Human centered design workshops as a meta-solution to diagnostic disparities.

OBJECTIVES: Diagnostic errors - inaccurate or untimely diagnoses or failures to communicate diagnoses - are harmful and costly for patients and health systems. Diagnostic disparities occur when diagnostic errors are experienced at disproportionate rates by certain patient subgroups based, for example, on patients' age, sex/gender, or race/ethnicity. We aimed to develop and test the feasibility of a human centered design workshop series that engages diverse stakeholders to develop solutions for mitigating diagnostic disparities. METHODS: We employed a series of human centered design workshops supplemented by semi-structured interviews and literature evidence scans. Co-creation sessions and rapid prototyping by patient, clinician, and researcher stakeholders were used to generate design challenges, solution concepts, and prototypes. RESULTS: A series of four workshops attended by 25 unique participants was convened in 2019-2021. Workshops generated eight design challenges, envisioned 29 solutions, and formulated principles for developing solutions in an equitable, patient-centered manner. Workshops further resulted in the conceptualization of 37 solutions for addressing diagnostic disparities and prototypes for two of the solutions. Participants agreed that the workshop processes were replicable and could be implemented in other settings to allow stakeholders to generate context-specific solutions. CONCLUSIONS: The incorporation of human centered design through a series of workshops promises to be a productive way of engaging patient-researcher stakeholders to mitigate and prevent further exacerbation of diagnostic disparities. Healthcare stakeholders can apply human centered design principles to guide thinking about improving diagnostic performance and to center diverse patients' needs and experiences when implementing quality and safety improvements.

Field assessment of horse-associated genetic markers HoF597 and mtCytb for detecting the source of contamination in surface waters.

We investigated the specificity and sensitivity of two horse-associated markers, HoF597 and Horse mtCytb, and 12 mitochondrial and bacterial markers of six animal species (human, cow, pig, bird, dog, chicken) in the faecal samples of 50 individual horses. Both horse markers were detected in 48 (96%) faecal samples. Cross-reactivity with dog (BacCan545) and pig (P23-2) occurred in 88% and 72% of horse faecal samples, respectively. Several other bacterial and mitochondrial markers of non-target hosts were also detected; however, their specificities were >80%. Analyses of samples from surface waters (n = 11) on or adjacent to properties from which horse faecal samples had been collected showed only the presence of HoF597 but not horse mitochondrial marker. Our data suggest that while bacterial and (or) mitochondrial markers of other animal species may be present in horse faeces, dog and pig markers may predominantly be present in horse faecal samples, which points to their nonspecificity as markers for microbial source tracking. Although HoF597 and Horse mtCytb are highly sensitive and specific for the detection of horse faecal pollution, because of their low numbers, mitochondrial (mtDNA) markers may not be robust for screening surface waters.

Exposure assessment of diesel bus emissions.

The goal of this study was to measure ultrafine particle concentrations with diameters less than 1 mum emitted by diesel buses and to assess resulting human exposure levels. The study was conducted at the Woolloongabba Busway station in Brisbane, Australia in the winter months of 2002 during which temperature inversions frequently occurred. Most buses that utilize the station are fuelled by diesel, the exhaust of which contains a significant quantity of particle matter. Passengers waiting at the station are exposed to these particles emitted from the buses. During the course of this study, passenger census was conducted, based on video surveillance, yielding person-by-person waiting time data. Furthermore, a bus census revealed accurate information about the total number of diesel versus Compressed Natural Gas (CNG) powered buses. Background (outside of the bus station) and platform measurements of ultrafine particulate number size distributions were made to determine ambient aerosol concentrations. Particle number exposure concentration ranges from 10 and 40 to 60% of bus related exhaust fumes. This changes dramatically when considering the particle mass exposure concentration, where most passengers are exposed to about 50 to 80% of exhaust fumes. The obtained data can be very significant for comparison with similar work of this type because it is shown in previous studies that exhaust emissions causes cancer in laboratory animals. It was assumed that significant differences between platform and background distributions were due to bus emissions which, combined with passenger waiting times, yielded an estimate of passenger exposure to ultrafine particles from diesel buses. From an exposure point of view, the Busway station analyzed resembles a street canyon. Although the detected exhaust particle concentration at the outbound platform is found to be in the picogram range, exposure increases with the time passengers spend on the platform along with their breathing frequency.