Publications by authors named "Farzan Sasangohar"

40 Publications

Quantifying Occupational Stress in Intensive Care Unit Nurses: An Applied Naturalistic Study of Correlations Among Stress, Heart Rate, Electrodermal Activity, and Skin Temperature.

Hum Factors 2021 Sep 3:187208211040889. Epub 2021 Sep 3.

23534 Houston Methodist Hospital, Texas, USA.

Objective: To identify physiological correlates to stress in intensive care unit nurses.

Background: Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap.

Method: Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4).

Results: Positive correlations included stress and heart rate (ρ = .35, < .001), stress and skin temperature (ρ = .49, < .05), and heart rate and skin temperatures (ρ = .54, = .0008).

Discussion: The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses.

Application: Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures.
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http://dx.doi.org/10.1177/00187208211040889DOI Listing
September 2021

Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States.

JACC CardioOncol 2021 Jun 15;3(2):236-246. Epub 2021 Jun 15.

Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.

Background: Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences.

Objectives: This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer.

Methods: From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost.

Results: The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population.

Conclusions: Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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http://dx.doi.org/10.1016/j.jaccao.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352280PMC
June 2021

Understanding Heart Rate Reactions to Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Naturalistic Study.

Hum Factors 2021 Jul 22:187208211034024. Epub 2021 Jul 22.

265514736 Texas A&M University, College Station, USA.

Objective: We collected naturalistic heart rate data from veterans diagnosed with post-traumatic stress disorder (PTSD) to investigate the effects of various factors on heart rate.

Background: PTSD is prevalent among combat veterans in the United States. While a positive correlation between PTSD and heart rate has been documented, specific heart rate profiles during the onset of PTSD symptoms remain unknown.

Method: Veterans were recruited during five cycling events in 2017 and 2018 to record resting and activity-related heart rate data using a wrist-worn device. The device also logged self-reported PTSD hyperarousal events. Regression analyses were performed on demographic and behavioral covariates including gender, exercise, antidepressants, smoking habits, sleep habits, average heart rate during reported hyperarousal events, age, glucocorticoids consumption, and alcohol consumption. Heart rate patterns during self-reported PTSD hyperarousal events were analyzed using Auto Regressive Integrated Moving Average (ARIMA). Heart rate data were also compared to an open-access non-PTSD representative case.

Results: Of 99 veterans with PTSD, 91 participants reported at least one hyperarousal event, with a total of 1023 events; demographic information was complete for 38 participants who formed the subset for regression analyses. The results show that factors including smoking, sleeping, gender, and medication significantly affect resting heart rate. Moreover, unique heart rate patterns associated with PTSD symptoms in terms of stationarity, autocorrelation, and fluctuation characteristics were identified.

Conclusion: Our findings show distinguishable heart rate patterns and characteristics during PTSD hyperarousal events.

Application: These findings show promise for future work to detect the onset of PTSD symptoms.
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http://dx.doi.org/10.1177/00187208211034024DOI Listing
July 2021

The Impact of Commutes, Work Schedules, and Sleep on Near-Crashes during Nurses' Post Shift-Work Commutes: A Naturalistic Driving Study.

IISE Trans Occup Ergon Hum Factors 2021 Jul 7:1-10. Epub 2021 Jul 7.

Center for Outcome Research, Houston Methodist, Houston, TX, USA.

OCCUPATIONAL APPLICATIONSDriving and survey data were collected from nurses following the night-shift and analyzed with logistic regression and frequency analysis. The analyses showed that prior near-crashes and drive length contributed significantly to near-crashes. The frequency analysis showed that most near-crashes occurred on major roadways, including principal arterials, major collectors, and interstates, within the first 15 minutes of the drive. These results highlight the urgent need for countermeasures to prevent drowsy driving incidents among night-shift nurses. Specifically, nurses and hospital systems should focus on countermeasures that encourage taking a break on the post work commute and those that can intervene during the drive. This may include the use of educational programs to teach nurses the importance of adequate rest or taking a break to sleep during their drive home, or technology that can recognize drowsiness and alert nurses of their drowsiness levels, prompting them to take a break.
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http://dx.doi.org/10.1080/24725838.2021.1945708DOI Listing
July 2021

Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic.

Hum Factors 2021 Mar 7:18720821998110. Epub 2021 Mar 7.

2655 Texas A&M University, College Station, USA.

Objective: This article analyzes the changes in downloads and activity of users of select popular mental health mobile applications (mHealth apps) during coronavirus disease 2019 (COVID-19).

Background: The outbreak of the COVID-19 crisis has shown a negative impact on public mental health. Mobile health has the potential to help address the psychological needs of existing and new patients during the pandemic and beyond.

