David M. Neyens

Crash risk factors related to individuals sustaining and drivers following traumatic brain injuries

OBJECTIVE Some crashes result in drivers experiencing (or sustaining) a traumatic brain injury (TBI) while other crashes involve drivers that have already experienced a TBI. The objective of this study is to examine the factors that influence these two TBI crash groups. METHODS Data from the Iowa Department of Public Healths Brain Injury Registry and Department of Transportations crash records were linked together and used in logistic regression models to predict the likelihood of a driver sustaining a TBI in a crash and those who drive after a TBI. RESULTS Between 2001 and 2006, there were 2382 crashes in which an individual sustained a TBI. As expected, a higher likelihood of sustaining a TBI was observed for motorcycle drivers who did not wear a helmet and in crashes that resulted in total or disabling vehicle damage. Focusing specifically on the post-TBI drivers (and not occupants), 1583 were involved in crashes. These post-TBI drivers were less likely to wear seatbelts or have passengers in the vehicle at the time of the crash, and were more likely to crash at night. Post-TBI drivers were also involved in significantly more multiple crashes (about 14%) when compared to drivers who have not experienced a TBI (about 10%) during the study period. When controlling for gender, date of injury, and severity of TBI (using Glasgow Coma Scale), individuals that sustained a TBI when they were younger were more likely to be involved in multiple crashes. CONCLUSIONS Different factors influence the crash likelihood for those that sustain a TBI in a crash and those that crash following a TBI. In general, post-TBI drivers have a higher occurrence of multiple crashes and this should be further explored to guide driver rehabilitation, evaluation, and training.

Assessing drivers' performance when automated driver support systems fail with different levels of automation

Adaptive cruise control (ACC) systems and lane keeping (LK) systems are two automated driver support systems that serve as convenience systems by changing the role of the driver from a controller to an automation supervisor. These higher levels of automation might impair drivers’ performance when the automated systems fail. This study examined how drivers’ performance differed when an automated system fails in two different levels of automation; with only LK engaged (lower level automation) and with both ACC and LK engaged (higher level automation). Drivers’ performance in conjunction with automated driving was compared in different road conditions (i.e., straight lane, curve lane, and in traffic). In addition, it was expected that drivers’ characteristics and attitudes towards automation, such as their automation complacency, interpersonal trust, acceptance of the LK, and trust of the LK would also influence driving performance. Results showed that participants had significantly longer response times to a system failure with a higher level of automation than with a lower level of automation. The higher level automation also led to significantly larger maximum lane deviation when a system failed. In addition, participants with higher level of interpersonal trust had significantly larger maximum lane deviation than participants with lower level of interpersonal trust. Thus, these results suggest that failures of higher levels of automation may lead to poorer driving performance during the detection and recovery from the failure and drivers’ level of interpersonal trust affects their detection and recovery from system failures.

An Investigation of the Informational Needs of Ovarian Cancer Patients and Their Supporters

Numerous Internet-based peer support groups exist to support the informational needs of patients with chronic illnesses. By analyzing the discussions available in the forum of a major ovarian cancer support group, the Ovarian Cancer National Alliance (OCNA), this study investigates the type of information that newly diagnosed ovarian cancer patients and their supporters seek. Using content analysis, 206 publicly available discussion posts exchanged on OCNA were analyzed by two researchers. Each discussion point was classified into one of the three broad themes that emerged: ovarian cancer-specific, treatment-related, or coping information. The discussion points were further analyzed using a multinomial logit model to predict the type of the desired information based on the role of the person looking for the information, the disease phase in which the information was sought, the emotional status of the information seeker, and the stage of the cancer. The results suggest that there is a wide variety of information seekers with divergent goals. Treatment-related material was the most sought-after information by patients, while coping information was most sought by supporters. When forum posts were negative in tone, the information seekers were more likely to be looking for ovarian cancer-specific information than either treatment-related information or coping information. This suggests that the presentation of ovarian cancer-specific information should be particularly sensitive to the negative emotional state of the people seeking this information.

