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Innovation in software is important to both members of the public and the software industry, and involves developing software that is both useful and novel. While novelty has attracted significant interest in relation to physical products, it is not so well studied in the context of software products. In this paper, we aim to help develop our understanding of novelty in software by investigating which kinds of software products are seen as more or less novel; what factors may contribute most to perceptions of novelty in software, and whether members of the public and those involved in software development think in the same ways about these things. Through a study consisting of 3 stages, we identify examples of software products that are seen as original, at time of writing, by both software specialists and members of the public, and also two key factors–use of software in a new context, and use of a new underlying technology, which appear to contribute strongly to perceptions of novelty in software. We briefly discuss the implications of our findings and directions for further work.

Refereed/Peer-reviewed Objective: To describe the distribution of 3 allied health professionals— occupational therapists, physiotherapists and podiatrists— in South Australia stratified by the Modified Monash Model and the Index of Relative Socio- Economic Disadvantage Design: A descriptive data linkage cross-sectional study. Setting: The state of South Australia, Australia Participants and main outcome measures: Distribution of the 3 registered allied health professional groups stratified by Modified Monash Model and Index of Relative Socio-Economic Disadvantage. Results: The largest proportion of the 3 allied health professional groups (occupational therapists, physiotherapists and podiatrists) were found in areas classified as Modified Monash 1 and Modified Monash 2 (86.5%). The lowest proportion of allied health professionals were found in Modified Monash 7. The largest number of allied health professionals per 10 000 population was found in areas classified as Modified Monash 1 and Modified Monash 2. The lowest number of allied health professionals per 10 000 population was found in Modified Monash 7 areas. The largest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio-Economic Disadvantage quintile 2, while the lowest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio-Economic Disadvantage quintile 1. Conclusions: The distribution of allied health professionals according to geographical remoteness, socio-economic disadvantage and per 10 000 population varies widely in South Australia. The number of allied health professionals per 10 000 population was lowest in rural and remote/very remote areas, explaining the typically poor access to allied health services for communities in these areas. The number of allied health professionals per 10 000 population according to Index of Relative Socio-Economic Disadvantage was variable within the context of both urban and rural areas.

We retrospectively included women with abnormal FTS analytes and compared outcomes between those with elevated and normal UtA-PI. Out of 582 women with abnormal FTS analytes, 65 (11.2%) had elevated UtA-PI. Neonates of women in this group had higher rates of birth weight3rd, 5th, and 10th percentile. The area under the ROC curve for predicting FGR10th percentile by UtA-PI was 0.584, for FGR5th percentile 0.593, and for FGR3rd percentile 0.720. In women with abnormal FTS, elevated UtA-PI is associated with higher rates of FGR, but its predictability is moderate-to-poor.

Ultrasound can be used to assess injury and structural changes to the soft-tissue structure of the foot. It may be useful to assess the feet of people with diabetes who are at increased risk of plantar soft-tissue pathological changes. The aim of this study was to determine if ultrasound measurements of plantar soft-tissue thickness and assessments of tissue acoustic characteristics are reliable in people with and without diabetes mellitus. A repeated measures design was used to determine intra-observer reliability for ultrasound measurements of plantar skin and fat pad thickness and intra- and inter-observer reliability of plantar skin and fat pad tissue characterisation assessments made at foot sites which are at risk of tissue injury in people with diabetes. Thickness measurements and tissue characterisation assessments were obtained at the heel and forefoot in both the unloaded and compressed states and included discrete layers of the plantar tissues: skin, microchamber, horizontal fibrous band, macrochamber and total soft-tissue depth. At each site, relative intra-observer reliability was achieved for the measurement of at least one plantar tissue layer. The total soft-tissue thickness measured in the unloaded state (ICC 0.925–0.976) demonstrated intra-observer reliability and is the most sensitive for detecting small change on repeated measures. Intra-observer agreement was demonstrated for tissue characteristic assessments of the skin at the heel (k = 0.70), fat pad at the lateral sesamoid region (k = 0.70) and both skin and fat pad at the second (k = 0.80, k = 0.70 respectively) and third metatarsal heads (k = 0.90, k = 0.79 respectively). However, acceptable inter-observer agreement was not demonstrated for any tissue characteristic assessment, therefore the use of multiple observers should be avoided when making these assessments. Refereed/Peer-reviewed

Human Information Behavior (HIB) research commonly examines behavior in the context of why information is acquired and how it will be used, but usually at the level of the work or everyday-life tasks the information will support. HIB has not been examined in detail at the broader contextual level of intellectual purpose (i.e. the higher-order conceptual tasks the information was acquired to support). Examination at this level can enhance holistic understanding of HIB as a ‘means to an intellectual end’ and inform the design of digital information environments that support information interaction for specific intellectual purposes. We investigate information-based ideation (IBI) as a specific intellectual information acquisition and use context by conducting Critical Incident-style interviews with ten game designers, focusing on how they interact with information to generate and develop creative design ideas. Our findings give rise to a framework of their ideation-focused HIB, which systems designers can leverage to reason about how best to support certain behaviors to drive design ideation. These findings emphasize the importance of intellectual purpose as a driver for acquisition and desired outcome of use.

