Promoting equality, diversity and inclusion in research and funding: reflections from a digital manufacturing research network.

BACKGROUND: Equal, diverse, and inclusive teams lead to higher productivity, creativity, and greater problem-solving ability resulting in more impactful research. However, there is a gap between equality, diversity, and inclusion (EDI) research and practices to create an inclusive research culture. Research networks are vital to the research ecosystem, creating valuable opportunities for researchers to develop their partnerships with both academics and industrialists, progress their careers, and enable new areas of scientific discovery. A feature of a network is the provision of funding to support feasibility studies - an opportunity to develop new concepts or ideas, as well as to 'fail fast' in a supportive environment. The work of networks can address inequalities through equitable allocation of funding and proactive consideration of inclusion in all of their activities. METHODS: This study proposes a strategy to embed EDI within research network activities and funding review processes. This paper evaluates 21 planned mitigations introduced to address known inequalities within research events and how funding is awarded. EDI data were collected from researchers engaging in a digital manufacturing network activities and funding calls to measure the impact of the proposed method. RESULTS: Quantitative analysis indicates that the network's approach was successful in creating a more ethnically diverse network, engaging with early career researchers, and supporting researchers with care responsibilities. However, more work is required to create a gender balance across the network activities and ensure the representation of academics who declare a disability. Preliminary findings suggest the network's anonymous funding review process has helped address inequalities in funding award rates for women and those with care responsibilities, more data are required to validate these observations and understand the impact of different interventions individually and in combination. CONCLUSIONS: In summary, this study offers compelling evidence regarding the efficacy of a research network's approach in advancing EDI within research and funding. The network hopes that these findings will inform broader efforts to promote EDI in research and funding and that researchers, funders, and other stakeholders will be encouraged to adopt evidence-based strategies for advancing this important goal.

A head mounted augmented reality design practice for maintenance assembly: Toward meeting perceptual and cognitive needs of AR users.

Head Mounted Display (HMD) based Augmented Reality (AR) is being increasingly used in manufacturing and maintenance. However, limited research has been done to understand user interaction with AR interfaces, which may lead to poor usability, risk of occupational hazards, and low acceptance of AR systems. This paper uses a theoretically-driven approach to interaction design to investigate the impact of different AR modalities in terms of information mode (i.e. video vs. 3D animation) and interaction modality (i.e. hand-gesture vs. voice command) on user performance, workload, eye gaze behaviours, and usability during a maintenance assembly task. The results show that different information modes have distinct impacts compared to paper-based maintenance, in particular, 3D animation led to a 14% improvement over the video instructions in task completion time. Moreover, insights from eye gaze behaviours such as number of fixations and transition between Areas of Interest (AOIs) revealed the differences in attention switching and task comprehension difficulty with the choice of AR modalities. While, subjective user perceptions highlight some ergonomic issues such as misguidance and overreliance, which must be considered and addressed from the joint cognitive systems' (JCSs) perspective and in line with the predictions derived from the Multiple Resources Model.

Understanding factors that influence unintentional insider threat: a framework to counteract unintentional risks.

The exploitation of so-called insiders is increasingly recognised as a common vector for cyberattacks. Emerging work in this area has considered the phenomenon from various perspectives including the technological, the psychological and the sociotechnical. We extend this work by specifically examining unintentional forms of insider threat and report the outcomes of a series of detailed Critical Decision Method (CDM) led interviews with those who have experienced various forms of unwitting cybersecurity breaches. We also articulate factors likely to contribute firmly in the context of everyday work-as-done. CDM's probing questions were used to elicit expert knowledge around how decision making occurred prior, during and post an unintentional cyber breach whilst participants were engaged in the delivery of cognitive tasks. Through the application of grounded theory to data, emerging results included themes of decision making, task factors, accidents and organisational factors. These results are utilised to inform an Epidemiological Triangle to represent the dynamic relationship between three vectors of exploit, user and the work environment that can in turn affect the resilience of cyber defences. We conclude by presenting a simple framework, which for the purposes of this work is a set of recommendations applicable in specific scenarios to reduce negative impact for understanding unintentional insider threats. We also suggest practical means to counteract such threats rooted in the lived experience of those who have fallen prey to them.

An interview analysis of coordination behaviours in Out-of-Hours secondary care.

This paper seeks to elicit and structure the factors that shape the execution and, in particular, the coordination of work in Out of Hours care. Evenings and weekends in UK hospitals are managed by specific Out of Hours (OoH) care arrangements, and associated technology. Managing care within the constraints of staff availability and demands is a key concern for both patient care and staff wellbeing, yet has received little attention from healthcare human factors. A study of sixteen clinical staff used Critical Decision Method to understand how work is coordinated and the constraints and criteria that are applied by the roles managing OoH care. The analysis identified ten types of coordination decision that, in turn, underpinned three types of adaptive behaviour - pre-emption, information augmentation and self-organisation - that were crucial for the effective performance in OoH care. These behaviours explain how OoH staff manage the task demands placed on them, individually and as a team.

