Daily Progress Research Articles

Work boundary violations and daily goal progress in remote work: the importance of the work role re-engagement

Purpose This paper aims to empirically study the effect of work boundary violations in remote settings on daily goal progress and the important role that work role reengagement plays for remote workers. Design/methodology/approach This paper conducted a five-day diary study in China, involving a total of 118 remote workers, to collect data on the effects of work boundary violations on daily goal progress. Findings The results demonstrated that self-control resource depletion plays a mediating role in the relationship between work boundary violations and daily goal progress. In addition, work role reengagement was found to mitigate the association between work boundary violations and self-control resource depletion. Practical implications This paper provides employees with the signals that cause them to perform less well in remote work situations than in traditional offices. Employees can develop work−family boundary management strategies to reduce work boundary violations while teleworking. Originality/value This paper enriches the existing literature on work boundary violations by incorporating ego depletion theory and integrating it with the current boundary management literature. The paper provides theoretically grounded recommendations for organizations seeking to enhance the efficiency of remote workers.

Critical Thinking Skills: Comparative Assessment of Further Mathematics and Non-Further Mathematics Students in Public and Private Schools

Critical thinking skills, essential for daily progress and academic success, are rarely studied in relation to Further Mathematics. This study compared the critical thinking skills of further mathematics and non-further mathematics students in Alimosho, Lagos, Nigeria. A total of 310 participants, including 153 further mathematics and 157 non-further mathematics students, were purposively selected from public and private secondary schools. Data were collected using a valid and reliable questionnaire (r=0.82) and analyzed using descriptive and inferential statistics, including frequency, mean, standard deviation, and t-test at a 0.05 significance level. The results revealed a significant difference in critical thinking skills between further mathematics and non-further mathematics students in public secondary schools. Similarly, a significant difference was found in the critical thinking skills of public and private school students, regardless of whether they studied mathematics. No significant difference was observed in the critical thinking skills of students taking further mathematics compared to those who did not, across both types of institutions. The study recommended that mathematics teachers focus on fostering critical thinking skills beyond problem-solving in further mathematics to support students' overall development.

A comparative study on risk factors, clinical presentation, recovery rates and cost burden of patients with ischemic and hemorrhagic stroke

Stroke is a significant cause of morbidity and mortality worldwide, with ischemic and hemorrhagic strokes being the two major types. Understanding their distinct risk factors, clinical presentations, recovery rates, and cost burden is crucial for optimizing patient management and healthcare resource allocation.To evaluate and compare the risk factors, clinical presentation, recovery rates, and cost burden associated with ischemic and hemorrhagic strokes in patients admitted to a tertiary care hospital.A comparative observational study was conducted on 300 stroke patients admitted to a tertiary care hospital, adhering to predefined inclusion criteria. Detailed demographic data, clinical presentation, comorbid conditions, and treatment costs were collected. Daily progress of inpatients was reviewed to assess recovery rates. The cost burden was calculated based on prescription costs for antistroke and other medications over a 5-day period.Among the 300 participants, 192 (64%) were diagnosed with ischemic stroke and 108 (36%) with hemorrhagic stroke. Hypertension was the most prevalent comorbidity, affecting 72% of ischemic stroke patients and 68% of hemorrhagic stroke patients. Clinical presentations varied, with hemiparesis being the most common symptom in ischemic strokes (45%) and severe headaches more frequent in hemorrhagic strokes (52%). Recovery rates were higher in ischemic stroke patients, with 70% showing significant improvement compared to 58% of hemorrhagic stroke patients within the study period. The mean prescription cost for inpatient treatment over 5 days was 973.4 INR for general drugs and 679.24 INR for stroke-specific therapies. For outpatients, the mean prescription cost was 98.73 INR for stroke-specific drugs and 18.3 INR for other medications.This study highlights the differences in risk factors, clinical presentation, recovery rates, and cost burden between ischemic and hemorrhagic strokes. Addressing these factors can aid in tailoring therapeutic strategies to improve patient outcomes and reduce healthcare expenses.

