Avoid equipment graveyards: rigorous process to improve identification and procurement of effective, affordable, and usable newborn devices in low-resource hospital settings.

BACKGROUND: Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals with appropriate technology to care for small and sick newborns. Expensive medical devices designed for high-resource settings often fail to withstand conditions in low-resource hospitals, including humidity, dust, frequent user turnover, complex maintenance, lack of stable power, or difficulty sourcing expensive consumables. Rigorous evaluation protocols are needed to identify effective, affordable, rugged, and easy-to-use medical devices appropriate for quality hospital-based newborn care in low-resource hospitals. METHODS: We developed an evidence-based technology review process to identify medical devices suitable for small and sick newborn care in low-resource hospitals. The eight-step process consists of: identifying devices needed for effective newborn care; defining Target Product Profiles (TPPs); identifying commercially-available products that may meet TPPs; conducting desk research to evaluate technologies against TPPs; performing technical performance verification testing under laboratory conditions; verifying technical performance after exposure to heat, humidity, dust, and power loss; performing usability evaluations with nurses, and qualifying devices that pass all steps. Devices were purchased, installed, and monitored in newborn wards across Kenya, Malawi, Nigeria, and Tanzania. RESULTS: Of 271 devices considered, only 45 (16.6%) met corresponding TPPs based on desk research. Thirty-nine were purchased and evaluated in the laboratory; five (12.8%) failed to meet TPPs. Thirty-four products passing laboratory evaluation underwent short-term environmental testing; only one (2.9%) device failed. Thirty-seven products underwent usability testing with 127 clinicians; surprisingly, 14 (37.8%) failed to meet TPPs. Twenty-three products passed all evaluations, and 2457 devices were installed across 65 newborn wards in Kenya, Malawi, Nigeria, and Tanzania. Continuous device monitoring reported minimal device failures, with failed devices typically returned to service within two days, resulting in an average uptime (service days divided by days installed) of 99%. CONCLUSION: An evidence-based device selection process can improve procurement of effective, affordable, rugged, usable newborn care devices for low-resource hospitals, and feedback to manufacturers can improve device quality. Similar processes could be adapted beyond newborn care to identify medical devices suitable for implementation in any low-resource setting.

Summative Usability Assessments of STAR-Vote: A Cryptographically Secure e2e Voting System That Has Been Empirically Proven to Be Easy to Use.

BACKGROUND: From the project's inception, STAR-Vote was intended to be one of the first usable, end-to-end (e2e) voting systems with sophisticated security. To realize STAR-Vote, computer security experts, statistical auditors, human factors (HF)/human-computer interaction (HCI) researchers, and election officials collaborated throughout the project and relied upon a user-centered, iterative design and development process, which included human factors research and usability testing, to make certain the system would be both usable and secure. OBJECTIVE: While best practices in HF/HCI methods for design were used and all apparent usability problems were identified and fixed, summative system usability assessments were conducted toward the end of the user-centered design process to determine whether STAR-Vote is in fact easy to use. METHOD AND RESULTS: After collecting efficiency, effectiveness, and satisfaction measurements per ISO 9241-11's system usability criteria, an analysis of the data revealed that there is evidence for STAR-Vote being the most usable, cryptographically secure voting system to date when compared with the previously tested e2e systems: Helios, Prêt à Voter, and Scantegrity. CONCLUSION AND APPLICATION: STAR-Vote being one of the first e2e voting systems that is both highly usable and secure is a significant accomplishment, because tamper-resistant voting systems can be used in U.S. elections to ensure the integrity of the electoral process, while still ensuring that voter intent is accurately reflected in the cast ballots. Moreover, this research empirically shows that a complex, secure system can still be usable-meaning that implemented security is not an excuse for poor usability.

Is It Time to Go Positive? Assessing the Positively Worded System Usability Scale (SUS).

OBJECTIVE: The goal of the research presented in this paper was to determine if the positively worded System Usability Scale (SUS) can be used in place of the positively and negatively worded standard SUS instrument for the subjective assessment of usability, and whether the results found here replicate those of Sauro and Lewis. BACKGROUND: Sauro and Lewis' previous study found no evidence that responses to SUS items differed across the standard SUS and the modified, positively worded version of the SUS when participants assessed websites. This study replicates and extends this work by examining a large number of different systems with larger sample sizes to add to the generalizability of previous findings. METHODS: So that participants could retrospectively assess 20 products, the standard SUS was administered to 268 participants and the positive SUS to 698 participants. SUS scores were computed and the data analyzed using psychometric methods to explore how the two versions of the SUS differed. RESULTS: The standard and positive versions of the SUS yielded similar SUS scores. In addition, both versions of the scale demonstrated evidence in support of reliability and validity. CONCLUSION: Either version of the SUS can be used with confidence to measure subjective usability. Furthermore, the scores generated from both versions of the SUS can be directly compared. APPLICATIONS: In situations where cognitive load, participants' spoken language, or item consistency with other surveys being given may be a factor, the positive SUS is a viable alternative to the standard SUS.

How Human Factors Can Help Preserve Democracy in the Age of Pandemics.

OBJECTIVE: To describe user-centered voting systems that would support the safe conduct of voting in a pandemic environment. BACKGROUND: The COVID-19 pandemic has complicated our democratic processes. Voters and poll workers feel threatened by the potential dangers of voting in business-as-usual polling stations. Indeed, significant problems were encountered in the recent 2020 primary elections in Wisconsin, where the National Guard had to be mobilized because so few poll workers reported to work, and more than 90% of polling places had to remain closed. METHOD: We describe a number of possible user-centered solutions that would help protect voters and poll workers in times of pandemic, and also report the results of a survey that asked voters and poll workers about what kinds of systems might make them willing to vote. RESULTS: Political as well as safety considerations will need to be considered as these safer voting solutions are designed since, surprisingly, the kinds of solutions preferred depend on the political affiliation of the voters. CONCLUSION: Human factors professionals have a large role to play in realizing the safe, successful implementation of these user-centered systems. Good human factors analysis can help minimize the risk to voters and poll workers. Moreover, human factors methods can help safeguard democracy by creating safe and well-engineered environments that are conducive to voting in the age of pandemics. APPLICATION: Creating safe and effective voting solutions that protect voters and poll workers during pandemic outbreaks is crucial to the preservation of democracy.