Feasibility of residential air quality monitoring to address asthma outcomes.

Improving asthma outcomes for underserved populations can be addressed through interventions to improve indoor air quality (IAQ). New protocol for measuring IAQ and health outcomes are imperative given advances in IAQ monitoring technology and challenges in conducting intervention research in homes. In this pilot study HEPA air purifiers and HEPA vacuum cleaners were provided to five homes with children with asthma. For 6 weeks, eight common components of air quality were measured using a low-cost multi-channel air quality monitoring device, with data conveyed directly from participant homes via Wi-Fi connection. In conjunction with periodic surveys on asthma control, impact of asthma on quality of life and intervention compliance, outcomes compared IAQ, home characteristics, and asthma-related measures. This pilot study demonstrates the feasibility of a protocol to evaluate a dual component intervention to improve IAQ in homes, as measured with a low-cost air quality monitoring device.

Novel Skin Prep Technique Reduces OR Preparation Times in a Randomized Trial for Podiatric and Orthopedic Procedures.

The primary objectives of any high-volume surgery department should be patient safety, block time utilization and operating room efficiency. Reducing preparation time in the OR prior to actual surgery can improve operating room efficiency and utilization, but only if patient safety can be maintained. With this goal, this study evaluated a novel skin preparation technique using a device named ULTRAPREP™, a sterile, medical-grade plastic bag that is applied to the upper or lower extremity in the pre-operative holding area which allows for skin disinfection outside the OR (referred to as "disinfection bag"). The study compared preparation times required in the OR and antiseptic efficiency (through Colony Forming Units (CFU) counts) for traditional methods versus using the disinfection bag on a total of 115 patients undergoing podiatric or orthopedic surgeries (upper and lower extremities) in one hospital. The disinfection bag reduced skin preparation time in the OR from 16.8±3.5min to 10.9±2.7min, which was a 35.2% reduction, and was statistically significant (p<0.01). Skin antisepsis met safety standards of <15 CFUs for all cases regardless of preparation type at 48h and 72h. There was no statistical difference in CFU levels between the traditional and disinfection bag methods at 48h or 72h (p>0.11). Therefore, ULTRAPREP™ has shown the ability to decrease operating room time while keeping surgical site infection rates to a minimum. Minimizing activities in the OR optimizes use of this costly resource and brings overall savings to the surgery department.

Resource evaluation framework for total knee arthroplasty.

PURPOSE: This article describes a framework for evaluating efficiency of OR procedures incorporating time measurement, personnel activity, and resource utilization using traditional industrial engineering tools of time study and work sampling. METHODS: The framework measures time using time studies of OR procedures and work sampling of personnel activities, ultimately classified as value-added or non-value-added. Statistical methods ensure that the collected samples meet adequate levels of confidence and accuracy. Resource utilization is captured through documentation of instrument trays used, defects in instruments, and trash weight and classification at the conclusion of surgeries. FINDINGS: A case study comprising 12 observations of total knee arthroplasty surgeries illustrates the use of the framework. The framework allows researchers to compare time, personnel, and resource utilization simultaneously within the OR setting. PRACTICAL IMPLICATIONS: The framework provides a holistic evaluation of methods, instrumentation and resources, and staffing levels and allows researchers to identify areas for efficiency improvement. ORIGINALITY/VALUE: The methods presented in this article are rooted in traditional industrial engineering work measurement methods but are applied to a healthcare setting in order to efficiently identify areas for improvement including time, personnel, and processes in operating rooms.

Community Paramedics' Perception of Frequent ED Users and the Community Paramedicine Program: A Mixed-Methods Study.

Community paramedicine (CP) model of care integrates existing emergency medical service (EMS) resources with primary care, public health, social services and community engagement. However, published studies about CP programs in the U.S. are sparse. To understand how paramedics perceive CP programs and patients in the program, we surveyed and interviewed 16 community paramedics (10 men and 6 women) who are currently delivering health care within a CP program. Our analyses highlighted that community paramedics: (1) defined CP patients in sympathetic terms; (2) reported patient and systemic factors contributing to ED overuse; and (3) expressed their frustrations and commendations for CP programs. Several suggestions were identified to improve CP program (all modifiable elements). Further, the frustrations expressed by paramedics highlight the barriers to health care access for underserved communities. We discuss the implications of this research for practice and recommend future qualitative studies on longer operating CP programs.

Effects of exoskeleton use on movement kinematics during performance of common work tasks: A case study.

BACKGROUND: An exoskeleton may assist performance of basic work-related tasks. Its application should not alter user kinematics, which compromise user safety. OBJECTIVE: This case study was used to assess whether people wearing a lower-body K-SRDTM exoskeleton could complete common work tasks without altering kinematics that may increase injury risk. METHODS: Three males performed three tasks: kneeling and standing (kneel), lifting and lowering a weighted box floor-to-waist (lift), and stair-climbing with a weighted box (climb), all repeated with and without exoskeleton use (EXO, NONE). RESULTS: Kinematics with EXO often mimicked NONE. Hip and knee flexion with EXO often exceeded NONE without increasing heart rate for kneel. During lift with EXO, participants avoided greater lateral trunk flexion associated with injuries and used the preferred semi-squat technique. Participants produced more foot clearance with EXO than NONE during climb. Other outcomes of heart rate, perceived exertion, fatigue, and usability were mixed. CONCLUSIONS: EXO augmentation does not need to alter movement kinematics during performances of kneel, lift, and climb tasks. EXO kinematic alterations did not appear to compromise user safety in terms of lateral trunk bending. It may encourage good technique, such as greater foot clearance to avoid tripping, for some tasks, and changes in lifting strategies to avoid extreme flexion and protect passive tissues.

