An adaptive physiology-aware communication framework for distributed medical cyber physical systems

For emergency medical cyber-physical systems, enhancing the safety and effectiveness of patient care, especially in remote rural areas, is essential. While the doctor to patient ratio in the United States is 30 to 10,000 in large metropolitan areas, it is only 5 to 10,000 in most rural areas; and the highest death rates are often found in the most rural counties. Use of telecommunication technologies can enhance effectiveness and safety of emergency ambulance transport of patients from rural areas to a regional center hospital. It enables remote monitoring of patients by the physician experts at the tertiary center. There are critical times during transport when physician experts can provide vital assistance to the ambulance Emergency Medical Technicians (EMT) to associate best treatments. However, the communication along the roads in rural areas can range irregularly from 4G to low speed 2G links, including some parts of routes with cellular network communication breakage. This unreliable and limited communication bandwidth together with the produced mass of clinical data and the many information exchanges pose a major challenge in real-time supervision of patients. In this study, we define the notion of distributed emergency care, and propose a novel adaptive physiology-aware communication framework which is aware of the patient condition, the underlying network bandwidth, and the criticality of clinical data in the context of the specific diseases. Using the concept of distributed medical CPS models, we study the semantics relation of communication Quality of Service (QoS) with clinical messages, criticality of clinical data, and an ambulance's undertaken route all in a disease-aware manner. Our proposed communication framework is aimed to enhance remote monitoring of acute patients during ambulance transport from a rural hospital to a regional center hospital. We evaluate the components of our framework through various experimentation phases including simulation, instrumentation, real-world profiling, and validation

Analyse de l’implantation d’un plan d’action pour le renforcement du rôle professionnel de la sage-femme dans le Royaume du Maroc