Method: Downloads data of 16 widely used apps were analyzed. The quality of apps was reviewed using the Mobile Application Rating Scale (MARS) framework. Correlation analysis was conducted to investigate the relationship between app quality and app popularity.

Results: Among the 16 apps, 10 were meditational in nature, 13 showed increased downloads, with 11 apps showing above 10% increase in the downloads after the pandemic started. The popular apps were satisfactory in terms of functionality and esthetics but lacked clinical grounding and evidence base. There exists a gap between app quality and app popularity.

Conclusion: This study provided evidence for increased downloads of mental mHealth apps (primarily meditation apps) during the COVID-19 pandemic but revealed several gaps and opportunities to address deficiencies in evidence-based design, usability and effective assessment, and integration into current workflows.

Application: The COVID-19 pandemic is a potential turning point for mHealth applications for mental health care. Whereas the evidence suggests a need for alternative delivery of care, human factors and ergonomics methods should be utilized to ensure these tools are user-centered, easy to use, evidence-based, well-integrated with professional care, and used sustainably.
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http://dx.doi.org/10.1177/0018720821998110DOI Listing
March 2021

Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review.

JMIR Form Res 2021 Mar 4;5(3):e14563. Epub 2021 Mar 4.

Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.

Background: The development, review, and approval process of therapeutic biological products in the United States presents two primary challenges: time and cost. Advancing a biotherapeutic from concept to market may take an average of 12 years, with costs exceeding US $1 billion, and the product may still fail the US Food and Drug Administration (FDA) approval process. Despite the FDA's practices to expedite the approval of new therapies, seeking FDA approval remains a long, costly, and risky process.

Objective: The objective of this paper is to explore the factors and gaps related to the FDA review and approval process that contribute to process inefficiencies and complexities as well as proposed methods and solutions to address such gaps. This paper also aims to investigate the available modeling efforts for the FDA approval process of therapeutic biological products.

Methods: A narrative review of literature was conducted to understand the scope of published knowledge about challenges, opportunities, and specific methods to address the factors and gaps related to the review and approval of new drugs, including therapeutic biological products. Relevant peer-reviewed journal articles, conference proceedings, book chapters, official reports from public policy professional centers, and official reports and guidelines from the FDA were reviewed.

Results: Of the 23 articles identified in this narrative literature review, none modeled the current FDA review and approval process structure to address issues related to the robustness, reliability, and efficiency of its operations from an external point of view. Although several studies summarize the FDA approval process with clarity, in addition to bringing to light the problems and challenges faced by the regulatory agency, only a few attempts have been made to provide solutions for the problems and challenges identified. In addition, although several reform models have been discussed, these models lack the application of scientific methodologies and modeling techniques in understanding FDA as a complex sociotechnical system. Furthermore, tools and methods to assess the efficacy of the models before implementation are largely absent.

Conclusions: The findings suggest the efficacy of model-based systems engineering approaches for identifying opportunities for significant improvements to the FDA review and approval process. Using this holistic approach will serve several investigative purposes: identify influential sources of variability that cause major delays, including individual, team, and organizational decision making; identify the human-system bottlenecks; identify areas of opportunity for design-driven improvements; study the effect of induced changes in the system; and assess the robustness of the structure of the FDA approval process in terms of enforcement and information symmetry.
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http://dx.doi.org/10.2196/14563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974759PMC
March 2021

Improving Psychiatric Care Through Integrated Digital Technologies.

J Psychiatr Pract 2021 03 5;27(2):92-100. Epub 2021 Mar 5.

This manuscript provides an overview of our efforts to implement an integrated electronic monitoring and feedback platform to increase patient engagement, improve care delivery and outcome of treatment, and alert care teams to deterioration in functioning. Patients First utilizes CareSense, a digital care navigation and data collection system, to integrate traditional patient-reported outcomes monitoring with novel biological monitoring between visits to provide patients and caregivers with real-time feedback on changes in symptoms such as stress, anxiety, and depression. The next stage of project development incorporates digital therapeutics (computerized therapeutic interventions) for patients, and video resources for primary care physicians and nurse practitioners who serve as the de facto front line for psychiatric care. Integration of the patient-reported outcomes monitoring with continuous biological monitoring, and digital supports is a novel application of existing technologies. Video resources pushed to care providers whose patients trigger a symptom severity alert is, to our knowledge, an industry first.
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http://dx.doi.org/10.1097/PRA.0000000000000535DOI Listing
March 2021

Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR).

JMIR Med Inform 2021 Feb 23;9(2):e26773. Epub 2021 Feb 23.

Houston Methodist, Houston, TX, United States.

