Innovative features and functionalities of an artificial pancreas system: What do youth and parents want?

AIMS: Participant-driven solutions may help youth and families better engage and maintain use of diabetes technologies. We explored innovative features and functionalities of an ideal artificial pancreas (AP) system suggested by youth with type 1 diabetes and parents. METHODS: Semi-structured interviews were conducted with 39 youth, ages 10-25 years, and 44 parents. Interviews were recorded, transcribed and coded using thematic analysis. RESULTS: Youth (72% female, 82% non-Hispanic white) were (M ± SD) ages 17.0 ± 4.7 years, with diabetes for 9.4 ± 4.9 years, and HbA1c of 68 ± 11 mmol/mol (8.4 ± 1.1%); 79% were pump-treated and 82% were continuous glucose monitor users. Of parents, 91% were mothers and 86% were non-Hispanic white, with a child 10.6 ± 4.5 years old. Youth and parents suggested a variety of innovative features and functionalities for an ideal AP system related to (1) enhancing the appeal of user interface, (2) increasing automation of new glucose management functionalities, and (3) innovative and commercial add-ons for greater convenience. Youth and parents offered many similar suggestions, including integration of ketone testing, voice activation, and location-tracking into the system. Youth seemed more driven by increasing convenience and normalcy while parents expressed more concerns with safety. CONCLUSIONS: Youth and parents expressed creative solutions for an ideal AP system to increase ease of use, enhance normalcy, and reduce burden of management. Designers of AP systems will likely benefit from incorporating the desired preferences by end users to optimize acceptance and usability by young persons with diabetes.

Design Drives Discovery in Causal Learning.

We assessed whether an artifact's design can facilitate recognition of abstract causal rules. In Experiment 1, 152 three-year-olds were presented with evidence consistent with a relational rule (i.e., pairs of same or different blocks activated a machine) using two differently designed machines. In the standard-design condition, blocks were placed on top of the machine; in the relational-design condition, blocks were placed into openings on either side. In Experiment 2, we assessed whether this design cue could facilitate adults' (N = 102) inference of a distinct conjunctive cause (i.e., that two blocks together activate the machine). Results of both experiments demonstrated that causal inference is sensitive to an artifact's design: Participants in the relational-design conditions were more likely to infer rules that were a priori unlikely. Our findings suggest that reasoning failures may result from difficulty generating the relevant rules as cognitive hypotheses but that artifact design aids causal inference. These findings have clear implications for creating intuitive learning environments.

It's not you, it's the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study.

BACKGROUND: Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today's patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors. METHODS: We conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics. RESULTS: We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub themes. The central statements rated for the major topics were: 1. "problems with alarm settings complicate patient monitoring." (56% agreed) 2. "artifacts complicate the assessment of the situation." (64% agreed) 3. "information overload makes it difficult to get an overview quickly." (56% agreed) 4. "problems with cables complicate working with patient monitors." (92% agreed) 5. "factors related to human performance lead to critical information not being perceived." (88% agreed) 6. "Switching between monitors from different manufacturers is difficult." (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03). CONCLUSION: This study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring.

Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Which Do Patients Prefer?

BACKGROUND: Deep brain stimulation (DBS) is increasingly used to treat a wide variety of neurological and psychiatric disorders. Implantable pulse generators (implantable pulse generators/batteries) for DBS were originally only available as a nonrechargeable option. However, there is now a choice between fixed-life and rechargeable batteries, with each having their own advantages and disadvantages. The extent of patient involvement in the choice of battery and the factors that matter to them have not been well studied. METHODS: Thirty consecutive adult patients with movement disorders attending a pre-DBS clinic were offered a choice of fixed-life or rechargeable battery and completed a questionnaire after the consultation on which factors influenced their decision. RESULTS: Nineteen patients (63%) chose the fixed-life battery and 11 patients (37%) chose the rechargeable battery. There were no significant differences in age, sex, underlying disease, disease duration or Unified Parkinson's Disease Rating Scale (UPDRS) (part 3) score (for patients with Parkinson disease) between those who chose the fixed-life vs. rechargeable battery. Most patients were not concerned about the size of the battery. Equal numbers were concerned about surgery to replace the battery, and less than half were concerned about the need to recharge the battery. More than half of patients felt that an acceptable charging frequency was monthly or yearly, and all patients felt that an acceptable charging duration was less than 1 hour, with half of all patients choosing less than 30 min. The main reasons cited for choosing the fixed-life battery were convenience and concern about forgetting to recharge the battery. The main reason for choosing the rechargeable battery was the avoidance of further surgery. DISCUSSION: Most patients in this adult cohort with movement disorders chose the fixed-life battery. The better lifestyle associated with a fixed-life battery is a major factor influencing their choice. Rechargeable batteries may be more acceptable if the recharging process is improved, more convenient, and discreet. CONFLICT OF INTEREST: The authors' institution has received educational grants from Medtronic, Abbott, and Boston Scientific companies.