Standardized Neonatal ICU Progress Note Template and Feedback System: A Clinical Documentation Improvement Initiative.

Introduction This quality improvement (QI) initiative aimed to improve the clinical documentation of daily progress notes in the neonatal intensive care unit (NICU) by applying a standardized documentation template and conducting regular cycles of audit and feedback to ensure compliance and improvement. Methods Firstly, to better assess documentation practices impacting patient care, members of the NICU auditing team identified seven key points in medical records. These points were then used for the audit of 30 randomly selected "progress notes" for infants admitted to the NICU between January and June 2022. We introduced a new standardized progress note template in the NICU based on the initial seven key points considered essential in NICU documentation. Subsequently, we educated the staff on the latest changes and their impact on patient care delivery. Also, we raised awareness amongthe NICU staff regarding the quality improvement project we were running and the requirement to adopt the new standard template. We also ensured that everyone had access to the new template. The QI team analyzed NICU progress notes every three months from October 2022 to July 2023; 45 notes were reviewed per cycle, a total of 135 notes. With each cycle, we took feedback from NICU team members regarding the deficiencies and opportunities for improvement in clinical documentation and encouraged adherence to key points. A template for the specific needs of the NICU was redesigned based on feedback received from all stakeholders on how to reduce the obstacles in adopting and retaining compliance with the new template. Results Compliance with the "key elements" of documentation improved dramatically after introducing a new template and feedback system. In the final cycle, the overall compliance was 81% (p<0.0001), well above our initial target of 60% compliance. Conclusion A unit that implements targeted audit-and-feedback measuresrelevant to the clinical team requirement can substantiallyand consistently improve documentation.

Evaluation of the Planet constellation’s daily coverage for estimating the number of vessels at Daikoku Pier automobile terminals, Port of Yokohama, Japan

The automotive industry is a key industry in Japan; however, the worker shortage has affected transportation in the ports and harbors, including that of automobile shipping. Automobiles are shipped using roll-on/roll-off (Ro-Ro) ships. When many Ro-Ro ships dock at the same time, problems related to the shortage of workers and limited storage space for automobiles are exacerbated, decreasing transportation efficiency. The spatial resolution and temporal frequency of satellite imagery have improved with Planet Labs satellite constellations making daily observations of the Earth’s surface. Moreover, the field of remote sensing is seeing an increasing number of logistic applications. As such, this study aimed to evaluate the Planet constellation’s daily coverage for estimating the actual usage of seaport automobile terminals by counting the number of vessels in each image. Here, we focused on Daikoku Pier automobile terminals in the Port of Yokohama, Japan, from 2018 to 2023. Images were classified by visual interpretation into three categories: data available for analysis, data not available for analysis due to cloud, and lack of data. Over the 6-year period, 37.1% of the data were classified as data available for analysis; 21.2%, data not available for analysis due to cloud; and 41.8%, lack of data. The visual inspection survey was conducted twice, with an agreement rate of 90.5% between the two surveys. The number of vessels were then counted two times from “data available for analysis” class, and the discrepancies were corrected. This result was compared to the actual schedule information and the accuracy was 89.0%. The number of vessels docked at the same time tended to be lower in August than in other months. The days from the 25th to 31st tended to have a higher number of vessels than other days, regardless of the month. It seems difficult to use Planet constellation for daily site progress management because data was sometimes available 1 day per month. Planet constellation can be useful in estimating the actual usage through long-term monitoring. We expect that the results of this study will be helpful to those interested in using daily satellite imagery for improving work conditions and efficiencies.

