risk of harm. This paper describes our attempts to achieve valid health IT design and avoid the two design errors. We performed iterative, patient-centered design to prototype a mobile application, Power to the Patient (P2P), supporting heart failure self-care management. Our multidisciplinary team of human factors, cardiology, and design experts developed and iteratively refined requirements based on data collection, review, and testing with patient research participants, a patient advisory board, a clinical advisory board, and experts on the team. We describe our process and reflect on working with multiple stakeholders toward the goal of valid health IT design.
The Challenges of Data Visualization for Precision Medicine
Authors: Silva Bevilacqua Tatiana , Mendoza da Nobrega Raphael , Chen Helen , Pelegrini Morita Plinio
Published: September 2019

Precision medicine is driving medicine towards a new era where technology and large amounts of data come together to play an essential role in treatment. Data needed to empower and inform decision-makers can be overwhelming to interpret and poses unique challenges related to the visualization of data generated by machine learning and deep learning algorithms. Therefore, the present study aims to provide an in-depth understanding of the challenges, current trends, and opportunities concerning data visualization for precision medicine.
Uncertainty Management Among Older Adults with Heart Failure: Responses to Receiving Implanted Device Data using a Fictitious Scenario Interview Method
Authors: Daley Carly , Cornet Victor , Patekar Gauri , Kosarabe Swapnil , Bolchini Davide , Toscos Tammy , Mirro Michael , Wagner Shauna , Martin Elizabeth , Ghahari Romisa Rohani , Ahmed Ryan , Miller Amy , Holden Richard J.
Published: September 2019

Heart failure (HF) is a complex chronic illness that affects the older adult population, requiring medical therapy and day-to-day management to prevent worsening and exacerbation. Patients with HF are often treated with cardiac implanted electronic devices (CIEDs) which capture diagnostic and predictive parameters for HF. In this work we explore how patients would respond to receiving data from an implanted device, using a fictitious scenario interview method with 24 older adults with HF. We applied an uncertainty management lens to better understand how patients face uncertain outcomes and integrate novel data into their decision making. The findings provide insight into how patients would engage and respond to a technology which provides an indicator of their HF status from an implanted device.
Crisis Checklists in Hospital: Translating From Complicated to Complex Care Environments
Authors: Subbe CP , Barach P
Published: September 2019

Failure to detect and treat clinical deterioration in patients, either from a medical condition or due to a complication of surgical treatment, is a common life threatening problem. Hospitals have introduced Rapid Response Systems (RRS) to manage patients with catastrophic physiological derangements. The first responders on general medical and surgical wards will nearly always be an ad hoc assembly of available providers with limited experience in managing common emergency situations. Checklists, borrowed from aviation solutions have been used effectively as a routine safety procedure. Studies describing the use of checklists beyond the highly controlled environments of the Intensive Care Unit (ICU) and the operating theatre are rare. Checklist formats similar to the operating theatre checklists, require a team of several responders already at the bedside. However, the first-responder on medicine-surgery wards is often a lone responder, most likely a registered nurse and/or a junior doctor with limited experience in managing emergencies. The successful implementation of crisis emergency checklists has the potential to improve patient care and outcomes. RRS crisis emergency checklists are likely to be effective when they are performed as a team routine in the context and readiness for change. The success of checklists will depend on careful listening to clinicians, uptake and acceptance by providers, supported by a strongly motivated and committed team ethos.
Using Tactile and Multimodal Notifications on Smart Watches in Clinical Settings
Authors: Li Huiyang , Chundi Hemanth Krishna
Published: September 2019

Recent research has explored the use of wearable/hand-free devices, such as smartwatches, in clinical settings. Smart watch, in particular, can display information in different modalities, including visual, auditory and tactile, and thus has the potential to improve communication and notification in clinical environments that are overloaded with sensory information. However, few studies have examined the effectiveness of notifications received on smart watches and the factors that affect the performance while using smartwatches for notifications. This study investigated the effects of type of notifications (multimodal vs. tactile) and the environmental noise level on user performance while receiving notifications on a smart watch in a simulated nursing home setting. Eighteen participants performed four different tasks in a simulated clinical settings while they were asked to respond to tactile and multimodal (tactile and auditory) notifications received on a smartwatch. Results showed that the modality of notification did not affect user performance. However participants rated multimodal notification as more helpful. The noise level and type of task had a significant effect on performance. The results of the study indicate that the effectiveness of smartwatch notifications varies in different clinical settings with varying environmental features and with different of primary task. Adjustment of parameters for each setting would be necessary.
FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis
Authors: Profozich Alexa , Sytsma Trevor , Arnold Ryan , Miller Kristen , Capan Muge
Published: September 2019

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.
Are “Human Factors Engineers” Prepared for the Medical Device Industry? – Preliminary Findings from an Interactive Poster Survey
Authors: Li Huiyang , Lau Michael
Published: September 2019

