Healthcare and Medical Devices

AHFE International

Accelerating Open Access Science in Human Factors Engineering and Human-Centered Computing

Healthcare and Medical Devices

book-cover

Editors: Jay Kalra, Nancy Lightner

Topics: Healthcare and Medical Devices

Publication Date: 2023

ISBN: 978-1-958651-55-1

DOI: 10.54941/ahfe1003465

Articles

Artificial Intelligence in Healthcare: The Explainability Ethical Paradox

Explainability is among the most debated and pivotal discussions in the advancement of Artificial Intelligence (AI) technologies across the globe. The development of AI in medicine has reached a tipping point in medicine with implications across all sectors. How we proceed with the issue of explainability will shape the direction and manner in which healthcare evolves. We require new tools that brings us beyond our current levels of medical understanding and capabilities. However, we limit ourselves to tools that we can fully understand and explain. Implementing a tool that cannot be fully understandable by clinicians or patients violates medical ethics of informed consent. Yet, denying patients and the population attainable benefits of a new resource violates medical ethics of justice, health equity and autonomy. Fear of the unknown is not by itself a reason to halt the progression of medicine. Many of our current advancements were implemented prior to fully understanding its intricacies. To convey competence, some subfields of AI research have emphasized validity testing over explainability as a way to verify accuracy and build trust in AI systems. As a tool AI has shown immense potential in idea generation, data analysis, and pattern identification. AI will never be an independent system and will always require human oversight to ensure healthcare quality and ethical implementation. By using AI to augment, rather than replace clinical judgement, the caliber of patient care that we provide can be enhanced in a safe and sustainable manner. Addressing the explainability paradox in AI requires a multidisciplinary approach to address technical, legal, medical, and ethical aspects of this challenge.

Patrick Seitzinger, Jay Kalra

Conference Proceedings

Expanding Our Grasp: Artificial Intelligence as the Next Leap Forward in Healthcare Quality

Healthcare quality and improvement relies on recognizing and improving patters of practice. AI involves self-learning systems using machine learning and pattern recognition to emulate thought processes typically conducted by humans. The purpose of this project was to assess the current state and challenges of healthcare quality and to charter a path forward for innovative applications of Artificial Intelligence technology to strengthen healthcare strategies. Knowledge integration was conducted across medical disciplines to identify key challenges in healthcare delivery and assess how Artificial Intelligence can be leveraged to strengthen healthcare quality. Currently, approximately half of the global population spends less than 5 minutes with their physician during doctor visits. It takes on average of 23.1 seconds for a physician to interrupt patients while they are telling their story. Most patients around the world will experience one or more diagnostic errors in their lifetime. Systematic reviews and narrative reviews of the available evidence report varying global diagnostic error rates ranging from 5% to 23.5%. Currently the physician suicide rate that is 1.5 to 4.5 times higher than that of the general population. Between 30-50% of medical students and residents experience burnout. Burnout is nearly doubling the rate of medical errors, and physicians involved in major errors are experiencing a threefold increase in suicidal ideation. AI technology has the potential to have transformative effects on increasing diagnostic accuracy, mmitigating medical errors, screening and early diagnosis, ddetermining disease susceptibility and progression. Advantages of AI include efficiency, accuracy, prediction/modelling, standardization, immune to fatigue, self-correcting abilities, and accuracy. Drawbacks of AI include developmental costs, unclear legislation, integration issues, lack of explainability, insufficient digital literacy, limited data sharing, and fear of the known. Even with unprecedented innovations in healthcare, we must utilize tried and true methods of healthcare assurance and improvement including identifying vulnerabilities, mitigating biases, and ensuring health equity. AI presents a tool to address longstanding issues in healthcare delivery and achieve a caliber of healthcare quality that was previously beyond our grasp.

Jay Kalra, Patrick Seitzinger

Conference Proceedings

Posture correction girdle with intelligent padding system to dynamically adjust the pressure distribution and correct the scoliotic spine

The progress of adolescent idiopathic scoliosis (AIS) affects the patient’s living quality by increasing the posture imbalance. In early scoliosis, postural correction may be provided to halt the progression of the deformity. Thus, bracing treatment will be introduced to the patients. Compared with the traditional hard brace, the soft brace is preferred due to its intrinsic compliance and light weight. However, in the soft brace, the ideal correction constraints and the contact pressure among the body points are hard to be identified. Therefore, in this study, a new pneumatic padding system is introduced to the posture correction girdle which could dynamically adjust the paddings’ contact pressure. With this calibration design, the therapist could immediately see the effects of the posture correction girdle on patients with different pneumatic pressure from a sitting balance sensing system. Hence, this padding system could provide precise adjustments in order to optimize the pressure level and corrective effect. We have conducted a wear trial with 3 mild scoliosis young subjects with cobb angle between 10-20 degrees. They were invited to undergo a 2-hour trial of the girdle with the optimized pressure parameter. The immediate effects of the posture correction girdle with intelligent pads were evaluated by comparing pre-wearing and post-trial X-ray and 3D scan images. The changes of Cobb and postural angles show that the girdle could reduce the scoliosis curvature and postural imbalance of the subjects. This study demonstrates that an intelligent and sophisticated padding system could be a new alterative intervention to provide optimized pressure with ergonomic designed garments that provide a better healthcare support for patients.

Zhongping Ye, Joanne Yip, Jason Cheung, Ruixin Liang, Jun Zhang, Xiaolu Li, Kai-Yu Tong

Conference Proceedings

Augmented Reality in Heat Stroke Emergency Medical Developing Design

Global temperature extremes have increased both the incidence and fatality rate of heat stroke, and the majority of cases take place outside of hospitals, without the assistance of medical personnel. People who work in manual labour ignore vital physiological signals and are unaware that heat stroke is happening, losing the crucial 30 minutes for rescue and risking permanent physical harm or death.The general public is unaware of the proper treatment for heat stroke, even though medical specialists can frequently recognize labour-related heat stroke rapidly. With the development of technology, augmented reality (AR) technology has been incorporated into a variety of industries, providing the medical sector with cutting-edge applications in the area of emergency care. Medical practitioners can swiftly and repeatedly exercise their medical skills by using the advantages of visual medicine when augmented reality technology is used in conjunction with applications for clinical training and practice. Numerous studies have adapted augmented reality technology into applications to help first responders make crucial ambulance decisions in increasingly complicated situations with a visual aid interface, improving the effectiveness of emergency care. In conclusion, this study focuses on how augmented reality technology may be used to create an interface that enables members of the general public to obtain care for heat stroke victims most quickly and effectively possible. This project adopts a Quality function Deployment to develop a user interface for heatstroke first aid that will satisfy users' demands and design criteria. The user interface is meant to give them a quick and easy way to understand how to manage heat stroke victims before they seek medical attention.

Shuo-Fang Liu, Chien Sheng Fei

Conference Proceedings

Trends in residents’ factual descriptions six months after refresher training in writing medical incident reports

Many free descriptions in medical incident reports lack factual information. In a previous study, I conducted initial training and refresher training with residents to accurately describe facts. In this study, I compared 23 actual incident reports submitted by residents after initial training, 80 reports 6 months after initial training, 21 reports after refresher training, and 18 reports 6 months after refresher training to verify whether their writing skills were retained. As a result, the description rate of patients and that of medicine and equipment information was significantly highest 6 months after refresher training. Reporter’s action, post-incident response, and original work procedures also maintained a high description rate in incident reports 6 months after refresher training. For these categories, refresher training boosted residents’ writing skills, and the effect persisted 6 months later. For environment, team member's actions, and safety check procedures, the description rate significantly decreased 6 months after initial training, but gradually recovered after refresher training. However, the description rate after 6 months of refresher training is still not high. Further improvement of refresher training is considered necessary for these categories.

Yoshitaka Maeda

Conference Proceedings

Usability Validation of Complex Medical Systems

The end goal of the application of Human Factors to the development of a safety-critical medical device is to validate the device’s safety and effectiveness in the hands of intended users. Generally, the complexity of validation studies varies according to the device intricacy. In the case of complex medical systems, such as a robotic surgical system which can be used for prolonged periods by multiple user groups at the same time and may interact with other devices in the operating room, the planning and execution of such studies require much more thinking, organization, and resources. Bearing that in mind, we have grouped the effort involved in validating complex medical systems into four categories for an optimized, practical approach. This paper discusses these four categories and provides essential guidance, based on our experience.

