Skin Phantom for Biowearable Device Testing

The biowearable industry currently utilizes animals, humans, and cadavers for testing skin mounted bio-devices. There is a need for a sustainable skin phantom that is capable of simulating the properties of skin. We proposed a skin phantom educational kit that emulates the perspiration and electrical properties (i.e. impedance spectrum) of skin. This kit can mimic the effects of different sweat concentrations and geometrical structures and allows students to visualize how these properties change electrical measurements. We designed a three-layered model composed of silicone rubber sandwiched between agar, which is similar to the skin\u27s elastomeric and porous texture. We used simple and safe equipment such as a digital multimeter and a low-voltage power source for testing our educational model. We also constructed a computational model using COMSOL Multiphysics to simulate important skin phantom properties. Our COMSOL model is more complex than the agar-silicone layered model in the sense that it allows analysis of the impedance spectrum as a function of the perspiration mechanics. Through our COMSOL model, we achieved simulation of perspiration and studies on the effects of electrode distance, and material conductivity and relative permittivity in relation to impedance. From these tests, the simulation proves viable for scaling up to a realistic size, as our final model is sized-down for improved model development and testing purposes. Our COMSOL model serves as the groundwork for future improvements on replicating the skin’s mechanical, fluid, and electrical properties in a computer simulation

Public perceptions of changing the terminology for low-risk thyroid cancer: A qualitative focus group study

Objectives To investigate public perceptions of overdiagnosis and overtreatment in low-risk thyroid cancer and explore opinions regarding the proposed strategy to change the terminology of low-risk cancers. Design Qualitative study using focus groups that included a guided group discussion and presentation explaining thyroid cancer, overdiagnosis and overtreatment, and proposed communication strategies. Transcripts were analysed thematically. Setting Sydney, Australia. Participants Forty-seven men and women of various ages from a range of socioeconomic backgrounds with no personal history of thyroid cancer. Results Participants had low pre-existing general awareness of concepts of overdiagnosis and overtreatment and expressed concern regarding this new information in relation to thyroid cancer. Overall, participants understood why the strategy to change the terminology was being proposed and could see potential benefits including reducing the negative psychological impact and stigma associated with the term 'cancer'; however, many still had reservations about the strategy. The majority of the concerns were around their worry about the risk of further disease progression and that changing the terminology may create confusion and cause patients not to take the diagnosis and its associated managements seriously. Despite varied views towards the proposed strategy, there was a strong overarching desire for greater patient and public education around overdiagnosis and overtreatment in both thyroid cancer and cancer generally in order to complement any revised terminology and/or other mitigation strategies. Conclusions We found a strong and apparently widely held desire for more information surrounding the topic of overdiagnosis and overtreatment. Careful consideration of how to inform both the public and current patients about the implications of a change in terminology, including changes to patients' follow-up or treatments, would be needed if such a change were to go ahead

Winning the Baldrige Award: How the Henry Ford Health System Undertook a Five‐Year Improvement Process

Henry Ford Health Systems (HFHS) won the 2011 Baldrige Award, a major accomplishment. This achievement resulted from a systemwide focus on minimizing and controlling medical errors, a cultural shift to stimulate innovation and creative problem solving, and service excellence at every level. The five‐year effort centered on meeting Baldrige Award criteria, typically utilized in the for‐profit setting. When applied to the nonprofit sector, HFHS managed to reduce costs, reduce medication and treatment errors, introduce multiple creative clinical programs, and launch a new Ritz Carlton‐quality, hotel‐style service.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102080/1/21088_ftp.pd

Implementing the Yote Bikeshare Program

As a relatively compact city, Vermillion has the potential to support a strong bike culture. Increased biking in Vermillion has many benefits for our campus and community, including decreased congestion of parking lots on campus and streets around campus, improved health of those who bike, and mitigation of environmental impacts such as emissions from transportation. The implementation of a bike share program on campus is one way to increase bike culture because it would provide students with access to bikes on an as-needed basis. A need assessment survey for the potential implementation of this program conducted by Vermillion’s “Making Lighter Footprints” Committee showed a positive response from the many USD students who participated. In order to improve the bike culture on campus and address the interest expressed by students who participated in the survey, the Sustainability Club applied for the SGA Green Initiative Fund in October of 2016, and was awarded the $4,950 grant in November of 2016. Upon receiving the grant, Sustainability Capstone students developed a plan for a bike share program that will begin the implementation process in the Spring Semester of 2017. Sustainability Capstone aspires to have the Yote Bike Share Program up and running by the Fall Semester of 2017.https://red.library.usd.edu/sustainability-projects/1003/thumbnail.jp