First responders (FRs) respond to critical incidents as an expectation of their profession, and after years of service, exposure to trauma can accumulate and potentially lead to mental health problems, such as posttraumatic stress disorder (PTSD). A gap persists in the research regarding duty-related risk factors and prevalence of mental health problems among FRs. Guided by existing evidence and in partnerships with the state's FR community, this study assessed the mental health needs of FRs, risk factors that may contribute to these problems, and the associations therein. A convenience sample of firefighters and emergency medical technicians/paramedics (n = 220) were recruited from across Arkansas to complete an online survey. This survey incorporated brief assessment tools to measure various mental health problems, and captured other data regarding possible risk factors. Results found that 14% reported moderate-severe and severe depressive symptoms, 28% reported moderate-severe and severe anxiety symptoms, 26% reported significant symptoms of PTSD, 31% reported harmful/hazardous alcohol use and dependence, 93% reported significant sleep disturbances, and 34% indicated high risk for suicide. Significant group differences were found across measures and gender (female), shift-structure (48 h or more), department setting (rural), relationship status (non-partnered), and having a medical history of hypertension. These findings pose significant implications for mental healthcare providers, as well as other healthcare providers and FR organizations. Findings will guide future research that will address the need for changes in decision-making, funding, and policy regarding FRs' MH and MH services available to them.

Background The neutral calcaneal stance position (NCSP), despite its known issues, is currently used as an “ideal” measure compared with the resting stance position in clinical podiatric medicine. The nonweightbearing (NWB) foot position, as used in the foot mobility magnitude (FMM), can provide an alternative comparative position, which is partially validated, if a significant correlation between the NCSP and the NWB position exists. This study aimed to establish the correlation between the component measures of the FMM in the NCSP and the NWB foot position of the FMM. Methods Eighty participants were recruited. Measures of dorsal arch height (DAH) and midfoot width (MFW) were obtained at the 50% total foot length mark in the NCSP and the NWB position by two examiners using the apparatus described by McPoil et al. Results Reliability analysis with intraclass correlation coefficients (ICCs) indicated intrarater results of 0.90 to 0.99 for DAH and 0.96 to 0.99 for MFW and interrater results of 0.90 for DAH and 0.96 for MFW in the NWB position. Using a Pearson product moment correlation coefficient analysis, there was a significant correlation between the NCSP and the NWB position for DAH (r = 0.82) and MFW (r = 0.86). Conclusions A significant correlation between the NCSP and the NWB position was evident when the measures of DAH and MFW were conducted. Therefore, clinically, the NWB position can potentially replace the NCSP as the ideal position for clinical treatment.

Background Possible human immunodeficiency virus (HIV)-1 clearance has rarely been reported. In this study, we describe a unique case of an HIV-positive, combination antiretroviral therapy (cART)-experienced woman with prior acquired immunodeficiency syndrome (AIDS) who has not experienced viral rebound for over 12 years since discontinuing cART. Methods Leukapheresis, colonoscopy, and lymph node excision were performed for detailed examination of virologic (including HIV reservoir) and immunologic features. Comparisons were made with chronically infected patients and healthy controls. Results No HIV-specific antibodies were detected in serum. Plasma HIV ribonucleic acid (RNA) levels were Conclusions This represents the first report of complete seroreversion, prolonged posttreatment virus suppression, a profoundly small HIV reservoir, and persistent HIV-specific T cells in an adult with prior AIDS.

Background Serological assays for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have roles in seroepidemiology, convalescent plasma-testing, antibody durability and vaccine studies. Currently, SARS-CoV-2 serology is performed using serum/plasma collected by venepuncture. Dried blood spot (DBS) testing offers significant advantages as it is minimally invasive, avoids venepuncture with specimens being mailed to the laboratory. Methods A pathway utilizing a newborn screening laboratory infrastructure was developed using an enzyme-linked immunosorbent assay to detect IgG antibodies against the receptor-binding domain of the SARS-CoV-2 spike protein in DBS specimens. Paired plasma and DBS specimens from SARS-CoV-2 antibody-positive and -negative subjects and polymerase chain reaction positive subjects were tested. DBS specimen stability, effect of blood volume and punch location were also evaluated. Results DBS specimens from antibody-negative ( n = 85) and -positive ( n = 35) subjects and polymerase chain reaction positive subjects ( n = 11) had a mean (SD; range) optical density (OD) of 0.14 (0.046; 0.03–0.27), 0.98 (0.41; 0.31–1.64) and 1.12 (0.37; 0.49–1.54), respectively. An action value OD >0.28 correctly assigned all cases. The weighted Deming regression for comparison of the DBS and the plasma assay yielded: y = 0.004041 + 1.005 x, r = 0.991, Sy/ x 0.171, n = 82. Extraction efficiency of antibodies from DBS specimens was >99%. DBS specimens were stable for at least 28 days at ambient room temperature and humidity. Conclusions SARS-CoV-2 IgG receptor-binding domain antibodies can be reliably detected in DBS specimens. DBS serological testing offers lower costs than either point of care or serum/plasma assays that require patient travel, phlebotomy and hospital/clinic resources; the development of a DBS assay may be particularly important for resource poor settings.

