Sensor-based proximity metrics for team research. A validation study across three organizational contexts.

Wearable sensors are becoming increasingly popular in organizational research. Although validation studies that examine sensor data in conjunction with established social and psychological constructs are becoming more frequent, they are usually limited for two reasons: first, most validation studies are carried out under laboratory settings. Only a handful of studies have been carried out in real-world organizational environments. Second, for those studies carried out in field settings, reported findings are derived from a single case only, thus seriously limiting the possibility of studying the influence of contextual factors on sensor-based measurements. This article presents a validation study of expressive and instrumental ties across nine relatively small R&D teams. The convergent validity of Bluetooth (BT) detections is reported for friendship and advice-seeking ties under three organizational contexts: research labs, private companies, and university-based teams. Results show that, in general, BT detections correlated strongly with self-reported measurements. However, the organizational context affects both the strength of the observed correlation and its direction. Whereas advice-seeking ties generally occur in close spatial proximity and are best identified in university environments, friendship relationships occur at a greater spatial distance, especially in research labs. We conclude with recommendations for fine-tuning the validity of sensor measurements by carefully examining the opportunities for organizational embedding in relation to the research question and collecting complementary data through mixed-method research designs.

Disclosure of harmful medical errors in out-of-hospital care.

Safety experts and national guidelines recommend disclosing harmful medical errors to patients. Communicating with patients and families about errors respects their autonomy, supports informed decisionmaking, may decrease malpractice costs, and can enhance patient safety. Yet existing disclosure guidelines may not account for the difficulty in discussing out-of-hospital errors with patients. Emergency medical services (EMS) providers operate in unpredictable environments that require rapid interventions for patients with whom they have only brief relationships. EMS providers also have limited access to patient medical data and risk management resources, which can make conducting disclosure conversations even more difficult. In addition, out-of-hospital errors may be discovered only after the transition of care to the inpatient setting, further complicating the question of who should disclose the error. EMS organizations should support the disclosure of out-of-hospital errors by fostering a nonpunitive culture of error reporting and disclosure, as well as developing guidelines for use by EMS systems.

Does the emergency medical treatment and labor act affect emergency department use?

BACKGROUND: Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA). STUDY OBJECTIVE: To determine whether modifying EMTALA might reduce ED use. METHODS: We surveyed ED patients to assess their knowledge of hospitals' obligations to treat all patients regardless of insurance and to determine whether knowledge is associated with ED use. RESULTS: Among 4136 study subjects, 72% reported awareness of the law. Sixty-one percent of subjects were moderate ED users (≥ 1 additional ED visit in 12 months). Moderate users more often knew the law (74% vs. 70%, p=0.005). Multivariate regression showed that factors associated with moderate use were: awareness of EMTALA (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.24-1.67), adult patient (OR 1.94; 95% CI 1.69-2.22), and government insurance (OR 2.67; 95% CI 2.30-3.08) or uninsured (OR 1.72; 95% CI 1.42-2.08). Only 8% of subjects were high-frequency users (≥5 visits). High-frequency users were more often aware of EMTALA (78% vs. 72%, p=0.02). Covariates associated with high frequency were EMTALA awareness (OR 1.69; 95% CI 1.28-2.24), adult patient (OR 2.59; 95% CI 2.00-3.36), and government insurance (OR 3.73; 95% CI 2.76-5.06) or uninsured (OR 3.77; 95% CI 2.65-5.35). CONCLUSION: Many patients know that the law requires hospitals to provide care. This knowledge is associated with more frequent ED use. EMTALA changes might reduce ED use, but broader policy implications should be considered.

Motivations Behind Lifestyle Changes.

