Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress among Emergency Physicians: A Shift-Level Approach.

OBJECTIVE: To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue. METHOD: EP (N = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (NEDOCS) per shift was calculated. Shift demands were assessed at the end of each shift. RESULTS: Multilevel models revealed that shift demands, NEDOCS, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic. CONCLUSIONS: Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.

Quantifying accuracy on distance estimation tasks: A Monte Carlo study.

An important aspect of perceptual learning involves understanding how well individuals can perceive distances, sizes, and time-to-contact. Oftentimes, the primary goal in these experiments is to assess participants' errors (i.e., how accurately participants perform these tasks). However, the manner in which researchers have quantified error, or task accuracy, has varied. The use of different measures of task accuracy, to include error scores, ratios, and raw estimates, indicates that the interpretation of findings depends on the measure of task accuracy utilized. In an effort to better understand this issue, we used a Monte Carlo simulation to evaluate five dependent measures of accuracy: raw distance judgments, a ratio of true to estimated distance judgments, relative error, signed error, and absolute error. We simulated data consistent with prior findings in the distance perception literature and evaluated how findings and interpretations vary as a function of the measure of accuracy used. We found there to be differences in both statistical findings (e.g., overall model fit, mean square error, Type I error rate) and the interpretations of those findings. The costs and benefits of utilizing each accuracy measure for quantifying accuracy in distance estimation studies are discussed.

Can scuba diving transform the lives of people with physical impairments? A mixed methods study.

PURPOSE: This study aimed to: (1) test and explain the type of experience scuba diving is among people with physical impairments based on the experience-type framework; (2) assess and describe their personality based on the Big Five domains; and (3) identify if personality, years diving, and diving level predict experience-type. METHODS: An explanatory sequential mixed methods design was employed. The quantitative phase used a cross-sectional survey (n = 103). The qualitative phase used follow-up interviews with 15 participants divided into 3 case study groups. Joint displays with meta-inferences integrated the data. RESULTS: Quantitative and qualitative findings concurred on scuba being a transformative experience. 82.52% of survey participants reported scuba as a transformative experience, with no significant differences on experience impact based on impairment category (p = 0.56), impairment onset (p = 0.66), gender (p = 0.08), race/ethnicity (p = 0.51), or age (p = 0.07). Big Five personality domains, years diving, or diving level did not predict experience impact (R2 = 0.14, F(12,90) = 1.304, p = 0.2305). Data strand results differed on salient personality domains. Seven qualitative themes emerged, five on experience-type and two on personality. CONCLUSIONS: We recommend the exploration of scuba diving as a prospective rehabilitation intervention.

Innovative rehabilitation interventions that provide positive experiences and long-term health benefits to people with physical impairments are needed.Participants reported that scuba diving had a positive transformative impact in their lives through positive emotions, peace/relaxation, personal growth, development of skills, social connections, physical and mental healing, and lasting behavioral changes.Reporting scuba diving as a transformative experience was not influenced by the scuba divers' personality domains, diving level, demographic characteristics, or the number of years they had been diving.Authors recommend the consideration and further exploration of scuba diving as a prospective physical and psychosocial rehabilitation intervention.

Diving into Health: A Mixed Methods Study on the Impact of Scuba Diving in People with Physical Impairments.

The impacts of scuba diving on people with physical impairments are unknown. Grounded on the social identity approach to health, the aim of this study was to test and describe the relationships between scuba diving social identity, self-efficacy, social health, psychological health, physical health, health-related quality of life (HRQOL), and disability level among recreational scuba divers with physical impairments. A mixed methods explanatory sequential design was employed. The quantitative strand used an 80-item cross-sectional survey, with the data analyzed via a path analysis. The qualitative strand used 1:1 interviews across 3 case study groups; the data were analyzed using deductive and inductive analyses. Mixing occurred via a joint display with meta-inferences. The quantitative results (n = 78) indicated that self-efficacy was a significant predictor of social health, psychological health, physical health, HRQOL, and disability level. The qualitative findings (n = 15) consisted of six themes, whereby participants described scuba as a positive social identity that provides them with meaning, purpose, and belonging. Furthermore, they described scuba diving as a positive contributor to their self-efficacy, social health, psychological health, physical health, and quality of life. During the mixing of data, the quantitative and qualitative results did not match on the influence of scuba diving social identity on self-efficacy, social health, psychological health, physical health, HRQOL, and disability level. A further analysis revealed that the range restriction impaired the conclusive quantitative evidence on the scuba diving social identity variable. The meta-inferences derived from the data integration suggest that scuba diving plays a role in the self-efficacy, health, HRQOL, and disability level among scuba divers with physical impairments. The findings point to the potential of scuba diving as a health promotion recreational activity and rehabilitation modality for people with physical impairments.

