Matching Items (158)
Description
HIV/AIDS is the sixth leading cause of death worldwide and the leading cause of death among women of reproductive age living in low-income countries. Clinicians in industrialized nations monitor the efficacy of antiretroviral drugs and HIV disease progression with the HIV-1 viral load assay, which measures the copy number of HIV-1 RNA in blood. However, viral load assays are not widely available in sub-Saharan Africa and cost between 50-$139 USD per test on average where available. To address this problem, a mixed-methods approach was undertaken to design a novel and inexpensive viral load diagnostic for HIV-1 and to evaluate barriers to its adoption in a developing country. The assay was produced based on loop-mediated isothermal amplification (LAMP). Blood samples from twenty-one individuals were spiked with varying concentrations of HIV-1 RNA to evaluate the sensitivity and specificity of LAMP. Under isothermal conditions, LAMP was performed with an initial reverse-transcription step (RT-LAMP) and primers designed for HIV-1 subtype C. Each reaction generated up to a few billion copies of target DNA within an hour. Presence of target was detected through naked-eye observation of a fluorescent indicator and verified by DNA gel electrophoresis and real-time fluorescence. The assay successfully detected the presence of HIV in samples with a broad range of HIV RNA concentration, from over 120,000 copies/reaction to 120 copies/reaction. In order to better understand barriers to adoption of LAMP in developing countries, a feasibility study was undertaken in Tanzania, a low-income country facing significant problems in healthcare. Medical professionals in Northern Tanzania were surveyed for feedback regarding perspectives of current HIV assays, patient treatment strategies, availability of treatment, treatment priorities, HIV transmission, and barriers to adoption of the HIV-1 LAMP assay. The majority of medical providers surveyed indicated that the proposed LAMP assay is too expensive for their patient populations. Significant gender differences were observed in response to some survey questions. Female medical providers were more likely to cite stigma as a source problem of the HIV epidemic than male medical providers while males were more likely to cite lack of education as a source problem than female medical providers.
ContributorsSalamone, Damien Thomas (Author) / Jacobs, Bertram L (Thesis advisor) / Marsiglia, Flavio (Committee member) / Stout, Valerie (Committee member) / Johnson, Crista (Committee member) / Arizona State University (Publisher)
Created2011
Description
The objective of this project was to evaluate human factors based cognitive aids on endoscope reprocessing. The project stems from recent failures in reprocessing (cleaning) endoscopes, contributing to the spread of harmful bacterial and viral agents between patients. Three themes were found to represent a majority of problems: 1) lack of visibility (parts and tools were difficult to identify), 2) high memory demands, and 3) insufficient user feedback. In an effort to improve completion rate and eliminate error, cognitive aids were designed utilizing human factors principles that would replace existing manufacturer visual aids. Then, a usability test was conducted, which compared the endoscope reprocessing performance of novices using the standard manufacturer-provided visual aids and the new cognitive aids. Participants successfully completed 87.1% of the reprocessing procedure in the experimental condition with the use of the cognitive aids, compared to 46.3% in the control condition using only existing support materials. Twenty-five of sixty subtasks showed significant improvement in completion rates. When given a cognitive aid designed with human factors principles, participants were able to more successfully complete the reprocessing task. This resulted in an endoscope that was more likely to be safe for patient use.
ContributorsJolly, Jonathan D (Author) / Branaghan, Russell J (Thesis advisor) / Cooke, Nancy J. (Committee member) / Sanchez, Christopher (Committee member) / Arizona State University (Publisher)
Created2011
Description
Establishing a healthcare practice in the U. S. by a Mexican national involves many different steps at federal as well as state levels. The recent implementation of the Patient Protection and Affordable Care Act overhauls some requirements which include increased Medicaid eligibility as well as mandatory health insurance coverage. With these changes taking place over the next few years, the need for healthcare providers will expand. Consequently, I look into the requirements of establishing an urgent care practice in the state of Arizona. Given that Phoenix has a 40.8% Hispanic population and that the Affordable Care Act will increase the coverage of this demographic, it is the city of focus for my analysis. In order to make access to the Arizona healthcare market more impartial and accessible to Mexican entrepreneurs, changes need to be made to the certification process of medical physicians who graduated from Mexican universities. The general disadvantage of Mexican physicians as compared to their U. S. counterparts comes in the form of increased certification times and additional processes. An equal playing field will allow the ease in movement of medical physicians between the U. S. and Mexico which will help meet the increased demand over the next few years. From ownership to taxation and medical billing and coding, this analysis focuses on the many requirements needed to establish an urgent care in Arizona.
