Automated vehicles for older adults with cognitive impairment: a survey study.

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training.Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

Pediatric asthma hospitalization: individual and environmental characteristics of high utilizers in South Texas.

Objective: Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations.Methods: The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: ≥4 times, medium: 2-3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers.Results: The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5-11 years (OR = 0.57, 95%CI = 0.35-0.93), longer LOS (2 days: OR = 1.80, 95%CI = 1.15-2.84; ≥3 days: OR = 3.38, 95%CI = 2.10-5.46), warm season at index admission (OR = 1.49, 95%CI = 1.01-2.20), and higher average ozone level in children's residential neighborhoods (OR = 1.78, 95%CI = 1.01-3.14) were significantly associated with a higher number of asthma hospitalizations.Conclusions: The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources.

Health-related consequences of the type and utilization rates of electronic devices by college students.

BACKGROUND: College students are leading an evolution of device use both in the type of device and the frequency of use. They have transitioned from desktop stations to laptops, tablets, and especially smartphones and use them throughout the day and into the night. METHODS: Using a 35-min online survey, we sought to understand how technology daily usage patterns, device types, and postures affect pain and discomfort to understand how knowledge of that pain might help students avoid it. Data were analyzed from 515 students (69.5% male) who completed an internet-delivered survey (81.3% response rate). RESULTS: Participants ranked smartphones as their most frequently used technology (64.0%), followed by laptops and tablets (both 53.2%), and desktop computers (46.4%). Time spent using smartphones averaged over 4.4 h per day. When using their devices, students were more likely to adopt non-traditional workplace postures as they used these devices primarily on the couch or at a chair with no desk. CONCLUSION: Recent trends in wireless academic access points along with the portability of small handheld devices, have made smartphones the most common link to educational materials despite having the least favorable control and display scenario from an ergonomic perspective. Further, the potential impact of transitions in work environments due to COVID-19 may further exacerbate ergonomic issues among millions highlighting the need for such work to be carried out.

Instrumental variable approach to estimating the scalar-on-function regression model with measurement error with application to energy expenditure assessment in childhood obesity.

Wearable device technology allows continuous monitoring of biological markers and thereby enables study of time-dependent relationships. For example, in this paper, we are interested in the impact of daily energy expenditure over a period of time on subsequent progression toward obesity among children. Data from these devices appear as either sparsely or densely observed functional data and methods of functional regression are often used for their statistical analyses. We study the scalar-on-function regression model with imprecisely measured values of the predictor function. In this setting, we have a scalar-valued response and a function-valued covariate that are both collected at a single time period. We propose a generalized method of moments-based approach for estimation, while an instrumental variable belonging in the same time space as the imprecisely measured covariate is used for model identification. Additionally, no distributional assumptions regarding the measurement errors are assumed, while complex covariance structures are allowed for the measurement errors in the implementation of our proposed methods. We demonstrate that our proposed estimator is L2 consistent and enjoys the optimal rate of convergence for univariate nonparametric functions. In a simulation study, we illustrate that ignoring measurement error leads to biased estimations of the functional coefficient. The simulation studies also confirm our ability to consistently estimate the function-valued coefficient when compared to approaches that ignore potential measurement errors. Our proposed methods are applied to our motivating example to assess the impact of baseline levels of energy expenditure on body mass index among elementary school-aged children.

Sit-Stand Desk Software Can Now Monitor and Prompt Office Workers to Change Health Behaviors.

OBJECTIVE: To determine the effectiveness of a computer-based intervention designed to increase sit-stand desk usage and help reverse workplace physical inactivity. BACKGROUND: Sit-stand desks have been successful in reducing workplace sedentary behavior, but the challenge remains for an effective method to increase the usage in order to experience the health and productivity benefits. METHOD: Data collection (1-year field study with 194 workers) used a novel method of computer software that continuously recorded objective electric sit-stand desk usage, while taking into account the time a worker spends away from their desk (breaks, meetings). During the baseline period, all workers' desk usage was recorded by the software, and the intervention period consisted of software reminders and real-time feedback to all workers to change desk positions. Pooled means were calculated to determine desk usage patterns, and effect sizes and pairwise mean differences were analyzed to test for intervention significance. RESULTS: The intervention doubled desk usage by increasing ~1 change to ~2 changes per work day. There was a 76% reduction in workers who never used the sit-stand function of the desk. Medium to large effect sizes from the intervention were observed in all three primary outcome measures (desk in sitting/standing position and desk position changes per work day). CONCLUSION: These findings demonstrate an effective intervention that increased postural transitioning and interrupted prolonged inactivity while remaining at the workstation. APPLICATION: The methods and results in this research study show that we can quantify an increase in desk usage and collect aggregate data continuously.

