BACKGROUND:Despite the advantages of simulation-based training, trainees are typically unable to view internal anatomical structures. This limitation can be overcome by using mixed reality (MR) wherein 3-D virtual anatomical images can be projected. This study was designed to evaluate the efficacy of an MR trainer for peripheral intravenous catheter (PIVC) placement.METHODS:Sixty-two participants used projected images of arm veins to place a PIVC in a mannequin arm. Participants were evaluated using a checklist on their ability to successfully place the PIVC. Participants completed a survey to elicit demographic information and perceptions of the trainer. A follow-up survey at two-weeks assessed clinical experiences with PIVC placement since using the MR trainer.RESULTS:First attempt catheter placement was successful in 48 (77.4%) cases. Only 11 (17.7%) and 3 (4.8%) of participants caused 'extravasation' and 'hematoma' formation on their first attempt, respectively. Fifty-nine participants (95.2%) agreed that ability to see internal structures was useful, and 58 (93.5%, respectively) agreed that the interactivity promoted learning and that MR should be included in training.CONCLUSIONS:Results of this study showed that use of a novel MR trainer for PIVC placement appears to provide an environment conducive to successful learning. Most participants were successful at PIVC placement on their first attempt and an overwhelming number found it helpful in identifying landmarks and confirming correct needle angles for insertion. Given the increasing emphasis on simulation training, highly immersive MR tools appear to offer promise to close the gap between classroom instruction and clinical experience.

Objective: Describe variation in the Non-Hispanic Black Infant Mortality among various counties in the United States in 2018. Methods: Data on Non-Hispanic Black (Black) infant death rates was extracted using publicly available Birth/Infant death files data from the United States Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (WONDER). Socio-economic data were obtained from the Robert Wood Johnson County Health Rankings and Roadmaps (2020). Multiple regression and Studentized, Jack-knife and DFIT analyses was conducted for analyzing outliers. Results: Forty-one counties were identified. Statistically significant correlations with non-Hispanic Black infant mortality were found for non-White-White segregation index (r=0.33, 0=0.03), percent Black children in poverty (r=0.43, p=0.005), overcrowding (r=-0.59, p<0.001) Black household income (r=-0.40, p = 0.009), and percent severe housing cost burden (r=0.41, p=0.007). Correlations were not statistically significant for Black-White segregation index, income inequality, violent crime rate, median household income and high school graduation rate. Due to high collinearity, the final multiple regression analysis included only the non-White-White segregation index and percent severe housing cost burden, both of which were significantly associated with Black infant mortality (p<0.001). Analysis for outliers identified Bronx County, NY (New York City) and Jackson County, MO (Kansas City) as having unusually lower black infant mortality rates than that predicted by the regression model (positive deviants), while Duval County, FL (Jacksonville) and Hamilton County, OH (Cincinnati) had unusually high rates (negative deviants). Conclusions: Analytic epidemiologic research designed a priori to do so is required to test hypotheses generated by these descriptive data. Two such hypotheses are that social determinants of non-Hispanic Black infant mortality are not deterministic and that racial resilience and racial fragility are not antonymous. Research pertaining to positive and negative deviant communities could provide important insights into community resilience as well as information about the roots of adverse mortality among non-Hispanic Black Infants.

Background: Pediatric airway emergencies are relatively rare, but have potentially devastating consequences. Simulation based education is important in providing zero-risk management experience for these critical events. Aims: The aim of the study was to assess usability and feasibility of combined interactive instructional videos and a novel Virtual Reality (VR) trainer for healthcare professionals and to evaluate the impact of this combination on learners’ knowledge of critical airway events in children. Methods: The study population included medical students, residents, faculty, and advanced practice nurses. Participants completed a short baseline knowledge pre-test of pediatric airway emergency management, followed by these consecutive interventions: (1) Interactive instructional pediatric airway videos and (2) VR trainer (HoloLens technology), simulating a pediatric critical airway event. Participants were randomized to manage anaphylaxis or foreign body aspiration. Finally, participants completed a second knowledge test (post-test) and a survey of their perceptions of the videos and VR trainer. Results: Forty-one participants were included in the study. Overall, both interventions were well received. Positive perceptions included realism, interactivity, and active learning environment. Negative comments focused on video speed and the VR trainer learning curve. Participants reported preferences for future training of pediatric airway events to include videos and VR trainers, with or without didactic lectures. Most areas of knowledge showed slight to significant improvements following the interventions. Specifically, questions on pediatric anatomy, anaphylaxis, Heimlich maneuver, and foreign body removal showed the highest improvement in scores (P < 0.05). Conclusions: Interactive videos, in combination with a VR experience, provide promising zero-risk training for pediatric critical airway events. Relevance for Patients: Pediatric airway emergencies are relatively rare, but the potential consequences are devastating. VR is established as a valued mode of education with regard to medical emergency training. Multimedia informational and instructional formats result in greater understanding of information. Results from our intervention, combining an interactive video tutorial and a VR experience, show this was well received by a cross section of health-care providers. We demonstrated improved test scores in a pediatric airways quiz.

