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- Creators: Arizona State University
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
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
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
Description
The objective of this research is to understand how a set of systems, as defined by the business process, creates value. The three studies contained in this work develop the model of process-based automation. The model states that complementarities among systems are specified by handoffs in the business process. The model also provides theory to explain why entry systems, boundary spanning systems, and back-end control systems provide different impacts on process quality and cost. The first study includes 135 U. S. acute care hospitals. The study finds that hospitals which followed an organizational pattern of process automation have better financial outcomes. The second study looks in more depth at where synergies might be found. It includes 341 California acute care hospitals over 11 years. It finds that increased costs and increase adverse drug events are associated with increased automation discontinuity. Further, the study shows that automation in the front end of the process has a more desirable outcome on cost than automation in the back end of the process. The third study examines the assumption that the systems are actually used. It is a cross-sectional analysis of over 2000 U. S. hospitals. This study finds that system usage is a critical factor in realizing benefits from automating the business process. The model of process-based automation has implications for information technology decision makers, long-term automation planning, and for information systems research. The analyses have additional implications for the healthcare industry.
ContributorsSpaulding, Trent Joseph (Author) / Santanam, Raghu T (Thesis advisor) / Vinze, Ajay (Committee member) / Furukawa, Michael F. (Committee member) / Arizona State University (Publisher)
Created2011
Description
This study investigates how the patient-provider relationship between lesbian, gay, and bisexual women and their healthcare providers influences their access to, utilization of, and experiences within healthcare environments. Nineteen participants, ages 18 to 34, were recruited using convenience and snowball sampling. Interviews were conducted inquiring about their health history and their experiences within the healthcare system in the context of their sexual orientation. The data collected from these interviews was used to create an analysis of the healthcare experiences of those who identify as queer. Although the original intention of the project was to chronicle the experiences of LGB women specifically, there were four non-binary gender respondents who contributed interviews. In an effort to not privilege any orientation over another, the respondents were collectively referred to as queer, given the inclusive and an encompassing nature of the term. The general conclusion of this study is that respondents most often experienced heterosexism rather than outright homophobia when accessing healthcare. If heterosexism was present within the healthcare setting, it made respondents feel uncomfortable with their providers and less likely to inform them of their sexuality even if it was medically relevant to their health outcomes. Gender, race, and,socioeconomic differences also had an effect on the patient-provider relationship. Non-binary respondents acknowledged the need for inclusion of more gender options outside of male or female on the reporting forms often seen in medical offices. By doing so, medical professionals are acknowledging their awareness and knowledge of people outside of the binary gender system, thus improving the experience of these patients. While race and socioeconomic status were less relevant to the context of this study, it was found that these factors have an affect on the patient-provider relationship. There are many suggestions for providers to improve the experiences of queer patients within the healthcare setting. This includes nonverbal indications of acknowledgement and acceptance, such as signs in the office that indicate it to be a queer friendly space. This will help in eliminating the fear and miscommunication that can often happen when a queer patient sees a practitioner for the first time. In addition, better education on medically relevant topics to queer patients, is necessary in order to eliminate disparities in health outcomes. This is particularly evident in trans health, where specialized education is necessary in order to decrease poor health outcomes in trans patients. Future directions of this study necessitate a closer look on how race and socioeconomic status have an effect on a queer patient's relationship with their provider.
ContributorsRajan, Sindhu (Co-author) / Bradley, Arianna (Co-author) / Larson, Michelle (Co-author) / Alvarado, Aimee (Co-author) / Ingram-Waters, Mary (Thesis director) / Arnold, Michelle (Committee member) / School of Molecular Sciences (Contributor) / School of Social Transformation (Contributor) / T. Denny Sanford School of Social and Family Dynamics (Contributor) / College of Public Service and Community Solutions (Contributor) / School of Human Evolution and Social Change (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
Medical policies, practices, and definitions do not exist solely in the clinical realm; they show up in the lived experiences of patients. This research examines how people with the chronic illness called myalgic encephalomyelitis (ME) define their own illness experiences. They have situated knowledge about their illness onset, search for care, and clinical encounters. Their knowledge complicates and challenges the existing norms in clinical practice and medical discourse, as the experience of searching for care with ME reveals weaknesses in a system that is focused on acute care. Patient narratives reveal institutional patterns that obstruct access to medical care, such as disbelief from clinicians and lack of training in chronic illness protocols. They also reveal patterns in physician behavior that indicate the likelihood of receiving effective care. These patient narratives serve as a basis for continued examination of ME as well as further reconstruction of medical practice and procedure.
ContributorsCutler, Carmen (Author) / Oliverio, Annamaria (Thesis advisor) / Mann, Annika (Thesis advisor) / Behl, Natasha (Committee member) / Arizona State University (Publisher)
Created2019
Description
This research seeks to better understand the current state of US healthcare FM industry hiring practices from colleges and universities to identify potential employment barriers into healthcare FM and interventions to help overcome them. Two national surveys were distributed to healthcare facility managers and directors to collect quantifiable information on healthcare organizations, hiring practices from FM academic programs, individual demographics, and opinions of FM college graduates. Designated survey respondents were also contacted for phone interviews. Additionally, a Delphi method was used for this research to draw upon the collective knowledge and experience of 13 experts over three iterative rounds of input.