Ana Cristina Barbosa Medeiros, Molly Smyth

Conference Proceedings

HealthGate: unobtrusive home monitoring of vital signs, weight and mobility of the elderly

This paper will discuss the feasibility of a monitoring setup HealthGate, designed to monitor the mobility, vital signs, and weight of an elderly person living in her own apartment. The versatile sensor setup will allow more comprehensive insights than what is currently available. Continuous home monitoring will enable early interventions and actions in e.g. suspected dehydration, mobility problems, and non-optimal or missed medication. The data can be used to form indices of e.g. frailty and sleep quality, to detect changes in health and behavior, and to alert the person, relatives or caregivers of detected and impending problems. Instead of interaction with the user, the setup seeks total unobtrusiveness: invisible or integrated sensors as well as automated measurements and data transmission. This is crucial with persons suffering from severe cognitive impairment: the operation does not rely on user actions and the setup is safe from a curious user. On the other hand, tailored reports can be provided to people who can and want to investigate their own status. The custom-made monitoring system uses three sensor types: a mm-range imaging FMCW radar (1), a seat foil sensor (2), and a novel four-element weight sensor array. The seat and weight sensors are positioned in a favorite armchair and the radar cabinet faces the chair, typically positioned next to the TV. The key events from which the data are recorded are the transitions to and from the chair and the moments sitting still in the in, typically watching TV. The system will monitor heart and breathing rate (both radar and seat foil), weight, and dynamic weight distribution across the sensors under the legs of the chair, as well as movement at and near the chair (radar). Sleep is monitored using a commercial sleep sensor (VTracker 2.0, eLive Ecosystem Ltd., Finland) placed underneath the topping mattress. As the chairs used in individual homes will vary making inter-subject comparisons more difficult, during each home monitoring period, the participants will also perform a guided sitting, standing-up and walking protocol using a similar setup but with a test chair. The 25 participants are residents of a senior community, living independently in their rental apartments but using home care services. The data are collected during a series of two two-week monitoring periods, five participants at a time, starting in November 2022. We will describe the setup and data collection solution as well as show the first multisensor data comparisons and the proposals for characteristic mobility parameters for a sit down - stand up sequence and walk. The quality, reliability and limits of the biosignals and movement parameters derived from the radar data will be discussed. The data will be compared to standard measures of frailty, collected in a controlled test session, consisting of grip force, walking speed, timed sit down – stand up, and agility tests, as well as the frailty index (3) computed from the interRAI-HC assessments collected bi-annually. The daily patterns, biosignal data and daily weight variation will be compared against sleep data and interview data on acute illnesses and other conditions influencing behavior and well-being. Finally, the usability and acceptability of the setup are discussed, based on the interview data collected from the participants and home care nurses.(1) M. Mercuri et al., (2016). Biomedical wireless radar sensor network for indoor emergency situations detection and vital signs monitoring. IEEE Topical Conference on Biomedical Wireless Technologies, Networks, and Sensing Systems (BioWireleSS), pp. 32-35(2) Anttonen, J., & Surakka, V. (2005, April). Emotions and heart rate while sitting on a chair. In Proceedings of the SIGCHI conference on Human factors in computing systems (pp. 491-499).(3) Faller JW, et al. (2019) Instruments for the detection of frailty syndrome in older adults: A systematic review. PLOS ONE 14(4): e0216166

Johanna Närväinen, Juha Kortelainen, Timo Urhemaa, Mikko Saajanlehto, Kari Bäckman, Johan Plomp

Conference Proceedings

A Taxonomy of Situation Awareness Failure Factors in Primary Care

General Practitioners (GPs) report frustration in locating, customising and prioritising data in Electronic Health Records, which impairs their situation awareness (SA) and consequently impacts decision making and quality of care. Gaining SA in primary care before and during the clinical consultation is challenging, mainly due to barriers including time constraints, fragmented data, limitations in GP-patient interaction, usability issues of the Electronic Health Record (EHR) and information overload. This is enhanced with an increasing ageing population, and patients with multimorbidity. Timely and effective communication of information through data visualizations and visual analytics are promising avenues to address some of the GPs situation awareness needs and barriers, potentially supporting clinicians in making more accurate and rapid decisions. In this paper we propose a taxonomy of situation awareness failure factors in Primary Care, based on interviews with Primary Care GPs and Endsley’s SA error taxonomy. We then discuss design implications towards enhancing situation awareness in Primary Care when using EHR systems, supporting the potential of holistic visualisations to enhance SA before and during the clinical consultation.

Ahmed Patel, Porat Talya, Weston Baxter

Conference Proceedings

Design of Children's Wearable Moxibustion Instrument Based on Emotional Design Theory

Research For children, the excessive use of antibiotics treatment will damage the liver and kidney functions of children, produce drug resistance, affect the health of children, and traditional Chinese medicine has the characteristics of safety, effective and green, among which children moxibustion application has been widely recognized, and the family traditional Chinese medicine health equipment for children is of great significance. Current studies believe that moxibustion plays the function of dredging meridians and regulating the whole body through three aspects: thermal action, near infrared action and biochemical action. But for children, the skin is delicate, and the nerve is weak. The traditional diagnosis and treatment method of moxibustion has some problems, such as heavy smoke smell, difficult time and temperature control, and complex operation. Besides, the quality of electronic moxibustion products on the market is uneven, and children have not been subdivided. The product design of moxibustion instrument that fully considers the physiological and psychological characteristics of users can have good physiotherapy effect and user experience.Research objective: Emotional design has three different dimensions, namely instinct, behavior and reflection, to study the cognitive response and psychological experience of users to products and apply it in design. This paper aims to explore children as the target user group, focus on the specific situation of home care, summarize and analyze the characteristics and needs of users, design a wearable children's home moxibustion instrument that acts on the body surface and acupoints, and create a good physiotherapy experience for users through visual information and interesting design.Research methods: Based on emotional design, this paper discusses the three-level theory method of products and applies it to the design of wearable children's home moxibustion instrument. This paper mainly from three parts: firstly, population analysis and demand exploration. In this study, the characteristics of children groups are summarized by means of observation and user interview, and the internal needs of related users in the home environment are analyzed. The physical and behavioral characteristics of children are fully considered, the psychological and emotional needs of children are studied, and the three-level theory of emotional design is combined to create an interesting physiotherapy experience. Secondly, summarize the application of pediatric moxibustion in daily health care. Summarize the main health needs of users through preliminary investigation, study the multiple diseases in the childhood stage, and sort out the corresponding treatment methods as the theoretical basis of health care. Thirdly, analyze the transmission mode of information and design visualization. In the design, the wearable sensor and communication equipment are investigated and analyzed, and the user's psychology and interaction scenarios were studied through role-playing, service blueprint and other methods, to design the information interface and product interaction mode.Conclusion: This design starts from the collection of users' physiological signals, receives and transforms them into visual information, puts forward health care plan based on children's moxibustion as a theoretical basis, and adjusts users' physical conditions by applying moxibustion patches in line with children's group characteristics to the surface acupoints. Through the three-level theory of emotional design, users are centered, and emotions are taken as the starting point to analyze the group characteristics and potential needs of users, so as to provide design help for providing positive emotional guidance, creating good experience and satisfying deep needs.

Yanyu Liu, Hong Chen

Conference Proceedings

Interface design for 360°real scenes-based virtual reality system with pedaling devices

As the elderly get older, they often have problems such as a gradual decline in physical function, it may even lead to the risk of lower limb disability if they stay at home or sit for a long time without regular exercise. In order to prevent the lower limbs of the elderly from being disabled, stepping devices are often used as a kind of exercise, which can not only control the amount of exercise but also improve cardiopulmonary function, and can also reduce the risk of injury during training. However, the elderly cannot maintain regular exercise due to insufficient training motivation.To understand and explore the motivation of 360° real scenes-based virtual reality for the elderly to use the lower limb pedaling device, we created VBike, a system that combines 360° real scenes-based virtual reality based on a pedaling device and a heart rate watch connected with Bluetooth. From this study, we can understand the design steps and implementation methods of the combination of 360° real scenes-based virtual reality with pedaling devices and confirm that 360° real scenes video will affect the motivation of the elderly to use the pedaling device. In the future, this study suggests adding the design of guide signs and audio-visual guides to help the elderly see and explore more in-depth 360° real scenes-based virtual reality and increase the experience of pedaling by the elderly.

