bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis
Authors: Bose Gauruv , Atkins Harold L , Bowman Marjorie , Freedman Mark S
Published: September 2018

Background:

Fatigue is a common problem in multiple sclerosis (MS) affecting as many as 90% of patients. The Fatigue Impact Scale (FIS) is a validated measure of fatigue in MS patients. The cause of fatigue in MS is likely multifactorial, with some evidence that ongoing central nervous system (CNS) inflammation is a contributing factor. Immunoablation and autologous hematopoietic stem cell transplantation (aHSCT) have been shown to halt ongoing CNS inflammation.

Objective:

To investigate whether halting all ongoing inflammation with aHSCT impacts FIS scores in patients with severe MS.

Methods:

In the Canadian aHSCT study ( ClinicalTrials.gov , NCT01099930), 23 patients underwent aHSCT and had FIS prospectively collected every 6 months for 36 months of follow-up. Change in FIS was analysed by repeated-measures analysis of variance (RMANOVA) with multiple linear regression to determine independent predictors.

Results:

The median FIS score decreased 36%, from 36 to 23 ( p = 0.001), and four patients had 100% reduction. Improvement in FIS correlated with lower age and Expanded Disability Status Scale at baseline, as well as increased independence as evidenced by a return to gainful employment and even driving.

Conclusion:

Patients had significantly less fatigue on average after aHSCT. This may serve to better understand the contribution of ongoing CNS inflammation to fatigue peculiar to MS.
Safety and Efficacy of Inferior Vena Cava Reconstruction During Hepatic Resection
Authors: Papamichail M. , Marmagkiolis K. , Pizanias M. , Koutserimpas C. , Heaton N.
Published: September 2018

Background and Aims:

Patients with liver tumors involving the inferior vena cava have a poor outcome without surgery. Liver resection en bloc with inferior vena cava resection and reconstruction is now performed in many centers. The purpose of this study is to investigate the safety and efficacy of inferior vena cava reconstruction during hepatic resection.

Materials and Methods:

A review of 12 centers reporting 240 patients with combined hepatectomy and inferior vena cava resection and reconstruction for malignant tumors was performed. Sample size, patient characteristics, histological type of the tumor, method of reconstruction, complications, and long-term survival (1-, 2-, and 5-year survival) were evaluated.

Results:

A total of 240 patients from 12 institutions (male 58%) with mean age 54 years underwent combined liver resection and inferior vena cava resection and reconstruction for colorectal liver metastases (43%), cholangiocarcinomas (26%), hepatocellular carcinomas (19%), leiomyosarcomas (4%), and other tumors (7.9%). Reconstruction included primary closure (35.8%), patch repair (13.3%), or interposition graft (50.8%) In-hospital mortality was 6.25% and overall morbidity was 42.1%. 1- and 10-year survival rates were 79.7% and 28.9%, respectively.

Conclusion:

Tumors arising in or extending to inferior vena cava that require liver resection should be considered for surgery as it can be performed with an acceptable mortality and morbidity in centers with liver transplantation and hepato-pancreato-biliary facilities.
Social isolation is associated with 90-day rehospitalization due to heart failure
Authors: Saito Hiroshi , Kagiyama Nobuyuki , Nagano Noriko , Matsumoto Kozue , Yoshioka Kenji , Endo Yoshiko , Hayashida Akihiro , Matsue Yuya
Published: September 2018

Background:

Social isolation has been reported to be associated with decreased quality of life and the onset of organic diseases. The objective of this study was to investigate the prevalence of social isolation in patients with heart failure and whether it is associated with rehospitalization.

Methods and results:

The study included consecutive patients aged ⩾55 years who were hospitalized due to heart failure. Social isolation was assessed using total scores less than 12 on an abbreviated version of the Lubben Social Network Scale. The endpoint was heart failure rehospitalization within 90 days after discharge. Among 148 patients with heart failure (80±8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group ( p=0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors.

Conclusion:

Half of the patients with heart failure reported social isolation, which had a strong association with heart failure rehospitalization.
Current Knowledge on Skin Cancer Prevention in Liver Transplant Recipients
Authors: Holmes G. Alden , Soo Joseph , Jacob Sharon E.
Published: September 2018

The improved survival of liver transplant recipients (LTRs) has been accompanied by a concomitant rise in long-term liver transplantation complications, including skin cancer. A recent study found that the prevalence of skin cancer among LTRs is 13.5%, a rate equivalent to that observed among kidney transplant recipients. Given the morbidity associated with skin cancer in LTRs, an individualized, multidisciplinary approach to skin cancer prevention that incorporates patient education, encourages consistent use of primary prevention methods, and ensures routine dermatologic screening should be universally adopted in this population. Chemopreventative measures should be considered in LTRs with a high skin cancer burden. Furthermore, additional studies should be performed in order to systematize these recommendations.
Utilizing a Remote LED Stimulus to Concurrently Measure Cognitive and Visual Task Demand
Authors: Motzkus Conner J. , Getty Douglas J. , Campos Andrea , Cooper Joel M. , Strayer David L.
Published: September 2018

