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1.  DiAs User Interface: A Patient-Centric Interface for Mobile Artificial Pancreas Systems 
Recent in-hospital studies of artificial pancreas (AP) systems have shown promising results in improving glycemic control in patients with type 1 diabetes mellitus. The next logical step in AP development is to conduct transitional outpatient clinical trials with a mobile system that is controlled by the patient. In this article, we present the user interface (UI) of the Diabetes Assistant (DiAs), an experimental smartphone-based mobile AP system, and describe the reactions of a round of focus groups to the UI. This work is an initial inquiry involving a relatively small number of potential users, many of whom had never seen an AP system before, and the results should be understood in that light.
We began by considering how the UI of an AP system could be designed to make use of the familiar touch-based graphical UI of a consumer smartphone. After developing a working prototype UI, we enlisted a human factors specialist to perform a heuristic expert analysis. Next we conducted a formative evaluation of the UI through a series of three focus groups with N = 13 potential end users as participants. The UI was modified based upon the results of these studies, and the resulting DiAs system was used in transitional outpatient AP studies of adults in the United States and Europe.
The DiAs UI was modified based on focus group feedback from potential users. The DiAs was subsequently used in JDRF- and AP@Home-sponsored transitional outpatient AP studies in the United States and Europe by 40 subjects for 2400 h with no adverse events.
Adult patients with type 1 diabetes mellitus are able to control an AP system successfully using a patient-centric UI on a commercial smartphone in a transitional outpatient environment.
PMCID: PMC3876320  PMID: 24351168
artificial pancreas; DiAs; graphical user interface; type 1 diabetes
2.  User Evaluation of an Innovative Digital Reading Room 
Journal of Digital Imaging  2011;25(3):337-346.
Reading room design can have a major impact on radiologists’ health, productivity, and accuracy in reading. Several factors must be taken into account in order to optimize the work environment for radiologists. Further, with the advancement in imaging technology, clinicians now have the ability to view and see digital exams without having to interact with radiologists. However, it is important to design components that encourage and enhance interactions between clinicians and radiologists to increase patient safety, and to combine physician and radiologist expertise. The present study evaluates alternative workstations in a real-world testbed space, using qualitative data (users’ perspectives) to measure satisfaction with the lighting, ergonomics, furniture, collaborative spaces, and radiologist workstations. In addition, we consider the impact of the added collaboration components of the future reading room design, by utilizing user evaluation surveys to devise baseline satisfaction data regarding the innovative reading room environment.
PMCID: PMC3348988  PMID: 22080291
Radiology reading room; Ergonomics; User evaluation; Musculoskeletal
3.  Improving the usability of intravenous medication labels to support safe medication delivery 
Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers’ product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital’s intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study.
PMCID: PMC3126152  PMID: 21731156
Medication labels; label design; medication errors; hospital pharmacy
4.  Intelliject’s novel epinephrine autoinjector: sharps injury prevention validation and comparable analysis with EpiPen and Twinject 
Currently marketed epinephrine autoinjectors (EAs) are prone to misuse that may lead to injury or a missed dose. A novel EA (NEA) (Intelliject Inc) was created to reduce such injuries by including features such as a unidirectional perceived injection end and a retractable needle.
To validate the sharps injury prevention features of the NEA and to obtain feedback on, and preference for, features of the NEA compared with Twinject and EpiPen.
Twenty-eight health care professionals experienced with using the EpiPen or Twinject each injected 18 NEAs into an orange and provided confirmation of needle injection and retraction. Half of the injections were conducted using wet hands to replicate diaphoretic hands or wet environmental conditions. Participants provided feedback via a post-test questionnaire and gave ordinal preference rankings for the NEA, EpiPen, and Twinject based on shape, size, ease of use, ease of training, and overall preference. Participants also described known cases in which the Twinject or EpiPen was not correctly administered.
For all 505 tested NEAs, the needle injected and retracted as intended. For overall preference, 100% of the experienced health care practitioners ranked the NEA first. Half of the participants recalled incidents in which the EpiPen or Twinject did not work as intended or caused an injury.
The sharps injury prevention feature was verified for the NEA, and health care professionals experienced in the use of EpiPen and Twinject for allergic emergencies perceived the NEA to be a safer and preferred alternative.
PMCID: PMC3155814  PMID: 21130387
5.  The design and evaluation of a graphical display for laboratory data 
Advances in healthcare information technology have provided opportunities to present data in new, more effective ways. In this study, we designed a laboratory display that features small, data-dense graphics called sparklines, which have recently been promoted as effective representations of medical data but have not been well studied. The effect of this novel display on physicians' interpretation of data was investigated.