Poyen Hsu, Yi Xiang Su, Chien-Hsu Chen

Conference Proceedings

The impact of prevalent behavioural mimicry in adolescents on disease prevention and maintenance of healthy behavioural activation

With the popularity and spread of social media, more and more social software is helping to bring people closer to each other [1]. It is increasingly easy for adolescents to get other people's updates from social media, including celebrities, internet celebrities and peers [2]. Also adolescence is a time when the brain undergoes many structural and functional changes, so it is likely that the part of the social brain responsible for regulating imitation is still maturing throughout adolescence, which may lead to more pronounced imitative behaviour [3]. In addition, adolescents gain popularity, status and attractiveness through imitation of their idols or among their peers [4]. Therefore, making good use of the prevalent behaviours that social media has created in society has the potential to provide better behavioural interventions for the adolescent population [5], helping to shape better behavioural habits in adolescents, improving the current trend of younger disease and potentially reducing the likelihood of preventable health problems.The aim of this study was to analyse how popular behavioural mimicry among adolescents can be used to promote the activation of their health behaviours. We asked two questions: 1. the extent to which imitation behaviours activate adolescents' health behaviours; 2. measuring the impact of knowledge, skills and beliefs involved in the activation of behavioural imitation on adolescents' health maintenance and disease prevention.A questionnaire was used to enumerate the population groups that have the greatest influence on adolescents as the test sample in this study. 100 participants took part in the questionnaire, including 50 participants from mainland China and 50 participants from Hong Kong, whose mean age was 16 ± 3 years. After administering the questionnaire, 50 of these participants, who were randomly and equally divided into 10 groups of 5 participants each, were surveyed using the Activation Inventory (PAM) to measure the current level of knowledge, skills and beliefs involved in the activation of the adolescent population to maintain health and prevent disease, and then measured again using the PAM 30 and 60 days after the adolescents were exposed to the imitated subjects.The adolescent group itself was not highly aware of healthy behaviours and the effectiveness of positive health behaviour imitation in changing health behaviours and outcomes was somewhat proven when they were exposed to positive health behaviours of imitators for 30 days. However, 60 days after participants were exposed to imitations of healthy behaviours, although the imitations were still effective in maintaining healthy behaviours, the 60-day activation of healthy behaviours produced some decline compared to the first 30 days of outcomes. Therefore, in the future, more research should be conducted on the preferences and needs of adolescent groups to identify the social factors and groups that best trigger imitation among adolescents, and to promote positive health behaviours among adolescents by developing mobile applications that are more in line with adolescents' expectations to trigger trends, create widespread social discussion and be present in their daily conversations.References1.Moira Burke and Robert E. Kraut. 2014. Growing closer on facebook: changes in tie strength through social network site use. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI '14). Association for Computing Machinery, New York, NY, USA, 4187–4196. https://doi.org/10.1145/2556288.25570942.C. Longobardi, M. Settanni, M.A. Fabris, D. Marengo, Follow or be followed: Exploring the links between Instagram popularity, social media addiction, cyber victimization, and subjective happiness in Italian adolescents, Children and Youth Services Review, Volume 113, 2020, 104955,ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2020.104955.3.Cook, J., Bird, G. Social attitudes differentially modulate imitation in adolescents and adults. Exp Brain Res 211, 601–612 (2011). https://doi.org/10.1007/s00221-011-2584-4.4.Raviv, A., Bar-Tal, D., Raviv, A. et al. Adolescent idolization of pop singers: Causes, expressions, and reliance. J Youth Adolescence 25, 631–650 (1996). https://doi.org/10.1007/BF01537358.5.Korda H, Itani Z. Harnessing Social Media for Health Promotion and Behavior Change. Health Promotion Practice. 2013;14(1):15-23. https://doi.org/10.1177/1524839911405850.

Xiaotong Li, Ao Jiang

Conference Proceedings

A virtual training system based on human information processing model for improving mild cognitive impairment (MCI)

In recent years, the incidence of age-related diseases has increased dramatically due to the increase in the average human lifespan. The most common age-related symptom is Mild Cognitive Impairment (MCI), which often represents the transition from healthy aging to dementia, a neurodegenerative disease that has hitherto been incurable. When people detect suspected cognitive decline, how should they respond in advance? Past studies have reported that short-term memory loss is the most predictive of dementia in neuropsychological tests, so strengthening memory training and encouraging consistent self-practice can slow the rate of cognitive deterioration into dementia. Maintaining memory is nothing more than exercising, learning new skills, cultivating interests, and participating in educational activities. However, people with cognitive degeneration often feel indifferent to activities and miss the critical period for cognitive recovery. With the advancement of technology and the upsurge of games driven by virtual reality (VR), it is hoped that this group of people will be willing to receive rehabilitation training under the appropriate situational design. There were some relevant research reports on applying VR game training to restore cognitive function degradation in the past. Still, the development and training of the overall game were rarely carried out in the cognitive model. In addition, the training effectiveness was mainly re-tested with a test questionnaire. Nevertheless, each detection tool has a "reasonable suspicion interval for cognitive deterioration" that will increase the precise assessment of training effectiveness. Therefore, this study aims to design a VR game training system based on the cognitive model. The significant differences between this training model and the game training developed in previous studies are:(1) The training system is built based on the four aspects of perception, cognition, action, and heuristics, not only emphasizing memory training or action response training.(2) The training required for the complete establishment of human information processing: Unlike other game training, it may only be a fragment of training and lacks the training of human message processing sequentially and coherently, thus limiting the effectiveness of the training.The study also applied the Receiver Operating Characteristic (ROC) evaluation method to evaluate the effect of training on cognitive function enhancement more accurately. The results show that if the traditional detection tool Mini-Mental State Examination (MMSE) is used for evaluation, the sensitivity is low, and the training effect cannot be specifically illustrated. However, when the ROC evaluation method is used, the indicator: AUC (Area Under Curve) analysis and Accuracy analysis have high sensitivity for training effect evaluation. In terms of the effectiveness of VR game training: if the participant's cognitive function is suspected to be degraded (but not dementia), the response effect is significantly improved after training, which has a particular effect on delaying dementia.

Cheng-Li Liu, Kuo-Wei Su

Conference Proceedings

Quality Care and Patient Safety: A Best Practice Model for Medical Error Disclosure

Over recent years, adverse events and medical errors have become topics of increased concern in health care. Despite the efforts of healthcare organizations and providers to prevent medical errors and adverse events, medical errors are still inevitable. Disclosure of an adverse event is essential in managing a medical error's consequences. We have previously reviewed disclosure policies at the provincial level and found no uniform approach to disclosure in Canada. Effective communication between healthcare providers, patients, and their families throughout the disclosure process is vital in supporting and fostering the physician-patient relationship. Given the variability of medical error disclosure policies, comparing the disclosure process between different health authorities may allow us to better understand the best practice model given the proper parameters. Disclosure policies can provide a framework and guidelines for appropriate disclosure, leading to more transparent practices. The purpose of this study is to review and compare the disclosure policies implemented by individual health authorities across Canada. We will evaluate each policy based on the inclusion of the following key points: avoidance of blame; support to the staff; an apology or expression of regret; avoidance of speculation; some form of patient support; education/training to healthcare workers; immediate disclosure; team-based approach; accessibility; and documentation. The clinical significance of the study is to find similarities and differences between various health regions' policies of disclosure as well as report the best practice model for medical error disclosure across Canada. We suggest implementing a uniform national policy that addresses errors in a non-punitive manner and respects the patient's right to an honest disclosure. A prime role exists for the accrediting and regulatory authorities to initiate policy changes and appropriate reforms in the area. Not only should disclosing medical errors be a routine part of medical care to enhance quality improvement, but it would also protect patients' health and autonomy.

Jay Kalra, Zoher Rafid-Hamed, Chiamaka Okonkwo, Patrick Seitzinger

Conference Proceedings

Knowledge Model for Interactive Safety Performance Indicators for Wearable Rehabilitation Robot: Uniform Standards for Interaction Safety Testing

Wearable rehabilitation robot (WRR) has become an important tool in the clinical application of rehabilitation medicine, and as WRR is usually attached to the patient's body and in close contact with the therapist, the safety of interaction during rehabilitation is an important consideration for device developers. As the WRR is still in its early stages of development, there is still a gap in international safety standards or technical standards for WRR. As more and more research is conducted on WRR and the technology is gradually improved, the corresponding safety test methods and indicators should be gradually improved. In order to gain a comprehensive understanding of the research hotspots and frontier areas in the field of WRR interactive safety performance, this study analyses the annual distribution of literature, distribution of journals, distribution of research power, important literature, research hotspots and frontiers based on bibliometric methods, and constructs a knowledge model of WRR interactive safety performance indicators. It is found that the research hotspots in WRR safety performance research are mainly focused on four areas: clinical reliability testing, safety performance testing equipment development, mechanical structure optimization and control algorithm optimization. Based on the above research, the knowledge model of interactive safety performance indicators is drawn, and the unified standard for interactive safety testing in the field of WRR safety performance is analyzed and summarized to provide reference for the construction of testing methods for the unified standard for WRR safety testing.

