Evaluation of pain related behaviors and disease related outcomes in an immunocompetent mouse model of prostate cancer induced bone pain.

Cancer-induced bone pain (CIBP) is the most common and devastating symptom of bone metastatic cancer that substantially disrupts patients' quality of life. Currently, there are few effective analgesic treatments for CIBP other than opioids which come with severe side effects. In order to better understand the factors and mechanisms responsible for CIBP it is essential to have clinically relevant animal models that mirror pain-related symptoms and disease progression observed in patients with bone metastatic cancer. In the current study, we characterize a syngeneic mouse model of prostate cancer induced bone pain. We transfected a prostate cancer cell line (RM1) with green fluorescent protein (GFP) and luciferase reporters in order to visualize tumor growth longitudinally in vivo and to assess the relationship between sensory neurons and tumor cells within the bone microenvironment. Following intra-femoral injection of the RM1 prostate cancer cell line into male C57BL/6 mice, we observed a progressive increase in spontaneous guarding of the inoculated limb between 12 and 21 days post inoculation in tumor bearing compared to sham operated mice. Daily running wheel performance was evaluated as a measure of functional impairment and potentially movement evoked pain. We observed a progressive reduction in the distance traveled and percentage of time at optimal velocity between 12 and 21 days post inoculation in tumor bearing compared to sham operated mice. We utilized histological, radiographic and µCT analysis to examine tumor induced bone remodeling and observed osteolytic lesions as well as extra-periosteal aberrant bone formation in the tumor bearing femur, similar to clinical findings in patients with bone metastatic prostate cancer. Within the tumor bearing femur, we observed reorganization of blood vessels, macrophage and nerve fibers within the intramedullary space and periosteum adjacent to tumor cells. Tumor bearing mice displayed significant increases in the injury marker ATF3 and upregulation of the neuropeptides SP and CGRP in the ipsilateral DRG as well as increased measures of central sensitization and glial activation in the ipsilateral spinal cord. This immunocompetent mouse model will be useful when combined with cell type selective transgenic mice to examine tumor, immune cell and sensory neuron interactions in the bone microenvironment and their role in pain and disease progression associated with bone metastatic prostate cancer.

Online protein unfolding characterized by ion mobility electron capture dissociation mass spectrometry: cytochrome C from neutral and acidic solutions.

Electrospray ionization mass spectrometry (ESI-MS) experiments, including ion mobility spectrometry mass spectrometry (ESI-IMS-MS) and electron capture dissociation (ECD) of proteins ionized from aqueous solutions, have been used for the study of solution-like structures of intact proteins. By mixing aqueous proteins with denaturants online before ESI, the amount of protein unfolding can be precisely controlled and rapidly analyzed, permitting the characterization of protein folding intermediates in protein folding pathways. Herein, we mixed various pH solutions online with aqueous cytochrome C for unfolding and characterizing its unfolding intermediates with ESI-MS charge state distribution measurements, IMS, and ECD. The presence of folding intermediates and unfolded cytochrome c structures were detected from changes in charge states, arrival time distributions (ATDs), and ECD. We also compared structures from nondenaturing and denaturing solution mixtures measured under "gentle" (i.e., low energy) ion transmission conditions with structures measured under "harsh" (i.e., higher energy) transmission. This work confirms that when using "gentle" instrument conditions, the gas-phase cytochrome c ions reflect attributes of the various solution-phase structures. However, "harsh" conditions that maximize ion transmission produce extended structures that no longer correlate with changes in solution structure.

Reading behaviors and text-to-speech technology perceptions of people with aphasia.

People with aphasia often have reading impairments that affect participation in daily activities. Text-to-speech (TTS) devices are technology-based supports that can facilitate processing of written materials. The purpose of this study was to gather information about the reading behaviors and TTS technology perceptions of people with aphasia who had first learned about system features and options. Sixteen people with chronic aphasia participated in single, one-on-one instructional and guided practice sessions using TTS systems. They answered close-ended questions about current reading behaviors and materials and ways they believed these would change given TTS system access. Participants reported reading at home and community locations. Most read calendars, newspapers, magazines, and mail. Participants who did not read lengthy materials - such as newspapers, magazines, and novels - indicated their interest in these materials would likely increase given TTS support. Although participants did not predict substantial comprehension changes given TTS support, most expressed interest in the technology after learning about it. Thus, people with aphasia perceive TTS systems as helpful for comprehending lengthy materials. Given modest predictions about comprehension benefits, presenting TTS as one of several support strategies is an appropriate recommendation.