Elite handcycling: a qualitative analysis of recumbent handbike configuration for optimal sports performance.

Our understanding of handbike configuration is limited, yet it can be a key determinant of performance in handcycling. This study explored how 14 handcycling experts (elite handcyclists, coaches, support staff, and manufacturers) perceived aspects of recumbent handbike configuration to impact upon endurance performance via semi-structured interviews. Optimising the handbike for comfort, stability, and power production was identified as key themes. Comfort and stability were identified to be the foundations of endurance performance and were primarily influenced by the seat, backrest, headrest, and their associated padding. Power production was determined by the relationship between the athletes' shoulder and abdomen and the trajectories of the handgrips, which were determined by the crank axis position, crank arm length, and handgrip width. Future studies should focus on quantifying the configuration of recumbent handbikes before determining the effects that crank arm length, handgrip width, and crank position have on endurance performance. Practitioner Summary: To gain a greater understanding of the impact of handbike configurations on endurance performance, the perceptions of expert handcyclists were explored qualitatively. Optimising the handbike for comfort and stability, primarily via backrest padding and power production, the position of the shoulders relative to handgrips and crank axis, were critical.

Plus size and obese workers: anthropometry estimates to promote inclusive design.

A significant proportion of the adult population globally is overweight, obese or classed as 'plus size'. This has led to variability in size and shape across the working population and exclusion in the workplace. A new dataset of the anthropometry of plus size people has been created. Length dimensions were similar to other data, but breadth, circumference, and depth measurements were substantially larger. The hip breadth and abdominal depth were important for predicting largeness in this population. These data help explain the high exclusion rates from design and the number of fit, reach, posture and clearance issues reported by participants with a high BMI: generally, the higher the BMI the greater prevalence of problems. It is hoped that a better understanding of the anthropometric characteristics of the plus size worker will inform the design of safe, productive work environments to promote inclusion for a wider range of people. Practitioner Summary: A new anthropometry dataset of plus size people has been created. The higher the BMI the greater the problems with design in the workplace for fit, reach, posture and clearance. To ensure inclusion and reduce stigma it is important to understand more about the size and shape of this population.

Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial.

BACKGROUND: Foot orthoses are routinely used to treat plantar fasciopathy in clinical practice. However, minimal evidence exists as to the effect of both truly custom designed foot orthoses, as well as that of the shoe the foot orthoses are placed into. This study investigated the effect of wearing custom foot orthoses and new athletic footwear on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks. METHODS: A parallel, three-arm randomised controlled trial with blinding of participants and assessors. 60 participants diagnosed with unilateral plantar fasciopathy were randomised to either custom foot orthoses and new shoes (orthoses group), a sham insole with a new shoes (shoe group) or a sham insole placed in the participant's regular shoes (control group). Primary outcome was first-step pain. Secondary outcomes were average 24-h pain and plantar fascia thickness measured on ultrasound. Outcomes were assessed at baseline, 4 week and 12 week trial time-points. RESULTS: At 4 weeks, the orthoses group reported less first-step pain (p = 0.002) compared to the control group. At 12 weeks, the orthoses group reported less first-step pain compared to both the shoe (p = < 0.001) and sham (p = 0.01) groups. Both the orthoses (p = < 0.001) and shoe (p = 0.006) groups reported less average 24-h pain compared to the control group at 4 and 12 weeks. The orthoses group demonstrated reduced plantar fascia thickness on ultrasound compared to both the shoe (p = 0.032) and control groups (p = 0.011). CONCLUSIONS: Custom foot orthoses in new shoes improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN 12613000446763 ). Submitted on the 10th of April 2013 and registered on the 18th of April 2013.

May Stakeholders be Involved in Design Without Informed Consent? The Case of Hidden Design.

