Biomarker screening for pulmonary hypertension in VLBW infants at risk for bronchopulmonary dysplasia.

BACKGROUND: Very low birth weight (VLBW) infants demonstrate altered alveolar and pulmonary vascular development and carry an increased risk of developing bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Risk stratification for BPD-associated PH (BPD-PH) in at-risk infants may help tailor management, improve outcomes, and optimize resource utilization. METHODS: VLBW infants were screened for PH with blood gas measurements, serum NT-proBNP and bicarbonate (HCO3) levels, and echocardiograms if they remained on respiratory support at 34 weeks corrected gestational age. We then tested 11 models using different cutoffs for NT-proBNP and HCO3 to predict infants at low risk of BPD-PH. RESULTS: We identified PH in 34 of 192 (17.6%) VLBW infants. The median NT-proBNP in VLBWs with PH was 2769 pg/mL versus 917 pg/mL in those without PH (p < 0.0001). A model with NT-proBNP < 950 pg/mL and HCO3 < 32 mmol/L had a sensitivity of 100%, specificity of 34.2%, and negative predictive value of 100%. Using this model, 54 of 192 (28%) of the patients in this study would have been categorized as low risk for PH and could have avoided a screening echocardiogram. CONCLUSION: NT-proBNP and HCO3 together may serve as sensitive and cost-effective screening tools for BPD-PH in VLBW infants. IMPACT: NT-proBNP and HCO3 concentrations obtained together may help identify very low birth weight infants at risk for bronchopulmonary dysplasia who should undergo screening for pulmonary hypertension with echocardiography. This large dataset demonstrates that NT-proBNP and HCO3 levels together are more sensitive than NT-proBNP alone in identifying VLBW infants to undergo echocardiography. The combination of NT-proBNP and HCO3 levels may identify VLBW infants at low risk for pulmonary hypertension and thus those who may be able to avoid screening echocardiography.

Health Literacy, Processing Capacity, Illness Knowledge, and Actionable Memory for Medication Taking in Type 2 Diabetes: Cross-Sectional Analysis.

BACKGROUND: Patient knowledge about the purpose of medications is crucial to ensure safe and correct use, so it is an important index of adherence in patients with chronic illness. OBJECTIVE: We examined how health literacy and its components (processing capacity and knowledge about illness) influence memory for medication purposes. DESIGN: We conducted a cross-sectional study to examine memory for medication purposes in relation to health literacy, processing capacity, and illness knowledge among patients with diabetes in outpatient clinics. PARTICIPANTS: Six hundred seventy-four adults who were diagnosed with type II diabetes mellitus, age 40 years or older, taking 5 or more current medications, native speakers of English, and with glycosylated hemoglobin (HbA1c) of 6.0 or more, were recruited to the study. MAIN MEASURES: We included measures of processing capacity, illness knowledge, health literacy, and actionable memory for medication taking (memory for medication purpose). KEY RESULTS: Results suggested an association between health literacy and both processing capacity and health knowledge, with some evidence that knowledge can compensate for limited processing capacity in order to maintain health literacy. Furthermore, health literacy was associated with memory for medication purposes, with processing capacity and health knowledge partly mediating this association. This pattern of results supports the process-knowledge model of health literacy. CONCLUSIONS: Our findings establish the role of health literacy in medication taking, in relation to broader cognitive abilities and knowledge. Implications for improving the learning of medication purpose among diverse older adults with chronic illness are discussed. TRIAL REGISTRATION: NIH trial registry number: NCT01296633.

A Framework for Design of Conversational Agents to Support Health Self-Care for Older Adults.

