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Saurin TA, Patriarca R, Hegde S, Rayo M. The influence of digital technologies on resilient performance: Contributions, drawbacks, and a research agenda. Appl Ergon 2024; 118:104290. [PMID: 38657384 DOI: 10.1016/j.apergo.2024.104290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/22/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
The growing use of digital technologies (DTs) has a myriad of implications to socio-technical systems, which are not yet fully recognised. This paper investigates the contributions and drawbacks of DTs to resilient performance (RP), an aspect that so far has received less attention in comparison to others such as efficiency. To this end, a survey questionnaire was applied to 79 academics and practitioners linked to resilience engineering. Data analysis involved descriptive statistics and a thematic analysis of the open-text responses to the survey. Mixed impacts were identified, with 10 themes related to contributions and 16 to drawbacks. Regarding the contributions, the results highlighted the use of DTs for monitoring and anticipating system performance. Machine learning seems to be the most promising approach for this purpose. A key drawback is the need for developing new skills across the workforce so that they can make sense of the outputs of DTs and are aware of their strengths and weaknesses. The human role is expected to remain crucial for RP, which makes the current coordination difficulties with DTs even more important to address. A research agenda composed of five topics is proposed, encompassing description, prescription, and assessment. The agenda emphasizes the need for mapping the attributes or functionalities of DTs onto resilience concepts, models, and frameworks.
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Affiliation(s)
- Tarcisio Abreu Saurin
- Industrial Engineering Post-Graduate Program, Universidade Federal Do Rio Grande Do Sul, Av. Osvaldo Aranha, 99, Porto Alegre, RS, CEP 90035-190, Brazil.
| | - Riccardo Patriarca
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Via Eudossiana 18, 00184, Rome, Italy.
| | - Sudeep Hegde
- Industrial Engineering, College of Engineering, Computing, and Applied Sciences, Clemson University, 272 Freeman Hall, Clemson, SC, 29634, United States.
| | - Mike Rayo
- Integrated Systems Engineering, The Ohio State University, Ker System Building 1971, Neil Ave Room 210, Columbus, United States.
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Segarra GC, Catchpole K, Rayo MF, Hegde S, Jefferies C, Woodward J, Taaffe K. Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools. Appl Ergon 2024; 119:104307. [PMID: 38735234 DOI: 10.1016/j.apergo.2024.104307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 101 Toolkit, which helps model how health-related outcomes are affected by healthcare work systems. Through observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, revealing complex interdependencies between the people, tools, and tasks occurring within it. The SPD, OR and Courier teams are found to have overlapping responsibilities and a clear co-dependence, with critical implications for the successful functioning of the whole hospital system.
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Affiliation(s)
- Gabriel C Segarra
- Medical University of South Carolina, Charleston, SC, United States.
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | | | - Jeffrey Woodward
- Medical University of South Carolina, Charleston, SC, United States
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Hegde S, Larsen E, Torbett O, Ponnala S, Pohl E, Sze R, Schaeubinger MM. A proactive learning approach toward building adaptive capacity during COVID-19: A radiology case study. Appl Ergon 2023; 110:104009. [PMID: 36905728 PMCID: PMC9986132 DOI: 10.1016/j.apergo.2023.104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has challenged organizations to adapt under uncertainty and time pressure, with no pre-existing protocols or guidelines available. For organizations to learn to adapt effectively, there is a need to understand the perspectives of the frontline workforce involved in everyday operations. This study implemented a survey-tool to elicit narratives of successful adaptation based on the lived experiences frontline radiology staff at a large multispecialty pediatric hospital. Fifty-eight members of the radiology frontline staff responded to the tool between July and October of 2020. Qualitative analysis of the free-text data revealed five categories of themes that underpinned adaptive capacity of the radiology department during the pandemic: information flow, attitudes and initiative, new and adjusted workflows, availability and utilization of resources, and collaboration and teamwork. Enablers of adaptive capacity included timely and clear communication about procedures and policies from the leadership to frontline staff, and revised workflows with flexible work arrangements, such as remote patient screening. Responses to multiple choice questions in the tool helped identify the main categories of challenges faced by staff, factors that enabled successful adaptation, and resources used. The study demonstrates the use of a survey-tool to proactively identify frontline adaptations. The paper also reports a system-wide intervention resulting directly from a discovery enabled by the findings based on the use of RETIPS in the radiology department. In general, the tool could be used in concert with existing learning mechanisms, such as safety event reporting systems, to inform leadership-level decisions to support adaptive capacity.
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Affiliation(s)
| | | | | | | | - Erin Pohl
- Children's Hospital of Philadelphia, USA
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Marriott AE, Dagley JL, Hegde S, Steven A, Fricks C, DiCosty U, Mansour A, Campbell EJ, Wilson CM, Gusovsky F, Ward SA, Hong WD, O'Neill P, Moorhead A, McCall S, McCall JW, Taylor MJ, Turner JD. Dirofilariasis mouse models for heartworm preclinical research. Front Microbiol 2023; 14:1208301. [PMID: 37426014 PMCID: PMC10324412 DOI: 10.3389/fmicb.2023.1208301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Dirofilariasis, including heartworm disease, is a major emergent veterinary parasitic infection and a human zoonosis. Currently, experimental infections of cats and dogs are used in veterinary heartworm preclinical drug research. Methods As a refined alternative in vivo heartworm preventative drug screen, we assessed lymphopenic mouse strains with ablation of the interleukin-2/7 common gamma chain (γc) as susceptible to the larval development phase of Dirofilaria immitis. Results Non-obese diabetic (NOD) severe combined immunodeficiency (SCID)γc-/- (NSG and NXG) and recombination-activating gene (RAG)2-/-γc-/- mouse strains yielded viable D. immitis larvae at 2-4 weeks post-infection, including the use of different batches of D. immitis infectious larvae, different D. immitis isolates, and at different laboratories. Mice did not display any clinical signs associated with infection for up to 4 weeks. Developing larvae were found in subcutaneous and muscle fascia tissues, which is the natural site of this stage of heartworm in dogs. Compared with in vitro-propagated larvae at day 14, in vivo-derived larvae had completed the L4 molt, were significantly larger, and contained expanded Wolbachia endobacteria titres. We established an ex vivo L4 paralytic screening system whereby assays with moxidectin or levamisole highlighted discrepancies in relative drug sensitivities in comparison with in vitro-reared L4 D. immitis. We demonstrated effective depletion of Wolbachia by 70%-90% in D. immitis L4 following 2- to 7-day oral in vivo exposures of NSG- or NXG-infected mice with doxycycline or the rapid-acting investigational drug, AWZ1066S. We validated NSG and NXG D. immitis mouse models as a filaricide screen by in vivo treatments with single injections of moxidectin, which mediated a 60%-88% reduction in L4 larvae at 14-28 days. Discussion Future adoption of these mouse models will benefit end-user laboratories conducting research and development of novel heartworm preventatives via increased access, rapid turnaround, and reduced costs and may simultaneously decrease the need for experimental cat or dog use.