Young adults' attitudes to sharing whole-genome sequencing information: a university-based survey.

BACKGROUND: Genomic services are increasingly accessible to young adults starting their independent lives with responsibility for their self-care, yet their attitudes to sharing genomic information remain under-researched. This study explored attitudes of university-based 18-25 year-olds towards sharing personal whole-genome sequencing (WGS) information with relatives. METHODS: We surveyed 112 young adults. Hypotheses were tested regarding the relationships between their preferences for sharing personal WGS information with relatives and factors including their gender, previous genetics-specific education, general educational attainment level and current study in a science, technology, engineering, maths or medicine (STEMM) field. RESULTS: Most participants were positive about both their intention to share their WGS results with their parents and siblings, and their desire to know their relatives' results. Being female and having a university-level genetics education were consistently positively correlated with intention to share one's results with parents and with siblings as well as the desire to know relatives' results. Additionally, females who had undertaken a genetics course at university had significantly greater intentions and desires than females who had not. Lower general educational attainment was related to a lower intention to share with siblings. Participants who were in a STEMM field had a greater desire to know their relatives' results. CONCLUSIONS: Participants' gender and prior genetics education were consistently related to their intentions to share WGS results with relatives and their desire to know relatives' results. Educational attainment was found to be positively correlated with intention to share with siblings. Being in a STEMM field was related to participants' desire to know their relatives' results. These findings indicate that gender and genetics education are particularly important influencers on young adults' stated sharing preferences. More research is required to examine the dependent variables studied to further understand their influence on attitudes to sharing WGS results. These findings are particularly interesting for information provision and support before genomic sequencing and post-results to improve the outcomes for individuals and their relatives.

The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation.

BACKGROUND: Patient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as "track and trigger," or rapid response systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient's bedside, improves visibility of patient data, and streamlines communication within clinical teams. OBJECTIVE: The aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology. METHODS: A total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom. RESULTS: Roll-out of eObs was associated with approximately 10% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7% to 25.6%). More time was spent at the nurses' station (6.6% to 41.7%). Patient contact time was more than doubled (2.9% to 7.3%). CONCLUSIONS: Since deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians.

Natural locomotion based on a reduced set of inertial sensors: Decoupling body and head directions indoors.

Inertial sensors offer the potential for integration into wireless virtual reality systems that allow the users to walk freely through virtual environments. However, owing to drift errors, inertial sensors cannot accurately estimate head and body orientations in the long run, and when walking indoors, this error cannot be corrected by magnetometers, due to the magnetic field distortion created by ferromagnetic materials present in buildings. This paper proposes a technique, called EHBD (Equalization of Head and Body Directions), to address this problem using two head- and shoulder-located magnetometers. Due to their proximity, their distortions are assumed to be similar and the magnetometer measurements are used to detect when the user is looking straight forward. Then, the system corrects the discrepancies between the estimated directions of the head and the shoulder, which are provided by gyroscopes and consequently are affected by drift errors. An experiment is conducted to evaluate the performance of this technique in two tasks (navigation and navigation plus exploration) and using two different locomotion techniques: (1) gaze-directed mode (GD) in which the walking direction is forced to be the same as the head direction, and (2) decoupled direction mode (DD) in which the walking direction can be different from the viewing direction. The obtained results show that both locomotion modes show similar matching of the target path during the navigation task, while DD's path matches the target path more closely than GD in the navigation plus exploration task. These results validate the EHBD technique especially when allowing different walking and viewing directions in the navigation plus exploration tasks, as expected. While the proposed method does not reach the accuracy of optical tracking (ideal case), it is an acceptable and satisfactory solution for users and is much more compact, portable and economical.

Understanding Is Key: An Analysis of Factors Pertaining to Trust in a Real-World Automation System.

OBJECTIVE: This paper aims to explore the role of factors pertaining to trust in real-world automation systems through the application of observational methods in a case study from the railway sector. BACKGROUND: Trust in automation is widely acknowledged as an important mediator of automation use, but the majority of the research on automation trust is based on laboratory work. In contrast, this work explored trust in a real-world setting. METHOD: Experienced rail operators in four signaling centers were observed for 90 min, and their activities were coded into five mutually exclusive categories. Their observed activities were analyzed in relation to their reported trust levels, collected via a questionnaire. RESULTS: The results showed clear differences in activity, even when circumstances on the workstations were very similar, and significant differences in some trust dimensions were found between groups exhibiting different levels of intervention and time not involved with signaling. CONCLUSION: Although the empirical, lab-based studies in the literature have consistently found that reliability and competence of the automation are the most important aspects of trust development, understanding of the automation emerged as the strongest dimension in this study. The implications are that development and maintenance of trust in real-world, safety-critical automation systems may be distinct from artificial laboratory automation. APPLICATION: The findings have important implications for emerging automation concepts in diverse industries including highly automated vehicles and Internet of things.