Drivers׳ merging behavior data in highway work zones.

There have been growing research interests in finding a suitable work zone layout to improve work zone safety and traffic efficiency. This paper contains data supporting the research article entitled: Effects of work zone configurations and traffic density on performance variables and subjective workload (Shakouri et al., 2014 [1]). A full factorial experiment was conducted to compare the efficiency of two work zone configurations by using a driving simulator with two levels of work zone configuration, two levels of traffic density and three levels of sign placement as fixed factors. Seven female and 23 male participants completed the experiment. In this paper we present the data relating to demographic information of participants, driving simulator data and subjective workload evaluation of participants for each work zone.

Effects of work zone configurations and traffic density on performance variables and subjective workload.

This paper investigates the effect of changing work zone configurations and traffic density on performance variables and subjective workload. Data regarding travel time, average speed, maximum percent braking force and location of lane changes were collected by using a full size driving simulator. The NASA-TLX was used to measure self-reported workload ratings during the driving task. Conventional lane merge (CLM) and joint lane merge (JLM) were modeled in a driving simulator, and thirty participants (seven female and 23 male), navigated through the two configurations with two levels of traffic density. The mean maximum braking forces was 34% lower in the JLM configuration, and drivers going through the JLM configuration remained in the closed lane longer. However, no significant differences in speed were found between the two merge configurations. The analysis of self-reported workload ratings show that participants reported 15.3% lower total workload when driving through the JLM. In conclusion, the implemented changes in the JLM make it a more favorable merge configuration in both high and low traffic densities in terms of optimizing traffic flow by increasing the time and distance cars use both lanes, and in terms of improving safety due to lower braking forces and lower reported workload.

Making safety an integral part of 5S in healthcare.

BACKGROUND: Healthcare faces major challenges with provider safety and rising costs, and many organizations are using Lean to instigate change. One Lean tool, 5S, is becoming popular for improving efficiency of physical work environments, and it can also improve safety. OBJECTIVE: This paper demonstrates that safety is an integral part of 5S by examining five specific 5S events in acute care facilities. We provide two arguments for how safety is linked to 5S:1. Safety is affected by 5S events, regardless of whether safety is a specific goal and 2. Safety can and should permeate all five S's as part of a comprehensive plan for system improvement. METHODS: Reports of 5S events from five departments in one health system were used to evaluate how changes made at each step of the 5S impacted safety. RESULTS: Safety was affected positively in each step of the 5S through initial safety goals and side effects of other changes. CONCLUSIONS: The case studies show that 5S can be a mechanism for improving safety. Practitioners may reap additional safety benefits by incorporating safety into 5S events through a safety analysis before the 5S, safety goals and considerations during the 5S, and follow-up safety analysis.

Handwheel valve operation: assessment of four opening methods in terms of muscle loading, perceived comfort, and efficiency.

Injuries due to manual valve handwheel operations are a major concern in the chemical process industry. Manual valves are used to start, stop, and control flow in process lines. The torque required to operate handwheels after the initial "breaking" can vary due to the size, design, and condition of the valve. This study tested four methods of turning the handwheel on a medium-sized gate valve at two different torque requirements (25 Nm and 50 Nm). The methods were compared to each other, in terms of efficiency, subjective ratings of perceived exertion, and electromyography activity of the upper extremity and trunk muscles. The results indicate that different methods and torque requirements are compensated for by the use of different muscles. Also, this use of different muscles, along with the increased mechanical advantage of the wrench, can affect the operator's actual and perceived comfort and efficiency while operating a valve handwheel.

Neck disorders among construction workers: understanding the physical loads on the cervical spine during static lifting tasks.

In this study a common yet very strenuous construction work activity, was evaluated biomechanically by studying electromyography (EMG) of the major neck muscles. The muscles studied were the sternocleidomastoid and the upper trapezius. Fifteen healthy participants (10 males and 5 females) with no history of musculoskeletal abnormalities participated in this study. The participants lifted 25%, 50%, and 75% of their maximum shoulder height static strength at neutral, maximally flexed, and maximally extended neck postures. The weight lifted as well as the neck posture significantly affected the activities of the neck muscles. Increase in the weight increased the activation of the neck muscles. The sternocleidomastoid muscle was most active at the extended neck posture, while the upper trapezius muscle was most active at the flexed neck posture. The results of this study indicate that the neck muscles play an active role during lifting and holding tasks at shoulder height. Thus, such tasks could be probable risk factors associated with neck disorders prevalent among construction workers.

Experimental manipulation of psychosocial exposure and questionnaire sensitivity in a simulated manufacturing setting.

PURPOSE: The objectives of this study were to determine the efficacy of experimental manipulations of psychosocial exposures and to evaluate the sensitivity of a psychosocial questionnaire by determining the factors perceived. METHODS: A 50-item questionnaire was developed from the job content questionnaire (JCQ) and the quality of worklife survey (QWL). The experiment involved simulated work at different physical and psychosocial levels. Forty-eight participants were exposed to two levels of one psychosocial manipulation (job control, job demands, social support, or time pressure). RESULTS: Significantly different questionnaire responses supported the effectiveness of psychosocial manipulations. Exploratory factor analysis revealed five factors: skill discretion and decision authority, stress level and supervisor support, physical demands, quality of coworker support, and decision-making support. CONCLUSIONS: These results suggest that psychosocial factors can be manipulated experimentally, and that questionnaires can distinguish perceptions of these factors. These questionnaires may be used to assess perceptions of psychosocial factors in experimental settings.