The ISO 17488 standard Detection Response Task (DRT) has been validated as an effective tool for measuring fluctuations in cognitive workload while driving and performing secondary tasks. This research evaluated the possibility of consolidating a dual stimulus DRT to a single remote LED stimulus to concurrently measure visual and cognitive demand. Hit rate and reaction times to a remote LED stimulus and an ISO standard vibrotactor stimulus were compared for three in-vehicles tasks: a single task baseline, a cognitively demanding task, and a visually demanding task. Analyses showed that the remote LED and vibrotactor were equally sensitive to cognitive load, while the remote LED was more sensitive to visual load. We suggest the remote LED DRT system serves as a cost-effective, practical, sensitive method to concurrently assess cognitive and visual demand.
Speed Considerations Can Be of Little Concern When Outsourcing Thought to External Devices
Authors: Weis Patrick P. , Wiese Eva
Published: September 2018

Most research on human cognition has focused on processes “inside the box”. Recently, researchers questioned this monopoly, promoting the relevance of cognitive processing “outside the box”, for instance, when using a GPS to navigate. For processing that is distributed between internal and external resources to work efficiently, humans need good heuristics that help them decide when to use which resource. A novel human-computer-interaction paradigm was employed to explore whether people follow the “minimal memory” heuristic and offload cognitive processing onto external resources whenever possible or the “soft constraint” heuristic and offload cognitive processing only if it is associated with an overall higher speed than internal processing. Participants, despite lower speed, nearly exclusively cognized outside the box, which contradicts the soft constraint heuristic and mostly supports the minimal memory heuristic. Implications for human-technology interaction as well as alternative heuristics relevant for cognitive offloading are discussed.
A Deeper Look at the NASA TLX and Where It Falls Short
Authors: McKendrick Ryan D. , Cherry Erin
Published: September 2018

The NASA task load index (TLX) is the most used tool for measuring mental workload. The tools widespread use is associated with its pedigree, and its simplicity of application and interpretation. However, the NASA TLX has been criticized for not measuring the mental construct it purports to measure. The particular claim is that the NASA TLX does not measure perceived mental workload, instead it measures perceived task difficulty. We explored this claim using a simple spatial memory task. The results were analyzed with polynomial hierarchical regression. The NASA TLX failed the test of construct validity and, the sub-components each had random interpretations depending on the participant. The second point is particularly troubling, as many system designs could be based on random, non-causal relationships. Both these observations raise doubts in toward the use of the NASA TLX as a calibrated instrument for human factors engineering.
Pilots’ Estimation of Altitude of a Small Unmanned Aircraft System (sUAS)
Authors: Lennertz Tracy , Sparko Andrea L. , Cardosi Kim , Yost Alan , Kendra Andrew , Lu Jason , Sheridan Tom
Published: September 2018

Small unmanned aircraft system (sUAS) operations are growing at a rapid rate, with an increasing number of civilian operations. Currently, the Federal Aviation Administration permits both hobbyist and commercial operations. The requirements for the operations differ; for commercial operations, the sUAS must generally be flown under 400 feet. Past data indicate that operators are poor at judging the altitude of sUAS, and there is variability in the altitude information that is presented to the operator. Here, we examined the ability of commercial and hobbyist sUAS pilots to estimate the altitude of their ownship during a realistic flying task. Participants flew a DJI Phantom 4 Pro to three prescribed altitudes: 50 feet, 200 feet, and 350 feet. In each trial, the participant flew the sUAS from its starting point, hovered at what he or she estimated to be the prescribed altitude, and took a photo of a target. Results indicated that participants’ altitude estimates were below the prescribed altitude of 50 feet 52% of the time, and they were below prescribed altitudes of 200 feet and 350 feet 89% of the time. Despite differences in background, performance did not differ between hobbyist and commercial pilots. Variability in absolute and barometric measurements of altitude was also observed. Taken together, the results suggest that sUAS pilots, regardless of their experience, are poor at judging the altitude of their ownship—especially at higher altitudes. The variability in performance and altitude measurements indicates that pilots need a reliable and standard way to measure the altitude of their ownship, especially given the increasingly complex environments in which sUAS intend to fly.
The Operational Issue of an Airliner’s Reduced-Crew Caused by Data-link Break-up to Remote Support
Authors: Schmid Daniela , Korn Bernd
Published: September 2018