Lifestyle modification has been demonstrated as a powerful tool in combating the morbidity and mortality of disease. Due to lack of training or education not enough physicians are discussing lifestyle changes with patients. The objective of this study was to determine what influenced participants to make lifestyle changes, and if it was a physician, what was said or done to motivate that decision. Inclusion criterion was participants were enrolled in a program dedicated to dietary modifications. One hundred participants were surveyed. Eighty-eight percent were over the age of 50; 78% were female; 92% were White; and 70% had a bachelor's degree or higher. Sixty-eight percent felt they had not been educated by their health care provider about nutrition; 41% of participants felt information provided was the most impactful statement; 60% of participants noted that their medical diagnosis had a moderate to significant impact on their decision to make a lifestyle change. This study emphasizes that dietary modifications are not being discussed enough to alter the health decisions of patients in the clinical setting. Furthermore, it is paramount physicians take into account patient motivations when discussing lifestyle changes, as well as the role that proper patient education plays in motivating patients to make a change.

Long-Term Subjective Functional Outcomes of Prostate Cancer: Prostatectomy vs Radiation.

BACKGROUND: Long-term subjective outcomes of prostate cancer are relatively unknown. The Oregon Urology Institute (OUI) has been collecting subjective functional outcome data to help determine the long-term subjective outcomes of prostatectomy vs radiation therapy. METHODS: Patients treated at OUI completed interval post-treatment questionnaires that assessed: urinary, bowel, sexual, and hormonal function, and overall treatment satisfaction. Two cohorts were established: prostatectomy vs radiation. Results from each cohort were compared and analyzed with a linear mixed effect model. RESULTS: Our longitudinal dataset includes a prostatectomy cohort of 410 patients and radiation therapy cohort of 416 patients surveyed at the 3-month interval, but the number of patients decreased after each time interval (ie 3, 6, 9, and 12 months and then annually for up till 14 years post-treatment). Urinary and sexual functional scores decreased by 4% and 8% after radiation, whereas prostatectomy had a 5% and 13% increase over time post-treatment, respectively. Over time, patients treated with prostatectomy were found to be more satisfied with the outcome of their treatment than patients receiving radiation therapy. CONCLUSION: Prostatectomy and radiation therapy had impacts on quality of life measurements that emphasize the importance of making the best-informed decision in each unique situation.

Challenging assumptions about uninsured children in the pediatric emergency department.

OBJECTIVE: Emergency departments (EDs) are experiencing increased volumes and crowding problems. Although crowding is often blamed on uninsured patients, the role of uninsured children is unclear. We compared ED use by insured and uninsured children. METHODS: Parents of children presenting at a tertiary care pediatric hospital ED were surveyed to determine health insurance coverage and frequency of ED use. Hospital billing records were reviewed separately to validate our survey results. Results were compared with Census Bureau data on the prevalence of uninsured children. RESULTS: We enrolled 2024 participants in the survey arm. Of all children 48.4% (n = 972) were privately insured, 42.1% (n = 846) have government insurance, and 9.5% (n = 191) were uninsured. Billing records showed that 10.2% (n = 3825) of pediatric ED patients during the previous year were uninsured. Census data showed that 13% of children statewide were uninsured. Among survey subjects, uninsured children were more likely than privately insured children (53% vs 42%), but less likely than children with government insurance (67%), to have moderate ED use (≥1 additional ED visit in 12 months; P < 0.001) or frequent ED use (≥5 visits in 12 months; 4% vs 2% vs 8%; P < 0.001). When private and government insurance categories were combined, uninsured children showed no greater likelihood of moderate ED use (53% vs 53%, P = 0.89) or frequent ED use (4% vs 5%, P = 0.71) than insured children did. CONCLUSIONS: Uninsured pediatric patients were not disproportionately represented in the ED population. Moreover, uninsured children were not more likely than insured children to be moderate or frequent ED users.

Tribological Performance of Additively Manufactured AISI H13 Steel in Different Surface Conditions.