Stakeholder involvement in design is desirable from both a practical and an ethical point of view. It is difficult to do well, however, and some problems recur again and again, both of a practical nature, e.g. stakeholders acting strategically rather than openly, and of an ethical nature, e.g. power imbalances unduly affecting the outcome of the process. Hidden Design has been proposed as a method to deal with the practical problems of stakeholder involvement. It aims to do so by taking the observation of stakeholder actions, rather than the outcomes of a deliberative process, as its input. Furthermore, it hides from stakeholders the fact that a design process is taking place so that they will not behave differently than they otherwise would. Both aspects of Hidden Design have raised ethical worries. In this paper I make an ethical analysis of what it means for a design process to leave participants uninformed or deceived rather than acquiring their informed consent beforehand, and to use observation of actions rather than deliberation as input for design, using Hidden Design as a case study. This analysis is based on two sets of normative guidelines: the ethical guidelines for psychological research involving deception or uninformed participants from two professional psychological organisations, and Habermasian norms for a fair and just (deliberative) process. It supports the conclusion that stakeholder involvement in design organised in this way can be ethically acceptable, though under a number of conditions and constraints.

Predicting passenger seat comfort and discomfort on the basis of human, context and seat characteristics: a literature review.

This literature review focused on passenger seat comfort and discomfort in a human-product-context interaction. The relationships between anthropometric variables (human level), activities (context level), seat characteristics (product level) and the perception of comfort and discomfort were studied through mediating variables, such as body posture, movement and interface pressure. It is concluded that there are correlations between anthropometric variables and interface pressure variables, and that this relationship is affected by body posture. The results of studies on the correlation between pressure variables and passenger comfort and discomfort are not in line with each other. Only associations were found between the other variables (e.g. activities and seat characteristics). A conceptual model illustrates the results of the review, but relationships could not be quantified due to a lack of statistical evidence and large differences in research set-ups between the reviewed papers. Practitioner Summary: This literature review set out to quantify the relationships between human, context and seat characteristics, and comfort and discomfort experience of passenger seats, in order to build a predictive model that can support seat designers and purchasers to make informed decisions. However, statistical evidence is lacking from existing literature.

Scoliosis brace design: influence of visual aesthetics on user acceptance and compliance.

Adolescent idiopathic scoliosis is a common condition found in adolescents. A rigid brace is often prescribed as the treatment for this spinal deformity, which negatively affects user compliance due to the discomfort caused by the brace, and the psychological distress resulting from its appearance. However, the latter, which is the impact of visual aesthetics, has not been thoroughly studied for scoliosis braces. Therefore, a qualitative study with in-depth interviews has been carried out with 10 participants who have a Cobb angle of 20°-30° to determine the impact of visual aesthetics on user acceptance and compliance towards the brace. It is found that co-designing with patients on the aesthetic aspects of the surface design of the brace increases the level of user compliance and induces positive user perception. Therefore, aesthetic preferences need to be taken into consideration in the design process of braces. Practitioner Summary: The impact of visual aesthetics on user acceptance and compliance towards a rigid brace for scoliosis is investigated. The findings indicate that an aesthetically pleasing brace and the involvement of patients in the design process of the brace are important for increasing user compliance and addressing psychological issues during treatment.

Effect of sports bra type and gait speed on breast discomfort, bra discomfort and perceived breast movement in Chinese women.

This study investigated the effect of sports bra type (encapsulation versus compression) and gait speed on perceptions of breast discomfort, bra discomfort and breast movement reported by Chinese women. Visual analogue scales were used to evaluate breast discomfort, bra component discomfort and perceived breast movement of 21 Chinese participants when they wore an encapsulation or a compression sports bra, while static and while exercising at three different gait speeds. Participants perceived less breast discomfort and breast movement when wearing a compression bra compared to an encapsulation bra at a high gait speed, suggesting that compression bras are likely to provide the most effective support for Chinese women. However, significantly higher bra discomfort was perceived in the compression bra compared to the encapsulation bra when static and at the lower gait speed, implying that ways to modify the design of sports bras, particularly the straps, should be investigated to provide adequate and comfortable breast support. PRACTITIONER SUMMARY: The compression sports bra provided more comfortable support than the encapsulation sports bra for these Chinese women when running on a treadmill. However, these women perceived higher bra discomfort when wearing the compression bra when stationary. Further research is needed to modify the design of sports bras, particularly the straps, to provide adequate and comfortable breast support.

The effects of display size on performance.