This article compares the impact on libraries and library services of the COVID-19 pandemic with past economic crises. In order to respond proactively to the current crisis, the author proposes sig...

The identification of the key factors that make a tangible product creative has been the focus of significant research in the area of design. However, the same effort for software products is almost non-existent. With the ever-increasing importance of software applications in day-to-day life, such endeavour becomes more necessary. In this paper we report on preliminary results that build on our understanding of how we evaluate the creativity of tangible products, to identify key criteria that can be used in assessing the creativity of intangible software products. We argue that this provides a basis for designers to work together with software developers in pushing the boundaries of software innovation.

Background:Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation.Methods:We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February–May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table.Results:Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant (P ≤ .09). Effect size of difference was –0.48 (95% CI, –1.16 to 0.22).Conclusions:In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.

Introduction While research suggests that asylum-seekers often present with a high level of medical and psychological needs, there is a dearth of research exploring sleep quality in this population, and, accordingly, the role that the sleep medicine community may be able to play in alleviating the suffering of this population. Therefore, this study aims to assess the prevalence of sleep disruption amongst asylum-seekers presenting to a South Florida clinic and to categorize these disruptions according to severity and type. Methods This is a cross-sectional study utilizing medical affidavits for asylum seekers in South Florida from 2018-2020 (n=54). Affidavits were reviewed for narrative descriptions of sleep quality and information from validated screeners regarding sleep; demographic information was also collected. Affidavits were excluded if they did not include itemized answers to screening questions. Results Out of 54 asylum-seekers (31% male, median age=34.5 years), 72.2% reported sleep disturbance. 38.9% reported nightmares, 66.7% reported insomnia of any type, and 29.6% reported severe insomnia. Asylum-seekers that screened positive for post-traumatic stress disorder (PTSD) were more likely to report ongoing sleep disturbance than asylum-seekers that screened negative for PTSD (p=.004). Sleep disturbance prevalence did not vary significantly by gender identity or country of origin. Conclusion This study reveals a high prevalence of sleep disruption amongst asylum-seekers in South Florida. The asylum-seekers in our study were more likely to experience insomnia than nightmares, but many experienced both; sleep disturbance was significantly associated with screening positive for PTSD. Our findings suggest that physicians working with asylum-seekers should ask about sleep quality and offer appropriate care. Directions for further research include investigating how poor sleep quality impacts the health and wellbeing of asylum-seekers. Support (if any) None

Background Ecological momentary assessment (EMA) offers a highly valid strategy to assess everyday functioning in people with severe mental illness. Adherence is generally good, but several questions regarding the impact of study length, daily density of sampling, and symptom severity on adherence remain. Methods EMA adherence in two separate studies was examined. One sampled participants with schizophrenia (n = 106) and healthy controls (n = 76) 7 times per day for 7 days and the other sampled participants with schizophrenia (n = 104) and participants with bipolar illness (n = 76) 3 times per day for 30 days. Participants were asked where they were, who they were with, what they were doing and how they were feeling in both studies. The impact of rates of very early adherence on eventual adherence was investigated across the samples, and adherence rates were examined for associations with mood state and most common location when answering surveys. Results Median levels of adherence were over 80% across the samples, and the 10th percentile for adherence was approximately 45% of surveys answered. Early adherence predicted study-long adherence quite substantially in every sample. Mood states did not correlate with adherence in the patient samples and being home correlated with adherence in only the bipolar sample. Implications: Adherence was quite high and was not correlated with the length of the study or the density of sampling per study day. There was a tendency for bipolar participants who were more commonly away from home to answer fewer surveys but overall adherence for the bipolar patients was quite high. These data suggest that early nonadherence is a potential predictor of eventual nonadherence and study noncompletion.

BACKGROUND: First responders (FRs) are at significant risk for developing mental health (MH) problems due to the nature, frequency, and intensity of duty-related traumatic exposure. However, their culture strongly esteems strength and self-reliance, which often inhibits them from seeking MH care. AIMS: This study explored factors that influenced FRs’ perceptions of MH problems and engagement in MH services. METHODS: A community-based approach and individual ethnographic qualitative interviews were used. Recruitment of a convenience sample of firefighters and emergency medical technicians/paramedics from across Arkansas was facilitated by our community partners. Interviews were analyzed using content analysis and constant comparison. RESULTS: Analysis generated three broad factors that influenced FRs’ perception of MH problems and engagement in MH services: (a) Knowledge, (b) Barriers to help-seeking, and (c) Facilitators to help-seeking. Knowledge was an overarching factor that encompassed barriers and facilitators: A lack of knowledge was a barrier to help-seeking but increased knowledge served as a facilitator. Barriers included five subthemes: Can’t show weakness, Fear of confidentiality breech, Therapist: negative experience, Lack of access and availability, and Family burden. Facilitators included five subthemes: Realizing “I’m not alone,” Buy-in, Therapist: positive experience, Problems got too bad, and Recommendations. CONCLUSIONS: Findings provide unique perspectives from FRs about how to best address their MH needs. First responders, as well as mental health care providers, need a more thorough understanding of these issues in order to mitigate barriers and facilitate help-seeking. As advocates, educators, and health care providers, psychiatric nurses are well-positioned to care for this at-risk population.