Accessing physical activity among young adults attending a university: the role of sex, race/ethnicity, technology use, and sleep.

BACKGROUND: Identifying factors associated with recommended physical activity (PA) levels are critical in efforts to combat the obesity epidemic and related comorbidities. METHODS: We conducted cross-sectional analyses of college students (n = 490) enrolled in a large southern state university in October of 2014. Our aim was to identify sociodemographic characteristics, technology use, and sleep patterns among college students and their independent relationship to recommended PA. An online survey was sent to all enrolled students. Logistic regression predicted achieving recommended ≥150 min per week of moderate-vigorous PA (MVPA) versus not (≤149 min MVPA). RESULTS: Approximately 69% of study participants were males, 18% were Hispanic, and more than half (60%) were within the normal body mass index (12% were obese). The average age of students was 21 years. On a daily average, individuals used smartphones most often (nearly 4.4 h), followed by laptops at 4.0 h, desktops at 1.2 h, and tablets at 0.6 h. The mean number of hours individuals reported sleeping was 6.7. Sociodemographic factors associated with reporting ≥150 min of MVPA included being male (OR = 4.0, 95% CI 2.2-7.1) versus female, being non-Hispanic White (OR = 1.8, CI 1.1-3.2) versus being a member of minority race group. Behavioral factors associated with reporting ≥150 min of MVPA included technology use (being moderate-heavy (OR = 2.3, CI 1.1-4.8) or heavy (OR = 3.4, CI 1.6-7.5) users of technology), and receiving low-moderate (OR = 1.9, 1.01-3.7) levels of sleep versus the lowest level of sleep. CONCLUSIONS: In the current study, minority status and being female were the strongest sociodemographic factors associated with inadequate PA levels, while high technology use (primarily driven by smartphone use) were associated with recommended PA levels. Identifying factors associated with being physically active will allow for targeted interventions to improve the health of young adults.

Stand-Biased Versus Seated Classrooms and Childhood Obesity: A Randomized Experiment in Texas.

OBJECTIVES: To measure changes in body mass index (BMI) percentiles among third- and fourth-grade students in stand-biased classrooms and traditional seated classrooms in 3 Texas elementary schools. METHODS: Research staff recorded the height and weight of 380 students in 24 classrooms across the 3 schools at the beginning (2011-2012) and end (2012-2013) of the 2-year study. RESULTS: After adjustment for grade, race/ethnicity, and gender, there was a statistically significant decrease in BMI percentile in the group that used stand-biased desks for 2 consecutive years relative to the group that used standard desks during both years. Mean BMI increased by 0.1 and 0.4 kilograms per meter squared in the treatment and control groups, respectively. The between-group difference in BMI percentile change was 5.24 (SE = 2.50; P = .037). No other covariates had a statistically significant impact on BMI percentile changes. CONCLUSIONS: Changing a classroom to a stand-biased environment had a significant effect on students' BMI percentile, indicating the need to redesign traditional classroom environments.

Predicting violent behavior in clinical settings: a case-control study of a mental health inpatient unit.

In order to assist staff in recognizing patients prone to violence and guide their clinical decision-making, this study summarizes mental health inpatient unit incidents over a one-year period. Results describe demographic and clinical information for patients, and evaluate risk assessment tools currently used to predict risk. A retrospective analysis included data on patients involved in incidents and frequency matched controls. There were a total of 44 incidents, caused by 38 unique patients. A constructed model to estimate patient characteristics and risk of violent incidents included involuntary admittance (OR 2.07, 95% CI 1.05-6.11, p = 0.039), more than one admission at the facility (OR 4.18, 95% CI 1.71-10.22, p = 0.002) and Global Subjective Irritability on day one (OR 4.24, 95% CI 1.77-10.16, p = 0.001). Violent incidents on the mental inpatient unit threaten safety and disrupt the therapeutic environment. The findings may be useful in aiding clinicians to quickly recognize patients that are prone to violence.

The Effect of Stand-biased Desks on Academic Engagement: An Exploratory Study.

BACKGROUND: Schools have been suggested as a viable avenue to combat childhood obesity. School administrators are sometimes faced with the conflicting demands of improving the health of their students and maintaining academic performance. Dynamic furniture such as stand-biased desks may be one way to address both academic and health demands placed on schools to prevent childhood obesity. METHOD: Classrooms with stand-biased desks were compared to classrooms using traditional seated desks in 2nd,3rd, and 4th grades. The academic engagement of 282 participants was observed in the fall and spring during one academic year. The engagement of the treatment classrooms was compared to the engagement of the control classrooms. RESULTS: Both groups showed general increases in their academic engagement over time. Stand-biased desks do not seem to result in adverse effects on academic engagement when used in elementary classrooms. CONCLUSION: The data suggests promising results for the use of stand-biased desks in elementary school classrooms. The results suggest that stand-biased desks can be introduced in the classroom to combat childhood obesity through increasing energy expenditure without affecting academic engagement.