Aim: This study evaluated the effect of an interactive, web-based educational program on parents' opioid risk knowledge, risk perceptions, analgesic self-efficacy and decision-making. Patients & methods: Totally, 64 parents from a tertiary care pediatric healthcare setting were assessed for risk understanding at baseline, immediately and 3 days after receiving the educational program. Results: Participants gained increased opioid risk knowledge, enhanced risk perceptions as well as enhanced analgesic self-efficacy after program exposure. The program had no effect on parental decisions about when to give or withhold a prescribed opioid. Conclusion: The interactive web-based program improved parental knowledge about opioid risks. Program enhancements may be needed to improve pain management decisions about when it is safe to use opioids and when they should be withheld.

Objectives: We examine variations in ischemic stroke prevalence, risk factors and hospital costs by age and gender among young, mid-age, and elderly patients. Based on the Women’s Health Study and other research, we wondered whether ischemic stroke be gender dominant at older ages, in part, because of loss of protective pre-menopause mechanisms in the elderly.

Objectives: Depression and anxiety are frequently observed in heart failure (HF) patients. However, effect of such factors on hospital costs of HF, and whether such costs vary by urbanization and gender remain poorly understood. This analysis delineates the prevalence of depression among HF patients and estimates depression effects on hospital costs of patients from rural and urban communities.

Introduction The value of simulation in medical education and procedural skills training is well recognized. Despite this, many mannequin-based trainers are limited by the inability of the trainee to view the internal anatomical structures. This study evaluates the usability and feasibility of a first-person point-of-view–augmented reality (AR) trainer on needle insertion as a component of central venous catheter placement. Methods Forty subjects, including medical students and anesthesiology residents and faculty, participated. Augmented reality glasses were provided through which the relevant internal anatomical landmarks were projected. After a practice period, participants were asked to place the needle in the mannequin without the benefit of the AR-projected internal anatomy. The ability of the trainees to correctly place the needle was documented. Participants also completed a short survey describing their perceptions of the AR technology. Results Participants reported that the AR technology was realistic (77.5%) and that the ability to view the internal anatomy was helpful (92.5%). Furthermore, 85% and 82.1%, respectively, believed that the AR technology promoted learning and should be incorporated into medical training. The ability to successfully place the needle was similar between experienced and nonexperienced participants; however, less experienced participants were more likely to inadvertently puncture the carotid artery. Conclusions Results of this pilot study demonstrated the usability and feasibility of AR technology as a potentially important adjunct to simulated medical skills training. Further development and evaluation of this innovative technology under a variety of simulated medical training settings would be an important next step.

Background: Traditionally, clinical psychomotor skills are taught through videos and demonstration by faculty, which does not allow for the visualization of internal structures and anatomical landmarks that would enhance the learner skill performance. Method: Sophomore and junior nursing students attending a large Midwestern institution (N = 69) participated in this mixed methods study. Students demonstrated their ability to place a nasogastric tube (NGT) after being randomly assigned to usual training (control group) or an iPad anatomy-augmented virtual simulation training module (augmented reality [AR] group). The ability of the participants to demonstrate competence in placing the NGT was assessed using a 17-item competency checklist. After the demonstration, students completed a survey to elicit information about students' level of training, prior experience with NGT placement, satisfaction with the AR technology, and perceptions of AR as a potential teaching tool for clinical skills training. Results: The ability to correctly place the NGT through all the checklist items was statistically significant in the AR group compared with the control group (p = .011). Eighty-six percent of participants in the AR group rated AR as superior/far superior with other procedural training programs to which they had been exposed, whereas, only 5.9% of participants in the control group rated the control program as superior/far superior (p < .001). Conclusions: Overall, the AR module was better received compared with the control group with regard to realism, identifying landmarks, visualization of internal organs, ease of use, usefulness, and promoting learning and understanding. (C) 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