ContributorsIbarra, Joseph Anthony (Author) / Carlos, Velez-Ibanez (Thesis director) / Cruz-Torres, Maria (Committee member) / Barrett, The Honors College (Contributor) / W. P. Carey School of Business (Contributor)
Created2014-05
Description
Many manmade chemicals used in consumer products are ultimately washed down the drain and are collected in municipal sewers. Efficient chemical monitoring at wastewater treatment (WWT) plants thus may provide up-to-date information on chemical usage rates for epidemiological assessments. The objective of the present study was to extrapolate this concept, termed 'sewage epidemiology', to include municipal sewage sludge (MSS) in identifying and prioritizing contaminants of emerging concern (CECs). To test this the following specific aims were defined: i) to screen and identify CECs in nationally representative samples of MSS and to provide nationwide inventories of CECs in U.S. MSS; ii) to investigate the fate and persistence in MSS-amended soils, of sludge-borne hydrophobic CECs; and iii) to develop an analytical tool relying on contaminant levels in MSS as an indicator for identifying and prioritizing hydrophobic CECs. Chemicals that are primarily discharged to the sewage systems (alkylphenol surfactants) and widespread persistent organohalogen pollutants (perfluorochemicals and brominated flame retardants) were analyzed in nationally representative MSS samples. A meta-analysis showed that CECs contribute about 0.04-0.15% to the total dry mass of MSS, a mass equivalent of 2,700-7,900 metric tonnes of chemicals annually. An analysis of archived mesocoms from a sludge weathering study showed that 64 CECs persisted in MSS/soil mixtures over the course of the experiment, with half-lives ranging between 224 and >990 days; these results suggest an inherent persistence of CECs that accumulate in MSS. A comparison of the spectrum of chemicals (n=52) analyzed in nationally representative biological specimens from humans and MSS revealed 70% overlap. This observed co-occurrence of contaminants in both matrices suggests that MSS may serve as an indicator for ongoing human exposures and body burdens of pollutants in humans. In conclusion, I posit that this novel approach in sewage epidemiology may serve to pre-screen and prioritize the several thousands of known or suspected CECs to identify those that are most prone to pose a risk to human health and the environment.
ContributorsVenkatesan, Arjunkrishna (Author) / Halden, Rolf U. (Thesis advisor) / Westerhoff, Paul (Committee member) / Fox, Peter (Committee member) / Arizona State University (Publisher)
Created2013
Description
Critical infrastructures in healthcare, power systems, and web services, incorporate cyber-physical systems (CPSes), where the software controlled computing systems interact with the physical environment through actuation and monitoring. Ensuring software safety in CPSes, to avoid hazards to property and human life as a result of un-controlled interactions, is essential and challenging. The principal hurdle in this regard is the characterization of the context driven interactions between software and the physical environment (cyber-physical interactions), which introduce multi-dimensional dynamics in space and time, complex non-linearities, and non-trivial aggregation of interaction in case of networked operations. Traditionally, CPS software is tested for safety either through experimental trials, which can be expensive, incomprehensive, and hazardous, or through static analysis of code, which ignore the cyber-physical interactions. This thesis considers model based engineering, a paradigm widely used in different disciplines of engineering, for safety verification of CPS software and contributes to three fundamental phases: a) modeling, building abstractions or models that characterize cyberphysical interactions in a mathematical framework, b) analysis, reasoning about safety based on properties of the model, and c) synthesis, implementing models on standard testbeds for performing preliminary experimental trials. In this regard, CPS modeling techniques are proposed that can accurately capture the context driven spatio-temporal aggregate cyber-physical interactions. Different levels of abstractions are considered, which result in high level architectural models, or more detailed formal behavioral models of CPSes. The outcomes include, a well defined architectural specification framework called CPS-DAS and a novel spatio-temporal formal model called Spatio-Temporal Hybrid Automata (STHA) for CPSes. Model analysis techniques are proposed for the CPS models, which can simulate the effects of dynamic context changes on non-linear spatio-temporal cyberphysical interactions, and characterize aggregate effects. The outcomes include tractable algorithms for simulation analysis and for theoretically proving safety properties of CPS software. Lastly a software synthesis technique is proposed that can automatically convert high level architectural models of CPSes in the healthcare domain into implementations in high level programming languages. The outcome is a tool called Health-Dev that can synthesize software implementations of CPS models in healthcare for experimental verification of safety properties.