Background: The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic.

Objective: We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization.

Methods: Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository-the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context.

Results: The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources.

Conclusions: A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support.
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http://dx.doi.org/10.2196/26773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903978PMC
February 2021

The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review.

JMIR Hum Factors 2021 Jan 29;8(1):e23796. Epub 2021 Jan 29.

Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.

Background: Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations.

Objective: This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older).

Methods: A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review.

Results: Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A (HbA) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology.

Conclusions: Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching.
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http://dx.doi.org/10.2196/23796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880804PMC
January 2021

Classification of Fatigue Phases in Healthy and Diabetic Adults Using Wearable Sensor.

Sensors (Basel) 2020 Dec 3;20(23). Epub 2020 Dec 3.

Department of Electrical & Computer Engineering, Texas A & M University at Qatar, Doha 23874, Qatar.

Fatigue is defined as "a loss of force-generating capacity" in a muscle that can intensify tremor. Tremor quantification can facilitate early detection of fatigue onset so that preventative or corrective controls can be taken to minimize work-related injuries and improve the performance of tasks that require high-levels of accuracy. We focused on developing a system that recognizes and classifies voluntary effort and detects phases of fatigue. The experiment was designed to extract and evaluate hand-tremor data during the performance of both rest and effort tasks. The data were collected from the wrist and finger of the participant's dominant hand. To investigate tremor, time, frequency domain features were extracted from the accelerometer signal for segments of 45 and 90 samples/window. Analysis using advanced signal processing and machine-learning techniques such as decision tree, k-nearest neighbor, support vector machine, and ensemble classifiers were applied to discover models to classify rest and effort tasks and the phases of fatigue. Evaluation of the classifier's performance was assessed based on various metrics using 5-fold cross-validation. The recognition of rest and effort tasks using an ensemble classifier based on the random subspace and window length of 45 samples was deemed to be the most accurate (96.1%). The highest accuracy (~98%) that distinguished between early and late fatigue phases was achieved using the same classifier and window length.
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http://dx.doi.org/10.3390/s20236897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729463PMC
December 2020

Neural Signatures of Handgrip Fatigue in Type 1 Diabetic Men and Women.

Front Hum Neurosci 2020 9;14:564969. Epub 2020 Nov 9.

Department of Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar.

Type 1 diabetes (T1D) is associated with reduced muscular strength and greater muscle fatigability. Along with changes in muscular mechanisms, T1D is also linked to structural changes in the brain. How the neurophysiological mechanisms underlying muscle fatigue is altered with T1D and sex related differences of these mechanisms are still not well investigated. The aim of this study was to determine the impact of T1D on the neural correlates of handgrip fatigue and examine sex and T1D related differences in neuromuscular performance parameters, neural activation and functional connectivity patterns between the motor regions of the brain. Forty-two adults, balanced by condition (healthy vs T1D) and sex (male vs female), and performed submaximal isometric handgrip contractions until voluntary exhaustion. Initial strength, endurance time, strength loss, force variability, and complexity measures were collected. Additionally, hemodynamic responses from motor-function related cortical regions, using functional near-infrared spectroscopy (fNIRS), were obtained. Overall, females exhibited lower initial strength ( < 0.0001), and greater strength loss ( = 0.023) than males. While initial strength was significantly lower in the T1D group ( = 0.012) compared to the healthy group, endurance times and strength loss were comparable between the two groups. Force complexity, measured as approximate entropy, was found to be lower throughout the experiment for the T1D group ( = 0.0378), indicating lower online motor adaptability. Although, T1D and healthy groups fatigued similarly, only the T1D group exhibited increased neural activation in the left ( = 0.095) and right ( = 0.072) supplementary motor areas (SMA) over time. A sex × condition × fatigue interaction effect ( = 0.044) showed that while increased activation was observed in both T1D females and healthy males from the Early to Middle phase, this was not observed in healthy females or T1D males. These findings demonstrate that T1D adults had lower adaptability to fatigue which they compensated for by increasing neural effort. This study highlights the importance of examining both neural and motor performance signatures when investigating the impact of chronic conditions on neuromuscular fatigue. Additionally, the findings have implications for developing intervention strategies for training, rehabilitation, and ergonomics considerations for individuals with chronic conditions.
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http://dx.doi.org/10.3389/fnhum.2020.564969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680760PMC
November 2020

Ethical Considerations When Using a Mobile Eye Tracker in a Patient-Facing Area: Lessons from an Intensive Care Unit Observational Protocol.

Ethics Hum Res 2020 Nov;42(6):2-13

Assistant professor in the Department of Industrial and Systems Engineering at Texas A&M University as well as a scientist and an assistant professor of outcomes research at Houston Methodist Hospital's Center for Outcomes Research.

