Browsing by Author "Parker, Sarah H."
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- Context Dependent Gaze Metrics for Evaluation of Laparoscopic Surgery Manual SkillsKulkarni, Chaitanya Shashikant (Virginia Tech, 2021-06-10)With the growing adoption of laparoscopic surgery practices, high quality training and qualification of laparoscopic skills through objective assessment has become critical. While eye-gaze and instrument motion analyses have demonstrated promise in producing objective metrics for skill assessment in laparoscopic surgery, three areas deserve further research attention. First, most eye-gaze metrics do not account for trainee behaviors that change the visual scene or context that can be addressed by computer vision. Second, feedforward control metrics leveraging on the relationship between eye-gaze and hand movements has not been investigated in laparoscopic surgery. Finally, eye-gaze metrics have not demonstrated sensitivity to skill progressions of trainees as the literature has focused on differences between experts and novices although feedback on skill acquisition is most useful for trainees or educators. To advance eye-gaze assessment in laparoscopic surgery, this research presents a three-stage gaze based assessment methodology to provide a standardized process for generating context-dependent gaze metrics and estimating the proficiency levels of medical trainees on surgery. The three stages are: (1) contextual scene analysis for segmenting surgical scenes into areas of interest, (2) compute context dependent gaze metrics based on eye fixation on areas of interest, and (3) defining and estimating skill proficiency levels with unsupervised and supervised learning, respectively. This methodology was applied to analyze 499 practice trials by nine medical trainees practicing the peg transfer task in the Fundamental of Laparoscopic Surgery program. The application of this methodology generated five context dependent gaze and one tool movement metrics, defined three proficiency levels of the trainees, and developed a model predicting proficiency level of a participant for a given trial with 99% accuracy. Further, two of six metrics are completely novel, capturing feed-forward behaviors in the surgical domain. The results also demonstrated that gaze metrics could reveal skill levels more precisely than between experts and novices as suggested in the literature. Thus, the metrics derived from the gaze based assessment methodology also shows high sensitive to trainee skill levels. The implication of this research includes providing automated feedback to trainees on where they have looked during practice trial and what skill proficiency level attained after each practice trial.
- Distributed Situation Awareness Framework to Assess and Design Complex SystemsAlhaider, Abdulrahman Abdulqader (Virginia Tech, 2023-01-20)Communication and coordination in complex sociotechnical systems require continuous assessment on its artefacts and how they are utilized to improve system performance. Situation Awareness (SA) is considered as a fundamental concept in designing and understanding interactions between human and non-human agents (i.e., information systems) that impact system performance. The interaction efficiency is partly determined by quality of information or SA distributed across agents to ensure the accuracy of decision making and resource allocations. Disrupting SA distribution between agents can significantly affect operations of the system with financial and safety consequences. This research applied the Distributed Situation Awareness (DSA) theory to study and improve patient flow management. The main objective of this research was to advance methodology in the DSA literature for (1) deriving design implications from DSA models, and (2) developing quantitative DSA models to formally compare system designs. This DSA research was situated in the domain of patient flow management. Data were collected using the three-part method of data elicitation, extraction, and representation to investigate DSA at a patient flow command and control center at Carilion Clinic in Roanoke, VA. The data used were elicited from observations and interviews on workers daily activities and available historical database (i.e., TeleTracking). Then, data were represented into a combined network to highlight social, task and knowledge elements in patient flows for studying and assessing patient flow management. The influence of the DSA on complex systems was examined qualitatively and quantitatively. The DSA combined network qualitatively characterized patient flow management and identified deficiencies of the command-and-control center functions. The network characterized admission, clinical (inside-hospital) transportation, discharge, and environmental services functions managed by Carilion Transfer and Communications Center (CTaC). These characterizations led to the identification of design principles on job roles, tasks performed, and SA transactions and distribution adopted by the state-of-the-art patient flow management facility. In addition, the network representing the current operation of CTaC illustrated the connection between functional groups, arbitration of resources, and job roles that could become the bottlenecks in transmitting SA. The network also helped identify inefficient task loops, which resulted in delay due to missing/poor SA, and task orders that could be modified to improve the patient flow and thus reduce the likelihood of delay. The qualitative (i.e., combined network) model was partially translated into a quantitative model based on discrete event simulation (DES) and agent-based modeling (ABM) to simulate patient transportation inside the hospital. The simulation model consisted of 28 patient origins, 29 equipment origins, 12 destinations, and more than 200 entities (i.e., simulation objects). The model was validated by lack of significant difference on various outcome metrics between 100 simulation replications and historical data using one-way t-tests. The simulation model captured the distribution and transactions of knowledge elements between agents within the modeled processes. Further, the model successfully verified the deficiencies in the existing system (i.e., delay and cancelation), attributing various instances of deficiency to be either SA related or non-SA related. The simulation model tested two interventions for eliminating SA deficiencies revealed by the qualitative model: (1) updating the wards nurse before picking up patients from inpatient floor, and (2) updating the X-ray nurse/team before arriving with the patient. Both interventions involved updates from the transporters to nurses, transmitting SA on the estimated time of arrival and patient information for the nurse to become aware of the transport status. The simulation ran for 1500 replications for results on transport time and cancellation rate on these two interventions. One-way t-tests revealed that the intervention to update the wards nurse resulted in significant reductions in mean transport and cancellation rate time compared to historical data (i.e., TeleTracking), yielding 0.42 minutes to 1.24 minutes reduction in transport time and 2% to 5% less cancelations. However, the second intervention resulted in a significant increase in transport time and thus was ineffective. DES and ABM supplemented the qualitative modeling with quantitative evidence on DSA concepts and assessment of potential interventions for improving DSA in patient flow management. Specifically, the DES and ABM enabled comparison and prediction of performance outcome from recommended changes to communication protocols. These findings indicate that DSA is a promising framework for analyzing communication and coordination in complex systems and assessing improvement on SA design quantitatively.
