The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana.

BACKGROUND: Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. RESULTS: Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). CONCLUSION: There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

Evaluation of an enhanced pulse oximeter auditory display: a simulaion study.

BACKGROUND: We compared anaesthetists' ability to identify haemoglobin oxygen saturation (SpO2) levels using two auditory displays: one based on a standard pulse oximeter display (varying pitch plus alarm) and the other enhanced with additional sound properties (varying pitch plus tremolo and acoustic brightness) to differentiate SpO2 ranges. METHODS: In a counter-balanced crossover study in a simulator, 20 experienced anaesthetists supervised a junior colleague (an actor) managing two airway surgery scenarios: once while using the enhanced auditory display and once while using a standard auditory display. Participants were distracted with other tasks such as paperwork and workplace interruptions, but were required to identify when SpO2 transitioned between pre-set ranges (target, low, critical) and when other vital signs transitioned out of a target range. They also identified the range once a transition had occurred. Visual displays were available for all monitored vital signs, but the numerical value for SpO2 was excluded. RESULTS: Participants were more accurate and faster at detecting transitions to and from the target SpO2 range when using the enhanced display (100.0%, 3.3 s) than when using the standard display plus alarm (73.2%, 27.4 s) (P<0.001 and P=0.004, respectively). They were also more accurate at identifying the SpO2 range once a transition had occurred when using the enhanced display (100.0%) than when using the standard display plus alarm (57.1%; P<0.001). CONCLUSIONS: The enhanced auditory display helps anaesthetists judge SpO2 levels more effectively than current auditory displays and may facilitate 'eyes-free' monitoring.

Communicating 3D data-interactive 3D PDF documents for expert reports and scientific publications in the field of forensic medicine.

INTRODUCTION: Modern forensic investigations increasingly revert to 3D imaging techniques, such as computed tomography, magnetic resonance imaging, and 3D surface imaging. Findings are therefore often based on 3D data sets; however, this information is commonly reported and communicated within 2D imagery. The use of interactive 3D PDFs is already established in the scientific community but has yet to be implemented in the field of forensic medicine. METHODS AND MATERIALS: Three example cases were chosen to serve as exemplary data for the most commonly applied imaging techniques in postmortem imaging. 3D surface models were created from postmortem magnetic resonance imaging (PMMR), postmortem computed tomography (PMCT), and 3D surface imaging data sets. RESULTS: PMMR revealed a space-occupying subdural hemorrhage that led to ipsilateral compression of the brain tissue of the right hemisphere. PMCT displayed a defect in the skull on the left side of the temporal bone. 3D surface imaging data displayed a patterned discoloration on the inside of the left forearm. DISCUSSION: Interactive 3D PDFs offer the possibility to communicate 3D information to the reader while maintaining all the benefits of a regular 2D PDF. With Adobe Acrobat, the reader can interactively navigate through 3D data sets and create sufficient depth cues to generate a realistic 3D perception of the data. CONCLUSION: The interactive 3D PDF is a useful extension of standard 2D PDFs and has the potential to communicate 3D data to the reader in a more complete, more comprehensible, and less subjective manner than 2D PDFs.

ALOHA: developing an interactive graph-based visualization for dietary supplement knowledge graph through user-centered design.

BACKGROUND: Dietary supplements (DSs) are widely used. However, consumers know little about the safety and efficacy of DSs. There is a growing interest in accessing health information online; however, health information, especially online information on DSs, is scattered with varying levels of quality. In our previous work, we prototyped a web application, ALOHA, with interactive graph-based visualization to facilitate consumers' browsing of the integrated DIetary Supplement Knowledge base (iDISK) curated from scientific resources, following an iterative user-centered design (UCD) process. METHODS: Following UCD principles, we carried out two design iterations to enrich the functionalities of ALOHA and enhance its usability. For each iteration, we conducted a usability assessment and design session with a focus group of 8-10 participants and evaluated the usability with a modified System Usability Scale (SUS). Through thematic analysis, we summarized the identified usability issues and conducted a heuristic evaluation to map them to the Gerhardt-Powals' cognitive engineering principles. We derived suggested improvements from each of the usability assessment session and enhanced ALOHA accordingly in the next design iteration. RESULTS: The SUS score in the second design iteration decreased to 52.2 ± 11.0 from 63.75 ± 7.2 in our original work, possibly due to the high number of new functionalities we introduced. By refining existing functionalities to make the user interface simpler, the SUS score increased to 64.4 ± 7.2 in the third design iteration. All participants agreed that such an application is urgently needed to address the gaps in how DS information is currently organized and consumed online. Moreover, most participants thought that the graph-based visualization in ALOHA is a creative and visually appealing format to obtain health information. CONCLUSIONS: In this study, we improved a novel interactive visualization platform, ALOHA, for the general public to obtain DS-related information through two UCD design iterations. The lessons learned from the two design iterations could serve as a guide to further enhance ALOHA and the development of other knowledge graph-based applications. Our study also showed that graph-based interactive visualization is a novel and acceptable approach to end-users who are interested in seeking online health information of various domains.

