Usability Study on Patient Monitoring Systems: An Evaluation of a User Interface Based on User Experience and Preference.

BACKGROUND The poor ergonomic design of patient monitoring systems can cause user errors and patient harm. This paper presents the results of a comparative usability study based on user experience and the results of a user preference survey. MATERIAL AND METHODS We conducted a usability study of 3 patient monitoring systems: Mediana M50, Philips IntelliVue MP70, and Philips IntelliVue MX700. Thirty-nine Coronary Care Unit nurses and 19 Pulmonology and Allergy Care Unit nurses participated in this usability study. User experience was assessed with the Post-Study System Usability Questionnaire and the National Aeronautics and Space Administration Task Load Index. A user preference survey was conducted to evaluate the subjective medical device design preferences for the M50 system's user interface. RESULTS Nurses from the Coronary Care Unit recognized a higher system usability for the MP70 than the M50 (P=0.001) system, and a lower workload for the MP70 compared with the M50 (P=0.005) system. There was no significant (P>0.05) difference in perceived system usability and workload between the M50 and MX700 systems for the nurses from the Pulmonology and Allergy Care Unit. Nurses preferred to activate the arrhythmia alarms except for the ST alarms and missed the beat alarm. They also preferred having a wave freeze function, standby mode, and early warning scoring function, which provides a signal for a patient's deterioration in health. CONCLUSIONS The study provides valuable data on a user interface evaluation based on user experience and preference. The outcome of this study will be helpful for designing next-generation patient monitors with improved patient safety.

Topoisomerase IIIß Deficiency Induces Neuro-Behavioral Changes and Brain Connectivity Alterations in Mice.

Topoisomerase IIIß (Top3ß), the only dual-activity topoisomerase in mammals that can change topology of both DNA and RNA, is known to be associated with neurodevelopment and mental dysfunction in humans. However, there is no report showing clear associations of Top3ß with neuropsychiatric phenotypes in mice. Here, we investigated the effect of Top3ß on neuro-behavior using newly generated Top3ß deficient (Top3ß-/-) mice. We found that Top3ß-/- mice showed decreased anxiety and depression-like behaviors. The lack of Top3ß was also associated with changes in circadian rhythm. In addition, a clear expression of Top3ß was demonstrated in the central nervous system of mice. Positron emission tomography/computed tomography (PET/CT) analysis revealed significantly altered connectivity between many brain regions in Top3ß-/- mice, including the connectivity between the olfactory bulb and the cerebellum, the connectivity between the amygdala and the olfactory bulb, and the connectivity between the globus pallidus and the optic nerve. These connectivity alterations in brain regions are known to be linked to neurodevelopmental as well as psychiatric and behavioral disorders in humans. Therefore, we conclude that Top3ß is essential for normal brain function and behavior in mice and that Top3ß could be an interesting target to study neuropsychiatric disorders in humans.

Clinical Implication of Altered Inhibitory Response in Patients with Post-traumatic Stress Disorder: Electrophysiological Evidence from a Go/Nogo Task.

Inhibitory dysfunction is closely associated to post-traumatic stress disorder (PTSD). The present study investigated the neurophysiological evidence for and the brain regions related to inhibitory dysfunction in PTSD. Fifty patients with PTSD and 63 healthy controls (HCs) participated in a Go/Nogo task combined with electroencephalographic recordings. The N2-P3 complexes of event-related potentials (ERPs) elicited during the Nogo condition were compared between groups. Participants underwent structural magnetic resonance imaging to examine cortical volumes and completed questionnaires. Correlations between altered ERPs and cortical volumes of regions of interest as well as psychological symptoms were analysed. Nogo-N2 latencies at five electrode sites (Fz, FCz, Cz, CPz, and Pz) were significantly delayed in patients with PTSD compared to HCs. Nogo-N2 latency had a significant negative correlation with the volume of gyrus in the inferior frontal cortex, orbitofrontal cortex, amygdala, and medial prefrontal cortex. Nogo-N2 latency was significantly and positively correlated with catastrophizing, anxiety, and perceived threat. These findings show inhibitory dysfunction in patients with PTSD, reflected by the delay in Nogo-N2 latencies. They also indicate that Nogo-N2 latencies are associated with smaller cortical volumes responsible for inhibition as well as with major symptoms of PTSD.

