Consistent Use Research Articles

Novel assessment of CPAP adherence data reveals distinct diurnal patterns.

Obstructive sleep apnea (OSA) is a prevalent condition effectively treated by continuous positive airway pressure (CPAP) therapy. CPAP adherence data, routinely gathered in clinical practice, include detailed information regarding both duration and timing of use. The purpose of the present study was to develop a systematic way to measure the diurnal pattern of CPAP adherence data and to see if distinct patterns exist in a clinical cohort. Machine learning techniques were employed to analyze CPAP adherence data. A cohort of 200 unselected patients was assessed and a cluster analysis was subsequently performed. Application of this methodology to 17 patients with different visually noted patterns was carried out to further assess performance. Each 30-day period of CPAP use for each patient was characterized by four variables describing the time of day of initiation and discontinuation of CPAP use, as well as the consistency of use during those times. Further analysis identified six distinct clusters, reflecting different timing and adherence patterns. Specifically, clusters with relatively normal timing versus delayed timing were identified. Finally, application of this methodology showed generally good performance with limitations in the ability to characterize shift worker and non-24 rhythms. This study demonstrates a methodology for analysis of diurnal patterns from CPAP adherence data. Furthermore, distinct timing and adherence patterns are demonstrated. The potential impact of these patterns on the beneficial effects of CPAP requires elucidation.

Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects.

Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.

Determinants of consistency of use of household water filters in emergencies: Insights from a protracted drought in Northern Kenya

The consistent use of household water treatment and storage (HWTS) technologies is necessary for human health. However, most HWTS options are designed for typical household use as opposed to emergency contexts, where use is less consistent. To investigate ways to improve the consistency of HWTS use in emergencies, we conducted in-person surveys with 108 households in northern Kenya and comparatively analyzed factors that influenced the use of household filters during a protracted drought. Findings showed that about 50% of respondents used their filter consistently over the course of the study. The main limitation to usability was that none of the filters were well-suited for the indoor living environment of the survey respondents. The factors associated with consistency of use varied by filter design. For one-bucket filters, consistent use was associated with ease of assembly, reported availability of spare parts, and peer approval of HWTS use. For two-bucket filters, consistent use was best explained by the certainty regarding when the filter was functioning or not. We suggest that filter manufacturers should reduce the number of parts to mitigate assembly difficulties and should develop flexible filter designs to improve compatibility across households in terms of space and height requirements. Those disseminating filters during protracted emergencies should conduct user training on the assembly and disassembly of unfamiliar filters and ensure affordable access to necessary replacement parts. Finally, to improve consistency of use of new types of filters, implementers should assess the peer approval of these HTWS options among the target population.

The Finer Aspects of Grid-Walking and Cylinder Tests for Experimental Stroke Recovery Studies in Mice.

The choice of behavioral tests and their proper execution is critically important for experimental and preclinical therapeutic stroke recovery studies, where improvement of impaired neurological function(s) is the main outcome measure. Two tests that focus on spontaneous motor behaviors of the forelimb during gait and exploratory rearing and are expert recommended for stroke recovery studies in mice are grid-walking and cylinder tasks. Both tests have been widely used in various experimental stroke studies to evaluate acute and chronic motor impairment. To facilitate adoption of these tests and consistency of use between different research laboratories, this chapter describes a simple and rigorous protocol and our schemes to successfully perform both tasks in mice and evaluate motor dysfunction and recovery after stroke. In addition, we provide practical tips to minimize experimental bias and acquire data for analyses.

