bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Tuberculosis Screening Technology in the Initiation of Correct Diagnosis of Pulmonary Tuberculosis at a Tertiary Care Hospital in Thailand: Comparative Analysis of Xpert MTB/RIF Versus Sputum AFB Smear
Authors: Khumsri Jiraporn , Hiransuthikul Narin , Hanvoravongchai Piya , Chuchottaworn Charoen
Published: September 2018

Pulmonary tuberculosis (PTB) is one of the top 10 causes of mortality worldwide in 2016. Early detection is very important, as it can help early treatment. This study compared 2 separate methods of diagnosing PTB among suspected patients, specifically examining correct diagnosis and the duration of receiving a correct diagnosis. It was carried out in a tertiary care public hospital in Bangkok, Thailand. Ninety patients were randomly assigned to 2 groups, one with the Xpert MTB/RIF ( Mycobacterium tuberculosis/rifampicin) and the other with sputum AFB (acid-fast bacilli) smear. The proportion of correct diagnosis was 90.9% and 83.7% for the Xpert MTB/RIF and the comparison group, respectively. The difference was not statistically significant ( P > .05). However, the time to correct diagnosis in the Xpert MTB/RIF group was significantly shorter than the comparison group (2.23 days). This could lead to early diagnosis and lower transmission rate of PTB cases. Results support the provision of Xpert MTB/RIF as the initial diagnostic test for PTB in Thailand.
Analytical model for a superelastic Timoshenko shape memory alloy beam subjected to a loading–unloading cycle
Authors: Van Viet Nguyen , Zaki Wael , Umer Rehan
Published: September 2018

We propose a new analytical model for a superelastic shape memory alloy prismatic cantilever beam subjected to a concentrated force at the tip. The force is gradually increased and then removed and the corresponding distribution of phase transformation fields in the beam is determined, analytically, in both the transverse and longitudinal directions. Analytical moment–curvature and shear force–shear strain relations are also derived during loading and unloading of the beam. The proposed model is validated against an exact numerical beam model as well as a three-dimensional finite element analysis model for the same beam, with very good agreement in each case. Moreover, an experiment is proposed and carried out to characterize the load–deflection response of a shape memory alloy beam under the same boundary conditions as those considered in deriving the model. The obtained response is in good agreement with the analytical model as well as three-dimensional finite element analysis simulations. The analytical method provides a direct mathematical way for describing the material and structural properties of the beam and the distribution of the different solid phase regions as they change under the influence of an applied load and allows the determination of details such as the boundaries of solid phase regions immediately and accurately using equations. The same would require postprocessing at possibly significant computational cost and personal effort if finite element analysis or similar numerical methods are used.
Home Care Workers’ Experiences of Client Death and Disenfranchised Grief
Authors: Tsui Emma K. , Franzosa Emily , Cribbs Kristen A. , Baron Sherry
Published: September 2018

While many types of health care workers experience patient death, home care workers do so under vastly different social and economic circumstances. When a client dies, home care workers often lose both a close relationship and a job. Though research suggests that health care workers’ grief may frequently be disenfranchised, there is no in-depth study of the mechanisms that disenfranchise home care workers’ grief specifically. To address this gap, our study used focus groups and peer interviews between home care workers in New York City. We describe four interrelated grief strategies they employ to navigate social and employer-based “grieving rules.” Our findings suggest that home care workers’ grief is disenfranchised via employer and societal underestimations of their relationships with clients and their losses when clients die, particularly job loss. Building on our findings, we suggest alterations to agency practices and home care systems to improve support for workers.
Illness as Experienced by Parents of Children With End-Stage Renal Disease: The “Ill Unit”
Authors: Jacoby Rebecca , Benveniste Shay , Goldzweig Gil
Published: September 2018

The purpose of this study is to shed light on the experience of parents of children who suffer from various stages of renal failure. Semistructured qualitative interviews conducted with 12 parents were analyzed using the interpretative phenomenological analysis method. Eight themes were identified and organized into two superordinate themes: intrasubjective experience and intersubjective experience. Based on our analysis, we argue that the illness is experienced as a mental system extending beyond the space and boundaries of the child’s body to include his or her parents which we refer to as the ill unit. We have borrowed Winnicott’s concept of primary maternal preoccupation in order to emphasize the role and position of parents of chronically ill children. Consequently, we propose a relational perspective in which psychological support should be delivered to the ill unit (parents and child).
Developing and Testing a Chart Abstraction Tool for ICU Quality Measurement
Authors: Lee Jarone , Austin J. Matthew , Kim Jungyeon , Miralles Paola D. , Kaafarani Haytham M. A. , Pronovost Peter J. , Ghimire Vipra , Berenholtz Sean M. , Donelan Karen , Martinez Elizabeth
Published: September 2018

