Justifying Breaking the Glass: How Accountability Can Deter Unauthorized Access

This research-in-progress study examines how accountability—the expectation that one will be required to answer for one’s actions, and justification—the requirement to give reasons for performing an action—can reduce instances of break-the-glass violations—can encourage compliance with data access policies. We examine whether justification can embolden users to break the glass in warranted situations, and deter users in inappropriate situations. We propose a series of lab experiments to test our hypotheses. We expect that our results will have implications for research on information security policy (ISP) compliance and practice

The Effects of Ambulatory Accelerations on the Stability of a Magnetically Suspended Impeller for an Implantable Blood Pump

National Institute for Health Research. Grant Number: II-LB-1111-2000

The influence of rotary blood pump speed modulation on the risk of intraventricular thrombosis

Rotary left ventricular assist devices (LVADs) are commonly operated at a constant speed, attenuating blood flow pulsatility. Speed modulation of rotary LVADs have been demonstrate to improve vascular pulsatility and pump washout. The effect of LV AD speed modulation on intraventricular flow dynamics is not well understood, which may have an influence on thromboembolic events. This study aimed to numerically evaluate intraventricular flow characteristics with a speed modulated LVAD. A severely dilated anatomical left ventricle was supported by a HeartWare HVAD in a three-dimensional multiscale computational fluid dynamics model. Three LVAD operating scenarios were evaluated: constant speed and sinusoidal co- and counter-pulsation. In all operating scenarios, the mean pump speed was set to restore the cardiac output to 5.0 l/min. Co-and counter-pulsation was speed modulated with an amplitude of 750 rpm. The risk of thrombosis was evaluated based on blood residence time, ventricular washout, kinetic energy densities and a pulsatility index map. Blood residence time for co-pulsation was on average 1.8% and 3.7% lower than constant speed and counter-pulsation mode, respectively. After introducing fresh blood to displace pre- existing blood for 10 cardiac cycles, co-pulsation had 1.5% less old blood in comparison to counter- pulsation. Apical energy densities were 84% and 27% higher for co-pulsation in comparison to counter-pulsation and constant speed mode, respectively. Co-pulsation had an increased pulsatility index around the left ventricular outflow tract and mid-ventricle. Improved flow dynamics with co-pulsation was caused by increased E-wave velocities which minimised blood stasis. In the studied scenario and from the perspective of intraventricular flow dynamics, co-pulsation of rotary LVADs could minimise the risk of intraventricular thrombosis

The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students

UnlabelledHuman patient simulation (HPS) is becoming a popular teaching method in nursing education globally and is believed to enhance both knowledge and critical thinking.ObjectiveWhile there is evidence that HPS improves knowledge, there is no objective nursing data to support HPS impact on critical thinking. Therefore, we studied knowledge and critical thinking before and after HPS in prelicensure nursing students and attempted to identify the predictors of higher critical thinking scores.MethodsUsing a one-group, quasi-experimental, pre-test post-test design, 154 prelicensure nursing students (age 25.7± 6.7; gender=87.7% female) from 3 schools were studied at the same point in their curriculum using a high-fidelity simulation. Pre- and post-HPS assessments of knowledge, critical thinking, and self-efficacy were done as well as assessments for demographics and learning style.ResultsThere was a mean improvement in knowledge scores of 6.5 points (P<0.001), showing evidence of learning. However, there was no statistically significant change in the critical thinking scores. A logistic regression with 10 covariates revealed three variables to be predictors of higher critical thinking scores: greater "age" (P=0.01), baseline "knowledge" (P=0.04) and a low self-efficacy score ("not at all confident") in "baseline self-efficacy in managing a patient's fluid levels" (P=.05).ConclusionThis study reveals that gains in knowledge with HPS do not equate to changes in critical thinking. It does expose the variables of older age, higher baseline knowledge and low self-efficacy in "managing a patient's fluid levels" as being predictive of higher critical thinking ability. Further study is warranted to determine the effect of repeated or sequential simulations (dosing) and timing after the HPS experience on critical thinking gains

MS

thesisThe purpose of this study was to determine if there was a positive relationship between nurses'role function; mother surrogate and healer, and such factors as job satisfaction and authoritarianism, in a selected private hospital. The sample consisted of forty-seven registered professional nurses employed at the Utah Valley Hospital in Provo, Utah. These nurses were working on the medicalf surgical, pediatric, obstetrical and overflow units of the hospital. The criteria used for selection of the nurses in the sample weres (1) that the nurse be a graduate of an accredited school of nursing, and (2) that she be presently employed at the Utah Valley Hospital. The measuring instruments used in this study consisted of two questionnaires. The first questionnaire was developed by Dr. Robert Gray of the University of Utah Sociology department. This questionnaire was used to place the nurses into one of two basic functional roles; mother surrogate or healer. The fob satisfaction scale from this questionnaire was also utilized. The second questionnaire was Adorno's Authoritarian F scale. This scale was used to test whether the nurse possessed authoritarian or nonauthoritarian persona I ity tra its. The review of literature indicated that there was role conflict in the changing role of the professional nurse in the hospital situation and that this disequilibrium was in some way related to the areas of conflict between the functional roles of mother surrogate and healer. Based on the review of literature two hypotheses were made. First, that there would be a positive correlation between mother surrogate scores and job satisfaction. That is, nurses classified as healers would tend to be more satisfied with their jobs than those classified as mother surrogates. The authoritarian personality as classified by Adorno and his colleagues was compared to the functional role of the nurse. It was hypothesized that because of the authoritarian atmosphere of the hospital the technical nurse would be authoritarian. Therefore, a positive correlation between the affective-technical scale and authoritarianism was expected. There was no reliable correlation between mother surrogate scores and job satisfaction or authoritarianism. The findings did not support the writer's hypothesis that there would be a positive relationship between the functional role of the nurse, as demonstrated by the mother surrogate scale, and job satisfaction and authoritarianism in a modern private hospital