A novel approach for predicting usability of upper limb prostheses.

Limb amputation can lead to significant functional challenges in daily activities, prompting amputees to use prosthetic devices (PDs). However, the cognitive demands of PDs and usability issues have resulted in user rejections. This study aimed to create a Human Performance Model for Upper-Limb Prosthetic Devices (HPM-UP). The model used formulations of learnability, error rate, memory load, efficiency, and satisfaction to assess usability. The model was validated in an experiment with 30 healthy participants using a bypass prosthetic device. Findings indicated that the HPM-UP successfully predicted the usability of prosthetic devices, aligning with human subject data. This research proposes a quantitative approach to predict upper limb prosthetic device usability by quantifying each dimension and computationally connecting them. The model, available on Github and executable with Rstudio, could enable clinicians to assess and analyze the human performance of various commercial prostheses, aiding in recommending optimal devices for patients.

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity.

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Digital human ergonomics training for remote office workers: Comparing a novel method to a traditional online format.

OBJECTIVE: This randomized controlled trial investigated the effectiveness of an online ergonomics training program with a digital human compared to an online ergonomics training program without a digital human. METHOD: Remote office workers (n = 138) were randomly assigned to either a digital human training, a traditional webpage training without a digital human, or a control group. Musculoskeletal discomfort, knowledge retention, and behavior change were measured. RESULTS: The overall group differences for increased behavior change and knowledge retention were statistically significant (p < 0.05). For knowledge retention, the digital human training group showed comparable improvement in knowledge scores compared to the traditional training group. For behavior scores, the traditional training showed improvement compared to the control group. Decreases in musculoskeletal discomfort for all groups were not statistically significant (p > 0.05). CONCLUSION: Digital humans have the potential to meet large-scale remote worker training needs.

Stand-Capable Workstations Reduce Occupational Sedentary Time Among Administrative Workers.

OCCUPATIONAL APPLICATIONSIn this study, we found that workers who use stand-biased desks stood more and sat less during their workday compared to workers who use traditional desks. Stand-biased users also experienced significantly less lower back discomfort compared to both traditional and sit-stand workstation users. Based on these findings, we recommend that the use of stand-biased workstations be considered when designing or renovating work office workspaces. The health risks of sedentary behavior are inherent in most office work, but these risks can be alleviated with intentional equipment choices. Using stand-biased desks can encourage workers to move more throughout the workday without their productivity or comfort being disturbed.

Background: Sedentary activity, especially occupational sitting, is a leading cause of musculoskeletal discomfort among office workers. The amount of time employees spend seated is associated with the type of workstation that they utilize.Purpose: We investigated differences in computer utilization, physical activity, and discomfort among office workers who used three workstation types (stand-biased, sit-stand, or traditional).Methods: Among a sample of office workers (n = 61), we used data-logging software to measure computer utilization over 10 days, activity sensors to measure daily general activity levels (i.e., sitting, standing, running, etc.) during the 8am­5pm workday and the 24-h day, and the Nordic Musculoskeletal Questionnaire (NMQ) to evaluate discomfort.Results: There was no significant difference in the number of keyclicks between the three groups; however, the stand-biased group had a significantly higher word count and more errors than the traditional group. The 24-h activity data revealed that the stand-biased group had significantly more standing time, less sitting time, and fewer transitions per hour compared to their traditional counterparts.Conclusions: Stand-biased workstations can be a viable workstation alternative to reduce sitting time without decreasing activity or creating additional discomfort.

The impact of multiple regions of pain and work-life balance among healthcare workers.

BACKGROUND: Although the association of chronic pain (CP) with a poor work-life balance has been well studied, the interaction effect of multiple pain sites on work-life balance is unknown. OBJECTIVE: To evaluate the most prevalent CP site among healthcare workers, the demographic characteristics of the individuals with the predominant pain type, and to assess the interaction of multiple pain sites on work-life balance. METHODS: Using data from the National Health Interview Survey, 2,458 healthcare works were identified for this study. The independent variables were chronic low back and hip pain. The dependent variables were (1) if pain affected their family or significant other, (2) if pain limited their life or work activities, and (3) Usually working >35 hours/week. Multiple logistic regression and an interaction analysis were used to analyze the impact of different pain sites on work-life balance. RESULTS: Among healthcare workers, chronic low back pain was more prevalent than chronic hip pain (69.4% vs 61.4%, p-value<0.001). Respondents with chronic low back pain were mostly 40 - 64 years of age (49.6%), females (71.2%), white (77.6%), married (55.5%), had no college degree (85.4%), earn greater than $75,000 (50.0%). In the interaction analysis, in the presence of chronic hip pain, those with chronic low back pain had an AOR of 2.20 (1.05 - 4.64), p-value 0.038 of chronic low back pain affecting their family and significant others, and an AOR of 2.18 (1.17- 4.05), p-value 0.014 of chronic low back pain affecting their life or work. CONCLUSION: Chronic low back pain was more prevalent than chronic hip pain among healthcare workers. Together both pain sites had a significant impact on the work-life balance of this population. Further studies should assess other dimensions of work-life balance and chronic pain.