OBJECTIVE:Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents' and children's understanding of clinical trial concepts and participation.METHODS:Parents (n=148) and children (n=135) were each randomised to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with inline exercises. Participants' understanding of the information was assessed using semistructured interviews prior to (pretest) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of information delivery and satisfaction with the process.RESULTS:Regardless of the mode of information delivery, all participants demonstrated improved pretest to post-test understanding. While there were no statistical differences in parents' post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65 (4.1) vs 8.85 (4.1) (2.8, 1.4, 4.2) 0-18 scale where 18=complete understanding). Furthermore, the IP was found to be significantly 'easier to follow' and 'more effective' in presenting information compared with the TF.CONCLUSIONS:Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process.

ObjectiveThe aim of this study was to determine whether an interactive computer program could improve patient knowledge regarding genetic screening and diagnostic concepts. MethodsIn this randomized trial, women 6-26weeks' gestation were assigned to standard care with provider-based counseling or to augmented counseling with an interactive computer program. The computer-based tool conveyed information about genetic testing options. Women were administered a 23-item test of content knowledge immediately and 2-4weeks after exposure. Test scores were compared between groups at both points using T-tests. ResultsA total of 150 women were randomized equally between groups. Groups were similar with regard to demographic characteristics. Women randomized to the interactive tool correctly answered a significantly greater proportion of questions than those who received standard counseling (69.4%+/- 14.2% vs. 46.0%+/- 15.2%, p<0.001) on the immediate questionnaire. One hundred and twenty-three (82%) participants participated in the follow-up test. Women randomized to the tool continued to correctly answer a significantly greater proportion of questions (60.6%+/- 16% vs. 49.7%+/- 18.9%, p=0.001). Education, health literacy, electronic health literacy, and other discussions with providers were not associated with a differential benefit from the educational intervention. ConclusionA patient-directed interactive computer program may help providers to convey relevant information about genetic screening and diagnostic concepts. (c) 2014 John Wiley & Sons, Ltd.

Introduction: Standard print and verbal information provided to patients undergoing treatments are often difficult to understand and may impair their ability to be truly informed.This study examined the effect of an interactive multimedia informational program with in-line exercises and corrected feedback on patients' real-time understanding of their cardiac catheterization procedure.Methods: 151 adult patients scheduled for diagnostic cardiac catheterization were randomized to receive information about their procedure using either the standard institutional verbal and written information (SI) or an interactive iPad-based informational program (IPI). Subject understanding was evaluated using semi-structured interviews at baseline, immediately following catheterization, and 2 weeks after the procedure. In addition, for those randomized to the IPI, the ability to respond correctly to several in-line exercises was recorded. Subjects' perceptions of, and preferences for the information delivery were also elicited.Results: Subjects randomized to the IPI program had significantly better understanding following the intervention compared with those randomized to the SI group (8.3 +/- 2.4 vs 7.4 +/- 2.5, respectively, 0-12 scale where 12 = complete understanding, P < 0.05). First-time correct responses to the in-line exercises ranged from 24.3% to 100%. Subjects reported that the in-line exercises were very helpful (9.1 +/- 1.7, 0-10 scale, where 10 = extremely helpful) and the iPad program very easy to use (9.0 +/- 1.6, 0-10 scale, where 10 = extremely easy) suggesting good clinical utility.

What is "American" about Melville's writings? Drawn from my keynote at the 2012 "Melville and Americanness" conference at the University of East Anglia, this essay explores various ways of responding to that question, while suggesting that there are no easy answers, in part because of Melville's ironic knowingness as a writer. Among the topics considered in the essay are Melville's perspectives on American literary nationalism, slavery and race, empire and imperialism, and democracy. I present Melville's "Americanness" as a "problem" that animates his writings and contributes to their continued vitality today.

