Matching Items (540)
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Description
Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based

Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based procedures include surgical and clinical procedures, some of which are protocol-driven. Cost and time required for individual team-based training sessions, along with other factors, contribute to making the training complex and challenging. A great deal of research has been done on medically-focused collaborative virtual reality (VR)-based training for protocol-driven procedures as a cost-effective as well as time-efficient solution. Most VR-based simulators focus on training of individual personnel. The ones which focus on providing team training provide an interactive simulation for only a few scenarios in a collaborative virtual environment (CVE). These simulators are suited for didactic training for cognitive skills development. The training sessions in the simulators require the physical presence of mentors. The problem with this kind of system is that the mentor must be present at the training location (either physically or virtually) to evaluate the performance of the team (or an individual). Another issue is that there is no efficient methodology that exists to provide feedback to the trainees during the training session itself (formative feedback). Furthermore, they lack the ability to provide training in acquisition or improvement of psychomotor skills for the tasks that require force or touch feedback such as cardiopulmonary resuscitation (CPR). To find a potential solution to overcome some of these concerns, a novel training system was designed and developed that utilizes the integration of sensors into a CVE for time-critical medical procedures. The system allows the participants to simultaneously access the CVE and receive training from geographically diverse locations. The system is also able to provide real-time feedback and is also able to store important data during each training/testing session. Finally, this study also presents a generalizable collaborative team-training system that can be used across various team-based procedures in medical as well as non-medical domains.
ContributorsKhanal, Prabal (Author) / Greenes, Robert (Thesis advisor) / Patel, Vimla (Thesis advisor) / Smith, Marshall (Committee member) / Gupta, Ashish (Committee member) / Kaufman, David (Committee member) / Arizona State University (Publisher)
Created2014
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Surgery as a profession requires significant training to improve both clinical decision making and psychomotor proficiency. In the medical knowledge domain, tools have been developed, validated, and accepted for evaluation of surgeons' competencies. However, assessment of the psychomotor skills still relies on the Halstedian model of apprenticeship, wherein surgeons are

Surgery as a profession requires significant training to improve both clinical decision making and psychomotor proficiency. In the medical knowledge domain, tools have been developed, validated, and accepted for evaluation of surgeons' competencies. However, assessment of the psychomotor skills still relies on the Halstedian model of apprenticeship, wherein surgeons are observed during residency for judgment of their skills. Although the value of this method of skills assessment cannot be ignored, novel methodologies of objective skills assessment need to be designed, developed, and evaluated that augment the traditional approach. Several sensor-based systems have been developed to measure a user's skill quantitatively, but use of sensors could interfere with skill execution and thus limit the potential for evaluating real-life surgery. However, having a method to judge skills automatically in real-life conditions should be the ultimate goal, since only with such features that a system would be widely adopted. This research proposes a novel video-based approach for observing surgeons' hand and surgical tool movements in minimally invasive surgical training exercises as well as during laparoscopic surgery. Because our system does not require surgeons to wear special sensors, it has the distinct advantage over alternatives of offering skills assessment in both learning and real-life environments. The system automatically detects major skill-measuring features from surgical task videos using a computing system composed of a series of computer vision algorithms and provides on-screen real-time performance feedback for more efficient skill learning. Finally, the machine-learning approach is used to develop an observer-independent composite scoring model through objective and quantitative measurement of surgical skills. To increase effectiveness and usability of the developed system, it is integrated with a cloud-based tool, which automatically assesses surgical videos upload to the cloud.
ContributorsIslam, Gazi (Author) / Li, Baoxin (Thesis advisor) / Liang, Jianming (Thesis advisor) / Dinu, Valentin (Committee member) / Greenes, Robert (Committee member) / Smith, Marshall (Committee member) / Kahol, Kanav (Committee member) / Patel, Vimla L. (Committee member) / Arizona State University (Publisher)
Created2013
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Description
A core principle in multiple national quality improvement strategies is the engagement of chronically ill patients in the creation and execution of their treatment plans. Numerous initiatives are underway to use health information technology (HIT) to support patient engagement however the use of HIT and other factors such as health