Different operational concepts for Single-Pilot and Reduced-Crew Operations (RCO) in commercial aviation include a ground based supportive component of a remote-copilot. The impact of an outage and break-up of the data-link connecting air and ground has not been investigated yet. Social Network Analysis (SNA) in combination with a Cognitive Work Analysis was used to compare the three crewing options of multi-crew, reduced-crew and a break-up of data-link in RCO in terms of social factors and interactions. A data-link loss decreased the networks density and its resilience to any off-nominal and emergency situations. The single-pilot suffers from higher functional loadings, is located more central and processes a higher information flow. A twofold degraded operational procedure was proposed to mitigate an outage and loss of data-link in combination with additional automation tools onboard. Nonetheless, further research is required to provide a data-link with a big bandwidth as reliable and secure as possible.
The peak-end effects in controllers’ mental workload evaluation
Authors: Qiao Han , Li Yazhe , Zhang Jingyu , Xiaotian E , Zou Xiangying , Jiang You , Xiong Lin , Sun Xianghong
Published: September 2018

People’ retrospective evaluation of their hedonic experience is heavily influenced by the most intense (peak) and the last (end) moment. This study examines whether such peak-end effect can also be applied to the evaluation of mental workload in the context of air traffic control. Twenty professional approach controllers finished four tasks on high fidelity simulators and rated overall workload after each task by NASA-TLX scale. A 2 (high vs. low peak) by 2 (high vs. low end) within-subject design was used. The results showed that there was a significant peak effect and a marginally significant end effect. This study calls for further investigation of the measurement issue of mental workload and provides insights for workload management strategies.
Making Sense of Team Information
Authors: Stevens Ronald , Galloway Trysha , Willemson-Dunlap Ann , Gorman Jamie , Halpin Donald
Published: September 2018

This paper describes how meaning can be extracted from large-scale dynamical data to make inferences about teamwork that are useful in both the theoretical and practical sense. The dynamics of an anesthesiology team are viewed from the perspectives of: 1) changes in the team’s neurodynamic organizations with large and small changes in the task; 2) how team member’s neurodynamics contribute to team neurodynamics; 3) the relationships between task events, heart-rate and neural dynamic organizations; 4) the linkages between speech flow, team and team member neurodynamics and topic discussions during Debriefing; and, 5) the micro-scale neural dynamics reflecting the involvement of the parietal lobes and gamma frequencies. These examples show how different sources of team data can contribute to multi-modal understandings of individual and teams dynamics that span micro and macro scales of teamwork.
Human Factors in Cybersecurity – Perspectives from Industries
Authors: Lau Nathan , Pastel Robert , Chapman Melissa R , Minarik Jennifer , Petit Jonathan , Hale Dave
Published: September 2018

Today, cybersecurity is impacting every individual and industry, but the level of effort from the human factors community seems negligible compared to the magnitude of the current security challenge. This panel invites professionals in the healthcare, computer and network, higher education, and automotive industries to share experiences, lessons learned and solutions. The panel characterizes the security landscape in different industries and facilitate discussion on human factors research and applications to address the formidable security challenge.
Designing Data & Dashboard Visualizations for Future UAV Systems
Authors: Hansberger Jeffrey T. , Meacham Sarah , Blakely Victoria
Published: September 2018

Technology advancements in unmanned aerial systems have provided greater levels of autonomy to the extent that it has fundamentally changed the operator’s task and information requirements. This research has applied a task analysis driven approach to identify these information requirements and generated new information visualizations to more effectively present mission critical information to the operators. Experimental results will show the performance benefits across both accuracy and response time to retrieve information and lessons learned related to task driven design and information visualizations.
Automation reliability and trust: A Bayesian inference approach
Authors: Wang Chenlan , Zhang Chongjie , Yang X. Jessie
Published: September 2018

Research shows that over repeated interactions with automation, human operators are able to learn how reliable the automation is and update their trust in automation. The goal of the present study is to investigate if this learning and inference process approximately follow the principle of Bayesian probabilistic inference. First, we applied Bayesian inference to estimate human operators’ perceived system reliability and found high correlations between the Bayesian estimates and the perceived reliability for the majority of the participants. We then correlated the Bayesian estimates with human operators’ reported trust and found moderate correlations for a large portion of the participants. Our results suggest that human operators’ learning and inference process for automation reliability can be approximated by Bayesian inference.
Intuitive Insights For Course Of Action Development
Authors: Hunter Aren , Randall Tania , Colbert Heather
Published: September 2018

Defence Research and Development Canada - Atlantic has been investigating ideas and tools to aid shipboard planning teams with course of action (COA) development. Considerable previous research on operational planning suggests that the process is not well-suited to shipboard planning. In light of the shortcomings of current planning methods, the PreMortem method was investigated as a methodology to aid shipboard planning teams in developing more intuitive and creative COAs. The aim of this research was to evaluate planning teams’ acceptance, ease of use and perceived value of the PreMortem as an addition to traditional decision matrix planning methods. The results suggest that the PreMortem method adds value in the form of COA creativity over traditional planning methods. The PreMortem method is a recommended addition to the current process.
Evaluating decision making in a multi-objective route planning-task
Authors: Coyne Joseph , Foroughi Cyrus , Brown Noelle , Sibley Ciara
Published: September 2018