Cheng Ming, Yanchen Du, Ao Jiang, Meng Xin, Hongliu Yu

Conference Proceedings

An examination of factors beyond the 5C Model in COVID-19 Vaccine Uptake Decisions

A delay in accepting or a refusal of vaccination despite the availability of vaccination services is referred to as vaccine hesitancy. Vaccine hesitancy has gained increased attention, particularly since the outbreak of the COVID-19 pandemic. The most commonly used framework in studies of vaccine hesitancy and its determinants has been the 5C model. The 5C model posits that the five individual-level determinants influencing vaccine hesitancy are confidence, complacency, constraints, calculation, and a feeling of collective responsibility. However, other factors that may also be important in influencing vaccine hesitancy, such as sociodemographic and psychological determinants, have received less attention. Objectives: This study analyzed 1) the effectiveness of the 5C model in predicting the COVID-19 vaccination decision and 2) the association between COVID-19 vaccination decisions and the fear of being infected with COVID-19, attitude toward the media’s COVID-19 vaccination information, monetary incentives, political attitudes, perception of Hong Kong’s future, and attitude toward the vaccination advice of authorities (government officials and healthcare professionals). Methods: This study used data collected in an online questionnaire distributed from May 2022 to June 2022 during the fifth wave of the Omicron variants in Hong Kong. The questionnaire had 32 items measuring the COVID-19 vaccination status, demographic characteristics, the five determinants of the 5C model, and the following six additional factors: 1) fear of being infected with COVID-19, 2) attitude toward the media’s COVID-19 vaccination information, 3) monetary incentive, 4) political attitudes, 5) perception of Hong Kong’s future, and 6) attitude toward the vaccination advice of authorities. Results and Conclusions: For the 5C determinants, only confidence was significantly positively associated with COVID-19 vaccination, whereas complacency, constraints, and collective responsibility were associated when a relaxed p-value (p ≤ 0.25) was used. For the six additional factors, only attitude toward the media’s COVID-19 vaccination information was significantly positively correlated with vaccination status, and when a relaxed p-value (p ≤ 0.25) was used, a fear of being infected with COVID-19, political attitudes, and perception of Hong Kong's future was found to be associated. There was no evidence that calculation, monetary incentives, attitude toward the vaccination advice from authorities, or demographic characteristics were associated with COVID-19 vaccination decisions. The collinearity analysis among the 5C determinants and six additional factors suggested that the six new variables are additional determinants of vaccination decisions.

Junyu Zhao, Calvin Or

Conference Proceedings

Usability evaluation of a process optimized integrated workstation based on the IEEE 11073 SDC standard

Several studies have identified that the Operating Room (OR) is costly to maintain, but also the most profit generating department. The 2019 approved ISO IEEE 11073 SDC family defines a manufacturer independent communication standard, which creates open interoperability in the OR and clinic for the first time. Using SDC, medical device data can be collected and used for display on a central cockpit, documentation purposes during an ongoing operation and also be streamed outside the OR. The goal of this research was to analyze and evaluate how medical device data and context information (current workflow step, location, patient, operator) could be used inside and outside the OR (e.g., maintenance and reparation) to improve clinical processes and benefit patient care. We also analyzed if the availability of such information might affect the efficiency and safety of patient care. A process analysis has been performed with clinical staff from the Uniklinik RWTH Aachen. The planning procedure of the OR management has been discussed and clinical use cases have been discussed with nurses, surgeons and anesthesiologists. Potential improvements using interoperable device data have been developed and corresponding interactive functional models have been implemented and discussed with the user groups. After several iterations, these concepts were implemented as part of surgical, anesthesia and OR management workstations. A formative usability evaluation (using the Thinking Aloud technique and questionnaires) has been carried out with a small user group (n=9) to check whether interoperable device data and context information improved the usability and safety of the clinical processes. Inside the demonstrator OR at the Chair of Medical Engineering (RWTH Aachen University) surgeons and anesthesiologists tested and evaluated different interfaces for OR procedures. During the formative evaluation, interfaces inside a remote SDC workstation were tested for: OR-Light, OR-Table, Video-Switch, High Frequency Cutting device and a navigation interface in combination with a standalone tracking system and a universal foot switch. The results were very promising and showed that most interfaces had a high degree of usability. Potential for improvement has been identified in the handling, comprehensibility and discernibility of the navigation system. In a second part, the developed processes for OR-optimization were discussed and evaluated. The clinical staff (n=9) reported that they need to gather information from various sources and systems during surgery (Ø 4.63 out of 5 on a Likert scale) and that repeated recordings of redundant information into multiple protocols is also required. They supported the access, availability and integration of device context information inside clinical processes. All clinical users agreed that utilizing automatic documentation through interoperable medical devices can save valuable time (Ø 4,85 of 5). A concept, in which workflow step specific device settings were suggested, was met with approval but also with criticism. The users saw benefits for time saving and standardization purposes, but also drawbacks for possible dependency and less independent thinking. The statement “The collected data helps to build up a database, on which OR-management can make more efficient decisions” was also met with approval (Ø 4,88 of 5). Interoperable medical devices (using ISO IEE 11073 SDC) can be used to create a useful data base and to support time and resource savings and helps to conduct efficient decisions inside and outside the OR. User interfaces were displayed and evaluated in combination with process supporting data. Workflow specific suggestions for device property changes were declared as helpful, although concerns have been expressed (see above). We showed that interoperable SDC medical device data and context information can be used to improve and support clinical processes.

Okan Yilmaz, Klaus Radermacher, Frank Beger, Jonas Roth, Armin Janß

Conference Proceedings

Specialized nurse care for the patient with an internal tracheotomy cannula in the intensive care public hospital of Peru

In the intensive care unit (ICU), specialized critical care is provided to patients with multi- organ problems resulting from multiple diseases, requiring invasive and intensive care, therapy and monitoring with the support of high-tech equipment (Moreno et al., 2021). The general objective was to collect evidence to generate specialized nursing care guides for patients with internal tracheostomy cannula in intensive care units (ICU) in public hospitals of the Minsa of Peru. A type of secondary research was developed with an Evidence-Based Nursing methodology, formulating the PICOT clinical question: What are the nursing care that must be performed to avoid complications in the intensive care unit patient with internal cannula? For the collection of information, the following techniques and instruments were used, systematic review, for the bibliographic search, Google Scholar, Pubmed search engines were used, as well as databases: Science Direct and SciELO, finding a total of 7 investigations that They were evaluated through the Gálvez Toro validation guide, then the Boverieth Astete checklist, finally the level of evidence is given through the list of the USPreventive Services Task Force (USPSTF) the review had a level of evidence III (Referring to the opinion of experts based on clinical experience) had a grade of recommendation B , based on the GRADE classification system. The results obtained show 12 relevant care such as: Secretion aspiration, stoma cure, tracheal cannula changes, decannulation, expulsion of the mucous plug, hydration of the patient, treatment with mucolytics, humidification of the environment with mucolytics, respiratory physiotherapy, avoiding bleeding, prevent infection of the stoma, cleaning the cannula. It is concluded that the use of electronic equipment allows the nursing professional to provide specialized care to the patient with tracheotomy, evidence that at the same time allows the addition of guidelines in which care is unified in the Intensive Care Unit (ICU).

Danicsa Espino, Carmen Arbulu, Madeleine Espino, Dávila Valdera Anny Katherine, Luis Dávila, Espino Carrasco Mayury Jackeline, Vasquez Cachay Royer, Alvites Gasco Ana Maria, Gomez Romero Clarisa, Díaz Calderón Ricardo Rafael, Dávila Valdera Lady Violeta

Conference Proceedings

Tactile information coding for touchless interaction with medical devices by means of hand gestures in the air

Non-contact control of medical devices in the operating room offers essential advantages. However, touchless forms of interaction such as gaze, hand and voice gesture control are poorly accepted in practical use in medicine due to insufficient feedback. Current gesture control systems usually output audiovisual feedback about a performed selection of a function. Consequently, audiovisual feedback does not relieve the already heavily loaded audiovisual perception channel of the surgeon. Therefore, the frequent request of surgeons results in a haptic feedback similar to the manipulation via a physical control element, where a direct feedback about the selection of a function is given. In this research project, the advantage of contamination-free manipulation of hand gesture control is combined with tactile feedback based on ultrasonic waves to transfer information by the tactile perception channel.For the study, various 10-point tactile scales were generated, which were examined with regard to their suitability for the transmission of information. The focus of the investigation was the subject‘s recognition of the information contents "increase", "decrease" and the marking of a "middle" or a "preferred scale value". Therefore, a virtual slider with a tactile feedback based on ultrasound waves was implemented. This slider was provided with a discrete tactile feedback in the form of a 10-point tactile scale, which could be perceived by the hand during a sliding movement. For the coding of information, the recognition of differences in the tactile scale was relevant. To identify the differences, the tactile feedback could be modified in terms of feedback intensity and scale spacing. A total of 16 different coding features were tested. 4 coding features for coding an “increase”, 4 coding features for coding a “decrease” and 8 coding features for coding a “middle” or “preferred value”. The tactile feedback was tested on 30 test persons (15 f / 15 m, Ø = 24.33 years, SD = 3.74 years). The experiment consisted of a main and a secondary task. The main task was to perform a precision task on a medical phantom. As a secondary task, the test persons had to perceive the change in the scale and adjust the scale position directly afterwards. The secondary task was performed blindly, without visual or acoustic feedback.The evaluation of the objective data such as task completion or operating time as well as the subjective data such as recognition of the tactile coding feature or mental load show differences between the characteristics of the coding features. With an interference statistical analysis of the results, significant differences between the different characteristics of the coding features concerning the effectiveness, efficiency and user satisfaction are identified. It’s also shown that the most appropriate coding features for marking an “increase”, a “decrease” and a “middle” or a “preferred scale value” based on this study need to be investigated in more detail in further studies. A particular focus of further investigations will be on the difference threshold with respect to feedback intensity and scale spacing of tactile feedback.