This article describes the process of designing, approving, and conducting an investigator-initiated protocol to use an eye-tracking device in a health care setting. Participants wore the device, which resembles eyeglasses, in a front-facing manner in an intensive care unit for the study of personnel gaze patterns, producing a visual record of workflow. While the data of interest for our study was not specifically the health information protected by the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA), a wide variety of such data was captured by the eye-tracking device, and the prospective consent of all people who might have been incidentally videotaped was not feasible. The protocol therefore required attention to unique ethical considerations-including consent, privacy and confidentiality, HIPAA compliance, institutional liability, and the use of secondary data. The richness of eye-tracker data suggests various beneficial applications in health care occupational research and quality improvement. Therefore, sharing our study's successful design and execution, including proactive researcher-institutional review board communication, can inform and encourage similarly valuable, ethical, and innovative audiovisual research techniques.
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http://dx.doi.org/10.1002/eahr.500068DOI Listing
November 2020

Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis.

BMJ Qual Saf 2021 09 7;30(9):715-721. Epub 2020 Oct 7.

Center for Critical Care, Houston Methodist Hospital, Houston, Texas, USA.

Background: When the COVID-19 pandemic restricted visitation between intensive care unit patients and their families, the virtual intensive care unit (vICU) in our large tertiary hospital was adapted to facilitate virtual family visitation. The objective of this paper is to document findings from interviews conducted with family members on three categories: (1) feelings experienced during the visit, (2) barriers, challenges or concerns faced using this service, and (3) opportunities for improvements.

Methods: Family members were interviewed postvisit via phone. For category 1 (feelings), automated analysis in Python using the Valence Aware Dictionary for sentiment Reasoner package produced weighted valence (extent of positive, negative or neutral emotive connotations) of the interviewees' word choices. Outputs were compared with a manual coder's valence ratings to assess reliability. Two raters conducted inductive thematic analysis on the notes from these interviews to analyse categories 2 (barriers) and 3 (opportunities).

Results: Valence-based and manual sentiment analysis of 230 comments received on feelings showed over 86% positive sentiments (88.2% and 86.8%, respectively) with some neutral (7.3% and 6.8%) and negative (4.5% and 6.4%) sentiments. The qualitative analysis of data from 57 participants who commented on barriers showed four primary concerns: inability to communicate due to patient status (44% of respondents); technical difficulties (35%); lack of touch and physical presence (11%); and frequency and clarity of communications with the care team (11%). Suggested improvements from 59 participants included: on demand access (51%); improved communication with the care team (17%); improved scheduling processes (10%); and improved system feedback and technical capabilities (17%).

Conclusions: Use of vICU for remote family visitations evoked happiness, joy, gratitude and relief and a sense of closure for those who lost loved ones. Identified areas for concern and improvement should be addressed in future implementations of telecritical care for this purpose.
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http://dx.doi.org/10.1136/bmjqs-2020-011604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380894PMC
September 2021

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective.

J Med Internet Res 2020 10 1;22(10):e22523. Epub 2020 Oct 1.

Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States.

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
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http://dx.doi.org/10.2196/22523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546859PMC
October 2020

Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study.

J Med Internet Res 2020 09 17;22(9):e22817. Epub 2020 Sep 17.

Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.

Background: Evidence suggests that the COVID-19 pandemic has generally increased levels of stress and depression among the public. However, the impact on college students in the United States has not been well-documented.

Objective: This paper surveys the mental health status and severity of depression and anxiety of college students in a large university system in the United States during the COVID-19 pandemic.

Methods: An online survey was conducted among undergraduate and graduate students recruited from Texas A&M University via email. The survey consisted of two standardized scales-the Patient Health Questionnaire-9 and the General Anxiety Disorder-7-for depression and anxiety, and additional multiple-choice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19.

Results: Among the 2031 participants, 48.14% (n=960) showed a moderate-to-severe level of depression, 38.48% (n=775) showed a moderate-to-severe level of anxiety, and 18.04% (n=366) had suicidal thoughts. A majority of participants (n=1443, 71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (n=882, 43.25%) indicated that they were able to cope adequately with the stress related to the current situation.

Conclusions: The proportion of respondents showing depression, anxiety, and/or suicidal thoughts is alarming. Respondents reported academic-, health-, and lifestyle-related concerns caused by the pandemic. Given the unexpected length and severity of the outbreak, these concerns need to be further understood and addressed.
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http://dx.doi.org/10.2196/22817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505693PMC
September 2020

Effects of COVID-19 on College Students' Mental Health in the United States: Interview Survey Study.

