Using a human-centered design approach for collaborative decision-making in pediatric asthma care.

OBJECTIVES: Human-centered design (HCD) is a qualitative methodology that empathizes with end-users and assists in formulating preferable and practical interventions. We explored the utility of HCD in improving pediatric asthma healthcare outcomes among patient and caregiver populations within an urban academic center. STUDY DESIGN: HCD employs a multiphase process that aims to identify the needs of end users and reframe solutions around each stakeholder's preference patterns. METHODS: Ethnographic-style observations were initiated among pediatric asthma healthcare providers, community environmental activists, local government public health officials, households with a young child (<12 years of age) with asthma, and adolescent asthmatics. Common themes from the observations served as the basis for understanding users' experiences and determining actionable areas of improvement within outpatient asthma care. Multistakeholder brainstorming sessions led to the emergence of three prototypes that underwent low-fidelity field testing. RESULTS: The first prototype elucidated caregivers' preferred outpatient asthma support systems using a newly created visual decision-making aid. The second constructed prototype was a child-oriented asthma activity sheet that allowed children to better communicate their understanding and impact of asthma care. The final prototype attempted to improve interactions between providers, caregivers, and children/adolescents using visual prompts to enhance empathetic and clinically-relevant dialogue. CONCLUSION: Engaging a diverse population of relevant stakeholders in disease processes that use design thinking yield relevant solutions with enhanced community buy-in. The prototypes are continuing to undergo iterative field testing in local community and academic asthma care sites.

Correlation of ambient pollution levels and heavily-trafficked roadway proximity on the prevalence of smear-positive tuberculosis.

OBJECTIVES: Varying levels of evidence exist for the contribution of indoor air pollution and environmental tobacco smoke as a risk factor for tuberculosis (TB). Despite a similar mechanism of action, the influence of outdoor air pollution exposure as an independent contributor to TB disease has yet to be explored. This area of inquiry is of increasing importance given the level of pollution in the rising economies of many TB-endemic nations. Los Angeles' unique physical environs and traffic patterns mirror other global megacities with a greater burden of TB therefore allowing for preliminary correlative studies. This preliminary study hypothesizes that individuals who reside proximal to elevated pollutant exposures are likely to have a greater burden of disease--as evidenced by sputum smear-positive TB. STUDY DESIGN: Retrospective medical records review. METHODS: Medical records of non-homeless individuals (n = 196) diagnosed with culture positive TB at Los Angeles County and University of Southern California Medical Center Hospital were analyzed from January 2007 to December 2008. The study population was grouped according to acid-fast bacilli (AFB) smear-positive (n = 111) and smear-negative (n = 85) status. Air pollutant exposure was captured using measurements of ozone (O3) and particulate matter with an aerodynamic diameter of less than 2.5 (PM2.5). Individual assignment to O3 and PM2.5 exposures were based on residential proximity to the nearest US Environmental Protection Agency's monitoring station. Proximity of home residences to traffic-related pollutants occurred by measurement of distance to the nearest freeway and major non-freeway road. RESULTS: Single factorial models yielded a significant correlation of smear-positive status and residential exposure to PM2.5. Residential distance to freeways and major arterial roads did not yield an association. CONCLUSIONS: This is the first report linking ambient pollution exposure as a risk factor for TB. PM2.5 may have the potential to impact TB lung pathology as evidenced by the linkage of fine particulate matter levels and smear-positive TB.

Observations on the pollical palmar interosseous muscle (of Henle).

Questions about the existence of a "pollical" (first) volar interosseous muscle have persisted since its description by Henle in 1858. A survey of current human anatomy texts and atlases reveals that the majority do not recognize a pollical volar interosseous muscle and therefore they identify only three palmar interossei. We examined the thumbs of 20 individuals of African and European origin in the human anatomy lab at University of the Witwatersrand (Johannesburg) and 15 individuals of European ancestry in the anatomy lab at the University at Stony Brook (New York). A pollical palmar interosseous muscle (PPIM) was found in 86% of individuals (17/20 of the Witwatersrand sample; 13/15 of the Stony Brook sample). Here, we offer a definition of the PPIM in an attempt to resolve the long-standing question of its existence and its relationship to the adductor pollicis obliquus and the deep head of flexor pollicis brevis. We suggest that the human hand usually possesses four palmar interossei as well as four dorsal interossei.