Peter Schmid, Thomas Maier

Conference Proceedings

Design and proof of concept of chatbot for people with dementia

Dementia is a chronic, degenerative, incapacitating disease that affects millions of people yearly. People with dementia require constant supervision and assistance, unfortunately, most caregivers are informal since professional healthcare can be unaffordable. We believe that this burden could be alleviated using a chatbot. Chatbots have seen an increase in use in healthcare over the past decade and they have been proven especially effective dealing with mental health disorders and chronic conditions. However, there is still room for improvement regarding their intelligence when compared to other cutting edge conversational agents and there are barely any bots that support Spanish. Furthermore, there are fewer chatbots specialized for people with any type of dementia. Alzheimer’s being the most common one, this research’s goal is to determine what features and characteristicsa chatbot for people with Alzheimer’s dementia should have. A comparative analysis of healthcare chatbots and development tools was conducted as groundwork for the design. An underdeveloped instance of said chatbot was implemented as a proof of concept, the architecture proposed allows for progress to be made on the chatbot without compromising its integrity. All the development was done using Azure tools, namely the bot framework composer, which was sufficient for the intended purposes but it poses serious limitations.

Agustin Pumarejo Ontañon, Rogelio Bustamante-Bello, Sergio Navarro Tuch, Ariel Lopez Aguilar, Lili Marlene Camacho Bustamante

Conference Proceedings

Of Seals and Humans. Media and scientific discourses about a caregiving medical device.

The approach we propose is developed within an integrated cancer research site or Siric CURAMUS (Cancer United Research Associating Medicine, University & Society) linked to the Groupe Hospitalier Pitié Salpêtrière - Sorbonne University. The eight Sirics accredited in France by the Institut du Cancer have the mission of optimizing and accelerating the production of new knowledge and promoting its dissemination and application in the treatment of cancer through integrated and translational multidisciplinary research programs. CURAMUS has three integrated research programs (neuro-oncology, rare immuno-hematological cancers, microsatellite instability cancers) linked to a cross-cutting program in human and social sciences whose objectives are to achieve multidisciplinary assessments, between technical expertise and patient preferences, and issues of ethics, equity, particularly in access to care.This paper aims to analyze the representations of mediation and assistance within the framework of cognitive deficits and/or accompaniment of cancer patients, through communication and mediatization around an animal-shaped technical communicating device: the stuffed seal Paro, an emotional robot for therapeutic assistance. Paro was originally developed in Japan in 2005. According to the french website dedicated to it, « Paro aims to offer health professionals an easy-to-use, high-tech tool to convey the benefits of animal therapy to people with behavioral and communication disorders (Alzheimer's patients and related disorders), or with motor and sensory deficiencies, by improving their well-being and quality of life in a non-medicated setting » .With this case study, the paper aims to explore the following research questions : What are the imaginary and presence of animal mediation in this specific medical context ? Which imaginary and presence of the power of technical mediation devices are conveyed with the use of Paro? What are the representations of communication, within the framework of medical caregiving, peddled by this device and its uses?These issues will be addressed using a composite methodology, combining semi-structured interviews with caregivers already using the seal, clinical staff members of CURAMUS about possibles uses of Paro in the context rare neurological and hematological cancers and semio-communicational analysis (content and discourse analysis) of a specific corpus. This corpus will include the following items : the french Paro website, international and specifically French press review about the Paro device and Web pages dedicated to Paro on French institutional websites about cancer (The Ligue contre le cancer for example). The purpose of this research is to encourage translational perspectives through the analysis of current uses in the French health system and the explorations of possible of use within the Siric CURAMUS clinical teams and hospital facilities.

Juliette Charbonneaux, Karine Berthelot Guiet

Conference Proceedings

Team-Based Text Analytics for Health Information Systems Learning

In healthcare operations, narrative text and comments from questionnaires are common and abundant. Making sense of and coming to some shared meanings around text comments from such questionnaires is often time consuming. A lack of resources and expertise may contribute to hesitation and indecisions when deciding on how or if to analyze text. Because of challenges with analyzing text in operational settings, there can be reluctance to capture rich narrative information. Nonetheless, narrative comments can be a source of rich information that with reliable and faster approaches for analyzing may help with informing operational decisions and human-centered design efforts. In this paper, we describe using text analytics approaches for contributing to thematic analysis of users’ comments to help with health information systems learning.Several text analytic approaches were explored as possible pathways to reduce the burden of reviewing comments about training around health information systems. Approaches included topic modelling, keyword extraction and creating word clouds, word co-occurrence and uniquely co-occurring word visualizations, and text classifiers and nomograms that highlights top linguistic features for the trained classifier. The team walked through example approaches and visualizations and decided on next steps.Visualizations of word co-occurrence and uniquely co-occurring word networks and top linguistic features used to train a naïve-bayes text classifier were used to envision possible categories or codes. Regular expressions were iteratively formulated consisting of some combination of words and stems as codes were formulated and extracts were repeatedly reviewed. Code formulation corresponded with refinement of regular expressions. Individual comments could be multi-labeled and not all comments were coded. Static visuals, text examples, regular expressions, and extract quantities were collected, presented, discussed, and refined with the review team.The purpose of this work was to explore text analytic approaches to assist with response interpretation and to apply filtering techniques for addressing concerns of information overload. Addressing concerns about information overload may reduce hesitation with collecting and examining text. By reframing this as a filtering problem, we began to inquire into ways to review, create codes, and code comments more quickly. Including and fine-tuning text analytics approaches may help teams learn more quickly from questionnaire comments about how users perceive working within health information systems. Finally, lowering thresholds for analyzing text may boost motivations for gathering rich information keeping us from missing out on vital viewpoints and language use across time.

Tim Arnold, Helen Fuller, Serge Yee, Seema Nazeer, Ruth Reeves

Conference Proceedings

Activities to Promote Resilience During Health Information System Transitions

Health information systems are ubiquitous in modern medicine. They are sometimes involved in problems with the delivery of care, and this seems to be especially prevalent when transitioning to a new system. Resilience is the ability of systems to respond to unexpected demands or circumstances to allow resumption or continuation of normal operations. We propose that some methods and techniques commonly used in human factors and usability work may promote system resilience, which may be especially important during times of transition. Examples include contextual inquiry, task analysis, risk assessment, and trade-off studies. These activities help people understand and communicate context of use and gain a more comprehensive understanding of the difference between work-as-done (WAD) and work-as-imagined (WAI), as well as navigate risks and benefits when making decisions regarding system changes.

Helen Fuller, Timothy Arnold, Michael O Neil, Darren Wilson

Conference Proceedings

Brain-Tactile Interactive Device for Dementia Prevention of the Early Elderly

The increase in aging populations worldwide has led to an increase in dementia cases, a reality that may significantly raise social costs. Reducing the number of dementia cases is likely a good strategy to directly decrease social expenses while ensuring a better quality of life among the elderly. Previous research results have shown that deep depression or loneliness among the elderly is highly likely to accompany dementia syndrome. The elderly in particular may feel lonely or depressed when living independently or losing contact with their children and friends (Khosravi et al., 2016). The problem of dementia involves a variety of complex issues ranging from decreased social interaction to a lack of physical and mental activities. Experts have suggested that the best way to reduce dementia risk is to create a device that can satisfy several of the above-mentioned issues in one. For instance, a device that provides both entertainment and brain training at the same time. This study has developed such a device, called the Brain-Tactile Interactive Board (BTIB), that young elderly (ages 55 to 65 years old) populations can use as a possible preventative measure against dementia. The BTIB can enhance elderly brain stimulation and cognition through physical interaction and math calculation activities. These activities enable users to fulfill their social urges while reducing dementia risk and promoting happiness and well-being.