OBJECTIVE: We examined the potential of conversational agents (CAs) to support older adults' self-care related to chronic illness in light of lessons learned from decades of pedagogical agent research, which investigates the impact and efficacy of CAs for a wide range of learners. BACKGROUND: The role of CAs in education (i.e., pedagogical agents) has been long studied, but their potential for supporting self-care has received less attention, especially for older adults. METHODS: We reviewed work on pedagogical agents and considered how it informs the design of CAs for older adults. We propose a framework for designing CAs to support older adult self-care, which organizes a review of work in this area and integration with the pedagogical agent literature. RESULTS: Our review of the pedagogical agent literature revealed an evolution from teaching machines to interactive, social systems that influence student motivational as well as learning outcomes. To integrate this review with work on CAs and self-care, we developed a framework that specifies how self-care goals evolve with stages of an illness, communication goals that support self-care at each stage, patient needs, and requirements for CAs to support these needs. The review identified an agenda for future research on CA functions and features that help older adults accept need for self-care, establish self-care, and sustain self-care over time. CONCLUSIONS: Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.

A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care.

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.

Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge.

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60-88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.

Type V aplasia cutis congenita: case report, review of the literature, and proposed treatment algorithm.

Aplasia cutis congenita (ACC) is the congenital absence of skin. There are a number of different classifications based on distribution and associated findings. Type V ACC is unique in that the lesions are typically symmetric and found primarily on the trunk but can also include the upper and lower extremities. Type V is associated with the loss of a monozygotic co-twin during the late first or early second trimester. Here we present an extensive case of type V ACC and a review of the literature, including a summary of treatment and outcomes. From the available literature, it appears that there is no benefit from early surgical intervention, and therefore we propose a treatment algorithm that starts with conservative management.

Improving comprehension of medication information: implications for nurse-patient communication.

Older adults with chronic illness have complex medication regimens that require an understanding of a wide range of information. The impact of patient characteristics (e.g., cognitive ability), health documents (language and multimedia), and the communication context (available time to communicate) in which older adults understand the information needed to take medication safely are considered to identify recommendations for nurses to communicate effectively with older adults. This article focuses on visually presented information (text and graphics) to motivate suggestions for improving patient education materials. Information communicated during provider-patient encounters is also considered, with implications for improving nurse-patient collaboration.

Designing Feedback Visualizations for Anti-Hypertensive Medication Adherence for Older Adults.

Adhering to anti-hypertensive medications contributes to control of blood pressure and improved health outcomes. However, adherence rates among older adults are low. Patient monitoring of medication taking helps increase adherence and technology has great potential to support self-monitoring, in part by providing visual feedback about medication taking performance. However, little attention has been paid to designing feedback visualizations in medication-monitoring technology for older adults. In this research, we identified guidelines for designing understandable and effective adherence visualizations for older adults from existing theories and literature. With the guidelines in mind, we designed, refined, and evaluated visualizations that provided adherence feedback for a smartphone application with 17 older participants. Based on theory and evidence, we identified design guidelines for feedback visualizations. These guidelines can support design of useful feedback visualizations that may improve medication adherence among older adults.

The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures.

We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (S-TOFHLA and REALM). One hundred forty six community-dwelling older adults participated; 103 had been diagnosed with hypertension. The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both of the health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. S-TOFHLA performance reflected processing capacity as well as general knowledge, whereas performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in various health care contexts.

Risk perception, decision-making, and risk communication in the time of COVID-19.

After first being declared a pandemic by the World Health Organization [WHO], (2020) in March 2020, coronavirus disease (COVID-19) spread rapidly and in the process altered our very way of life. At the same time, it became increasingly clear that a wide range of new behavioral science research was necessary to understand fully how people comprehend and respond to such an unprecedented and long lasting health threat as COVID-19. One of the primary aims for this Special Issue was to gather and publish that research. The studies contained in this Special Issue, conducted between April 2020 and March 2021, were selected to represent experimental research that is relevant to this unique situation and that also inform and extend existing theory. These studies investigate three broad topics: Risk perception, decision-making under risk, and risk communication in the context of COVID-19. Collectively, they advance our knowledge of risk calibration, health communication interventions, and decisions about behaviors that address risk in the context of a global health threat. Perhaps most importantly they also make a practical contribution to how we approach these issues going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Electronic health record usability and workload changes over time for provider and nursing staff following transition to new EHR.