Additive manufacturing of metallic tribological components offers unprecedented degrees of freedom, but the surface roughness of most as-printed surfaces impedes the direct applicability of such structures, and postprocessing is necessary. Here, the tribological performance of AISI H13 steel samples was studied. These were additively manufactured through laser powder bed fusion (L-PBF), also referred to as selective laser melting (SLM). Samples were tested in four different surface conditions: as-printed, polished, ground and polished, and laser-surface-textured (LST) with round dimples. Friction experiments were conducted in a pin-on-disk fashion against bearing steel disks under lubrication with an additive-free mineral base oil for sliding speeds between 20 and 170 mm/s. Results demonstrated that, among the four surface treatments, grinding and polishing resulted in the lowest friction coefficient, followed by the as-printed state, while both polishing alone and laser-surface texturing increased the friction coefficient. Surprisingly, direct correlation between surface roughness and friction coefficient, i.e., the rougher the surface was, the higher the friction force, was not observed. Wear was minimal in all cases and below what could be detected by gravimetrical means. These results highlight the need for an adequate post-processing treatment of additively manufactured parts that are to be employed in tribological systems.

Abusive head trauma in children presenting with an apparent life-threatening event.

OBJECTIVE: To identify rates of abusive head trauma and associated clinical risk factors in patients with an apparent life-threatening event (ALTE). STUDY DESIGN: Retrospective study of infants, 0 to 12 months, admitted for an apparent life-threatening event (ALTE; 1999-2003). Patients with abusive head trauma were identified at presentation or on follow-up; statistical analysis identified characteristics associated with abusive head trauma. RESULTS: Of 627 patients with ALTE, 48% were male. Nine (1.4%) were diagnosed with abusive head trauma, of whom 5 were diagnosed in the emergency department. All cases detected in the emergency department had physical examination findings indicative of abusive head trauma. Patient age, male sex, or ethnicity were not significantly different between those with and without abusive head trauma. More children with abusive head trauma had a documented 911 call (56% vs 22%, P = .029), vomiting (56% vs 19%, P = .018), or irritability (22% vs 3%, P = .033). Multivariate analysis revealed odds ratio for abusive head trauma were 4.9 with a 911 call (P = .037), 5.3 with vomiting (P = .024), and 11.9 with irritability (P = .0197). CONCLUSIONS: Abusive head trauma is in the differential for infants with an ALTE, although almost half of the cases are missed by current emergency department management. Vomiting, irritability, or a call to 911 are significantly associated with heightened risk for abusive head trauma.

Prediction of child abuse risk from emergency department use.

OBJECTIVE: To examine whether pre-abuse rates and patterns of emergency department (ED) visits between children with supported child abuse and age-matched control subjects are useful markers for abuse risk. STUDY DESIGN: A population-based case-control study using probabilistic linkage of four statewide data sets. Cases were abused children <13 years of age, identified between January 1, 2002, and December 31, 2002. For each case, a birth date-matched, population-based control was obtained. Outcome measures were rate ratios of ED visits in cases compared with control subjects. RESULTS: Cases (n = 9795) and control subjects (n = 9795) met inclusion criteria; 4574 cases (47%) had an ED visit; thus linked to the ED database versus 2647 control subjects (27%). The crude ED visit rate per 10,000 person-days of exposure was 8.2 visits for cases compared with 3.9 visits for control subjects. Cases were almost twice as likely as control subjects (adjusted rate ratio = 1.8; 95% CI, 1.5, 1.8) to have had a prior ED visit. Leading ED discharge diagnoses were similar for both groups. CONCLUSIONS: Children with supported child abuse have higher ED use before abuse diagnosis, when compared with the general pediatric population. However, neither the rate of ED use nor the pattern of diagnoses offers sufficient specificity to be useful markers of risk for abuse.

Narrative review: do state laws make it easier to say "I'm sorry?".