Tyan Yu Wu, Wen Yi Lin

Conference Proceedings

Measuring Subjective Usability of Medical Devices - Questionnaire Development and Evaluation

Safety and effectiveness are major usability concerns for the development process of medical devices. Other relevant factors like user satisfaction or overall user experience (UX) are sometimes neglected as they are not required from a regulatory perspective, nor can they be evaluated well through the classical approach of usability testing. Usability/UX questionnaires can measure these subjective variables, however, only few researchers have addressed the development of standardized questionnaires for medical products. This two-parted research aims to further close this gap. First, numerous attributes of usability/UX were researched and then critically evaluated by usability experts (N=9) with practical experience in healthcare. The constructs relevant and applicable were then divided into clusters and items were newly created or carefully chosen from existing questionnaires and then condensed to a 70-item raw version of the questionnaire. In the second part of this study, nurses (N=106) from South Africa, UK, and USA evaluated a dialysis device, providing responses to the questionnaire statements alongside the System Usability Scale (SUS) for validation purposes. Psychometric analysis showed that the average internal reliability across the eleven subscales was α = .70 and ranged from .48 to .84. Seven items were chosen to be eliminated because of their weak item discrimination and difficulty which would lead to an increase of internal reliability. The initial scores for 9 out of the 11 subscales moderately correlated with the SUS (r = .53 to .60) with a significance of α < .05. Overall, the results indicate that the newly developed questionnaire could be feasible to close the identified gap. Nevertheless, the modified questionnaire ought to be validated with a larger sample size and across a broader range of medical products.

Marisa Koopmann, Bernhard Wandtner, Michael Thorwarth, Karsten Nebe

Conference Proceedings

Suspension pillow reduces stress and improves nocturnal sleep.

The head of an adult human weighs approximately 5 kg. A heavy head is always supported by the neck, causing stiffness in the neck and shoulders. Stiffness results in physical and mental stress. A suspension pillow (SP; Hammock Pillow, M. I-Story, Japan) was devised to disperse the pressure on the neck while the user laid down on a mat. The SP has three pillars that suspend a hard cloth like a hammock. The head is held on the cloth. The SP is expected to decrease stiffness, relieve physical and mental stress, and improve the sleep quality. In the first experiment, we showed stress-relieving effect of the SP by measuring and analyzing fluctuation of heart beat interval (heart rate variability: HRV). HRV is indexed as LH/HF and signifies autonomic nervous system activity. The participant was instructed to lay the head on the pillow and exercise very lightly for 7 min to stretch the neck muscles and facilitate cardiovascular circulation. On the next day, he or she was asked to perform the same exercise without the SP. The experimental schedule was randomized among the participants (n=7). Heart beats were measured using a plethysmogram from the index finger. The LF/HF ratio decreased by 39% after exercise with the pillow. Statistical analysis also revealed significant activation of the parasympathetic nervous system and a stress-reducing effect of the SP. This indicates that the SP can be a tool for stress reduction. In the second experiment, we performed a sleep study to demonstrate the sleep-promoting effect of the SP. Middle-aged and older adults tend to explicitly complain of deteriorated sleep quality compared to young adults. Therefore, we recruited these participants for this experiment to demonstrate the sleep-promoting effect of the SP. Six participants (40-70 years old) participated in the experiment. They slept with the SP or a Japanese traditional and popular pillow stuffed with buckwheat chaff (JP) in their bedrooms for four to five consecutive nights. Data obtained during the first night with each pillow were excluded to avoid the first-night effect. The order of pillow usage was randomized among the participants. Heart beat and body movements were monitored using a plethysmogram on the index finger and an accelerometer placed around the wrist to measure nocturnal sleep quality. The results demonstrated that the SP improved sleep efficiency and increased the amount of deep sleep in NREM (non-REM sleep but decreased the counts and amount of nocturnal awakening. These results prove that the SP improves sleep quality in middle-aged and older adults. In the last experiment, we recorded polysomonography data from three young participants (21-23 years old) in an electromagnetically shielded room. We found that sleep latency was shortened significantly in the three young participants with the SP compared to JP. The findings obtained from three experiments revealed that the SP holds the head adequately, resulting in reduced stress by activating the parasympathetic nervous system and improving sleep quality.

Motoharu Takao, Hiromi Sakamoto

Conference Proceedings

Inclusive design for older adult with degenerative scoliosis: The integration of monitoring sensors and functional garment

Adult Degenerative Scoliosis (ADS) is an aging population condition that occurs as a result of a degenerative change with an abnormal lateral curve greater than 10. Increased concerns over the health effects of ADS have been raised due to its increasing prevalence. Thus, inclusive design products, such as smart monitoring functional garments, are recommended for ADS, which integrate smart monitoring sensors with garments that help ADS to rebalance the spine through active self-correction. However, present research on smart monitoring clothing for ADS focuses more on intelligent monitoring components and systems. There is insufficient research on the integration design process of smart sensors with garments. Hence, this study aims to establish a scientific integration design framework for inclusive smart monitoring functional garments for ADS.Mixed research methods that combined qualitative and quantitative methods were used in this study. Specifically, the qualitative study, including a case study of a previous prototype and practical research of developing an iteration prototype, was conducted to investigate the integration design of smart monitoring functional garments for ADS. Then quantitative data of detailed anthropometric measurements, patterns, and characteristics of electronic accessories and fabric were collected and analysed using 3D modelling and fitting by CLO3D software. The quantitative result was then combined with the qualitative result to build an integration design framework for inclusive smart monitoring functional garments for ADS.The results showed that the development of smart monitoring functional garments for ADS is based on both the body factors of ADS and intelligent monitoring component factors. Furthermore, our findings suggested that the internal garment structure, combining positions, combining techniques, and fabric selection interact with each other under the spiral iteration design process. Finally, the proposed integration design framework and the iteration smart monitoring functional garment for ADS were established. Our findings established a thorough scientific basis for the knowledge on the integration design approach of smart monitoring functional garments for ADS.

Xiaolu Li, Joanne Yip, Ruixin Liang, Jun Zhang

Conference Proceedings

Re-establishing the balance: A New Community-based Chronic Disease Management Service Model in China

As China's aging process accelerates, chronic diseases such as diabetes and high blood pressure gradually become hidden dangers that endanger the health of the elderly. Based on this, China has formulated a hierarchical medical system for chronic diseases and proposed a community-based chronic disease management plan. However, there are some problems, such as insufficient service resources and unreasonable satisfaction of patients' needs in the actual implementation process. Based on the Kano model, this study analyzes the demands of patients with chronic diseases in the Chinese community at this stage. It matches their existing service subjects according to the priority of demands and then constructs a community-based chronic disease management service model. This study aims to accurately identify the demands of patients with chronic diseases, redistribute and reuse existing facilities and resources, and balance the supply and demand relationship among service subjects and patients. It can provide more humane health management services for chronic disease patients in the community context.

Renxuan Liu, Duan Wu

Conference Proceedings

Highlighting Usability in Healthcare System Selection

When an organization plans to replace a healthcare information system, usability initially seems like a critical evaluation component. While leadership often cites “user experience” as important, as the organization must also consider other important components such as cost, functionality, and schedule, they may reduce the emphasis on usability. This paper presents a method to highlight usability concerns throughout the system selection process.

Nancy Lightner, Helen Fuller, Timothy Arnold

Conference Proceedings

Usability Evaluation of Intravascular Administration Set with Safety Lock Regulator to Prevent Medication Error

The safety lock regulator is part of an intravascular administration set with a safety lock to control the infusion rate of fluid and prevent accidents in which fluid is excessively injected due to unexpected events. This study aims to evaluate the usability and satisfaction of intravascular administration set with a safety lock regulator through a usability test. In the usability test, consisting of 22 tasks and 5 scenarios, experienced nurses with an average experience of 6.6 years or more participated to perform tasks and evaluate satisfaction. we collected a number of observational data such as task completion, task completion with an issue and not completion as well as subjective data such as user satisfaction scores and comprehensive opinions. As a result of the evaluation, the success rate of the entire task was 96%, and there were almost no use errors at 4%. The root causes of the observed use errors were low risk due to the lack of understanding of the tasks. The user satisfaction with the 10 questionnaires evaluated on the 5-point Likert scale showed 4.7 scores for the user manual and 4.4 scores for the intravascular administration set. In addition, comprehensive opinions such as user improvement requirements for medical devices and specific reasons for satisfaction were collected. This study confirms that users can safely perform tasks of the use scenario without serious use errors and that safety was improved by preventing operations of the non-medical person by making it difficult to unlock the safety lock regulator. In future studies, it is expected that it will be possible to develop an intravascular administration set that further improves usability and safety by deriving user requirements from the collected comprehensive opinions.