Dans le cadre d’une stratégie nationale visant les objectifs du Millénaire pour le développement 4 et 5 au Maroc - réduire la mortalité maternelle et infantile -, un plan d’action a été développé au sein des trois systèmes (socioculturel, éducationnel, disciplinaire) dans lesquels évolue un rôle professionnel de la santé et ce, pour renforcer le rôle professionnel de la sage-femme. La présente thèse vise à évaluer le niveau d’implantation du plan d’action et à comprendre les facteurs contextuels ayant affecté son implantation et susceptibles d’empêcher l’atteinte de ses effets. Le cadre conceptuel adopté dérive du modèle de Hatem-Asmar (1997) concernant l’interaction entre les systèmes éducationnel, disciplinaire et socioculturel pour changer un rôle professionnel de la santé; et le cadre de Damschroder et al. (2009) pour l’analyse de l’implantation d’une intervention en santé. Le devis est une étude de cas unique à trois niveaux d’analyse. Les données sont recueillies à partir de multiples sources de données : 11 entrevues individuelles semi-structurées, 20 groupes de discussion, observations d’activités de formation, analyse de documents. Les résultats ont montré des déficits notables au niveau de l’implantation. Seize barrières et sept facilitateurs ont été catégorisés sous les construits du cadre de Damschroder et al. (2009) et sous les dimensions des trois systèmes. Un alignement inadéquat entre les dimensions (valeurs, méthodes, acteurs et finalités) du système socioculturel et celles (valeurs, méthodes, acteurs) des systèmes éducationnel et disciplinaire d’une part, avec le plan d’action d’autre part empêche son implantation globale. La structure bureaucratique et le manque de préparation du système socioculturel ont constitué les barrières les plus influentes sur: la diffusion de l’information; l’implication des acteurs du terrain dans le processus; et l’état de préparation du système éducationnel. Les principaux facilitateurs étaient : les valeurs promues à l’égard des droits humains et le mouvement politique pour renforcer le rôle professionnel de la sage-femme et réduire la mortalité maternelle. Quant au plan, il a été perçu comme étant bénéfique mais complexe et émanant d’une source externe. Les résultats mettent l’accent sur la nécessité de contourner les barrières identifiées dans les trois systèmes afin d’obtenir des contextes propices à la production des effets. Par ailleurs, les résultats ont soulevé aussi sept barrières qui risquent de compromettre l’atteinte des effets désirés. Elles concernent: le cadre légal, les représentations sociales et le support médiatique au niveau du système socioculturel; le réseautage et les mécanismes de communication, les caractéristiques liées au rôle, à l’environnement de pratique, et le niveau de préparation du système disciplinaire. Notre recherche confirme qu’un changement visant le système éducationnel isolément représente une vision réductrice pour le renforcement du rôle des sages-femmes. Une combinaison des conditions contextuelles favorables au niveau des dimensions des trois systèmes est requise pour atteindre le but de la stratégie gouvernementale, soit fournir des sages-femmes qualifiées selon les normes globales de la Confédération Internationale des sages-femmes, capables d’offrir des soins de qualité en santé de la reproduction qui permettront de contribuer à réduire la mortalité maternelle et néonatale.As part of a national strategy for reaching the Millennium Development Goals 4 and 5 in Morocco – to reduce maternal and infant mortality - an action plan covering the three systems (socio-cultural, educational, disciplinary) in which evolves a health professional role was developed in order to strengthen the midwifery professional role. This thesis aims to assess the level of implementation of the action plan and to understand the contextual factors affecting its implementation and that may prevent reaching the targeted outcomes. We used a conceptual framework that builds on Hatem-Asmar’s model regarding the interaction between the socio-cultural, educational and disciplinary systems to change a health professional role; and on the Consolidated Framework for Implementation Research (CFIR) for the implementation analysis of a health intervention. A single case study design with three levels of analysis was chosen for this thesis. The data were collected through multiple data sources: 11 individual semi-structured interviews, 20 focus groups, observations of training activities, analysis of documents. The results showed a significant deficit in the implementation. Sixteen barriers and seven facilitators encountered during the implementation were categorized into the four system’s dimensions. Misalignment between the dimensions (values, methods, actors and targets) of the socio-cultural system and those (values, methods, actors) of the educational and disciplinary systems on the one hand, and with the action plan on the other hand, prevent its global implementation. The bureaucratic structure and lack of readiness of the socio-cultural system were among the most influential barriers on: diffusion of information; involvement of key actors in the process, readiness of the educational system. The main facilitators were the values promoted with respect to human rights, and the political movement to strengthen midwives’ professional role and to reduce maternal mortality. The plan was perceived as beneficial but complex and externally driven. The results emphasize the need to overcome the barriers identified in the three systems in order to obtain contextual conditions favorable to achieve outcomes. In addition, seven barriers were identified in the analysis that may compromise the achievement of the targeted outcomes. They relate to the: legal framework, social representations and media support at the socio-cultural system; and the practice environment, networks and communication mechanisms, characteristics related to the role and the readiness of the disciplinary system. Our research confirms that conducting a change in the educational system represents a partially focused view for strengthening the midwives’ role. A combination of favorable contextual conditions at the dimensions of the three systems is required to achieve the goal of the government's strategy which is to provide qualified midwives according to the International Confederation of Midwives global standards for midwifery, able to provide quality reproductive health care, and to contribute to reducing maternal and neonatal mortality

Learning plan networks in conversational video games

Thesis (S.M.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2007.Includes bibliographical references (p. 121-123).We look forward to a future where robots collaborate with humans in the home and workplace, and virtual agents collaborate with humans in games and training simulations. A representation of common ground for everyday scenarios is essential for these agents if they are to be effective collaborators and communicators. Effective collaborators can infer a partner's goals and predict future actions. Effective communicators can infer the meaning of utterances based on semantic context. This thesis introduces a computational cognitive model of common ground called a Plan Network. A Plan Network is a statistical model that provides representations of social roles, object affordances, and expected patterns of behavior and language. I describe a methodology for unsupervised learning of a Plan Network using a multiplayer video game, visualization of this network, and evaluation of the learned model with respect to human judgment of typical behavior. Specifically, I describe learning the Restaurant Plan Network from data collected from over 5,000 players of an online game called The Restaurant Game.by Jeffrey David Orkin.S.M

Exploring women and adolescent girls’ attitudes and experiences with child and maternal health in Uganda

