Human Factors Considerations in a Telemedicine-Integrated Ambulance-Based Caregiving Environment for Stroke Care

Telemedicine, the use of communications technology to connect patients to medical professionals remotely, can be applied to a variety of settings, for example connecting older adults with their physicians from home, specialists to rural county hospitals or patients to physicians for emergency care. This dissertation focuses on the use of telemedicine for ambulance-based care for stroke patients, including how the design of this system impacts caregivers. The initial study investigated both the usability of a telemedicine system implemented in ambulances for stroke care as well as the possibility of human error when using it. The heuristic evaluation of usability violations found several issues that needed to be addressed, including the lack of clarity in the tab structure and the lack of suggestions for correct data inputs. Similarly, the analysis of possible errors also determined several issues with this system, with the two most common being miscommunication and difficulty in locating data input or selecting an incorrect option. Several remediations strategies were recommended based on this study: improvement of the labelling of the tab structure, consistent formatting, rigid or suggested formatting for data input, automation of task structure and camera movement, and audio/visual improvements to support communication. The second study investigated the experience of caregivers with the ambulance-based stroke telemedicine system, focusing on the support of the distributed cognition of the caregiving teams. Teams comprised of a neurologist, nurse, and paramedic were observed conducting 13 simulated stroke consults, after which each caregiver completed a survey on the perceived workload, usability, and teamwork during the session and an interview about their experience with the telemedicine system. In total, thirty-nine caregivers were interviewed, and the data collected were analyzed for themes. The themes that emerged identified such barriers to and facilitators for using telemedicine for ambulance-based stroke caregiving as training and experience, technical difficulty barriers, and patient care and efficiency improvement facilitators. The findings from this study resulted in design recommendations for supporting healthcare professionals during caregiving, especially ones that support their distributed cognition when using ambulance-based telemedicine for stroke care. The final study evaluated the effect of design recommendations implemented in a new telemedicine system on the neurologist’s workload, situation awareness, and task performance in addition to evaluating the perceived usability of this new design and its support of distributed cognition. For this study based on a within-subjects experimental design, 20 neurologists completed simulated stroke assessments using both the new design and the design investigated in the two previous studies and evaluated each system. Overall, the results found that the neurologists experienced a lower workload, performed better in their task, exhibited higher situation awareness, and rated usability highly in the new design. In addition, most participants thought that the new design better supported distributed cognition principles and preferred the new system for ambulance-based stroke consults

Anti-Crusoes, Alternative Crusoes: Revisions of the Island Story in the Twentieth Century

In lieu of an abstract, here are the chapter\u27s first two paragraphs: Everyone thinks they know the plot of Robinson Crusoe. The story of the man who is shipwrecked on an island alone is ubiquitous and feels deeply familiar, even for those who have not read it. Robinson Crusoe has been plagiarized, cannibalized, and serialized almost since the moment it hit the streets of London in 1719. Here is a passage from an Argentinean novel by Victoria Slavuski published in 1993 that captures the sense of familiarity and also the distance twentieth-century readers have in their relationship to Robinson Crusoe: “On days like these we promised each other that at long last we would take the time to read the copy of Robinson (Crusoe) that each household kept alongside the Bible and Twenty-five Ways to Prepare Lobster, written on Juan Fernandez by Amelita Riera. Nobody got past page fifteen of Robinson and almost nobody opened the Bible.”1 Literary critics often treat the multitude of twentieth-century versions of Crusoe as antagonistic to Defoe’s character. They tend to consider contemporary novels or films or poems as entities in competition with Robinson Crusoe’s fictional world. However, these modern renderings are never so neatly drawn. More often than not, writers use these alternative Crusoes to forge lines of affiliation and empathy, between the eighteenth century and our own time as well as between different regions and languages. Argentinean, Caribbean, and African Crusoes are in conversation with one another as much as they are in dialogue with the historic Defoe. Writers around the globe adapt and transform Crusoe and Defoe’s novel to establish a literary web of connection that has come to define our own global moment where fiction travels beyond national and linguistic borders. In this chapter I will move through a few observations on nineteenth-century Crusoes before delving into the twentieth-century map of literary islands crisscrossing the globe

Prediction of survival probabilities with Bayesian Decision Trees

Practitioners use Trauma and Injury Severity Score (TRISS) models for predicting the survival probability of an injured patient. The accuracy of TRISS predictions is acceptable for patients with up to three typical injuries, but unacceptable for patients with a larger number of injuries or with atypical injuries. Based on a regression model, the TRISS methodology does not provide the predictive density required for accurate assessment of risk. Moreover, the regression model is difficult to interpret. We therefore consider Bayesian inference for estimating the predictive distribution of survival. The inference is based on decision tree models which recursively split data along explanatory variables, and so practitioners can understand these models. We propose the Bayesian method for estimating the predictive density and show that it outperforms the TRISS method in terms of both goodness-of-fit and classification accuracy. The developed method has been made available for evaluation purposes as a stand-alone application