The role of resilience in navigating work stress and achieving daily work goals

SummaryOn a daily basis, resilience is critical for employees to cope with difficulties and challenges in achieving work goals. Understanding the dynamic resilience process throughout the workday is crucial for gaining insights into how employees can effectively leverage their resilience to meet their daily work goals. The present study aims to examine this dynamic resilience process in response to work stress while pursuing work goals among employees with different levels of trait resilience. Drawing on resilience literature and the conservation of resources theory, we propose a resilience‐depleting process in response to morning work stress within a short, half‐day timeframe. We further examine whether state resilience impacts subsequent work goal striving at the within‐person level. Additionally, we explore the buffering effect of trait resilience on the resilience‐depleting process after experiencing work stress. To test our hypotheses, we employed the experience sampling methodology with 108 full‐time employees over five consecutive workdays. Multilevel analyses revealed that morning work stress significantly diminished state resilience, indirectly influencing daily work goal progress through work goal activation. Notably, trait resilience buffered the negative impact of work stress on state resilience. These results offer insights into theoretical understanding and practical implications for managing employee state resilience in the face of work stress to achieve daily work goals.

Improving discharge times for patients admitted for allogeneic stem cell transplantation.

290 Background: Among patients admitted for allogeneic stem cell transplant (SCT) at University of Virginia (UVA) Health from 01/2022 through 12/2022, 0% were discharged by noon, even when discharge was anticipated. The discharge of SCT recipients is dynamic, impacted by events occurring throughout admission. Delays in discharge can result in patient/provider dissatisfaction, postponed admissions, additional costs, and poor utilization of healthcare resources. Methods: A multidisciplinary team of licensed providers, pharmacists, nurses and key stakeholders in the SCT program attended ASCO’s Quality Training Program in 2023, with the aim of increasing the percentage of patients discharged by noon to 20%. After review of baseline data and development of current and ideal process maps, the team distributed a survey to the department to identify perceived sources of delay. Results were corroborated with baseline data and arranged into a pareto chart and priority matrix to synthesize an action plan. The most commonly identified causes for discharge delay included: medication delivery time, complex medication issues, and delay in placing the discharge order. Results: From 10/2023 through 12/2023, the first PDSA cycle focused on anticipation of discharge and prompt placement of the discharge order, which was identified as a process measure. A discharge checklist was created via EPIC smartphrase and incorporated into daily progress notes. Data analysis demonstrated no change in the percentage of patients discharged by noon, but did show numerical improvement in the average time of discharge order placement and discharge time. The second PDSA cycle from 01/2024 through 05/2024 involved standardization of the team responsible for discharging SCT patients, with continued use of the smartphrase. Subsequently, the percentage of patients discharged by noon increased to 14.3%, with significant improvement in the time of discharge order placement and discharge time from baseline (see Table). Conclusions: Through implementation of quality improvement concepts, our team was able to improve our process measure of discharge order placement time. While we have made strides in regards to our outcome measure of percentage of patients discharged by noon, we have not met our goal yet. With continued progress and consistent auditing, we may see improvements in length of stay, bed availability, and financial burden. Future PDSA cycles are planned with an emphasis on medication delivery time. Key times during discharge for patients admitted for allogeneic stem cell transplantation. Mean Baseline PDSA 1 PDSA 2 p-value (PDSA 1 and PDSA 2) Discharge Order Time 11:46 AM 11:09 AM (p ≤ 0.304) 9:32 AM (p ≤ 0.0001) p ≤ 0.023 Discharge Time 4:20 PM 4:03 PM (p ≤ 0.559) 3:08 PM (p ≤ 0.022) p ≤ 0.239 Length of Stay (days) 26.8 25.9 (p ≤ 0.647) 26.6 (p ≤ 0.898) p ≤ 0.663 Medication Delivery Time 2:18 PM 1:00 PM (p ≤ 0.054) 12:18 PM (p ≤ 0.002) P ≤ 0.402

The The Design of an Interprofessional Health Record Form for Diabetes Mellitus Care at Primary Health Care Facility: A Recommendation