A core principle in multiple national quality improvement strategies is the engagement of chronically ill patients in the creation and execution of their treatment plans. Numerous initiatives are underway to use health information technology (HIT) to support patient engagement however the use of HIT and other factors such as health literacy may be significant barriers to engagement for older adults. This qualitative descriptive study sought to explore the ways that older adults with multi-morbidities engaged with their plan of care. Forty participants were recruited through multiple case sampling from two ambulatory cardiology practices. Participants were English-speaking, without a dementia-related diagnosis, and between the ages of 65 and 86. The older adults in this study performed many behaviors to engage in the plan of care, including acting in ways to support health, managing health-related information, attending routine visits with their doctors, and participating in treatment planning. A subset of patients engaged in active decision-making because of the point they were at in their chronic disease. At that cross roads, they expressed uncertainly over which road to travel. Two factors influenced the engagement of older adults: a relationship with the provider that met the patient's needs, and the distribution of a Meaningful Use clinical summary at the conclusion of the provider visit. Participants described the ways in which the clinical summary helped and hindered their understanding of the care plan.

Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist.
ContributorsJiggins Colorafi, Karen (Author) / Lamb, Gerri (Thesis advisor) / Marek, Karen (Committee member) / Greenes, Robert (Committee member) / Evans, Bronwynne (Committee member) / Arizona State University (Publisher)
Created2015
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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

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
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Description
Clinical Decision Support (CDS) is primarily associated with alerts, reminders, order entry, rule-based invocation, diagnostic aids, and on-demand information retrieval. While valuable, these foci have been in production use for decades, and do not provide a broader, interoperable means of plugging structured clinical knowledge into live electronic health record (EHR)

Clinical Decision Support (CDS) is primarily associated with alerts, reminders, order entry, rule-based invocation, diagnostic aids, and on-demand information retrieval. While valuable, these foci have been in production use for decades, and do not provide a broader, interoperable means of plugging structured clinical knowledge into live electronic health record (EHR) ecosystems for purposes of orchestrating the user experiences of patients and clinicians. To date, the gap between knowledge representation and user-facing EHR integration has been considered an “implementation concern” requiring unscalable manual human efforts and governance coordination. Drafting a questionnaire engineered to meet the specifications of the HL7 CDS Knowledge Artifact specification, for example, carries no reasonable expectation that it may be imported and deployed into a live system without significant burdens. Dramatic reduction of the time and effort gap in the research and application cycle could be revolutionary. Doing so, however, requires both a floor-to-ceiling precoordination of functional boundaries in the knowledge management lifecycle, as well as formalization of the human processes by which this occurs.

This research introduces ARTAKA: Architecture for Real-Time Application of Knowledge Artifacts, as a concrete floor-to-ceiling technological blueprint for both provider heath IT (HIT) and vendor organizations to incrementally introduce value into existing systems dynamically. This is made possible by service-ization of curated knowledge artifacts, then injected into a highly scalable backend infrastructure by automated orchestration through public marketplaces. Supplementary examples of client app integration are also provided. Compilation of knowledge into platform-specific form has been left flexible, in so far as implementations comply with ARTAKA’s Context Event Service (CES) communication and Health Services Platform (HSP) Marketplace service packaging standards.

Towards the goal of interoperable human processes, ARTAKA’s treatment of knowledge artifacts as a specialized form of software allows knowledge engineers to operate as a type of software engineering practice. Thus, nearly a century of software development processes, tools, policies, and lessons offer immediate benefit: in some cases, with remarkable parity. Analyses of experimentation is provided with guidelines in how choice aspects of software development life cycles (SDLCs) apply to knowledge artifact development in an ARTAKA environment.

Portions of this culminating document have been further initiated with Standards Developing Organizations (SDOs) intended to ultimately produce normative standards, as have active relationships with other bodies.
ContributorsLee, Preston Victor (Author) / Dinu, Valentin (Thesis advisor) / Sottara, Davide (Committee member) / Greenes, Robert (Committee member) / Arizona State University (Publisher)
Created2018
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Description
High childhood obesity rates have resulted in many interventions to attempt to lower these rates. Interventions such as day camps, residential camps, therapy-based interventions and family-based interventions lead to changes in weight and self-esteem but family-based intervention leads to the longest-term success for children ages nine to 17. Analysis of

