Matching Items (102)
Description
Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.
ContributorsVankipuram, Mithra (Author) / Greenes, Robert A (Thesis advisor) / Patel, Vimla L. (Thesis advisor) / Petitti, Diana B. (Committee member) / Dinu, Valentin (Committee member) / Smith, Marshall L. (Committee member) / Arizona State University (Publisher)
Created2012
Description
This work involved the analysis of a public health system, and the design, development and deployment of enterprise informatics architecture, and sustainable community methods to address problems with the current public health system. Specifically, assessment of the Nationally Notifiable Disease Surveillance System (NNDSS) was instrumental in forming the design of the current implementation at the Southern Nevada Health District (SNHD). The result of the system deployment at SNHD was considered as a basis for projecting the practical application and benefits of an enterprise architecture. This approach has resulted in a sustainable platform to enhance the practice of public health by improving the quality and timeliness of data, effectiveness of an investigation, and reporting across the continuum.
ContributorsKriseman, Jeffrey Michael (Author) / Dinu, Valentin (Thesis advisor) / Greenes, Robert (Committee member) / Johnson, William (Committee member) / Arizona State University (Publisher)
Created2012
Description
Immunosignaturing is a technology that allows the humoral immune response to be observed through the binding of antibodies to random sequence peptides. The immunosignaturing microarray is based on complex mixtures of antibodies binding to arrays of random sequence peptides in a multiplexed fashion. There are computational and statistical challenges to the analysis of immunosignaturing data. The overall aim of my dissertation is to develop novel computational and statistical methods for immunosignaturing data to access its potential for diagnostics and drug discovery. Firstly, I discovered that a classification algorithm Naive Bayes which leverages the biological independence of the probes on our array in such a way as to gather more information outperforms other classification algorithms due to speed and accuracy. Secondly, using this classifier, I then tested the specificity and sensitivity of immunosignaturing platform for its ability to resolve four different diseases (pancreatic cancer, pancreatitis, type 2 diabetes and panIN) that target the same organ (pancreas). These diseases were separated with >90% specificity from controls and from each other. Thirdly, I observed that the immunosignature of type 2 diabetes and cardiovascular complications are unique, consistent, and reproducible and can be separated by 100% accuracy from controls. But when these two complications arise in the same person, the resultant immunosignature is quite different in that of individuals with only one disease. I developed a method to trace back from informative random peptides in disease signatures to the potential antigen(s). Hence, I built a decipher system to trace random peptides in type 1 diabetes immunosignature to known antigens. Immunosignaturing, unlike the ELISA, has the ability to not only detect the presence of response but also absence of response during a disease. I observed, not only higher but also lower peptides intensities can be mapped to antigens in type 1 diabetes. To study immunosignaturing potential for population diagnostics, I studied effect of age, gender and geographical location on immunosignaturing data. For its potential to be a health monitoring technology, I proposed a single metric Coefficient of Variation that has shown potential to change significantly when a person enters a disease state.
ContributorsKukreja, Muskan (Author) / Johnston, Stephen Albert (Thesis advisor) / Stafford, Phillip (Committee member) / Dinu, Valentin (Committee member) / Arizona State University (Publisher)
Created2012
Description
The aim of this study is to evaluate whether or not fitness can be determined using a well-researched six minute walk test (6MWT) in a young adult population with Down syndrome (DS). This holds importance in today's health industry because this particular target group is at high risk for several cardiovascular, cognitive and clinical factors that contribute to their well-being and longevity. As well, the findings of this research could potentially contribute to the low volume of research that currently exists regarding fitness and the DS population and provide pertinent knowledge towards intervention programs. Fourteen participants with DS performed one 6MWT at a self-selected rate during an exercise intervention study to assess physical fitness. The results showed that walk distance increased with decreased BMI and walk distance increased with increased walking speed and increased leisure activity. These findings are clear indicators of physical fitness relating to healthy physical behavior. All results were consistent with past research in specific at-risk health related populations. This data suggests that this physical test is an adequate indicator of fitness levels in populations with DS, which may additionally provide explicit avenues for intervention and treatment to improve health.
ContributorsMoss Hunt, Lauren Charlie (Author) / Ringenbach, Shannon (Thesis director) / Shaibi, Gabriel (Committee member) / Maraj, Brian (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor)
Created2013-05
Description
The aim was to examine the effectiveness of a cycling intervention on body composition in adolescents with Down syndrome (DS). Four participants completed three interventions over eight consecutive weeks. The interventions were: 1) Voluntary Cycling (VC), in which participants cycled at their self-selected pedaling rate 2) Assisted Cycling (AC), in which the participants' voluntary pedaling rates were augmented with a motor to ensure the maintenance of 80 rpms. 3) No cycling (NC), in which the participants acted as controls. Total weight of the participants and percentage body fat of the participants both decreased but not in values that were statistically significant. The only statistically significant value was the ratio of android fat to gynoid fat, which increased. Future research will try to replicate this data with statistically significant values for more cycling adolescents with DS.