Quality measures are increasingly used to measure the performance of providers, hospitals, and health care systems. Intensive care units (ICUs) are an important clinical area in hospitals, given that they generate high costs and present high risks to patients. Yet, currently, few valid and clinically significant ICU-specific outcome measures are reported nationally. This study reports on the creation and evaluation of new abstraction tools that evaluate ICU patients for the following clinically important outcomes: central line–associated bloodstream infection, methicillin-resistant Staphylococcus aureus, gastrointestinal bleed, and pressure ulcer. To allow ICUs and institutions to compare their outcomes, the tools include risk-adjustment variables that can be abstracted from the chart.
Integration of Structural Family Therapy and Dialectical Behavior Therapy With High-Conflict Couples
Authors: Finney Natasha , Tadros Eman
Published: September 2018

There is a gap in existing literature regarding the integration of family therapies and dialectical behavior therapy (DBT) with high-conflict couples and families. A case application is utilized to highlight how the integration of structural family therapy (SFT) and DBT can inform the conceptualization and treatment of clients. The following case study involves a high-conflict, Children’s Services Bureau–referred couple presenting to therapy with reported multiple stressors and problems. For the purposes of this article, therapeutic change occurs within the family unit, by accepting each member as they are, while at the same time working together to change maladaptive familial structures. The aim of this article is to begin closing the gap in research by exploring how structural family therapy and dialectical behavior can be integrated to create a comprehensive theory and approach to treatment.
How to Handle Lymphadenectomy Specimens to Identify Metastasis More Accurately in Gynecologic Pathology
Authors: Kimyon Comert Gunsu , Dincer Nazmiye , Usubutun Alp
Published: September 2018

Aim. To identify the value of processing multiple sections to detect metastasis in lymph nodes (LNs) dissected during gynecologic cancer surgery, and to evaluate the sizes of metastatic LNs in each region to compare with the largest one. Materials and Methods. This retrospective study included 362 patients who had gynecologic cancer with at least one metastatic LN. Slides of 627 metastatic LN specimens were categorized according to the processing technique into single and more than one section (MOS) groups. In the MOS group, the LNs were cut into 2 or 3 parallel slices because their greatest dimensions exceeded 0.5 cm. Sizes of LN metastatic foci (MF) were measured and defined as follows: MF ⩽2 mm as micrometastasis and MF >2 mm as macrometastasis. The largest LN diameters among the metastatic LNs and the largest LNs in those regions were measured. Groups were compared using the Kruskal-Wallis test. Results. Sixty-five (10.3%) of the metastatic LNs included in this study had micrometastases and 40 (6.3%) of them had MF ⩽1 mm. The rate of micrometastasis was higher in the MOS group than in the single-section group (11.8% vs 8.5%, respectively). Twenty-eight percent (n = 175) of metastatic LNs were not the largest, and 55.5% of those were less than 1 cm in diameter. Conclusion. Methods of LN processing and macroscopic evaluation are not standardized, and processing single sections from LNs may overlook micrometastases. The detection rate of micrometastases can be improved by processing multiple sections from LNs.
Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle
Authors: Tomczak Cassandra , Beaman Douglas , Perkins Serene
Published: September 2018

Background:

The severely deformed, infected, and unstable neuroarthropathic ankle is challenging to treat. We evaluated our preliminary experience and results of combined internal and external ring fixation for a complex neuropathic population.

Methods:

We retrospectively reviewed medical records and radiographs for 8 patients with unilateral severely deformed ankle neuroarthropathy associated with infection and ulceration. Treatment included single-stage reconstruction arthrodesis with an interlocked intramedullary nail coated with antibiotic-containing cement combined with ring fixation. Taylor Spatial Frame™ technology was used when the deformity was not amenable to acute correction (5 patients). Protected postoperative weightbearing was permitted. Their mean age averaged 55.6 (range, 42-66) years with an average body mass index of 38.4 (range, 28.7-49.6) kg/m2.

Results:

Seven patients achieved limb preservation. Average time for fusion healing was 15.2 (range, 12.2-22.2) weeks, frame time was 17.7 (range, 12.2-23.0) weeks, and follow-up was 34.1 (range, 24.1-68.8) months. All presenting wounds and infection successfully resolved. Reinker and Carpenter scale was excellent for 2 patients, good for 2 patients, and fair for 3 patients. Foot and Ankle Ability Measure averaged 59.0% (range, 39.3%-87.5%). One patient developed a recalcitrant calcaneal ulcer with osteomyelitis that required a transtibial amputation 17 months after successful ankle arthrodesis.

Conclusions:

Combined use of interlocked intramedullary nail and ring external fixation for neuroarthropathic ankle arthrodesis achieved a functional and clinically stable salvaged lower limb for most patients.