Snapshot Report: A Uniformed Handoff Tool for All Perioperative Services

<h3>Background Information</h3> The Joint Commission reports 80% of serious medical errors are the result of miscommunication during transfer or hand-off and 5 out of 10 sentinel events are directly relate to the perioperative setting. This setting is unique due to large intermittent patient volumes in a brief period, multiple interdisciplinary caregivers, decreased ability for patient engagement due to sedating medications. <h3>Objectives of Project</h3> The handoff process requires a complete understanding of the patient's condition and status to ensure their safety. Bedside handoff is evidence based and is known to reduce errors in patient care, decrease length of stay and improve patient satisfaction. The snapshot tool was created within the EMR to ensure all ASPAN key safety elements were included. The snapshot handoff tool promotes inclusion of important patient details in one report. <h3>Process of Implementation</h3> Assessed and appraised present literature on best practices concerning handoff tools/process. Reviewed present hospital policies. Performance Improvement council members worked with unit staff for input on needs for handoff tool. Final draft sent to our IT department where the tool was drafted. Education of staff prior to implementation. Snapshot tool implemented June 2020. <h3>Statement of Successful Practice</h3> No medication errors reported. Improvement in "overall teamwork between doctors, nurses and staff" patient satisfactions scores. Delay in first case on time starts with "due to nursing" code approximately 5% per month down from 10%. Nurse satisfaction of handoff improved with snapshot tool due to ease and consistency of use at handoff as well as the ability to review a patient case prior to report and admission to the receiving unit. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses will understand the benefits and use a uniformed handoff process within all phases of the perioperative service lines. Perianesthesia nurses will understand potential risk factors from lack of communication during handoff. Perianesthesia nurses will be able to apply JACHO and ASPAN best practices in handoff reporting. Perianesthesia nurses will understand and be able to use the seven steps of implementing practice changes.

Factors Affecting the Use of Speech Testing in Adult Audiology.

ObjectiveTo evaluate hearing healthcare professionals’ (HHPs) speech testing practices in routine adult audiology services, and better understand the facilitators and barriers to speech testing provision.DesignA cross-sectional questionnaire studyStudy SampleA sample (n=306) of HHPs from the public (64%) and private sector (36%), in the United Kingdom (UK), completed the surveyResultsIn the UK, speech testing practice varied significantly between health sectors. Speech testing was carried out during the audiology assessment by 73.4% of private sector HHPs and 20.4% of those from the public sector. During the hearing aid intervention stage speech testing was carried out by 56.5% and 26.5% of HHPs from the private and public sector, respectively. Recognised benefits of speech testing included: 1) providing patients with relatable assessment information, 2) guiding hearing aid fitting, 3) supporting a diagnostic test battery. A lack of clinical time was a key barrier to uptake.ConclusionUse of speech testing varies in adult audiology. Results from the present study found the percentage of UK HHPs making use of speech tests was low compared to other countries. HHPs recognised different benefits of speech testing in audiology practice but the barriers limiting uptake were often driven by factors derived from decision makers rather than clinical rationale. Privately funded HHPs used speech tests more frequently than those working in the public sector where time and resources are under greater pressure and governed by guidance that does not include a recommendation for speech testing. Therefore, the inclusion of speech testing in national clinical guidelines could increase the consistency of use and facilitate the comparison of practice trends across centres.

Newly arrived Asian-born gay men in Australia: exploring men\u2019s HIV knowledge, attitudes, prevention strategies and facilitators toward safer sexual practices

BackgroundAsian-born gay, bisexual and other men who have sex with men (gbMSM) newly arrived in Australia are more than four times as likely than their Australian-born counterparts to be diagnosed with incident HIV. Our aim was to explore experiences of Asian-born gbMSM newly arrived in Australia and attending a sexual health centre with regards to their knowledge of and preference for HIV prevention strategies.ResultsTwenty-four gbMSM aged 20–30 years attending Melbourne Sexual Health Centre who were born in Asia and arrived in Australia in the preceding four years, participated in semi-structured face-to-face interviews from 8th May 2019 and 23rd December 2019. Men were excluded if they were living with HIV. Interviews were recorded, transcribed verbatim and analysed thematically. Men reported little knowledge of HIV prevention strategies outside of condom use prior to coming to Australia. Although participants reported basic knowledge of HIV transmission and treatment, exposure to sexual identity and HIV-related stigma in their countries of birth meant they imagined a HIV diagnosis would be devastating. Most relied on condoms to stay HIV negative however their consistency of use varied. Seven men were on pre-exposure prophylaxis (PrEP); all but one started PrEP after coming to Australia. Many indicated interest in PrEP but described it as too expensive given they do not have access to government-subsidized healthcare. Sexual health counselling and connections with LGBTQI community groups appeared to facilitate PrEP and consistent condom use.ConclusionsAsian-born gbMSM newly-arrived to Australia may have limited knowledge of HIV prevention strategies aside from condom use. Increased connections with sexual health services and LGBTQI communities may facilitate more effective HIV prevention strategies.

