Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing.

Background: Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional.

Impact of Prehospital Ultrasound Training on Simulated Paramedic Clinical Decision-Making.

Introduction: When used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence.

Methods: We evaluated the ultrasound competence of 31 participants using post-course written and practical assessments.

User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication in a Randomized Trial.

Objectives:  To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia.

Methods:  Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner.

Adapting Cognitive Task Analysis Methods for Use in a Large Sample Simulation Study of High-Risk Healthcare Events.

Cognitive task analysis (CTA) methods are traditionally used to conduct small-sample, in-depth studies. In this case study, CTA methods were adapted for a large multi-site study in which 102 anesthesiologists worked through four different high-fidelity simulated high-consequence incidents. Cognitive interviews were used to elicit decision processes following each simulated incident.

Decision-Making During High-Risk Events: A Systematic Literature Review.

Effective decision-making in crisis events is challenging due to time pressure, uncertainty, and dynamic decisional environments. We conducted a systematic literature review in PubMed and PsycINFO, identifying 32 empiric research papers that examine how trained professionals make naturalistic decisions under pressure. We used structured qualitative analysis methods to extract key themes.

Thermoplasmonic Controlled Optical Absorber Based on a Liquid Crystal Metasurface.

Metasurfaces can be realized by organizing subwavelength elements (e.g., plasmonic nanoparticles) on a reflective surface covered with a dielectric layer.

White light thermoplasmonic activated gold nanorod arrays enable the photo-thermal disinfection of medical tools from bacterial contamination.

The outspread of bacterial pathogens causing severe infections and spreading rapidly, especially among hospitalized patients, is worrying and represents a global public health issue. Current disinfection techniques are becoming insufficient to counteract the spread of these pathogens because they carry multiple antibiotic-resistance genes. For this reason, a constant need exists for new technological solutions that rely on physical methods rather than chemicals.

Antibiotic clinical decision support for pneumonia in the ED: A randomized trial.

Background: Electronic health record-based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED).

Objective: To compare the effectiveness of antibiotic CDS vs.

Understanding Patient and Clinician Reported Nonroutine Events in Ambulatory Surgery.

Objective: Nonroutine events (NREs, i.e., deviations from optimal care) can identify care process deficiencies and safety risks.

Near-infrared sensitive two-wave mixing adaptive interferometer based on a liquid crystal light valve with a semiconductor substrate.

Two-wave mixing adaptive interferometer based on a liquid crystal light valve with a semiconductor GaAs substrate is realized and studied at 1064 nm wavelength. The local response of the dynamic hologram recorded in the liquid crystal layer of the light valve allows for detection of small phase modulations of the object beam. The characteristics of the interferometer are estimated experimentally.

A Study of Postoperative Complications Occurring at Home With Pediatric Gastrostomy Feeding Tubes.

Objective: Gastrostomy tubes (G-tubes) provide long-term feeding assistance to children with severe feeding dysfunction. Although there are a host of complications that occur at home with current pediatric G-tube feeding, their prevalences and outcomes remain relatively unstudied. This study aims to identify and describe such complications.

Perioperative Care Structures and Non-Routine Events: Network Analysis.

Non-routine events (NREs) are any aspect of care perceived by clinicians as a deviation from optimal care. The reporting of NREs to peers (or care teams) may help healthcare organizations improve patient safety in high-risk work environments (e.g.

PedBotHome: A Video Game-Based Robotic Ankle Device Created for Home Exercise in Children With Neurological Impairments.

Purpose: This pilot study assesses the feasibility of using PedBotHome to promote adherence to a home exercise program, the ability of the device to withstand frequent use, and changes in participant ankle mobility.PedBotHome is a robotic ankle device with integrated video game software designed to improve ankle mobility in children with cerebral palsy.

Methods: Eight participants enrolled in a 28-day trial of PedBotHome.

A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement.

Background: Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement.