As the medical device industry establishes more rigorous human factors practices in their design and development process, this is accompanied by an increase in demand in human factors professionals. The human factors activities have been performed by both professionals with formal human factors education and training and those who come from other backgrounds, such as engineering, natural science, medical fields, design and more. Both across those disciplines and the within human factors field, there is no standard curriculum or requirements for educating and preparing human factors engineers/professionals for the medical device/health care domain. To better understand how (well) human factors professionals are prepared for the medical device industry, a survey was administered in the form of an interactive poster at the 2019 International Symposium in Human Factors and Ergonomics in Health Care. Data were collected regarding where symposium attendees, most of whom are human factors professionals in health care/medical device, learned the important knowledge/skills required for human factors practice in the medical device industry. In this paper, the method is described in details, and results from the poster survey are presented and discussed.
Human Factors and Medical Device Instructions for Use: It’s Not Just Good Business and Good Science, It’s the Law
Authors: Alper Samuel J. , Arndt Steve , Borgardt Joy , Johnson Korey
Published: September 2019

The stated purpose of this panel was to discuss how the application of human factors science to the design, evaluation and development of medical device labeling and instructions for use is both good business and consistent with the law. Specific examples of the law were briefly discussed in the panel and are described in more detail in this paper. Questions posed by the audience quickly made it apparent that a higher-level conversation around risk was desired. One of the main topics addressed was that of unintended misuse; a summary of that discussion is also included in the paper. The overarching theme of the panel was as follows: The best we can do as human factors professionals is perform good science, document the work that we’ve done and the reasons for decisions that were made. We should also always strive to create the best product which requires balancing numerous constraints and competing goals.
Considering the Dynamics of FDA Human Factors ValidationRequirement: Implications of Failure and Need to Ensure ProjectSuccess - A Conceptual Framework
Authors: Rojas Katia M. , Sharareh Nasser , Cosier Leon , Santos Daryl L.
Published: September 2019

Recognizing the role of human factors engineering (HFE) in the development of medical devices and combination products that involve devices, the Food and Drug Administration (FDA) now requires human factors (HF) validations before market approval. Manufacturers are responsible for ensuring their products are safe and effective through the application of HFE. However, key stakeholders are still learning and developing capabilities to adapt to the regulatory component. Nonetheless, the lack of the corresponding HF capabilities hinders compliance with the FDA’s expectations, and though ultimate success. No known previous work has looked into FDA HF validation projects to assess the underlying factors and implications of failed submissions. Applying system dynamics (SD), a causal loop diagram (CLD) was developed. CLDs are useful for the exploration of the causal interactions among factors or variables, as well as the underlying feedback structure of a complex system. This work can serve to help manufacturers better understand the FDA’s HF requirement to enable overall product success. Further, with patient safety as a common goal, HF service providers (HFSPs) and regulators should be aware of the need to ensure the consistent quality of the HF element in premarket submissions.
Risky Business: Predicting Patient Mortality at a Glance
Authors: Schubel Laura C , Boxley Christian L , Littlejohn Robin , Capan Muge , Arnold Ryan , Miller Kristen
Published: September 2019

Clinicians are constantly forecasting patient trajectories to make critical point of care decisions intended to influence clinical outcomes. Little is known, however, about how providers interpret mortality risk against validated scoring systems. This research aims to understand how providers forecast mortality specifically for that of patients with sepsis. Defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, sepsis is commonly hard to diagnose, progresses rapidly, and lacks a “gold standard” test. Participants were nurses and doctors from the general medical and surgical floors of six different hospitals. Each was presented with ten different patient cases, categorized into low and high severity sepsis, and were asked about care decisions, along with estimations of mortality risk. The resulting data provides a unique look into the differences of risk forecasting between profession and patient severity.
Usability of Hand Hygiene Observation Apps
Authors: Sivek Amanda , Sparnon Erin , Tremoulet Patrice D
Published: September 2019

Effective hand hygiene among clinicians decreases the incidence of healthcare-associated infections and helps slow the rate of antibiotic resistance, but hand hygiene compliance (HHC) rates among clinicians is often low. Facility-wide HHC monitoring is required by the U.S. Centers for Medicare & Medicaid Services. In general, HHC monitoring is important to identify facility care areas, units or departments that have low HHC rates so that targeted interventions can be implemented. Recently several hand hygiene observation apps (HHOA), which enable observers to use mobile devices to record HHC data, have become available.