Results indicate that the healthcare FM industry is hiring very few college interns and new college graduates for entry-level management jobs. Strong homogeneousness demographics, backgrounds, and paths of entry among existing healthcare FM professionals has created an industry bias against candidates attempting to enter healthcare FM from non-traditional sources. The healthcare FM industry’s principal source for new talent comes from building trade succession within healthcare organizations. However, continuing to rely on building tradespersons as the main path of entry into the healthcare FM industry may prove problematic. Most existing healthcare facility managers and directors will be retiring within 10 years, yet it is taking more than 17 years of full-time work experience to prepare building tradespersons to assume these roles.
New college graduates from FM academic programs are a viable recruitment source for new talent into healthcare FM as younger professionals are commonly entering the healthcare FM through the path of higher education. Although few new college graduates enter the healthcare FM industry, they are experiencing similar promotion timeframes compared to other candidate with many years of full-time work experience. Unfamiliarity with FM academic programs, work experience requirements, limited entry-level jobs within small organizations, low pay, and a limited exposure to healthcare industry topics present challenges for new FM college graduates attempting to enter the healthcare FM industry. This study shows that gaps indeed exist in student learning outcomes for a comprehensive healthcare FM education; key technical topics specific to the healthcare industry are not being addressed by organizations accrediting construction and facility management academic programs. A framework is proposed for a comprehensive healthcare FM education including accreditation, regulatory and code compliance, infection control, systems in healthcare facilities, healthcare construction project management and methods, and clinical operations and medical equipment. Interestingly, academics in the field of FM generally disagree with industry professionals that these technical topics are important student learning outcomes. Consequently, FM academics prefer to teach students general FM principles with the expectation that specific technical knowledge will be gained in the workplace after graduation from college. Nevertheless, candidates attempting to enter healthcare FM without industry specific knowledge are disadvantaged due to industry perceptions and expectations. University-industry linkage must be improved to successfully attract students into the field of healthcare FM and establish colleges and universities as a sustainable recruitment source in helping address FM attrition.
This paper is valuable in establishing the current state of the US healthcare industry’s hiring practices from FM academic programs and identifying major barriers of entering the healthcare FM industry for new FM college graduates. Findings facilitate development of interventions by healthcare organizations and universities to further open FM academic programs as a sustainable source of new talent to help address healthcare FM attrition, including a healthcare FM education framework to elucidate college student learning outcomes for successful employment in healthcare FM. These student learning outcomes provide a framework for both the healthcare industry and academia in preparing future facility managers.
Results indicate that the healthcare FM industry is hiring very few college interns and new college graduates for entry-level management jobs. Strong homogeneousness demographics, backgrounds, and paths of entry among existing healthcare FM professionals has created an industry bias against candidates attempting to enter healthcare FM from non-traditional sources. The healthcare FM industry’s principal source for new talent comes from building trade succession within healthcare organizations. However, continuing to rely on building tradespersons as the main path of entry into the healthcare FM industry may prove problematic. Most existing healthcare facility managers and directors will be retiring within 10 years, yet it is taking more than 17 years of full-time work experience to prepare building tradespersons to assume these roles.
New college graduates from FM academic programs are a viable recruitment source for new talent into healthcare FM as younger professionals are commonly entering the healthcare FM through the path of higher education. Although few new college graduates enter the healthcare FM industry, they are experiencing similar promotion timeframes compared to other candidate with many years of full-time work experience. Unfamiliarity with FM academic programs, work experience requirements, limited entry-level jobs within small organizations, low pay, and a limited exposure to healthcare industry topics present challenges for new FM college graduates attempting to enter the healthcare FM industry. This study shows that gaps indeed exist in student learning outcomes for a comprehensive healthcare FM education; key technical topics specific to the healthcare industry are not being addressed by organizations accrediting construction and facility management academic programs. A framework is proposed for a comprehensive healthcare FM education including accreditation, regulatory and code compliance, infection control, systems in healthcare facilities, healthcare construction project management and methods, and clinical operations and medical equipment. Interestingly, academics in the field of FM generally disagree with industry professionals that these technical topics are important student learning outcomes. Consequently, FM academics prefer to teach students general FM principles with the expectation that specific technical knowledge will be gained in the workplace after graduation from college. Nevertheless, candidates attempting to enter healthcare FM without industry specific knowledge are disadvantaged due to industry perceptions and expectations. University-industry linkage must be improved to successfully attract students into the field of healthcare FM and establish colleges and universities as a sustainable recruitment source in helping address FM attrition.
This paper is valuable in establishing the current state of the US healthcare industry’s hiring practices from FM academic programs and identifying major barriers of entering the healthcare FM industry for new FM college graduates. Findings facilitate development of interventions by healthcare organizations and universities to further open FM academic programs as a sustainable source of new talent to help address healthcare FM attrition, including a healthcare FM education framework to elucidate college student learning outcomes for successful employment in healthcare FM. These student learning outcomes provide a framework for both the healthcare industry and academia in preparing future facility managers.
ContributorsCall, Steven Alan (Author) / Sullivan, Kenneth (Thesis advisor) / Hurtado, Kristen (Committee member) / Standage, Richard (Committee member) / Arizona State University (Publisher)
Created2019