ECOdrug: a database connecting drugs and conservation of their targets across species.

Pharmaceuticals are designed to interact with specific molecular targets in humans and these targets generally have orthologs in other species. This provides opportunities for the drug discovery community to use alternative model species for drug development. It also means, however, there is potential for mode of action related effects in non-target wildlife species as many pharmaceuticals reach the environment through patient use and manufacturing wastes. Acquiring insight in drug target ortholog predictions across species and taxonomic groups has proven difficult because of the lack of an optimal strategy and because necessary information is spread across multiple and diverse sources and platforms. We introduce a new research platform tool, ECOdrug, that reliably connects drugs to their protein targets across divergent species. It harmonizes ortholog predictions from multiple sources via a simple user interface underpinning critical applications for a wide range of studies in pharmacology, ecotoxicology and comparative evolutionary biology. ECOdrug can be used to identify species with drug targets and identify drugs that interact with those targets. As such, it can be applied to support intelligent targeted drug safety testing by ensuring appropriate and relevant species are selected in ecological risk assessments. ECOdrug is freely accessible and available at: http://www.ecodrug.org.

Estimating drug-free period using a graphical method: an alternative way to monitor extended-interval dosing of gentamicin therapy.

OBJECTIVES: Published nomograms to monitor extended-interval dosing (EID) gentamicin therapy were based on a fixed dose of 5 or 7 mg/kg. However, the average dose used for EID gentamicin regimen in our setting was about 3 mg/kg per day. We developed a new method of monitoring based on the duration of drug-free period (DFP) in a 24-h dosing interval. METHODS: Hospitalised adult patients on EID gentamicin were selected. We considered a DFP of between 2 and 8 h as appropriate. Data from two blood samples (2 and 6 h postdose) from each patient were used to estimate the duration of DFP (i.e. DFP method 1). DFP was also calculated for the same patient using an empirically estimated elimination rate constant (Ke ) and the same 6 h postdose concentration value (DFP method 2). Correlation between the two methods was made. An alternative graphical method to estimate DFP was attempted. KEY FINDINGS: Correlation between Ke and age was favourable (r = -0.453; P = 0.001). Ke derived from this empirical relationship was used to estimate DFP method 2. DFP method 1 correlated well with DFP method 2 (r = 0.742; P < 0.001). On this basis, two curves representing minimum and maximum DFPs of 2 and 8 h, respectively, were constructed. The final coordinates, which were plotted from an empirically estimated Ke and a 6 h postdose concentration, were used to determine whether the DFP was within the targeted range. CONCLUSIONS: We have proposed using DFP to monitor EID of gentamicin therapy. A graphical method offers a convenient way to estimate this parameter.

Designing Media for Visually-Impaired Users of Refreshable Touch Displays: Possibilities and Pitfalls.

This paper discusses issues of importance to designers of media for visually impaired users. The paper considers the influence of human factors on the effectiveness of presentation as well as the strengths and weaknesses of tactile, vibrotactile, haptic, and multimodal methods of rendering maps, graphs, and models. The authors, all of whom are visually impaired researchers in this domain, present findings from their own work and work of many others who have contributed to the current understanding of how to prepare and render images for both hard-copy and technology-mediated presentation of Braille and tangible graphics.

Evaluating the accuracy of size perception on screen-based displays: Displayed objects appear smaller than real objects.

Accurate perception of the size of objects in computer-generated imagery is important for a growing number of applications that rely on absolute scale, such as medical visualization and architecture. Addressing this problem requires both the development of effective evaluation methods and an understanding of what visual information might contribute to differences between virtual displays and the real world. In the current study, we use 2 affordance judgments--perceived graspability of an object or reaching through an aperture--to compare size perception in high-fidelity graphical models presented on a large screen display to the real world. Our goals were to establish the use of perceived affordances within spaces near to the observer for evaluating computer graphics and to assess whether the graphical displays were perceived similarly to the real world. We varied the nature of the affordance task and whether or not the display enabled stereo presentation. We found that judgments of grasping and reaching through can be made effectively with screen-based displays. The affordance judgments revealed that sizes were perceived as smaller than in the real world. However, this difference was reduced when stereo viewing was enabled or when the virtual display was viewed before the real world.