In 1925, in the classic novel An American Tragedy, Theodore Dreiser portrayed a poignant yet powerful picture of youthful loneliness in industrial society and of the American mirage that beckons some of the young to disaster.In 2012, an American tragedy of far greater urgency and public health importance is the alarming rate of homicide among young black men. Interracial homicide, whether the victim or the perpetrator is black, is abhorrent. Nonetheless, from the perspective of the health of the general public, the circumstances in which a young black man is both the victim and the perpetrator cause far more premature deaths.Homicide is, far and away, the leading cause of death of young black men. In stark contrast, accidents are, far and away, the leading cause of death among young nonblack men and women of all races and ethnicities. Black men are 6 times more likely to die as the result of and 7 times more likely to commit murder than their white counterparts. One eighth of the population is black, but one half of all homicide victims are black. Their reduced life expectancy of more than 6 years would be improved more from eliminating homicide than abolishing any other causes of death except cardiovascular disease or cancer.1Potter L. Influence of homicide on racial disparity in life expectancy–United States, 1998.MMWR Morb Mortal Wkly Rep. 2001; 50: 780-782PubMed Google ScholarFrom 1999 to 2009, among those aged 15 to 34 years, there were 106,271 homicides, 85% (89,887) among men and 49% (52,265) among black men. One major and hotly debated issue is firearms. Specifically, 81% (85,643) of all homicides were due to firearms, including 91% (47,513) among black men.2Centers for Disease Control and Prevention, National Center for Health StatisticsCompressed Mortality File 1999-2009 CDC WONDER Online Database, compiled from Compressed Mortality File 1999-2009 Series 20 No. 2O, 2012.http://wonder.cdc.gov/cmf-icd10.htmlGoogle Scholar All attempts to address this complex issue should include, but not be limited to, optimizing the health of the general public, the strength of the existing evidence, and the constitutional right of individuals to bear arms.In most circumstances, public health practitioners are charged to identify threats to the health of the community and to bring scientific evidence to the attention of policy makers, even if the threats are lawful and whether or not policy makers choose to act on that evidence. For example, cigarettes are both lawful and popular, but public health support of laws controlling their exposure to the general population has contributed to the reduction of the premature mortality they cause.To date, however, this has not been the case for firearms. For policy makers proposing new gun laws, establishing an evidence-based legislative record may be especially important.3Vernick J.S. Rutkow L. Webster D.W. Teret S.P. Changing the constitutional landscape for firearms: the US Supreme Court's recent Second Amendment decisions.Am J Public Health. 2011; 101: 2021-2026Crossref PubMed Scopus (15) Google Scholar Nonetheless, federal public health practitioners are barred from such activities, due, in part, to the Anti-Lobbying Act and a 1996 action by the Congress of the United States, which defines such activities as "lobbying," which is considered a felony. Instead, federally employed public health officials are instructed by legislators to consider only the existing totality of available evidence. To date, this primarily includes descriptive data that are useful to formulate but not test hypotheses.4Hennekens C.H. DeMets D. Statistical association and causation: contributions of different types of evidence.JAMA. 2011; 305: 1134-1135Crossref PubMed Scopus (72) Google Scholar Nobody would disagree that individual behavior change is an important and necessary strategy for lowering homicide rates, but there is legitimate debate about whether it would be sufficient. It seems plausible, if not likely, that major societal changes amenable to responsible government but beyond individual control also are needed to achieve decreases in premature mortality from homicide among young black men.At present, we are aware of no reliable evidence on these important questions from analytic studies designed a priori to test hypotheses. For example, there is no reliable evidence about whether mandatory prison sentences for possession of an unlicensed firearm would have a positive, negative, or no impact. There is an urgent need for a sufficient totality of evidence on which to base the most rational judgments for individuals, as well as policy decisions for the health of the general public. Although it is not incumbent on policy makers to follow recommendations, if reliable evidence supports the current legislative position, then there would be a rational basis on which it should be upheld. It also may be that reliable evidence emerges to support modifications in laws concerning exposure to firearms. Outcomes may range, in theory, from relaxing current guidelines, to enforcing the status quo on firearms, to greater licensing requirements or some other solution. Any of these outcomes would be only one component of a multifactorial and multidisciplinary strategy to combat the epidemic of premature mortality from homicide among young black men. Death is inevitable, but premature death is not, including among young black men.5Levine R.S. Rust G. Kilbourne B. et al.United States counties with low black male mortality rates.Am J Med. 2013; 126: 76-80Abstract Full Text Full Text PDF PubMed Scopus (13) Google ScholarAn urgent and necessary first step to abort this epidemic should include increased awareness of the general public, health care providers, and public health professional organizations. One example of a successful strategy is the US National High Blood Pressure Education Program.6National Heart, Lung, and Blood InstituteGuidelines in Development: The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8).http://www.nhlbi.nih.gov/guidelines/hypertension/jnc8/index.htmGoogle Scholar Before this program, hypertension had been established as a leading cause of premature morbidity and mortality from stroke and coronary heart disease. Nonetheless, only one half of hypertensive subjects were being detected; of these subjects, only one half were treated and hypertension was controlled in only one half. Thus, only one eighth of people with hypertension were effectively treated, a figure that has increased to more than one half in the last 41 years. This is due, in part, to the increased awareness of healthcare providers and the general public about a sufficient totality of evidence on the individual risks and benefits of therapeutic lifestyle changes and the need for multiple drug therapies of life-saving benefit. The 8th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure is being drafted by the US National Heart, Lung, and Blood Institute. Every decision reached by the best possible independent medical review is subject to modification by other academic and public health experts, including various governmental agencies. The National Heart, Lung, and Blood Institute clearly states that their "sponsored clinical guidelines are developed by voluntary expert panels which they convene and are, therefore, not official government positions." Nonetheless, they may inform policy decisions of other government agencies and other groups.Medical and public health practitioners should be free to gather a sufficient totality of evidence and make official recommendations. To paraphrase Martin Luther King, Jr, the renowned black clergyman, activist, and prominent civil rights leader who preached and practiced nonviolence but was murdered by a gun—substandard science anywhere is a threat to science everywhere.7King Jr, M.L.K. http://www.africa.upenn.edu/Articles_Gen/Letter_Birmingham.htmlGoogle Scholar