Search Results (15)

The increasing complexity of airway management, particularly in high-stakes or emergency settings, demands a holistic approach that accounts not only for technical skill but also for the systems in which clinicians operate. Advances in airway devices such as videolaryngoscopes, videolaryngeal mask airways, flexible intubation scopes, combined techniques, and single-use technologies offer new opportunities for improving outcomes—but also introduce new challenges. This article explores the intersection of human factors and the implementation of new airway devices, using a systems-based lens informed by the SEIPS 3.0 framework. Drawing on recent guidelines, real-world case studies, and design principles, we examine how technological changes affect team dynamics, decision-making, equipment layout, and cognitive load. We also highlight the importance of standardized processes, training, and environmental design in mitigating risk and enhancing performance. Ultimately, we propose actionable strategies to integrate human factors into airway device adoption to improve both patient safety and clinician well-being. This review underscores the fact that embedding human factor principles into the adoption and use of airway technologies is essential to build safer, more resilient, and team-centered airway management systems. Full article

Generalized lipodystrophies (GLs) are rare diseases characterized by a lack of body fat. When patients with a GL phenotype are referred with a presumptive diagnosis of congenital generalized lipodystrophy (CGL) but genetic testing for known pathogenic variants is negative, the diagnosis of acquired generalized lipodystrophy (AGL) becomes a more likely diagnosis. No single test confirms such a diagnosis, and it is crucial to recognize the similarities and differences between these diseases. We review the literature and report four GL cases from our lipodystrophy outpatient clinic, highlighting the main points for an accurate diagnosis. Similarities: phlebomegaly, umbilical scar protrusion, loss of Bichat’s fat pad, muscle hypertrophy, and hepatomegaly can occur in both. Cirrhosis can also arise, but in AGL, it occurs as a consequence of hepatic steatosis and also due to autoimmune hepatitis. Insulin resistance is frequent, and patients present acanthosis nigricans and acrochordons and may develop difficult-to-control diabetes and its complications, despite very high daily doses of insulin. Low HDL and hypertriglyceridemia are frequent and may progress to acute pancreatitis. Serum leptin levels are typically low and contribute to hyperphagia. Differences: AGL patients’ body fat loss occurs gradually in childhood or adolescence, whereas CGL patients are born with the characteristic phenotype. Evaluating photographs of AGL patients in the first years of life can provide evidence of this selective and gradual fat loss. Some AGL patients may have panniculitis (inflamed and painful subcutaneous nodules), with or without autoimmune diseases. In conclusion, recognizing both similarities and differences is crucial for making an accurate diagnosis and ensuring the most appropriate treatment. Full article

Handover of patient care is the most common form of communication across hospitals. Enabling effective handover has been identified as a key priority for patient safety. This Human Factors Ergonomics socio-technical systems study aims to understand the current system of handover within departments, across departments, and at the interface of provider services, and then use this knowledge to co-design recommendations to enable resilience in clinical handover. The Systems Engineering Initiative for Patient Safety 3.0 (SEIPS3.0) framework is used to take a systems approach to observing clinical handover. Over 26 h of handover, involving 218 healthcare professionals handing over patient care across an acute hospital setting and at the interface of two external ambulance service systems, was observed. From these observations of clinical handovers, we co-designed—with the input of 41 medical, nursing, health, and social care professionals, quality and safety professionals, and patient partners—70 recommendations for enabling resilience in handover using two socio-technical systems analysis frameworks: SEIPS3.0 and the Cube. These 70 recommendations were inductively coded, and ten emergent properties that can support resilience in handover were identified, including person-centred care, multi-disciplinary team working, culture, communication, evidence-based practice, operations management, education, digitally enabled care, evidence-based design, and understanding context. This study contributes important knowledge for healthcare professionals and Human Factors Ergonomics practitioners on the systemic enablers of resilience in clinical handover in acute hospital settings. Full article