ContributorsFankhauser, Kristin Marie (Author) / Ringenbach, Shannon (Thesis director) / Shaibi, Gabriel (Committee member) / Hillman, Charles (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor)
Created2014-05
Description
Background:
Pediatric obesity is associated with lower quality of life (QOL) and populations with high obesity rates, such as Latinos, are especially vulnerable. We examined the effects of a 12-week diabetes prevention program on changes in weight-specific QOL in Latino youth.
Method:
Fifteen obese Latino adolescents (BMI%=96.3±1.1;age=15.0±1.0) completed a 12-week intervention. Youth completed weight-specific QOL measures at baseline, post intervention, and 1-year follow-up. For comparison purposes, intervention youth were matched for age and gender with lean controls.
Results:
At baseline, obese youth exhibited significantly lower weight-specific QOL compared with lean youth (70.8±5.4 to 91.2±2.2, p<0.005). The intervention did not significantly impact weight (90.6±6.8 to 89.9±7.2kg, p=0.44). However, significant increases in weight-specific QOL were observed (70.8±20.9 to 86.2±16.9, p<0.001). Post-intervention QOL scores were no longer significantly different than lean controls (P=0.692). Data from nine youth who returned for follow-up indicated that increases in weight-specific QOL were maintained over time (90.5±4.5 to 85.8±5.9, p=0.74).
Conclusion:
These results indicate that a community-based diabetes prevention program can result in sustained improvements in weight-specific QOL among obese Latino youth. Lifestyle interventions that focus on social interaction and physical activity, rather than weight-loss per se, may help improve the psychosocial health of obese Latino youth.
Pediatric obesity is associated with lower quality of life (QOL) and populations with high obesity rates, such as Latinos, are especially vulnerable. We examined the effects of a 12-week diabetes prevention program on changes in weight-specific QOL in Latino youth.
Method:
Fifteen obese Latino adolescents (BMI%=96.3±1.1;age=15.0±1.0) completed a 12-week intervention. Youth completed weight-specific QOL measures at baseline, post intervention, and 1-year follow-up. For comparison purposes, intervention youth were matched for age and gender with lean controls.
Results:
At baseline, obese youth exhibited significantly lower weight-specific QOL compared with lean youth (70.8±5.4 to 91.2±2.2, p<0.005). The intervention did not significantly impact weight (90.6±6.8 to 89.9±7.2kg, p=0.44). However, significant increases in weight-specific QOL were observed (70.8±20.9 to 86.2±16.9, p<0.001). Post-intervention QOL scores were no longer significantly different than lean controls (P=0.692). Data from nine youth who returned for follow-up indicated that increases in weight-specific QOL were maintained over time (90.5±4.5 to 85.8±5.9, p=0.74).
Conclusion:
These results indicate that a community-based diabetes prevention program can result in sustained improvements in weight-specific QOL among obese Latino youth. Lifestyle interventions that focus on social interaction and physical activity, rather than weight-loss per se, may help improve the psychosocial health of obese Latino youth.
ContributorsBrito, Elizabeth (Author) / Shaibi, Gabriel (Thesis director) / Barroso, Cristina (Committee member) / Patrick, Donald (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution and Social Change (Contributor)
Created2013-05
Description
DNA methylation, a subset of epigenetics, has been found to be a significant marker associated with variations in gene expression and activity across the entire human genome. As of now, however, there is little to no information about how DNA methylation varies between different tissues inside a singular person's body. By using research data from a preliminary study of lean and obese clinical subjects, this study attempts to put together a profile of the differences in DNA methylation that can be observed between two particular body tissues from this subject group: blood and skeletal muscle. This study allows us to start describing the changes that occur at the epigenetic level that influence how differently these two tissues operate, along with seeing how these tissues change between individuals of different weight classes, especially in the context of the development of symptoms of Type 2 Diabetes.