Background Pain is recognised to have both a sensory dimension (intensity) and an affective dimension (unpleasantness). Pain feels like a single unpleasant bodily experience, but investigations of human pain have long considered these two dimensions of pain to be separable and differentially modifiable. The evidence underpinning this separability and differential modifiability is seldom presented. We aimed to fill this gap by evaluating the current evidence base for whether or not the sensory and affective dimensions of pain can be selectively modulated using cognitive manipulations. Methods A rigorous systematic search, based on a priori search terms and consultation with field experts, yielded 4270 articles. A detailed screening process was based on the following recommendations: (i) evaluation of effectiveness; (ii) examination of methodological rigour, including each study having an a priori intention to cognitively modulate one of the two dimensions of pain; and (iii) sound theoretical reasoning. These were used to ensure that included studies definitively answered the research question. Results After in-depth critique of all 12 articles that met the inclusion criteria, we found that there is no compelling evidence that the sensory and affective dimensions of pain can be selectively and intentionally modulated using cognitive manipulations in humans. Conclusions We offer potential explanations for this discrepancy between assumptions and evidence and contend that this finding highlights several important questions for the field, from both the research and clinical perspectives.

Previous work has shown that end-user developers (EUDs) find diagnosing and fixing circuit bugs in physical computing prototypes challenging. This paper reports on the design of a card deck to support troubleshooting by novice EUDs. The deck provides EUDs with ideas for different troubleshooting tactics and guides them in their use by encouraging reflection to help build EUDs’ troubleshooting knowledge and skill. We describe the design process and the resulting card deck. Our work contributes a new way of supporting EUDs in troubleshooting physical computing prototypes.

Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Commutability of quantitative standards allows patient results to be compared across molecular diagnostic methods and laboratories. This is critical to establishing quantitative thresholds for use in clinical decision-making. A matrix effect associated with the 1st cytomegalovirus (CMV) WHO international standard (IS) was identified using the Abbott RealTime CMV assay. A commutability study was performed to compare the CMV WHO IS and patient specimens diluted in plasma and whole blood. Patient specimens showed similar CMV DNA quantitation values regardless of the diluent or extraction procedure used. The CMV WHO IS, on the other hand, exhibited a matrix effect. The CMV concentration reported for the WHO IS diluted in plasma was within the 95% prediction interval established with patient samples. In contrast, the reported DNA concentration of the CMV WHO IS diluted in whole blood was reduced approximately 0.4 log copies/ml, and values fell outside the 95% prediction interval. Calibrating the assay by using the CMV WHO IS diluted in whole blood would introduce a bias for CMV whole-blood quantitation; samples would be reported as having higher measured concentrations, by approximately 0.4 log IU/ml. Based on the commutability study with patient samples, the RealTime CMV assay was standardized based on the CMV WHO IS diluted in plasma. A revision of the instructions for use of the CMV WHO IS should be considered to alert users of the potential impact from the diluent matrix. The identification of a matrix effect with the CMV WHO IS underscores the importance of assessing commutability of the IS in order to achieve consistent results across methods.

Objectives To assess the utility of uterine artery Doppler study and the risk of fetal growth restriction (FGR) in the presence of abnormal serum analytes in the first trimester screening (FTS). Methods We conducted a retrospective cohort study of women who had a placental study following abnormal serum analytes in FTS. FTS included PAPP-A, PlGF, free β-hCG and AFP. Placental ultrasound was conducted during the second trimester and included the gestational age-adjusted mean uterine artery pulsatility index (UtA-PI). Outcomes of pregnancies with elevated UtA-PI (MoM >95% percentile) were compared with those of pregnancies with normal UtA-PI (≤95% percentile). ROC curve was calculated to assess the utility of uterine artery Doppler study in the prediction of FGR. Results 546 women were included. Of those, 52 (9.5%) had elevated UtA-PI. This group had higher mean pre-pregnancy BMI and higher rates of abnormal PAPP-A and ≥2 abnormal analytes. All other characteristics were similar between groups. Neonates of women with elevated UtA-PI had lower mean birth weight (BW), and higher rates of BW Conclusions In women at high risk for FGR based on abnormal FTS analytes, elevated UtA-PI is associated with higher rates of FGR but does not improve the prediction of FGR.