We examined the systematic effects of display size on task performance as derived from a standard perceptual and cognitive test battery. Specifically, three experiments examined the influence of varying viewing conditions on response speed, response accuracy and subjective workload at four differing screen sizes under three different levels of time pressure. Results indicated a ubiquitous effect for time pressure on all facets of response while display size effects were contingent upon the nature of the viewing condition. Thus, performance decrement and workload elevation were evident only with the smallest display size under the two most restrictive levels of time pressure. This outcome generates a lower boundary threshold for display screen size for this order of task demand. Extrapolations to the design and implementation of all display sizes and forms of cognitive and psychomotor demand are considered.

The influence of highly automated driving on the self-perception of drivers in the context of Conduct-by-Wire.

Today, new driving paradigms are being introduced that aim to reduce the number of standalone driver assistance systems by combining these into one overarching system. This is done to reduce the demands on drivers but often leads to a higher degree of automation. Feasibility and driver behaviour are often the subject of studies, but this is contrasted by a lack of research into the influence of highly automated driving on the self-perception of drivers. This article begins to close this gap by investigating the influences of one highly automated driving concept--Conduct-by-Wire--on the self-perception of drivers via a combined driving simulator and interview study. The aim of this work is to identify changes in the role concept of drivers indicated by highly automated driving, to evaluate these changes from the drivers' point of view and to give suggestions of possible improvements to the design of highly automated vehicles.

Decision-making and response strategies in interaction with alarms: the impact of alarm reliability, availability of alarm validity information and workload.

Responding to alarm systems which usually commit a number of false alarms and/or misses involves decision-making under uncertainty. Four laboratory experiments including a total of 256 participants were conducted to gain comprehensive insight into humans' dealing with this uncertainty. Specifically, it was investigated how responses to alarms/non-alarms are affected by the predictive validities of these events, and to what extent response strategies depend on whether or not the validity of alarms/non-alarms can be cross-checked against other data. Among others, the results suggest that, without cross-check possibility (experiment 1), low levels of predictive validity of alarms ( ≤ 0.5) led most participants to use one of two different strategies which both involved non-responding to a significant number of alarms (cry-wolf effect). Yet, providing access to alarm validity information reduced this effect dramatically (experiment 2). This latter result emerged independent of the effort needed for cross-checkings of alarms (experiment 3), but was affected by the workload imposed by concurrent tasks (experiment 4). Theoretical and practical consequences of these results for decision-making and response selection in interaction with alarm systems, as well as the design of effective alarm systems, are discussed.

The user experience of violinists playing with a novel ergonomic chinrest: An evaluation on motivation, usage behaviour, usability and acceptance.

BACKGROUND: This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important. OBJECTIVE: To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product. METHODS: Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions. RESULTS: Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study. CONCLUSION: Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.

Examining the impact of familiarity on faucet usability for older adults with dementia.

BACKGROUND: Changes in cognition caused by dementia can significantly alter how a person perceives familiarity, impacting the recognition and usability of everyday products. A person who is unable to use products cannot autonomously complete associated activities, resulting in increased dependence on a caregiver and potential move to assisted living facilities. The research presented in this paper hypothesised that products that are more familiar will result in better usability for older adults with dementia. Better product usability could, in turn, potentially support independence and autonomy. METHODS: This research investigated the impact of familiarity on the use of five faucet designs during 1309 handwashing trials by 27 older adults, who ranged from cognitively intact to the advanced (severe) stages of dementia. Human factors methods were used to collect empirical and self-reported data to gauge faucets' usability. Participants' data were grouped according to cognition (i.e., no/mild, moderate, or severe dementia). Logistic regression, ranking by odds, and Wald tests of odds ratios were used to compare performance of the three groups on the different faucets. Qualitative data were used in the interpretation of quantitative results. RESULTS: Results indicated that more familiar faucets correlated with lower levels of assistance from a caregiver, fewer operational errors, and greater levels of operator satisfaction. Aspects such as the ability to control water temperature and flow as well as pleasing aesthetics appeared to positively impact participants' acceptance of a faucet. The dual lever design achieved the best overall usability. CONCLUSIONS: While work must be done to expand these findings to other products and tasks, this research provides evidence that familiarity plays a substantial role in product usability for older adults that appears to become more influential as dementia progresses. The methods used in this research could be adapted to analyse usability for other products by older adults with dementia.

Management of sleep-time masticatory muscle activity using stabilisation splints affects psychological stress.