Level of Evidence:

Level IV, retrospective case series.
Interaction between two nanoscale elliptical holes with surface tension
Authors: Wang Shuang , Gao Cun-Fa , Chen Zeng-Tao
Published: September 2018

In this paper, the plane problem of two elliptical nanoscale holes with surface tension is investigated. Firstly, the basic equations are given via the complex variable methods. Then, the stress boundary condition caused by surface tension is derived through the integral-form Gurtin–Murdoch model. The problem is finally solved by the conformal mapping along with the series expansion methods. The results show that the stress field decreases as the two holes become further away from each other. When the distance between the two holes is more than three times the sum of their sizes, the interaction between the two holes can be neglected. In addition, the stress field is greatly influenced by the orientation, aspect ratio and size of the holes. The positions of the maximum hoop stress are also discussed. When the two elliptical holes are put close horizontally, the hoop stress around one hole usually obtain its maximum at the endpoint close to the other hole. However, if one elliptical hole is not horizontal, the hoop stress around it will no longer attain its maximum at the endpoints. Another exception is that when one elliptical hole becomes larger, the hoop stress around the smaller hole would tend to achieve a local minimum at the endpoint close to the larger hole.
Institutional Barriers and Bridges for Climate Proofing Waterway Infrastructures
Authors: Willems Jannes J. , Busscher Tim
Published: September 2018

Although the urgency for climate proofing waterway assets grows, to date, little is known about the organizational learning process of infrastructure operators to address this urgency. Climate proofing infrastructure increasingly requires infrastructure operators to rethink the original aims of their networks (such as bringing prosperity by enabling transportation), which relates to the notion of double-loop learning. The goal of this article is to identify institutional barriers and bridges that condition learning processes of infrastructure operators in climate proofing waterway infrastructures. This article is based on a case study of the Dutch national inland waterway network. Our findings suggest that climate proofing infrastructure requires an integrative and inclusive approach, in which the focus on waterway assets is loosened and infrastructure operators become more oriented towards wider, larger regional developments. However, the barriers and bridges encountered in the case study suggest that the Dutch waterway operator Rijkswaterstaat mainly focuses on refining and optimizing the current waterway network, i.e., single-loop learning. The questioning of underlying values, i.e., double-loop learning, is more complicated and has to be actively organized.
Transient responses of sandwich structure based on the generalized thermoelastic diffusion theory with memory-dependent derivative
Authors: He Tianhu , Li Yan
Published: September 2018

The present work is devoted to investigating the transient responses of a sandwich structure based on the generalized thermoelastic diffusion theory with memory-dependent derivative. Both the left and the right bounding surfaces are subjected to a thermal shock and a chemical potential shock simultaneously. It is assumed that the values of thermal contact resistance and diffusional contact impedance at the interface are zero with ideal adhesion. The coupled governing equations containing time delay factors and kernel functions, which can be chosen freely according to specific problems, are solved by the Laplace transform together with its numerical inversion. The influences of the material characteristic parameters at the interface on the structural responses are emphatically discussed, and the non-dimensional temperature, chemical potential, displacement, stress as well as concentration at different values of time delay factors and kernel functions are obtained and illustrated graphically. The results show that: the changes of the time delay factors, kernel functions, and material characteristic parameters have the varying degrees of influences on the considered variables. Based on the above conclusions, the sandwich structure working under the thermoelastic diffusion coupling condition can be designed reasonably.
Longing for agency: New materialisms’ wrestling with despair
Authors: Bargetz Brigitte
Published: September 2018

In recent years, feelings such as melancholia, paranoia, despair and political depression have been deemed distinctive political moods, also within critical theories. This, the author argues, is the affective landscape for understanding and situating new materialist endeavours. As much as new materialist approaches have been praised and even celebrated lately, they have also provoked highly controversial reactions and evoked questions, such as: Why a new materialism, why at this historical moment? And what is so attractive about this material turn? In this article, the author argues that new materialist approaches seek to oppose the contemporary affective condition of political depression, despair and hopelessness by desiring and mobilizing to achieve a different political future, one that ultimately relates to care and commonality as well as to (new) modes and modalities of political agency. However, while new materialist approaches doubtlessly provide engaged and powerful inventions and interventions within contemporary struggles for agency, the author also demonstrates the risk of depoliticization inherent in this longing for something different, which can ultimately even compromise opening up possibilities for agency. This article, thus, aims to discuss new materialist concerns within the context of contemporary political and theoretical landscapes in order to better decipher the new materialist signals of our times, but also to critically push further the possibilities for political agency within feminist theory, at times even against all odds.
Writing as skin: Negotiating the body in(to) learning about the managed self
Authors: Brewis Deborah N , Williams Eley
Published: September 2018