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Affiliation(s)
- A. E. Marriott
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - J. L. Dagley
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - S. Hegde
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - A. Steven
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - C. Fricks
- TRS Laboratories Inc, Athens, GA, United States
| | - U. DiCosty
- TRS Laboratories Inc, Athens, GA, United States
| | - A. Mansour
- TRS Laboratories Inc, Athens, GA, United States
| | - E. J. Campbell
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - C. M. Wilson
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - F. Gusovsky
- Eisai Global Health, Cambridge, MA, United States
| | - S. A. Ward
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - W. D. Hong
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - P. O'Neill
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - A. Moorhead
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - S. McCall
- TRS Laboratories Inc, Athens, GA, United States
| | - J. W. McCall
- TRS Laboratories Inc, Athens, GA, United States
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - M. J. Taylor
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - J. D. Turner
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Son C, Hegde S, Markert C, Zahed K, Sasangohar F. Use of a Mobile Biofeedback Application to Provide Health Coaching for Stress Self-Management: Findings from a Pilot Quasi-Experiment. JMIR Form Res 2023; 7:e41018. [PMID: 36952560 PMCID: PMC10131670 DOI: 10.2196/41018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Mental health is an increasing concern among vulnerable populations, including college students and veterans. OBJECTIVE The purpose of this study was to determine if mobile Health (mHealth) technology combined with health coaching can better enable user to self-manage their mental health. METHODS This study evaluated a mobile Biofeedback app that provided health coaching on stress self-management for college student veterans' mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives using the Biofeedback app and smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at two-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile Biofeedback app. RESULTS Deep breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants' heart rate during the 6-minute time period immediately after conducting the breathing exercises [Spearman's rank correlation coefficient of -0.61 (P<.001 and S=9,816,176)]. There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicate that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. CONCLUSIONS Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. CLINICALTRIAL
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Affiliation(s)
- Changwon Son
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
- Texas Tech University, Lubbock, US
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
- Clemson University, Clemson, US
| | - Carl Markert
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
| | - Karim Zahed
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
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Foster SA, Hegde S, O'Brien TC, Tucker EL. Organizational Adaptive Capacity during a Large-Scale Surprise Event: A Case Study at an Academic Institution during the COVID-19 Pandemic. IISE Trans Occup Ergon Hum Factors 2023; 11:32-47. [PMID: 37353995 DOI: 10.1080/24725838.2023.2221045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023]
Abstract
OCCUPATIONAL APPLICATIONSThe COVID-19 pandemic caused large organizations and institutions to adapt their decision-making procedures and hierarchical structures to address pandemic-specific concerns. By examining a large public university, we found that effective adaptation occurred through restructuring the decision-making processes, coordinating decisions between departments, and effective monitoring of prior decisions. When considering the COVID-19 pandemic as a fundamental surprise event, our work identified strategies and decision-making that both maintained and increased adaptive capacity through the course of such an event. Through this case study, we highlight decisions that can be made by similar large organizations, to increase adaptive capacity when they are faced with similar surprise events.
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Affiliation(s)
- Steven A Foster
- Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Sudeep Hegde
- Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Tyler C O'Brien
- Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Emily L Tucker
- Industrial Engineering, Clemson University, Clemson, SC, USA
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Marron T, Maier B, LaMarche N, Hegde S, Belabed M, Mattiuz R, Hennequin C, LeBerichel J, Park M, Hall N, Ogrady D, Fitzgerald B, Gomez J, Doroshow D, Veluswamy R, Rolfo C, Smith C, Rohs N, Yankelevitz D, Chaddha U, Harkin T, Beasley M, Hirsch F, Merad M. P2.12-05 Cancer and Atopy: Parallel Drivers? IL-4 Blockade Synergizes with PD-L1 Blockade to Reverse Type-2Mediated Immunosuppression. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sadeghi M, Sasangohar F, McDonald AD, Hegde S. Understanding Heart Rate Reactions to Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Naturalistic Study. Hum Factors 2022; 64:173-187. [PMID: 34292055 DOI: 10.1177/00187208211034024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We collected naturalistic heart rate data from veterans diagnosed with post-traumatic stress disorder (PTSD) to investigate the effects of various factors on heart rate. BACKGROUND PTSD is prevalent among combat veterans in the United States. While a positive correlation between PTSD and heart rate has been documented, specific heart rate profiles during the onset of PTSD symptoms remain unknown. METHOD Veterans were recruited during five cycling events in 2017 and 2018 to record resting and activity-related heart rate data using a wrist-worn device. The device also logged self-reported PTSD hyperarousal events. Regression analyses were performed on demographic and behavioral covariates including gender, exercise, antidepressants, smoking habits, sleep habits, average heart rate during reported hyperarousal events, age, glucocorticoids consumption, and alcohol consumption. Heart rate patterns during self-reported PTSD hyperarousal events were analyzed using Auto Regressive Integrated Moving Average (ARIMA). Heart rate data were also compared to an open-access non-PTSD representative case. RESULTS Of 99 veterans with PTSD, 91 participants reported at least one hyperarousal event, with a total of 1023 events; demographic information was complete for 38 participants who formed the subset for regression analyses. The results show that factors including smoking, sleeping, gender, and medication significantly affect resting heart rate. Moreover, unique heart rate patterns associated with PTSD symptoms in terms of stationarity, autocorrelation, and fluctuation characteristics were identified. CONCLUSION Our findings show distinguishable heart rate patterns and characteristics during PTSD hyperarousal events. APPLICATION These findings show promise for future work to detect the onset of PTSD symptoms.