J Med Internet Res 2020 09 3;22(9):e21279. Epub 2020 Sep 3.

Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.

Background: Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus.

Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students.

Methods: We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods.

Results: Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms.

Conclusions: Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students.
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http://dx.doi.org/10.2196/21279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473764PMC
September 2020

Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study.

J Med Internet Res 2020 09 3;22(9):e20143. Epub 2020 Sep 3.

Departments of Anesthesiology and Critical Care, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States.

Background: The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak.

Objective: The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients' families during the pandemic.

Methods: The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non-COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non-COVID-19 units to provide urgent, emergent, and code blue support to all ICUs.

Results: Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment.

Conclusions: Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.
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http://dx.doi.org/10.2196/20143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473763PMC
September 2020

Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework.

JMIR Ment Health 2020 Jul 22;7(7):e16654. Epub 2020 Jul 22.

Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.

Background: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric condition that is associated with symptoms such as hyperarousal and overreactions. Treatments for PTSD are limited to medications and in-session therapies. Assessing the way the heart responds to PTSD has shown promise in detecting and understanding the onset of symptoms.

Objective: This study aimed to extract statistical and mathematical approaches that researchers can use to analyze heart rate (HR) data to understand PTSD.

Methods: A scoping literature review was conducted to extract HR models. A total of 5 databases including Medical Literature Analysis and Retrieval System Online (Medline) OVID, Medline EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Excerpta Medica Database (Embase) Ovid, and Google Scholar were searched. Non-English language studies, as well as studies that did not analyze human data, were excluded. A total of 54 studies that met the inclusion criteria were included in this review.

Results: We identified 4 categories of models: descriptive time-independent output, descriptive and time-dependent output, predictive and time-independent output, and predictive and time-dependent output. Descriptive and time-independent output models include analysis of variance and first-order exponential; the descriptive time-dependent output model includes a classical time series analysis and mixed regression. Predictive time-independent output models include machine learning methods and analysis of the HR-based fluctuation-dissipation method. Finally, predictive time-dependent output models include the time-variant method and nonlinear dynamic modeling.

Conclusions: All of the identified modeling categories have relevance in PTSD, although the modeling selection is dependent on the specific goals of the study. Descriptive models are well-founded for the inference of PTSD. However, there is a need for additional studies in this area that explore a broader set of predictive models and other factors (eg, activity level) that have not been analyzed with descriptive models.
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http://dx.doi.org/10.2196/16654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407264PMC
July 2020

Night-shift nurses and drowsy driving: A qualitative study.

Int J Nurs Stud 2020 Dec 15;112:103600. Epub 2020 May 15.

Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX 77843, USA; Center for Outcomes Research, Houston Methodist, 6550 Fannin St., Houston, TX 77030, USA. Electronic address:

Background: Drowsy driving following the night shift is persistent among nurses resulting in elevated rates of vehicle crashes and crash-related injuries and deaths. While considerable effort has been dedicated to the development of countermeasures, implementation of these countermeasures in nursing has lagged behind other shift work oriented industries. Developing effective countermeasures for drowsy driving in nurses requires a thorough characterization of nurse's perceptions of drowsy driving and potential mitigations.

Objective: The objective of this research was to elicit night shift nurses' perceptions of drowsy driving, countermeasures, and educational and technological interventions.

Design: Perceptions were elicited through a semi-structured interview protocol. The protocol design was driven by previously identified research gaps. Questions focused on four topics: perceptions of drowsy driving, current practices and methods to mitigate drowsiness during the shift and commute, preferences and expectations for training on drowsiness management, and, preferences and expectations for technological mitigations.

Setting: The data collection took place at a large urban hospital in Texas, USA.

Participants: Thirty night-shift nurses were recruited with voluntary sampling. No nurses declined to participate after initially consenting. The participants were male and female nurses who currently worked a 12 hour night shift. The nurses had between 1 and more than 20 years of experience and worked in a variety of units.

Method: The interview recordings were transcribed by the research team and entered into a qualitative data analysis software. Transcripts were analyzed by two independent coders with a grounded theory approach to identify common themes and subthemes across participants.

Findings: Feelings of drowsiness typically manifested immediately following the shift or during the post work commute. Nurses responded to drowsiness by engaging in multiple ineffective countermeasures (e.g., listening to music) and effective countermeasures (e.g., naps) were used sparingly. Experiences and mitigation methods traversed through the nurses' social network although they did not always alter behavior. Nurses were uncertain but enthusiastic about educational and technological interventions preferring practical training and auditory interactive alerts.

