An Affordable Portable Obstetric Ultrasound Simulator for Synchronous and Asynchronous Scan Training

The increasing use of Point of Care (POC) ultrasound presents a challenge in providing efficient training to new POC ultrasound users. In response to this need, we have developed an affordable, compact, laptop-based obstetric ultrasound training simulator. It offers freehand ultrasound scan on an abdomen-sized scan surface with a 5 degrees of freedom sham transducer and utilizes 3D ultrasound image volumes as training material. On the simulator user interface is rendered a virtual torso, whose body surface models the abdomen of a particular pregnant scan subject. A virtual transducer scans the virtual torso, by following the sham transducer movements on the scan surface. The obstetric ultrasound training is self-paced and guided by the simulator using a set of tasks, which are focused on three broad areas, referred to as modules: 1) medical ultrasound basics, 2) orientation to obstetric space, and 3) fetal biometry. A learner completes the scan training through the following three steps: (i) watching demonstration videos, (ii) practicing scan skills by sequentially completing the tasks in Modules 2 and 3, with scan evaluation feedback and help functions available, and (iii) a final scan exercise on new image volumes for assessing the acquired competency. After each training task has been completed, the simulator evaluates whether the task has been carried out correctly or not, by comparing anatomical landmarks identified and/or measured by the learner to reference landmark bounds created by algorithms, or pre-inserted by experienced sonographers. Based on the simulator, an ultrasound E-training system has been developed for the medical practitioners for whom ultrasound training is not accessible at local level. The system, composed of a dedicated server and multiple networked simulators, provides synchronous and asynchronous training modes, and is able to operate with a very low bit rate. The synchronous (or group-learning) mode allows all training participants to observe the same 2D image in real-time, such as a demonstration by an instructor or scan ability of a chosen learner. The synchronization of 2D images on the different simulators is achieved by directly transmitting the position and orientation of the sham transducer, rather than the ultrasound image, and results in a system performance independent of network bandwidth. The asynchronous (or self-learning) mode is described in the previous paragraph. However, the E-training system allows all training participants to stay networked to communicate with each other via text channel. To verify the simulator performance and training efficacy, we conducted several performance experiments and clinical evaluations. The performance experiment results indicated that the simulator was able to generate greater than 30 2D ultrasound images per second with acceptable image quality on medium-priced computers. In our initial experiment investigating the simulator training capability and feasibility, three experienced sonographers individually scanned two image volumes on the simulator. They agreed that the simulated images and the scan experience were adequately realistic for ultrasound training; the training procedure followed standard obstetric ultrasound protocol. They further noted that the simulator had the potential for becoming a good supplemental training tool for medical students and resident doctors. A clinic study investigating the simulator training efficacy was integrated into the clerkship program of the Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center. A total of 24 3rd year medical students were recruited and each of them was directed to scan six image volumes on the simulator in two 2.5-hour sessions. The study results showed that the successful scan times for the training tasks significantly decreased as the training progressed. A post-training survey answered by the students found that they considered the simulator-based training useful and suitable for medical students and resident doctors. The experiment to validate the performance of the E-training system showed that the average transmission bit rate was approximately 3-4 kB/s; the data loss was less than 1% and no loss of 2D images was visually detected. The results also showed that the 2D images on all networked simulators could be considered to be synchronous even though inter-continental communication existed

Data-Driven Synthesis and Evaluation of Syntactic Facial Expressions in American Sign Language Animation

Technology to automatically synthesize linguistically accurate and natural-looking animations of American Sign Language (ASL) would make it easier to add ASL content to websites and media, thereby increasing information accessibility for many people who are deaf and have low English literacy skills. State-of-art sign language animation tools focus mostly on accuracy of manual signs rather than on the facial expressions. We are investigating the synthesis of syntactic ASL facial expressions, which are grammatically required and essential to the meaning of sentences. In this thesis, we propose to: (1) explore the methodological aspects of evaluating sign language animations with facial expressions, and (2) examine data-driven modeling of facial expressions from multiple recordings of ASL signers. In Part I of this thesis, we propose to conduct rigorous methodological research on how experiment design affects study outcomes when evaluating sign language animations with facial expressions. Our research questions involve: (i) stimuli design, (ii) effect of videos as upper baseline and for presenting comprehension questions, and (iii) eye-tracking as an alternative to recording question-responses from participants. In Part II of this thesis, we propose to use generative models to automatically uncover the underlying trace of ASL syntactic facial expressions from multiple recordings of ASL signers, and apply these facial expressions to manual signs in novel animated sentences. We hypothesize that an annotated sign language corpus, including both the manual and non-manual signs, can be used to model and generate linguistically meaningful facial expressions, if it is combined with facial feature extraction techniques, statistical machine learning, and an animation platform with detailed facial parameterization. To further improve sign language animation technology, we will assess the quality of the animation generated by our approach with ASL signers through the rigorous evaluation methodologies described in Part I