We draw on the notion of ‘skin’ to discuss the ways in which writing in management and organisation studies wrestles with two drives in its endeavour to represent the reality of our ‘organised’ lives: the drive to share internal lived experience, and the drive to externalise and abstract. Through exploring skin as a metaphor for a negotiating interface between these forces in our writing, we (a) argue that both are critical parts of writing, needed in order to learn about management and organisation and (b) explore different ways in which they might be brought into contact. Reviewing, synthesising and building on critiques of ‘scientific’ writing that have been made from within management and organisation studies, and on creative commentary from the arts, we think reflexively about the ways in which writing mediates learning by being both representative of experience and an experience in itself. A collaboration between management scholar and creative writer, the text of this article is a critical-creative experiment that outlines the experiential ‘skin-text’ while simultaneously producing an example of such a text.
Sense-ational organization theory! Practices of democratic scriptology
Authors: Rhodes Carl
Published: September 2018

This article critically reviews the use of non-conventional writing in organization studies from the 1980s to the present day as it relates to the relationship between freedom, politics and theory. Just as research justifies itself through an elaboration of methodology, it is suggested that we can consider ‘scriptology’ – the reflexively aware articulation of the relationship between writing and knowledge – as a means to liberate knowledge production in organization studies from its self-imposed conservatism. While there are numerous actual examples of non-conventional scriptologies in use, it is argued the most politically radical and emancipatory of them can be found in contemporary feminine and feminist writing. Such writing provides a new textual aesthetic for organization studies that promises a democratic and egalitarian practice where expression seeks to defy the rules that would inhibit it rather than adhere to the ones that would authorize it. Such scriptologies can provide a way that knowledge can try, in its way, to be free.
Movable text
Authors: Patrickson Bronwin
Published: September 2018

During the early adoption of e-books, this unfamiliar digital format was made more palatable through analogy to the printed book. Texts were divided into ‘pages’ that could turn on screen, and e-book repositories were referred to as ‘libraries’. However, as digital texts have increasingly taken on characteristics of digital systems, the metaphor of the printed book has lost currency. Given the limitations of this conventional metaphor for the digital text, I propose an alternative conception, one that is as archaic in origin as the printed-book metaphor, yet surprisingly robust for describing the customizable texts of today’s Academy: the metaphor of movable text. The image derives from German printer Johannes Gutenberg’s 15th-century innovation for the mass production of books, a mechanical system that used paper, ink and the relatively cheap and reusable display of cubed, metal letters that could be arranged and rearranged into words on a tray ready to be pressed into print. This metaphor of book-as-movable text is useful in that it captures how the form of the academic textbook is now entangled with its process, as much as its context. But, how does this metaphor apply to the academic text in particular? If a movable academic book asks to be interpreted, does the mobility of meaning that it creates defy such interpretative engagement? In this article, I argue that when automated texts are effectively scaffolded by cultural critiques, they can support deep research processes. To become more effective, these searches demand focus as much as evaluation and thus drive towards the crafts of collation, synthesis and eventual reconfiguration.
Where places fold: The co-production of matter and meaning in an Aymara ritual setting
Authors: Aedo Angel
Published: September 2018

This article explores the enigmatic centrality of a seemingly unoccupied place located at the very heart of an Andean community in northern Chile. It investigates how the apparent emptiness of a ritual site paradoxically operates as an ineffable agent that articulates beings, things and landscapes. The author argues that the study of what happens in this place is of significance beyond regional studies. It goes beyond the usual cultural frameworks to consider theoretical concepts such as topology, materiality, vitality and relationality. In order to explore this, he investigates how the ‘empty’ heart of the ceremonial centre, Isluga Marka – the place that blurs borders and centres ( taypi) – emerges as a theoretically challenging topological phenomenon. The ethnography underlying this article is problematized in order to contribute to the general understanding of how matter, place and meaning can become entangled and mutually constituted.
The music matrix: A qualitative participatory action research project to develop documentation for care home music therapy services
Authors: Wood Stuart , Crow Fiona
Published: September 2018

This article presents a small Participatory Action Research project involving music therapists working in a care home company, creating a documentation tool (The Music Matrix) that is fit for purpose. The project emerged out of a commonly held dissatisfaction with existing documentation among the Music Therapists in the care home company’s national team. The Music Matrix tool uses graphic notation to record observations of client participation, systematised into 10 dimensions of activity. The tool was developed in a cycle of practice and reflection between members of the music therapy team and stakeholders in the wider organisation. This was systematised in a three-stage trial process of profiling, peer review and thematic synthesis of feedback. Findings suggest that the tool was viewed to be useful in a number of aspects. First, it enabled insights for Music Therapists, in seeing patterns and recognising unacknowledged habits in their own practice. It helped show complex experience in an immediate graphic way. This was useful for reporting to stakeholders and was flexible in applying to numerous formats of practice. However, this flexibility also created a level of uncertainty for some research respondents, as the tool’s wide applicability does not have the appearance of objectivity afforded by other methods. Stakeholders saw applications beyond music therapy, particularly for non-musical care work and activities. Insights emerged regarding how Music Therapists can usefully meet the many demands that care documentation serves.
Seismic behavior and shear strength of new-type fired perforated brick walls with high void ratio
Authors: Wang Qiuwei , Shi Qingxuan , Tao Yi
Published: September 2018