ContributorsBanerjee, Ayan (Author) / Gupta, Sandeep K.S. (Thesis advisor) / Poovendran, Radha (Committee member) / Fainekos, Georgios (Committee member) / Maciejewski, Ross (Committee member) / Arizona State University (Publisher)
Created2012
Description
The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Through a qualitative case study analysis of innovation implementation, a new framework of leadership was uncovered. This framework presented new characteristics of leaders that led to the successful implementation of an innovation. Characteristics uncovered included boundary spanning, risk taking, visioning, leveraging opportunity, adaptation, coordination of information flow, and facilitation. These characteristics describe how leaders throughout the system were able to influence information flow, relationships, connections, and organizational context to implement innovation.
ContributorsWeberg, Daniel Robert (Author) / Fluery, Julie (Thesis advisor) / Malloch, Kathy (Thesis advisor) / Porter-O'Grady, Timothy (Committee member) / Hagler, Debra (Committee member) / Arizona State University (Publisher)
Created2013
Description
Population growth and fresh water depletion challenge drinking water utilities. Surface water quality is impacted significantly by climate variability, human activities, and extreme events like natural disasters. Dissolved organic carbon (DOC) is an important water quality index and the precursor of disinfection by-products (DBPs) that varies with both hydrologic and anthropogenic factors. Granular activated carbon (GAC) is a best available technology for utilities to meet Stage 2 D/DBP rule compliance and to remove contaminants of emerging concern (CECs) (e.g., pharmaceutical, personal care products (PCPs), etc.). Utilities can operate GAC with more efficient and flexible strategies with the understanding of organic occurrence in source water and a model capable predicting DOC occurrence. In this dissertation, it was found that DOC loading significantly correlated with spring runoff and was intensified by dry-duration antecedent to first flush. Dynamic modeling based on reservoir management (e.g., pump-back operation) was established to simulate the DOC transport in the reservoir system. Additionally, summer water recreational activities were found to raise the level of PCPs, especially skin-applied products, in raw waters. GAC was examined in this dissertation for both carbonaceous and emerging nitrogenous DBP (N-DBP) precursors (i.e., dissolved organic nitrogen (DON)) removal. Based on the experimental findings, GAC preferentially removes UV254-absorbing material, and DOC is preferentially removed over DON which may be composed primarily of hydrophilic organic and results in the low affinity for adsorption by GAC. The presence of organic nitrogen can elevate the toxicity of DBPs by forming N-DBPs, and this could be a major drawback for facilities considering installation of a GAC adsorber owing to the poor removal efficiency of DON by GAC. A modeling approach was established for predicting DOC and DON breakthrough during GAC operation. However, installation of GAC adsorber is a burden for utilities with respect to operational and maintenance cost. It is common for utilities to regenerate saturated GAC in order to save the cost of purchasing fresh GAC. The traditional thermal regeneration technology for saturated GAC is an energy intensive process requiring high temperature of incineration. Additionally, small water treatment sites usually ship saturated GAC to specialized facilities for regeneration increasing the already significant carbon footprint of thermal regeneration. An innovative GAC regeneration technique was investigated in this dissertation for the feasibility as on-site water treatment process. Virgin GAC was first saturated by organic contaminant then regenerated in-situ by iron oxide nanocatalysts mixed with hydrogen peroxide. At least 70 % of adsorption capacity of GAC can be regenerated repeatedly for experiments using modeling compound (phenol) or natural organic matter (Suwannee River humic acid). The regeneration efficiency increases with increasing adsorbate concentration. Used-iron nanocatalysts can be recovered repeatedly without significant loss of catalytic ability. This in-situ regeneration technique provides cost and energy efficient solution for water utilities considering GAC installation. Overall, patterns were found for DOC and CEC variations in drinking water sources. Increasing concentrations of bulk (DOC and DON) and/or trace organics challenge GAC operation in utilities that have limited numbers of bed-volume treated before regeneration is required. In-situ regeneration using iron nanocatalysts and hydrogen peroxide provides utilities an alternative energy-efficient operation mode when considering installation of GAC adsorber.