From start to finish: Examining the interplay of reasoned action theory and constructivism as they mutually inform an instructional development effort

Thesis (PhD) - Indiana University, School of Education, 2007This effort examined the interplay of reasoned action theory and constructivist epistemology as they mutually inform an instructional development effort to decrease the prevalence of pressure ulcers and their associated sequelae in home health care. The effort is framed by the point of view, drawn from health behavior theory, that, barring external barriers, behavior occurs when people know what to do, know how to do it, and, in fact, want to do it. Moreover, in terms of wanting to do something, behavior can be predicted from people's intentions to engage in the behavior, attitudes toward the behavior, perceived norms regarding the behavior, and perceived control over the behavior. This framework becomes richer when behavior and behavioral change are considered from an epistemological perspective that views individuals as active makers of meaning, as creators of personal stories. These dynamic personal narratives are influenced by experience and in turn influence interpretation of experience; they guide behavior, and they provide an explanation for it. From this perspective, for behavior to be understood, and behavior change to be fostered, researchers and developers need to find ways to understand, connect with, and influence personal narratives. Guided by reasoned action theory, beliefs and associated psychosocial constructs regarding pressure ulcer preventive care were determined through elicitation and survey studies among home healthcare providers. This data, along with factual and procedural objectives identified in conjunction with subject matter experts, was used within a constructivist framework to inform the design of an instructional video. The video was evaluated in a between-within design with multiple dependent variables. Significant differences in learning were observed, with those viewing the video demonstrating greater gains on measures of knowledge, on multivariate composite of psychosocial variables, and on perceived control. No differences in intentions, attitudes, or perceived norms were observed. Those viewing the video rated it highly on measures of consumer satisfaction. The results of each stage of the effort are discussed individually and overall. The roles of reasoned action theory and the constructivist epistemological framework are discussed individually and as they mutually affect one another. Implications for other instructional intervention efforts are drawn

Seventh Annual Workshop on Space Operations Applications and Research (SOAR 1993), volume 2

This document contains papers presented at the Space Operations, Applications and Research Symposium (SOAR) Symposium hosted by NASA/Johnson Space Center (JSC) and cosponsored by NASA/JSC and U.S. Air Force Materiel Command. SOAR included NASA and USAF programmatic overviews, plenary session, panel discussions, panel sessions, and exhibits. It invited technical papers in support of U.S. Army, U.S. Navy, Department of Energy, NASA, and USAF programs in the following areas: robotics and telepresence, automation and intelligent systems, human factors, life support, and space maintenance and servicing. SOAR was concerned with Government-sponsored research and development relevant to aerospace operations

Mapping Communicative Activity: A CHAT Approach to Design of Pseudo- Intelligent Mediators for Augmentative and Alternative Communication (AAC)

The development of AAC technologies is of critical importance to the many people who are unable to speak intelligibly (or at all) due to a communication disorder, and to their many everyday interlocutors. Advances in digital technologies have revolutionized AAC, leading to devices that can “speak for” such individuals as aptly as it is illustrated in the case of the world famous physicist, Stephen Hawking. However, given their dependence on prefabricated language (and constant management by teams of people), current AAC devices are very limited in their ability to mediate everyday interactions. We argue here that the limits of AAC are firstly theoretical — grounded in prosthetic models that imagine AAC devices as replacements for damaged body parts and in transmission models of language production as communication. In contrast, our multidisciplinary team aims to design pseudo-intelligent mediators (PIMs) of communication by blending strengths of human mediators with features of current AAC technologies. To inform the design process, we report here our initial situated studies focusing on the distributed nature of everyday communicative activities conducted with potential AAC/PIM users. Our analysis focuses on the discursive alignments of these participants and their interlocutors, attending especially to the various ways their personal aides function as human mediators. Specifically, we focus on mapping the communicative activity around each of these differently-abled individuals (the majority of whom have cerebral palsy) as they navigated a university campus. We profile the everyday interactional patterns within functional systems and across settings, and present close discourse analysis of one interaction to highlight the diverse roles personal aides adopted in mediating communication. Finally, we argue that attending to differently “abled” bodies as they move through everyday communicative environments pushes CHAT to more fully theorize physicality, individual mobilities, and the roles of bodies in the laminated assemblage of functional systems.