Operating room design using agent-based simulation to reduce room obstructions.

This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the procedure affect surgical team movement and contacts. We video recorded staff movements during a set of surgical procedures. Then we divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination through zones. This data was abstracted into a generalized, agent-based, discrete event simulation model to study how OR size and OR equipment layout affected surgical staff movement and total number of surgical team contacts during a procedure. A full factorial experiment with seven input factors - OR size, OR shape, operating table orientation, circulating nurse (CN) workstation location, team size, number of doors, and procedure type - was conducted. Results were analyzed using multiple linear regression with surgical team contacts as the dependent variable. The OR size, the CN workstation location, and team size significantly affected surgical team contacts. Also, two- and three-way interactions between staff, procedure type, table orientation, and CN workstation location significantly affected contacts. We discuss implications of these findings for OR managers and for future research about designing future ORs.

Factors Contributing to Adolescents' and Young Adults' Participation in Web-Based Challenges: Survey Study.

BACKGROUND: Web-based challenges, phenomena that are familiar to adolescents and young adults who spend large amounts of time on social media, range from minimally harmful behaviors intended to support philanthropic endeavors to significantly harmful behaviors that may culminate in injury or death. OBJECTIVE: This study aims to investigate the beliefs that lead adolescents and young adults to participate in these activities by analyzing the amyotrophic lateral sclerosis (ALS) ice bucket challenge, representing nonharmful behaviors associated with web-based challenges, and the cinnamon challenge, representing web-based challenges that lead to harmful behaviors. METHODS: A retrospective quantitative study was conducted with a total of 471 participants aged between 13 and 35 years who either had participated in the ALS ice bucket challenge or the cinnamon challenge, or had never participated in any web-based challenge. Binomial logistic regression models were used to classify those who participated in the ALS ice bucket challenge or cinnamon challenge versus those who did not engage in either challenge using the integrated behavioral model's beliefs as predictors. RESULTS: The findings showed that participants of both the cinnamon challenge and the ALS ice bucket challenge had significantly greater expectations from the public to participate in the challenge they completed in comparison with individuals who never participated in any challenge (P=.01 for the cinnamon challenge and P=.003 for the ALS ice bucket challenge). Cinnamon challenge participants had greater value for the outcomes of the challenge (P<.001) and perceived positive public opinion about the challenge (P<.001), in comparison with individuals who never participated in any challenge. In contrast, ALS ice bucket challenge participants had significantly greater positive emotional responses than individuals who never participated in any challenge (P<.001). CONCLUSIONS: The constructs that contribute to the spread of web-based challenges vary based on the level of self-harm involved in the challenge and its purpose. Intervention efforts could be tailored to address the beliefs associated with different types of web-based challenges.

Job Demands and Resources among Healthcare Professionals during Virus Pandemics: A Review and Examination of Fluctuations in Mental Health Strain during COVID-19.

The present article examines how job demands and resources are related to indices of strain among healthcare professionals during virus pandemics. The article also presents the results of a study examining the relationships between COVID-19 demands (e.g., lack of personal protective equipment, concerns about infecting family members), resources (meaningful work, social support), and mental health strain within a sample of emergency medicine personnel over six consecutive weeks. COVID-19-related demands and hours worked were hypothesized to be positively related to mental health strain, whereas meaningful work and social support were hypothesized to be negatively related to mental health strain. Hours worked the prior week were hypothesized to exacerbate the positive relationships between COVID-19 demands and mental health strain, whereas the resources of meaningful work and social support were expected to buffer the relationships. Multilevel models controlling for mental health strain the prior week revealed that COVID-19 demands, along with hours worked, were each related to higher mental health strain during the week. Hours worked magnified the within-person relationship between personal COVID-19 demands and mental health strain. In contrast to the hypotheses, social support and meaningful work were not related to mental health strain. Discussion focuses on the implications of the findings for healthcare professionals.