Yourim Kim, Wonseuk Jang

Conference Proceedings

Ergonomic problems in surgical smoke control during surgery

Surgical smoke is the plume and air contaminants produced by energy devices such as electrocautery and laser scalpels during the surgery. Surgical smoke consists of fine particles containing pathogenic microorganisms and chemical substances from high-temperature carbonized tissues, and poses a health risk to medical personnel during the surgery. The COVID-19 pandemic has highlighted the importance of surgical smoke control. As a surgical smoke protection on the medical staff side, personal protective equipment such as N-95 high-performance masks are widely used. On the other hand, the surgical smoke exhaust system includes ventilation equipment for the entire operating room and a device that directly aspirates surgical smoke in the operative field. Wearing a mask for a long time poses problems such as fatigue, hypercapnia and loss of concentration. Increasing the smoke evacuation efficiency of a surgical instrument-mounted smoke evacuation device poses problems such as deterioration of operability and patient temperature maintenance. Surgical instruments equipped with smoke suction tubes suffer from deterioration in operability due to increased size and weight. Increased ventilation in the surgical environment may cause drying of organs and hypothermia. Surgical instruments with smoke exhaust devices require further reduction in weight, diameter, and ergonomic design.　 In addition, it is necessary to equip surgical instruments and the ventilation function of the operating room with an automatic maintenance function of body temperature and body cavity temperature and humidity.It is important to enlighten medical workers about the importance of measures against surgical smoke, and to improve the smoke exhaust system considering maintenance of physiological environment and solve ergonomic problems.

Kazuhiko Shinohara

Conference Proceedings

Pilot study on the filtration efficiency of non-medical facemasks according to fit

A non-medical facemask is one of the health care products used to prevent harmful substances from entering the human body. In the wake of COVID-19 outbreak, the effect of wearing a facemask has been researched all over the world. However, the comfort based on fit while wearing a facemask in the community setting continues to be an issue. Therefore, we have been studying the fit and comfort of non-medical facemasks in an effort to develop our own design. In this presentation, we report the filtration efficiency (FE) of our prototype facemask based on the patterns with four sizes. The patterns were analysed in an earlier study. The FEs of the facemasks against particles with a particle size of 0.3–5.0 µm, from smallest to largest size, were 45.4%, 95.2%, 98.0%, and 98.3%. The prototype facemask with larger sizes statistically demonstrated a high FE. The FE depended on the area of the facemask and fit against the facial surface. The patterns were useful from the viewpoints of protection against particles.

Mika Morishima, Momoka Fujii

Conference Proceedings

Innovative Agonology – Definition, Detailed Theories, Laws, and General Rule of Struggle

The idea of ‘innovative agonology’ came into being in 2016 in the Archives of Budo journal with the thematic section ‘Prophylactic and Therapeutic Agonology”. Innovative agonology (IA) is an applied science dedicated to promotion, prevention and therapy related to all dimensions of health and regarding the optimization of activities that increase the ability to survive (from micro to macro scales). The basic method of IA in the research and application sphere is a complementary approach in the broadest possible cognitive-behavioural perspective.At the essence of any particular science is the substantiation of its claims. Since any time one needs to either maintain health, survive, eliminate or slow down the effects of destructive factors, the key phenomenon is some form of combat, so the justification for these necessary actions is provided by the science of struggle. All five existing theories of struggle are published in Polish, with the terminology of Tadeusz Kotarbiński’s (1938) general theory of struggle (agonology) prevailing over the others. Kotarbiński placed military struggles on the ‘ground floor’, parliamentary and judicial disputes, commercial competition, sports fights, etc. on the ‘middle floor’, and he reserved the top floor’ for the general theory of action (praxeology), which includes agonology  but not vice versa. Since the usefulness of almost every scientific discovery is considered from a military perspective, it is not surprising that another theory (detailed one) by Józef Konieczny concerns destruction (1969). Paradoxically, Jarosław Rudniański published the theory of non-armed struggle during martial law in Poland under a camouflaged title (1983). In 1989, when Russian troops were still stationed (they left Poland on September 17, 1993), he re-issued the work (without camouflage) and supplemented it with the theory of compromise. At that time (1991) I published the theory of defensive struggle together with the theoretical basis for complementary prevention and therapy of somatic and mental health and increasing personal safety (survival). The law of the only possibility, as defined in my theory of combat sports (2000), is universal enough to be used in interpretations of even such remote phenomena as miraculous healings.Rudniański defined general rule of struggle as “an action in which a material or surrounding all the action’s time is in independent motion from an acting one, creating simultaneously strong and various resistance; act this way to be able at any moment possibly change both a plan of action and its manner”. Such a broad rule encompasses every case of human struggle with the need to overcome (fight) against factors that threaten one’s own or others’ health or life, as well as the defence of universally recognized values, nature, cultural products, technology, etc.Familiarity (by at least one member of the research or practical problem-solving team) with the languages and algorithms of detailed struggle theories, as well as with the basics of complementary research methodologies, is a prerequisite to minimize the possibility of omitting important details.

Roman Maciej Kalina

Conference Proceedings

Hypothesis on the supreme value criteria of the global civilization

The three sets of premises imply the most general hypothesis about the supreme criteria of the value of global civilization. This hypothesis can be defined more concretely, but to ignore it would be to consent to self-destruction at our own request. Such a prospect is real in a much shorter time frame than the most optimistic (in fact naive) predictions of those trusting that humans en bloc will not allow this to happen.The first set (pessimistic) contains tragic experiences from the micro to the macro scale related to both the COVID-19 pandemic and the Russian aggression against Ukraine, which has been ongoing since February 24, 2022; also the history of mankind, the shortest description of which contains a multi-page list of dates and names of wars. The second (optimistic) contains the wisdom recorded in the Holy Books, philosophical writings, and constantly handed down in the distinguished departments of all arts; heritage of the so-called ‘higher culture’; groundbreaking scientific discoveries related to the protection of health and life. The third one (seemingly neutral, since tools in the ethical sense are intrinsically neutral, and the way they will be used is ultimately decided by man): technology that actually enables real-time communication of the entire human population, but the effective use of this technology  while respecting the guiding criteria of universal human values  requires competent and therefore responsible coordination.The hypothesis is: survival of humans and nature in a non-degenerate form and responsibility for coming generations. The open problem is to train and elect suitable coordinators and assign them with the mission of coordinating elements that, from the micro- to the macro scale, will form a whole, worthy of the name ‘safe civilization of wisdom’ (wisdom includes responsibility). In a sense, paradoxically, it makes sense to reverse the direction from macro to micro, according to the principle of ‘the example comes from the top’.While Innovative Agonology (in fact the first experts in this new science) provides a methodological basis, many detailed methods and recommendations, it is far from pointing to a way of imminently dealing with a phenomenon that Albert North Whitehead described 97 years ago in simple terms: „significant fact of the modern world is the discovery of a method of training professionals who specialize in particular areas of thought and progressively increase the sum of knowledge within their own limited research topics.” His words justify the caution expressed above about indicating a way to deal with the phenomenon of necessary coordination, precisely in the context of the hypothesis formulated: “The tasks of coordination are left to those who lack the strength or character to be successful in a particular field”.

