A Visual Approach to Improving the Experience of Health Information for Vulnerable Individuals

Many individuals with low health literacy (LHL) and limited English proficiency (LEP) have poor experiences consuming health information: they find it unengaging, unappealing, difficult to understand, and un-motivating. These negative experiences may blunt, or even sabotage, the desired effect of communicating health information: to increase engagement and ability to manage health. It is imperative to find solutions to improve poor experiences of health information, because such experiences heighten vulnerability to poor health outcomes. We aimed to address a gap in the health literacy literature by studying the patient experience of health information and how visualization might be able to help. Our four studies involved patients presented with health information in various settings to improve understanding and management of their care. We used semi-structured interviews and observations to understand patient experiences of receiving personal health information in the hospital. We learned that the return of results is desired and has the potential to promote patient engagement with care. We developed a novel method to analyze LHL, LEP caregiver experience and information needs in the community setting. The novel method increased our understanding and ability to detect differences in experiences within the same ethnic group, based on language preference. Next, we interrogated the literature for a solution to easily communicate complicated health information to disinterested, LHL, LEP individuals. We found that visualizations can help increase interest, comprehension, support faster communication, and even help broach difficult topics. Finally, our findings were used to develop a novel prototype to improve experiences of consuming genetic risk information for those having LHL and LEP. Unlike traditional approaches that focus on communicating risk numbers and probabilities, the novelty of our approach was that we focused on communicating risk as a feeling. We achieved this by leveraging vicarious learning via real patient experience materials (e.g., quotes, videos) and empathy with an emotive relational agent. We evaluated and compared the prototype to standard methods of communicating genetic risk information via a mixed methods approach that included surveys, questionnaires, interviews, observations, image analysis, and facial analysis. Main outcome variables were perceived ease of understanding, comprehension, emotional response, and motivation. We employed t-tests, ANOVAs, directed content analysis, correlation, regression, hierarchical clustering, and Chernoff faces to answer the research questions. All variables were significantly different for the prototype compared to the standard method, except for motivation as rated by 32 LHL, LEP community members. Findings revealed that LHL, LEP individuals have difficulty appropriately processing standard methods of communicating risk information, such as risk numbers supported by visual aids. Further, appealing visuals may inappropriately increase confidence in understanding of information. Visualizations affected emotions, which influenced perceived ease of understanding and motivation to take action on the information. Comprehension scores did not correlate with perceived ease of understanding, emotional response, or motivation. Findings suggest that providing access to comprehensible health information may not be enough to motivate patients to engage with their care; providing a good experience (taking into account the aesthetics and emotional response) of health information may be essential to optimize outcomes

Phylogeography and population genetic structure of two anuran species inhabiting the Mojave Desert

Three studies are presented that apply the principles and methodologies of phylogeography to two anuran species (a frog and a toad) that inhabit the Mojave Desert of North America. The first study evaluates the geographic distributions of mitochondrial DNA (mtDNA) lineages (clades) within the broadly distributed toad, Bufo punctatus, as these relate to vicariant events hypothesized to have structured desert biotas within North America. Phylogeographic analyses support three clades with distributions corresponding to the Peninsular Desert of Baja, California, Chihuahuan Desert - Colorado Plateau (Eastern), and Mojave - Sonoran deserts (Western). Divergence levels and congruence with postulated vicariant events indicate separation of clades during the Late Neogene. Evaluation of mtDNA diversity and nested analysis reveal likely post-Pleistocene dispersal and contact across barriers separating the Eastern and Western clades. Speculation is made as to why the observed deep phylogeographic structure has not been eroded during Pleistocene interglacials; A second study elucidates population genetic structure of B. punctatus among aquatic sites within mountain ranges and among mountain range groups, and relates patterns to previously determined hypotheses of population structure. Results from hierarchical analysis of molecular variance show generally high levels of genetic structure among mountain ranges, but little variation among sites within most mountain ranges. In mountain ranges demonstrating significant inter-site genetic structure, pairwise FST comparisons indicate that only a few sites are responsible. A likely range expansion is inferred in two ranges. Recent convergence between two divergent lineages is indicated within one range. Bufo punctatus occurs primarily in patchy populations within mountain ranges, but populations appear to be isolated among ranges; The third study focuses on the evolutionary distinctiveness of leopard frogs (Rana sp.) along the Colorado and Virgin River drainages within the northeastern Mojave Desert. Phylogenetic analyses of mtDNA control region sequences, restriction site variation, and congruent patterns from randomly amplified polymorphic DNA (RAPDs), indicate that these leopard frogs differ from R. yavapaiensis, a sister-taxon occurring in the Sonoran Desert. These two taxa show significant multivariate morphological differentiation. Leopard frogs from the Mojave Desert are phylogenetically distinct and recognizable as R. onca