Conclusions: The findings suggest a strong need for real time drowsiness interventions during or immediately prior to nurses' post work commutes. Nurses' enthusiasm for training and technology to prevent drowsy driving suggests high levels of readiness and acceptance for such interventions. Future work should focus on the development and implementation of practical training and technological interventions for drowsy driving in nurses.
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http://dx.doi.org/10.1016/j.ijnurstu.2020.103600DOI Listing
December 2020

Disaster Ergonomics: Human Factors in COVID-19 Pandemic Emergency Management.

Hum Factors 2020 11 10;62(7):1061-1068. Epub 2020 Jul 10.

2655 Texas A&M University, College Station, USA.

Objective: We aimed to identify opportunities for application of human factors knowledge base to mitigate disaster management (DM) challenges associated with the unique characteristics of the COVID-19 pandemic.

Background: The role of DM is to minimize and prevent further spread of the contagion over an extended period of time. This requires addressing large-scale logistics, coordination, and specialized training needs. However, DM-related challenges during the pandemic response and recovery are significantly different than with other kinds of disasters.

Method: An expert review was conducted to document issues relevant to human factors and ergonomics (HFE) in DM.

Results: The response to the COVID-19 crisis has presented complex and unique challenges to DM and public health practitioners. Compared to other disasters and previous pandemics, the COVID-19 outbreak has had an unprecedented scale, magnitude, and propagation rate. The high technical complexity of response and DM coupled with lack of mental model and expertise to respond to such a unique disaster has seriously challenged the response work systems. Recent research has investigated the role of HFE in modeling DM systems' characteristics to improve resilience, accelerating emergency management expertise, developing agile training methods to facilitate dynamically changing response, improving communication and coordination among system elements, mitigating occupational hazards including guidelines for the design of personal protective equipment, and improving procedures to enhance efficiency and effectiveness of response efforts.

Conclusion: This short review highlights the potential for the field's contribution to proactive and resilient DM for the ongoing and future pandemics.
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http://dx.doi.org/10.1177/0018720820939428DOI Listing
November 2020

Cognition in crisis management teams: an integrative analysis of definitions.

Ergonomics 2020 Oct 30;63(10):1240-1256. Epub 2020 Jun 30.

Department of Environmental and Occupational Health, Texas A&M University, College Station, TX, USA.

In large-scale extreme events, multidisciplinary crisis management teams (CMTs) are required to function together cognitively. Despite theoretical maturity in team cognition and recurrent emphasis on cognition in the crisis management practices, no synthesis of theoretical and practical discourses is currently available, limiting empirical investigations of cognition in CMTs. To address this gap, this paper aims to review the definitions of cognition in CMTs, with a particular focus on examining if and to what extent they are diversified. Through a systematic process to search peer-reviewed journal articles published in English from 1990 to 2019, 59 articles were selected with 62 coded definitions of 11 different constructs. The similarities and variabilities of the definitions were examined in terms of their theoretical and practical emphases and then synthesised into an integrative definition expected to serve as a general guide of reference for future researchers seeking an operational definition of cognition in CMTs. Understanding of cognition in CMTs is grounded in various theories and models with varying assumptions. An integrative conceptualisation of such cognition as interaction within and across CMTs to perceive, diagnose, and adapt to the crisis may facilitate the accumulation of knowledge and future operationalisations. CMT(s): crisis management team(s); SMM: shared mental model; TMM: team mental model; COP: common operating picture; SSA: shared situation awareness; TSA: team situation awareness; DC: distributed cognition; ITC: interactive team cognition; TMS: transitive memory system(s); DSA: distributed situation awareness.
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http://dx.doi.org/10.1080/00140139.2020.1781936DOI Listing
October 2020

Technologies for Opioid Use Disorder Management: Mobile App Search and Scoping Review.

JMIR Mhealth Uhealth 2020 06 5;8(6):e15752. Epub 2020 Jun 5.

Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.

Background: Advances in technology engender the investigation of technological solutions to opioid use disorder (OUD). However, in comparison to chronic disease management, the application of mobile health (mHealth) to OUD has been limited.

Objective: The overarching aim of our research was to design OUD management technologies that utilize wearable sensors to provide continuous monitoring capabilities. The objectives of this study were to (1) document the currently available opioid-related mHealth apps, (2) review past and existing technology solutions that address OUD, and (3) discuss opportunities for technological withdrawal management solutions.

Methods: We used a two-phase parallel search approach: (1) an app search to determine the availability of opioid-related mHealth apps and (2) a scoping review of relevant literature to identify relevant technologies and mHealth apps used to address OUD.

Results: The app search revealed a steady rise in app development, with most apps being clinician-facing. Most of the apps were designed to aid in opioid dose conversion. Despite the availability of these apps, the scoping review found no study that investigated the efficacy of mHealth apps to address OUD.