An Investigation of Information Sought by Caregivers of Alzheimer’s Patients on Online Peer-Support Groups

Alzheimer’s caregivers seek social support through online communities to deal with their issues. The research team conducted a content analysis of ALZConnected.org to investigate the characteristics of information searched by caregivers and responses received. Two-hundred fifty posts and related responses were randomly selected and analyzed using a classification tool derived from the analysis of 500 posts and related responses spanning a yearlong period. The Linguistic Inquiry and Word Count (LIW C) generated an average tone rating of 25.94 for the posts and 52.69 for the responses. The findings highlighted the caregiver’s need for emotional support (59.6%), and confusion about Alzheimer’s symptoms (12%). Most responses suggested informational resources (40.16%) and advised to seek professional assistance (21.31%). One of the key needs identified to inform future design of an Alzheimer’s Caregiver Forum was a design sensitive to the capabilities of its elder user audience

Testing the effects of opacity and the chemical mixture on the excitation of pulsations in B stars of the Magellanic Clouds

The B-type pulsators known as \beta Cephei and Slowly Pulsating B (SPB) stars present pulsations driven by the \kappa mechanism, which operates thanks to an opacity bump due to the iron group elements. In low-metallicity environments such as the Magellanic Clouds, \beta Cep and SPB pulsations are not expected. Nevertheless, recent observations show evidence for the presence of B-type pulsator candidates in both galaxies. We seek an explanation for the excitation of \beta Cep and SPB modes in those galaxies by examining basic input physics in stellar modelling: i) the specific metal mixture of B-type stars in the Magellanic Clouds; ii) the role of a potential underestimation of stellar opacities. We first derive the present-day chemical mixtures of B-type stars in the Magellanic Clouds. Then, we compute stellar models for that metal mixture and perform a non-adiabatic analysis of these models. In a second approach, we simulate parametric enhancements of stellar opacities due to different iron group elements. We then study their effects in models of B stars and their stability. We find that adopting a representative chemical mixture of B stars in the Small Magellanic Cloud cannot explain the presence of B-type pulsators there. An increase of the opacity in the region of the iron-group bump could drive B-type pulsations, but only if this increase occurs at the temperature corresponding to the maximum contribution of Ni to this opacity bump. We recommend an accurate computation of Ni opacity to understand B-type pulsators in the Small Magellanic Cloud, as well as the frequency domain observed in some Galactic hybrid \beta Cep-SPB stars.Comment: 16 pages, 12 figures. Accepted for publication in MNRA

The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians.

Background With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. Methods Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. Results From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53–2.52, p = 0.719) for clients from urban compared to regional areas. Conclusion The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians

The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians

Background: With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. Methods: Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. Results: From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53–2.52, p = 0.719) for clients from urban compared to regional areas. Conclusion: The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians

The effectiveness of public health interventions to reduce the health impact of climate change:a systematic review of systematic reviews

Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases

Is Poverty Decentralising? Quantifying Uncertainty in the Decentralisation of Urban Poverty

In this paper we argue that the recent focus on the suburbanisation of poverty is problematic because of the ambiguities and inconsistencies in defining suburbia. To improve transparency, replicability and comparability, we suggest that research on the geographical changes to the distribution of poverty should focus on three questions: (1) How centralised is urban poverty? (2) To what extent is it decentralising? (3) Is it becoming spatially dispersed? With respect to all three questions, the issue of quantifying uncertainty has been under-researched. The main contribution of the paper is to provide a practical and robust solution to the problem of inference based on a Bayesian multivariate conditional autoregressive (CAR) model, made accessible via the R-software package CARBayes. Our approach can be applied to spatio-temporally autocorrelated data, and can estimate both levels of and change in global RCIs (relative centralisation index), local RCIs and dissimilarity indices. We illustrate our method with an application to Scotland's four largest cities. Our results show that poverty was centralised in 2011 in Glasgow, Dundee and Aberdeen. Poverty in Edinburgh, however, was decentralised: non-poor households tend to live closer to the centre than poor ones, and increasingly so. We also find evidence of statistically significant reductions in centralisation of poverty in all four cities. To test whether this change is associated with poverty becoming more dispersed, we estimate changes to evenness and local decentralisation of poverty, revealing complex patterns of change

Bayesian decision trees for predicting survival of patients: a study on the US National Trauma Data Bank

Trauma and Injury Severity Score (TRISS) models have been developed for predicting the survival probability of injured patients the majority of which obtain up to three injuries in six body regions. Practitioners have noted that the accuracy of TRISS predictions is unacceptable for patients with a larger number of injuries. Moreover, the TRISS method is incapable of providing accurate estimates of predictive density of survival, that are required for calculating confidence intervals. In this paper we propose Bayesian in ference for estimating the desired predictive density. The inference is based on decision tree models which split data along explanatory variables, that makes these models interpretable. The proposed method has outperformed the TRISS method in terms of accuracy of prediction on the cases recorded in the US National Trauma Data Bank. The developed method has been made available for evaluation purposes as a stand-alone application