Anesthesia maintenance and vigilance: Examining task switching

Limited research has focused on vigilance during the maintenance phase of anesthesia work. The goal of this study was to identify anesthesia maintenance tasks and to identify the transitions between these tasks within the perspective of the vigilance paradigm. In this study, three bariatric surgeries were recorded and analyzed using a task categorization structure. Across the surgeries the primary anesthesia provider spent 71% of their time doing patient or display monitoring tasks. Task frequency and transition visualizations were generated to identify trends in the task switching. Transitions between the task categories occurred approximately once every nine seconds for the primary anesthesia provider. Additionally, it appears that regardless of the task, there was a high frequency of task transitions to looking at the visual displays and then from the visual displays towards the patient. The results of this study emphasize the importance of vigilance for anesthesia display design.

The Effects of Driver Distraction for Individuals With Traumatic Brain Injuries

Objective: The aim of this study was to evaluate the effects of secondary tasks on the driving performance of individuals with mild traumatic brain injuries (TBIs). Background: Studies suggest detrimental impacts of driving with TBI or while distracted but the impact of driver distraction on TBI drivers is not well documented. Method: Bayesian regression models were used to estimate the effect of relatively simple secondary tasks on driving performance of TBI and healthy control (HC) drivers. A driving simulator was used to develop prior distribution of task effects on driving performance for HCs. An on-road study was conducted with TBI and HC drivers to generate effect estimates for the posterior distributions. The Bayesian models were also compared to frequentist models. Results: During a coin-sorting task, all drivers exhibited larger maximum lateral acceleration and larger standard deviation of speed than in a baseline driving segment. There were no significant driving performance differences between the TBI and the HC drivers during the tasks. Across all tasks, TBI drivers spent more time looking at the tasks and made more frequent glances toward the tasks. Conclusions: The findings show that even drivers with mild TBI have significantly longer and more glances toward the tasks compared to the HCs. Application: This study demonstrates a Bayesian approach and how the results differ from frequentist statistics. Using prior distributions in a Bayesian model helps account for the probabilities associated with otherwise unknown parameters. This method strengthens the Bayesian parameter estimates compared to that of a frequentist model.

Simulated Estimates of Pre-Pregnancy and Gestational Diabetes Mellitus in the US: 1980 to 2008

Purpose To simulate national estimates of prepregnancy and gestational diabetes mellitus (GDM) in non-Hispanic white (NHW) and non-Hispanic black (NHB) women. Methods Prepregnancy diabetes and GDM were estimated as a function of age, race/ethnicity, and body mass index (BMI) using South Carolina live singleton births from 2004–2008. Diabetes risk was applied to a simulated population. Age, natality and BMI were assigned to women according to race- and age-specific US Census, Natality and National Health and Nutrition Examination Surveys (NHANES) data, respectively. Results From 1980–2008, estimated GDM prevalence increased from 4.11% to 6.80% [2.68% (95% CI 2.58%–2.78%)] and from 3.96% to 6.43% [2.47% (95% CI 2.39%–2.55%)] in NHW and NHB women, respectively. In NHW women prepregnancy diabetes prevalence increased 0.90% (95% CI 0.85%–0.95%) from 0.95% in 1980 to 1.85% in 2008. In NHB women from 1980 through 2008 estimated prepregnancy diabetes prevalence increased 1.51% (95% CI 1.44%–1.57%), from 1.66% to 3.16%. Conclusions Racial disparities in diabetes prevalence during pregnancy appear to stem from a higher prevalence of prepregnancy diabetes, but not GDM, in NHB than NHW.

Developing a 3D Gestural Interface for Anesthesia-Related Human-Computer Interaction Tasks Using Both Experts and Novices

Objective: The purpose of this research was to compare gesture-function mappings for experts and novices using a 3D, vision-based, gestural input system when exposed to the same context of anesthesia tasks in the operating room (OR). Background: 3D, vision-based, gestural input systems can serve as a natural way to interact with computers and are potentially useful in sterile environments (e.g., ORs) to limit the spread of bacteria. Anesthesia providers’ hands have been linked to bacterial transfer in the OR, but a gestural input system for anesthetic tasks has not been investigated. Methods: A repeated-measures study was conducted with two cohorts: anesthesia providers (i.e., experts) (N = 16) and students (i.e., novices) (N = 30). Participants chose gestures for 10 anesthetic functions across three blocks to determine intuitive gesture-function mappings. Reaction time was collected as a complementary measure for understanding the mappings. Results: The two gesture-function mapping sets showed some similarities and differences. The gesture mappings of the anesthesia providers showed a relationship to physical components in the anesthesia environment that were not seen in the students’ gestures. The students also exhibited evidence related to longer reaction times compared to the anesthesia providers. Conclusion: Domain expertise is influential when creating gesture-function mappings. However, both experts and novices should be able to use a gesture system intuitively, so development methods need to be refined for considering the needs of different user groups. Application: The development of a touchless interface for perioperative anesthesia may reduce bacterial contamination and eventually offer a reduced risk of infection to patients.

