Investigating visual preferences of clinical mechanical anesthetic vibration: a cross-sectional image survey.

While mechanical vibration lessens discomfort associated with injection site pain (ISP), many local anesthetic injectors (LAIs) do not use vibratory anesthetic devices (VADs). Injector preference of vibration device is influenced by functional concerns, but qualitatively there is an element of adoption that is driven by visual feedback. We sought to capture operator preferences of vibration device design elements to further understand why injectors do not use these devices. We conducted a survey of image preferences among nurses and medical assistants employed at 8 dermatological clinics to investigate barriers to VAD use. Images were electronically modified with features distinct from the original device (a VAD commonly used in clinical practice). Participants rated their likelihood and comfort of use of each VAD represented in the images. Two-sample t-tests were used to compare the rating of the unmodified VAD to each modified VAD within participants. A response rate of 100% was achieved with 35 participants (average age, 38.5 years; 6 (17.1%) male, 29 (82.9%) female). Despite 28 (80%) participants knowing that mechanical vibration reduces ISP, only 16 (45.7%) endorsed ever using mechanical vibration as topical anesthetic. Images modified by pattern, color, and sterility covering were rated significantly lower than the original, unmodified VAD image (plain white VAD), confirming that visual feedback does impact adoption. Through independent comment categorization, aesthetics were found to be important to LAIs. Aesthetic preferences opposing functional concerns may factor into the lack of VAD use. Defining these visual preference barriers to adoption may help promote VAD use during dermatologic procedures.

Readability of iPledge materials for isotretinoin education in English and Spanish.

iPledge is a program meant to reduce the incidence of pregnancy in patients using isotretinoin, a teratogenic acne medication. Adherence to the iPledge program is essential in preventing pregnancy complications among isotretinoin users. We present an analysis of the readability of both English and Spanish patient education materials published by iPledge. Readability grade levels for twelve iPledge documents were compared using both Lexile and graph-based methods (English: Fry; Spanish: Gilliam-Peña-Mountain). In both English and Spanish, aggregate Lexile grade levels are written below the 6th grade level; however, approximately one-third of pages are written above the 6th grade level. Aggregate graph-based grade levels are written above the 6th grade level as well. This suggests that iPledge materials should be rewritten at a lower grade level. Doing so may allow more patients to understand and utilize the important information presented in iPledge.

Dominance hierarchy establishment in the invasive round goby, Neogobius melanostomus.

Organisms living at high densities may be forced to engage in conflict for access to resources such as food or shelter. When these resources are limited, the outcome of interactions may have important fitness implications. We investigated the behavioural interactions of the invasive Round Goby (Neogobius melanostomus) in a shelter-limited environment. Round Goby are benthic fish that utilize rocky shelters for predator avoidance and as reproductive sites in which territorial males defend clutches of eggs. Previous work on this and other species has shown that larger individuals have greater resource holding potential in dyadic interactions. In order to understand the outcome of agonistic interactions in more complex social environments, we observed groups of three goby of the same sex which varied in relative size in an aquarium in which individuals had the opportunity to compete for access to shelters. We predicted that larger goby would behave aggressively towards smaller goby, and outcompete smaller goby for access to shelters. Because males defend shelters while breeding, we also predicted that male goby would compete more aggressively than females over dominance status. We found that larger goby in groups were socially dominant to smaller goby, regardless of sex. Additionally, we found that the largest goby in each group was involved in more aggressive interactions than the second or third largest goby in each group. We found no effect of relative size or sex on aggressive interaction or the emergent dominance relationships. Our findings highlight that aspects of the social environment may limit the opportunity for individuals to establish dominance or establish ownership of resources.