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Affiliation(s)
| | | | | | - Sudeep Hegde
- 265514736 Texas A&M University, College Station, USA
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Onkaramurthy M, Vishwakarma KK, Singh P, Hegde S, Azeemuddin MM, Rafiq M, Babu UV. Herbal Formulations Ameliorates Chronic Venous Insufficiency, Venotonicity and Elastase Inhibition in the Management of Varicose Veins: A Preclinical Study. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Bhardwaj P, Thattaruparambil VP, Vellaisamy G, Mahadevaiah S, Hegde S. Gastric teratoma presenting as melena in the newborn: A case report. J Neonatal Perinatal Med 2022; 15:667-669. [PMID: 35694937 DOI: 10.3233/npm-210931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Melena is reported in 1 of 350 to 400 new-borns. Significant upper gastrointestinal bleeding in a neonate with an antenatally diagnosed abdominal mass has not been reported before. This case highlights an unusual presentation of a gastric teratoma and proposes a probable embryological explanation for the site of occurrence.
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Affiliation(s)
- P Bhardwaj
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - V P Thattaruparambil
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - G Vellaisamy
- Department of Pathology, St. John's Medical College, Bengaluru, India
| | - S Mahadevaiah
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - S Hegde
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
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Shariff M, Doshi R, Pedreira Vaz I, Adalja D, Krishnan A, Hegde S, Kumar A. Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock.
Purpose
A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed.
Methods
The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence.
Results
Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP.
Conclusion
This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock.
30-days Mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Shariff
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| | - R Doshi
- University of Nevada, Internal Medicine, Reno, United States of America
| | - I Pedreira Vaz
- Jackson Memorial Hospital, Internal Medicine, Miami, United States of America
| | - D Adalja
- Gotri Medical Education and Research Centre, Internal Medicine, Vadodara, India
| | - A Krishnan
- JJM Medical College, Internal Medicine, Davangere, India
| | - S Hegde
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Cardiology, Mysore, India
| | - A Kumar
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
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Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. J Med Internet Res 2020; 22:e22817. [PMID: 32897868 PMCID: PMC7505693 DOI: 10.2196/22817] [Citation(s) in RCA: 553] [Impact Index Per Article: 138.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence suggests that the COVID-19 pandemic has generally increased levels of stress and depression among the public. However, the impact on college students in the United States has not been well-documented. OBJECTIVE This paper surveys the mental health status and severity of depression and anxiety of college students in a large university system in the United States during the COVID-19 pandemic. METHODS An online survey was conducted among undergraduate and graduate students recruited from Texas A&M University via email. The survey consisted of two standardized scales-the Patient Health Questionnaire-9 and the General Anxiety Disorder-7-for depression and anxiety, and additional multiple-choice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19. RESULTS Among the 2031 participants, 48.14% (n=960) showed a moderate-to-severe level of depression, 38.48% (n=775) showed a moderate-to-severe level of anxiety, and 18.04% (n=366) had suicidal thoughts. A majority of participants (n=1443, 71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (n=882, 43.25%) indicated that they were able to cope adequately with the stress related to the current situation. CONCLUSIONS The proportion of respondents showing depression, anxiety, and/or suicidal thoughts is alarming. Respondents reported academic-, health-, and lifestyle-related concerns caused by the pandemic. Given the unexpected length and severity of the outbreak, these concerns need to be further understood and addressed.
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Affiliation(s)
- Xiaomei Wang
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Sudeep Hegde
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Changwon Son
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Bruce Keller
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Alec Smith
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Farzan Sasangohar
- Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
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Son C, Hegde S, Smith A, Wang X, Sasangohar F. Effects of COVID-19 on College Students' Mental Health in the United States: Interview Survey Study. J Med Internet Res 2020; 22:e21279. [PMID: 32805704 PMCID: PMC7473764 DOI: 10.2196/21279] [Citation(s) in RCA: 896] [Impact Index Per Article: 224.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/01/2020] [Accepted: 08/15/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. OBJECTIVE Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students. METHODS We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods. RESULTS Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms. CONCLUSIONS Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students.
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Affiliation(s)
- Changwon Son
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Alec Smith
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Xiaomei Wang
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
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14
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Hegde S, Hettinger AZ, Fairbanks RJ, Wreathall J, Krevat SA, Jackson CD, Bisantz AM. Qualitative findings from a pilot stage implementation of a novel organizational learning tool toward operationalizing the Safety-II paradigm in health care. Appl Ergon 2020; 82:102913. [PMID: 31450045 DOI: 10.1016/j.apergo.2019.102913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
'Safety-II' is a new approach to safety, which emphasizes learning proactively about how safety and efficacy are achieved in everyday frontline work. Previous research developed a new lesson-sharing tool designed based on the Safety-II approach: Resilience Engineering Tool to Improve Patient Safety (RETIPS). The tool comprises questions designed to elicit narratives of adaptations that have contributed to effectiveness in care delivery. The purpose of this study is to revise and validate the design of RETIPS. The tool was revised based on feedback of clinicians at a large multi-specialty hospital, resulting in a version customized for anesthesia residents, RETIPS-AnRes. RETIPS-AnRes was administered on a pilot-basis to anesthesia resident groups for a limited period of time. A review of the reports obtained shows a strong alignment of responses with the conceptual basis of the tool, i.e. learning about how things go well in everyday work. The exemplars include both, specific instances of successful patient care, as well as generic routines that contribute to safe and/or effective care delivery. These findings support RETIPS as a tool to operationalize the Safety-II paradigm in healthcare. Lessons and implications for implementation on a wider scale are discussed.
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Affiliation(s)
- Sudeep Hegde
- University at Buffalo - State University of New York (SUNY), 12 Capen Hall, Buffalo, NY, 14260, USA.
| | - Aaron Z Hettinger
- MedStar Health, 10980 Grantchester Way, Columbia, MD, 21044, USA; Georgetown University School of Medicine, 3900 Reservoir Road, NW Washington, DC, 20057, USA
| | - Rollin J Fairbanks
- University at Buffalo - State University of New York (SUNY), 12 Capen Hall, Buffalo, NY, 14260, USA; MedStar Health, 10980 Grantchester Way, Columbia, MD, 21044, USA; Georgetown University School of Medicine, 3900 Reservoir Road, NW Washington, DC, 20057, USA
| | - John Wreathall
- John Wreathall & Co., 4157 Macduff Way, Dublin, OH, 43016, USA
| | - Seth A Krevat
- MedStar Health, 10980 Grantchester Way, Columbia, MD, 21044, USA; Georgetown University School of Medicine, 3900 Reservoir Road, NW Washington, DC, 20057, USA
| | - Cullen D Jackson
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02215, USA
| | - Ann M Bisantz
- University at Buffalo - State University of New York (SUNY), 12 Capen Hall, Buffalo, NY, 14260, USA
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15
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Misra U, TcR R, Kumaravelu S, Arjundas D, Wadia R, Nair R, Alurkar A, Pujarai S, Udhar M, Palasdeonkar N, Buddha S, Kumar S, Salvadeeswaran M, Deasai S, Pammidimukkala V, Sharma M, Kumar K, Percival G, Hegde S, Machhavada K. Indian registry in ischemic stroke- tenecteplase (IRIS- TNK)- An interim analysis. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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N V, Hegde S, Kamble N, Yadav R, Pal PK. Cognitive profile of Parkinson’s disease with and without deficits in motor speed. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Wang X, Kim TC, Hegde S, Hoffman DJ, Benda NC, Franklin ES, Lavergne D, Perry SJ, Fairbanks RJ, Hettinger AZ, Roth EM, Bisantz AM. Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine. Appl Clin Inform 2019; 10:693-706. [PMID: 31533171 PMCID: PMC6751068 DOI: 10.1055/s-0039-1695800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. OBJECTIVE This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. METHODS ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. RESULTS Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire-mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. CONCLUSION A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.