A new type of fired perforated brick with void ratio of more than 30% has been developed to improve the applicability of brick masonry structures. When the new perforated bricks are used for load-bearing walls, it will be a question whether the seismic performance of walls could satisfy the requirements under not obviously increasing the cost. This article presents an experimental study to investigate the seismic behavior and shear capacity of new-type perforated brick walls with high void ratio. For this purpose, six cross walls and three longitudinal walls with constructional columns under low reversed cyclic loading were tested, and the failure patterns, hysteretic characteristics, skeleton curves, energy dissipation capacity, ductility and reinforcement strain were observed. The test results indicate that (1) most new-type perforated brick wall specimens display shear failure, and hysteretic curves of cross walls are plump while there is some pinch phenomenon for longitudinal walls; (2) the specimens have considerable deformation and energy dissipation capacity, with displacement ductility factors of over 2.0; (3) the bearing capacity of walls increases but the ductility decreases with an increase of vertical compressive stress, and the bearing capacity and deformation all increase while considering the effect of horizontal reinforcement; and (4) the central brick wall and construction columns could resist shear force together before the peak load, while the shear force would be mainly born by construction columns at the later loading stage. Based on the test results, the constraint coefficient in current Chinese code was modified, and the calculation formula of shear capacity for cross walls was proposed. Comparison of calculated results with test data shows that the method will provide a way to predict the shear capacity of new-type fired perforated brick walls.
News brand attribution in distributed environments: Do people know where they get their news?
Authors: Kalogeropoulos Antonis , Fletcher Richard , Nielsen Rasmus Kleis
Published: September 2018

The digital media environment is increasingly characterized by distributed discovery, where media users find content produced by news media via platforms like search engines and social media. Here, we measure whether online news users correctly attribute stories they have accessed to the brands that have produced them. We call this “news brand attribution.” Based on a unique combination of passive tracking followed by surveys served to a panel of users after they had accessed news by identifiable means (direct, search, social) and controlling for demographic and media consumption variables, we find that users are far more likely to correctly attribute a story to a news brand if they accessed it directly rather than via search or social. We discuss the implications of our findings for the business of journalism, for our understanding of source cues in an increasingly distributed media environment and the potential of the novel research design developed.
Watching the 2016 Olympics on Brazil’s alternative media: From platform hijack to discourse autonomy
Authors: Levy Helton , Sarmento Claudia
Published: September 2018

This article analyses the alternative media coverage of the 2016 Olympics from the perspective of an emerging literature on ‘platform hijack’ of media events. By conducting a frame analysis (n = 60), we explore the extent to which alternative media producers have sought to seize the attention from the Olympics to their agendas or issues. While they expectedly appeared emphasising the damaging effects over communities, results otherwise suggest no intent to directly ‘hijack’ the Olympics’ platforms, as seen in past episodes of disruptive activism. Instead, we propose interpreting the evidence as indicative of discourse autonomy, which adds nuances to the way in which alternative media producers prefer to remain tied to their local issues even during global media events.
Planning affectively: Power, affect, and images of the future
Authors: Marotta Steve , Cummings Austin
Published: September 2018

This article addresses the deficit between affect theory and planning scholarship. In doing so, we focus on three intertwined theoretical ideas, all of which underlie the practical experiences of navigating place change. First, we consider the desire of power to control that which overwhelms the body’s capacity for being affected. Second, we situate the confrontation between power and uncertainty (e.g. over a place’s future) in the milieu or atmosphere of a place. Third, we put place theory into conversation with Lauren Berlant’s concept of “impasse” to examine place attachments during the flux of rapid redevelopment. To animate these theoretical ideas, the latter portion of the article discusses the nearly complete redevelopment of a subsection of Portland’s (OR, USA) Pearl District neighborhood and the “images of the future” that adorn almost every local construction site. Relying on the work of Deleuze and Berlant among others, we address these images as mediations of power, on the grounds of the affects that elude control, and in the context of resident anxieties about uncertain futures and fraying place attachments. Throughout the article we locate planning in the same “between” spaces that affective analyses so adeptly identify. We argue that this positions planning scholarship as a natural forum for exploring the affective infrastructures that enliven the relationships between people and places.
The impact of alcohol consumption on homicide: A time-series analysis of three Nordic countries
Authors: Lehti Martti , Sirén Reino
Published: September 2018