The present study is an initial investigation of complex decision making performance. Specifically, this work investigated how individuals make decisions involving risk and uncertainty within a spatially focused route planning task involving multiple simulated unmanned vehicles and objectives. Forty-three participants were instructed to create twenty-four route plans, half of which included a combination of risky route suggestions and enhanced icons. Given the high working memory demands of developing a route for multiple vehicles, it was expected that enhanced visualizations, which provided redundant information on target priority, uncertainty, and deadline, would reduce demands on working memory and improve performance. Additionally, it was predicted that providing risky route suggestions would negatively impact performance, yet enhanced visualizations would reduce the effect of risky route suggestions. However, findings supported neither hypothesis; there was no performance difference in providing enhanced visualizations, and risky sub-optimal route suggestions actually improved the expected value of the submitted route. These results could have occurred due to multiple factors, including the multi-objective route planning task being too complex, or the scenarios lacking sufficient variability in expected value. An additional interpretation of these findings is that humans are really poor at performing these complex multi-objective tasks, and failed to comprehend the uncertainty and risk inherent in their decisions.
How Does Physical Demand Affect Cognitive Performance? Interference Between Outdoor Running And Narrative Memory
Authors: Epling Samantha L. , Edgar Graham K. , Russell Paul N. , Helton William S.
Published: September 2018

Dual-tasking situations are common in military, firefighting, search and rescue, and other high risk operations. Cognitive and physical demands can occur at the same time, but little is known about the specific demands of real world tasks or how they might interfere with one another. It is well known that attempting simultaneous tasks will divide and divert attention, but to what extent? In this experiment, a narrative memory task was paired with an outdoor running task, and as expected, memory task performance declined when participants were asked to run at the same time. It is suggested that more cognitively demanding physical tasks be used within this dual-task paradigm for a better understanding of the human cognitive resource structure, i.e., how and why certain tasks interfere.
Evaluating Children’s Interaction with Touchscreens From 0 to 8 Years Old
Authors: Soliman Sommayah , Nathan-Roberts Dan
Published: September 2018

Children start using mobile devices at a very young age. In this paper, we review the research done to evaluate children’s capabilities and limitations when interacting with multi-touch screens. The different factors affecting children’s touch gestures performance are evaluated. It was found that children are able to perform several complex touch gestures that are not currently used in applications targeting their age. The current research showed that children’s usage of different multi-touch gestures is affected by their age and screen size. Design guidelines are recommended to improve young children’s usability of multi-touch devices.
Fitting Motivation to Fitts’ Law : Effect of a Penalty Contingency on Controlled Movement
Authors: Gillan Douglas J. , Bias Randolph G.
Published: September 2018

An experiment examined the effect of a penalty on performance of target acquisition movements, focusing on overall movement time, the fit of the data to Fitts’ Law, and ballistic and homing submovements. Fitts’ Law, MT = a + b[Index of Difficulty], where Index of Difficulty (ID) = log2[Movement distance/target size], focuses on the control of the movement by external stimuli, rather than the consequences of a movement. In this study, participants moved a cursor on a computer screen from a starting point to a target with movement distance and target size varying systematically. In the Penalty condition, when the movement missed the target, the computer screen went blank and the next trial was delayed for 30 seconds. In the Nonpenalty condition, participants did not receive a penalty for missing the target. The results showed that receiving a penalty led to higher movement times, a higher Fitts’ Law slope parameter, fewer errors, and fewer nonerror overshoots of the target. Also, receiving penalties resulted in target acquisition movements with less time spent in the ballistic submovement. The results show that consequences of a movement control movement behavior.
“Oh, Look, A Butterfly!” A Framework For Distracting Attackers To Improve Cyber Defense
Authors: Gutzwiller Robert , Ferguson-Walter Kimberly , Fugate Sunny , Rogers Andrew
Published: September 2018

Inverting human factors can aid in cyber defense by flipping well-known guidelines and using them to de-grade and disrupt the performance of a cyber attacker. There has been significant research on how we perform cyber defense tasks and how we should present information to operators, cyber defenders, and analysts to make them more efficient and more effective. We can actually create these situations just as easily as we can mitigate them. Oppositional human factors are a new way to apply well-known research on human attention allocation to disrupt potential cyber attackers and provide much-needed asymmetric benefits to the defender.
Analysis of Human-Swarm Visualizations
Authors: Roundtree Karina A. , Manning Matthew D. , Adams Julie A.
Published: September 2018