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Affiliation(s)
- Xiaomei Wang
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Tracy C. Kim
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Daniel J. Hoffman
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Natalie C. Benda
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Ella S. Franklin
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - David Lavergne
- Smart Information Flow Technologies, Minneapolis, Minnesota, United States
| | - Shawna J. Perry
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, United States
| | - Rollin J. Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - A. Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Emilie M. Roth
- Roth Cognitive Engineering, Stanford, California, United States
| | - Ann M. Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
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18
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Hegde S, Patodia A, Shah K, Dixit U. The applicability of the Demirjian, Willems and Chaillet standards to age estimation of 5-15 year old Indian children. J Forensic Odontostomatol 2019; 37:40-50. [PMID: 31187742 PMCID: PMC6875241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Demirjian's method of age estimation has been reported to overestimate age and Willems' method to give consistently more accurate results. Not enough, however, is known about the applicability of Chaillet's standards. AIM The present study aimed to compare the accuracy of Demirjian's, Willems' and Chaillet's standards in age estimation of 5 to 15 year-old Indian children. DESIGN In this cross-sectional observational study, three methods were compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years. RESULTS Demirjian's method overestimated age by +0.24 ± 0.80 years, +0.11 ± 0.81years and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80 years, +0.08 ± 0.80 years and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Chaillet's method underestimated age by -0.12 ± 0.69 years, -0.45 ± 0.88 years and -0.25 ± 0.83 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant sex-based differences were observed only with Demirjian's and Chaillet's methods (p < 0.05). CONCLUSION Willems' method was the most accurate in age estimation, followed by Demirjian's and Chaillet's methods. While Demirjian's method was more accurate than Chaillet's in females, Chaillet's method better predicted the age of males.
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Affiliation(s)
- S Hegde
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - A Patodia
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - K Shah
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - U Dixit
- Department of Pediatric and Preventive Dentistry, D. Y. Patil University- School of Dentistry, Navi Mumbai, Maharashtra, India
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19
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Cetinsaya B, Gromski MA, Lee S, Xia Z, Demirel D, Halic T, Bayrak C, Jackson C, De S, Hegde S, Cohen J, Sawhney M, Stavropoulos SN, Jones DB. A task and performance analysis of endoscopic submucosal dissection (ESD) surgery. Surg Endosc 2019; 33:592-606. [PMID: 30128824 PMCID: PMC6344246 DOI: 10.1007/s00464-018-6379-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/10/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries. METHODS We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons. RESULTS The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores. CONCLUSIONS We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
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Affiliation(s)
- Berk Cetinsaya
- Department of Computer Science, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - Mark A Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sangrock Lee
- Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Zhaohui Xia
- Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Doga Demirel
- Department of Computer Science, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - Tansel Halic
- Department of Computer Science, University of Central Arkansas, 201 Donaghey Ave, Conway, AR, 72035, USA.
| | - Coskun Bayrak
- Department of Computer Science & Information Systems, Youngstown State University, Youngstown, OH, USA
| | - Cullen Jackson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Suvranu De
- Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Sudeep Hegde
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonah Cohen
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mandeep Sawhney
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Daniel B Jones
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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20
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Nayak RC, Hegde S, Althoff MJ, Wellendorf AM, Mohmoud F, Perentesis J, Reina-Campos M, Reynaud D, Zheng Y, Diaz-Meco MT, Moscat J, Cancelas JA. The signaling axis atypical protein kinase C λ/ι-Satb2 mediates leukemic transformation of B-cell progenitors. Nat Commun 2019; 10:46. [PMID: 30610188 PMCID: PMC6320370 DOI: 10.1038/s41467-018-07846-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 11/21/2018] [Indexed: 01/01/2023] Open
Abstract
Epigenetically regulated transcriptional plasticity has been proposed as a mechanism of differentiation arrest and resistance to therapy. BCR-ABL leukemias result from leukemic stem cell/progenitor transformation and represent an opportunity to identify epigenetic progress contributing to lineage leukemogenesis. Primary human and murine BCR-ABL+ leukemic progenitors have increased activation of Cdc42 and the downstream atypical protein kinase C (aPKC). While the isoform aPKCζ behaves as a leukemic suppressor, aPKCλ/ι is critically required for oncogenic progenitor proliferation, survival, and B-cell differentiation arrest, but not for normal B-cell lineage differentiation. In vitro and in vivo B-cell transformation by BCR-ABL requires the downregulation of key genes in the B-cell differentiation program through an aPKC λ/ι-Erk dependent Etv5/Satb2 chromatin repressive signaling complex. Genetic or pharmacological targeting of aPKC impairs human oncogenic addicted leukemias. Therefore, the aPKCλ/ι-SATB2 signaling cascade is required for leukemic BCR-ABL+ B-cell progenitor transformation and is amenable to non-tyrosine kinase inhibition. The upstream pathways regulating leukemic transcriptional plasticity for differentiation arrest and resistance to therapy are unclear. Here the authors show that aPKC λ/ι-controls leukemic B-cell precursor differentiation arrest trough RAC/MEK/ERK/SATB2 epigenetic repression
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Affiliation(s)
- R C Nayak
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - S Hegde
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA
| | - M J Althoff
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA.,Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - A M Wellendorf
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - F Mohmoud
- Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - J Perentesis
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - M Reina-Campos
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - D Reynaud
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Y Zheng
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - M T Diaz-Meco
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - J Moscat
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - J A Cancelas
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA. .,Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
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21
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Hegde S, Bawa M, Mahajan JK, Rao KLN. Erb's palsy complicating a case of annular pancreas. J Neonatal Perinatal Med 2018; 11:97-99. [PMID: 29689736 DOI: 10.3233/npm-1816156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report an unusual presentation of annular pancreas with pneumoperitoneum in a newborn with an associated left sided Erb's palsy. The neurological deficit caused considerable confusion in the diagnosis and unexpected complications after surgery. We highlight the importance of clinical examination and the complications that an Erb's palsy can cause. This unusual triad of Erb's palsy, eventration of diaphragm and annular pancreas has hitherto not been described in literature.