Consistency With and Disengagement From Self-monitoring of Weight, Dietary Intake, and Physical Activity in a Technology-Based Weight Loss Program: Exploratory Study.

BackgroundDigital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant consistency and disengagement with these tools.ObjectiveThis study characterizes the consistency of use and time to disengagement with digital self-monitoring tools during a 6-month weight loss intervention and investigates whether the provision of phone-based intervention improved self-monitoring adherence.MethodsParticipants were 54 adults with overweight or obesity (mean age 49.6 years, SD 12.4 years; mean BMI 32.6 kg/m2, SD 3.2 kg/m2) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone app), with and without additional interventionist contact, on weight loss. All participants received weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants adhered to self-monitoring recommendations (7 out of 7 days). Disengagement was defined as the first of 2 consecutive weeks that the 7-day self-monitoring adherence goal was not met. Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral targets. t tests (2-tailed) and Cox proportional hazards models were used to examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss.ResultsParticipants consistently self-monitored physical activity for more weeks (mean 17.4 weeks, SD 8.5 weeks) than weight (mean 11.1 weeks, SD 8.5 weeks) or dietary intake (mean 10.8 weeks, SD 8.7 weeks; P<.05). Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks; P<.001). Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared with participants who did not (P=.006); however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity (P=.24 and P=.25, respectively). Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake (P<.001 and P=.004, respectively) but not for physical activity (P=.57).ConclusionsResults demonstrated that self-monitoring adherence differed by behavioral target, with greater consistency and longer time to disengagement associated with lower-burden tools (ie, self-monitoring of physical activity). Consistent with supportive accountability theory, additional interventionist contact improved consistency and lengthened time to disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools.

MODELING OF MASS TYPES OF PUBLIC BUILDINGS AS DYNAMIC SPATIAL STRUCTURES

The article presents a method for modeling mass types of public buildings as dynamic spatial structures, developed to determine the nature of their structure. The essence of this method is to identify the belonging of the premises to the "hard" structure based on five features: direct participation in technology; stationary equipment; sustainability of appointment; consistency of use; constancy of spatial configuration. By identifying important (integrative) connections for the functional purpose, it is possible to determine the nature of the structure of which the room is a part. With the help of the proposed algorithm, the affiliation of any room to the operational and conservative subsystem is established. Based on the determination of the affiliation of all premises to both subsystems, a "map" of the distribution of "hard" and "flexible" areas in the structure of the object is created and its structural analysis is performed. Determining the characteristics of the premises on these grounds determines its place in one or another substructure of the object. The developed method helps to take into account further changes in the conditions for the use of space and various unforeseen factors and conditions that may arise in the future. The proposed method can be supplemented in the future with other features, which will enable a deeper analysis of the structure of architectural objects and the creation of more rational planning schemes during design. Determining the belonging of each room and space of the building to both subsystems allows you to get a "map" of the location of "hard" and "flexible" sections in its structure. This algorithm has been tested in the analysis of dozens of public facilities for various functional purposes. A visual map of the distribution of conservative and operational subsystems in the system and "rigid" and "flexible" sections in the structure of these buildings is obtained. The analysis of the planning structure of public buildings showed that the traditional approach did not take into account the factor of "change over time". The "hard" parts of the conservative subsystem are located scattered and thus "cut" the potentially "flexible" and efficient in its entirety space of the operating subsystem.