Background/Objectives: Maternal mortality occurs at alarming rates in the United States. In 2018, there were 17 maternal deaths for every 100,000 births—double that of other high-income countries, including France and Canada. Postpartum hemorrhage (i.e., excessive blood loss during delivery or within the 24 h following) is a leading cause of maternal mortality and is a treatable condition if identified and managed in a timely manner. One aspect of work that impacts patient care during postpartum hemorrhage is the safety culture. The safety culture is the beliefs, values, and norms shared by members of the organization that influence their actions and behaviors. In this study, we use the Systems Engineering Initiative for Patient Safety (SEIPS) model to understand and describe how the sociotechnical system shapes safety culture during postpartum hemorrhage. Methods: We conducted interviews and focus groups with 29 clinicians to describe the work system and the barriers and facilitators during postpartum hemorrhage. Then, we inductively categorized the barriers and facilitators into emergent properties of sociotechnical systems related to safety culture. Results: We identified 45 barriers and 158 facilitators into five emergent properties related to the safety culture (i.e., staffing, communication, organizational management and leadership, organizational processes, and teamwork). The participants identified more positive aspects than negative, suggesting that the safety culture positively influences their actions and behaviors. Conclusions: Our results indicate that safety culture could be improved by redesigning the work system to mitigate barriers related to staffing, communication, organizational management, and teamwork that hinder the safety culture. Full article

Printed textile-based flexible batteries are gaining attention in several applications, but they are becoming more relevant to the health care industry in terms of realizing wearable and skin-conformable electronic devices. A flexible battery must ideally be deformable along multiple directions. In this work, with an aim to develop a fully printed omnidirectional deformable battery, we report the fabrication process of a novel single-polymer-based flexible non-rechargeable planar Ag₂O-Zn battery on a textile substrate using the stencil printing method. Except for the electrolyte, all the components of the battery, including the current collectors, the anode, the cathode, and the separator membrane, are fabricated using a single polymer, namely styrene–ethylene–butylene–styrene (SEBS). To fabricate the SEBS separator, we introduce the solvent evaporation-induced phase separation (SEIPS) process. In the SEIPS method, toluene and dimethyl sulfoxide (DMSO) are selected as the solvent–nonsolvent pair. The SEBS: toluene: DMSO system with a wt% ratio of 6:85:9 showed improved performance regarding the OCV tests. A polyacrylic acid (PAA)-based alkaline polymer gel is used as an electrolyte. The demonstrated process is simple, and, with suitable modifications, it should find its use in the development of digitally printed alkaline batteries. Full article

Seipin, a protein encoded by the Berardinelli-Seip congenital lipodystrophy type 2 (BSCL2) gene, is famous for its key role in the biogenesis of lipid droplets and type 2 congenital generalised lipodystrophy (CGL2). BSCL2 gene mutations result in genetic diseases including CGL2, progressive encephalopathy with or without lipodystrophy (also called Celia’s encephalopathy), and BSCL2-associated motor neuron diseases. Abnormal expression of seipin has also been found in hepatic steatosis, neurodegenerative diseases, glioblastoma stroke, cardiac hypertrophy, and other diseases. In the current study, we comprehensively summarise phenotypes, underlying mechanisms, and treatment of human diseases caused by BSCL2 gene mutations, paralleled by animal studies including systemic or specific Bscl2 gene knockout, or Bscl2 gene overexpression. In various animal models representing diseases that are not related to Bscl2 mutations, differential expression patterns and functional roles of seipin are also described. Furthermore, we highlight the potential therapeutic approaches by targeting seipin or its upstream and downstream signalling pathways. Taken together, restoring adipose tissue function and targeting seipin-related pathways are effective strategies for CGL2 treatment. Meanwhile, seipin-related pathways are also considered to have potential therapeutic value in diseases that are not caused by BSCL2 gene mutations. Full article