Applied visualization researchers often work closely with domain collaborators to explore new and useful applications of visualization. The early stages of collaborations are typically time consuming for all stakeholders as researchers piece together an understanding of domain challenges from disparate discussions and meetings. A number of recent projects, however, report on the use of creative visualization-opportunities (CVO) workshops to accelerate the early stages of applied work, eliciting a wealth of requirements in a few days of focused work. Yet, there is no established guidance for how to use such workshops effectively. In this paper, we present the results of a 2-year collaboration in which we analyzed the use of 17 workshops in 10 visualization contexts. Its primary contribution is a framework for CVO workshops that: 1) identifies a process model for using workshops; 2) describes a structure of what happens within effective workshops; 3) recommends 25 actionable guidelines for future workshops; and 4) presents an example workshop and workshop methods. The creation of this framework exemplifies the use of critical reflection to learn about visualization in practice from diverse studies and experience.

Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p = 0.001) and performing 64 min more inside chores on average per day (p = 0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r = 0.52–0.66, p = 0.005–0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1818–1825, 2015.

Cell-of-origin determination has emerged as an important prognostic factor for patients initially diagnosed with diffuse large B cell lymphoma (DLBCL). Specifically, the nongerminal center B cell–like (non-GCB) subtype, composed predominantly of the activated B cell–like (ABC) molecular subtype, has been shown to portend poor prognosis because of its more aggressive nature and resistance to standard cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (CHOP)-like chemotherapy compared with the GCB subtype. The recurrent MyD88 L265P mutation, present in 29% of ABC DLBCL, was reported as an independent poor prognostic factor for patients with newly diagnosed DLBCL. For patients whose disease relapses or is refractory to first-line chemotherapy, high-dose chemotherapy with autologous stem cell transplantation (ASCT) is frequently offered as salvage therapy. However, the impact of MyD88 mutation status on post-ASCT outcome has not been reported. Here, we retrospectively analyzed, with up to 20 years of follow-up, 165 patients who underwent ASCT for relapsed/refractory DLBCL at our institution. We found that MyD88 mutation status did not correlate with overall survival (OS), post-ASCT OS, or progression-free survival (PFS). Patients with non-GCB subtype had significantly worse OS from initial diagnosis and after ASCT. Notably, high International Prognostic Index score was predictive of poor pre- and post-transplant PFS and post-transplant OS.

Positive emotions can enhance the ability of people to generate original ideas, and its intensity can determine the degree to which people are able to think originally. How to design a technology that can be used to hack into this link between the intensity of positive emotion and creative thinking is, however, still an open problem. To address this we have conceived, developed, and experimentally evaluated a proof-of-concept interactive system that generates believable computational feedback about the originality of a user’s own ideas in real-time. This system can manipulate this feedback to make a user’s own ideas appear more or less original than people would typically judge them to be, and can also vary the order of this manipulation over time. This has enabled us to test experimentally that: (i) the order in which the positivity and negativity of the feedback is varied can be used to condition people’s expectations, which (ii) can be used to later determine an intended intensity a positive emotion that a user experience, and which (iii) subsequently influence the degree to which the user is able to generate original ideas. The findings demonstrate that an interactive system can be designed to determine the type and intensity of an emotional response, in a manner that enhances the people’s ability to generate original ideas.

Purpose: To describe strategies salient to physical activity (PA) initiation and maintenance among older women who participated in a clinical trial that tested a PA intervention. Design: A descriptive phenomenological, qualitative design for a process evaluation of a successful clinical trial. Setting: Senior primary care clinics associated with a large medical center in a southern state. Participants: A total of 20 older women at least 60 years without advanced frailty. Method: Purposive sampling using maximum variation technique was used to select participants. A semi-structured interview guide facilitated individual, in-depth interviews lasting 45 to 90 minutes. Narratives were analyzed using content analysis with constant comparison technique to summarize the data. Results: Eight African American and 12 white older women with a mean age of 68 from control and intervention arms participated. Five central themes described salient strategies to promote and maintain PA: sensed benefits, motivation, and self-efficacy were central to success, while a reduction in barriers was essential before maintaining PA. The last theme, a life-changing awareness indicated that PA had become a shared value. An explanatory model describing interrelationships is presented. Conclusions: This study suggests key strategies to include in PA interventions with older women. An unexpected finding was that PA became a shared value, an action promoted by the Culture of Health initiative to improve population health and well-being.

Context HIV antiretroviral (ARV) therapy is associated with renal and bone toxicity, but little is known about the potential cumulative effects in adults exposed to ARVs from birth. Objective To prospectively evaluate renal and bone health in young adults with lifelong HIV and extensive ARV exposure. Design Cross-sectional comparison of bone mineral density (BMD) by dual-energy X-ray absorptiometry, bone turnover, and renal function in young adults infected with HIV in early life (n = 65) to matched healthy controls (n = 23) and longitudinal evaluation (mean follow-up = 4.4 years) within a subset of the HIV cohort (n = 33). Setting Government outpatient research clinic. Results Albumin/creatinine ratio, protein/creatinine ratio, anion gap, N-terminal telopeptides, and osteocalcin were significantly increased in persons with HIV compared with controls, whereas whole-body BMD and BMD z scores were lower. Within the HIV group, duration of tenofovir disoproxil fumarate (TDF) correlated with higher anion gap but did not correlate with bone parameters. Longer duration of didanosine and stavudine use correlated with lower BMD and BMD z scores. Longitudinal analyses revealed that BMD and bone metabolism significantly improved over time. No subject had an estimated glomerular filtration rate (eGFR)

To correctly assess abnormalities within the foot, reliable and accurate measurements are necessary for clinicians to prescribe foot orthoses that effectively manage malalignment (Elveru et al., 20...