RGB plots as a tool for the simultaneous visualization of multiple data layers in a two dimensional space.

Visualization of multidimensional data helps in understanding complex systems and environments. We present here a red, green, blue (RGB) visualization method that can serve to display environmental properties. The saturation of each color is used to represent the concentration of a given property. The implementation of that figure is illustrated through visualization of three dissolved inorganic nutrient concentrations along a vertical transect of the Mediterranean, as well as through a vertical time series of three phytoplankton group cell numbers. The RGB figures show well known properties of the water column. In addition, they reveal some lesser-known properties, such as regions in shallow water in which the ratio of phosphorus and silica to nitrogen is high, and a deep eukariotic phytoplankton community. Visualization of such data is usually performed with three separate contour or surface plots, and occasionally two properties are presented as an overlay in a single figure. The RGB figure offers a better way to visualize the interactions among the three separate plots than is commonly available.

Drug-induced liver injury and drug development: industry perspective.

Despite intensive ongoing research, drug-induced live injury (DILI) remains a serious issue for care providers and patients, and has been a major cause of drug withdrawal and non-approval by regulatory authorities in the past 50 years. Consequently, DILI remains a major concern for the pharmaceutical industry and a leading cause for attrition during drug development. In most instances, severe DILI is an uncommon idiosyncratic reaction, which typically does not present during preclinical phases or early clinical phases of drug development. In the majority of cases, drugs that caused severe DILI in humans have not shown clear and consistent hepatotoxic signals in preclinical assessment including animal studies, cell cultures, or other methods. Despite intensive efforts to develop better biomarkers that would help in predicting DILI risk in earlier phases of drug development, such biomarkers are currently not supported by sufficient evidence and are not yet available for routine use by drug makers. Due to the lack of effective and accurate methods for prediction of idiosyncratic DILI during preclinical phases of drug development, different drug makers have adopted different approaches, which are often not supported by strong systematic evidence. Based on growing experience, it is becoming increasingly evident that milder forms of liver injury occurring during clinical development, when assessed correctly, may significantly enhance our ability to predict the drug's potential to cause more severe liver injury postmarketing. Strategies based on this concept have been adopted by many drug makers, and are being increasingly implemented during drug development. Meticulous causality assessment of individual hepatic cases and adherence to strict hepatic discontinuation rules are critical components of this approach and have to rely on thorough clinical evaluation and occasionally on assessment by liver experts experienced with DILI and drug development.

Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis.

OBJECTIVE: To compare performance error and perceived difficulty during toe-out gait modification in people with knee osteoarthritis (OA) across 3 different types of visual feedback: mirror, raw video, and real-time biofeedback of toe-out angle. DESIGN: Repeated-measures, within-subject trial. SETTING: University motion analysis laboratory. PARTICIPANTS: Individuals with knee OA (N=20; 11 women; mean age, 65.4±9.8y) participated in this study. Seven participants had mild knee OA, 9 had moderate knee OA, and 4 had severe knee OA. INTERVENTIONS: Participants were trained to walk on a treadmill while matching a target indicating a 10° increase in stance phase toe-out compared with toe-out angle measured during self-selected walking. The target was provided visually via the 3 types of feedback listed above and were presented in a random order. MAIN OUTCOME MEASURES: Kinematic data were collected and used to calculate the difference between the target angle and the actual performed angle for each condition (toe-out performance error). Difficulty was assessed using a numerical rating scale (0-10) provided verbally by participants. RESULTS: Toe-out performance error was significantly less when using the real-time biofeedback method than when using the other 2 methods (P=.025; mean difference vs mirror=2.05°; mean difference vs raw video=1.51°). Perceived difficulty was not statistically different between the groups (P=.51). CONCLUSIONS: Although statistically significant, the 2° difference in toe-out gait performance error may not necessitate the large economic and personnel costs of real-time biofeedback as a means to modify movement in clinical or research settings.

Toward an integrated health data display for aging in place.