Multiple outcome interactions in healthcare systems: a participatory outcome mapping approach.

Outcomes, which are the result state or condition from a process or intervention, are essential elements of healthcare system design and an important indicator of performance. They are included in well-known system analysis frameworks such as the Systems Engineering Initiative for Patient Safety (SEIPS) and Cognitive Work Analysis (CWA). However, fewer practical approaches exist for understanding and communicating interactions among healthcare outcomes. This study applies a novel mapping method as a practical approach to collect, aggregate and visualise interrelations among multiple healthcare outcomes. Graphic facilitation mapping sessions with eleven healthcare providers and ten patients with chronic conditions were conducted. Participants created outcome interrelationship maps following a six-step process. Two outcome-based network visualisations were synthesised using network analysis. This outcome-based approach advances how we frame healthcare systems, focussing on accommodating multiple stakeholders' visions, understanding interrelations, and defining trade-offs. This practical approach may complement frameworks such as SEIPS and CWA. Practitioner summary: The presented outcome-based mapping approach can facilitate the understanding of outcomes as part of the interrelated healthcare system. The approach allows the discussion and integration of different stakeholders' outcome priorities to identify critical elements and better inform the development or adaptation of healthcare systems. Abbreviations: SEIPS: engineering initiative for patient safety; CWA: cognitive work analysis; HFE: human factors and ergonomics; AH: abstraction hierarchy; POTS: postural orthostatic tachycardia syndrome; DRM: design research methodology; FA2: forceAtlas2; HbA1c: glycated haemoglobin; NHS: National Health Service; UK: United Kingdom.

How technology can impact customer-facing train crew experiences.

Customer-facing train crew members have to follow strict procedures to guarantee that trains are safe and run on time. They are also responsible for revenue protection and customer care. Human factors and ergonomics research are instrumental to understand the safety-critical aspects and improve work. We bring user experience research and personas to describe how train crew perceive their routines and how new technology may impact them. We conducted 7 hours of interviews and 30 hours of shadowing observations with the train crew (N = 22) to provide an understanding of who are they and to define their experiences. We present the crew's current routines and created two personas to represent them. One is slightly reluctant to adopt the proposed technology, whereas the other is more accepting. Results indicate how such technology may affect crew work ergonomics and experiences, and suggest which valuable aspects should be maintained, for example the positive interactions with passengers. Practitioner summary: This study investigated the work routines of the customer-facing train crew. Interviews and shadowing were conducted with 22 crew from a large operator in the UK. Personas were created to represent them. Results show their preferred activities and how these would be affected by the introduction of new technology. Abbreviations: CH; customer host (onboard catering staff); DOO: driver-only operation; ETA: estimated time of arrival; PTI: platform-train interface; TM: train manager (onboard customer-facing authority); UCD: user-centred design; UX: user experience.

Journey mapping from a crew's perspective: Understanding rail experiences.

Technological developments present diverse opportunities to modernise services for the rail industry. Systems can be implemented to improve passengers' experiences, but these may also affect the experiences of crew working on board trains. This first-of-a-kind research extends the concept of customer journey mapping as a design tool to understand the experiences of train crew. To produce these crew journey maps, interviews and user observation methods were adopted (N = 22). Results show that two main negative touchpoints for the crew occur at the platform-train interface and during revenue protection activities. This paper presents an innovative methodological contribution around journey mapping to better understand rail experiences, but revolving around the crew rather than the expected consumer experience. We conclude this paper proposing requirements for technological systems and indicate opportunities for the design of systems to generate human-centred improvements for the working practices and experiences of train crew.

User expectations of partial driving automation capabilities and their effect on information design preferences in the vehicle.

Partially automated vehicles present interface design challenges in ensuring the driver remains alert should the vehicle need to hand back control at short notice, but without exposing the driver to cognitive overload. To date, little is known about driver expectations of partial driving automation and whether this affects the information they require inside the vehicle. Twenty-five participants were presented with five partially automated driving events in a driving simulator. After each event, a semi-structured interview was conducted. The interview data was coded and analysed using grounded theory. From the results, two groupings of driver expectations were identified: High Information Preference (HIP) and Low Information Preference (LIP) drivers; between these two groups the information preferences differed. LIP drivers did not want detailed information about the vehicle presented to them, but the definition of partial automation means that this kind of information is required for safe use. Hence, the results suggest careful thought as to how information is presented to them is required in order for LIP drivers to safely using partial driving automation. Conversely, HIP drivers wanted detailed information about the system's status and driving and were found to be more willing to work with the partial automation and its current limitations. It was evident that the drivers' expectations of the partial automation capability differed, and this affected their information preferences. Hence this study suggests that HMI designers must account for these differing expectations and preferences to create a safe, usable system that works for everyone.