Interest in robotic swarms has increased exponentially. Prior research determined that humans perceive biological swarm motions as a single entity, rather than perceiving the individuals. An open question is how the swarm’s visual representation and the associated task impact human performance when identifying current swarm tasks. The majority of the existing swarm visualizations present each robot individually. Swarms typically incorporate large numbers of individuals, where the individuals exhibit simple behaviors, but the swarm appears to exhibit more intelligent behavior. As the swarm size increases, it becomes increasingly difficult for the human operator to understand the swarm’s current state, the emergent behaviors, and predict future outcomes. Alternative swarm visualizations are one means of mitigating high operator workload and risk of human error. Five visualizations were evaluated for two tasks, go to and avoid, in the presence or absence of obstacles. The results indicate that visualizations incorporating representations of individual agents resulted in higher accuracy when identifying tasks.
Deep Reasoning for Enhancing Etextbooks (DREE): Using Deep-Level Questions for Guiding Learning
Authors: Craig Scotty D. , Zhang Shasha , Prewitt Deborah
Published: September 2018

The popularity of ebooks does not extend to an increasing interest in etextbooks among students. A common form of etextbooks is the digital replica of the original printed book; however, a lack of interactivity was considered as an issue of etextbook among college students. To explore the potential beneficial interactive affordances, this study proposes a web-based interactive etextbook with built-in multimedia videos and self-test quizzes. Assessments have been conducted to examine the effect of using the interactive etextbook on learning and perception of learning. The results imply that a combination of multiple interactive features in etextbooks could produce optimal perception on learning and show the potential for impacting learning.
Embracing The Grind: Why We Chose Higher Education Administration; Maybe You Should Too
Authors: Smith-Jackson Tonya , Bisantz Ann , Mayhorn Christopher B. , Kleiner Brian M. , Babski-Reeves Kari , McBride Maranda
Published: September 2018

Newspapers, broadcast agencies, and social media outlets frequently feature stories about higher education administrators who are terminated, forced to resign, or otherwise removed from their posts. While the events are based in reality, many across the nation, especially the public, faculty and students, might develop a very negative view of what it means to be a leader in higher education administration. Yet, higher education administration could be one of the most rewarding and growth-contributing careers for many. This panel consists of faculty from various universities who made the selfless choice to serve in challenging administrative roles. They will share their experiences; good, bad, and in-between. Discussions will include lessons learned and how to prepare for these positions, with applications to those with academic experience and those who may come from government or industry occupations that afford a degree skills and knowledge transfer to academia. Information will be provided about work-life balance as well.
Usability Analysis of Freeform Marking on Engineering Problem Solving
Authors: Memarian Bahar , McCahan Susan
Published: September 2018

Freeform comments as a means of providing formative feedback on engineering problems, from the perspective of feedback providers (i.e. assessors), is examined. The aim of this research is to collect and analyze assessors’ ratings on the usability of this type of task. Two course topics with different error loads in the sample solutions were used as the basis for the work. Assessors were divided into two groups: Group 1 received an evaluation package containing first year mechanics students’ test solutions with a high error load (Error1=32), while Group 2 received first year circuits students’ test solutions with low error load (Error2=11). Assessment time was held constant (ttot=20min). A standard instrument for usability was utilized. Analysis of the survey data from the assessors (n1=11, n2=19) revealed some significant differences between the two groups. In particular, Group 1 reported a lower degree of perceived consistency in marking relative to Group 2.
Greenery versus Aquatic: Cognitive Restoration of Different Components of Nature for Improvement in Environmental Design
Authors: Nguyen Theresa , Neilson Brittany , Klein Martina I.
Published: September 2018

Prior research has indicated that aquatic components (e.g., lakes, rivers) of a nature environment have been perceived to be more restorative than nature environments containing greenery components (e.g., trees, grass); this finding has been coined as the “dose effect of water.” However, the validity of this finding has been questioned as researchers have failed to generalize the dose effect of water to novel photos. Although subsequent research has been unable to generalize the dose effect of water to an individual’s perceived restoration, no studies have observed the cognitive restoration of different nature scenes using performance measures on a sustained attention task. The current study was conducted to determine if certain nature components lead to higher levels of cognitive restoration. Our results indicate there is not a certain nature component that leads to higher cognitive restoration via performance on a brief sustained attention task.
Designing a Global Learning Environment
Authors: Stone Nancy J. , Mara Bazley Conne , Robertson Michelle M. , Larson Nancy LJ , Blickensderfer Elizabeth L. , Boring Ronald Laurids
Published: September 2018