The prevention and management of chronic disease primarily requires risk reduction measures, through strategic coordination across various government areas. Recognizing that health workers and the public health workforce are integral to building strong and resilient health, the present study analyses the relation between Psychosocial Risk Factors (PRFs, to which formal caregivers are exposed in the healthcare settings), and the work system related elements of the Systems Engineering Initiative for Patient Safety (SEIPS 3.0) framework. An empirical study was carried out, involving 333 formal caregivers of healthcare services. A total of 31 PRFs were assessed (using the COPSOQ III), making it possible to find a relationship between the PRFs analyzed with three elements of the work system, namely Task (5 PRFs), Organizational factors (17 PRFs), and Individual (9 PRFs). The present work contributes not only in terms of outcomes that allow the development of mental illness prevention and mental health promotion actions for healthcare formal caregivers, but also in terms of the relevance that these factors can have on the quality of health services, as well as their users (patients), in line with SEIPS 3.0 model. Full article

Obesity prevalence is increasing worldwide, leading to cardiometabolic morbidities. Adipocyte dysfunction, impairing white adipose tissue (WAT) expandability and metabolic flexibility, is central in the development of obesity-related metabolic complications. Rare syndromes of lipodystrophy characterized by an extreme paucity of functional adipose tissue should be considered as primary adipocyte dysfunction diseases. Berardinelli-Seip congenital lipodystrophy (BSCL) is the most severe form with a near absence of WAT associated with cardiometabolic complications such as insulin resistance, liver steatosis, dyslipidemia, and cardiomyopathy. Twenty years ago, mutations in the BSCL2 gene have been identified as the cause of BSCL in human. BSCL2 encodes seipin, an endoplasmic reticulum (ER) anchored protein whose function was unknown back then. Studies of seipin knockout mice or rats demonstrated how seipin deficiency leads to severe lipodystrophy and to cardiometabolic complications. At the cellular levels, seipin is organized in multimers that are particularly enriched at ER/lipid droplet and ER/mitochondria contact sites. Seipin deficiency impairs both adipocyte differentiation and mature adipocyte maintenance. Experiments using adipose tissue transplantation in seipin knockout mice and tissue-specific deletion of seipin have provided a large body of evidence that liver steatosis, cardiomyopathy, and renal injury, classical diabetic complications, are all consequences of lipodystrophy. Rare adipocyte dysfunctions such as in BSCL are the key paradigm to unravel the pathways that control adipocyte homeostasis. The knowledge gathered through the study of these pathologies may bring new strategies to maintain and improve adipose tissue expandability. Full article

The adipokine leptin, which is best-known for its role in the control of metabolic function, is also a master regulator of cardiovascular function. While leptin has been approved for the treatment of metabolic disorders in patients with congenital generalized lipodystrophy (CGL), the effects of chronic leptin deficiency and the treatment on vascular contractility remain unknown. Herein, we investigated the effects of leptin deficiency and treatment (0.3 mg/day/7 days) on aortic contractility in male Berardinelli-Seip 2 gene deficient mice (gBscl2^-/-, model of CGL) and their wild-type control (gBscl2^+/+), as well as in mice with selective deficiency in endothelial leptin receptor (LepR^EC-/-). Lipodystrophy selectively increased vascular adrenergic contractility via NO-independent mechanisms and induced hypertrophic vascular remodeling. Leptin treatment and Nox1 inhibition blunted adrenergic hypercontractility in gBscl2^-/- mice, however, leptin failed to rescue vascular media thickness. Selective deficiency in endothelial leptin receptor did not alter baseline adrenergic contractility but abolished leptin-mediated reduction in adrenergic contractility, supporting the contribution of endothelium-dependent mechanisms. These data reveal a new direct role for endothelial leptin receptors in the control of vascular contractility and homeostasis, and present leptin as a safe therapy for the treatment of vascular disease in CGL. Full article

Congenital Generalized Lipodystrophy (CGL) is a rare syndrome characterized by the almost total absence of subcutaneous adipose tissue due to the inability of storing lipid in adipocytes. Patients present generalized lack of subcutaneous fat and normal to low weight. They evolve with severe metabolic disorders, non-alcoholic fatty liver disease, early cardiac abnormalities, and infectious complications. Although low body weight is a known risk factor for osteoporosis, it has been reported that type 1 and 2 CGL have a tendency of high bone mineral density (BMD). In this review, we discuss the role of bone marrow tissue, adipokines, and insulin resistance in the setting of the normal to high BMD of CGL patients. Data bases from Pubmed and LILACS were searched, and 113 articles published until 10 April 2021 were obtained. Of these, 76 were excluded for not covering the review topic. A manual search for additional literature was performed using the bibliographies of the studies located. The elucidation of the mechanisms responsible for the increase in BMD in this unique model of insulin resistance may contribute to the understanding of the interrelationships between bone, muscle, and adipose tissue in a pathophysiological and therapeutic perspective. Full article