106 leaves : illustrations, map ; 29 cmIncludes abstract and appendices.Includes bibliographical references (leaves 64-82).This research aims to better understand women and adolescent girls’ attitudes and experiences towards child and maternal health and education. It examines education through formal health services and education, as well as informal, community-led initiatives helping to improve child and maternal health and education outreach. Educating young women about communicable and non-communicable diseases and the health risks involved in childbirth and neonatal development will help women make informed decisions, which should ultimately reduce mortality. Thus if young women decide to become pregnant, the goal is that they have the information and tools to better care for their own health and sanitation during pregnancy, as well as during newborn development

Developing Learning System in Pesantren The Role of ICT

According to Krashen's affective filter hypothesis, students who are highly motivated have a strong sense of self, enter a learning context with a low level of anxiety, and are much more likely to become successful language acquirers than those who do not. Affective factors, such as motivation, attitude, and anxiety, have a direct impact on foreign language acquisition. Horwitz et al. (1986) mentioned that many language learners feel anxious when learning foreign languages. Thus, this study recruits 100 college students to fill out the Foreign Language Classroom Anxiety Scale (FLCAS) to investigate language learning anxiety. Then, this study designs and develops an affective tutoring system (ATS) to conduct an empirical study. The study aims to improve students’ learning interest by recognizing their emotional states during their learning processes and provide adequate feedback. It is expected to enhance learners' motivation and interest via affective instructional design and then improve their learning performance

Promoting Andean children's learning of science through cultural and digital tools

Conference Theme: To see the world and a grain of sand: Learning across levels of space, time, and scaleIn Peru, there is a large achievement gap in rural schools. In order to overcome this problem, the study aims to design environments that enhance science learning through the integration of ICT with cultural artifacts, respecting the Andean culture and empower rural children to pursue lifelong learning. This investigation employs the Cultural-Historical Activity Theory (CHAT) framework, and the Design-Based Research (DBR) methodology using an iterative process of design, implementation and evaluation of the innovative practice.published_or_final_versio

Model to strengthen maternal healthcare service delivery in Gauteng Province, South Africa