The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers (MD and Advance Practice Nurses) versus nurses (RNs and MAs), 3) determine if usability predicts workload, 4) identify potential sources of EHR design flaws. Workload (NASA-Task Load Index) and usability (System Usability Scale) measures were administered pre, 6-8 month and 30-32 months post-implementation. We found significant increase in perceived workload post-implementation that persisted for 2.5 years (p < .001). The workload increase was associated with usability ratings, which in turn may relate to EHR interface design violations identified by a heuristic evaluation. Our findings suggest further innovation and attention to interface design flaws are needed to improve EHR usability and reduce clinician workload.

Stress Measurement of a Pressurized Vessel Using Ultrasonic Subsurface Longitudinal Wave With 1-3 Composite Transducers.

This article aims to develop a stress-sensing method for a pressurized vessel based on subsurface longitudinal (SSL) waves confined in a specific waveform by using 1-3 composite transducers. Although ultrasonic SSL waves have been commonly utilized for stress sensing, wave excitation under the predefined function using the composite-type transmitter is not well studied. In this article, composite-type transducers having a wide frequency bandwidth (> 60%) and a predominant thickness mode are utilized to enhance the signal intensity of the SSL wave and the accuracy of the sensor by incorporating a specific toneburst waveform. Finite element analysis demonstrates that the signal intensity of the composite-type transducer is up to 45.3% higher than that of a single-phase transducer. Pulse-echo tests reveal that the frequency bandwidth of the developed transducer reaches up to 60.7% and is, therefore, sufficient (> 57.0%) to transmit and receive Hanning-windowed toneburst signals. Results of stress sensing affirm a linear relationship between the time delay of SSL wave and the mechanical stress of a pressurized vessel (0.335 ns/MPa). Accordingly, the regression model is constructed via principal component regression (PCR) under temperature-varying condition. PCR has a less significant degree of error (0.62 MPa) compared to that of a typical least square regression (9.49 MPa).

Expertise promotes facilitation on a collaborative memory task.

The effect of expertise on collaborative memory was examined by comparing expert pilots, novice pilots, and non-pilots. Participants were presented with aviation scenarios and asked to recall the scenarios alone or in collaboration with a fellow participant of the same expertise level. Performance in the collaborative condition was compared to nominal group conditions (i.e., pooled individual performance). Results suggest that expertise differentially impacts collaborative memory performance. Non-experts (non-pilots and novices) were relatively disrupted by collaboration, while experts showed a benefit of collaboration. Verbal protocol analyses identified mechanisms related to collaborative skill and domain knowledge that may underlie experts' collaborative success. Specifically, experts were more likely than non-experts to explicitly acknowledge partner contributions by repeating back previously made statements, as well as to further elaborate on concepts in those contributions. The findings are interpreted according to the retrieval strategy disruption theory of collaborative memory and theories of grounding in communication.

Preliminary evaluation of a self-guided fall risk assessment tool for older adults.

Falls are a major health problem for older adults with significant physical and psychological consequences. The first step of successful fall prevention is to identify those at risk of falling. Recent technology advancement offers the possibility of objective, lowcost and self-guided fall risk assessment. The present work evaluated the preliminary validity and usability of a Kinect camera-based selfinitiated fall risk assessment system in a hospital setting. A convenience sample of 29 female participants (77.5 ± 7.9 years old) enrolled in this study. This low-cost self-guided system included a Kinect depth-sensing camera, a PC-based computer, and custom-built software. An onscreen Fall Risk Assessment Avatar (FRAAn) utilizing visual and verbal instructions led participants through a fall risk assessment consisting of self-report measures and clinically validated balance and mobility tests. Participants also completed clinical fall risk evaluation (Timed-Up and Go, and Berg Balance Scale) led by a researcher. User experience was evaluated by the System Usability Scale (SUS). Results indicate that FRAAn-based outcome measures (postural sway metrics, and sit-to-stand speed) were highly correlated with clinical fall risk measures, and were able to differentiate individuals with increased fall risk. Additionally, 83% participants reported high usability (SUS > 80), indicating the system is well received among older users. Overall, our results indicate that the FRAAn system has promise for providing a self-guided fall risk assessment, and is well received by older users. This affordable, portable and self-guided system has potential to facilitate objective fall risk assessment in older adults in various settings.