Conclusions: Our findings highlight a general gap in technological solutions of OUD management and the potential for mHealth apps and wearable sensors to address OUD.
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http://dx.doi.org/10.2196/15752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305558PMC
June 2020

Investigating resilience in emergency management: An integrative review of literature.

Appl Ergon 2020 Sep 24;87:103114. Epub 2020 Apr 24.

Industrial and Systems Engineering, Texas A&M University, 101 Bizzel St., Colleg Station, Texas, 77843, USA.

There is a growing need for resilience in dealing with unexpected events during disasters. The purpose of this review was to summarize and synthesize the literature that examined resilience in the context of emergency management (EM). Four groups of findings were synthesized: definitions, key dimensions, technical tools, and research settings employed in the research. First, definitions of resilience, improvisation, and adaptation were summarized and critically evaluated. Second, four key dimensions of EM resilience were identified: collective sensemaking, team decision making, harmonizing work-as-imagined and work-as-done, and interaction and coordination. Third, this review identified five prevalent technical tools used to enhance resilience in EM: mapmaking, event history logging, mobile communication applications, integrated information management system, and decision support tools. Fourth, two major design features of emergency simulations, incident scenarios and participant roles, are evaluated. For each finding, directions for future research efforts to improve resilience in EM are proposed.
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http://dx.doi.org/10.1016/j.apergo.2020.103114DOI Listing
September 2020

Diabetes Management Experience and the State of Hypoglycemia: National Online Survey Study.

JMIR Diabetes 2020 Jun 17;5(2):e17890. Epub 2020 Jun 17.

Department of Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar.

Background: Hypoglycemia, or low blood sugar levels, in people with diabetes can be a serious life-threatening condition, and serious outcomes can be avoided if low levels of blood sugar are proactively detected. Although technologies exist to detect the onset of hypoglycemia, they are invasive or costly or exhibit a high incidence of false alarms. Tremors are commonly reported symptoms of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood.

Objective: This study aimed to understand diabetic patients' perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to ultimately inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia.

Methods: A cross-sectional internet panel survey was administered to adult patients with type 1 diabetes using the Qualtrics platform in May 2019. The questions focused on 3 main constructs: (1) perceived experiences of hypoglycemia, (2) experiences and expectations about a diabetes management device and mobile app, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this paper focuses on the first two constructs. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity.

Results: Data from 212 respondents (129 [60.8%] females) revealed statistically significant differences in perceived noticeability of tremors by gender, whereby males noticed their tremors more (P<.001), and age, with the older population reporting lower noticeability than the young and middle age groups (P<.001). Individuals living longer with diabetes noticed their tremors significantly less than those with diabetes for ≤1 year but not in terms of frequency or severity. Additionally, the majority of our participants (150/212, 70.7%) reported experience with diabetes-monitoring devices.

Conclusions: Our findings support the need for cost-efficient and noninvasive continuous monitoring technologies. Although hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be severe compared with other symptoms such as sweating, which was the highest rated symptom in our study. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events.
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http://dx.doi.org/10.2196/17890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330735PMC
June 2020

Veteran-Centered Investigation of Architectural and Space Design Considerations for Post-Traumatic Stress Disorder (PTSD).

HERD 2021 Jan 22;14(1):164-173. Epub 2020 May 22.

Department of Industrial & Systems Engineering, 14736Texas A&M University, College Station, TX, USA.

Aim: This study sought to investigate architectural and space design considerations for veterans with post-traumatic stress disorder (PTSD).

Background: Anecdotal evidence suggests that urban design features could have a positive impact on the mental well-being of individuals suffering from PTSD. However, evidence-based architectural and space design guidelines for PTSD are largely absent.

Methods: Semi-structured interviews were conducted with 17 veterans diagnosed with PTSD to gain insights into their personal experiences with physical indoor and outdoor spaces, and to inquire about their needs and expectations for future architectural design. Transcripts were analyzed thematically.

Results: Architectural design features including windows, entrances and exits, walkways and hallways, open space, defensible space, and green space; interior design features including furnishings and color; and ambient features including light, air quality, and noise levels were identified as most influential design features.

Conclusions: Our results underscore the first important step to developing comprehensive architectural and space design guidelines for veterans with PTSD. Work is in progress to solicit more feedback from veterans.
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http://dx.doi.org/10.1177/1937586720925554DOI Listing
January 2021

Understanding the scope of downtime threats: A scoping review of downtime-focused literature and news media.

Health Informatics J 2020 12 14;26(4):2660-2672. Epub 2020 May 14.