Determining Barriers and Facilitators Associated With Willingness to Use a Personal Health Information Management System to Support Worksite Wellness Programs

Purpose. To determine the barriers and facilitators associated with willingness to use personal health information management (PHIM) systems to support an existing worksite wellness program (WWP). Design. The study design involved a Web-based survey. Setting. The study setting was a regional hospital. Subjects. Hospital employees comprised the study subjects. Measures. Willingness, barriers, and facilitators associated with PHIM were measured. Analysis. Bivariate logit models were used to model two binary dependent variables. One model predicted the likelihood of believing PHIM systems would positively affect overall health and willingness to use. Another predicted the likelihood of worrying about online security and not believing PHIM systems would benefit health goals. Results. Based on 333 responses, believing PHIM systems would positively affect health was highly associated with willingness to use PHIM systems (p < .01). Those comfortable online were 7.22 times more willing to use PHIM systems. Participants in exercise-based components of WWPs were 3.03 times more likely to be willing to use PHIM systems. Those who worried about online security were 5.03 times more likely to believe PHIM systems would not help obtain health goals. Conclusions. Comfort with personal health information online and exercise-based WWP experience was associated with willingness to use PHIM systems. However, nutrition-based WWPs did not have similar effects. Implementation barriers relate to technology anxiety and trust in security, as well as experience with specific WWP activities. Identifying differences between WWP components and addressing technology concerns before implementation of PHIM systems into WWPs may facilitate improved adoption and usage.

Learning in simulated environments: An assessment of 4-week retention outcomes

Simulations offer the benefits of a safer and more accessible learning environment, where learners can practice until the point of proficiency. While research into the effectiveness of simulations as learning tools has found tangible benefits, fewer studies have examined retention and differences between high and low fidelity simulations. This research sought to supplement the literature in this domain by investigating whether participants who learned to construct an electrical circuit using a 2D or 3D breadboard simulation could achieve comparable learning, transfer, and retention outcomes to those who learned using a physical breadboard. The influence of learner characteristics - cognitive ability and goal orientation - were also evaluated. This study had two parts: a cross-sectional portion that examined learning and transfer outcomes and a longitudinal portion that examined retention outcomes after a 2 and 4-week period. The cross-sectional analysis included 70 participants and the longitudinal analysis included 40 participants. The results found that the physical fidelity of the learning environment significantly impacted several transfer outcomes (construction and construction time) but not retention outcomes. Cognitive ability was a significant predictor of learning (gain score, circuit design score) and retention (posttest scores, construction time) outcomes. Learning goal orientation significantly predicted circuit construction over time and measurement occasion significantly predicted posttest scores and interacted with fidelity to predict circuit design score. The study demonstrated that simulated environments can lead to comparable, or better, proficiency than physical environments. These findings have implications for the design and implementation of simulated environments, specifically for courses delivered in an online setting.

Investigating Intraoperative and Intraprofessional Handoffs in Anesthesia

Handoffs occur frequently in healthcare systems, and miscommunications and critical omissions within handoffs have been linked to serious medical errors. Handoff quality is a priority of patient safety initiatives across several international organizations. The majority of previous research in handoffs have focused on postoperative handoffs; yet, there is a need to specifically investigate intraoperative handoffs, especially within individual professions or subspecialties. Each subspecialty within a surgical team may approach handoffs differently. The anesthesia team is especially unique as they take a team-based approach to patient care where multiple anesthesia providers may be involved in one surgical case. We describe an observational study of intraoperative and intraprofessional handoffs in anesthesia. Temporary and permanent handoffs were investigated as well as the contextual elements that influenced handoff procedures. In a sample of 35 video recorded surgeries, a total of 16 handoffs were identified for the maintenance phase of surgery. These handoffs ranged between 33 seconds and 7.42 minutes in duration. Our study revealed variability in intraoperative handoffs during the maintenance phase of anesthesia and emphasizes that intraoperative and intraprofessional handoffs warrant more in-depth examination in order to develop effective strategies or tools for high quality handoffs in anesthesia.