Background: Xerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population. Methods: A systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II - IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted. Results: A total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies). Conclusions: No conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another. Refereed/Peer-reviewed

This article provides a synthesis of the literature addressing the psychological and social effects on children and adolescents after disasters, and the factors that contribute to protecting this population from experiencing related symptoms. Clinical implications are presented for health care providers to reduce the possibility of long-term psychopathologies based on the National Commission on Children and Disasters 2010 Report.

Summary Effective off-loading is considered to be an important part of the successful clinical management of diabetic foot ulcers. The aim of this systematic review is to investigate the safety and effectiveness of different off-loading devices for the treatment of diabetic foot ulcers. The medical literature was extensively searched from January 1966 to May 2012. Systematic reviews and controlled studies that compared the use of different off-loading devices formed the evidence base. Studies were critically appraised to determine their risk of methodological bias, and data were extracted. Results were pooled using random effects meta-analysis and tested for heterogeneity. When compared with removable devices, non-removable off-loading devices were found, on average, to be more effective at promoting the healing of diabetic foot ulcers (RRp = 1.43; 95% CI 1.11, 1.84; I2 = 66.9%; p = 0.001; k = 10). Analysis, stratified by type of removable device, did not detect a statistically significant difference between non-removable off-loading devices and removable cast walkers; however, on average non-removable off-loading devices performed better than therapeutic shoes at promoting the healing of diabetic foot ulcers (RRp = 1.68; 95% CI 1.09, 2.58; I2 = 71.5%; p = 0.004; k = 6). The two types of non-removable off-loading devices i.e. total contact casts and instant total contact casts (removable cast walker rendered irremovable by securing with bandage or lace), were found to be equally effective (RRp = 1.06; 95% CI 0.88, 1.27; I2 = 3.3%; p = 0.31; k = 2). In conclusion, non-removable off-loading devices regardless of type, are more likely to result in ulcer healing than removable off-loading devices, presumably because patient compliance with off-loading is facilitated. Copyright © 2013 John Wiley & Sons, Ltd.

This article considers the construction of authenticity in documentary films dealing with repression in the former East Germany, focusing on Stefan Weinert’s Gesicht zur Wand (2009) and Christian Klemke and Jan N. Lorenzen’s Das Ministerium für Staatssicherheit: Alltag einer Behörde (2002). Taking as its starting point the observation of two modes of authenticity in Florian Henckel von Donnersmarck’s Oscar-winning feature film, Das Leben der Anderen (2006), the article analyses the interaction between referential and emotive elements in non-fictional representations of repression. The use of eyewitness testimony is central to both documentary films, and the grouping of personal accounts can create a self-authenticating ‘mediated remembering community’. However, the observation of complementary and competing authenticities in the medium highlights how the authenticity of the witness account can be both harnessed and undermined by its (re)mediation in cultural artefacts. This adds to our understanding of how versions of contested pasts circulate and become salient.

Considerable research has focused on the problems that end users face when programming software, in order to help them overcome their difficulties, but there is little research into the problems that arise in physical computing when end users construct circuits and program them. In an empirical study, we observed end-user developers as they connected a temperature sensor to an Arduino microcontroller and visualized its readings using LEDs. We investigated how many problems participants encountered, the problem locations, and whether they were overcome. We show that most fatal faults were due to incorrect circuit construction, and that often problems were wrongly diagnosed as program bugs. Whereas there are development environments that help end users create and debug software, there is currently little analogous support for physical computing tasks. Our work is a first step towards building appropriate tools that support end-user developers in overcoming obstacles when constructing physical computing artifacts.

In collaborative learning groups, students' awareness of each others' activities is key to enhancing the effectiveness of collaboration. Some studies have reported that many of the breakdowns in collaboration in learning groups happen because of a lack of activity awareness. While some technologies have been developed to support activity awareness, the potential of persuasive technology has not yet been explored. We report the design, development and evaluation of a persuasive technology for this purpose in the form of a digital social actor. The design of the social actor was shaped by persuasive design principles. The evaluation involved 21 participants who used the app during group projects as part of a postgraduate course. Results showed that activity awareness increased towards the end of the project work and that participants felt the social actor changed their awareness behaviour. This research makes two contributions: it investigates a novel approach to promoting activity awareness in small learning groups by using a social actor to change students' attitudes and behaviours, and it reports a first attempt to design, develop and evaluate a persuasive social actor based on the Persuasive Systems Design model.