The overall goal of our effort was to evaluate how helpful five different HHOAs were in supporting users in collecting and aggregating HHC data. Overall our participants, which included nine individuals with clinical training, and eight biomedical engineers found that all five HHOAs were fairly hard to use given that they have a relatively simple and straightforward function. There was an interesting interaction, however, with the biomedical engineers rating highest the HHOAs that the clinically-trained users rated lowest.
An Ergonomic Framework for Researching and Designing Speech Recognition Technologies in Health Care with an Emphasis on Safety
Authors: Arnold Tim , Fuller Helen J. A.
Published: September 2019

Automatic speech recognition (ASR) systems and speech interfaces are becoming increasingly prevalent. This includes increases in and expansion of use of these technologies for supporting work in health care. Computer-based speech processing has been extensively studied and developed over decades. Speech processing tools have been fine-tuned through the work of Speech and Language Researchers. Researchers have previously and continue to describe speech processing errors in medicine. The discussion provided in this paper proposes an ergonomic framework for speech recognition to expand and further describe this view of speech processing in supporting clinical work. With this end in mind, we hope to build on previous work and emphasize the need for increased human factors involvement in this area while also facilitating the discussion of speech recognition in contexts that have been explored in the human factors domain. Human factors expertise can contribute through proactively describing and designing these critical interconnected socio-technical systems with error-tolerance in mind.
Taxonomy of Surgical Delay Related to Sterile Processing and Domino Effect
Authors: LaForge Kimberly A. , Fuller Helen J. A. , Arnold Timothy , Chrouser Kristin , Gunnar William
Published: September 2019

Successful surgery does not just depend on the skills and knowledge of those in the operating room but also on the staff that insure the needed instrumentation is available and sterile. The process that continuously provides reusable medical equipment (RME) to the Operating Room (OR) requires highly specialized expertise over a wide range of instrumentation. The reprocessing team must be familiar with instructions for use (IFU), and how to apply them to process every piece of RME from surgeries, endoscopies, and clinic procedures. Coupled with the limitations of staff, time, and resources and with competing demands to produce sterile instruments and environments that work in almost total isolation from each other, there are several gaps in the process that must be identified and bridged. While the workflow for moving between the Sterile Processing Department (SPD) and the OR is sometimes thought as a fairly simple circular flowchart, the realities of work done versus work imagined are vastly different. In addition, these challenges vary considerably across different departments, even in a single healthcare system, and as such there are no simple solutions. Understanding the demands on the SPD, the needs in the OR for sterile RME, and the patient safety concerns that drive this cycle are critical if we are to improve the process.
Relationship Between Subjective Reports of Temporary Threshold Shift and the Prevalence of Hearing Problems in Military Personnel
Authors: Brungart Douglas S. , Barrett Mary E. , Schurman Jaclyn , Sheffield Benjamin , Ramos Leilani , Martorana Roberta , Galloza Hector
Published: September 2019

Traditional hearing conservation programs are based on the premise that noise dose, as measured by the time-weighted average noise level, is the primary risk factor associated with occupational hearing loss and that permanent threshold shifts are the most relevant outcome measures for determining when a noise-related hearing loss has occurred. However, recent studies in animal models have suggested that significant neurological damage to the hearing system can occur from noise exposures even when they are not severe enough to result in permanent threshold shifts. This has led to a number of studies attempting to relate subjective measures of noise exposure to subjective measures of hearing difficulty and suprathreshold measures of hearing performance (e.g., speech-in-noise tests). In this study, 3,330 U.S. service members volunteered to complete a survey on noise exposure, subjective hearing complaints, and tinnitus in conjunction with their annual hearing tests. Two questions were also included about the frequency and duration of temporary hearing losses that may have been experienced by the service member. The results show that subjective reports of temporary threshold shifts were substantially more predictive of tinnitus and other hearing complaints than more traditional questions based on the frequency of noise exposure.
Discrimination Faced by the Socially Disadvantaged Students with Respect to Corporal Punishment
Authors: Dehadray Vrushali
Published: September 2019

Punishment is an inevitable part of growing up experience of children. It is considered as a necessary instrument for developing a disciplined society. Indian society is fragmented from ancient times based on hierarchical system of caste. Traditionally, some castes and communities are assigned the lowest status in this hierarchy. This socially disadvantaged section is deprived of several rights and has to face discrimination in all walks of life including education. In the present article, a comparison has been made between socially disadvantaged and other students with respect to violation of Right to Education Act pertaining to caste-based discrimination in the form of punishment given at school. Two groups were compared on causes and nature of punishments. The total sample comprised 484 students of which 40.45 per cent belonged to the socially disadvantaged group. The data were collected with the help of a structured interview schedule. The findings have shown that there was not much difference between the reasons for which they were punished. But a marked difference was observed with respect to all four categories of punishments. The students from the socially disadvantaged group received more punishments as compared to the other group. The difference between the two groups was more for severe punishments.
Book review: John Solomon, A Subaltern History of the Indian Diaspora in Singapore: The Gradual Disappearance of Untouchability 1872–1965
Authors: Rana Kumar
Published: September 2019

John Solomon, A Subaltern History of the Indian Diaspora in Singapore: The Gradual Disappearance of Untouchability 1872–1965. London and New York: Routledge, 2016, 220 pp. (hardback). ISBN: 978-1-138-95589-9.
Swarup Dutta, Ishita Sinha and Adya Parashar. 2018. Dalit women and water: Availability, access and discrimination in rural India
Authors: Caparas Merry Jean
Published: September 2019

Swarup Dutta, Ishita Sinha and Adya Parashar. 2018. Dalit women and water: Availability, access and discrimination in rural India. Journal of Social Inclusion Studies, 4(1), 1–18