The article explores the statistical association between annual alcohol consumption and homicide mortality in Finland, Sweden and Norway from the early 19th century to 2013. The results show statistically significant impacts on overall and male homicide mortality in Finland and on male homicide mortality in Sweden. In Norway, we found no significant impacts. The results suggest that changes in the level of alcohol consumption have had a stronger impact on homicide rates in Finland, characterized by a heavier drinking culture, than in Norway or Sweden. The strength of the association between alcohol consumption and homicide levels seems also to vary over time and to be conditioned by economic and socio-political factors.
Design variable analysis and generation for performance-based parametric modeling in architecture
Authors: Brown Nathan C , Mueller Caitlin T
Published: September 2018

Many architectural designers recognize the potential of parametric models as a worthwhile approach to performance-driven design. A variety of performance simulations are now possible within computational design environments, and the framework of design space exploration allows users to generate and navigate various possibilities while considering both qualitative and quantitative feedback. At the same time, it can be difficult to formulate a parametric design space in a way that leads to compelling solutions and does not limit flexibility. This article proposes and tests the extension of machine learning and data analysis techniques to early problem setup in order to interrogate, modify, relate, transform, and automatically generate design variables for architectural investigations. Through analysis of two case studies involving structure and daylight, this article demonstrates initial workflows for determining variable importance, finding overall control sliders that relate directly to performance and automatically generating meaningful variables for specific typologies.
An Immunologically Modified Nanosystem Based on Noncovalent Binding Between Single-Walled Carbon Nanotubes and Glycated Chitosan
Authors: Saha Leton Chandra , Nag Okhil Kumar , Doughty Austin , Liu Hong , Chen Wei R.
Published: September 2018

Functionalized single-walled carbon nanotubes are currently being explored as novel delivery vehicles for proteins and therapeutic agents to treat various diseases. In order to maximize treatment efficacy, a strong binding between single-walled carbon nanotubes and their functionalized molecules is necessary. Glycated chitosan, a polymer with potent immunostimulatory properties for cancer treatment, has been used as a surfactant of single-walled carbon nanotubes to form an immunologically modified nanosystem for biomedical applications. In this study, we investigated the binding characteristics of single-walled carbon nanotube and glycated chitosan using molecular dynamics simulations. The mean square displacement, radius of gyration, interaction energy, and radial distribution function of the single-walled carbon nanotube-glycated chitosan system were analyzed. The results from the simulations demonstrated that glycated chitosan was bound to single-walled carbon nanotubes by a strong, noncovalent interaction. The stability of glycated chitosan on the single-walled carbon nanotubes surface was enhanced by the length of glycated chitosan, and the binding energy of the 2 molecules was closely related to the diameter and chirality of single-walled carbon nanotubes, with the most stable single-walled carbon nanotube-glycated chitosan system being formed by the combination of long polymer, large single-walled carbon nanotube, and armchair single-walled carbon nanotube. The understanding of the interactions between single-walled carbon nanotube and glycated chitosan and the structure of single-walled carbon nanotube-glycated chitosan allows the modifications of the novel nanosystem for disease diagnostics and therapeutics.
Perceived Workload and an Automated Workload Alert System: A Comparison in the Emergency Department
Authors: Forsyth Katherine L. , Hawthorne Hunter J. , Cammon Wesley D. , Linden Anna R. , Blocker Renaldo C.
Published: September 2018

The aim of this study was twofold—(1) to compare the current ED staffing workload alert system to clinicians’ perceptions of workload in the ED, and (2) to examine the potential impact of a multi-faceted, systems-level intervention on clinicians’ perceptions of workload. Constant flow of patients into the Emergency Departments (ED) regularly increases the workload of clinicians and can compromise the quality of care delivery and patient safety. An automatic staffing workload alert system was created and implemented in response to an observed shift in patient volume to the overnight hours at one academic quaternary care center. Surveys addressing workload and interruptions were administered to ED clinicians, pre-and post-intervention implementation. Output from the staffing workload alert system was recorded for each clinician shift. Clinicians’ perceptions of workload were able to predict swing shift activations, χ2(6) = 14.14, p = 0.028. Only the performance subscale significantly correlated with swing shift activations, p=0.006. A Kruskal-Wallis H test found perceived interruptions changed following systems-level changes, χ2(1) = 7.195, p = 0.007. Utilizing subjective measure of clinicians’ workload validated an objective, automated staffing workload alert system that determined if swing shift activations are necessary.
Spreading the Word: Improving Outcomes with Human Factors Engineering (When Common Sense Is Not Enough)
Authors: Rayo Michael F. , Rayo Michael F. , (Terry) Fairbanks Rollin J. , Parker Sarah Henrickson , Wolf Laurie , Kennedy Rosemary
Published: September 2018