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Affiliation(s)
- S Hegde
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - J K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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22
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Pathak G, Agostino MJ, Bishara K, Capell WR, Fisher JL, Hegde S, Ibrahim BA, Pilarzyk K, Sabin C, Tuczkewycz T, Wilson S, Kelly MP. PDE11A negatively regulates lithium responsivity. Mol Psychiatry 2017; 22:1714-1724. [PMID: 27646265 PMCID: PMC5359083 DOI: 10.1038/mp.2016.155] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 01/15/2023]
Abstract
Lithium responsivity in patients with bipolar disorder has been genetically associated with Phosphodiesterase 11A (PDE11A), and lithium decreases PDE11A mRNA in induced pluripotent stem cell-derived hippocampal neurons originating from lithium-responsive patients. PDE11 is an enzyme uniquely enriched in the hippocampus that breaks down cyclic AMP and cyclic GMP. Here we determined whether decreasing PDE11A expression is sufficient to increase lithium responsivity in mice. In dorsal hippocampus and ventral hippocampus (VHIPP), lithium-responsive C57BL/6J and 129S6/SvEvTac mice show decreased PDE11A4 protein expression relative to lithium-unresponsive BALB/cJ mice. In VHIPP, C57BL/6J mice also show differences in PDE11A4 compartmentalization relative to BALB/cJ mice. In contrast, neither PDE2A nor PDE10A expression differ among the strains. The compartment-specific differences in PDE11A4 protein expression are explained by a coding single-nucleotide polymorphism (SNP) at amino acid 499, which falls within the GAF-B homodimerization domain. Relative to the BALB/cJ 499T, the C57BL/6J 499A decreases PDE11A4 homodimerization, which removes PDE11A4 from the membrane. Consistent with the observation that lower PDE11A4 expression correlates with better lithium responsiveness, we found that Pde11a knockout mice (KO) given 0.4% lithium chow for 3+ weeks exhibit greater lithium responsivity relative to wild-type (WT) littermates in tail suspension, an antidepressant-predictive assay, and amphetamine hyperlocomotion, an anti-manic predictive assay. Reduced PDE11A4 expression may represent a lithium-sensitive pathophysiology, because both C57BL/6J and Pde11a KO mice show increased expression of the pro-inflammatory cytokine interleukin-6 (IL-6) relative to BALB/cJ and PDE11A WT mice, respectively. Our finding that PDE11A4 negatively regulates lithium responsivity in mice suggests that the PDE11A SNPs identified in patients may be functionally relevant.
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Affiliation(s)
- G Pathak
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - K Bishara
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - W R Capell
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - J L Fisher
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - S Hegde
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - B A Ibrahim
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - K Pilarzyk
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - C Sabin
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - S Wilson
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - M P Kelly
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
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23
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Roy A, Hegde S, Srinivas M. Sequelae of stroke a prospective study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Kalz L, Kalz-Füller B, Hegde S, Schwanitz G. Polymorphisms of Q-band Heterochromatin: Qualitative and Quantitative Analyses of Features in 3 Ethnic Groups (Europeans, Indians, and Turks). INT J HUM GENET 2017. [DOI: 10.1080/09723757.2005.11885919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- L. Kalz
- Institute for Human Genetics, Bonn, Germany
| | | | - S. Hegde
- Manipal Hospital, Bangalore, India
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25
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Clark LN, Benda NC, Hegde S, McGeorge NM, Guarrera-Schick TK, Hettinger AZ, LaVergne DT, Perry SJ, Wears RL, Fairbanks RJ, Bisantz AM. Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques. Appl Ergon 2017; 60:356-365. [PMID: 28166896 PMCID: PMC5377444 DOI: 10.1016/j.apergo.2016.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 12/19/2016] [Accepted: 12/23/2016] [Indexed: 06/06/2023]
Abstract
This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.
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Affiliation(s)
- Lindsey N Clark
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA
| | - Natalie C Benda
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Nicolette M McGeorge
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | | | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Emergency Medicine, Georgetown University School of Medicine, Washington D.C., USA
| | - David T LaVergne
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Shawna J Perry
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert L Wears
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA; Clinical Safety Research Unit, Imperial College London, London, UK
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA; Department of Emergency Medicine, Georgetown University School of Medicine, Washington D.C., USA
| | - Ann M Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA.
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Abstract
The Critical Incident Technique (CIT) and the Critical Decision Method (CDM) have been employed successfully to elicit information about human activities, explicate expert knowledge and model decision-making in various domains. Because of their proven efficacy in naturalistic settings, we adapted these methods to develop a script for interviews about resilience in health care. The multi-stage, semi-structured format of the CIT and CDM was adopted as a broad template for the script. However, new questions and probe-types for each stage were created which conformed to the theoretical framework of resilience engineering (RE). Hollnagel’s Resilience Analysis Grid (RAG) was used to derive a majority of the probes for each of the capabilities of a resilient organization – monitoring, anticipating, responding and learning. The interview script was iteratively revised based on responses to pilot interviews as well as feedback by human factors and RE experts. The final script was used to successfully interview physician and nurse-providers at various organizational levels and units.