GOOGLE CLASSROOM: BEYOND THE TRADITIONAL SETTING

This research explored the participants’ use of Google Classroom and evaluated its acceptability using the Technology Acceptability Model (TAM). The respondents were limited to 56 teachers enrolled in the research methodology class in a graduate school of a certain university in Bulacan during the first semester of the school year 2019-2020. The study utilized a mixed-method design. Triangulated were the result of the TAM survey, the analysis of the open-ended survey, and the record of the submission frequency of the respondents through Google Classroom. The descriptive approach was also utilized to describe the respondents' technology acceptance when using Google Classroom through the administration of the TAM survey questionnaire. The study also determined which TAM factor affected the consistency of the use of Google Classroom the most. Among the factors, actual system use appeared to have significantly affected the respondents' consistency of using Google Classroom. A separate open-ended survey was conducted to verify the data derived from the TAM survey questionnaire. The open-ended survey revealed that despite the difficulty of having a good internet connection, all of the respondents agreed that Google Classroom is very useful, easy to use and would recommend its use to others. The consistency of actual use, through online submission, was recorded and served as the dependent variable. In terms of consistency, it was observed that 62.5% of the respondents were able to submit 11 to 12 out of 12 total number of activities through Google Classroom. It was concluded that the use of Google Classroom, though a new experience, made them realize how their life as a teacher can be more comfortable with the use of this technology. Keywords: active system use, behavioral intention, Google Classroom, perceived ease of use, perceived usefulness, technology acceptance

Seasonal patterns of spatial fidelity and temporal consistency in the distribution and movements of a migratory ungulate.

How animals use their range can have physiological, ecological, and demographic repercussions, as well as impact management decisions, species conservation, and human society. Fidelity, the predictable return to certain places, can improve fitness if it is associated with high‐quality habitat or helps enable individuals to locate heterogenous patches of higher‐quality habitat within a lower‐quality habitat matrix. Our goal was to quantify patterns of fidelity at different spatial scales to better understand the relative plasticity of habitat use of a vital subsistence species that undergoes long‐distance migrations. We analyzed a decade (2010–2019) of GPS data from 240 adult, female Western Arctic Herd (WAH) caribou (Rangifer tarandus) from northwest Alaska, U.S.A. We assessed fidelity at 2 spatial scales: to site‐specific locations within seasonal ranges and to regions within the herd's entire range by using 2 different null datasets. We assessed both area and consistency of use during 6 different seasons of the year. We also assessed the temporal consistency of migration and calving events. At the scale of the overall range, we found that caribou fidelity was greatest during the calving and insect relief (early summer) seasons, where the herd tended to maximally aggregate in the smallest area, and lowest in winter when the seasonal range is largest. However, even in seasons with lower fidelity, we found that caribou still showed fidelity to certain regions within the herd's range. Within those seasonal ranges, however, there was little individual site‐specific fidelity from year to year, with the exception of summer periods. Temporally, we found that over 90% of caribou gave birth within 7 days of the day they gave birth the previous year. This revealed fairly high temporal consistency, especially given the spatial and temporal variability of spring migration. Fall migration exhibited greater temporal variability than spring migration. Our results support the hypothesis that higher fidelity to seasonal ranges is related to greater environmental and resource predictability. Interestingly, this fidelity was stronger at larger scales and at the population level. Almost the entire herd would seek out these areas with predictable resources, and then, individuals would vary their use, likely in response to annually varying conditions. During seasons with lower presumed spatial and/or temporal predictability of resources, population‐level fidelity was lower but individual fidelity was higher. The herd would be more spread out during the seasons of low‐resource predictability, leading to lower fidelity at the scale of their entire range, but individuals could be closer to locations they used the previous year, leading to greater individual fidelity, perhaps resulting from memory of a successful outcome the previous year. Our results also suggest that fidelity in 1 season is related to fidelity in the subsequent season. We hypothesize that some differences in patterns of range fidelity may be driven by seasonal differences in group size, degree of sociality, and/or density‐dependent factors. Climate change may affect resource predictability and, thus, the spatial fidelity and temporal consistency of use of animals to certain seasonal ranges.