How People with Dementia and their Carers Adapt their Homes. A Qualitative Study.

The objective was to explore the ways in which people with dementia and their carers adapt their homes, including the barriers and use of available information. Semi-structured interviews were conducted with 10 people with dementia and their informal carer. The collected data were analysed using thematic analysis. Three core themes emerged: Maintaining familiarity and coping with change, Having knowledge and finding knowledge and Meeting challenges through home adaptation. The most significant barriers to making home adaptations were lack of knowledge and maintaining familiarity. Having more information and making home modifications earlier might enable individuals with dementia to adjust to their adapted environment.

Public Awareness, Usage, and Predictors for the Use of Doctor Rating Websites: Cross-Sectional Study in England.

BACKGROUND: With the advent and popularity of social media and consumer rating websites, as well as the emergence of the digitally engaged patient, there has been an increased interest in doctor rating websites or online patient feedback websites, both inside and outside academia. However, there is very little known about how the public across England views such rating websites as a mode to give patient experience feedback. OBJECTIVE: The aim of the overall study was to measure and understand public awareness, usage, and attitudes towards doctor rating websites as a mode to give experiential feedback about GPs in general practice in England. This paper reports on the findings of one of the aims of the study, which was to measure public awareness, current usage and future consideration of usage of online patient feedback websites, within the context of other feedback methods, This could allow the value of online patient feedback websites to be determined from the patients' perspective. METHODS: A mixed methods population questionnaire was designed, validated and implemented face-to-face using a cross-sectional design with a representative sample of the public (n=844) in England. The results of the questionnaire were analyzed using chi-square tests, binomial logistic regressions, and content analysis. The qualitative results will be reported elsewhere. RESULTS: Public awareness of online patient feedback websites as a channel to leave experiential feedback about GPs was found to be low at 15.2% (128/844). However, usage and future consideration to use online patient feedback websites were found to be extremely low, with current patient usage at just 0.4% (3/844), and patient intention to use online patient feedback in the future at 17.8% (150/844). Furthermore, only 4.0-5.0% of those who would consider leaving feedback about a GP in the future selected doctor rating websites as their most preferred method; more than half of patients said they would consider leaving feedback about GPs using another method, but not using an online patient feedback website. CONCLUSIONS: The findings suggest that online patient feedback websites may not be an effective channel for collecting feedback on patient experience in general practice. Feedback on online patient feedback websites is not likely to be representative of the patient experience in the near future, challenging the use of online patient feedback not just as a mode for collecting patient experience data, but for patient choice and monitoring too. We recommend the National Health Service channels its investment and resources towards providing more direct and private feedback methods in general practice (such as opportunities for face-to-face feedback, email-based feedback, and web-based private feedback forms), as these are currently much more likely to be used by the majority of patients in England.

The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study.

Background and Objectives: Forty percent of residents living in care homes in the United Kingdom have significant depressive symptoms. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown. This study explores the relationship between the physical environment and depressive symptoms of older people living in care homes. Research Design and Methods: In a prospective cohort study the physical environment of 50 care homes were measured using the Sheffield Care Environment Assessment Matrix (SCEAM) and depressive symptoms of 510 residents measured using the Geriatric Depression Scale (GDS-15). The study was supplemented with semi-structured interviews with residents living in the care homes. Quantitative data were analyzed using multi-level modeling, and qualitative data analyzed using a thematic framework approach. Results: The overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Controlling for dependency, social engagement, and home type, having access to outdoor space was the only environmental variable to significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside. Discussion and Implications: We provide new evidence to suggest that access to outdoor space predicts depressive symptoms in older people living in care home. Interventions aimed at increasing access to outdoor spaces could positively affect depressive symptoms in older people.

Assessing user acceptance towards automated and conventional sink use for hand decontamination using the technology acceptance model.