Differences in Attentional Bias Toward e-Cigarette Cues Between e-Cigarette Users and Nonusers.

ABSTRACT: The use of electronic nicotine delivery systems (ENDS) has increased rapidly in recent years, particularly among young adults. There is a dearth of research on the cognitive factors that contribute to ENDS use. One of the possible cognitive mechanisms involved with addictive behavior is attentional bias (AB). AB can manifest as either facilitated attention engagement toward or delayed attention disengagement from a relevant stimulus. The purpose of this study was to examine the difference in AB toward ENDS-related cues between ENDS users and non-ENDS users. ENDS users (n = 29) and nonusers (n = 24) between the ages of 18 and 29 years participated in the dot-probe and eye-tracking picture-viewing tasks. The results showed that there was a significant difference in the variance of AB between the two groups. In the eye-tracking task, ENDS users displayed significantly greater net dwell time and fixation time at time frames of 6-9, 9-12, and 12-15 seconds, compared to nonusers. It is noteworthy that ENDS users exhibited attentional fluctuation toward ENDS cues as well as difficulties disengaging attention from ENDS cues. The current findings offer insight into the nature of attentional processes associated with ENDS cues and provide useful data to guide the development of a nurse-led cognitive intervention focusing on biased attentional processing related to ENDS cues.

Perspectives on Electronic Nicotine Delivery System Use Cessation Among Adults in Rural Areas: Implications for Future Studies.

INTRODUCTION: More young adults (age 18-24 years) in rural areas versus urban areas use electronic nicotine delivery systems (ENDS) - also known as e-cigarettes. Little is known about young adults' perceptions toward ENDS use and cessation. The objective of this study was to examine barriers and facilitators to ENDS use cessation among young adults living in rural areas, as well as their perceptions about ENDS use and cessation and to determine implications for future cessation studies. METHODS: We administered cross-sectional online surveys to young adults living in rural Midwestern counties. A total of 100 individuals responded to the surveys. Descriptive statistics were used to report their perceptions of ENDS use as well as barriers and facilitators to ENDS use cessation. The content analysis method was used to analyze the answers to an open-ended question regarding perceptions about the ENDS use cessation in the context of rural areas. RESULTS: Barriers to ENDS use cessation included perceived advantages to ENDS use, high nicotine dependence, and the perception that ENDS use was less harmful cigarettes. Facilitators to ENDS use cessation included cost of ENDS use, perceived harm, and high confidence in ability to quit. Participants' perceptions about ENDS use cessation in the context of rural areas were conceptualized under the themes of (1) exposure to and initiation of ENDS use, (2) continuation of ENDS use, and (3) prevention and cessation of ENDS use. CONCLUSIONS: Health care providers, tobacco control researchers, and public health advocates should be aware of barriers and facilitators to ENDS use cessation among young adults for future cessation intervention studies relevant specifically to rural areas.

Discovery, verification, and validation of walnut protein marker peptides using LC-MS approaches.

A key requirement of liquid chromatography-mass spectrometry (LC-MS)-based allergenic food protein analysis methods is to use protein marker peptides with good analytical performances in LC-MS analysis of commercial processed foods. In this study, we developed a multi-stage walnut protein marker peptide selection strategy involving marker peptide discovery and verification and LC-MS validation of chemically equivalent stable isotope-labeled peptides. This strategy proposed three walnut protein marker peptides, including two new marker peptides. Our LC-MS-based walnut protein analysis method using the three stable isotope-labeled peptides showed acceptable linearity (R2 >0.99), matrix effects (coefficient of variation <±15%), sensitivity (limit of detection >0.3 pg/µL, limit of quantification >0.8 pg/µL), recovery (85.1-103.4%), accuracy, and precision (coefficient of variation <10%). In conclusion, our multi-stage marker peptide selection strategy effectively selects specific protein marker peptides for sensitive detection and absolute quantification of walnut proteins in LC-MS analysis of commercial processed foods.

