Improving the communication of hand hygiene procedures: Controlled observation, redesign, and randomized group comparisons.

OBJECTIVE: To assess the clarity and efficacy of the World Health Organization (WHO) hand-rub diagram, develop a modified version, and compare the 2 diagrams. DESIGN: Randomized group design preceded by controlled observation and iterative product redesigns. SETTING: The Cognitive Ergonomics Lab in the School of Psychology at the Georgia Institute of Technology. PARTICIPANTS: We included participants who were unfamiliar with the WHO hand-rub diagram (convenience sampling) to ensure that performance was based on the diagram and not, for example, on prior experience. METHODS: We iterated through the steps of a human factors design procedure: (1) Participants simulated hand hygiene using ultraviolet (UV) absorbent lotion and a hand-rub technique diagram (ie, WHO or a redesign). (2) Coverage, confusion judgments, and behavioral videos informed potentially improved diagrams. And (3) the redesigned diagrams were compared with the WHO version in a randomized group design. Coverage was assessed across 72 hand areas from multiple UV photographs. RESULTS: The WHO diagram led to multiple omissions in hand-surface coverage, including inadequate coverage by up to 75% of participants for the ulnar edge. The redesigns improved coverage significantly overall and often substantially. CONCLUSIONS: Human factors modification to the WHO diagram reduced inadequate coverage for naïve users. Implementation of an improved diagram should help in the prevention of healthcare-associated infections.

Comparative Efficacy Of 35% Glycolic Acid Peel vs. Jessner Peel as an Adjuvant to Topical Triple Combination (2% Hydroquinone, 0.025% Tretinoin, 0.01% Fluocinolone Acetonide) Therapy in Melasma Females Cases.

Melasma is a common, acquired, circumscribed hypermelanosis of sun-exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. Compare the efficacy of 35% gycolic acid (GA) peel vs. Jessner peel (JP) as an adjuvant to topical triple combination (2% Hydroquinone, 0.025% tretinoin, 0.01% Fluocinolone acetonide) therapy in Melasma in females. Sixty cases of Melasma attending Skin-VD OPD, Baroda Medical College from September 1, 2016 to July 30,/2017 were enrolled. Among them, 12% cases had history of menstrual irregularity, 5% cases had past history of oral contraceptive (OC) pill intake, and 10% cases had history of working outdoors. Most common pattern of melasma was centrofacial 32 cases (53%) which was followed by malar pattern in 27 cases (47%) and mandibular pattern in one case (2%). Fifty cases who completed study were evaluated for comparative efficacy of GA peel versus JP as an adjuvant to topical triple combination therapy. Average reduction in Melasma Area and Severity Index (MASI) score in cases treated with GA peel group was 58.56% with Jessner peel group was 59.12%. In GA peel group, 84% cases had moderate to good improvement, whereas in JP group 92% cases had moderate to good improvement. According to present study, safety and efficacy profile of 35% GA peel vs. JP was almost same. Both can be used as an adjuvant to topical triple combination therapy of 2% hydroquinone, 0.025% tretinoin, and 0.01% fluocinolone acetonide in females suffering from melasma. We recommend that it will be safer for the pregnant women to get the GA peel rather than the treatment containing hydroquinone and tretinoin since the activity/performance is very similar.

Effects of Probabilistic Risk Situation Awareness Tool (RSAT) on Aeronautical Weather-Hazard Decision Making.

We argue that providing cumulative risk as an estimate of the uncertainty in dynamically changing risky environments can help decision-makers meet mission-critical goals. Specifically, we constructed a simplified aviation-like weather decision-making task incorporating Next-Generation Radar (NEXRAD) images of convective weather. NEXRAD radar images provide information about geographically referenced precipitation. NEXRAD radar images are used by both pilots and laypeople to support decision-making about the level of risk posed by future weather-hazard movements. Using NEXRAD, people and professionals have to infer the uncertainty in the meteorological information to understand current hazards and extrapolate future conditions. Recent advancements in meteorology modeling afford the possibility of providing uncertainty information concerning hazardous weather for the current flight. Although there are systematic biases that plague people's use of uncertainty information, there is evidence that presenting forecast uncertainty can improve weather-related decision-making. The current study augments NEXRAD by providing flight-path risk, referred to as the Risk Situational Awareness Tool (RSAT). RSAT provides the probability that a route will come within 20 NMI radius (FAA recommended safety distance) of hazardous weather within the next 45 min of flight. The study evaluates four NEXRAD displays integrated with RSAT, providing varying levels of support. The "no" support condition has no RSAT (the NEXRAD only condition). The "baseline" support condition employs an RSAT whose accuracy is consistent with current capability in meteorological modeling. The "moderate" support condition applies an RSAT whose accuracy is likely at the top of what is achievable in meteorology in the near future. The "high" support condition provides a level of support that is likely unachievable in an aviation weather decision-making context without considerable technological innovation. The results indicate that the operators relied on the RSAT and improved their performance as a consequence. We discuss the implications of the findings for the safe introduction of probabilistic tools in future general aviation cockpits and other dynamic decision-making contexts. Moreover, we discuss how the results contribute to research in the fields of dynamic risk and uncertainty, risk situation awareness, cumulative risk, and risk communication.

On developing a framework for detection of oscillations in data.

Oscillation is a phenomenon very commonly observed in systems, ranging from simple ones to complex distributed network. Several techniques have been proposed in the literature for detecting oscillations to study their importance in domains ranging from physiology to climate studies. However, there is a lack of a common framework accommodative of important features of data such as non-stationarity, intermittent oscillations, measurement noise, multimodal oscillations, and the like. In this article, we outline a framework that addresses these challenges, the results of which can then be analyzed along with appropriate knowledge about the underlying system. We present results of an extensive simulation study that establishes the robustness and reliability of the proposed technique and demonstrate its applicability to real datasets in climate and in industrial datasets.

Hair casts.

Hair casts or pseudonits are circumferential concretions, which cover the hair shaft in such a way that, it could be easily removed. They are thin, cylindrical, and elongated in length. We present an unusual case of an 8-year-old girl presenting with hair casts. Occurrence of these is unusual, and they may have varied associations. This patient was suffering from developmental delay. It is commonly misdiagnosed as and very important to differentiate from pediculosis capitis.