Hand hygiene (HH) prevents harmful contaminants spreading in settings including domestic, health care and food handling. Strategies to improve HH range from behavioural techniques through to automated sinks that ensure hand surface cleaning. This study aimed to assess user experience and acceptance towards a new automated sink, compared to a normal sink. An adapted version of the technology acceptance model (TAM) assessed each mode of handwashing. A within-subjects design enabled N = 46 participants to evaluate both sinks. Perceived Ease of Use and Satisfaction of Use were significantly lower for the automated sink, compared to the conventional sink (p < 0.005). Across the remaining TAM factors, there was no significant difference. Participants suggested design features including jet strength, water temperature and device affordance may improve HH technology. We provide recommendations for future HH technology development to contribute a positive user experience, relevant to technology developers, ergonomists and those involved in HH across all sectors. Practitioner Summary: The need to facilitate timely, effective hand hygiene to prevent illness has led to a rise in automated handwashing systems across different contexts. User acceptance is a key factor in system uptake. This paper applies the technology acceptance model as a means to explore and optimise the design of such systems.

Exploring Patients' Views Toward Giving Web-Based Feedback and Ratings to General Practitioners in England: A Qualitative Descriptive Study.

BACKGROUND: Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback. OBJECTIVE: The aim of this study was to explore patients' views toward giving Web-based feedback and ratings to general practitioners (GPs), within the context of other feedback methods available in primary care in England, and in particular, paper-based feedback cards. METHODS: A descriptive exploratory qualitative approach using face-to-face semistructured interviews was used in this study. Purposive sampling was used to recruit 18 participants from different age groups in London and Coventry. Interviews were transcribed verbatim and analyzed using applied thematic analysis. RESULTS: Half of the participants in this study were not aware of the opportunity to leave feedback for GPs, and there was limited awareness about the methods available to leave feedback for a GP. The majority of participants were not convinced that formal patient feedback was needed by GPs or would be used by GPs for improvement, regardless of whether they gave it via a website or on paper. Some participants said or suggested that they may leave feedback on a website rather than on a paper-based feedback card for several reasons: because of the ability and ease of giving it remotely; because it would be shared with the public; and because it would be taken more seriously by GPs. Others, however, suggested that they would not use a website to leave feedback for the opposite reasons: because of accessibility issues; privacy and security concerns; and because they felt feedback left on a website may be ignored. CONCLUSIONS: Patient feedback and rating websites as they currently are will not replace other mechanisms for patients in England to leave feedback for a GP. Rather, they may motivate a small number of patients who have more altruistic motives or wish to place collective pressure on a GP to give Web-based feedback. If the National Health Service or GP practices want more patients to leave Web-based feedback, we suggest they first make patients aware that they can leave anonymous feedback securely on a website for a GP. They can then convince them that their feedback is needed and wanted by GPs for improvement, and that the reviews they leave on the website will be of benefit to other patients to decide which GP to see or which GP practice to join.

General Practitioners' Concerns About Online Patient Feedback: Findings From a Descriptive Exploratory Qualitative Study in England.

BACKGROUND: The growth in the volume of online patient feedback, including online patient ratings and comments, suggests that patients are embracing the opportunity to review online their experience of receiving health care. Very little is known about health care professionals' attitudes toward online patient feedback and whether health care professionals are comfortable with the public nature of the feedback. OBJECTIVE: The aim of the overall study was to explore and describe general practitioners' attitudes toward online patient feedback. This paper reports on the findings of one of the aims of the study, which was to explore and understand the concerns that general practitioners (GPs) in England have about online patient feedback. This could then be used to improve online patient feedback platforms and help to increase usage of online patient feedback by GPs and, by extension, their patients. METHODS: A descriptive qualitative approach using face-to-face semistructured interviews was used in this study. A topic guide was developed following a literature review and discussions with key stakeholders. GPs (N=20) were recruited from Cambridgeshire, London, and Northwest England through probability and snowball sampling. Interviews were transcribed verbatim and analyzed in NVivo using the framework method, a form of thematic analysis. RESULTS: Most participants in this study had concerns about online patient feedback. They questioned the validity of online patient feedback because of data and user biases and lack of representativeness, the usability of online patient feedback due to the feedback being anonymous, the transparency of online patient feedback because of the risk of false allegations and breaching confidentiality, and the resulting impact of all those factors on them, their professional practice, and their relationship with their patients. CONCLUSIONS: The majority of GPs interviewed had reservations and concerns about online patient feedback and questioned its validity and usefulness among other things. Based on the findings from the study, recommendations for online patient feedback website providers in England are given. These include suggestions to make some specific changes to the platform and the need to promote online patient feedback more among both GPs and health care users, which may help to reduce some of the concerns raised by GPs about online patient feedback in this study.