Resilience allows teams to function at their optimal capacity and skill level in times of uncertainty. The SARS-CoV-2 (COVID-19) pandemic created a perfect opportunity to study resilience culture during a time of limited healthcare team experience, protocols, and specific personal protective equipment (PPE) needed. Little is known about healthcare team resilience as a phenomenon; existing definitions and empiric referents do not capture the nature of healthcare team resilience, as the traditional focus has been placed on individual resilience. This qualitative research protocol provides the rationale and methodology to examine this phenomenon and builds a bridge between resilience engineering and individual resilience. The sample is composed of healthcare team members from the US. This research may add to the body of knowledge on resilience culture in healthcare teams during the COVID-19 pandemic. This qualitative research protocol paper outlines the rationale, objective, methods, and ethical considerations entailed in this research. Full article

Lipid homeostasis is essential for normal cell physiology. Generally, lipids are stored in a lipid droplet (LD), a ubiquitous organelle consisting of a neutral lipid core and a single layer of phospholipid membrane. It is thought that LDs are generated from the endoplasmic reticulum and then released into the cytosol. Recent studies indicate that LDs can exist in the nucleus, where they play an important role in the maintenance of cell phospholipid homeostasis. However, the details of nuclear lipid droplet (nLD) generation have not yet been clearly characterized. SEIPIN is a nonenzymatic protein encoded by the Berardinelli-Seip congenital lipodystrophy type 2 (BSCL2) gene. It is associated with lipodystrophy diseases. Many recent studies have indicated that SEIPIN is essential for LDs generation. Here, we review much of this research in an attempt to explain the role of SEIPIN in nLD generation. From an integrative perspective, we conclude by proposing a theoretical model to explain how SEIPIN might participate in maintaining homeostasis of lipid metabolism. Full article

Cystic fibrosis (CF) is one of the most common life-threatening, genetic conditions. People with CF follow complex, time-consuming treatment regimens to manage their chronic condition. Due to the complexity of the disease, multidisciplinary care from CF Foundation (CFF)-accredited centers is recommended for people with CF. These centers include several types of healthcare professionals specializing in CF; however, pharmacists are not required members. The purpose of this study was to identify the outpatient care needs of people living with CF that pharmacists could address to improve their quality of care. Healthcare members from a CFF accredited center and pharmacists were recruited to participate in semi-structured, audio-recorded interviews. Prevalent codes were identified and data analysis was conducted, guided by the systems engineering initiative for patient safety (SEIPS) model. The objective was to understand the medication and pharmacy-related needs of patients with CF and care team perspectives on pharmacists providing support for these patients. From the themes that emerged, pharmacists can provide support for people living with CF (medication burden, medication access, medication education) and the CF care team (drug monitoring and adherence, prior authorizations and insurance coverage, refill history). Pharmacists are well-positioned to address these difficulties to improve quality of care for people living with cystic fibrosis. Full article

Seipin (BSCL2/SPG17) is a key factor in lipid droplet (LD) biology, and its dysfunction results in severe pathologies, including the fat storage disease Berardinelli-Seip congenital lipodystrophy type 2, as well as several neurological seipinopathies. Despite its importance for human health, the molecular role of seipin is still enigmatic. Seipin is evolutionarily conserved from yeast to humans. In yeast, seipin was recently found to cooperate with the lipid droplet organization (LDO) proteins, Ldo16 and Ldo45, two structurally-related proteins involved in LD function and identity that display remote homology to the human protein promethin/TMEM159. In this study, we show that promethin is indeed an LD-associated protein that forms a complex with seipin, and its localization to the LD surface can be modulated by seipin expression levels. We thus identify promethin as a novel seipin partner protein. Full article