Savouring as a moderator of the combat exposure-mental health symptoms relationship.

Engaging in firefights or witnessing death and other types of combat experiences are occupational hazards associated with Post Traumatic Stress Disorder (PTSD) and depression in military personnel returning from combat deployments. The present study examined savouring beliefs as a moderator of the relationship between combat exposure and mental health symptoms among U.S. Army soldiers deployed to Operation Iraqi Freedom and Operation Enduring Freedom. Soldiers (N = 885) completed measures of combat exposure, savouring beliefs, PTSD, and depression. Savouring was negatively related to symptoms of PTSD and depression and moderated the relationship between combat exposure and PTSD and depression among military personnel. These findings demonstrate that savouring positive life experiences may be beneficial to overall positive mental health and potentially buffer negative mental health symptoms related to traumatic experiences. Discussion focuses on the possibility of training individuals exposed to trauma in savouring techniques.

Interactive Tools for Measuring Visual Scanning Performance and Reaction Time.

Occupational therapists are constantly searching for engaging, high-technology interactive tasks that provide immediate feedback to evaluate and train clients with visual scanning deficits. This study examined the relationship between two tools: the VISION COACH™ interactive light board and the Functional Object Detection© (FOD) Advanced driving simulator scenario. Fifty-four healthy drivers, ages 21-66 yr, were divided into three age groups. Participants performed braking response and visual target (E) detection tasks of the FOD Advanced driving scenario, followed by two sets of three trials using the VISION COACH Full Field 60 task. Results showed no significant effect of age on FOD Advanced performance but a significant effect of age on VISION COACH performance. Correlations showed that participants' performance on both braking and E detection tasks were significantly positively correlated with performance on the VISION COACH (.37 < r < .40, p < .01). These tools provide new options for therapists.

Observers' Judgments of the Effects of Glare on Their Visual Acuity for High and Low Contrast Stimuli.

Disability glare refers to a reduction in the ability to discern a stimulus that is positioned near another stimulus that has a much higher luminance. While it is common for drivers to report that they have been "blinded" by oncoming headlights, it is unclear whether observers can accurately judge when they are visually disabled by glare. This experiment sought to quantify the accuracy with which observers can judge when a glare source reduces their visual acuity. Seventeen observers estimated their disability glare threshold (DGT)-the luminance of a glare source that would be just sufficient to impair their ability to discern the orientation of a Landolt C that was surrounded by the glare source. These estimated DGTs were compared to the participant's actual DGTs. Participants consistently underestimated the intensity of glare that was required to impair their acuity. On average, estimates of glare threshold were 88% lower than actual glare threshold intensities. Participants' judgments were affected by stimulus size but not stimulus contrast. These results suggest that observers can exaggerate the debilitating effects of glare and that they can fail to appreciate that high contrast stimuli are more robust to glare. A driver who believes that even the lowest intensities of headlight glare can visually impair an oncoming driver may be reluctant to use high beam headlamps, despite their significant visibility advantages.

Drivers' judgments of the effect of headlight glare on their ability to see pedestrians at night.

INTRODUCTION: Several studies have concluded that pedestrians typically overestimate their own conspicuity to approaching drivers at night. The present experiments extended this research by exploring the accuracy of drivers' judgments of pedestrian conspicuity while facing varying degrees of headlight glare. METHOD: In Experiment 1, participants on an open road estimated their ability to see a roadside pedestrian in each of two clothing configurations and with each of three different glare intensities present. In Experiment 2, participants responded to a roadside pedestrian under the same open road conditions; the participants were naïve with regard to both the position of the pedestrian and to the clothing and glare manipulations. RESULTS: Consistent with earlier research, estimates of response distance were, on the average, over three times greater than actual recognition distance. The extent to which participants overestimated conspicuity was greater when the pedestrian wore a retroreflective vest, and participants incorrectly judged that headlight glare would not degrade drivers' ability to see a pedestrian wearing a retroreflective vest. CONCLUSIONS AND PRACTICAL APPLICATIONS: These results confirm that road users' understanding of issues involving drivers' night vision is limited. These misunderstandings may result in road users behaving in ways that increase the risk of nighttime collisions with pedestrians.

An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital.