Twelve physicians talked aloud as they assessed laboratory data from four patients in a pediatric intensive care unit with the graph display and with a conventional table display.
Verbalizations were coded based on the abnormal values and trends identified for each lab variable. The correspondence of interpretations of variables in each display was evaluated, and patterns were investigated across participants. Assessment time was also analyzed.
Physicians completed assessments significantly faster with the graphical display (3.6 min vs 4.4 min, p=0.042). When compared across displays, 37% of interpretations did not match. Graphs were more useful when the visual cues in tables did not provide trend information, while slightly abnormal values were easier to identify with tables.
Data presentation format can affect how physicians interpret laboratory data. Graphic displays have several advantages over numeric displays but are not always optimal. User, task and data characteristics should be considered when designing information displays.
PMCID: PMC2995657  PMID: 20595309
Data display; clinical laboratory information systems; user-computer interface; intensive care; sparklines
Despite attention to prevention and screening for depression and alcohol use, Healthy People 2010 objectives continue to include goals to increase the detection of depression and decrease the rates of alcohol abuse. These problems remain significant. The overall goal of this study was to develop a computer-based electronic screening tool and to determine the feasibility of implementing computer-based electronic screening technology (eScreening) for rural visitors to a primary care clinic. The study called specifically for an electronic touch screen with voice prompts. This tool, called the eScreening tool, screens for alcohol abuse and depression among rural patients in a primary care setting. The screening was offered to rural adults who are not in acute distress and not at end-of-life, regardless of their stated reason for seeking medical care. Phase one of the pilot was used to determine the perceptions of nurses, other providers and consumers regarding the acceptability and perceived usefulness of an eScreening tool. Phase two involved user testing of the eScreening tool. The longer-term goals of the research program are to work with rural nurses to improve patient outcomes, develop interventions, and for educational, consultation and/or direct clinical care.
PMCID: PMC3132812  PMID: 21685835
depression; screening; alcohol; eScreen; touch screen
7.  A comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference 
Prefilled epinephrine autoinjectors are sometimes improperly used by patients, caregivers, and physicians. A user-centered design process led to the development of 2 prototype epinephrine autoinjectors (INT01 and INT02) that have a unidirectional perceived injection end, a self-retracting needle, and, with INT02, voice instructions to assist in guiding users through administration.
To compare the usability and patient preference among 4 epinephrine autoinjectors: EpiPen, TwinJect, INT01, and INT02.
A total of 48 participants were divided equally among 3 age groups: 7 to 10, 11 to 15, and 16 to 55 years. In each group, half had prior TwinJect or EpiPen training. In 1-hour sessions, without training, participants performed simulated-use testing under observation for all 4 epinephrine delivery systems. Usability (ie, the ability to perform the manufacturer’s labeled instructions), task completion time, and preferences were assessed and analyzed based on device, age, previous experience, sex, device malfunction, and testing order.
More participants correctly followed all device instructions with INT02 (22 [46%]) than with INT01 (13 [27%]), EpiPen (6 [12%]), or TwinJect (0 [0%]). The difference among devices was significant (P < .01) after adjusting for device malfunctions and age group (the youngest age group [those aged 7–10 years] performed significantly worse than the other 2 groups). Prior experience, sex, and testing order did not significantly affect this measure. The first choice of overall preference was greater (P < .001) for INT02 (35 participants [73%]) vs INT01 (7 participants [15%]), EpiPen (5 participants [10%]), and TwinJect (1 participant [2%]).
The user-centered device design may have a significant impact on correct epinephrine autoinjector use and patient preference.
PMCID: PMC2892620  PMID: 20306821
8.  Visualization of near-optimal sequence alignments 
Bioinformatics (Oxford, England)  2004;20(6):953-958.
Mathematically optimal alignments do not always properly align active site residues or well-recognized structural elements. Most near-optimal sequence alignment algorithms display alternative alignment paths, rather than the conventional residue-by-residue pairwise alignment. Typically, these methods do not provide mechanisms for finding effectively the most biologically meaningful alignment in the potentially large set of options.
We have developed Web-based software that displays near optimal or alternative alignments of two protein or DNA sequences as a continuous moving picture. A WWW interface to a C++ program generates near optimal alignments, which are sent to a Java Applet, which displays them in a series of alignment frames. The Applet aligns residues so that consistently aligned regions remain at a fixed position on the display, while variable regions move. The display can be stopped to examine alignment details.
Available at noptalign. For source code contact the authors at
PMCID: PMC2836811  PMID: 14751975

Results 1-8 (8)