Pairing long-term population monitoring and wildlife crossing structure interaction data to evaluate road mitigation effectiveness

Roads negatively affect wildlife populations directly as a source of mortality and indirectly through habitat fragmentation, restricted movement, and altered habitat use. Wildlife crossing structures and roadside fencing are two common road mitigation strategies implemented to reduce wildlife road mortalities and maintain population connectivity. Metrics quantifying use of crossing structures by wildlife are often used to determine their effectiveness, but interpreting these metrics can be challenging when local population processes and individual variation in use are not considered. We used over six years of remote camera data, including two years of post-construction data, from a road improvement project in south Texas to evaluate mitigation efforts in the context of long-term felid abundance. Variation in seasonal felid abundance was tied to precipitation in the preceding 12 months, highlighting the importance of accounting for baseline wildlife abundance when measuring structure efficacy. Crossing structure use by felids was positively correlated with abundance estimates, though frequency and consistency of use varied among individuals. Probability of use was related to roadside fencing, canopy cover, time since crossing construction, and presence of water in the structure. Our results suggest that conventional indices of crossing structure effectiveness, such as crossing rates, are more informative when ongoing population processes are considered. By interpreting structure use in the context of long-term abundance trends and individual variation, managers can compare use across sites to better determine factors that influence crossing structure effectiveness and take steps to site, construct, and maintain structures that enable safe wildlife road crossing and promote connectivity.

Burn patient decontamination outside of mass casualties.

ObjectiveDecontamination protocols for victims of mass casualty events are well documented and emphasized to protect physicians, nurses and facilities. Decontamination practices outside of mass casualty events are unknown. This pilot study was undertaken to assess the current practices of burn patient decontamination outside of mass casualty events within level I and II trauma center emergency departments in the state of Michigan.MethodsUsing the Michigan Trauma Quality Improvement Project membership, a 10‐question online survey was sent to trauma program managers at all level I and II trauma centers in Michigan. Survey questions focused on institutional decontamination protocols and consistency of use.ResultsSurvey response was 50%. Of the responding facilities, 31% did not decontaminate burn patients. Of the centers who indicated that they did decontaminate burn patients, 31% did not follow a standardized protocol. Our survey revealed that 69% of facilities used a protocol for decontamination: 45% used the protocol consistently on all burns, and 55% at physician discretion. Products used most frequently to decontaminate burn patients included water (100%) followed by soap (44%).ConclusionThis pilot survey of level I and II trauma centers in the state of Michigan revealed variability in the use of burn patient decontamination protocols and consistency of use. Additional research is warranted to determine if our results are reflective of trauma centers nationally.

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

BackgroundEmergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region.MethodsThis is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach.ResultsIn each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool.Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site.ConclusionIn PICs and other global contexts where EC resources are underdeveloped, a PECA-style approach to conducting an EC Needs Assessment can trigger positive change through high local stakeholder engagement. Testing this qualitative implementation method with a standardised EC assessment tool in other limited resource contexts is the next step to further improve global EC.

Anti-crisis approach in the industrial enterprise management: methodological tools of preventive regulation