The dichotomy of the application of a systems approach in UK healthcare the challenges and priorities for implementation.

There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety. Practitioner Summary: healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems.

Physiological Parameter Response to Variation of Mental Workload.

OBJECTIVE: To examine the relationship between experienced mental workload and physiological response by noninvasive monitoring of physiological parameters. BACKGROUND: Previous studies have examined how individual physiological measures respond to changes in mental demand and subjective reports of workload. This study explores the response of multiple physiological parameters and quantifies their added value when estimating the level of demand. METHOD: The study presented was conducted in laboratory conditions and required participants to perform a visual-motor task that imposed varying levels of demand. The data collected consisted of physiological measurements (heart interbeat intervals, breathing rate, pupil diameter, facial thermography), subjective ratings of workload (Instantaneous Self-Assessment Workload Scale [ISA] and NASA-Task Load Index), and the performance. RESULTS: Facial thermography and pupil diameter were demonstrated to be good candidates for noninvasive workload measurements: For seven out of 10 participants, pupil diameter showed a strong correlation ( R values between .61 and .79 at a significance value of .01) with mean ISA normalized values. Facial thermography measures added on average 47.7% to the amount of variability in task performance explained by a regression model. As with the ISA ratings, the relationship between the physiological measures and performance showed strong interparticipant differences, with some individuals demonstrating a much stronger relationship between workload and performance measures than others. CONCLUSION: The results presented in this paper demonstrate that physiological and pupil diameter can be used for noninvasive real-time measurement of workload. APPLICATION: The methods presented in this article, with current technological capabilities, are better suited for workplaces where the person is seated, offering the possibility of being applied to pilots and air traffic controllers.

Living with an autonomous spatiotemporal home heating system: Exploration of the user experiences (UX) through a longitudinal technology intervention-based mixed-methods approach.

Rising energy demands place pressure on domestic energy consumption, but savings can be delivered through home automation and engaging users with their heating and energy behaviours. The aim of this paper is to explore user experiences (UX) of living with an automated heating system regarding experiences of control, understanding of the system, emerging thermal behaviours, and interactions with the system as this area is not sufficiently researched in the existing homes setting through extended deployment. We present a longitudinal deployment of a quasi-autonomous spatiotemporal home heating system in three homes. Users were provided with a smartphone control application linked to a self-learning heating algorithm. Rich qualitative and quantitative data presented here enabled a holistic exploration of UX. The paper's contribution focuses on highlighting key aspects of UX living with an automated heating systems including (i) adoption of the control interface into the social context, (ii) how users' vigilance in maintaining preferred conditions prevailed as a better indicator of system over-ride than gross deviation from thermal comfort, (iii) limited but motivated proactivity in system-initiated communications as best strategy for soliciting user feedback when inference fails, and (iv) two main motivations for interacting with the interface - managing irregularities when absent from the house and maintaining immediate comfort, latter compromising of a checking behaviour that can transit to a system state alteration behaviour depending on mismatches. We conclude by highlighting the complex socio-technical context in which thermal decisions are made in a situated action manner, and by calling for a more holistic, UX-focused approach in the design of automated home systems involving user experiences.

The field becomes the laboratory? The impact of the contextual digital footprint on the discipline of E/HF.

The increasing prevalence of affordable digital sensors, ubiquitous networking and computation puts us at what is only the start of a new era in terms of the volume, coverage and granularity of data that we can access about individuals and workplaces. This paper examines the consequences of harnessing this data deluge for the practice of E/HF. Focusing on what we term the 'contextual digital footprint', the trail of data we produce through interactions with many different digital systems over the course of even a single day, we describe three example scenarios (drawn from health care, distributed work and transportation) and examine how access to data directly drawn in considerable volume from the field will potentially change our application of design and evaluation methods. We conclude with a discussion of issues relevant to ethical and professional practice within this new environment including the increased challenges of respecting anonymity, working with n = all data-sets and the central role of ergonomists in promulgating positive uses of data while retaining a systems-based humanistic approach to work design. Practitioner summary: The paper envisions the impact of new and emerging sources of data about people and workplaces upon future practice in E/HF. We identify practical consequences for ergonomics practice, highlight new areas of professional competence likely to be required and flag both the risks and benefits of adopting a more data-driven approach.