Paweł Piepiora, Roman Maciej Kalina

Conference Proceedings

Multidimensional Educational Models Recommended by Innovative Agonology – Examples of Physical Education and Music Education

Almost all types of education are in some sense multidimensional, even if it is difficult to ascribe formal, or passion-driven, experiential, cognitive-behavioral competences closely related to the subject of education to the teaching subject (an individual or a team). From the perspective of the mission of innovative agonology, the most valuable ways, methods, forms and means of educational activities are those whose use (in a session, in a cycle, or as a ‘passion for life’) stimulates as much as possible some aspect of somatic, mental and social health, but also at least one element (component) of survival.From a broader point of view, i.e. the social mission of evidence-based science, the important premise is that although humans are genetically adapted to operate in terrestrial environments, however, they are also active underground, in water, in the air and in space. In each of these environments, one pole of the continuum of survival possibilities accumulates minimal health criteria, while the opposite pole – a long list of factors that mean inevitable death. This diversity of human operating environments and the roles they fulfill within them implies the legitimacy of recommending very complex educational models, some of which require multilevel selection.Apart from individual career paths, swimming and wrestling (even if pursued without the pressure of sports performance) optimally stimulate the somatic dimension of health (hard-respiratory capacity, strength and endurance of the largest muscle groups and flexibility) compared to other sporting activities. The survival dimension is already diverse. For instance, swimming skills increase the chance of survival in an aquatic environment while hand-to-hand combat skills increase the likelihood of effective self-defense in situations of physical aggression. And wrestling is a contact sport (psychophysical activity involving a permanent ‘dialogue of minds and bodies’), so it qualifies as a model that also stimulates the mental dimension of health. Moreover, in general, also the adepts of other martial arts interact in a peculiar way with the centuries-old heritage of the cultures from which these arts originate (social dimension of health). Unfortunately, the effective and attractive status of educational models based on martial arts is depreciated by the pathology of bloody fights of neo-gladiatorship. These spectacles are promoted and camouflaged in the public sphere precisely under the banner of mixed martial arts (the first part of the phrase ‘mixed’ is only 31.25% of the name).Brazilian capoeira is an example of a multifaceted educational model that combines martial art with music. Although innovative agonology is an appropriate science for formulating justifications at the interface between these two arts (martial art and music), the well-established standards of music education are its competition. These standards include respect for centuries-old traditions and multiculturalism, a commitment to routine with an awareness of the unlimited potential for creating beauty and positive emotions. The coordinating perfectionism of the instrumentalists is also admired. However, a hypothesis is justified: ignoring scientific knowledge (including human motor skills) from areas of activity other than music is the cause of, among other things, interpersonal conflicts (for instance teacher-student) and negative effects encompassing all dimensions of health.

Elizabeth Waszkiewicz

Conference Proceedings

Struggle: the Most Frequently Used Word in the Public Sphere Since the Beginning of the COVID-19 Pandemic

Already Jarosław Rudniański, the originator of the theory of a non-armed struggle, underlined that a man uses most often the word ‘a struggle’ (and synonymic terms: combat, contest, grapple, fight, wrestle, etc.) when “a given action is distinguishable by a high level of difficulty and psychic suspense.” Therefore, in Rudniański’s opinion, ‘struggle’ could be, for instance, forming mutations by bacteria or viruses to adjust to vaccinations and antibiotics as extreme cases of counteraction. The fact that living organisms do not have human consciousness has no vital meaning for those who fight them. Therefore, it is not surprising that the titles of many scientific publications dedicated to the COVID-19 pandemic, in addition to the media coverage, include the word ‘struggle’ or its synonym.The main barrier to the dissemination of knowledge about the science of struggle  identified with the general theory of struggle (agonology) and its four specific theories  in the global scientific sphere (dominated by the English language) relates primarily to the language in which they were published: all of them (since 1938 till 2000) were published in Polish. Admittedly agonology was included by its creator Tadeusz Kotarbiński into praxeology and translated into English, Czech, German, Japanese, Russian and Serbo-Croatian. In the fundamental lecture of praxeology by T. Kotarbiński “A Treatise on Good Work,” (first edition in 1955), it is included in the chapter entitled “Technique of struggle”. The political factor was a fundamental obstacle to the dissemination of both praxeology and agonology when Poland was beyond the Iron Curtain. Jarosław Rudniański published the theory of a non-armed struggle in two steps. Admittedly, his “Elements of praxeological theory of struggle. From the issues of negative cooperation” (1983) was published during the martial law in Poland, but it was not available for official sale. Its best recommendation would be the fact that for many of Solidarity’s leaders, it was a kind of instruction manual for conducting the struggle against communist authorities in a nonviolent way and led to achievement of the ultimate result: the overthrow of those authorities. The second step: “A Compromise and a Struggle. The efficiency and ethics of positive and negative cooperation in a dense social environment” (1989) is at the same time the most complete development of agonology; unfortunately, available only to those familiar with the Polish language. Paradoxically, the pandemic and the aggression against Ukraine are factors that can spark interest in innovative agonology which includes the theory of a non-armed struggle and the theory of compromise.

Kazimierz Witkowski, Roman Maciej Kalina

Conference Proceedings

Language of Innovative Agonology: a Guide in Combining Micro and Macro Scales of Preventive, Therapeutic and Defensive Actions

The language of innovative agonology (IA) concerns three layers. One is the terminology, whose basic frame of reference is Tadeusz Kotarbiński’s general theory of struggle (agonology). The remaining ones are: the ambiguity of the same terms used in different sciences (some of which have been appropriated by the public media language); and the need to adapt key words (and even to create neologisms in English for the universal language of IA) which describes scientific discoveries of phenomena included the field of IA research, but originally published in languages other than English.Kotarbiński’s definition of struggle relates to people: “a struggle is any activity, in which at least two subjects participate (assuming that a team can be a subject), while at least one of the subjects hinders the other”. However, Jaroslaw Rudniański’s extension of the concept of ‘struggle’ means that in a certain category of combat (the fight against the pandemic), the parties may not only be human beings. Therefore, in the language of IA (that is, also in a methodology based on a complementary approach), it is legitimate to assume that the ‘material’ means the opponent (subject or thing) with whom the person (individually or in a group) fights.An example of the dilemmas with the ambiguity of using the same terms in different areas of communication is the semantic category ‘development’, elementary to IA (a term used only in a positive sense). The commonly accepted phrase ‘development of a disease’ is patently absurd. Even if the user explains that they meant ‘development in a negative sense’, all the more it shows that they are ignorant as to the semantics.One of the concepts originating from the Lviv-Warsaw school of the methodology of sciences is the term ‘wiedzotwórczy’, which has no equivalent in English. In many methodological arguments edited in Polish, it is a convenient combination of the words ‘knowledge’ and ‘creative’. Future IA professionals will undoubtedly face similar semantic dilemmas. Identifying, interpreting and formulating algorithms for phenomena that need to be effectively addressed (from micro to macro scales) in the areas of prevention, therapy and, in certain circumstances, call for undertaking a strong defense, requires unambiguous language that is understandable to experts in even distant fields.

Justyna Bagińska, Roman Maciej Kalina

Conference Proceedings

Complementary Medicine – An Example of the application of the Basic Research Method of Innovative Agonology

We owe the term ‘complementary medicine’ (1932) to Max Friedemann (according to WoS data). Determining who first applied the term ‘complementary approach’ to science would not be easy. Historians and philosophers of science, as well as specialists in the general methodology of sciences, would easily argue that science  as a whole  is based on the complementary approach. Unfortunately, those accustomed to the separation of individual disciplines (among whom there is no shortage of novices and luminaries of science) miss the important detail that ignoring such an approach leads directly to the dehumanization of science and harms the foundations of sustainable human development en bloc in almost every respect.An inspiring source for such reasoning can be found in the maxim “Let none but geometers enter here” at the entrance to the olive grove that is Plato’s Academy (387 BC to 529 AD), dedicated to the Athenian hero Akademos. Whoever already knew geometry and was given the honour of taking the first and subsequent steps in this symbolic university of antiquity became a living example of the complementary approach. Looking at science precisely from a historical and symbolic perspective entitles us to assign some questions (i.e. issues worthy of being recognized as scientific) to each new step; it also entitles us to assign methods, means and tools (figuratively the compass, ruler, etc.) to answers to these questions. Over time, the generalized sets of questions and answers from symbolic geometry evolved into the general methodology of the sciences, as part of logic.The author of this outline of the methodological foundations of the complementary approach in contemporary scientific research was inspired by four main premises: the achievements of the Lviv-Warsaw school of logic and the methodology of sciences; praxeology (i.e. Tadeusz Kotarbiński’s proper methodology); Albert N. Whitehead’s reflection on Science and the Modern Word; and the cognitive and social mission of innovative agonology. A simple model of the social mission of science is expressed by the triad ‘curiosity - understanding - applications’. The first two terms, on the one hand, show the origin of science ‘from curiosity to satisfying the need for understanding’. On the other hand, they are directly related to the postulate of freedom of scientific research and any idealization of the mission of science. The third part, applications, is admittedly meant to emphasize the positive aspects of science and the hope that, through scientific discoveries, the mission of dignified survival of homo sapiens can be realized with a clear emphasis on respect for all life, the natural environment and human dignity. Unfortunately, the third part of the triad also includes numerous pathologies. The most dangerous are the interferences of authorities and interest groups at various levels in the freedom of science. A sophisticated way to satisfy the selfish goals of these entities is the instrumental use of scientists and the most competent research teams in a given field, with varying degrees of success. Concern for the freedom of science and the fulfilment of its social mission is a sufficient reason not to ignore these threats or the methodological possibilities of innovative agonology while respecting the complementary approach as a method of modern scientific research.

Roman Maciej Kalina

Conference Proceedings