This research focuses on the pillars of primary care transformation by increasing primary services' capacity and capability, especially Diabetes Mellitus (DM) care. The study aims to produce a recording form containing simple, interprofessional records of DM patient care that can be used by various professions and can be applied in multiple primary health facilities. The design was developed through a development research approach with stages of form modification, expert and practitioner review, revision, trial, focus group discussion, and final revision. The trial was carried out by Community Health Center (Puskesmas) nurses in services at the Puskesmas through home visits for DM patients, Posbindu services, and outpatient care. Data from expert opinions, user opinions, and observations of the forms tested were analyzed qualitatively using the Technology Acceptance Model concept approach. The resulting form consists of two pages containing primary patient data and daily progress notes in tabular form. Research participants showed positive beliefs, attitudes, and behavior toward the forms being tested—the actual use of the form on an average of 3 patients per participant. The completeness was 90 percent filled. They expressed their intention to use the form further and recommended widespread dissemination to implement it in practice. The form is acceptable and ready to be applied for outpatient care, health monitoring, and home care for DM cases. Recommendations can be given to policymakers and health service providers to implement in services. Apart from that, the form can be further developed in electronic form by information technology developers.

Implementation of a Standardized Red Blood Cell Transfusion Policy in a Level IV Neonatal Intensive Care Unit: A Quality Improvement Project.

Within the neonatal intensive care unit (NICU), infants frequently receive packed red blood cell (PRBC) transfusions. Although medically necessary, potential negative long- and short-term outcomes exist following PRBC transfusions in very low birth-weight (VLBW) infants (<1500g). Synthesis of the literature demonstrates that the use of a restrictive PRBC transfusion policy can lead to a decreased number of transfusions administered with no increase in long-term neurodevelopmental outcomes. Blood transfusions have also been linked to the diagnosis of necrotizing enterocolitis (NEC) or intraventricular hemorrhage (IVH) in VLBW infants. For this quality improvement project, a restrictive PRBC transfusion policy was implemented in a level IV NICU to promote consistent care and evaluate changes in PRBC administration. The data were collected both pre- and post-policy implementation including: the number of blood transfusions, diagnosis of NEC, and diagnosis of IVH among infants <1500g. The data showed no significant change in the number of PRBC transfusions administered. Likewise, few infants were diagnosed with NEC or IVH during this same time period with minimal change between pre- and post-policy implementation data. Following policy implementation, there was a significant improvement in communication among providers regarding transfusion ordering and the inclusion of hematocrit thresholds in daily progress notes. This unintended outcome has helped to promote sustainability and enhance patient care within the NICU where this policy was implemented. Continued data collection may be beneficial in indicating whether a standardized PRBC transfusion policy will impact the administration of transfusions and diagnosis of NEC or IVH.

Hybrid Summarization of Medical Records for Predicting Length of Stay in the Intensive Care Unit

Electronic health records (EHRs) are a critical tool in healthcare and capture a wide array of patient information that can inform clinical decision-making. However, the sheer volume and complexity of EHR data present challenges for healthcare providers, particularly in fast-paced environments such as intensive care units (ICUs). To address this problem, the automatic summarization of the main problems of patients from daily progress notes can be extremely helpful. Furthermore, by accurately predicting ICU patients’ lengths of stay (LOSs), resource allocation and management can be optimized, allowing for a more efficient flow of patients within the healthcare system. This work proposes a hybrid method to summarize EHR notes and studies the potential of these summaries together with structured data for the prediction of LOSs of ICU patients. Our investigation demonstrates the effectiveness of combining extractive and abstractive summarization techniques with a concept-based method combined with a text-to-text transfer transformer (T5), which shows the most promising results. By integrating the generated summaries and diagnoses with other features, our study contributes to the accurate prediction of LOSs, with a support vector machine emerging as our best-performing classifier with an accuracy of 77.5%, surpassing existing systems and highlighting the potential for optimal allocation of resources within ICUs.