The increase in Massive Open Online Courses (MOOCs) and other “in-the-moment” learning opportunities suggests the need for an understanding of how to effectively design the global learning environment, which includes more than the content, but also includes the modes of delivery or instructional design, as well as the environment in which the learner receives the content. Therefore, not only must the learning environment match the learning content, but also the technologies used and the characteristics of the learners (e.g., engagement, self-regulated learning). Additionally, the likelihood that online learners are multitasking while interacting with the learning material makes it important to understand other aspects of the learners’ selected environment. Unfortunately, there is little research on the learners’ environment in which the student interacts with the online materials. The purpose of this panel is to address and highlight these issues and offer suggestions for designing effective global learning environments.
The Ubiquitous Orange Traffic Cone: An Observational Study
Authors: Morrison Robert E.
Published: September 2018

Daily sightings of traffic cones were logged over a six-month period in an attempt to provide data about the frequency and novelty of such encounters, and to yield examples of the variety of uses for cones. Analysis of the data show that traffic cones were seen nearly every day and usually in new situations not previously encountered. Many unique uses were observed, both for hazardous conditions and for non-hazardous purposes.

Though impressive in variety and inventiveness, these fall into general categories of use. Due to the multiplicity of purpose and the frequency of encounter it is argued that the public may not always perceive the message intended by the cone owner.
Study of Employee Slip/Trip/Fall Hazards at a Midwestern Urban Hospital Campus
Authors: Grieser Brian C.
Published: September 2018

Nearly 500 employee slip, trip and fall incidents were reported in just over three years on a Midwestern urban hospital campus of approximately 10,000 employees. In an attempt to reduce the fall frequency, the hospital analyzed employee incident data during this period. Specifically, management searched for facility locations where multiple incidents occurred. However, the hospital found few, if any, patterns in the data with respect to fall location. In response, the hospital hired the author to provide them assistance in their effort to reduce the employee fall rate. The author first re-analyzed the data according to fall hazard rather than fall location and found common causes of incidents that accounted for large percentages of all falls. The data analysis was followed up with a site investigation and written recommendations.
Slip Resistance Assessment of Common Shoe Sole Materials on Selected Floor Surfaces
Authors: Grieser Brian C. , Frantz Jared
Published: September 2018

The four primary factors affecting the likelihood of slipping and falling include walking surface material and finish, footwear sole design and condition, contaminants present at the interface between the floor and shoe sole, and human factors issues such as gait dynamics and expectancy. Perhaps the least studied of these factors is footwear. Footwear sole materials vary widely in their composition, tread pattern, and hard-ness. The purpose of this study was to assess the slip resistance of a variety of common shoe sole materials on selected floor surfaces under wet and dry conditions. Five shoe sole materials were tested on six floor surfaces. The results showed a wide variance in slip resistance among popular shoe sole materials. Moreo-ver, some shoe sole materials were substantially more susceptible to reductions in slip resistance when the floor surface was contaminated with water.
Forensic Human Factors 101: Interactive Transportation and Product Liability Case Studies
Authors: Whetsel Borzendowski Stephanie A. , Hartman Leah S.
Published: September 2018

This special joint session with shared interest from multiple technical groups (Forensics Professional Group, Product Design Technical Group, Safety Technical Group, and Surface Transportation Technical Group) provides audience members with an opportunity to conduct a forensic analysis of two cases involving human factors issues. The audience will form four groups in order to conduct their analysis of the behavior and actions of either the plaintiff or the defendant(s) involved in their assigned case. Participants in this session will be provided with information about the case they are analyzing, including descriptions of the circumstances surrounding the case and other factual information required to conduct a forensic analysis. One case will involve a collision between a commercial vehicle and a pedestrian, while the other will relate to the alleged failure of an air regulator utilized in diving. The teams will be asked to develop outlines of expert opinions relying on their knowledge, experience, and familiarity with applicable research. At the conclusion of the teams’ discussions, each team will briefly present the opinions reached by the team. To conclude the session, the audience will have the opportunity to discuss both cases and the value of human factors professionals in litigation. This session will emphasize the broad application of human factors and that forensic human factors work is accessible to a variety of practitioners.
Investigating Intraoperative and Intraprofessional Handoffs in Anesthesia
Authors: Jurewicz Katherina , Alfred Myrtede , Neyens David M. , Catchpole Ken , Joseph Anjali , Reeves Scott T.
Published: September 2018

Handoffs occur frequently in healthcare systems, and miscommunications and critical omissions within handoffs have been linked to serious medical errors. Handoff quality is a priority of patient safety initiatives across several international organizations. The majority of previous research in handoffs have focused on postoperative handoffs; yet, there is a need to specifically investigate intraoperative handoffs, especially within individual professions or subspecialties. Each subspecialty within a surgical team may approach handoffs differently. The anesthesia team is especially unique as they take a team-based approach to patient care where multiple anesthesia providers may be involved in one surgical case. We describe an observational study of intraoperative and intraprofessional handoffs in anesthesia. Temporary and permanent handoffs were investigated as well as the contextual elements that influenced handoff procedures. In a sample of 35 video recorded surgeries, a total of 16 handoffs were identified for the maintenance phase of surgery. These handoffs ranged between 33 seconds and 7.42 minutes in duration. Our study revealed variability in intraoperative handoffs during the maintenance phase of anesthesia and emphasizes that intraoperative and intraprofessional handoffs warrant more in-depth examination in order to develop effective strategies or tools for high quality handoffs in anesthesia.
Minimizing the impact of interruptions in a pediatric retail pharmacy
Authors: Craig Curtis M. , Patzer Brady , Morris Nichole L.
Published: September 2018