Supporting parents with complementary feeding is part of the health visitor's role. Today, parents are influenced not only by official guidance and health professionals' advice but also by the internet, friends and family. This article explores the evolution of complementary feeding trends since the 18th century and the current social context of complementary feeding, in particular the growing popularity of baby-led weaning. It aims to provide health visitors with an overview of the historical background of complementary feeding, to enhance understanding of the development of feeding trends.

In an effort to gain a deeper understanding of how to better facilitate creative collaboration during early stage design activities, a survey and a number of interviews were undertaken to determine current practice in this field. A key aim of this research was to review how tools and technologies are currently used to support collaborative creativity and problem solving in design. The outcome is an overview of early stage activities, the environments in which they are currently carried out, and the role of tools and technologies within them.

This article examines the potential of the new media to provide space for the voicing of traumatic pasts. Using the example of www.stasiopfer.de , a site dedicated to the victims of persecution in the former German Democratic Republic (GDR), I consider the development of remembering communities on the internet. Close textual analysis of a selection of posts reveals the ways in which group belonging is constructed linguistically. The observation of a hybrid language form between orality and textuality, and the staging of temporal immediacy, is linked to the concept of a medial trace that has a structuring impact on the memories produced. I argue that in the case of internet communication part of this medial trace is the ‘catching’ of otherwise evanescent memory, that is, the mediatization of communicative memory. In this way, discussion forums that focus on memory can be described as both part of ‘stored’ cultural memory and mediated remembering communities.

Background: Sever’s disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. Methods: Children with Sever’s disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever’s disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al–type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. Results: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. Conclusions: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever’s disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation. (J Am Podiatr Med Assoc 101(2): 133–145, 2011)

Background Current pediatric CAP guidelines recommend empiric antibiotic treatment based on patient’s immunization status against Haemophilus influenzae and Streptococcus pneumoniae. The primary objective of this study was to assess the current empiric antimicrobial treatment practices for CAP based on the immunization status of pediatric patients. Methods This retrospective cohort included pediatric patients diagnosed with CAP and received initial empiric antibiotics after presenting to the institution. The cohorts were categorized as fully immunized or not fully immunized consistent with state immunization health records and national recommendations according to the child’s age. The primary outcome was receipt of appropriate vs. inappropriate antibiotics according to guideline recommendations. Multivariable analyses were used to evaluate inappropriate empiric antibiotics for CAP with immunizations status as exposure of interest. Secondary outcomes included length of stay and 30-day readmission rates. Results A total of 189 patients (129 fully immunized and 60 not fully-immunized) were included in the interim analysis. A total of 104 patients (55%) received inappropriate antibiotics [62 of the fully immunized (48%) and 42 of the not fully immunized (70%) received inappropriate antibiotics (P = 0.0048)]. Multivariable analysis identified not fully-immunized and age as independent predictors for inappropriate empiric antibiotics for CAP, aOR 2.77, 95% CI (1.20, 5.89), P = 0.008, and aOR 1.41, 95% CI (1.15, 1.72), P = 0.001; respectively. In terms of secondary outcomes, not fully-immunized patients had longer length of stay, higher readmission in 30 days, and greater need for oxygen supplementation, but none of these results were statistically significant. Conclusion Currently, the majority of pediatric patients treated for CAP received inappropriate empiric antibiotics. Not fully-immunized patients were more likely to receive inappropriate empiric antibiotics for CAP and subsequently did not have improved morbidity. Disclosures All authors: No reported disclosures.

Introduction Diabetes mellitus (DM) is associated with hyperglycaemia and advanced glycosylation end products.In the foot, the consequences of chronic or uncontrolled diabetes are micro and macrovascular disease, neuropathy, reduced joint mobility and structural and soft tissue changes that increase the risk of ulcer development and amputation. Diabetes foot assessment currently includes a comprehensive history, neurological and vascular assessments and examination focussed on dermatological and musculoskeletal abnormalities. Whilst these assessments are helpful for predicting ulceration risk, direct identifiers that enable early therapeutic intervention are lacking. The intention of this review was to ascertain if B-mode ultrasound could be clinically applied to identify structural change in the diabetic foot and be utilised as an early predictor of ulceration risk. Methods Primary databases and grey literature sources were systematically searched. Selection criteria were that the study included a diabetic sample and used B-mode ultrasound to assess soft tissue structures of the foot (plantar skin, plantar fat pad or intrinsic muscles). Results Fifteen studies were identified for inclusion (combined diabetic sample of 773). Ultrasound demonstrated reductions in tissue thickness in diabetics compared to non-diabetics under first (p = 0.01) and second (p = 0.03) metatarsal heads, but not the third (p = 0.24). Statistical heterogeneity was high for ultrasound thickness measures under metatarsal heads four/five(I² 65%, 81%) and very high for plantar skin (I² 98%), heel pad (I² 76%) and intrinsic muscles(I² 91%, 81%). Extensor digitorum brevis (EDB) ultrasound measures were significantly thinner in diabetics for all dimension measures compared to healthy controls except one study, which reported no significant differences in EDB thickness. Conclusions No direct evidence was found to indicate B-mode ultrasound measures can predict soft tissue changes in the plantar foot in diabetes, although low level studies indicate ultrasound has the potential to identify structural change. Clinical, methodological and statistical heterogeneity limit result applicability. This review highlights the need for robust prospective longitudinal research to examine the predictive validity of this method. Refereed/Peer-reviewed