In 1925, in the classic novel An American Tragedy, Theodore Dreiser portrayed a poignant yet powerful picture of youthful loneliness in industrial society and of the American mirage that beckons some of the young to disaster. In 2012, an American tragedy of far greater urgency and public health importance is the alarming rate of homicide among young black men. Interracial homicide, whether the victim or the perpetrator is black, is abhorrent. Nonetheless, from the perspective of the health of the general public, the circumstances in which a young black man is both the victim and the perpetrator cause far more premature deaths. Homicide is, far and away, the leading cause of death of young black men. In stark contrast, accidents are, far and away, the leading cause of death among young nonblack men and women of all races and ethnicities. Black men are 6 times more likely to die as the result of and 7 times more likely to commit murder than their white counterparts. One eighth of the population is black, but one half of all homicide victims are black. Their reduced life expectancy of more than 6 years would be improved more from eliminating homicide than abolishing any other causes of death except cardiovascular disease or cancer.1Potter L. Influence of homicide on racial disparity in life expectancy–United States, 1998.MMWR Morb Mortal Wkly Rep. 2001; 50: 780-782PubMed Google Scholar From 1999 to 2009, among those aged 15 to 34 years, there were 106,271 homicides, 85% (89,887) among men and 49% (52,265) among black men. One major and hotly debated issue is firearms. Specifically, 81% (85,643) of all homicides were due to firearms, including 91% (47,513) among black men.2Centers for Disease Control and Prevention, National Center for Health StatisticsCompressed Mortality File 1999-2009 CDC WONDER Online Database, compiled from Compressed Mortality File 1999-2009 Series 20 No. 2O, 2012.http://wonder.cdc.gov/cmf-icd10.htmlGoogle Scholar All attempts to address this complex issue should include, but not be limited to, optimizing the health of the general public, the strength of the existing evidence, and the constitutional right of individuals to bear arms. In most circumstances, public health practitioners are charged to identify threats to the health of the community and to bring scientific evidence to the attention of policy makers, even if the threats are lawful and whether or not policy makers choose to act on that evidence. For example, cigarettes are both lawful and popular, but public health support of laws controlling their exposure to the general population has contributed to the reduction of the premature mortality they cause. To date, however, this has not been the case for firearms. For policy makers proposing new gun laws, establishing an evidence-based legislative record may be especially important.3Vernick J.S. Rutkow L. Webster D.W. Teret S.P. Changing the constitutional landscape for firearms: the US Supreme Court's recent Second Amendment decisions.Am J Public Health. 2011; 101: 2021-2026Crossref PubMed Scopus (15) Google Scholar Nonetheless, federal public health practitioners are barred from such activities, due, in part, to the Anti-Lobbying Act and a 1996 action by the Congress of the United States, which defines such activities as "lobbying," which is considered a felony. Instead, federally employed public health officials are instructed by legislators to consider only the existing totality of available evidence. To date, this primarily includes descriptive data that are useful to formulate but not test hypotheses.4Hennekens C.H. DeMets D. Statistical association and causation: contributions of different types of evidence.JAMA. 2011; 305: 1134-1135Crossref PubMed Scopus (72) Google Scholar Nobody would disagree that individual behavior change is an important and necessary strategy for lowering homicide rates, but there is legitimate debate about whether it would be sufficient. It seems plausible, if not likely, that major societal changes amenable to responsible government but beyond individual control also are needed to achieve decreases in premature mortality from homicide among young black men. At present, we are aware of no reliable evidence on these important questions from analytic studies designed a priori to test hypotheses. For example, there is no reliable evidence about whether mandatory prison sentences for possession of an unlicensed firearm would have a positive, negative, or no impact. There is an urgent need for a sufficient totality of evidence on which to base the most rational judgments for individuals, as well as policy decisions for the health of the general public. Although it is not incumbent on policy makers to follow recommendations, if reliable evidence supports the current legislative position, then there would be a rational basis on which it should be upheld. It also may be that reliable evidence emerges to support modifications in laws concerning exposure to firearms. Outcomes may range, in theory, from relaxing current guidelines, to enforcing the status quo on firearms, to greater licensing requirements or some other solution. Any of these outcomes would be only one component of a multifactorial and multidisciplinary strategy to combat the epidemic of premature mortality from homicide among young black men. Death is inevitable, but premature death is not, including among young black men.5Levine R.S. Rust G. Kilbourne B. et al.United States counties with low black male mortality rates.Am J Med. 2013; 126: 76-80Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar An urgent and necessary first step to abort this epidemic should include increased awareness of the general public, health care providers, and public health professional organizations. One example of a successful strategy is the US National High Blood Pressure Education Program.6National Heart, Lung, and Blood InstituteGuidelines in Development: The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8).http://www.nhlbi.nih.gov/guidelines/hypertension/jnc8/index.htmGoogle Scholar Before this program, hypertension had been established as a leading cause of premature morbidity and mortality from stroke and coronary heart disease. Nonetheless, only one half of hypertensive subjects were being detected; of these subjects, only one half were treated and hypertension was controlled in only one half. Thus, only one eighth of people with hypertension were effectively treated, a figure that has increased to more than one half in the last 41 years. This is due, in part, to the increased awareness of healthcare providers and the general public about a sufficient totality of evidence on the individual risks and benefits of therapeutic lifestyle changes and the need for multiple drug therapies of life-saving benefit. The 8th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure is being drafted by the US National Heart, Lung, and Blood Institute. Every decision reached by the best possible independent medical review is subject to modification by other academic and public health experts, including various governmental agencies. The National Heart, Lung, and Blood Institute clearly states that their "sponsored clinical guidelines are developed by voluntary expert panels which they convene and are, therefore, not official government positions." Nonetheless, they may inform policy decisions of other government agencies and other groups. Medical and public health practitioners should be free to gather a sufficient totality of evidence and make official recommendations. To paraphrase Martin Luther King, Jr, the renowned black clergyman, activist, and prominent civil rights leader who preached and practiced nonviolence but was murdered by a gun—substandard science anywhere is a threat to science everywhere.7King Jr, M.L.K. http://www.africa.upenn.edu/Articles_Gen/Letter_Birmingham.htmlGoogle Scholar