A novel autonomous vehicle interface for older adults with cognitive impairment.

The population of older Americans with cognitive impairments, especially memory loss, is growing. Autonomous vehicles (AVs) have the potential to improve the mobility of older adults with cognitive impairment; however, there are still concerns regarding AVs' usability and accessibility in this population. Study objectives were to (1) better understand the needs and requirements of older adults with mild and moderate cognitive impairments regarding AVs, and (2) create a prototype for a holistic, user-friendly interface for AV interactions. An initial (Generation 1) prototype was designed based on the literature and usability principles. Based on the findings of phone interviews and focus group meetings with older adults and caregivers (n = 23), an enhanced interface (Generation 2) was developed. This generation 2 prototype has the potential to reduce the mental workload and anxiety of older adults in their interactions with AVs and can inform the design of future in-vehicle information systems for older adults.

Examining workweek variations in computer usage patterns: An application of ergonomic monitoring software.

Alternative work arrangements have emerged as potential solutions to enhance productivity and work-life balance. However, accurate and objective measurement of work patterns is essential to make decisions about adjusting work arrangements. This study aimed at evaluating objective computer usage metrics as a proxy for productivity using RSIGuard, an ergonomics monitoring software. Data were collected from 789 office-based employees over a two-year period between January 1, 2017 and December 31, 2018 at a large energy company in Texas. A generalized mixed-effects model was utilized to compare computer usage patterns across different days of the week and times of the day. Our findings demonstrate that computer output metrics significantly decrease on Fridays compared to other weekdays, even after controlling for total active hours. Additionally, we found that workers' output varied depending on the time of day, with reduced computer usage observed in the afternoons and a significant decrease on Friday afternoons. The decrease in the number of typos was much less than that in the number of words typed, indicating reduced work efficiency on Friday afternoons. These objective indicators provide a novel approach to evaluating the productivity during the workweek and can help optimize work arrangements to promote sustainability for the benefit of employers, employees, and the environment.

Using stand/sit workstations in classrooms: lessons learned from a pilot study in Texas.

Childhood obesity has grown into a national epidemic since the 1980s. Many school-based intervention efforts that target childhood obesity involve curriculum and programming that demands instructional time, which disincentivizes school participation. Stand-biased classrooms are an environmental intervention that promotes standing rather than sitting by utilizing standing height desks that allow students to stand during normal classroom activities. The quasi-experimental pilot study was conducted in 5 first-grade classrooms in a Texas elementary school, with 2 control classrooms, 2 treatment classrooms, and 1 classroom that was a control in the fall and treatment in the spring (to allow for within-group comparisons). This intervention has been shown effective in significantly increasing caloric expenditure. In addition, the present study reveals potential behavioral effects from standing. This article presents lessons learned from the pilot study that may prove useful for others implementing similar interventions and calls for additional research on the academic benefits of standing for students.

Impact of workplace displacement during a natural disaster on computer performance metrics: A 2-year interrupted time series analysis.

BACKGROUND: Remote working may enhance company resiliency during natural disasters and other events causing workplace displacement. OBJECTIVE: We conducted an interrupted time series analysis to investigate the impact of Hurricane Harvey on employee computer use during and after a seven-month displacement period from the physical workplace. METHODS: Ergonomic software was used to collect information on employees' computer usage. RESULTS: Although there was no change in total computer use in response to the hurricane (ß 0.25), active computer use significantly declined (ß -0.90). All measured computer use behaviors returned to baseline prior to the complete return to the physical workspace. CONCLUSION: Despite a transient period of reduced activity during closure of the workplace building, productivity returned to normal prior to the employees' return to a commercial workspace. The ability to work remotely may improve resiliency of employees to perform workplace tasks during events causing workplace displacement.

The impact of stand-biased desks in classrooms on calorie expenditure in children.

Childhood obesity is a public health concern with significant health and economic impacts. We conducted a prospective experimental study in 4 classrooms in central Texas to determine the effect of desks that encourage standing rather than sitting on caloric expenditure in children. Students were monitored with calorie expenditure-measuring arm-bands worn for 10 days in the fall and spring. The treatment group experienced significant increases in calorie expenditure over the control group, a finding that has implications for policy and practice.