Researchers identified two needs of the in-hospital pediatric retail pharmacy. First was the reduction of the risk and frequency of errors. Second was the need to improve the efficiency of primary pharmacy tasks. Interruptions were identified as the primary issue. The team performed an extensive literature review and conducted interviews and observations to assess the pharmacy work system, work flow, and the impact of interruptions. A human factors analysis was done to accurately represent the pharmacy work system from data collection, and derive recommendations to improve efficiency and accuracy. Some of the recommendations were rapidly implemented into the pharmacy work system, including increased staffing during periods of high work demand, changes to counter spacing, and design changes to bags intended to contain refrigerated components. The research team conducted follow-up observations and collected survey data from pharmacy staff to determine the impact of the implemented interventions and identify key improvements.
A Framework for Integrating Safety in Usability Engineering for Electronic Health Records
Authors: Green Rebecca , Brandt Rachael , Miller Anne
Published: September 2018

Usability engineering approaches, borrowed from commercial software development, rarely hold safety as a significant design priority. This paper presents our approach for integrating safety into EHR usability testing and reporting. We present five insights gained in our attempts to better integrate safety into EHR usability testing and we present the Usability FMEA as a framework for more effectively integrating safety into usability testing. Takeaways from this presentation include 1): Usability testing has evolved out of non-safety critical environments; 2) Safety must be designed into test scenarios and scripts, and tested for explicitly; 3) The Usability FMEA with the SEIPS model can help to identify factors that may be affected by the implementation of a new technology; 4) Usability testing and evaluations should be extended into the post-implementation phase in client sites.
A Formal Analysis of Masking Between Reserved Alarm Sounds of the IEC 60601-1-8 International Medical Alarm Standard
Authors: Bolton Matthew L. , Edworthy Judy , Boyd Andrew D.
Published: September 2018

The IEC 60601-1-8 international medical alarm standard was created to give engineers guidance for designing alarms that are easily perceivable by humans. Included within this are a number of reserved alarm sounds that use tonal melodies to represent common types of alarms. Despite the standard, practitioners can still fail to hear and respond to alarms. This can have a profound negative impact on patient life and health. One of the factors that contributes to this problem is simultaneous masking: a condition where one or more alarms can be rendered imperceptible in the presence of other alarms due to limitations of the human perception system. Unfortunately, the tonal nature of the IEC 60601-1-8 reserved sounds makes them particularly susceptible to masking. It can be difficult to determine how masking can manifest in a collection of alarms that can sound concurrently given the inherent complexity of the statespace. In this work, we employ a computational method that employs mathematical proof techniques to determine if masking is possible in a model of a configuration of medical alarms. We use this to analyze the low and medium priority reserved alarm sounds of the IEC 60601-1-8 standard. We describe our method, present the results of our analyses, discuss these results, and explore future research directions.
Spectral Spectacle: Traps, Disappearances, and Disembodiment in Nineteenth-Century British Melodrama
Authors: Urban Eliza Dickinson
Published: September 2018

Two nineteenth-century melodramas, J.R. Planché's The Vampire (1820) and Dion Boucicault's The Corsican Brothers (1852) exert a haunting influence on how we in the present conceptualise ghosts. Through rendering the seemingly invisible – that is, the ghostly body – spectacular through technology, while simultaneously concealing the mechanism behind that feat, the plays' eponymous traps heighten the effect of the spectral even as their workings elude visual perception. My study elucidates the mediation of the traps through other facets of production. To accomplish this task, I undertake a phenomenological inquiry into the play's sound, lighting, and scene design via an examination of the plays' production materials as well as modern reconstructions of the traps. The sensory signifiers associated with the traps, including musical motifs and lighting cues, linger in the public consciousness even when the technology behind them has been rendered obsolete by later technological iterations.
Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience
Authors: Rivera-Ortega Pilar , Hayton Conal , Blaikley John , Leonard Colm , Chaudhuri Nazia
Published: September 2018