The paper covers the theoretical and methodological framework for assessment of the crisis management effectiveness and the enterprise bankruptcy probability. At the present stage of the Ukrainian economic development, the main weaknesses in the activities of enterprises include: loss of sales markets, imperfect production and sales policy, lack of working capital, inefficient financial management, significant production costs, which produce signs of crisis processes and determine the feasibility of preventive approach anti-crisis management use. At the same time, the choice of the topic is due to insufficient research of this scientific problem as a whole and its relevance for the economy of Ukraine, especially in the context of the search for external investment resources, cooperation on this basis with the European Union. It was determined that one of the ways to solve the problem of predicting the probability of bankruptcy is the use of insolvency prediction models developed on the basis of the discriminant analysis method – Z-coefficients. The authors systematized the most well-known approaches to predicting the likelihood of bankruptcy of industrial enterprises, illustrated their advantages and disadvantages, the mutual consistency of use. It has been established that additional opportunities for monitoring the effectiveness of anti-crisis measures are created by a system of indicators characterizing the level of effectiveness of the anti-crisis management system. Evaluating the effectiveness of the anti-crisis program only on the basis of an analysis of relative indicators is not enough: during the global financial crisis, sometimes convincing indicators of efficiency are absolute indicators and a projected trend of their change. As part of this study, attention is paid to the analytical levers of the crisis management mechanism, which are aimed at preventive regulation and localization of crisis processes in the enterprise, restoring the effectiveness of production and marketing activities.

Pregnancy preferences and contraceptive use among US women

ObjectivesAn understanding of the relationship between individuals’ pregnancy preferences and contraceptive use is essential for appropriate patient-centered counseling and care. We examined the relationship between women’s pregnancy preferences and contraceptive use using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale. Study DesignAs part of a study examining women’s suspicion and confirmation of new pregnancies, we recruited patients aged 15 – 45 from seven reproductive health and primary health facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016–2017. We used multivariable logistic, multinomial logistic, and linear regression models to examine the associations among DAP scores (range: 0 – 4) and contraceptive use outcomes and identify factors associated with discordance between DAP and use of contraception. ResultsParticipants with a greater preference to avoid pregnancy had higher odds of contraceptive use (aOR = 1.63, 95% CI: 1.31, 2.04) and used contraceptives more consistently (aβ = 8.9 percentage points, 95% CI: 5.2, 12.7). Nevertheless, 63% of women with low preference to avoid pregnancy reported using a contraceptive method. Higher preference to avoid pregnancy was not associated with type of contraceptive method used: women with the full range of pregnancy preferences reported using all method types. ConclusionWhen measured using a rigorously developed instrument, pregnancy preferences were associated with contraceptive use and consistency of use. However, our findings challenge assumptions that women with the highest preference against pregnancy use more effective methods and that women who might welcome pregnancy do not use contraception. ImplicationsWomen’s preferences about pregnancy contribute significantly to their use of contraception. However, health care providers and researchers should consider that contraceptive features besides effectiveness in preventing pregnancy shape contraceptive decision-making and use.

Human Factors Associated with Continuous Glucose Monitor Use in Patients with Diabetes: A Systematic Review.

Consistent continuous glucose monitor (CGM) use is associated with substantial improvements in glycemic control, yet the uptake and continued use of these technologies remains low. This systematic review aims to identify and summarize the state of science on human factors and their association with CGM use to inform training methods and best practices that support adherence to CGM use and automated insulin delivery systems. A literature search was conducted in PubMed, CINAHL, The Cochrane Library, and PsychInfo databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that reported psychological human factors related to CGM or sensor-augmented pump use in patients with type 1 diabetes. In total, 389 records were identified through our database search and 26 studies published between 2010 and 2017 were included. Articles underwent quality appraisal using the Effective Public Health Practice Project Quality Assessment Tool and were categorized according to study outcomes. Identified human factors with a potential association with CGM use were treatment satisfaction, quality of life, emotional distress, and self-efficacy. Eight patient-reported barriers to CGM use were identified as a subcomponent of satisfaction. To date, studies of human factors associated with CGM use generally lack standardized measures and sufficient methodological rigor necessary to establish causation. A more robust understanding of how identified human factors influence CGM use is necessary. Future studies should test interventions that target human factors to improve consistency of use and establish best practices for enhancing patients' experience and acceptance of these technologies, especially within adolescents and young adults.

Severe neurological impairment: a review of the definition.