ContributorsRappazzo, Micah Gabriel (Author) / Coletta, Dawn (Thesis director) / Katsanos, Christos (Committee member) / Dinu, Valentin (Committee member) / Barrett, The Honors College (Contributor) / Harrington Bioengineering Program (Contributor) / Department of Psychology (Contributor)
Created2013-12
Description
High fat diets (HFD) are known to cause hepatic non-alcoholic steatosis in rats in as few as four weeks. Accumulation of triglycerides in liver and skeletal muscle is associated with insulin resistance and obesity. However, studies of fat accumulation in cardiac muscle are not as prevalent. Therefore, the first hypothesis of this study was that HFD would lead to hepatic steatosis as well as lipid accumulation in pectoralis and cardiac muscles, tissues responsible for the majority of postprandial glucose disposal. Prior studies also indicated that HFD leads to increased inflammation and oxidative stress within the vasculature resulting in impaired endothelium-dependent vasodilation, however biomarkers of immune system reactivity were not assessed. Therefore, the second aim of this study was to explore additional pathways of immune system reactivity and stress (natural antibodies; heat shock protein 60 (HSP60)) in rats fed either a control (chow) or high fat (HFD) diet. HSP60 has also recently been recognized as an early marker of vascular dysfunction in humans. The hypothesis was that immune system reactivity and early vascular dysfunction would be heightened in rats fed a HFD compared to chow-fed controls. Young male Sprague-Dawley rats (140-160g) were maintained on a chow diet (5% fat, 57.33% carbohydrate, 3.4kcal/g) or HFD (60% fat, 20% carbohydrate, 5.24 kcal/g) for 6 weeks. HFD rats developed hepatic steatosis with significantly elevated liver triglyceride concentrations compared to chow-fed controls (20.73±2.09 vs.9.75±0.52 mg triglycerides/g tissue, respectively; p=0.001). While lipid accumulation appeared to be evident in the pectoralis muscle from HFD rats, triglyceride concentrations were not significantly different from controls. Likewise, there was no evidence of lipid infiltration in cardiac muscles of HFD rats. Lipid accumulation in the liver of overweight HFD rats may contribute to the observed insulin resistance in these animals. Contrary to the second hypothesis, there were no significant differences in plasma HSP60 expression between HFD and chow rats (p>0.05). Likewise, hemagglutination and hemolysis responses were similar between HFD and chow-fed rats (p>0.05). These findings suggest that immune system responses may not be affected by 6 weeks of high fat intake and that HSP60 is not an early marker of vascular dysfunction in this rodent model.
ContributorsLiss, Tyler Jessee (Author) / Sweazea, Karen (Thesis director) / Shaibi, Gabriel (Committee member) / Johnston, Carol (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor)
Created2013-05
Description
The aim of this case study was to help MH, a young adult male with Down syndrome, lose weight and improve his health. Initially he was morbidly obese, suffering from physical, mental, emotional, and health-related side effects. MH and his mother requested help from Dr. Shannon Ringenbach, and resided in Arizona for four months during the process of developing and implementing a program of diet and exercise for him. We created a plan to maximize weight loss in this short period of time. Overall, MH reduced his weight from 276 lbs. to 217 lbs. in four months, his lowest weight being 201 lbs. after he and his mother returned home to Oregon. This is a 75 lb. weight loss and body mass index (BMI) reduction of 13.7 kg/m2. Although to reach a healthy body weight MH would still need to continue his weight loss, this is a significant amount of weight, which is especially difficult for people with Down syndrome to lose. In this case study it was crucial to take into consideration the other aspects that affect weight gain and loss, such as motivation, family life, diet, and lifestyle.
ContributorsBrennan, Julia (Co-author) / Wright, Berlin (Co-author) / Ringenbach, Shannon (Thesis director) / Shaibi, Gabriel (Committee member) / Chen, Chih-Chia (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor)
Created2013-05
Description
Background: The prevalence of childhood obesity has disproportionately affected Latino youth. This increase in obesity is seen with an increased incidence of Type 2 Diabetes. Objective/Hypothesis: The objective of this study was to determine the effects of a community based lifestyle intervention, which encompassed nutrition education and physical activity, on diabetes risk in pre-diabetic Latino adolescents. Diabetes risk was assessed using pancreatic beta cell function as measured by proinsulin: insulin ratio. It was hypothesized that reductions in added sugar intake and reductions in saturated fat intake will be associated with improved beta cell function as measured by proinsulin: insulin ratio. Study Design/Participants: In this quasi-experimental study design, n=17 pre-diabetic Latino adolescents between the ages of 14-16 participated in a lifestyle intervention. Methods: Anthropometric measurements (weight, height, waist circumference, BMI) and body composition (body %) were determined for all participants at baseline and post intervention. Fasting proinsulin (PI), fasting insulin (I) and 2hr-OGTT were also determined. Dietary intake was measured using the Block Kids Food Screener for kids ages 2-17y (2007). The intervention consisted of nutrition education classes and physical activity sessions for 12 weeks. Results: We found significant decreases in body fat % following the intervention. There were no significant decreases in fasting insulin. Proinsulin significantly decreased. However we did no see a significant change in PI/I (p= 0.003). Dietary behaviors of added sugar (p=0.03) and saturated fat (p=0.04) showed significant decreases. No significant associations were found between changes in added sugar to improvements in beta cell function, r=0.072, p-value= 0.7. We also did not observe significant associations between reductions in saturated fat intake and improvements in beta cell function, r=0.152, p-value =0.6. Conclusions: We concluded that a 12-week lifestyle intervention resulted in significant changes in dietary behaviors. These changes were not however associated with improvements in beta cell function.
ContributorsKaur, Manroop (Author) / Shaibi, Gabriel (Thesis director) / Bruening, Meredith (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor)
Created2015-05