High childhood obesity rates have resulted in many interventions to attempt to lower these rates. Interventions such as day camps, residential camps, therapy-based interventions and family-based interventions lead to changes in weight and self-esteem but family-based intervention leads to the longest-term success for children ages nine to 17. Analysis of the interventions was measured using tools such as BMI, BMI-percentiles, and weight. Psychological measures such as self-esteem, happiness, and quality of life analysis was preferred, however were not measured in all studies. While most interventions resulted in weight loss and increased self-esteem, results were often not long-term. Studies provided evidence that family-based therapy has potential to last long-term, however there is a lack of research. To determine the most effective childhood nutrition intervention research must conduct follow-ups for many years after the initial intervention to ensure they provide long-term results.
ContributorsAnderson, Megan Lee (Author) / McCoy, Maureen (Thesis director) / Kniskern, Megan (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Description
The purpose of this study was to develop proposal lesson plans for 4th-6th graders based on active learning to integrate movement physical activity into the curriculum. The 4th-6th graders were chosen, as this is the age where teaching typically transitions from active learning to sedentary/lecture style teaching. Research compiled indicated

The purpose of this study was to develop proposal lesson plans for 4th-6th graders based on active learning to integrate movement physical activity into the curriculum. The 4th-6th graders were chosen, as this is the age where teaching typically transitions from active learning to sedentary/lecture style teaching. Research compiled indicated positive effects of active based learning on children such as increased attention span, retention, and general focus. A survey was created to not only assess the perception of active versus didactic learners, but to also assess the effects of movement-based learning on the variables that research claimed to change. The lesson plans developed here should be transferable to a classroom lesson to evaluate the hypothesized results.
ContributorsTanna, Nimisha (Author) / Hyatt, JP (Thesis director) / Ainsworth, Barbara (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description
About 75% of men and 66.58% of women are considered overweight or obese (BMI ≥25). $117 billion dollars is spent each year in medical costs due to physical inactivity. Aerobic exercise has been well defined in its’ benefits to cardiovascular health; however, the effects of resistance training are still not

About 75% of men and 66.58% of women are considered overweight or obese (BMI ≥25). $117 billion dollars is spent each year in medical costs due to physical inactivity. Aerobic exercise has been well defined in its’ benefits to cardiovascular health; however, the effects of resistance training are still not well defined. The purpose of this preliminary analysis was to evaluate the vascular health effects (central and peripheral blood pressure and VO2 max) of two different types of resistance training programs: high load, low repetitions resistance training and low load, high repetitions resistance training. Fourteen participants aged 18-55 years (6 males, 8 females) were involved in this preliminary analysis. Data were collected before and after the 12-week long exercise program (36 training sessions) via pulse wave analysis and VO2peak testing. Multivariate regression analysis of training program effects, while adjusting for body mass index and time, did not result in significant training effects on central and peripheral diastolic blood pressure, nor VO2peak. A statistical trend was observed between the different training programs for systolic blood pressure, suggesting that subjects partaking in the high load, low repetitions program exhibited higher systolic blood pressures than the low load, high repetitions group. With a larger sample size, the difference in systolic blood pressure may increase between training program groups and indicate that greater loads with minimal repetitions may increase lead to clinically significant elevations in blood pressure. Further work is needed to uncover the relationship between different types of resistance training and blood pressure, especially if these lifting regimens are continued for longer lengths of time.
ContributorsHill, Cody Alan (Co-author) / Hill, Cody (Co-author) / Whisner, Corrie (Thesis director) / Angadi, Siddhartha (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description
Introduction: Individuals with rotator cuff tears have been found to compensate in their movement patterns by using lower thoracohumeral elevation angles during certain tasks, as well as increased internal rotation of the shoulder (Vidt et al., 2016). Leading joint hypothesis suggests there is one leading joint that creates the foundation