In a typical aging-in-place setting, electronic medical record, telemedicine data, and sensor data are used by different groups of decision makers, but the data may not be viewed in a holistic display to promote clinical decision making. Employing a user-centered design and evaluation framework, we analyzed relational data displays of congestive heart failure and provided an in-depth description of user characteristics, preferences, systems functionality, basic tasks and effective representations in such an information distributed setting. As a result, the prototypical design demonstrates our effort toward an integrated data display for chronic disease management in long-term care and clinical decision support which would enhance aging in place.

Setting semantics: conceptual set can determine the physical properties that capture attention.

The ability of a stimulus to capture visuospatial attention depends on the interplay between its bottom-up saliency and its relationship to an observer's top-down control set, such that stimuli capture attention if they match the predefined properties that distinguish a searched-for target from distractors (Folk, Remington, & Johnston, Journal of Experimental Psychology: Human Perception & Performance, 18, 1030-1044 1992). Despite decades of research on this phenomenon, however, the vast majority has focused exclusively on matches based on low-level physical properties. Yet if contingent capture is indeed a "top-down" influence on attention, then semantic content should be accessible and able to determine which physical features capture attention. Here we tested this prediction by examining whether a semantically defined target could create a control set for particular features. To do this, we had participants search to identify a target that was differentiated from distractors by its meaning (e.g., the word "red" among color words all written in black). Before the target array, a cue was presented, and it was varied whether the cue appeared in the physical color implied by the target word. Across three experiments, we found that cues that embodied the meaning of the word produced greater cuing than cues that did not. This suggests that top-down control sets activate content that is semantically associated with the target-defining property, and this content in turn has the ability to exogenously orient attention.

Assessing visual control during simulated and live operations: gathering evidence for the content validity of simulation using eye movement metrics.

BACKGROUND: Although virtual reality (VR) simulators serve an important role in the training and assessment of surgeons, they need to be evaluated for evidence of validity. Eye-tracking technology and measures of visual control have been used as an adjunct to the performance parameters produced by VR simulators to help in objectively establishing the construct validity (experts vs. novices) of VR simulators. However, determining the extent to which VR simulators represent the real procedure and environment (content validity) has largely been a subjective process undertaken by experienced surgeons. This study aimed to examine the content validity of a VR transurethral resection of the prostate (TURP) simulator by comparing visual control metrics taken during simulated and real TURP procedures. METHODS: Eye-tracking data were collected from seven surgeons performing 14 simulated TURP operations and three surgeons performing 15 real TURP operations on live patients. The data were analyzed offline, and visual control metrics (number and duration of fixations, percentage of time the surgeons fixated on the screen) were calculated. RESULTS: The surgeons displayed more fixations of a shorter duration and spent less time fixating on the video monitor during the real TURP than during the simulated TURP. This could have been due to (1) the increased complexity of the operating room (OR) environment (2) the decreased quality of the image of the urethra and associated anatomy (compared with the VR simulator), or (3) the impairment of visual attentional control due to the increased levels of stress likely experienced in the OR. CONCLUSIONS: The findings suggest that the complexity of the environment surrounding VR simulators needs to be considered in the design of effective simulated training curricula. The study also provides support for the use of eye-tracking technology to assess the content validity of simulation and to examine psychomotor processes during live operations.

Attentional engagement is not sufficient to prevent spatial capture.

What conditions, if any, can fully prevent attentional capture (i.e., involuntary allocation of spatial attention to an irrelevant object) has been a matter of debate. In a previous study, Folk, Ester, and Troemel (Psychonomic Bulletin & Review 16:127-132, 2009) suggested that attentional capture can be blocked entirely when attention is already engaged in a different object. This conclusion relied on the finding that in a search for a known-color target in a rapid serial visual presentation stream, a peripheral distractor with the target color did not further impair target identification performance when a distractor also with the target color that appeared in the stream had already captured attention. In the present study, we argue that this conclusion is unwarranted, because the effects of the central and peripheral distractors could not be disentangled. In order to isolate the effect of the peripheral distractor, we introduced a distractor-target letter compatibility manipulation. Our results showed that the peripheral distractor summoned attention, irrespective of whether attention had just been engaged. We conclude that neither spatially focused attention nor attentional engagement is sufficient to prevent attentional capture.

Visualizing health: a novel visualization method for personalized health summarization and guidance.