Design of a Mobile App to Compliment Midwifery Care

POSTE

Design of a Mobile App to Compliment Midwifery Care

The aim of this project was to pilot a mobile phone app for pregnant women that is evidence-based, informative for decision-making, and promotes physiological birth. Among medical apps, pregnancy apps are the most accessed and have the highest number of downloads and consumer ratings. One in every five searches through google is related to pregnancy. Despite the need for pregnancy information and popularity of internet use, no app exists that encourages or promotes midwifery care, therefore women are not informed of ways to promote physiological birth and often are unaware of the choices they may have in their care. Pregnant women have a need for additional information that extends beyond the health visit. Prenatal and postpartum health encounters are limited by time, leaving health providers unable to sufficiently address all potential learning needs; women then turn to the internet to fill these gaps. Research has shown that much of the available online information lacks references to substantiate evidence-based facts. This factor, among others, has contributed to the reluctance of midwives to recommend apps to patients. There is a strong need for an evidence-based, user friendly, mobile phone app that can fill the gap created by limited clinical information and will meet the need for reliable information. An app that exemplifies a midwifery approach to care will provide evidence-based information that emphasizes women's choices about their care, and thus will promote self-determination through informed decision-making. Evidence-based information that promotes physiologic birth and invites patient discussion will likely be endorsed by midwives. Objectives for this project included, 1) identification of educational topics and content for selected childbearing phases to pilot the app, 2) form the identified content into a demo app, 3) distribute the app to 15 pregnant women for trial and evaluation, 4) improve the app with user feedback 5) inform midwives of the app and its future availability. The project was implemented by selecting three discrete topics to trial in the areas of antepartum, intrapartum, and post-partum, gathering the essential evidence-based information in the selected areas and presenting it on a demo app. The information was tailored with appealing graphics and clear language that grasps the reader's attention. After IRB exemption, the demo app was piloted with 15 pregnant women who evaluated the content and ease of use with a short questionnaire after two weeks of reviewing the app. The 15 pregnant women were recruited via social media and word of mouth-they personally volunteered, tagged pregnant friends and family members, and provided personal contact information with consent to review the app. After reviewal of their feedback more content was incorporated into the app, more graphics were added, and forums were made for moms to communicate with another. Midwives in the area were introduced to the app components in a regional midwifery meeting held in April 2017. Every woman deserves choices during their pregnancy. Every woman needs resources that promote choice and empowerment during their pregnancy and beyond. A mobile app that promotes conversation with health providers, and is endorsed by midwives will likely lead to improved patient understanding and participation during the childbearing years. This project is the beginning step for a midwifery-focused app that will not only be informative to pregnant women but it will also market midwifery care to an increasing number of women who use electronic resources for health information

PhD

dissertationCentral vascular catheters (CVCs) are essential for patients receiving a bone marrow transplant (BMT). Central line infections (CLI) pose a serious threat to BMT patients, causing increases in morbidity, financial expenses, and even treatment-related mortality. Determining best practices in prevention of CLI in BMT patients is vital but understudied. The Centers for Disease Control and Prevention (CDC) has published guidelines, including four specific performance indicators (Pis), for prevention of intravascular catheter-related infections. To date, no published study has examined use of the Pis in the CDC guidelines in the care of BMT patients. The purpose of this study was to examine practice patterns among US BMT centers and to determine whether select recommendations in the CDC guidelines are used to prevent CLI in BMT patients. Specific aims of this study were to (a) describe selfreported practice patterns for prevention of CLI in participating US BMT centers, (b) to determine the extent of use of the Pis, (c) to determine which other practice factors are associated with self-reported use of the Pis, and (d) to describe self-reported rates of CLI in participating BMT centers. A survey was mailed to all US BMT centers listed on the BMT InfoNet website. Sixty of 189 BMT centers (32%) participated by completing and returning the survey. The survey assessed practices related to prevention of CLI in BMT patients. Results of the study indicated (a) that practice patterns for CLI prevention vary among participating BMT centers, (b) that overall self-reported use of three of the four CDC Pis was generally high, (c) that six factors were associated with self-reported use of the Pis, and (d) that most participants could not or would not report CLI incidence rates for their BMT centers. CLI in BMT patients can be a matter of life and death. Improving patient outcomes by decreasing rates of CLI depends upon tracking and trending rates of CLI, strengthening roles and coordination within the BMT care team, and strengthening BMT center healthcare worker education programs