Initiatives intended to reduce the frequency and impact of medical errors generally rely on recognition and disclosure of medical errors. However, fear of malpractice liability is a barrier to physician disclosure. Some U.S. state legislatures have attempted to encourage physicians to disclose medical errors by enacting "apology laws." The authors reviewed the codified statutes of each of the 50 states and the District of Columbia to determine the prevalence and characteristics of such apology laws. They found that many states have recently adopted apology laws and that there is variability in these laws. The authors review some of the important differences in these laws and explore the potential impact of apology laws.

The reimbursement gap: providing and paying for pediatric procedural sedation in the emergency department.

A number of medical, ethical, and legal obligations compel physicians to provide procedural sedation and analgesia (PSA) to pediatric patients requiring painful procedures in the emergency department (ED). Recognizing the additional demands that PSA places on ED physicians, the American Medical Association has approved Current Procedural Terminology codes for PSA in conjunction with ED procedures. However, some insurers have indicated reluctance or refusal to pay for PSA in the ED, despite these Current Procedural Terminology codes and the legal and ethical imperatives. This reimbursement gap between an obligation to provide care and an inability to obtain reimbursement from insurers places ED physicians who care for children in an awkward position. This article reviews physicians' legal and ethical obligations to provide PSA to pediatric patients in the ED, assesses health insurers' obligations to pay for this procedure, and examines insurers' policies and practices. We found significant variability among private and public insurers in their willingness to pay for PSA. Emergency department PSA charges at one tertiary care pediatric center are reimbursed at less than half the rate of other ED services. Although existing state laws and federal regulations arguably require that insurers provide reimbursement for pediatric PSA, certain legislative and regulatory initiatives could clarify insurers' payment obligations.

Using Sensors in Organizational Research-Clarifying Rationales and Validation Challenges for Mixed Methods.

Sensor-based data are becoming increasingly widespread in social, behavioral, and organizational sciences. Far from providing a neutral window on "reality," sensor-based big-data are highly complex, constructed data sources. Nevertheless, a more systematic approach to the validation of sensors as a method of data collection is lacking, as their use and conceptualization have been spread out across different strands of social-, behavioral-, and computer science literature. Further debunking the myth of raw data, the present article argues that, in order to validate sensor-based data, researchers need to take into account the mutual interdependence between types of sensors available on the market, the conceptual (construct) choices made in the research process, and the contextual cues. Sensor-based data in research are usually combined with additional quantitative and qualitative data sources. However, the incompatibility between the highly granular nature of sensor data and the static, a-temporal character of traditional quantitative and qualitative data has not been sufficiently emphasized as a key limiting factor of sensor-based research. It is likely that the failure to consider the basic quality criteria of social science measurement indicators more explicitly may lead to the production of insignificant results, despite the availability of high volume and high-resolution data. The paper concludes with recommendations for designing and conducting mixed methods studies using sensors.

The clinical presentation of pediatric thoracolumbar fractures: a prospective study.

BACKGROUND: Thoracolumbar spine (TLS) fractures are rare in the pediatric population but may result in significant morbidity, necessitating a prompt diagnosis. No formal recommendations have been made for screening pediatric trauma patients for TLS fractures; early diagnosis has traditionally relied on clinical parameters extrapolated from adult data. METHODS: From March 2004 to April 2005 patients presenting to a level one pediatric trauma center were consecutively enrolled. Clinicians were asked to assess eligible patients and prospectively state their TLS examination findings and degree of clinical suspicion for fracture. RESULTS: A total of 228 patients were enrolled (mean age of 8.2 years), 16 with TLS fractures. Clinical performance of the TLS spine examination diagnosed a fracture with a sensitivity of 81% (95% CI: 0.57, 0.93), specificity of 68% (0.62, 0.74), and odds ratio of 9.38 (2.59, 34.01). A clinician's degree of suspicion detected a TLS fracture with a sensitivity of 56% (95% CI: 0.33, 0.77), specificity of 82% (0.77, 0.87), and odds ratio of 6.08 (2.13, 17.37). CONCLUSIONS: The clinician is able to clinically diagnose TLS fractures in pediatric trauma patients with good sensitivity and average specificity, however, TLS fractures were missed. Screening radiographs may still be required until larger studies confirm these findings.