Introduction: Individuals with rotator cuff tears have been found to compensate in their movement patterns by using lower thoracohumeral elevation angles during certain tasks, as well as increased internal rotation of the shoulder (Vidt et al., 2016). Leading joint hypothesis suggests there is one leading joint that creates the foundation for the entire limb motion, and there are other subordinate joints which monitor the passive interaction torque and create a net torque aiding to limb motions required for the task. This experiment seeks to establish a better understanding of joint control strategies during a wide range of arm movements. Based on the leading joint hypothesis, we hypothesize that when a subject has a rotator cuff tear, their performance of planar and three-dimensional motions should be altered not only at the shoulder, which is often the leading joint, but also at other joints on the arm, such as the elbow and wrist. This paper will focus on the effect of normal aging on the control of the joints of the arm.
Methods: There were 4 groups of participants: healthy younger adults (n=14)(21.74 ± 1.97), healthy older adults (n=12)(55-75), older adults (n=4)(55-75) with a partial-thickness rotator cuff tear, and older adults (n=4)(55-75) with a full-thickness rotator cuff tear (RCT). All four groups completed strength testing, horizontal drawing and pointing tasks, and three dimensional (3D) activities of daily living. Kinematic and kinetic variables of the arm were obtained during horizontal and 3D tasks using data from 12 reflective markers placed on the arm, 8 motion capture cameras, and Cortex motion capture software (Motion Analysis Corp., Santa Rosa, CA). Strength testing tasks were measured using a dynamometer. All strength testing and 3D tasks were completed for three trials and horizontal tasks were completed for two trials.
Results: Results of the younger adult participants showed that during the forward portion of seven 3D tasks, there were four phases of different joint control mechanics seen in a majority of the movements. These phases included active rotation of both the shoulder and the elbow joint, active rotation of the shoulder with passive rotation of the elbow, passive rotation of the shoulder with active rotation of the elbow, and passive rotation of both the shoulder and the elbow. Passive rotation during movements was a result of gravitational torque on the different segments of the arm and interaction torque caused as a result of the multi-joint structure of human limbs. The number of tested participants for the minor RCT, and RCT older adults groups is not yet high enough to produce significant results and because of this their results are not reported in this article. Between the older adult control group and the young adult control group in the tasks upward reach to eye height and hair comb there were significant differences found between the groups. The differences were found in shorter overall time and distance between the two groups in the upward eye task.
Discussion: Through the available results, multiple phases were found where one or both of the joints of the arm moved passively which further supports the LJH and extends it to include 3D movements. With available data, it can be concluded that healthy older adults use movement control strategies, such as shortening distance covered, decreasing time percentage in active joint phases, and increasing time percentage in passive joint phases, to account for atrophy along with other age-related declines in performance, such as a decrease in range of motion. This article is a part of a bigger project which aims to better understand how older adults with RCTs compensate for the decreased strength, the decreased range of motion, and the pain that accompany this type of injury. It is anticipated that the results of this experiment will lead to more research toward better understanding how to treat patients with RCTs.
ContributorsFlores, Noah Mateo (Author) / Dounskaia, Natalia (Thesis director) / Vidt, Meghan (Committee member) / College of Health Solutions (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
After volunteering at a clinic in Guatemala and seeing the sexism that is so engrained into their culture, I decided to take a look at the U.S. healthcare system. I wanted to uncover the stereotypes, statistics and gender and societal norms that are present in our culture. I first started

After volunteering at a clinic in Guatemala and seeing the sexism that is so engrained into their culture, I decided to take a look at the U.S. healthcare system. I wanted to uncover the stereotypes, statistics and gender and societal norms that are present in our culture. I first started with the application process and the acceptance rates to medical school. I discovered that men are accepted to medical school at higher rates than women unless that man is deemed dangerous or foreign. I then moved on to the environment in medical school. Many women are subjected to snide comments or “bro talk” made to make them feel inferior. Men always graduate at higher rates than women, which could be because of the unwelcoming environment in medical school or the lack of female faculty chairs or mentors. After medical school, a new doctor must choose a specialty. Men gravitate towards specialties that focus on surgical work and large sums of money. Women tend to choose specialties that require a more soothing and caring environment. Women are more likely to pick specialties where there is a higher proportion of female residents. After specialties, I then explored the life of a doctor. Slightly over half of all doctors in the workforce are men and they make an average of $78,288 more per year than female physicians. Women are discriminated against if they become pregnant on the job and they are more likely to develop mental health issues. Female physicians are overall, more compassionate, rule abiding and patient-focused than their male counterparts but are not receiving the acknowledgments that they deserve. After delving into the U.S. healthcare system, I have realized that sexism in the workforce is blatantly apparent and is one of the outcomes of our patriarchal society. The only way we can make a change is to acknowledge the problem and come together as a society to combat the issue.
ContributorsPurkey, Caroline Rose (Author) / Collins, Michael (Thesis director) / Barry, Anne (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05