Does the Loudness Dependence of Auditory Evoked Potential Predict Response to Selective Serotonin Reuptake Inhibitors?: A Meta-analysis.

OBJECTIVE: Loudness of dependence of the auditory evoked potential (LDAEP) is an electroencephalogram-based measure that represents amplitude changes of auditory evoked potentials in primary auditory cortex. Several narrative reviews argued that pre-treatment LDAEP values predict responses to selective serotonin reuptake inhibitors (SSRIs). This study aims to quantify the overall relationship between baseline LDAEP values and treatment response to SSRIs in patients with depression and generalized anxiety disorders, evidenced by clinical symptoms reductions, across multiple studies. METHODS: In our meta-analysis, seven articles with a total sample of 241 patients were included. RESULTS: Our results showed that stronger baseline LDAEP values predicted favorable response to SSRIs for depression and anxiety, with a moderate effect size. CONCLUSION: The current results support the idea that LDAEP is a promising biomarker for SSRIs treatment prediction in patients with depression and generalized anxiety disorder.

Prefrontal Functional Connectivity During the Verbal Fluency Task in Patients With Major Depressive Disorder: A Functional Near-Infrared Spectroscopy Study.

Deviations in activation patterns and functional connectivity have been observed in patients with major depressive disorder (MDD) with prefrontal hemodynamics of patients compared with healthy individuals. The graph-theoretical approach provides useful network metrics for evaluating functional connectivity. The evaluation of functional connectivity during a cognitive task can be used to explain the neurocognitive mechanism underlying the cognitive impairments caused by depression. Overall, 31 patients with MDD and 43 healthy individuals completed a verbal fluency task (VFT) while wearing a head-mounted functional near-infrared spectroscopy (fNIRS) devices. Hemodynamics and functional connectivity across eight prefrontal subregions in the two groups were analyzed and compared. We observed a reduction in prefrontal activation and weaker overall and interhemispheric subregion-wise correlations in the patient group compared with corresponding values in the control group. Moreover, efficiency, the network measure related to the effectiveness of information transfer, showed a significant between-group difference [t (71.64) = 3.66, corrected p < 0.001] along with a strong negative correlation with depression severity (rho = -0.30, p = 0.009). The patterns of prefrontal functional connectivity differed significantly between the patient and control groups during the VFT. Network measures can quantitatively characterize the reduction in functional connectivity caused by depression. The efficiency of the functional network may play an important role in the understanding of depressive symptoms.

Frontal Alpha Asymmetry Moderated by Suicidal Ideation in Patients with Major Depressive Disorder: A Comparison with Healthy Individuals.

OBJECTIVE: Frontal alpha asymmetry (FAA) of electroencephalography (EEG) has been studied to differentiate patients with major depressive disorder (MDD) from healthy controls (HC). However, inconsistent results have been obtained thus far. Suicidal ideation (SI) has been known to alter frontal lobe activity, and could be an important covariate in FAA studies. This study aimed to explore the influence of FAA on the relationship among MDD patients with SI and without SI, and HC. METHODS: Sixty-seven patients with MDD (44 without and 23 with SI) and 60 HCs were recruited. Resting state EEG was recorded with their eyes open, and FAA as a lateralized index of alpha power was calculated in the frontal brain region. Hamilton Rating Scale for Anxiety and Depression scores were estimated. RESULTS: FAA was higher (increased alpha power in the left frontal region) in the MDD group than in the HC group. The FAA was lower (reduced alpha power in the left frontal region) in MDD patients with SI than in MDD patients without SI. The severity of depression and anxiety symptoms were significantly correlated with FAA only in MDD patients with SI. SI moderated the effects of depressive symptom on FAA in the MDD group. CONCLUSION: Our results suggest that SI is a clinically important moderator of frontal alpha asymmetry in patients with MDD.

Interaction between catechol-O-methyltransferase polymorphism and childhood trauma in suicidal ideation of patients with post-traumatic stress disorder.