Authorising bortezomib treatment prior to reviewing haematology results: a step toward home administration.

Bortezomib treatment requires four visits to a chemotherapy unit in each 21-day cycle. Analysis of the Day 1 full blood count could allow clinicians to predict the risk of Grade 4 thrombocytopenia, thus negating the need to review the full blood count prior to each dose. The freedom to administer bortezomib without reviewing full blood count results on each treatment day could minimise appointment times and be a step toward home administration. A prospective study of treatment authorisation following a full toxicity assessment and full blood count results from the previous treatment day was undertaken. The full blood count results from 27 patients, receiving 381 doses revealed 12 treatment episodes where bortezomib was administered in the presence of Grade 4 thrombocytopenia. One instance of bleeding and two episodes of neutropenic sepsis were detected during toxicity assessments and treatment was not administered. Only one instance of Grade 4 thrombocytopenia was reported on any other treatment day when the Day 1 platelet count was greater than 75 × 10(9) units/l. From this data, Day 1 full blood count parameters were derived, which minimise the risk of Grade 4 haematological toxicity on subsequent treatment days, allowing clinicians to identify suitable patients for administration of bortezomib prior to reviewing full blood count results. When platelet counts on Day 1 are greater than 75 × 10(9) units/l and neutrophil counts are greater than 1.0 × 10(9) units/l, the administration of bortezomib can be authorised without the need for review of the full blood count on subsequent days of that cycle.

Sound source information to improve cardiothoracic patients' comfort.

Hospital sound has been well documented through acoustic measurement and the classification of its adverse effects on patients and nurses. However, little consideration has been given to how the perception of these unavoidable soundscapes can be improved. For instance, does a better understanding of the variety of sounds improve patients' feeling? This paper begins to answer this and documents a pilot questionnaire-based study looking at the effects and potential benefits of sound source information (SSI) on patients' subjective reactions to a ward soundscape. The study was carried out from July to September 2011 with 31 patients in a cardiothoracic ward. Although strong inferences were not made, it was found that this simple intervention created a 21-26% positive change perception (p<0.05). The paper discusses the results in relation to nursing practice, concluding that SSI could be beneficial in helping patients to feel more comfortable.

The influence of company identity on the perception of vehicle sounds.

In order to determine how the interior of a car should sound, automotive manufacturers often rely on obtaining data from individual evaluations of vehicle sounds. Company identity could play a role in these appraisals, particularly when individuals are comparing cars from opposite ends of the performance spectrum. This research addressed the question: does company identity influence the evaluation of automotive sounds belonging to cars of a similar performance level and from the same market segment? Participants listened to car sounds from two competing manufacturers, together with control sounds. Before listening to each sound, participants were presented with the correct company identity for that sound, the incorrect identity or were given no information about the identity of the sound. The results showed that company identity did not influence appraisals of high performance cars belonging to different manufacturers. These results have positive implications for methodologies employed to capture the perceptions of individuals. STATEMENT OF RELEVANCE: A challenge in automotive design is to set appropriate targets for vehicle sounds, relying on understanding subjective reactions of individuals to such sounds. This paper assesses the role of company identity in influencing these subjective reactions and will guide sound evaluation studies, in which the manufacturer is often apparent.

Bivalirudin anticoagulation for a patient with hypercoagulable immune syndromes undergoing mitral valve surgery.

Unfractionated heparin has been a near universal anticoagulant for cardiac surgery; however it is contraindicated in heparin-induced thrombocytopenia type II. Alternative anticoagulants such as bivalirudin (a direct thrombin inhibitor) are being utilized. Bivalirudin was successfully used in an immunologically complex patient (diagnoses of heparin-induced thrombocytopenia type II, systemic lupus erythematosus, antiphospholipid syndrome, and dialysis-dependent renal failure) requiring cardiopulmonary bypass. Thrombotic events are common in antiphospholipid syndrome patients undergoing cardiac surgery utilizing high-dose heparin. This may represent unrecognized heparin-induced thrombocytopenia type II. Our patient did not experience perioperative thrombotic or bleeding complications. The possible cross-reactivity between heparin induced thrombocytopenia type II and antiphospholipid syndrome has not been investigated.