Decision support for assessing the feasibility of a product for remanufacture

Remanufacturing is the process of restoring old, damaged and failed products to a condition as good as new . Whilst the practice of remanufacture has been conducted for almost a century, the attention it receives within mainstream business is increasing due to potential benefits associated with economic savings and reduced environmental impact. There are several challenges in operating a successful remanufacturing business, one of which is how to assess the feasibility of remanufacturing. Remanufacturing does not lend itself towards every product due to factors related to the product, process, market and business capabilities, therefore careful assessment should be conducted before taking on a remanufacturing endeavour. This thesis reports the research undertaken to aid decision makers assessing the feasibility of a product for remanufacture. The aim has therefore been to determine the requirements of assessing remanufacturing feasibility, then to develop a tool to support this activity. Requirements of the decision making process were established through a detailed review of the literature supplemented with additional interviews from remanufacturing businesses, whilst research gaps for support tools were identified through a systematic review of existing tools presented within academia. Through these reviews it was determined that current methods do not provide enough support in determining the impact of uncertainties found within remanufacturing against key assessment criteria, such as economic cost. Focus upon the tool development was therefore directed at estimating remanufacturing cost of a product under uncertain conditions. The tool was designed, utilising techniques such as Monte Carlo analysis, fuzzy sets and case based reasoning. A prototype of the tool was then implemented within an object oriented structure and deployed as web service. Testing and validation were conducted by demonstrating the functionality of the tool against a set of specification requirements, through two contrasting remanufacturing case studies identified within industry. In summary this research has developed a tool to support the assessment of remanufacturing viability through cost estimation under uncertain conditions, identifying requirements through a detailed literature review and interviews with industry and providing validation through two detailed case studies. The tool is novel in its ability to calculate both cost and the risk associated with the uncertainties present within the remanufacturing domain

An exploration of end-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's family