INTRODUCTION: Suicidal behavior of post-traumatic stress disorder (PTSD) patients is influenced by genetic and environmental factors. The catechol-O-methyltransferase (COMT) gene has been known to be associated with suicidal ideation. The present study aimed to explore the relationship of COMT polymorphism, childhood trauma, and suicidal ideation in patients with PTSD. METHODS: Fifty patients with PTSD and 62 healthy controls (HCs) were recruited, and COMT variants rs4680 and rs4633 were genotyped through peripheral blood. Psychological assessments such as the childhood trauma questionnaire (CTQ), the scale for suicidal ideation, the clinician-administered PTSD scale for DSM-5, and a PTSD checklist were administered. A regression analysis, the Johnson-Neyman technique, and a two-way analysis of covariance were conducted. RESULTS: Interaction of COMT polymorphism (rs4680, rs4633) and childhood emotional abuse (subscale of CTQ) predicted suicidal ideation in patients with PTSD. Patients with the rs4680 Val/Val genotype, compared to Met carriers genotype, showed higher suicidal ideation when childhood emotional abuse was high. Patients with the rs4633 CC genotype, compared to T carriers genotype, showed higher suicidal ideation when childhood emotional abuse was high. CONCLUSION: Our results suggest that vulnerability to suicide could be increased in the Val/Val genotype of COMT rs4680 and the CC genotype of rs4633 in patients with PTSD. Moreover, PTSD group with high childhood emotional abuse demonstrated a significantly higher suicidal ideation than did those with low childhood emotional abuse.

Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia.

OBJECTIVE: While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. METHODS: A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. RESULTS: Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. CONCLUSION: Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.

Neurophysiological and Psychological Predictors of Social Functioning in Patients with Schizophrenia and Bipolar Disorder.

OBJECTIVE: The aim of this study is to examine social functioning in patients with schizophrenia and bipolar disorder and explore the psychological and neurophysiological predictors of social functioning. METHODS: Twenty-seven patients with schizophrenia and thirty patients with bipolar disorder, as well as twenty-five healthy controls, completed measures of social functioning (questionnaire of social functioning), neurocognition (Verbal fluency, Korean-Auditory Verbal Learning Test), and social cognition (basic empathy scale and Social Attribution Task-Multiple Choice), and the childhood trauma questionnaire (CTQ). For neurophysiological measurements, mismatch negativity and heart rate variability (HRV) were recorded from all participants. Multiple hierarchical regression was performed to explore the impact of factors on social functioning. RESULTS: The results showed that CTQ-emotional neglect significantly predicted social functioning in schizophrenia group, while HRV-high frequency significantly predicted social functioning in bipolar disorder patients. Furthermore, emotional neglect and HRV-HF still predicted social functioning in all of the subjects after controlling for the diagnostic criteria. CONCLUSION: Our results implicated that even though each group has different predictors of social functioning, early traumatic events and HRV could be important indicators of functional outcome irrespective of what group they are.

Prefrontal Asymmetry during Cognitive Tasks and its Relationship with Suicide Ideation in Major Depressive Disorder: An fNIRS Study.

Reduced oxygenation changes in the prefrontal cortex during cognitive tasks have been reported in major depressive disorder (MDD). However, prefrontal asymmetry during cognitive tasks and its relation to suicide ideations have been less frequently examined in patients with MDD. This study investigated prefrontal asymmetry and its moderating effect on the relationship between depression severity and suicidal ideation in MDD patients during cognitive tasks. Forty-two patients with MDD and 64 healthy controls (HCs) were assessed for changes in oxygenated and deoxygenated hemoglobin (Hb) in the prefrontal cortex using functional near-infrared spectroscopy (fNIRS) during the verbal fluency task (VFT), Stroop task, and two-back task. Depression, anxiety, and suicide ideation were measured through self-report questionnaires. Relatively smaller left oxy-Hb changes during VFT, but not during the Stroop or two-back tasks, were found in MDD patients compared with HCs. Furthermore, prefrontal asymmetry during VFT moderated the effect of depression severity on suicide ideation, and was significantly and positively correlated with suicide ideation in patients with MDD. Specifically, relatively greater left oxy-Hb changes were associated with greater suicide ideation. These findings suggest fNIRS-measured prefrontal asymmetry as a potential biomarker for MDD and for the assessment of suicidal risk in patients with MDD.