Evaluating Digital Health Technologies to Advance Parkinson's Disease Care

Parkinson’s disease (PD) is a common progressive neurological disorder characterised by a complex range of motor and non-motor symptoms (NMS). Current PD service provision does not meet the needs of patients, and puts pressure on services with limited capacity. Digital Health Technologies (DHTs), including body-worn sensors and portable devices, may provide advantages, by enabling continual and objective monitoring of symptoms, and facilitating patient self-management. I carried out a series of studies and evaluations of DHTs for use in PD, to evaluate their ability to identify and monitor symptoms in both a clinical and research context. These included: 1. The evaluation of a computerised paced finger tapping task (PFT) that was found to correlate with a measure of verbal fluency, suggesting there may be potential to implement the PFT as part of a wider finger tapping battery to be used as a screening tool for PD executive dysfunction. 2. The iterative, user-centred design and formative evaluation of NMS Assist, a smartphone-based app to enable regular assessment of NMS as well as provide education for patients. The app was found to be highly usable, and key areas of amendment were identified. 3. A clinical service evaluation of the PKGTM, a PD remote monitoring device. The findings revealed the PKGTM is useful for identifying patients with unmet treatment need, even in newly diagnosed people with Parkinson’s (PwP) who experience more frequent clinic review. 4. A systematic review of neuroprotective trial design in PD. The results demonstrated a wide range of primary outcome measures is used across trials, and there is little evidence of patient stratification. The findings highlighted the potential for DHTs to improve various aspects of clinical trial design. I discuss the potential value of DHTs, as well as challenges associated with their use, identified as a result of this research

The Evaluation and Assessment of Body Image Perception and Distortion in Men

Background: Perceptual body image distortion can be defined as a discrepancy between an individual’s mental representation of their body and their actual body size and shape, and is associated with negative physical and psychological health outcomes. Current methods to assess perceptual body image in men tend to utilise poor imagery, lack ecological validity, focus on Body Mass Index (BMI) variation, and demonstrate little consideration of males-pecific body concerns and ideals. Aims: This thesis presents 6 research studies that aimed to: (i) develop novel visual body stimuli that overcome current limitations of existing measures, (ii) evaluate their reliability and validity in estimating perceptual body image in community-based male samples, and (iii) improve our understanding of the methodological and individual factors that influence visual male body size and weight judgements. Methods and Results: Study 1 evaluated the accuracy of men’s visual body size discriminations using figures ranging in BMI from underweight to obese. This study identified the Just Noticeable Difference (JND) of body size between pairs of figures using a method of constant stimuli, providing evidence of perceptual discriminations consistent with Weber’s law. This informed the development of two male figure scales with a perceptual underpinning for the BMI differentiation between figures. Preliminary evidence for the reliability and validity of these figure scales in estimating men’s current and ideal body perceptions was provided in Study 2. In Study 3, a calibrated mapping between male body shape, fat mass and muscle mass was developed using a database of 3D body scans and body composition measurements. Principal component analysis identified main components of shape variation that were visually modelled as a function of fat mass and muscle mass to develop an interactive body scale. The face validity of this scale was evaluated in Study 4 through fat and muscle ratings of the body model calibrated for points along each body composition dimension. Findings indicated that men were able to visually perceive changes in both dimensions as intended. Preliminary evidence for the reliability and validity of this interactive scale was provided in Study 5. Study 6 investigated the accuracy of categorical male body weight judgements, using 3D body scans presented at 2- and 8-viewpoints. Categorical weight perceptions and weight-loss beliefs were found to be directly related to the BMI and viewpoint of the stimuli, as well as the individual’s sex and attitudinal body image. Conclusion: Several novel visual body stimuli have been developed that present high-quality imagery, wide variation in body size and shape, precise calibration to measurements of body composition, and/or consider visual discriminations of male body weight. Preliminary evidence for the reliability, validity, and suitability of these measures among community-based male samples has been provided, with recommendations for further evaluations and potential modifications. This thesis has also given insights into individual and methodological factors that influence male body weight judgements and supports the visualisation of male body composition in perceptual body image measures