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Affiliation(s)
- Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo-SUNY, Buffalo, NY
| | - A. Zach Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, Washington DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington DC
- Department of Emergency Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Rollin J. Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, Washington DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington DC
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington DC
| | | | - Robert L. Wears
- Department of Emergency Medicine, University of Florida, Jacksonville, FL
- Clinical Safety Research Unit, Imperial College, London, Paddington, UK
| | - Ann M. Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo-SUNY, Buffalo, NY
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Openshaw JJ, Hegde S, Sazzad HMS, Khan SU, Hossain MJ, Epstein JH, Daszak P, Gurley ES, Luby SP. Bat Hunting and Bat-Human Interactions in Bangladeshi Villages: Implications for Zoonotic Disease Transmission and Bat Conservation. Transbound Emerg Dis 2016; 64:1287-1293. [PMID: 27125493 PMCID: PMC5086320 DOI: 10.1111/tbed.12505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 01/03/2023]
Abstract
Bats are an important reservoir for emerging zoonotic pathogens. Close human–bat interactions, including the sharing of living spaces and hunting and butchering of bats for food and medicines, may lead to spillover of zoonotic disease into human populations. We used bat exposure and environmental data gathered from 207 Bangladeshi villages to characterize bat exposures and hunting in Bangladesh. Eleven percent of households reported having a bat roost near their homes, 65% reported seeing bats flying over their households at dusk, and 31% reported seeing bats inside their compounds or courtyard areas. Twenty percent of households reported that members had at least daily exposure to bats. Bat hunting occurred in 49% of the villages surveyed and was more likely to occur in households that reported nearby bat roosts (adjusted prevalence ratio [aPR] 2.3, 95% CI 1.1–4.9) and villages located in north‐west (aPR 7.5, 95% CI 2.5–23.0) and south‐west (aPR 6.8, 95% CI 2.1–21.6) regions. Our results suggest high exposure to bats and widespread hunting throughout Bangladesh. This has implications for both zoonotic disease spillover and bat conservation.
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Affiliation(s)
- J J Openshaw
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - S Hegde
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - H M S Sazzad
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - S U Khan
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - M J Hossain
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | | | - P Daszak
- EcoHealth Alliance, New York, NY, USA
| | - E S Gurley
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - S P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.,International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
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McGeorge N, Hegde S, Berg RL, Guarrera-Schick TK, LaVergne DT, Casucci SN, Hettinger AZ, Clark LN, Lin L, Fairbanks RJ, Benda NC, Sun L, Wears RL, Perry S, Bisantz A. Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center. J Cogn Eng Decis Mak 2015; 9:329-346. [PMID: 27974881 PMCID: PMC5152766 DOI: 10.1177/1555343415613723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants' level of situation awareness, and participants' workload during the simulated tasks. Participants rated the new displays significantly higher than the control displays in terms of cognitive support. There was no significant difference in workload scores between the display conditions. There was no main effect of display type on situation awareness, but there was a significant interaction; participants using the new displays showed improved situation awareness from the middle to the end of the session. This study demonstrates that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays. These methods provide a means to develop emergency department information systems-and more broadly, health information technology-that better support the cognitive needs of healthcare providers.
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Affiliation(s)
- Nicolette McGeorge
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Rebecca L Berg
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Theresa K Guarrera-Schick
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - David T LaVergne
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Sabrina N Casucci
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, and Department of Emergency Medicine, Georgetown University
| | - Lindsey N Clark
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation
| | - Li Lin
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, and Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, and Department of Emergency Medicine, Georgetown University, and Simulation Training & Education Lab (SiTEL), MedStar Health
| | - Natalie C Benda
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, and National Center for Human Factors in Healthcare, MedStar Institute for Innovation
| | - Longsheng Sun
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Robert L Wears
- Department of Emergency Medicine, University of Florida, and Clinical Safety Research Unit, Imperial College London
| | - Shawna Perry
- Department of Emergency Medicine, University of Florida
| | - Ann Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
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Hegde S, Jain M, Shubha AB. A Rare Bilateral Presentation of Multiple Dens Invaginatus, Shovel-Shaped Incisor and Talon Cusp With Mesiodens. ACTA ACUST UNITED AC 2015; 12:292-5. [DOI: 10.3126/kumj.v12i4.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to describe a unique and unusual case of concomitant appearance of morphological dental anomalies in the maxillary anterior region, along with its management in a patient with no systemic abnormality. This case report describes the clinical and radiographic features of talon cusp, dens invaginatus, shovel-shaped incisors and a supernumerary tooth occurring in a single patient, which is a rare presentation. All 4 permanent maxillary incisors had dens invaginatus, the permanent maxillary canines showed the presence of talon cusps, the permanent maxillary central incisors were shovel-shaped and an erupted mesiodens was also observed. Treatment included restorative, surgical and orthodontic approaches.Kathmandu University Medical Journal Vol.12(4) 2014; 292-295
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Zhou Y, Ancker JS, Upadhye M, McGeorge NM, Guarrera TK, Hegde S, Crane PW, Fairbanks RJ, Bisantz AM, Kaushal R, Lin L. The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study. Inform Prim Care 2014; 21:21-9. [PMID: 24629653 DOI: 10.14236/jhi.v21i1.36] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. OBJECTIVE To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. METHODS Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. RESULTS High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. CONCLUSION This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.
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Affiliation(s)
- Yuan Zhou
- Department of Industrial and Systems Engineering University at Buffalo 339b Bell Hall Buffalo, NY 14260, USA.
| | - Jessica S Ancker
- Departments of Pediatrics and Public Health, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mandar Upadhye
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Nicolette M McGeorge
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Theresa K Guarrera
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Peter W Crane
- Department of Emergency Medicine, University of Rochester, Rochester, NY 14642, USA
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC 20008, USA; Department of Emergency Medicine, Georgetown University, Washington, DC 20007, USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Ann M Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Rainu Kaushal
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, NewYork, NY 10065, USA
| | - Li Lin
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA; Health Information Technology Evaluation Collaborative Investigators
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Manoor Maiya V, Vaid N, Basu S, Vatyam S, Hegde S, Deshmukh S, Zade B. The Use of Xylitol for the Prevention of Xerostomia in Patients Receiving Intensity Modulated Radiation Therapy for Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hettinger AZ, Fairbanks RJ, Hegde S, Rackoff AS, Wreathall J, Lewis VL, Bisantz AM, Wears RL. An evidence-based toolkit for the development of effective and sustainable root cause analysis system safety solutions. J Healthc Risk Manag 2014; 33:11-20. [PMID: 24078204 DOI: 10.1002/jhrm.21122] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Root cause analysis (RCA) after adverse events in healthcare is a standard practice at many institutions. However, healthcare has failed to see a dramatic improvement in patient safety over the last decade. In order to improve the RCA process, this study used systems safety science, which is based partly on human factors engineering principles and has been applied with success in other high-risk industries like aviation. A multi-institutional dataset of 334 RCA cases and 782 solutions was analyzed using qualitative methods. A team of safety science experts developed a model of 13 RCA solutions categories through an iterative process, using semi-structured interview data from 44 frontline staff members from 7 different hospital-based unit types. These categories were placed in a model and toolkit to help guide RCA teams in developing sustainable and effective solutions to prevent future adverse events. This study was limited by its retrospective review of cases and use of interviews rather than clinical observations. In conclusion, systems safety principles were used to develop guidelines for RCA teams to promote systems-level sustainable and effective solutions for adverse events.