ContributorsChiu, Chao-An (Author) / Westerhoff, Paul (Thesis advisor) / Rittmann, Bruce (Committee member) / Hristovski, Kiril (Committee member) / Arizona State University (Publisher)
Created2012
Description
In modern healthcare environments, there is a strong need to create an infrastructure that reduces time-consuming efforts and costly operations to obtain a patient's complete medical record and uniformly integrates this heterogeneous collection of medical data to deliver it to the healthcare professionals. As a result, healthcare providers are more willing to shift their electronic medical record (EMR) systems to clouds that can remove the geographical distance barriers among providers and patient. Even though cloud-based EMRs have received considerable attention since it would help achieve lower operational cost and better interoperability with other healthcare providers, the adoption of security-aware cloud systems has become an extremely important prerequisite for bringing interoperability and efficient management to the healthcare industry. Since a shared electronic health record (EHR) essentially represents a virtualized aggregation of distributed clinical records from multiple healthcare providers, sharing of such integrated EHRs may comply with various authorization policies from these data providers. In this work, we focus on the authorized and selective sharing of EHRs among several parties with different duties and objectives that satisfies access control and compliance issues in healthcare cloud computing environments. We present a secure medical data sharing framework to support selective sharing of composite EHRs aggregated from various healthcare providers and compliance of HIPAA regulations. Our approach also ensures that privacy concerns need to be accommodated for processing access requests to patients' healthcare information. To realize our proposed approach, we design and implement a cloud-based EHRs sharing system. In addition, we describe case studies and evaluation results to demonstrate the effectiveness and efficiency of our approach.
ContributorsWu, Ruoyu (Author) / Ahn, Gail-Joon (Thesis advisor) / Yau, Stephen S. (Committee member) / Huang, Dijiang (Committee member) / Arizona State University (Publisher)
Created2012
Description
ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the looming shortage of nurses, which has been linked to the physical demands and potential occupational hazards intrinsic to the profession; as well as to the graying of the nursing workforce who experiences gradual loss of strength and agility that accompanies aging as time in the career advances. In a hospital Emergency Department, the level of nursing physical fatigue can potentially reach its threshold in light of challenging workloads, scope of job assignments and demanding schedules. While in other safety-sensitive industries such as aviation and nuclear plants, similar concerns have been the object of systematic research and addressed with consequent regulations, just recently, the healthcare sector has been engaged in further investigations. This study proposed to explore the linkage between Emergency Department design-layout and nursing physical fatigue. It was expected that further understanding on this relationship would support evidence-based design propositions linking nursing wellness, job satisfaction, and performance to a higher quality of care and improved patient safety levels. To this end, data collection was performed during four weeks in a community-based hospital. A convenience sample of twenty-four eligible nurses was invited to participate in this two-part study. The first section consisted of the completion of a self-administered questionnaire, which assessed nurses' perception of the impact of working conditions on nursing physical fatigue. The second section included the monitoring, through the use of accelerometers, of nurses' actual activity intensity levels during three consecutive shifts. Among other findings, data demonstrated that nurses perceive several attributes or components of the built environment as potential contributors to physical fatigue. In addition, various operational practices and organizational protocols were linked to physical fatigue. Contrary to nurses' perception of physical fatigue, their actual physical activity levels fell mostly between sedentary or light intensity ranges. This paradox offers the opportunity for design interventions that, in alignment with operational practices and organizational protocols will enhance nurses' performance and improve nurses' retention.
ContributorsShakman, Karen (Author) / Bender, Diane (Thesis advisor) / Stein, Morris (Committee member) / Lamb, Gerri (Committee member) / Arizona State University (Publisher)
Created2011
Emerging Information Technology, Storage and Evaluation within Healthcare: A Discerning IMT Analysis
Description
The introduction of novel information technology within contemporary healthcare settings presents a critical juncture for the industry and thus lends itself to the importance of better understanding the impact of this emerging "health 2.0" landscape. Simply, how such technology may affect the healthcare system is still not fully realized, despite the ever-growing need to adopt it in order to serve a growing patient population. Thus, two pertinent questions are posed: is HIT useful and practical and, if so, what is the best way to implement it? This study examined the clinical implementation of specific instances of health information technology (HIT) so as to weigh its benefits and risks to ultimately construct a proposal for successful widespread adoption. Due to the poignancy of information analysis within HIT, Information Measurement Theory (IMT) was used to measure the effectiveness of current HIT systems as well as to elucidate improvements for future implementation. The results indicate that increased transparency, attention to patient-focused approaches and proper IT training will not only allow HIT to better serve the community, but will also decrease inefficient healthcare expenditure.
ContributorsMaietta, Myles Anthony (Author) / Kashiwagi, Dean (Thesis director) / Kashiwagi, Jacob (Committee member) / Barrett, The Honors College (Contributor) / Department of Psychology (Contributor) / School of Life Sciences (Contributor)
Created2015-05