Cognitive Sparing in Proton versus Photon Radiotherapy for Pediatric Brain Tumor Is Associated with White Matter Integrity: An Exploratory Study.

Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (n = 10) or PRT (n = 12) underwent neuropsychological testing and diffusion weighted imaging >7 years post-radiotherapy. A healthy comparison group (n = 23) was also recruited. Participants completed age-appropriate measures of intellectual functioning, visual-motor integration, and motor coordination. Tractography was conducted using automated fiber quantification (AFQ). Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 12 tracts of interest. Overall, both white matter integrity (FA) and neuropsychological performance were lower in XRT patients while PRT patients were similar to healthy control participants with respect to both FA and cognitive functioning. These findings support improved long-term outcomes in PRT versus XRT. This exploratory study is the first to directly support for white matter integrity as a mechanism of cognitive sparing in PRT.

Defining thumb reach envelopes for handheld devices.

OBJECTIVE: Our objective is to provide thumb reach envelopes to help guide the placement of controls on handheld devices and to provide useful methods to gather and analyze thumb reach data. BACKGROUND: With the proliferation of handheld, interactive devices, such as cameras, mobile phones, game systems, and remote controls, human factors professionals involved in designing these products need data to help guide the placement of controls. Previous studies have not provided adequate two-dimensional thumb reach envelopes for the primary control surfaces of handheld devices. METHOD: A total of 90 participants in three groups (adolescent females, young mothers, and young fathers) placed representations of primary controls in preferred locations on a device model and "painted" their individual reach envelopes on a touch-screen device running a paint application. RESULTS: We present two-dimensional thumb reach envelopes on the primary control surface for handheld devices. The primary reach zone for adolescent females is slightly larger and more circular than that of the adults. The preferred location for controls matches the primary thumb reach zones fairly well. CONCLUSION: The reach envelopes presented are the first of their kind and are likely to be useful to human factors professionals. The method used to obtain the data may also be useful. APPLICATION: The thumb reach envelopes should be applicable to the design of many handheld, interactive devices with dimensions similar to the models used in this study. The method presented allows design teams to collect and analyze thumb reach data quickly and inexpensively for different target user populations or product dimensions.

Ergonomic Assessment of Floor-based and Overhead Lifts.

Manual full-body vertical lifts of patients have high risk for developing musculoskeletal disorders. Two primary types of battery-powered lift assist devices are available for these tasks: floor-based and overhead-mounted devices. Studies suggest that the operation of floor-based devices may require excessive pushing and pulling forces and that overhead-mounted devices are safer and require lower operating forces. This study evaluated required operating hand forces and resulting biomechanical spinal loading for overhead-mounted lifts versus floor-based lifts across various floor surfaces and patient weight conditions. We did not examine differences in how operators performed the tasks, but rather focused on differences in required operating forces and estimated biomechanical loads across various exposure conditions for a typical operator. Findings show that the floor-based lifts exceeded recommended exposure limits for pushing and pulling for many of the floor/weight conditions and that the overhead-mounted lifts did not. As expected, forces and spinal loads were greater for nonlinoleum floor surfaces compared with linoleum floors. Based on these findings, it is suggested that overhead-mounted devices be used whenever possible, particularly in instances where carpeted floors would be encountered.

Risk factors associated with patient assaults of home healthcare workers.

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47-12.67), routinely handling patients (OR = 8.48, 95% CI 1.89-37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75-11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.

Ambulatory facility design and patients' perceptions of healthcare quality.

OBJECTIVE: This research examines whether the physical attractiveness of an outpatient practice influences patients' perceptions of healthcare quality, including patient and staff perceptions of the quality of staff-patient interaction. BACKGROUND: Despite the high and increasing percentage of healthcare dollars for care delivered on an outpatient basis, relatively little research has examined the relationship between the design of ambulatory facilities and patient outcomes. Few studies have examined how patients' perceptions of healthcare quality differ in the same outpatient practice before and after a move to a new facility designed to be patient-centered. This study is the second phase of a study comparing patients' perceived quality of care in ambulatory facilities that differ markedly in physical attractiveness. METHODS: Using both a patient and staff survey, and structured interviews, this study compared staff and patient perceptions of healthcare quality (including staff-patient interactions) before and after a move to a new facility designed to be patient-centered. RESULTS: Patients' perceived quality of care, and their perceptions of the quality of interaction with staff, was significantly better in the patient-centered facility. Few differences were found in actual patient-staff interaction behaviors. CONCLUSIONS: This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and perceived quality of care. For this reason, the results are more credible than they would be were they inconsistent with other research or were this the only study examining these issues. These results support the value of investing in the physical attractiveness of patient areas in the ambulatory care setting. Further research is needed to identify specific physical elements that contribute to positive attributions related to quality of care, as well as where the "tipping point" is in investments to improve physical attractiveness.

The abbreviated vigilance task and cerebral hemodynamics.

Transcranial Doppler sonography (TCD) and transcranial cerebral oximetry (TCCO) measures of cerebral blood flow velocity and oxygenation levels were collected during an abbreviated 12-min vigilance task. Both the TCD and TCCO measures showed higher levels of cerebral vascular activity in the right than in the left cerebral hemisphere; the cerebral laterality of vigilance occurs in an abbreviated task. Although there was a significant decline in performance over time, there was no significant change in the physiological measures over time during the abbreviated vigil. This latter finding does not match the physiological changes detected in long-duration vigils.

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 2: lift and transfer assistance for non-weight-bearing home care patients.

Home healthcare (HHC) is one of the fastest-growing professions, currently employing more than 1 million workers in the United States. Unfortunately, these workers sustain an exceptionally high rate of musculoskeletal disorders. This is the second article in a two-part series providing information and suggestions for preventing overexertion that can lead to such disorders.

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: lift and transfer assistance for partially weight-bearing home care patients.

Home healthcare is one of the fastest-growing professions, currently employing more than 1 million workers in the United States. Unfortunately, these workers sustain an exceptionally high rate of musculoskeletal disorders. This is the first article in a two-part series providing information and suggestions for preventing overexertion that can lead to such disorders.

Training for vigilance: using predictive power to evaluate feedback effectiveness.

OBJECTIVE: We examined the effects of knowledge of results (KR) on vigilance accuracy and report the first use of positive and negative predictive power (PPP and NPP) to assess vigilance training effectiveness. BACKGROUND: Training individuals to detect infrequent signals among a plethora of nonsignals is critical to success in many failure-intolerant monitoring technologies. KR has been widely used for vigilance training, but the effect of the schedule of KR presentation on accuracy has been neglected. Previous research on training for vigilance has used signal detection metrics or hits and false alarms. In this study diagnosticity measures were applied to augment traditional analytic methods. METHOD: We examined the effects of continuous KR and a partial-KR regimen versus a no-KR control on decision diagnosticity. RESULTS: Signal detection theory (SDT) analysis indicated that KR induced conservatism in responding but did not enhance sensitivity. However, KR in both forms equally enhanced PPP while selectively impairing NPP. CONCLUSION: There is a trade-off in the effectiveness of KR in reducing false alarms and misses. Together, SDT and PPP/NPP measures provide a more complete portrait of performance effects. APPLICATION: PPP and NPP together provide another assessment technique for vigilance performance, and as additional diagnostic tools, these measures are potentially useful to the human factors community.