Severe neurological impairment (SNI) is a term commonly used in the medical literature, though there is no agreed definition. This limits opportunities for research into healthcare needs, treatment opportunities, resource planning, and outcome. We reviewed the literature to establish consistency of use of the term and to place it in the context of other commonly employed terms used to describe children with severe, complex medical needs. Forty-two articles were included for full-text analysis, with 23 including a definition of SNI. Motor impairment, intellectual disability, communication difficulties, and increased care needs were included in the definition in 80%, 70%, 30%, and 13% of papers respectively. Dependence on others for decision-making, chronicity, and distinction between disorders of the central nervous system and peripheral nervous system were less frequently included. There is wide variation in the use of the term SNI. A consensus-based definition of this term would be useful to facilitate future research. WHAT THIS PAPER ADDS: There is inconsistency in use of the term severe neurological impairment (SNI), limiting research efforts. In defining SNI, considerations are mobility, intellectual disability, communication difficulties, and increased care needs. Distinction between acute and chronic, central and peripheral nervous system disorders, and dependence on others for decision-making were less significant.

Examining perceptions of existing and newly created accessibility symbols

BackgroundSymbols are used to convey messages in a clear, understandable manner, without the use of written language. The most widely recognized symbol used to denote access for persons with disabilities is the International Symbol of Access. This symbol has been criticized for its inadequate representation of disability diversity poorly representing universal design of space and products. ObjectiveThis descriptive study explored individual comprehension and perceptions of nine existing and newly created accessibility pictograph symbols and identified one that represented universal access to fitness equipment. MethodsA survey was disseminated electronically and face-to-face to individuals, groups and organizations affiliated with inclusive fitness equipment, space and programming. Quantitative data was analyzed for descriptive statistics, rank order of symbols and group comparisons of rankings. Thematic analysis of open-ended question results revealed themes to enhance understanding of symbol rank order. Results981 participants completed the survey. Symbol four, shaped as a Venn diagram containing three icons representing individuals with varying ability levels, was ranked highest with no significant differences in group comparisons between participants with and without a disability and U.S. residents versus non-U.S. residents. 85.4% of participants demonstrated accurate comprehension of this symbol. Though symbol five had the same symbol rank median value, this symbol's distribution of scores was lower. ConclusionsParticipants accurately comprehended symbol four and it was identified as the highest ranked symbol representing universal access to fitness equipment. Because of symbol unfamiliarity, adoption will require education and consistency of use and placement.

Poor Identification of Emergency Department Acute Recreational Drug Toxicity Presentations Using Routine Hospital Coding Systems: the Experience in Denmark, Switzerland and the UK

BackgroundUnderstanding emergency department and healthcare utilisation related to acute recreational drug toxicity (ARDT) generally relies on nationally collated data based on ICD-10 coding. Previous UK studies have shown this poorly captures the true ARDT burden. The aim of this study was to investigate whether this is also the case elsewhere in Europe.MethodsThe Euro-DEN Plus database was interrogated for all presentations 1st July to 31st December 2015 to the EDs in (i) St Thomas’ Hospital, London, UK; (ii) Universitätsspital Basel, Basel, Switzerland; and (iii) Zealand University Hospital, Roskilde, Denmark. Comparison of the drug(s) involved in the presentation with the ICD-10 codes applied to those presentations was undertaken to determine the proportion of cases where the primary/subsequent ICD-10 code(s) were ARDT related.ResultsThere were 619 presentations over the 6-month period. Two hundred thirteen (34.4%) of those presentations were coded; 89.7% had a primary/subsequent ARDT-related ICD-10 code. One hundred percent of presentations to Roskilde had a primary ARDT ICD-10 code compared to 9.6% and 18.9% in Basel and London respectively. Overall, only 8.5% of the coded presentations had codes that captured all of the drugs that were involved in that presentation.ConclusionsWhile the majority of primary and secondary codes applied related to ARDT, often they did not identify the actual drug(s) involved. This was due to both inconsistencies in the ICD‐10 codes applied and lack of ICD‐10 codes for the drugs/NPS. Further work and education is needed to improve consistency of use of current ICD‐10 and future potential ICD‐11 coding systems.