Text in English with abstract and keywords in English and SetswanaMaternal healthcare service delivery influences the obstetric outcomes of the women in their perinatal period, including six weeks after childbirth. It is in that regard that the purpose of this study was to determine the nature and extent of maternal healthcare service delivery in Gauteng Province, South Africa. The research study adopted a three-phased sequential exploratory mixed-methods research (MMR) design approach, involving qualitative and quantitative data collection, and convergent data analysis respectively. The study population comprised midwives working at the four selected public hospitals in Gauteng Province, as well as the perinatal women accessing their maternal health at the self-same public hospitals. Due to the multiple data collection instruments applied, the study concomitantly adopted different sampling strategies involving purposive, maximum variation, stratified random, and convenience sampling. Finally, a sample size of 392 was obtained, consisting of 105 midwives and 287 perinatal women. Qualitative data collection was implemented through focus group discussions (FGDs), in-depth interviews and documentary analysis. The quantitative data collection was facilitated through checklists and structured questionnaires. Both thematic and content data analysis were applied in the study’s qualitative phase. For quantitative data analysis, the Statistical Package for Social Sciences (SPSS), Version 27 and STATA 16 computer programs were utilised. The study findings revealed diverse assumptions, statements and beliefs that urge for a reconfiguration of current domination and authority practices over women and other vulnerable groups. Furthermore, the study found that five dominant literature-based themes were still observable in the practical environment of midwives and their patients in the maternity wards. These are: individual factors, interpersonal relations, organisational challenges; as well as community and policy and government factors. The researcher’s developed model was based on the actual findings in the current study and was subsequently evaluated by the midwifery experts. The purpose of the model was to contribute towards improvements in maternal healthcare service delivery for the reduction of maternal mortality.Thebolelo ya ditirelo tsa pelegi e na le tlhotlheletso e kgolo mo dipholong tsa pelegi mo basading ka nako ya boimane le botsetse jwa bone go fitlha dikgwedi di le thataro. Mo ntlheng eno, maitlhomo a thuto e, ke go batlisisa gore ditirelo tsa pholo mo basading ba porofense ya Gauteng – Aferika Borwa ke tsa mofuta ofe le go leba kamano ya tsone Dipatlisiso tsa thuto e, di di dirisitse magato a le mararo a sequential exploratory mixed method, a akaretsang mekgwa ya kokoantsha tshedimosetso ka qualitative, le quantitative le go kopantsha tshedimosetso ka go latelana jalo. Tshedimosetso e tswa mo setlhopheng sa baoki ba ba katiseditsweng pelegi e bile ba dira, le basadi ba ba leng mo nakong ya pelegi ba tlhoka tlhokomelo mo dipataleng tsa puso tse nne (04) mo porofenseng ya Gauteng. Ka ntlha ya methale e e fapaneng ya go kokoanya tshedimosetso, mmatlisisi o ne a dirisa purposive, maximum variation, stratified random, le convenience sampling. Ka jalo, o ne a feleletsa ka palo ya bannaleseabe ba le 392, e e akaretsang ba belegisi ba le 105 and basadi ba le 287. Kokoantsha tshedimosetso ya qualitative e ne ya dirisa dipuisano tsa ditlhopha le tsa bongwe le go le tlhatlhoba ditokumente. Mme, lenaane and foromo ya dipotso tsone di ne tsa dirisiwa mo tshobokanyo ya tshedimosetso ya quantitative. Go sekaseka ga di teng tsa qualitative go direlwe ka setshwantsho sa thematic le content, fa Statistical Package ya Social Sciences (SPSS), kgaolo ya 27 le STATA 16 porokeramo ya khomphuta di dirisitswe mo quantitative. Dipholo tsa thuto di bontsha thulaganyo ya maatla a ditumelo tse di faroganeng mo ntlheng ya dipegelo tsa basadi. Go bonagala ditheme di le tlhano (05) go tswa mo dibukeng le mo dipuisanong le babelegisi le basadi mo dipateleng tsa bone. Ditheme tse, di bontsha mabaka a a latelang: mabaka a motho ka esi, tirisano mmogo, thulaganyo ya tsamaiso mo tirong, tsabosetshaba, taolo le tsamaiso. Kwa bofelong, mmatlisisi o ne a tlhoma sekao se se tshegetsang babelegising le basadi mo leetong la pelegi, e bile sekao se se ne sa tlhotlhwafatswa ke baitsaanape mo lefapheng la tsa boimana. Leano la sekao se, ke matlafatsa ditirelo tsa basadi le pelegi ka maitlhomo a fokotsa dintsho tse di amanang le pelegi.Health StudiesPh. D. (Nursing Sciences

From worry to hope : an ethnography of midwife – woman interactions in the antenatal appointment

Better outcomes for mother and baby observed in 'midwifery continuity of carer' programmes are attributed to positive midwife-woman relationships formed within these models, but this effect is not fully understood. Like midwife-led care, continuity of midwifery carer in Australia continues not to be seen as mainstream. To advocate for and better understand this continuity of carer model, this study used video ethnography framed by feminism and a critical approach. Midwife-woman interactions in a number of late pregnancy antenatal appointments were observed and filmed. These were at two Sydney hospitals with either the midwifery continuity of carer programme or in standard maternity care. Focus groups and interviews were undertaken. Thematic and content analysis techniques were used. Worry was a common feature of the antenatal appointment. It reflects the worry pregnant women report: worry about pregnancy, their baby, uncertainty about birth and transition to motherhood. 'Dysfunctional' or 'iatrogenic' worry occurred with system-focused midwives invested in standardised/medicalised tasks, whereas 'functional' worry occurred with woman-centred midwives invested in the woman. Hope creation was also seen, although less frequently. It occurred when worry was moderated and linked with adaptation of standardised and medicalised appointment factors, including environment, time, and midwife investment (how she interacted with the woman). Regardless of where they worked, some midwives were 'adaptive experts', but in most instances the midwives in continuity had greater opportunity to adapt. This adaptation resulted in midwife-woman interactions being bidirectional and shared, with discussing and storytelling taking place, rather than one-way midwife telling. These shared interactions created connection, or reflected the connection created by continuity of carer. This study showed the benefit of the midwifery continuity of carer programme. It provided opportunity for midwives to adapt, worry was moderated, and women appeared more hopeful. Being more hopeful may enable women to better manage their labours and parenting, creating these improved outcomes