Size, weight, and power breakthrough in nonmechanical beam and line-of-sight steering with geo-phase optics.

Thin-film geo-phase optics have the potential to dramatically reduce size, weight, and power for large-aperture optical components as well as provide nonmechanical functionality. Topics are presented in manner of increasing conceptual and system complexity to convey the different levels and aspects of system performance improvements. An 8 aperture, lightweight geo-phase lens is presented followed by discussions on both mechanical and nonmechanical beam steering embodiments.

Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study.

Background: Collaboration is vital within health care institutions, and it allows for the effective use of collective health care worker (HCW) expertise. Human-computer interactions involving electronic health records (EHRs) have become pervasive and act as an avenue for quantifying these collaborations using statistical and network analysis methods.

Objective: We aimed to measure HCW collaboration and its characteristics by analyzing concurrent EHR usage.

Aortic quadfurcation with persistent left sciatic artery: an extremely rare anatomic variant in a 3-year-old boy.

Reports of aortoiliac variant anatomy are rare, especially in the pediatric population. A 3-year-old male patient with hypertension and left foot polydactyly with syndactyly was referred to our interventional radiology service for evaluation of a possible renovascular cause of the hypertension. Angiograms revealed an extremely rare anatomic variant consisting of the absence of the common iliac arteries bilaterally, resulting from quadfurcation of the abdominal aorta into the bilateral internal and external iliac arteries.

Reliability of simulation-based assessment for practicing physicians: performance is context-specific.

Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.

Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.

2 × 2 anisotropic transfer matrix approach for optical propagation in uniaxial transmission filter structures.

Multi-layered metamaterial structures show promise in a wide variety of optical applications such as superlenses, electromagnetic cloaking, tunable filters, sensors, and spatial light modulators. Optical transmission analysis of multilayer metallo-dielectric stacks with overall thickness less than the wavelength of light can be modeled using effective medium theory and the Berreman matrix method. For multilayer anisotropic stacks of arbitrary thickness, a rigorous 4 × 4 transfer matrix embodiment is typically used.

Shared Decisions: A Qualitative Study on Clinician and Patient Perspectives on Statin Therapy and Statin-Associated Side Effects.

Background Despite guideline recommendations and clinical trial data suggesting benefit, statin therapy use in patients with atherosclerotic cardiovascular disease remains suboptimal. The aim of this study was to understand clinician and patient views on statin therapy, statin-associated side effects (SASEs), SASE management, and communication around statin risks and benefits. Methods and Results We conducted qualitative interviews of patients with atherosclerotic cardiovascular disease who had SASEs (n=17) and clinicians who regularly prescribe statins (n=20).

Charge trapping by iodine ions in photorefractive SnPS crystals.

Electron paramagnetic resonance (EPR) is used to establish the role of iodine as an electron trap in tin hypothiodiphosphate (SnPS) crystals. Iodine ions are unintentionally incorporated when the crystals are grown by the chemical-vapor-transport method with SnI as the transport agent. The SnPS crystals consist of Sn ions and (PS) anionic groups.

Artificial neural network discovery of a switchable metasurface reflector.

Optical materials engineered to dynamically and selectively manipulate electromagnetic waves are essential to the future of modern optical systems. In this paper, we simulate various metasurface configurations consisting of periodic 1D bars or 2D pillars made of the ternary phase change material GeSbTe (GST). Dynamic switching behavior in reflectance is exploited due to a drastic refractive index change between the crystalline and amorphous states of GST.

Incidence and Classification of Nonroutine Events during Anesthesia Care.

Background: A nonroutine event is any aspect of clinical care perceived by clinicians or trained observers as a deviation from optimal care based on the context of the clinical situation. The authors sought to delineate the incidence and nature of intraoperative nonroutine events during anesthesia care.

Methods: The authors prospectively collected audio, video, and relevant clinical information on 556 cases at three academic hospitals from 1998 to 2004.