Proposing a new solution implies an underlying prediction that the design will succeed in its direct purpose and will minimize unintended negative consequences. These consequences could happen immediately or slowly through a cascade of changes as the system adapts to the new work patterns that the solution requires. Human Factors Engineering (HFE) has a long and storied history of being consulted after an implementation goes badly, but HFE practitioners are often not able to meaningfully impact the design of these solutions before implementation. Our panel will share exemplar cases in which HFE was not initially involved, but ultimately contributed to effective solutions. The purpose of sharing these stories is three-fold: (1) to provide examples of successful healthcare interventions, (2) to provide evidence and guidance for practitioners who are trying to influence their organizations earlier in the design process, and (3) to spur our community to share our stories more widely.
Do Objective Measures of Communication Predict Clinical Performance? – Application in Acute Care Trauma Simulation
Authors: Peng Yuhao , Anton Nicholas E. , Cha Jackie , Mizota Tomoko , Hennings Julie M , Stambro Ryan , Rendina Megan A. , Stanton Katie , Stefanidis Dimitrios , Yu Denny
Published: September 2018

Effective communication in healthcare is critical for effective patient care. This study explored communication in an acute care team simulation where medical students were asked to perform as the physician in charge to manage pre-and post-operative patients. Students’ speech was analyzed to determine differences according to communication receiver (i.e., student to nurse, student to patient). Statistical analyses revealed that speech ratio, speech intensity, and number of questions students asked to the nurse or patient were significantly different between communication receivers ( p<0.05). Furthermore, communications initiated by student to nurse contributed 34% of the total time, and 31% from student to patient. Lastly, students spoke 3% higher volume to patient than to nurse, 20% more questions were asked to nurse than to patient. Findings indicated an overall positive relationship between measured audio variables and performance.
Can Crowdworkers be used to Rate the Quality of Ultrasound Images?
Authors: Ashdown Amanda , Scerbo Mark W. , Knapp Barry J. , Toreno Felicia , Goodmurphy Craig , Byars Don
Published: September 2018

The present study examined whether inexperienced individuals can evaluate ultrasonography (US) images using a new rating scale and visual aids. A US image assessment tool and visual aids in the form of alignable comparison standards (one good and one poor example) were developed to rate images of the hepatorenal interface along eight characteristics. Twenty novice participants from Amazon.com’s Mechanical Turk service used the visual aids to evaluate 42 US images in good and poor categories. The results revealed that crowdworkers could distinguish the good from poor US images. Their ratings were highly and positively correlated with those of experts. However, the crowdworkers’ ratings were more severe than those of the experts. These results suggest that inexperienced individuals can use a rating scale and visual aids to reliably distinguish good from poor US images but may require a more extensive set of visual cues or additional training to match ratings provide by experts.
Gathering Information in Healthcare Settings: A Tool to Facilitate On-Site Work
Authors: Herout Jennifer , Dobre Jolie , Plew William , Saleem Jason J.
Published: September 2018

The coordination of site visits to execute human factors methods, such as onsite usability tests, interviews, or observations, in clinical settings requires a high level of management to attain successful data collection outcomes. Members of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Human Factors Engineering (HFE) team occasionally visit VHA medical centers or outpatient clinics to complete our work. We have developed a site visit checklist as a practice innovation to facilitate logistical coordination when gathering data onsite. This Practice-Oriented paper includes the full checklist, as well as discussion of its use to enable other groups to benefit from lessons we have learned in conducting onsite work in health care settings.
Moderating Styles: Understanding Diverse Techniques for Investigating the Root Cause of Use Events
Authors: Tippey Kathryn G. , McGrath Larry S. , Yovanoff Mary , Sneeringer Peter
Published: September 2018

This article explores how a moderator’s style shapes the techniques they use for conducting usability testing on medical devices. Different moderating styles offer distinct routes to arrive at analogous root-cause data when the moderator is appropriately trained. We interviewed three moderators from a human factors medical device consulting company about how they approach investigating the root cause of use events. A typology of three styles emerged from the interviews: Direct Moderator, Indirect Moderator, and Social Moderator. No style was inherently superior. Each moderator employs a distinct toolkit to gain insights about users’ interactions with devices. These data provide product developers with either recommendations for device improvements or with documentation for human factors FDA validation.Moderators may gain from learning about alternate moderating styles to enhance their mental flexibility during testing sessions. Knowledge of various styles also encourages a more diverse set of practitioners to enter the human factors field.
Signaling Sepsis Scenario Development & Validation
Authors: Weldon Danielle L.M. , Kowalski Rebecca , Schubel Laura , Schuchardt Brett , Arnold Ryan , Capan Muge , Blumenthal Joseph , Franklin Ella , Catchpole Ken , Jacob Seagull F. , Sanford Schwartz J. , Miller Kristen
Published: September 2018