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Affiliation(s)
- A Zachary Hettinger
- Assistant Professor, Emergency Medicine at Georgetown University School of Medicine and Director of Informatics Research, National Center for Human Factors in Healthcare
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Sullivan JA, Jankowska-Gan E, Shi L, Roenneburg D, Hegde S, Greenspan DS, Wilkes DS, Denlinger LC, Burlingham WJ. Differential requirement for P2X7R function in IL-17 dependent vs. IL-17 independent cellular immune responses. Am J Transplant 2014; 14:1512-22. [PMID: 24866539 PMCID: PMC4295495 DOI: 10.1111/ajt.12741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/24/2014] [Accepted: 03/10/2014] [Indexed: 01/25/2023]
Abstract
IL17-dependent autoimmunity to collagen type V (Col V) has been associated with lung transplant obliterative bronchiolitis. Unlike the T helper 1 (Th1)-dependent immune responses to Tetanus Toxoid (TT), the Th17 response to Col V in lung transplant patients and its Th1/17 variant observed in coronary artery disease patients requires IL-1β, tumor necrosis factor α and CD14(+) cells. Given the involvement of the P2X7 receptor (P2X7R) in monocyte IL-1β responses, we investigated its role in Th17-, Th1/17- and Th1-mediated proinflammatory responses. Transfer of antigen-pulsed peripheral blood mononucleated cells (PBMCs) from Col V-reactive patients into SCID mouse footpads along with P2X7R antagonists revealed a selective inhibition of Col V-, but not TT-specific swelling responses. P2X7R inhibitors blocked IL-1β induction from monocytes, including both Col V-α1 peptide-induced (T-dependent), as well as native Col V-induced (T-independent) responses. Significantly higher P2X7R expression was found on CXCR3(neg) CCR4(+)/6(+) CD4(+) [Th17] versus CXCR3(+)CCR4/6(neg) CD4(+) [Th1] subsets in PBMCs, suggesting that the paradigm of selective dependence on P2X7R might extend beyond Col V autoimmunity. Indeed, P2X7R inhibitors suppressed not only anti-Col V, but also Th1/17-mediated alloimmunity, in a heart transplant patient without affecting anti-viral Epstein-Barr virus responses. These results suggest that agents targeting the P2X7R might effectively treat Th17-related transplant pathologies, while maintaining Th1-immunity to infection.
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Affiliation(s)
- JA Sullivan
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - E Jankowska-Gan
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - L Shi
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - D Roenneburg
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | | | - DS Greenspan
- Department of Cell & Regenerative Biology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - DS Wilkes
- Department of Medicine, University of Indiana, 340 W 10th St Suite 6200 Indianapolis, IN 46202
| | - LC Denlinger
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - WJ Burlingham
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792,To whom correspondence should be addressed: 600 Highland Avenue, Room G4/702, Madison, WI 53792. Tel: (608) 263-0119 Fax: (608) 262-6280
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Guarrera TK, McGeorge NM, Ancker JS, Hegde S, Zhou Y, Lin L, Crane PW, Fairbanks RJ, Kaushal R, Bisantz AM. Characterising the effect of interoperability on healthcare work: a novel framework. Theoretical Issues in Ergonomics Science 2013. [DOI: 10.1080/1463922x.2013.838318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hegde S, Hettinger AZ, Fairbanks RJ, Wreathall J, Lewis V, Wears R, Bisantz AM. A Bottom-Up Approach to Understanding the Efficacy of Event-Analysis in Healthcare. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1541931213571146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Root Cause analysis (RCA) is a widely implemented event-analysis tool in healthcare, used to improve pa-tient safety. Several studies have assessed the effectiveness of RCA solutions and provided recommenda-tions for improving the approach; however few have suggested a systematic approach to align RCA-based interventions with the realities of work practice in healthcare. In this study, semi-structured interviews were conducted with frontline healthcare staff (nurses, nurse managers and technicians) in order to assess their perspectives on the effectiveness and sustainability of RCA-based solutions in a large academic medical center. In general, preventive interventions such as physical environment or equipment changes were more effective and sustainable than reactive or passive measures such as reviews and compliance checks. A the-matic analysis of respondents’ narratives highlighted several issues related to the design and implementa-tion of various RCA-driven interventions. The analysis however, also revealed important facets of frontline medical practice, including the role played by staff in overcoming systemic hazards in order to increase pa-tient safety. These findings are discussed in the context of the emerging Resilience Engineering approach to safety in complex systems.
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Affiliation(s)
- Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo-SUNY, Buffalo, NY
| | - A. Zach Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, Washington DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington DC
- Department of Emergency Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Rollin J. Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, Washington DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington DC
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington DC
| | | | - Vicky Lewis
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, Washington DC
| | - Robert Wears
- Department of Emergency Medicine, University of Florida, Jacksonville, FL
- Clinical Safety Research Unit, Imperial College London, Paddington, UK
| | - Ann M. Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo-SUNY, Buffalo, NY
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Bennett C, Gangadhar B, Hegde S, Kashyap H, Keshav Kumar J, Mukundan C, Nehra A, Raguram A, Rajakumari K, Rajeswaran J, Rao S, Sadana D, Sadasivan A, Shereena E, Sudhir P, Thomas S. List of contributors. Neuropsychol Rehabil 2013. [DOI: 10.1016/b978-0-12-416046-0.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sen P, Bhuwanesh K, Ashutosh K, Engineer Z, Hegde S, Sen P, Lal R. Micro-Scale Multi-Effect Distillation System for Low Steam Inputs. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.proeng.2013.03.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Unnikrishnan B, Jagannath V, Ramapuram JT, Hegde S. Study of depression and its associated factors among women living with HIV AIDS in coastal South India. Retrovirology 2012. [PMCID: PMC3360354 DOI: 10.1186/1742-4690-9-s1-p137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE Effects of display size and dual display setting on preferred display and keyboard positions were evaluated. BACKGROUND User-preferred display position may vary as its size changes or when multiple displays are used. It is also not known whether the use of larger displays or multiple displays would influence positioning of the keyboard. METHOD Participants (N=19) who had normal visual acuity (20/30 or better) determined preferred positions of the display and the keyboard during a data entry task in four display setups (19, 24, 27.5, and dual 19 in.). The size of capital characters (3.2 mm high) was kept consistent between setups. RESULTS Preferred viewing distance ranged from 0.68 m (19-in. display) to 0.76 m (27.5-in. display). No significant differences in viewing distance and display height were found between the single 19-in. display and dual 19-in. displays setups. The preferred position of the keyboard was consistent between display setups. CONCLUSION Participants placed larger displays farther and lower while maintaining the display top at or near eye height. Preferred position of the dual displays in landscape setting did not differ from that of a single display. It appears that the preferred display position varies with the vertical dimension of the overall viewable area of the display. APPLICATION The results of this study can be used to determine the dimensions or adjustability of computer workstations for larger displays or multiple displays settings.