Capnography and depth of sedation during propofol sedation in children.

STUDY OBJECTIVE: To evaluate the relationship between continuous capnography and observed airway and respiratory adverse effects and the depth of sedation when using propofol for pediatric orthopedic procedures. METHODS: We administered propofol after opioid premedication in a prospective convenience sample of children undergoing orthopedic reduction in our emergency department (ED). All children received supplemental oxygen (1 L/minute by nasal cannula) and continuous capnography and had depth of sedation assessed every 2 minutes. Adverse airway or respiratory events and any associated interventions were recorded. RESULTS: Adverse airway or respiratory events with intervention occurred in 14 of the 125 enrolled children (11%; 95% confidence interval 4.0% to 14%): jaw thrust in 4, supplemental oxygen in 6, and bag-valve-mask ventilation in 4. All interventions required were brief (<30 seconds). Capnography detected apnea before clinical examination or pulse oximetry in all 5 occurrences and similarly first detected airway obstruction in 6 of the 10 occurrences. The median maximal modified Ramsay score was 6 (range 3 to 8), ie, deep sedation. CONCLUSION: When propofol is administered for ED deep sedation to facilitate pediatric orthopedic reduction, continuous capnography detects most airway and respiratory events leading to intervention before clinical examination or pulse oximetry.

Pediatric emergency medicine physicians' current practices and beliefs regarding mental health screening.

BACKGROUND: Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population. OBJECTIVE: To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening. METHODS: A 23-question survey on screening practices for pediatric mental illness (PMI) was sent to PEM physician participants identified through the American Academy of Pediatrics Section on Emergency Medicine mailing list. RESULTS: Of the 576 physicians meeting our inclusion criteria, 384 (67%) surveys were returned. Eighty-six percent of respondents indicated screening for PMI in 10% or less of their eligible patients. Overall, 43% of respondents indicated screening only if the chief complaint was psychiatric in nature. The remaining 217 physicians most commonly screened for depression (83%), suicidality (76%), and substance abuse (67%). Only 9% of physicians stated that they used evidence-based medicine in determining their screening practices. Women physicians (odds ratio, 1.94; 95% confident interval, 1.08-3.47) and those using evidence-based medicine (odds ratio, 3.88; 95% confidence interval, 1.92-7.85) were more likely to conduct screening. Significant limitations to screening identified by respondents include the following: time limitations (93%), absence of a validated screening tool (62%), limited resources (46%), and lack of training (44%). Eighty-eight percent of physicians believe that a validated and standardized screening tool would improve their ability to identify PMI. CONCLUSIONS: Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.

Assessment of Research Interests of First-Year Osteopathic Medical Students.

CONTEXT: According to a 2014 survey, 59% of students entering allopathic medical school reported previous research experience. However, limited data exist on the amount of research experience that students have before entering osteopathic medical school. A strong understanding of the research skills and level of interest of first-year osteopathic medical students is essential for developing research programs at osteopathic medical schools. Limited data exist on the amount of research experience that students have before starting osteopathic medical school. A strong understanding of the research skills and level of interest of first-year medical students is essential for developing research programs at osteopathic medical schools. OBJECTIVE: To determine the amount of previous research experience of first-year osteopathic medical students, their level of interest in participating in research during medical school, the factors influencing their interest in research, and their research fields of interest. METHODS: First-year osteopathic medical students (class of 2019) at the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific in Pomona, California (WesternU/COMP), and Pacific-Northwest in Lebanon, Oregon (WesternU/COMP-Northwest), campuses were surveyed about their previous research experiences and whether they were interested in participating in research during medical school. Surveys were administered through an anonymous online portal. Responses were evaluated for evidence of interest in conducting research. RESULTS: Of the 346 osteopathic medical students invited to participate in the study, the response rate was 77% (N=266). A total of 167 from WesternU/COMP and 99 from the WesternU/COMP-Northwest responded. More than 215 students (81%) reported they had participated in research before entering medical school. In addition, 200 students (75%) either expressed a strong interest in participating in research during medical school or were currently conducting research. Among research areas, clinical research was the overwhelming favorite, with 218 students (82%) expressing interest. CONCLUSION: First-year osteopathic students may have comparable amounts of research experience as allopathic medical students. Although these findings are limited to 2 campuses of 1 osteopathic medical school, they suggest that first-year osteopathic medical students are highly motivated to participate in research while in medical school.