Patient-based scenario-driven usability tests are routinely created for health information technology and clinical decision support evaluations. Due to low clinician awareness of sepsis, a study was undertaken to understand clinician performance and preference of different display types for sepsis clinical decision support through multi-centered usability testing. Patient-based clinical scenarios were created to mimic the environment in which providers would interact with clinical decision support. The data provided in the scenarios were drawn from real patient cases from two sepsis databases, including: demographics, visit/operational details, medical history (comorbidities, assessments, vital signs, laboratory values, clinician documentation), and patient disposition/outcomes. The purpose of this work is to inform electronic health record alert optimization and clinical practice workflow to support the effective and timely delivery of high quality sepsis care. This paper discusses the methodology, selection, and validation of patient-based cases used as the clinical scenarios in usability testing.
Exploration of Relationships among Individual and Organizational Characteristics, Nurse Leader Fatigue, and Turnover Intention
Authors: Brzozowski Sarah , Rainbow Jessica G. , Pinekenstein Barbara , Knudsen Élise Arsenault , Steege Linsey
Published: September 2018

Understanding nurse leader fatigue and its relationship with turnover intention is essential for maintaining a viable leadership workforce. This secondary analysis of a national survey of nurse leaders explored the relationships of organizational and individual factors with nurse leader fatigue and turnover intention. A nurse leader’s membership in individual and organizational classes is associated with differences in acute and chronic fatigue levels. There were significant relationships between acute and chronic fatigue states and turnover intention. Acute fatigue was a mediating factor between individual and organizational classes and turnover intention. Future interventions to decrease nurse leader turnover intention could be tailored for different types of organizations, individual classes and fatigue type.
A Formal Methods Approach for Predicting How Users will Utilize System Features
Authors: Li Meng , Behdad Sara , Bolton Matthew L.
Published: September 2018

Model checking is increasingly being used with task analytic behavior models to prove whether models of human-interactive systems are safe and reliable. Such methods could be used to predict how different types of users will choose to use system features. However, existing methods focus on modeling the full space of possible human behaviors without considering how users will choose to navigate this space. In this work, we present a new approach that enables model checking to predict how different types of users will use features of an interactive system by employing a novel combination of task analytic modeling and utility theory. This paper presents this method and illustrates its power with a smart thermostat application. The results of the application analysis and its implications for future research are discussed.
CURATe Measures for Human-Integrated Systems: A Model Checking Approach
Authors: Abbate Andrew J. , Bass Ellen J.
Published: September 2018

To support safe and effective human-system integration, a safety-critical system should be Complete, Understandable, Robust, Accurate, and Time efficient (CURATe) with respect to the user, interface, device, and environmental context. Using highly automated model checkers, researchers have shown that CURATe-related specifications can be verified early in the design process for a subset of system elements and interactions. This research introduces an extended model checking approach that aims to address all CURATe measures with respect to a broader range of human-integrated system elements: the interface, including documentation, configurable hardware, and control units; the user, including capabilities, actions, and knowledge; the device, including automation, actuators, and transducers; and the environment, including stimuli and constraints that could shape behavior. We describe a concept for what elements/interactions among them need to be modeled formally as well as a concept for applicable CURATe specifications. With respect to these concepts, we propose a formal model architecture and one temporal logic encoding for each CURATe specification.
Modeling the Effects of Time pressure and Feedback on Eye movements and Learning Performance
Authors: Kim Ji-Eun , Nembhard David A.
Published: September 2018

Eye movement measurement is both non-invasive to the learner, and available at a cost that is steadily decreasing. There are currently several mainstream laptop computers on the market that ship with fully integrated eye-tracking. Eye movements will take on a role as inputs to predict individualized learning performance. In response to the increased usage of this tool, this study uses eye-tracking technology to investigate the effects of time pressure and feedback on changes in eye movement by generating structural models. We tracked participants’ eye movement, and to relate this eye movement to human learning behaviors while participants were asked to complete online training for a Project Management task. The study measured participants’ eye-movements in response to the amount of time to deadlines and feedback updating the remaining time. Results showed that eye movement partially mediated the relationship between time to deadline and task completion time. The results of the study will be advantageous in predicting individualized learning performance based on eye movements.
Cue Utilization, Perceptions, and Experience in the Interpretation of Weather Radar Returns
Authors: Wiggins Mark W. , Crane Monique , Loveday Thomas
Published: September 2018

This study was designed to examine the role of cue utilization, perceptions, and measures of operational experience in the interpretation of a scenario involving the interpretation of weather radar returns. A total of 47 qualified pilots completed EXPERTise 2.0, an online assessment of cue utilization in the context of weather radar systems. They also completed a scenario involving the interpretation of weather radar returns which required an assessment as to whether they could continue the flight safely in the absence of a change in track or altitude. Consistent with research in other domains, the results revealed a relationship between performance and cue utilization. No relationships were evident on the basis of flight experience nor the inclination to use or trust weather radar systems. The results provide the basis for a tool that might be employed to assess pilots’ cue utilization, thereby enabling more targeted approaches to pilot training and weather radar system design.