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Affiliation(s)
- Gwanseob Shin
- Department of Industrial and Systems Engineering, 415 Bell Hall, University at Buffalo, State University of New York Buffalo, NY 14260, USA.
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Hegde S, Bajaj A, Entwisle J. Incidence of thrombosis in lung cancer. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Congenital alveolar dysplasia (CAD) is a rare disorder thought to represent alveolar growth arrest at the canalicular stage of development. An infant with CAD diagnosed on lung biopsy is reported, her respiratory problems resolved spontaneously and she was doing well at follow-up. The infant additionally suffered from systemic hypertension and hypertrophic pyloric stenosis. In conclusion, we speculate that the association of CAD with systemic hypertension and hypertrophic pyloric stenosis might be explained by abnormalities of isoforms of nitric oxide synthase (NOS) resulting in congenital deformities involving smooth muscles.
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Affiliation(s)
- S Hegde
- Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine at Guy's, King's College and St. Thomas' Hospitals, London, UK
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Miquel ME, Rhode KS, Acher PL, Macdougall ND, Blackall J, Gaston RP, Hegde S, Morris SL, Beaney R, Deehan C, Popert R, Keevil SF. Using combined x-ray and MR imaging for prostate I-125 post-implant dosimetry: phantom validation and preliminary patient work. Phys Med Biol 2006; 51:1129-37. [PMID: 16481682 DOI: 10.1088/0031-9155/51/5/005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Post-implantation dosimetry is an important element of permanent prostate brachytherapy. This process relies on accurate localization of implanted seeds relative to the surrounding organs. Localization is commonly achieved using CT images, which provide suboptimal prostate delineation. On MR images, conversely, prostate visualization is excellent but seed localization is imprecise due to distortion and susceptibility artefacts. This paper presents a method based on fused MR and x-ray images acquired consecutively in a combined x-ray and MRI interventional suite. The method does not rely on any explicit registration step but on a combination of system calibration and tracking. A purpose-built phantom was imaged using MRI and x-rays, and the images were successfully registered. The same protocol was applied to three patients where combining soft tissue information from MRI with stereoscopic seed identification from x-ray imaging facilitated post-implant dosimetry. This technique has the potential to improve on dosimetry using either CT or MR alone.
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Affiliation(s)
- M E Miquel
- Division of Imaging Sciences, King's College London, London, SE1 9RT, UK
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45
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Sermesant M, Rhode K, Sanchez-Ortiz GI, Camara O, Andriantsimiavona R, Hegde S, Rueckert D, Lambiase P, Bucknall C, Rosenthal E, Delingette H, Hill DLG, Ayache N, Razavi R. Simulation of cardiac pathologies using an electromechanical biventricular model and XMR interventional imaging. Med Image Anal 2005; 9:467-80. [PMID: 16006170 DOI: 10.1016/j.media.2005.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Simulating cardiac electromechanical activity is of great interest for a better understanding of pathologies and for therapy planning. Design and validation of such models is difficult due to the lack of clinical data. XMR systems are a new type of interventional facility in which patients can be rapidly transferred between X-ray and MR systems. Our goal is to design and validate an electromechanical model of the myocardium using XMR imaging. The proposed model is computationally fast and uses clinically observable parameters. We present the integration of anatomy, electrophysiology, and motion from patient data. Pathologies are introduced in the model and simulations are compared to measured data. Initial qualitative comparison on the two clinical cases presented is encouraging. Once fully validated, these models will make it possible to simulate different interventional strategies.
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Affiliation(s)
- M Sermesant
- Cardiac MR Research Group, King's College London, 5th Floor Thomas Guy House, Guy's Hospital, London, UK.
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46
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Lambiase PD, Hegde S, Sermesant M, Rhode KS, Hill DL, Razavi R, Gill JS. Integrated X-ray & Magnetic Resonance imaging (XMR) -a novel strategy for guiding pulmonary vein ablation. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Williams MR, Hegde S, Norton MR. Informed consent and surgeons in training: do patients consent to allow surgical trainees to operate on them? Ann R Coll Surg Engl 2005; 86:465-6. [PMID: 15527593 PMCID: PMC1964262 DOI: 10.1308/1478708041127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M R Williams
- Department of Trauma and Orthopaedics, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, UK
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48
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Affiliation(s)
- N E Moghal
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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49
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Hegde S, Coulthard MG. End stage renal disease due to bilateral renal malakoplakia. Arch Dis Child 2004; 89:78-9. [PMID: 14709516 PMCID: PMC1755936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Malakoplakia typically affects the bladders of immunocompromised adults who have defective intracellular killing of Escherichia coli. Renal malakoplakia is rare in children and generally has a good outcome. In the case presented, however, it caused end stage renal failure in a 5 year old girl. The management dilemmas surrounding renal transplantation are highlighted.
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Affiliation(s)
- S Hegde
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, UK
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50
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Vetting M, Roderick SL, Hegde S, Magnet S, Blanchard JS. What can structure tell us about in vivo function? The case of aminoglycoside-resistance genes. Biochem Soc Trans 2003; 31:520-2. [PMID: 12773148 DOI: 10.1042/bst0310520] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Resistance to antibiotics used in the treatment of bacterial infections is an expanding clinical problem. Aminoglycosides, one of the oldest classes of natural product antibiotics, exert their bactericidal effect as the result of inhibiting bacterial protein synthesis by binding to the acceptor site of the 30 S ribosomal subunit. The most common mechanism of clinical resistance to aminoglycosides results from the expression of enzymes that covalently modify the aminoglycoside. We will discuss the enzymology and structure of two representative chromosomally encoded aminoglycoside N-acetyltransferases, Mycobacterium tuberculosis AAC(2')-Ic and Salmonella enterica AAC(6')-Iy, and speculate about their possible physiological function and substrates.
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Affiliation(s)
- M Vetting
- Department of Biochemistry, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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