Differences in herbal and dietary supplement use in the Hispanic and non-Hispanic pediatric populations.

BACKGROUND: Complementary and alternative medical therapies are becoming increasingly popular in the general population. OBJECTIVE: To describe the cultural differences in the use of herbal and dietary supplements in the Hispanic and non-Hispanic-Caucasian outpatient pediatric populations. METHODS: Questionnaires were administered over a 2-month period to a convenience sample of adolescents and parents of patients younger than 12 years, presenting to an emergency department, an urban private pediatric practice, and a community-based clinic. RESULTS: There were 643 surveys completed. Ethnic distribution was 65% Caucasian, 27% Hispanic, 2% Pacific Islander, and 1% each Asian, African American and Native American. Mean respondent age was 30.8 years. Mean child age was 4.6 years; 51% were male. Use of nonprescribed dietary supplements was significantly greater in Hispanic (33%) versus Caucasian children (9%) (P < 0.01); most commonly used supplements were herbal teas (56%) and echinacea (14%). More Hispanic respondents reported receiving information on herbal preparations from a family member compared with non-Hispanic patients (56.0% vs. 18.7%). Complementary and alternative medicine use had not been discussed with a health care provider by 38% of the total users and 47% of those thought it not important to do so. CONCLUSIONS: There is significant use of complementary and alternative medicine in the pediatric population, and herbal and dietary supplement use varies between Hispanic and Caucasian children. In addition, this dietary supplement use is often not discussed with health care providers. These factors should be taken into consideration by all health care providers.

Gastric trichobezoar: an important cause of abdominal pain presenting to the pediatric emergency department.

Abdominal pain is a common presenting complaint of children seen in urgent care settings. It is the manifestation of a wide variety of disease processes ranging from benign to immediately life-threatening. Gastric bezoars are among the etiologies of chronic childhood abdominal pain that, when undiagnosed, may result acutely in serious complications, including gastric ulceration, bleeding and perforation, intussusception, and small bowel obstruction. To reinforce the importance of including this entity in the differential diagnosis of abdominal pain, we present the case of a 10-year-old girl with a history of chronic epigastric complaints who was ultimately presented with acute small bowel obstruction following fragmentation and distal migration of her gastric trichobezoar. Finally, we review and briefly summarize the current literature regarding the etiology, diagnosis, and management of this disorder in children.

Seizures in children following an apparent life-threatening event.

The characteristics of seizures and epilepsy in infants who have had an apparent life-threatening event have been poorly defined. Our objective was to characterize in depth the cohort of patients with apparent life-threatening events who developed seizures. We collected data from infants hospitalized for an apparent life-threatening event, and evaluated patients for subsequent seizures or chronic epilepsy. Of 471 patients with an apparent life-threatening event, 25 (5.3%) had seizures and 17 (3.6%) developed chronic epilepsy. There was no increased risk for febrile seizures. Abnormal brain magnetic resonance imaging results and developmental delay were only found in those patients who developed chronic epilepsy. Of those who developed chronic epilepsy, 47% were diagnosed with seizures within 1 week of their apparent life-threatening event. The discharge diagnosis at the time of the apparent life-threatening event was poorly predictive of those who developed seizures. In most cases the cause of chronic epilepsy was unknown, although cortical dysplasias made up a significant percentage (12%).