Texas A&M University, USA; Houston Methodist Research Institute, USA.

Electronic health record downtimes are any period where the computer systems are unavailable, either for planned or unexpected events. During an unexpected downtime, healthcare workers are rapidly forced to use rarely-practiced, paper-based methods for healthcare delivery. In some instances, patient safety is compromised or data exposed to parties seeking profit. This review provides a foundational perspective of the current state of downtime readiness as organizations prepare to handle downtime events. A search of technical news media related to healthcare informatics and a scoping review of the research literature were conducted. Findings ranged from theoretical exploration of downtime to empirical direct comparison of downtime versus normal operation. Overall, 166 US hospitals experienced a total of 701 days of downtime in 43 events between 2012 and 2018. Almost half (48.8%) of the published downtime events involved some form of cyber-attacks. Downtime contingency planning is still predominantly considered through a top-down organizational focus. We propose that a bottom-up approach, involving the front-line clinical staff responsible for executing the downtime procedure, will be beneficial. Significant new research support for the development of contingency plans will be needed.
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http://dx.doi.org/10.1177/1460458220918539DOI Listing
December 2020

Muddling through troubled water: resilient performance of incident management teams during Hurricane Harvey.

Ergonomics 2020 Jun 29;63(6):643-659. Epub 2020 Apr 29.

Industrial and Systems Engineering Department, Texas A&M University, College Station, TX, USA.

Modern communities face escalating threats from natural disasters. Thus, the resilience of incident management teams (IMTs) during adverse events becomes crucial to protect lives and physical systems. However, prior studies have only partially highlighted factors related to IMT resilience. To provide a holistic understanding of the resilience of the IMTs, this study conducted semi-structured interviews with 10 experienced IMT personnel during Hurricane Harvey. Thematic analysis revealed six characteristics of resilient IMTs during a hurricane event: (i) establishing a common operating picture, (ii) adopting and adapting plans and protocols, (iii) proactive, re-prioritizing, and unconventional decision-making, (iv) enhancing resourcefulness and redundancy, (v) learning for improved anticipation and response readiness, and (vi) inter-organisational relationship to promote IMT functions. As an empirical investigation of the resilience of the IMTs, the findings inform future endeavours for developing incident information technologies and strategies to harmonise pre-established plans with adaptive actions in the field and fostering capabilities to learn from incidents. Resilient incident management teams establish a common operating picture; effectively adopt and adapt plans and protocols; make decisions in an unconventional and anticipatory fashion; constantly re-prioritize goals and tasks; enhance resourcefulness and redundancy; continuously learn skills for improved anticipation and response readiness; and exhibit good inter-organisational coordination and planning skills.
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http://dx.doi.org/10.1080/00140139.2020.1752820DOI Listing
June 2020

Evaluation of work-as-done in information management of multidisciplinary incident management teams via Interaction Episode Analysis.

Appl Ergon 2020 Apr 10;84:103031. Epub 2020 Jan 10.

Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, 77843-3131, USA.

Multidisciplinary incident management teams (IMTs) are required to operate in resilient ways as emergency situations unfold unexpectedly. Although resilience in emergency management has been widely studied in many emergency contexts, the development of a new method to investigate actual resilient performance of the IMTs under realistic settings has been limited. To address such gap, this paper first introduces Interaction Episode Analysis (IEA), a novel approach to capture and describe emergent team performance. As an exploratory observation study, we apply the IEA to an information management aspect of the IMTs in two emergency exercises carried out in a high-fidelity environment. As a result, the IEA provides comparable sets of episodes as instances of work-as-done, rendering opportunities to further analyze essential elements of interactions between team members as well as information management activities. Moreover, the IEA enables comparisons between the observations and identification of challenges faced by the team in managing incident information and adaptive behaviors used to address the challenges. By gathering more evidences as well as addressing limitations identified in this study, the IEA is expected to serve as a method that facilitates the analysis of work-as-done of complex team work and the reconciliation between work-as-done and work-as-imagined to promote resilience in emergency management.
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http://dx.doi.org/10.1016/j.apergo.2019.103031DOI Listing
April 2020

Correction to: The past, present and future of opioid withdrawal assessment: a scoping review of scales and technologies.

BMC Med Inform Decis Mak 2019 Jul 8;19(1):126. Epub 2019 Jul 8.

Industrial and Systems Engineering Department, Texas A and M University, College Station, TX, 77843, USA.

Following publication of the original article [1], the authors reported an error in one of the authors' names. In this Correction the incorrect and correct author name are shown. The original publication of this article has been corrected.
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http://dx.doi.org/10.1186/s12911-019-0851-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613248PMC
July 2019
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