The value of prognostic ultrasound features of breast cancer in different molecular subtypes with a focus on triple negative disease

The ultrasound (US) features of breast cancer have recently been shown to have prognostic significance. We aim to assess these features according to molecular subtype. 1140 consecutive US visible invasive breast cancers had US size and mean stiffness by shearwave elastography (SWE) recorded prospectively. Skin thickening (> 2.5 mm) overlying the cancer on US and the presence of posterior echo enhancement were assessed retrospectively while blinded to outcomes. Cancers were classified as luminal, triple negative (TN) or HER2 + ve based on immunohistochemistry and florescent in-situ hybridization. The relationship between US parameters and breast cancer specific survival (BCSS) was ascertained using Kaplan–Meier survival curves and ROC analysis. At median follow-up 6.3 year, there were 117 breast cancer (10%) and 132 non-breast deaths (12%). US size was significantly associated with BCSS all groups (area under the curve (AUC) 0.74 in luminal cancers, 0.64 for TN and 0.65 for HER2 + ve cancers). US skin thickening was associated most strongly with poor prognosis in TN cancers (53% vs. 80% 6 year survival, p = 0.0004). Posterior echo enhancement was associated with a poor BCSS in TN cancers (63% vs. 82% 6 year survival, p = 0.02). Mean stiffness at SWE was prognostic in the luminal and HER2 positive groups (AUC 0.69 and 0.63, respectively). In the subgroup of patients with TN cancers receiving neo-adjuvant chemotherapy posterior enhancement and skin thickening were not associated with response. US skin thickening is a poor prognostic indicator is all 3 subtypes studied, while posterior enhancement was associated with poor outcome in TN cancer

Clinic Capacity to Provide Patient-centered Contraceptive Care to Adolescents in the U.S. South: Impact of Rurality and Clinic Type

Introduction: Federally qualified health centers (FQHCs) and health departments (HDs) are essential in providing contraceptive care and ensuring reproductive autonomy for adolescents. Through offering adolescent-specific services and by training providers in adolescent-specific care and patient-centered contraceptive counseling, clinics can ensure access to high quality contraceptive care for adolescents. Despite the significant decrease in adolescent pregnancy rates, rates remain high in the South and in rural counties, suggesting that clinics in these areas may not have the capacity to provide adolescent-specific services and patient-centered counseling. This study compares the capacity to provide adolescent-specific and patient-centered contraceptive services in rural and urban FQHCs and HDs in two southeastern states -- South Carolina (SC) and Alabama (AL). Methods: Data were collected from a statewide survey of FQHC and HD clinics in SC and AL in 2020. A total of 239 clinics were included (FQHC N=112 and HD N=127) and were identified as rural (N=101) or urban (N=138) using Rural-Urban Continuum Codes. Capacity to provide patient-centered adolescent care is defined as 1) a clinic offering adolescent-specific services; 2) providers at the clinic receiving training in patient-centered counseling; and 3) providers receiving training in adolescent-specific care. To measure capacity, these three survey items were dichotomized into Yes/No responses and then combined into a new variable to measure clinics who responded Yes to each survey item. The type of adolescent-specific services was also measured as being onsite, offsite, outreach, or none. Capacity to provide patient-centered adolescent care was compared across clinics located in rural and urban settings and by clinic type. Statistical differences were determined using the Chi-Square test of independence (α= 0.05). Results: Overall, 44.8% of participating clinics in SC and AL had the capacity to provide patient-centered adolescent contraceptive services. Approximately 51.8% of rural and 66.1% of urban HDs reported the capacity to provide adolescent-specific services. In contrast, 26.7% of rural and 35.4% of urban FQHCs reported the capacity to provide adolescent-specific services. Approximately 55.4% of rural and 71.4% of urban HDs provided any adolescent-specific services, but fewer rural HDs (30.2%) provided onsite services than urban HDs (59.3%) (p=0.003). Fewer than half of rural (42.2%) and urban (48.8%) FQHCs provided adolescent-specific services, with approximately 23.8% of rural and 27.9% of urban sites providing onsite services. Conclusions: The capacity of clinics in SC and AL to provide contraceptive counseling to adolescents, which is anchored in reproductive autonomy, is contingent upon the provision of adolescent-specific services and provider training. Most clinics, especially rural clinics, did not have the capacity to provide patient-centered contraceptive counseling to adolescents. This gap in services may contribute to the higher adolescent pregnancy rates in rural areas of SC and AL. Clinics in SC and AL, especially FQHCs, should develop policies that support adolescent-specific contraceptive services and provider training