Contextualizing numeric clinical test results for gist comprehension: Implications for EHR patient portals.

Patient portals to Electronic Health Record (EHR) systems are underused by older adults because of limited system usability and usefulness, including difficulty understanding numeric information. We investigated whether enhanced context for portal messages about test results improved responses to these messages, comparing verbally, graphically, and video-enhanced formats. Older adults viewed scenarios with fictitious patient profiles and messages describing results for these patients from cholesterol or diabetes screening tests indicating lower, borderline, or higher risk levels. These messages were conveyed by standard format (table of numerical test scores) or one of the enhanced formats. Verbatim and gist memory for test results, risk perception, affective response, attitude toward and intention to perform self-care behaviors, and satisfaction were measured. Verbally and video enhanced context improved older adults' gist but not verbatim memory compared to the standard format, suggesting we were successful in designing messages that highlight gist-based information. Little evidence was found for benefits related to the graphically enhanced format. Although verbally and video enhanced formats improved gist memory and message satisfaction, they had less impact on the other responses to the messages. However, these responses reflected level of risk: As risk associated with test results increased, positive affect decreased whereas negative affect, perceived risk, behavioral attitudes, and intentions increased, as predicted by behavioral change theories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognition and health literacy in patients with hypertension.

BACKGROUND: Approximately half of the US population has marginal or inadequate health literacy, a measure highly associated with health outcomes. This measure is often linked to age and education, but recent evidence from patients with chronic heart failure suggests that much of age-related variability in health literacy can be explained by cognitive abilities (e.g., working memory, processing speed). OBJECTIVE: We examined the role of cognitive and sensory abilities as mediators of age and education in determining functional health literacy among patients with hypertension. PARTICIPANTS: Four hundred ninety two community-dwelling adults diagnosed with hypertension (aged 21 to 92 years) participated. They were primarily female (73%), African-American (68%), and reported taking on average 7.8 prescribed medications. MEASUREMENTS: Before participation in a medication adherence intervention study, participants completed a battery of health literacy-related tasks. They completed tests that measured health literacy [Short Test of Functional Health Literacy in Adults (STOFHLA)], cognitive abilities (working memory, processing speed), sensory abilities (visual acuity and hearing), and physical health. RESULTS: Regression analyses showed that health literacy was related to age, education, and race (accounting for 24.4% of variance in STOFHLA scores). Cognitive ability accounted for an additional 24% of variance and greatly reduced the influence of age, education, and race (by 75%, 40%, and 48%, respectively). CONCLUSIONS: When controlling for cognitive and sensory variables, the association of age and education with STOFHLA scores was dramatically reduced. Thus, future interventions aimed at improving self-care for patients with low health literacy should aim to reduce demands on patients' cognitive abilities.

The effects of an engaged lifestyle on cognitive vitality: a field experiment.

Experimental studies on cognitive training have suggested that the effects of experience are narrow in augmenting or maintaining cognitive abilities, while correlational studies report a wide range of benefits of an engaged lifestyle, including increased longevity, resistance to dementia, and enhanced cognitive flexibility. The latter class of evidence is ambiguous because it is possible that it is simply the case that those with relatively better cognitive vitality seek out and maintain a wider range of activities. The authors report data from a field experiment in which older adults were randomly assigned to participate in a program intended to operationalize an engaged lifestyle, built on a team-based competition in ill-defined problem solving. Relative to controls, experimental participants showed positive change in a composite measure of fluid ability from pretest to posttest. This study, thus, provides experimental evidence for the proposition that engagement, in the absence of specific ability training, can mitigate age-related cognitive declines in fluid ability.

Pharmacist intervention to improve medication adherence in heart failure: a randomized trial.