DNA of learning behaviors: A novel approach of learning performance prediction by NLP

In recent years, the field of learning analytics has gained significant attention as educators and researchers seek to understand and optimize the learning process in online learning systems. This paper presents a novel methodology for predicting learning performance in online learning systems by leveraging natural language processing (NLP) and embedding techniques. The study focuses on two online learning systems, namely BookRoll and Viscode, and aims to analyze the learning behaviors of students using system logs extracted from the databases. The logs are converted into semester and daily learning description documents to capture the daily activities and progress of the learners. To transform the natural language data into numerical representations, the transformer-based BERT model, Google Gemini, and OpenAI large text embedding methodology are employed to generate embeddings for the learning descriptions. Subsequently, k-means clustering is applied to identify distinct learning behaviors exhibited by students. These clusters are labeled with numbers, and the daily learning descriptions are combined into a sequence, referred to as the DNA of learning behaviors. By utilizing this DNA representation, the learning status of students is effectively captured, and a machine learning model is trained to predict learning performance. The experimental results demonstrate the efficacy of the proposed methodology in achieving highly convincing predictions. The contributions of this research lie in the adoption of a unique approach, integrating NLP methodologies and embeddings techniques, to enable accurate learning performance prediction in online learning systems.

Impacto de las tecnologías de la Información en la Inteligencia de Negocios

Technological advancement has allowed computer tools to be fed with constant information due to the processing of data that people share through social networks or purchasing platforms. This is an opportunity for large companies since they can make sales or segmentation projections of market in an efficient way and running less risk of failure by having data on the purchasing behavior of potential customers. Once the data is processed using statistical algorithms, focused business rules can be established that allow customers to be offered products that adapt to their needs, generating an important value chain for the growth of the sales margin and mainly thanks to measurement tools. Data visualization can control the daily progress of goals from the mobile device and make appropriate management decisions for the effective implementation of business intelligence.

A randomized controlled mHealth trial that evaluates social comparison-oriented gamification to improve physical activity, sleep quantity, and quality of life in young adults

IntroductionThe integration of gamification in mHealth interventions presents a novel approach to enhance user engagement and health outcomes. This study aims to evaluate whether comparison-oriented gamification can effectively improve various aspects of health and well-being, including physical activity, sedentary behavior, sleep, and overall quality of life among young adults. MethodsPotential 107 young adults (from 19 to 28 years old) participated in an 8-week trial. Participants were assigned to either a gamified mHealth intervention (LevantApp) with daily leaderboards and progress bars (n = 53, 26 % dropped-out), or a control condition without gamification (n = 52, 29 % dropped-out). Physical activity (number of steps, moderate and moderate-to-vigorous physical activity -MVPA-) and sleep quantity were measured objectively via accelerometry and subjectively using the International Physical Activity Questionnaire(IPAQ), Pittsburgh Sleep Quality Index(PSQI), Sedentary Behavior Questionnaire(SBQ), and Short Form Health Survey(SF-36). ResultsThis mHealth intervention with social comparison-oriented gamification significantly improved moderate physical activity to a greater extent than the control group. Additionally, the intervention group showed improvements in the number of steps, moderate physical activity, sedentary time, emotional wellbeing, and social functioning. However, no significant group by time interaction was observed. No significant differences were observed in sleep quality or quantity. Conclusions: The LevantApp gamified mHealth intervention was effective in improving moderate physical activity, physical functioning, and role-emotional in young adults. No significant effects were found on step counts, MVPA or sleep, suggesting that while gamification can enhance specific aspects of physical activity and quality of life, its impact may vary across different outcomes.

Framework for assessing bridges construction impact on work zone traffic using BrIM

This research presents a framework for visualizing bridge construction impact on work zone traffic using Bridge Information Modelling (BrIM) and Google Maps API. The framework consists of four modules. The first module contains the construction data of the bridge by reporting the construction's daily progress. The second module is designated to model traffic data of the work zone using Google Maps API, traffic Survey counting, and Google Earth Images. The third module performs a traffic simulation for the work zone, and calculating the user cost of different stages. The fourth module visualizes the bridge's construction using Bridge Information Modelling (BrIM) and virtual reality in the Twinmotion engine to demonstrate the construction stages and the corresponding traffic states. An actual case study of El-Nahas Bridge in Cairo city-Egypt is presented to demonstrate the main features of the developed framework and its practical aspects. The case study results reveal that the impact of the construction stages varies on work zone traffic throughout the project period. The impact greatly influences the traffic status at the beginning of the project associated with high user costs. Then, the impact declines in later stages depending on the type of construction activities in each stage.