Access to Contraceptive Services during the COVID-19 Pandemic: Perceptions of Choose Well Hospital Partners

Introduction: Contraceptive decision-making is individual in nature and access to high-quality contraceptive care, including counseling and the full range of contraceptive methods, can help individuals achieve their personal reproductive goals and prevent unintended pregnancy. The COVID-19 pandemic disrupted provision and utilization of contraceptive counseling and contraceptive methods. Long-acting reversible contraception (LARC) methods, such as the contraceptive implant and intrauterine devices (IUDs), were particularly affected by the pandemic because they require placement by a health care provider in a clinical setting. Choose Well (CW), an ongoing statewide contraceptive access initiative in South Carolina, launched in 2017 and continues through 2022. CW aims to implement best practices of contraceptive care via training and funding for IUD and implant methods. This study examined the perceptions of access to contraceptive counseling and implant and IUD methods during the pandemic in 2020 among CW hospital partners. Methods: Data were collected in 2021 via key informant interviews with partners (n=9) at CW implementing hospitals to assess perceptions of CW activities in 2020, the first year of the COVID-19 pandemic. A semi-structured interview guide was used, and interviews were recorded, transcribed, and consensus coded. A codebook was developed based on the interview guide. Data from select questions of interest related to perceived access to contraceptive counseling, access to LARC methods, and the impact of the pandemic on contraceptive care services were analyzed for this study. Coding was conducted with NVivo software version 1.6.1. Results: Findings show that there was continued provision of contraceptive services during COVID-19 at CW partner hospitals, including an increase in access to contraceptive counseling and LARCs in 2020. The most prevalent facilitator for increased access to contraceptive counseling and LARCs at CW partner hospitals was having key personnel available such as physicians and Obstetrics (OB) navigators. Expanded access to outpatient sites was also noted as a facilitator of contraceptive counseling. Advertising and wide-spread patient education, buy-in and engagement from staff were additional facilitators for the increased access to LARCs. Considering the context of the COVID-19 pandemic, patients wanting to quickly leave the hospital and challenges with staffing contributed to an overall decline in access in some hospital locations. Challenges with staffing included not being able to receive training and nurses being overworked and overburdened. Conclusion: While COVID-19 has posed challenges to contraceptive care service provision, most individuals perceived an increase in access to contraceptive counseling and LARCs at CW partner hospitals. Hospital partners have continued to provide contraceptive services during COVID-19. The findings suggest the success of the CW initiative in increasing access to contraceptive services, particularly during COVID-19 through key facilitators. Staffing positions such as OB Navigators should be funded and maintained to increase access to contraceptive care services in hospital inpatient settings. Coordinating care between hospital inpatient and outpatient settings is similarly important for widespread patient education about contraceptive care services

Differences In Mechanics Between First And Second Drop Vertical Jump Landings

A drop jump and landing, followed by another maximal jump and landing, has been used when assessing injury risk utilizing the Landing Error Scoring System (LESS). Vertical ground reaction force (vGRF) and knee excursion are also commonly analyzed during a drop vertical jump. Previous studies have assessed initial drop vertical jump landing mechanics without assessing the second landing from the subsequent vertical jump. Additionally, analyzing landing mechanics based on subject jump height has not been examined for either landing 1 (L1) or landing (L2). The purpose of this study was to investigate whether there was a difference in LESS scores, vGRF, and knee excursion between the first and second landings of the drop vertical jump in all subjects and when divided into subgroups based on jump height.https://dune.une.edu/pt_studrrposter/1004/thumbnail.jp