BACKGROUND: Patients with heart failure who take several prescription medications sometimes have poor adherence to their treatment regimens. Few interventions designed to improve adherence to therapy have been rigorously tested. OBJECTIVE: To determine whether a pharmacist intervention improves medication adherence and health outcomes compared with usual care for low-income patients with heart failure. DESIGN: Randomized, controlled trial conducted from February 2001 to June 2004. SETTING: University-affiliated, inner-city, ambulatory care practice. PATIENTS: 314 low-income patients 50 years of age or older with heart failure confirmed by their primary care physician. INTERVENTION: Patients were randomly assigned to intervention (39% [n = 122]) or usual care (61% [n = 192]) groups and were followed for 12 months. A pharmacist provided a 9-month multilevel intervention, with a 3-month poststudy phase. An interdisciplinary team of investigators designed the intervention to support medication management by patients who have low health literacy and limited resources. MEASUREMENTS: Primary outcomes were adherence, as measured by using electronic prescription monitors, and exacerbations requiring emergency department care or hospital admission. Secondary outcomes included health-related quality of life, patient satisfaction with pharmacy services, and total direct costs. RESULTS: During the 9-month intervention period, medication adherence was 67.9% and 78.8% in the usual care and intervention groups, respectively (difference, 10.9 percentage points [95% CI, 5.0 to 16.7 percentage points]). However, these salutary effects dissipated in the 3-month postintervention follow-up period, in which adherence was 66.7% and 70.6%, respectively (difference, 3.9 percentage points [CI, -5.9 to 6.5 percentage points]). Medications were taken on schedule 47.2% of the time in the usual care group and 53.1% of the time in the intervention group (difference, 5.9 percentage points [CI, 0.4 to 11.5 percentage points]), but this effect also dissipated at the end of the intervention (48.9% vs. 48.6%, respectively; difference, 0.3 percentage point [CI, -5.9 to 6.5 percentage points]). Emergency department visits and hospital admissions were 19.4% less (incidence rate ratio, 0.82 [CI, 0.73 to 0.93]) and annual direct health care costs were lower ($-2960 [CI, $-7603 to $1338]) in the intervention group. LIMITATIONS: Because electronic monitors were used to ascertain adherence, patients were not permitted to use medication container adherence aids. The intervention involved 1 pharmacist and a single study site that served a large, indigent, inner-city population of patients. Because the intervention had several components, intervention effects could not be attributed to a single component. CONCLUSIONS: A pharmacist intervention for outpatients with heart failure can improve adherence to cardiovascular medications and decrease health care use and costs, but the benefit probably requires constant intervention because the effect dissipates when the intervention ceases. ClinicalTrials.gov registration number: NCT00388622.

External support for collaborative problem solving in a simulated provider/patient medication scheduling task.

Taking medication requires developing plans to accomplish the activity. This planning challenges older adults because of age-related cognitive limits and inadequate collaboration with health providers. The authors investigated whether an external aid (medtable) supports collaborative planning in the context of a simulated patient/provider task in which pairs of older adults worked together to create medication schedules. Experiment 1 compared pairs who used the medtable, blank paper (unstructured aid), or no aid to create schedules varying in complexity of medication constraints (number of medications and medication co-occurrence restrictions) and patient constraints (available times during the day to take medication). Both aids increased problem-solving accuracy and efficiency (time per unit accuracy) compared to the no-aid condition, primarily for more complex schedules. However, benefits were similar for the two aids. In Experiment 2, a redesigned medtable increased problem-solving accuracy and efficiency compared to blank paper. Both aids presumably supported problem solving by providing a jointly visible workspace for developing schedules. The medtable may be more effective because it externalizes constraints (relationships between medication and patient information), so that participants can more easily organize information.

Publishing papers that matter.

Daniel G. Morrow introduces himself as the fifth editor of the Journal of Experimental Psychology: Applied (JEPA). The journal is the premier outlet for "use-inspired basic research" (Stokes, 2011) in the psychological sciences. (PsycINFO Database Record