How to report and summarize a user's health or wellness status from the Electronic Health Records (EHR) is a important topic since a well-designed health report can provide not only a valued information source for users to exam their physical health status but also a guidance to a better health level. Existing health reports are not totally satisfying and easily bores a user by words and numeral data in them. Facial complexion is one of important indicator in the clinical diagnosis. The pathological changes of health status could often be diagnosed by inspecting the changes of facial complexion. Based on this facial complexion idea, a visualized health report, which reversely visualizes a user's health status directly on his/her outside appearance, is proposed to provide a better alternative than conventional text-based report. Due to its unique characteristic, the proposed visualized health information and guidance is expected to provide valued personalized health information and also effectively encourage users toward healthier lifestyle.

Spearcons (speech-based earcons) improve navigation performance in advanced auditory menus.

OBJECTIVE: The goal of this project is to evaluate a new auditory cue, which the authors call spearcons, in comparison to other auditory cues with the aim of improving auditory menu navigation. BACKGROUND: With the shrinking displays of mobile devices and increasing technology use by visually impaired users, it becomes important to improve usability of non-graphical user interface (GUI) interfaces such as auditory menus. Using nonspeech sounds called auditory icons (i.e., representative real sounds of objects or events) or earcons (i.e., brief musical melody patterns) has been proposed to enhance menu navigation. To compensate for the weaknesses of traditional nonspeech auditory cues, the authors developed spearcons by speeding up a spoken phrase, even to the point where it is no longer recognized as speech. METHOD: The authors conducted five empirical experiments. In Experiments 1 and 2, they measured menu navigation efficiency and accuracy among cues. In Experiments 3 and 4, they evaluated learning rate of cues and speech itself. In Experiment 5, they assessed spearcon enhancements compared to plain TTS (text to speech: speak out written menu items) in a two-dimensional auditory menu. RESULTS: Spearcons outperformed traditional and newer hybrid auditory cues in navigation efficiency, accuracy, and learning rate. Moreover, spearcons showed comparable learnability as normal speech and led to better performance than speech-only auditory cues in two-dimensional menu navigation. CONCLUSION: These results show that spearcons can be more effective than previous auditory cues in menu-based interfaces. APPLICATION: Spearcons have broadened the taxonomy of nonspeech auditory cues. Users can benefit from the application of spearcons in real devices.

Health providers' perceptions of novel approaches to visualizing integrated health information.

OBJECTIVES: We evaluated the design of three novel visualization techniques for integrated health information with health care providers in older adult care. Through focus groups, we identified generalizable themes related to the visualization and interpretation of health information. Using these themes we address challenges with visualizing integrated health information and provide recommendations for designers. METHODS: We recruited ten health care providers to participate in three focus groups. We applied a qualitative descriptive approach to code and extract themes related to the visualization of graphical displays. RESULTS: We identified a set of four common themes across focus groups related to: 1) Trust in data for decision-making; 2) Perceived level of detail for visualization (subthemes: holistic, individual components); 3) Cognitive issues (subthemes: training and experience; cognitive overload; contrast); and 4) Application of visual displays. Furthermore, recommendations are provided as part of the iterative design process for the visualizations. CONCLUSIONS: Data visualization of health information is an important component of care, impacting both the accuracy and speed of decision making. There are both functional and cognitive elements to consider during the development of appropriate visualizations that integrate different components of health.

Why the audiogram is upside-down.

Two quite sensible ways of recording audiometric threshold data emerged in the early 1920s. They were advanced by Edmund Prince Fowler, an otologist, and by Harvey Fletcher, a physicist. Either would probably have been better than the present system, and would have preserved scientific tradition relative to the orientation of the ordinates of graphs.

Using response time distributions to examine top-down influences on attentional capture.

Three experiments examined contingent attentional capture, which is the finding that cuing effects are larger when cues are perceptually similar to a target than when they are dissimilar to the target. This study also analyzed response times (RTs) in terms of the underlying distributions for valid cues and invalid cues. Specifically, an ex-Gaussian analysis and a vincentile analysis examined the influence of top-down attentional control settings on the shift and skew of RT distributions and how the shift and the skew contributed to the cuing effects in the mean RTs. The results showed that cue/target similarity influenced the size of cuing effects. The RT distribution analyses showed that the cuing effects reflected only a shifting effect, not a skewing effect, in the RT distribution between valid cues and invalid cues. That is, top-down attentional control moderated the cuing effects in the mean RTs through distribution shifting, not distribution skewing. The results support the contingent orienting hypothesis (Folk, Remington, & Johnston, Journal of Experimental Psychology: Human Perception and Performance, 18, 1030-1044, 1992) over the attentional disengagement account (Theeuwes, Atchley, & Kramer, 2000) as an explanation for when top-down attentional settings influence the selection of salient stimuli.