Family Perception of OpenNotes in the Neonatal Intensive Care Unit.

OpenNotes, or sharing of medical notes via a patient portal, has been studied extensively in the adult population, but less in pediatric populations, and even more rarely in inpatient pediatric or intensive care settings. This study aimed to understand families' interaction with and perception of inpatient hospital notes shared via patient portal in a community Neonatal Intensive Care Unit (NICU). At the end of the NICU discharge education, completed in the patient portal before discharge, families were offered an anonymous survey on OpenNotes. Out of 446 NICU patients from March 16, 2022 to March 16, 2023, there were 59 respondents (13%). Race was primarily Asian (48%), and English was the predominant language (93%). Most families indicated that the notes were "very or somewhat easy to understand" (93%). Seventy-three percent of respondents felt much better about the doctor(s) after reading the notes, and 53% contacted the physicians about something in the notes. Six (16%) felt that OpenNotes were more confusing than helpful. To the authors' knowledge, this is the first study on NICU families' perceptions of OpenNotes, which indicated positive interactions with the doctors' daily progress notes and gave important suggestions for improvement.

ОБЗОР И ОЦЕНКА БИОЛОГИЧЕСКИ АКТИВНЫХ ПЕПТИДОВ ИЗ СЫРЬЯ ЖИВОТНОГО ПРОИСХОЖДЕНИЯ

The purpose of this work is an analytical review of available scientific information on methods for obtaining biologically active peptides from raw materials of animal origin, their main functions and properties. Recently, there has been a growing interest in the scientific community in the discovery of new bioactive compounds that can be isolated from foods or substances, which provides great opportunities for obtaining new peptides with pharmacological effects. The daily progress of modern science in the study of the structure and components of raw materials of animal origin is noted. Biologically active peptides are compounds consisting of a chain of amino acids in animal and vegetable proteins. Biologically active peptides demonstrate a significant effect on ongoing processes in the human body: they regulate metabolic processes, increase the life cycle of cells by restoring their regeneration, and have a powerful pharmacological effect, which makes them valuable therapeutic and prophylactic components.

Back to Babies: Reducing Documentation Time in the NICU

Abstract Background There is no accepted best practice for generation and content of daily progress notes in the neonatal intensive care unit (NICU). Objectives This study aimed to implement a consistent documentation standard process for a neonatology provider group at a level IV tertiary care NICU. The primary aim was to improve timeliness of daily progress note completion. Secondary aims were to maintain or improve clinician satisfaction, reduce variability, and reduce attending neonatologist electronic medical record (EMR) documentation tasks. Methods We formed a work group including advanced practice providers (APPs) and physicians from the NICU that met over 6 months to define the ideal NICU documentation content, map the workflow for documentation, identify gaps in EMR content, and create solutions for each gap. Baseline assessment included a change readiness survey to identify barriers to workflow change and a review of neonatologist signature timestamp to determine time to note completion. Twenty random progress notes were sampled weekly for 6 months prior to implementation of new workflow as well as 6 months postimplementation. Average time to note completion was compared in the pre- and postintervention groups. Results In total, 962 notes were sampled, 481 each in the pre- and postintervention states. Twenty neonatologists were captured in the preintervention state, 24 in the postintervention state, 18 were captured in both samples. Final note completion time mean improved from 10 hours and 32 minutes (from starting note to final sign) to 8 hours and 40 minutes (p &lt; 0.01). Those sampled in both epochs improved from 10 hours and 6 minutes to 8 hours and 30 minutes (p &lt; 0.05). Conclusion Progress notes generated by neonatologists are completed earlier than those generated by an APP with a Neonatologist addendum. Specialty-specific education and training are critical to high satisfaction in large EMR workflow transitions.