Background and aim: In the absence of rigorous evidence-based clinical guidelines, end-of-life care (EOLC) practices in the ICU vary considerably. Ideally, EOLC should be appropriately planned, implemented and informed by robust evidence; however the ICU is a setting where a patient’s health can deteriorate rapidly. Consequently, families (including family members, relatives and carers) are particularly vulnerable, and may experience shock, uncertainty and powerlessness in this technical and unfamiliar environment during EOLC. Families are optimally positioned to identify the key components of care at the end of life in the ICU, however their views and needs are under-represented in key policy and guidance documents. A potentially rich source of families’ views is qualitative studies. By capturing the complex experiential aspects of healthcare phenomena, qualitative evidence can provide knowledge that may inform the delivery of healthcare. A number of qualitative studies have examined the perspective of families on EOLC in the ICU, however, a systematic review of this evidence has not been undertaken. Therefore, a systematic review and meta-synthesis was conducted to identify the experiences and perceptions of patients’ families, of the EOLC delivered in the ICU setting, when life-sustaining treatments are withheld or withdrawn. The findings of this systematic review will provide policy-makers, clinicians and researchers with robust evidence to: (1) inform the development of future policy and evidence-based clinical guidelines; (2) promote quality and consistency of EOLC delivery, and; (3) assist with optimising the EOLC experiences of the patient’s family in the ICU, when life-sustaining treatments are withheld or withdrawn. Methods: Systematic review and meta-synthesis was conducted using meta-aggregation. A comprehensive search for eligible published and unpublished qualitative studies (January 2006 – May 2016) was conducted across seventeen electronic databases. Quality assessment, data extraction, data synthesis and ConQual (a method used to rate the confidence of the synthesised findings) were conducted using an adaption of the methods of meta-aggregation. Thematic analysis processes were added to achieve analytic depth. Results: Thirteen studies of variable quality met the inclusion criteria. No Australasian studies were identified. Data collection methods across the studies included face-to-face interviews and focus groups. Meta-aggregation and thematic analysis resulted in 14 Page 13 of 229 categories and five synthesised findings, as follows: (1) the dying person: valued attributes of patient care; (2) communication with the family and within the healthcare team; (3) preparing the family and promoting a peaceful family-centred death; (4) family-centred support and care, and; (5) bereavement care. A conceptual model of preparedness was developed based on these findings that reflects the elements of EOLC care that are most valued by families. Central to preparedness was communication. Conclusion: The synthesised findings showed that families experienced both positive and negative aspects of EOLC, and have unmet needs for communication, family-centred support and care and bereavement care. The conceptual model of preparedness, which reflects families’ views of high-quality EOLC in the ICU, can be utilised to target areas for practice improvement. As defined in this study, the concept of preparedness in the ICU, explains the circumstance in which families can best manage the death, their sadness, loss, and grief. The findings show that nurses in particular are optimally positioned to provide individualised support and care that aligns with the values, needs and wishes of each family. Achieving a state of preparedness in the ICU setting requires a unique combination of care and support, as reflected in the model. Research, policy and education recommendations are suggested based on the findings of this systematic review. An Australasian qualitative, multi-centre study that captures this healthcare phenomenon would provide robust evidence to inform region-specific policy and guideline development. In addition, a qualitative synthesis that incorporates evidence on the views of survivors of critical illness, families of survivors, and clinicians about the quality of EOLC delivered in the ICU setting, will contribute to our understanding of the barriers and facilitators to effective EOLC. Development of a practice standard on the delivery of EOLC in the ICU is also recommended, that is aligned with key performance indicators and mandated by registration bodies and governing critical care nursing/medicine agencies. Finally, undergraduate and postgraduate courses should consider preparing nurses to provide individualised care across a range of clinical settings to the dying person and their family, including effective communication and bereavement care

Vehicle level health assessment through integrated operational scalable prognostic reasoners

Today’s aircraft are very complex in design and need constant monitoring of the systems to establish the overall health status. Integrated Vehicle Health Management (IVHM) is a major component in a new future asset management paradigm where a conscious effort is made to shift asset maintenance from a scheduled based approach to a more proactive and predictive approach. Its goal is to maximize asset operational availability while minimising downtime and the logistics footprint through monitoring deterioration of component conditions. IVHM involves data processing which comprehensively consists of capturing data related to assets, monitoring parameters, assessing current or future health conditions through prognostics and diagnostics engine and providing recommended maintenance actions. The data driven prognostics methods usually use a large amount of data to learn the degradation pattern (nominal model) and predict the future health. Usually the data which is run-to-failure used are accelerated data produced in lab environments, which is hardly the case in real life. Therefore, the nominal model is far from the present condition of the vehicle, hence the predictions will not be very accurate. The prediction model will try to follow the nominal models which mean more errors in the prediction, this is a major drawback of the data driven techniques. This research primarily presents the two novel techniques of adaptive data driven prognostics to capture the vehicle operational scalability degradation. Secondary the degradation information has been used as a Health index and in the Vehicle Level Reasoning System (VLRS). Novel VLRS are also presented in this research study. The research described here proposes a condition adaptive prognostics reasoning along with VLRS

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Background Dementia has an enormous impact on the lives of individuals and families, and on health and social services, and this will increase as the population ages. The needs of people with dementia and their carers for information and support are inadequately addressed at all key points in the illness trajectory. Methods The Unit is working specifically on an evaluation of the impact of the Mental Capacity Act 2005, and will develop practice guidance to enhance concordance with the Act. Phase One of the study has involved baseline interviews with practitioners across a wide range of services to establish knowledge and expectations of the Act, and to consider change processes when new policy and legislation are implemented. Findings Phase 1, involving baseline interviews with 115 practitioners, identified variable knowledge and understanding about the principles of the Act. Phase 2 is exploring everyday decision-making by people with memory problems and their carers