OBJECTIVE: Conventional print materials for presenting risks and benefits of treatment are often difficult to understand. This study was undertaken to evaluate and compare subjects' understanding and perceptions of risks and benefits presented using animated computerized text and graphics.METHODS: Adult subjects were randomized to receive identical risk/benefit information regarding taking statins that was presented on an iPad (Apple Corp, Cupertino, Calif) in 1 of 4 different animated formats: text/numbers, pie chart, bar graph, and pictograph. Subjects completed a questionnaire regarding their preferences and perceptions of the message delivery together with their understanding of the information. Health literacy, numeracy, and need for cognition were measured using validated instruments.RESULTS: There were no differences in subject understanding based on the different formats. However, significantly more subjects preferred graphs (82.5%) compared with text (17.5%, P < .001). Specifically, subjects preferred pictographs (32.0%) and bar graphs (31.0%) over pie charts (19.5%) and text (17.5%). Subjects whose preference for message delivery matched their randomly assigned format (preference match) had significantly greater understanding and satisfaction compared with those assigned to something other than their preference.CONCLUSIONS: Results showed that computer-animated depictions of risks and benefits offer an effective means to describe medical risk/benefit statistics. That understanding and satisfaction were significantly better when the format matched the individual's preference for message delivery is important and reinforces the value of "tailoring" information to the individual's needs and preferences. (C) 2012 Elsevier Inc. All rights reserved. The American Journal of Medicine (2012) 125, 1103-1110