Emotion regulation capacity in older adults: Effects on facial expression and memory

This thesis primarily investigated the extent to which the capacity for emotion regulation is preserved in older adults. In doing this, the current research explored possible contributors that might help explain how older adults regulate their emotions as well as young adults, and the limitations to emotion regulation ability in ageing. Subtle changes in muscle activity associated with positive and negative facial expressions were measured with zygomaticus and corrugator facial electromyography (EMG) as a novel technique to determine age differences in specific emotion regulation use, as well as age differences in emotional reactivity

Assessing the quality of mobile apps for oral health: content analysis and usability

AIM: To review and characterize dental mobile apps in the peer-reviewed literature and two popular mobile app stores, and assess their quality. METHODS: A scoping review methodology was used to identify different types of mobile dental apps in seven medical and technical databases. The data of the identified research studies on dental apps were extracted (coded) by two researchers in a systematic process and the results were analyzed. Dental apps’ characteristics, publication pattern, development methodology, efficacy, and usability were reported. Then, a systematic review was conducted in Google Play and iOS app stores to identify patient-facing dental apps. Popular keywords were identified from multiple sources such as using Google Trends. Two researchers extracted the information of the identified dental apps and descriptive, and correlation analyses were conducted. Apps were evaluated for the presence of behavior change techniques (BCTs), evidence-based guidelines, technological features, privacy and security, credibility and health literacy. Lastly, a quality assessment using MARS scale was conducted for a selected sample of dental patient-facing apps from the published literature and the popular app stores. RESULTS: The search resulted in 38 studies on dental apps. The identified dental apps (37) targeted multiple users and the common topic was oral pathology such as dental caries. The majority of dental apps was developed for diagnostics and screening purposes (40.5%). Apps included varied features and educational strategies. Only two papers used theories for developing dental apps, and five studies followed user-centered design principles. Fourteen papers only reported the use of clinical guidelines for developing dental apps (36.8%). Mobile app search resulted in 52 patient-facing dental apps (37 Android apps, and 15 iOS apps). The majority of apps focused on Oral Hygiene Behavior (31%). Apps targeted multiple users and contained varied features and BCTs including instructions (80.8%) and credible source (67.3%). Eleven apps were identified for the third project and the highest total MARS score was Philips Sonicare. The app contained the largest number of features compared to other apps (24). CONCLUSION: The dissertation will warrant the selection and prescription of high-quality dental apps, and will advance the research work in mobile apps in dentistry

The Distinct Roles of First Impressions and Physiological Compliance in Establishing Effective Teamwork

Objective measures of team dynamics would be valuable complementary tools for researchers and practitioners to use along with subjective measures when deciding which individuals work together most effectively as a team, or when designing training or task environments to promote more effective teams and teamwork. Consistent with control theory, the present study investigates how first impressions and physiological compliance early during team formation impact team effectiveness outcomes including: team satisfaction, work-related flow experiences, team processes, and performance outcomes. In a theory-driven attempt to objectively measure the extent of mutual control during teamwork, physiological compliance was calculated as root-mean squared (RMS) error of instantaneous ventilatory drive between participants; lower RMS error indicated higher physiological compliance. Ad hoc two-person teams (N=55) participated in a simulated business and marketing decision-making task while their breathing was monitored continuously. Results from Actor-Partner Interdependence Model (APIM) and mixed-model analyses indicated that first impressions and physiological compliance early during team formation both influenced team effectiveness outcomes: first impressions were predictive of team satisfaction, shared work-related flow experiences and interpersonal processes, while physiological compliance was predictive of performance satisfaction and objective task performance. Overall, results provided initial validation of an objective measure of physiological compliance and show how team dynamics early in team formation can impact overall team effectiveness. Observed relationships suggest that subjective indicators of team formation may only provide a partial view of team dynamics while the addition of an objective indicator of mutual control affords a more comprehensive and in-depth examination