Early and accumulated experience shape migration and flight in Egyptian vultures

Two types of experience affect animals' behavioral proficiencies and, accordingly, their fitness: early-life experience, an animal's environment during its early development, and acquired experience, the repeated practice of a specific task.1,2,3,4,5,6,7,8 Yet, how these two experience types and their interactions affect different proficiencies is still an open question. Here, we study the interactions between these two types of experience during migration, a critical and challenging period.9,10 We do so by comparing migratory proficiencies between birds with different early-life experiences and explain these differences by testing fine-scale flight mechanisms. We used data collected by GPS transmitters during 127 autumn migrations of 65 individuals to study the flight proficiencies of two groups of Egyptian vultures (Neophron percnopterus), a long-distance, soaring raptor.11,12 The two groups differed greatly in their early-life experience, one group being captive bred and the other wild hatched.13 Both groups improved their migratory performance with acquired experience, exhibiting shorter migration times, longer daily progress, and improved flight skills, specifically more efficient soaring-gliding behavior. The observed improvements were mostly apparent for captive-bred vultures, which were the least efficient during their first migration but were able to catch up in their migratory performance already in the second migration. Thus, we show how the strong negative effects of early-life experience were offset by acquired experience. Our findings uncover how the interaction between early-life and acquired experiences may shape animals' proficiencies and shed new light on the ontogeny of animal migration, suggesting possible effects of sensitive periods of learning on the acquisition of migratory skills.

Collaboratively Designing an App for a More Personalized, Community-Endorsed Continuous Glucose Monitoring Onboarding Experience: An Early Study.

Acclimating to a new technology device, such as a continuous glucose monitor (CGM), can be challenging. Current resources may not sufficiently answer questions patients living with diabetes (PWD) may have. We asked how we might improve the process to onboard a PWD to CGM. Our specific aims were (1) to develop, employing a co-designing approach, a prototype of an app for facilitating onboarding to CGM and (2) to obtain early feedback on its usability. We applied a human-centered design (HCD) approach; this process first seeks to deeply understand the unmet needs and frustrations users face. After wearing a demonstration CGM; observing PWD onboarding with health care professionals (HCPs) in clinic; and interviewing 8 PWD and 2 HCP, we developed, tested, and refined a low-fidelity prototype of a clickable app. With insights from this initial round of feedback, we then created a high-fidelity prototype with 3 key features: (1) individual entry of goals and questions; (2) a daily progress tracker for these goals; and (3) a community portal that facilitates exchange of questions and answers. We used the validated System Usability Scale (SUS) to quantify user feedback. Focus group participants found our early app to be usable and acceptable. Measurement of usability by the SUS yielded a score of 74, which is above average (68) reported for all applications tested, per usability.gov. Our early prototype app is a more personalized, additional tool that could bridge an information and support gap for patients who are new to CGM. This app could also help PWD on an ongoing basis, by evolving with them to enhance ease and engagement with diabetes self-management.

The influence of socioeconomic and spatial variables on total maximum daily load progress in the United States

Abstract The total maximum daily load (TMDL) program requires each state in the United States to assess their water bodies, list those that are impaired, and develop TMDL plans or programs to restore them. However, the impact that spatial and socioeconomic variables have on TMDL progress is unknown. This study seeks to fill this gap through a nation-wide analysis of the influence of spatial and socioeconomic variables on indicators of TMDL progress. To do so, data were collected and analyzed for each state, including indicators of TMDL progress, spatial variables, and socioeconomic data. Then, these data were applied to identify overall trends and to define the relationships between indicators of TMDL progress and spatial and socioeconomic variables. Results indicate that the size of a state, the length of total streams, and median household income are related to the percentage of streams that are assessed within a state. In addition, states largely followed similar patterns in TMDL progress based on the US Environmental Protection Agency region that they were within, indicating that location plays a large role. Overall, this study helps to contextualize progress in TMDL development and aid in our understanding of factors that influence the implementation of water quality programs.