Book Review| September 01 2011 Review: Antislavery Discourse and Nineteenth-Century American Literature: Incendiary Pictures, by Julie Husband Julie Husband, Antislavery Discourse and Nineteenth-Century American Literature: Incendiary Pictures. New York: Palgrave Macmillan, 2010. Pp. xiv + 160. $80. Robert S. Levine Robert S. Levine University of Maryland, College Park Robert S. Levine is Professor of English and Distinguished Scholar-Teacher at the University of Maryland, College Park. His recent books include Dislocating Race and Nation: Episodes in Nineteenth-Century American Literary Nationalism (2008) and The Works of James M. Whitfield: “America” and Other Writings by a Nineteenth-Century African American Poet (2011), coedited with Ivy Wilson. Search for other works by this author on: This Site PubMed Google Scholar Nineteenth-Century Literature (2011) 66 (2): 250–253. https://doi.org/10.1525/ncl.2011.66.2.250 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Robert S. Levine; Review: Antislavery Discourse and Nineteenth-Century American Literature: Incendiary Pictures, by Julie Husband. Nineteenth-Century Literature 1 September 2011; 66 (2): 250–253. doi: https://doi.org/10.1525/ncl.2011.66.2.250 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentNineteenth-Century Literature Search This content is only available via PDF. © 2011 by The Regents of the University of California. All rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press's Rights and Permissions website, at http://www.ucpress.edu/journals/rights.htm.2011 Article PDF first page preview Close Modal You do not currently have access to this content.

Standard written methods of presenting research information may be difficult for many parents and children to understand. This pilot study was designed to examine the use of a novel prototype interactive consent program for describing a hypothetical pediatric asthma trial to parents and children. Parents and children were interviewed to examine their baseline understanding of key elements of a clinical trial, eg, randomization, placebo, and blinding. Subjects then reviewed age-appropriate versions of an interactive computer program describing an asthma trial, and their understanding of key research concepts was again tested along with their understanding of the details of the trial. Parents and children also completed surveys to examine their perceptions and satisfaction with the program. Both parents and children demonstrated improved understanding of key research concepts following administration of the consent program. For example, the percentage of parents and children who could correctly define the terms clinical trials and placebo improved from 60% to 80%, and 80% to 100% among parents and 25% to 50% and 0% to 50% among children, respectively, following review of the interactive programs. Parents and children's overall understanding of the details of the asthma trial were 14.2 ± 0.84 and 9.25 ± 4.9 (0-15 scale, where 15 is complete understanding), respectively. Results also suggest that the interactive programs were easy to use and facilitated understanding of the clinical trial among parents and children. Interactive media may offer an effective means of presenting understandable information to parents and children regarding participation in clinical trials. Further work to examine this novel approach appears warranted.