See I told you I was taking it! - Attitudes of adolescents with asthma towards a device monitoring their inhaler use: Implications for future design.

Adherence to treatment in asthma is often poor, particularly in adolescents and children where the condition is most prevalent. Electronic monitoring devices have shown potential for improving inhaler use, yet little research has considered the attitudes of patients towards these devices. We gave seven adolescents with asthma an electronic monitoring device to use for one month and collected their views on important issues including monitoring and data sharing. Our results showed that participants felt positively about using the data to demonstrate responsibility for their condition to both their parents and medical professionals, but expressed concern for the attention the device's appearance could draw to them and their asthma. This paper considers the positive and negative perceptions of this novel device and provides new insight into the attitudes of adolescents towards inhaler monitoring, as well as future directions for design and development of monitoring devices for asthma and other chronic medical conditions.

The experience of couples being given an oxygen concentrator to use at home: A longitudinal interpretative phenomenological analysis.

This longitudinal study explores the lived experience of four couples where one person from each couple is prescribed an oxygen concentrator to use at home. Transcripts were analysed using interpretative phenomenological analysis. The findings reported here focus on two super-ordinate themes: 'the journey of acceptance' and 'negotiating changing relationships'. Participants described a gradual process of accepting the device into their lives, the impact on couple's relationships and the role that expectations have in mediating that process. These themes suggest that patient education that considers the psychological and social issues may prove useful in facilitating the acceptance process.

Out of hours workload management: Bayesian inference for decision support in secondary care.

OBJECTIVE: In this paper, we aim to evaluate the use of electronic technologies in out of hours (OoH) task-management for assisting the design of effective support systems in health care; targeting local facilities, wards or specific working groups. In addition, we seek to draw and validate conclusions with relevance to a frequently revised service, subject to increasing pressures. METHODS AND MATERIAL: We have analysed 4 years of digitised demand-data extracted from a recently deployed electronic task-management system, within the Hospital at Night setting in two jointly coordinated hospitals in the United Kingdom. The methodology employed relies on Bayesian inference methods and parameter-driven state-space models for multivariate series of count data. RESULTS: Main results support claims relating to (i) the importance of data-driven staffing alternatives and (ii) demand forecasts serving as a basis to intelligent scheduling within working groups. We have displayed a split in workload patterns across groups of medical and surgical specialities, and sustained assertions regarding staff behaviour and work-need changes according to shifts or days of the week. Also, we have provided evidence regarding the relevance of day-to-day planning and prioritisation. CONCLUSIONS: The work exhibits potential contributions of electronic tasking alternatives for the purpose of data-driven support systems design; for scheduling, prioritisation and management of care delivery. Electronic tasking technologies provide means to design intelligent systems specific to a ward, speciality or task-type; hence, the paper emphasizes the importance of replacing traditional pager-based approaches to management for modern alternatives.

What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective.

INTRODUCTION: Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process. METHODS: Three rounds of surveys in a Delphi format were used to assess the most important pros and cons of EMDs for asthma care in a sample of 31 stakeholders which included healthcare professionals and members of clinical commissioning groups. RESULTS: The respondents identified 29 pros and 32 cons. Pros that were rated as most important included new visual evidence to aid clinical discussions with a patient and an increase in patient involvement and motivation. The cons that were rated as most important included a need for more clinical evidence of the effectiveness of EMDs, as well as better clarity over who has responsibilities in managing, interpreting and discussing data with a patient. CONCLUSIONS: The research provides a guide for EMD developers by highlighting where these devices may provide the most benefit as well as prioritising the key issues that need addressing if they are to be used effectively in everyday asthma care.

NightShift simulation to train newly qualified doctors in non-technical skills: a feasibility study.

There is growing evidence of greater rates of morbidity and mortality in hospitals during out-of-hours shifts, which appears to be exacerbated during the period in which newly qualified doctors commence work. In order to combat this issue, an online simulation of a night shift was developed and trialled in order to improve the non-technical skills of newly qualified doctors and, ultimately, improve clinical outcomes. A randomised feasibility trial of the electronic training simulation was performed with medical students (n=30) at the end of their training and in the initial weeks of working at a large teaching hospital. The study showed that participants in the intervention group completed their non-urgent tasks more rapidly than the control group: mean (SD) time to complete a non-urgent task of 85.1 (50.1) versus 157.6 (90.4) minutes, p=0.027. This difference persisted using linear regression analysis, which was undertaken using rota and task volume as independent cofactors (p=0.028). This study shows the potential for simulation technologies to improve non-technical skills.