Idiopathic pulmonary fibrosis (IPF) is a fibrotic interstitial lung disease associated with significant morbidity and mortality. Previously, IPF has been managed using immunosuppressive therapy; however, it has been shown that this is associated with increased mortality. In the last 5 years, two disease-modifying agents have been licensed for use in IPF, namely pirfenidone and nintedanib. Nintedanib is a tyrosine kinase inhibitor with antifibrotic properties that has also been shown to significantly reduce the progression of the disease. The scientific evidence shows that nintedanib is effective and well tolerated for the treatment of IPF in mild, moderate and severe stages of the disease. Real-world experiences also support the findings of previously conducted clinical trials and show that nintedanib is effective for the management of IPF and is associated with reducing disease progression. Gastrointestinal events, mainly diarrhoea, are the main adverse events caused by the treatment. Recent real-word studies also suggest that nintedanib stabilizes lung function till lung transplantation, with no increased surgical complications or postoperative mortality after lung transplantation. In this review, we will discuss the clinical trial evidence and real-world experience for nintedanib in the management of IPF.
Nivolumab for the treatment of Japanese patients with advanced metastatic non-small cell lung cancer: a review of clinical trial evidence for efficacy and safety
Authors: Hida Toyoaki
Published: September 2018

Programmed cell death (PD)-1 immune checkpoint inhibitors have emerged as promising options for the treatment of multiple cancer types. Nivolumab is a fully human immunoglobulin G4 monoclonal antibody, which inhibits the PD-1 receptor and has been approved in the United States, Europe, and Asia for the treatment of advanced NSCLC. This review focuses on nivolumab’s efficacy and safety in the treatment of NSCLC patients in Japan.
Preventing and treating brain metastases with three first-line EGFR-tyrosine kinase inhibitors in patients with EGFR mutation-positive advanced non-small cell lung cancer
Authors: Su Po-Lan , Wu Yi-Lin , Chang Wei-Yuan , Ho Chung-Liang , Tseng Yau-Lin , Lai Wu-Wei , Su Wu-Chou , Lin Chien-Chung , Yang Szu-Chun
Published: September 2018

Introduction:

Brain metastases (BM) are common in advanced non-small cell lung cancer (NSCLC), and the prognosis is poor with few therapeutic options. This study evaluated the efficacy of three epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) in preventing and treating BM in patients with EGFR mutation-positive advanced NSCLC.

Methods:

Patients with EGFR mutation-positive advanced NSCLC who visited a tertiary referral center from 1 December 2013 to 30 November 2017 were analyzed retrospectively. They received gefitinib, erlotinib, or afatinib until disease progression, death, or intolerable adverse events. The cumulative incidence of subsequent BM of initial non-BM patients, progression-free survival (PFS), and overall survival (OS) of the BM and non-BM patients were estimated and compared using the Kaplan–Meier and log-rank tests.

Results:

306 NSCLC patients were enrolled, with 116, 75, and 115 receiving first-line gefitinib, erlotinib, and afatinib, respectively. The afatinib group had a better PFS [12.7 versus 9.8 months; hazard ratio (HR) 0.59, p  = 0.001] and OS (39.1 versus 22.0 months; HR 0.64, p  = 0.035) than the gefitinib group. Afatinib tended to provide better BM prevention than gefitinib (BM cumulative incidence, HR 0.49; 95% confidence interval 0.34–0.71, p < 0.001) according to a Cox model adjusted for possible confounders. Patients with initial BM had a shorter PFS ( p < 0.001) and OS ( p  = 0.015) than those without initial BM. Among the former, there were no differences in median PFS ( p  = 0.34) and median OS ( p  = 0.46) in the three EGFR-TKI groups.

Conclusions:

Our data suggested that, compared with gefitinib, afatinib provided better benefits significantly in terms of PFS and OS. Both had the same effectiveness in preventing subsequent BM.
Design of Genuine Birth Environment: Midwives Intuitively Think in Terms of Evidence-Based Design Thinking
Authors: Folmer Mette Blicher , Jangaard Karin , Buhl Henrik
Published: September 2018

Objective:

The objective of this study is to investigate a development project initiated and led by midwives.

Background:

The aim was to design an environment that could accommodate the wish to support professionalism while creating better and more cohesive patient treatment, improved patient safety, greater efficiency, higher quality, and stronger focus on the patient.

Theory:

The theoretical and analytical account is conducted within the framework of design thinking (DT), replacing the traditional evidence-based design approach with an evidence-based design thinking (EBDT) process underpinning participatory DT and co-creation.

Method:

Based on a longitudinal case study on a participatory design process, interviews are conducted. DT principles are used in the analysis of the interviews.

Results:

Genuineness arises when all users experience that the physical setting optimally underpins the birthing situation. It is essential to make visible the importance of the physical setting to human behavior in any situation.

Conclusion:

This study shows that midwives intuitively do EBDT. EBDT commands awareness of both research, design, midwifery care, and perspectives on space from women giving birth and their relatives. Collectively, that can provide the genuine scope of a healing birth environment.