This article analyses the crisis of memory resulting from the historical rupture of 1989 and the opening of the Stasi files in 1992. Focusing on the GDR writer, Hermann Kant, I compare Kant's own account of his involvement with the Stasi in post-1989 autobiography and journalism with the portrayal of these events in the files themselves. The Stasi files have been described as both an aid to memory and a form of hostile biography, and a tension can be seen in the responses of both ‘Inoffizielle Mitarbeiter’ and victims of Stasi observation between the desire to use the files to reconstruct forgotten past events and the need to reject this secondary perspective on one's life. Hermann Kant can be seen to react to this crisis of memory with a total refusal to accept the validity of the file and an assertion of the superiority of his autobiography over this second biography. Analysis of the files and autobiography in conjunction with each other points to the ambiguity and complexity of intellectual life in the GDR and the difficulty of remembering this complexity in the post-1989 political context amidst conflicting evidence shaped by different political circumstances.

Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition. Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212–223, 2008)

Purpose Appropriate and timely foot self-care practices may prevent diabetes-related foot complications. However, self-care practices are often neglected, particularly by older adults. The purpose of this study was to conduct an integrative, systematic literature review of the psychosocial barriers and enablers of foot self-care practices among older adults diagnosed with diabetes. Methods An integrative, systematic literature review and a deductive thematic analysis was conducted to determine psychosocial barriers and enablers of foot self-care practices among older adults. Results A total of 130 different studies were retrieved from the search strategy. From these, 9 studies were identified and included for review. Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications. Conclusion Foot self-care practices appear underutilized as primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications. Health care professionals such as diabetes educators, podiatrists, and general practitioners may play an important role in the prevention of foot complications among older adults by recognizing, referring, and providing early education to older adults.

Academic research has produced many model-based specification and analysis techniques, however, most organisations continue to document requirements as textual statements. To help bridge this gap between academic research and requirements practice, this paper reports an extension to the RESCUE process in which patterns for generating requirements statements from i* system models were manually applied to i* models developed for a complex air traffic control system. The paper reports the results of this application and describes them with examples, the benefits of the approach to the project, and ongoing research to implement these patterns in the REDEPEND modelling tool to make requirements engineers more productive. We review similar work on requirements modelling and expression, and compare our work to it to demonstrate the proposed advance in the state of the art. Finally the paper discusses future uses of requirements generation from model patterns in RESCUE.

Objective The objective of this systematic review is to evaluate the clinical effectiveness of podiatric management in the treatment of the Charcot foot. Research questions How effective is podiatric management with: 1. reducing lesions, ulceration and surgical intervention 2. reducing hospital admission, and 3. improving the quality of life of subjects. Inclusion Criteria Participants Subjects with an active primary diagnosis of Charcot foot, and of neuropathic aetiology, irrespective of gender, race, age, or nationality. Excluded: Subjects with Charcot –Marie-Tooth disease. Interventions Immobilisation by using non weight bearing crutches or a total contact plaster cast, removable cast walkers, advise/dispense appropriate footwear, prescribing of orthotics, use of Bisphosphonates, removal of calluses, compared to placebo, no intervention, or compared with other standard treatment used for the treatment of Charcot foot. Outcomes 1. incidence of foot ulceration, infection, amputation 2. callus development; resolution of callus 3. number and duration of hospital admissions 4. acceptability of the treatment as measured by the number of people dropping out during the trial and post randomisation exclusions 5. Quality of life measures: average change on any scale at the end of treatment.

When an adolescent sexually offends, it is a traumatic experience in the lives of their families. However, there is limited research about the experiences of these family members. This article presents two qualitative pilot studies that explored the experiences of eight parents and parental figures of adolescents who have sexually offended (ASOs). Both studies are presented to give a more complete description of the experience. Data were collected using a focus group and individual interviews. The purpose of Study 1 was to identify how parents of ASOs felt when they provided support to their child after his sexual offense. The overarching theme that emerged from the data was to prevent reoffending within the context of the prescribed treatment. Three main themes emerged within this process: an interactive relationship between the parent and the child, identified as being there; the parental toll; and aspirations for the child’s future. Study 2 was then conducted to further explore the parental toll using an interview guide that was developed using the Trauma Outcome Process as a theoretical framework. It aimed to identify their lived experience and describe ways in which they coped with the emotional toll. Four main themes emerged: coping with the initial response, coping with feeling responsible, coping with feeling alone and overwhelmed, and benefits from participating in a family support group. These findings revealed parents’ perceptions of reality while living and coping with the experience of having a child who sexually offended. Results will be used in the development of an intervention to help this population gain acceptance and cope with this experience.