To treat sleep bruxism (SB), symptomatic therapy using stabilisation splints (SS) is frequently used. However, their effects on psychological stress and sleep quality have not yet been examined fully. The objective of this study was to clarify the effects of SS use on psychological stress and sleep quality. The subjects (11 men, 12 women) were healthy volunteers. A crossover design was used. Sleep measurements were performed for three consecutive days or longer without (baseline) or with an SS or palatal splint (PS), and data for the final day were evaluated. We measured masseter muscle activity during sleep using portable electromyography to evaluate SB. Furthermore, to compare psychological stress before and after sleep, assessments were made based on STAI-JYZ and the measurement of salivary chromogranin A. To compare each parameter among the three groups (baseline, SS and PS), Friedman's and Dunn's tests were used. From the results of the baseline measurements, eight subjects were identified as high group and 15 as low group. Among the high group, a marked decrease in the number of bruxism events per hour and an increase in the difference in the total STAI Y-1 scores were observed in the SS group compared with those at baseline (P < 0·05). No significant difference was observed in sleep stages. SS use may be effective in reducing the number of SB events, while it may increase psychological stress levels, and SS use did not apparently influence sleep stages.

Participants' dynamic orientation to folder navigation when using a VOCA with a touch screen in talk-in-interaction.

This paper reports on a conversation-analysis case study of interaction between a child with cerebral palsy and an adult using a computer-based voice output communication aid (VOCA) device with a touch-sensitive screen-input system. Data was collected from video recordings of everyday activities at school. The public nature of the VOCA-mediated turn construction process (hand movements towards the screen, on-screen folder navigation, synthetic speech) displays the projection of the turn under way and its possible continuations. The adult interlocutor orients to such projections when contributing to the topic of the ongoing turn and when initiating repair on its topical development. Contributing may activate the AAC user's further involvement in the ongoing turn, while repair may restrict the AAC user's influence on the topical progression. The findings are relevant for clinical assessment and intervention.

Effect of epinephrine autoinjector design on unintentional injection injury.

Epinephrine is an essential medication for the treatment of anaphylaxis. Factors associated with autoinjector design may have a role in its correct use. We compared a new and old epinephrine autoinjector with respect to correct autoinjector use. We invited all interns of the 2011-2012 training period in our medical school. The participants were randomly assigned into two groups. After all participants were given a three-step written and visual instruction sheet about epinephrine autoinjector use, they were asked to show its use either with the old or the new epinephrine autoinjector trainer. The old and new trainers, which were exactly identical to the original epinephrine autoinjectors except for the medication and needle, were used. The performance of each participant was assessed with a standardized scoring system. Among 220 invited interns, 180 (81.8%) were enrolled. The number of participants correctly showing the use of epinephrine autoinjectors and the mean total score did not differ significantly between the two groups (p = 0.639 and p = 0.233, respectively). Significantly fewer participants had unintentional injections in the new compared with the old epinephrine autoinjector group (p < 0.001). When all assessment steps are considered, only the rate of placing a wrong tip into the outer thigh was significantly lower in the new compared with the old epinephrine autoinjector group (p < 0.05). The new epinephrine autoinjector is more effective in unintentional injection injuries than the old one; however, it still does not fulfill the criteria of an ideal epinephrine autoinjector.

The influence of product aesthetics and usability over the course of time: a longitudinal field experiment.

A longitudinal field experiment was carried out over a period of 2 weeks to examine the influence of product aesthetics and inherent product usability. A 2 × 2 × 3 mixed design was used in the study, with product aesthetics (high/low) and usability (high/low) being manipulated as between-subjects variables and exposure time as a repeated-measures variable (three levels). A sample of 60 mobile phone users was tested during a multiple-session usability test. A range of outcome variables was measured, including performance, perceived usability, perceived aesthetics and emotion. A major finding was that the positive effect of an aesthetically appealing product on perceived usability, reported in many previous studies, began to wane with increasing exposure time. The data provided similar evidence for emotion, which also showed changes as a function of exposure time. The study has methodological implications for the future design of usability tests, notably suggesting the need for longitudinal approaches in usability research. PRACTITIONER SUMMARY: This study indicates that product aesthetics influences perceived usability considerably in one-off usability tests but this influence wanes over time. When completing a usability test it is therefore advisable to adopt a longitudinal multiple-session approach to reduce the possibly undesirable influence of aesthetics on usability ratings.