OBJECTIVE: This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table. BACKGROUND: This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand. METHODS: The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. RESULTS: Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand. CONCLUSIONS: Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized.

The reliability of a VISION COACH task as a measure of psychomotor skills.

The VISION COACH™ interactive light board is designed to test and enhance participants' psychomotor skills. The primary goal of this study was to examine the test-retest reliability of the Full Field 120 VISION COACH task. One hundred eleven male and 131 female adult participants completed six trials where they responded to 120 randomly distributed lights displayed on the VISION COACH interactive light board. The mean time required for a participant to complete a trial was 101 seconds. Intraclass correlation coefficients, ranging from 0.962 to 0.987 suggest the VISION COACH Full Field 120 task was a reliable task. Cohen's d's of adjacent pairs of trials suggest learning effects did not negatively affect reliability after the third trial.

Evaluation of four steering wheels to determine driver hand placement in a static environment.

While much research exists on occupant packaging both proprietary and in the literature, more detailed research regarding user preferences for subjective ratings of steering wheel designs is sparse in published literature. This study aimed to explore the driver interactions with production steering wheels in four vehicles by using anthropometric data, driver hand placement, and driver grip design preferences for Generation-Y and Baby Boomers. In this study, participants selected their preferred grip diameter, responded to a series of questions about the steering wheel grip as they sat in four vehicles, and rank ordered their preferred grip design. Thirty-two male participants (16 Baby Boomers between ages 47 and 65 and 16 Generation-Y between ages 18 and 29) participated in the study. Drivers demonstrated different gripping behavior between vehicles and between groups. Recommendations for future work in steering wheel grip design and naturalistic driver hand positioning are discussed.

Managing heteroscedasticity in general linear models.

Heteroscedasticity refers to a phenomenon where data violate a statistical assumption. This assumption is known as homoscedasticity. When the homoscedasticity assumption is violated, this can lead to increased Type I error rates or decreased statistical power. Because this can adversely affect substantive conclusions, the failure to detect and manage heteroscedasticity could have serious implications for theory, research, and practice. In addition, heteroscedasticity is not uncommon in the behavioral and social sciences. Thus, in the current article, we synthesize extant literature in applied psychology, econometrics, quantitative psychology, and statistics, and we offer recommendations for researchers and practitioners regarding available procedures for detecting heteroscedasticity and mitigating its effects. In addition to discussing the strengths and weaknesses of various procedures and comparing them in terms of existing simulation results, we describe a 3-step data-analytic process for detecting and managing heteroscedasticity: (a) fitting a model based on theory and saving residuals, (b) the analysis of residuals, and (c) statistical inferences (e.g., hypothesis tests and confidence intervals) involving parameter estimates. We also demonstrate this data-analytic process using an illustrative example. Overall, detecting violations of the homoscedasticity assumption and mitigating its biasing effects can strengthen the validity of inferences from behavioral and social science data.

Respiratory sinus arrhythmia as a measure of cognitive workload.

The current standard for measuring cognitive workload is the NASA Task-load Index (TLX) questionnaire. Although this measure has a high degree of reliability, diagnosticity, and sensitivity, a reliable physiological measure of cognitive workload could provide a non-invasive, objective measure of workload that could be tracked in real or near real-time without interrupting the task. This study investigated changes in respiratory sinus arrhythmia (RSA) during seven different sub-sections of a proposed selection test for Navy aviation and compared them to changes reported on the NASA-TLX. 201 healthy participants performed the seven tasks of the Navy's Performance Based Measure. RSA was measured during each task and the NASA-TLX was administered after each task. Multi-level modeling revealed that RSA significantly predicted NASA-TLX scores. A moderate within-subject correlation was also found between RSA and NASA TLX scores. The findings support the potential development of RSA as a real-time measure of cognitive workload.

Developing a driving simulator based functional object detection task.

The purpose of this study was to validate a driving simulator-based tool for assessing functional visual scanning while driving (Goodenough, 2010) by replicating a previous study and assessing whether the results of the task are moderated by strategic decisions regarding task prioritization. Participants completed a functional object detection task that includes a peripheral target detection task and a central braking response task. Results indicated that the simulator task can identify differences in older and younger participants' abilities to functionally scan the driving environment and these differences appear unaffected by prioritizing either the scanning or braking task. Implications are discussed.