- Effects of Perfusate Composition (Na+ and Ca2+) on Cardiac Electrical and Mechanical Function in the Isolated Langendorff-Perfused HeartKing, David Ryan (Virginia Tech, 2021-02-11)Following the landmark studies on scientific reproducibility, or the lack thereof, by Bayer and Amgen in the past decade, there has been a renewed interest in scientific rigor and reproducibility in both the scientific and public media. In several recent reports, the high attrition rate observed in clinical trials has been attributed to irreproducibility at the preclinical level. Cardiology is no exception to this rule. In our systematic review of the ex vivo Langendorff-perfused heart, we found methods reporting to be sparse at best, specifically as it pertains to documenting the ex vivo perfusate compositions employed in the Langendorff heart. Our lab has demonstrated that variation in perfusate compositions can unmask disease states in genetically modified animals. In this dissertation, we exploit this concept with a therapeutic end-point in mind. We show that perfusate variation, specifically sodium and calcium elevations, can attenuate conduction slowing associated with severe hyperkalemia. Likewise, elevating sodium is capable of sustaining intrinsic rhythm where hearts would otherwise go asystolic. In doing so, elevated sodium prevents repolarization prolongation in these hearts. Together, these studies would suggest that elevating extracellular sodium, and calcium, should be considered as therapeutic targets in the context of conduction defects. However, when considering the heart's primary role as a pump, we found that elevating sodium actually depresses cardiac mechanical function. This is both in a pre- and post-ischemic setting. In short, we show that electrolyte variation may influence both cardiac electrophysiology and contraction; however, an improvement in one does not guarantee an improvement in both. Maintaining proper cardiac physiological function is a complex process that is tightly regulated by the ionic makeup of the extracellular environment. To improve insights from preclinical studies at the clinical level it is paramount that researchers properly document methods so that any significant results may be properly interpreted in clinical trial design.
- Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operationKeller, Sandra; Yule, Steven; Smink, Douglas S.; Zagarese, Vivian; Safford, Shawn D.; Parker, Sarah H. (2020-12-07)Abstract Background Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. Methods We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. Results We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. Conclusions Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.
- Evaluating Rescuer Performance in Response to Opioid Overdose in a Community Setting: Evidence for Medically Appropriate Process MeasuresEdwards, G. Franklin III; Mierisch, Cassandra; Strauss, Allison; Mutcheson, Brock; Coleman, Keel; Horn, Kimberly; Parker, Sarah H. (Elsevier, 2023-02)Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees’ application of hands-on skills, and conduct formative assessments.
- Evaluation of biofeedback components for the management of acute stress in healthcareKennedy-Metz, Lauren Rose (Virginia Tech, 2018-11-27)Medical error is the third leading cause of death in the United States, with surgery being a critical area for improvement. Of particular interest for this dissertation is understanding and mitigating the impact of acute stress experienced by surgeons. Previous research demonstrates the detrimental effects mismanaged acute stress can have on cognitive performance integral in optimal surgical practice. Biofeedback consists of objectively monitoring signs of stress, presenting physicians with their own physiological output in real time. Introducing appropriate, targeted coping mechanisms when they are most needed may facilitate behavioral adjustments in the face of acute stress. The goal of this dissertation research was to evaluate the potential benefit of biofeedback and coping instructions, measured by reduced perceived and physiological stress, and improved task performance. In the first study, college students participated in a first-person shooter videogame while receiving visual coping instructions. Instructions that were presented at moments of elevated stress improved downstream physiology compared to randomly administered instruction, and the presence of coping instructions was more beneficial than their absence at highly stressful times. In the second study, I adapted and validated a computer-based task to focus on components of workload experienced by physicians. This study yielded one high-stress and one-low stress version of a more demographic-appropriate task. In the final study, medical students and residents completed this task. The independent variables tested included a visual biofeedback interface, intermittent auditory coping instructions, and/or brief training on stress management and emotional intelligence. Results from this study showed that despite high cognitive workload experienced by participants receiving both biofeedback and coping instructions, performance across stress levels was indistinguishable, and physiological indicators of stress immediately following discrete coping instructions was reflective of decreased stress. Taken together, the results of these studies validate the generation of a new lab-based task to induce stress among healthcare providers, and the physiological and performance benefits associated with physiologically-based coping instructions. Future work should investigate how these concepts can be tailored towards surgical workflow with feedback modality in mind, extended to teams, and/or scaled up to higher levels of fidelity to better capture the work environment.
- Exploration of training as an implementation strategy to promote physical activity within community settings: research, theory, and practiceRamalingam, NithyaPriya Shivanthi (Virginia Tech, 2018-05-02)The prevalence of inactivity remains high, with more than 80 percent of adults failing to meet physical activity guidelines. Numerous evidence-based interventions for physical activity promotion have been developed and tested to address this need, but are typically not scaled-up and sustained in the intended practice setting. Many of these physical activity promotion programs suggest community-based delivery, often requiring researchers to train delivery personnel on intervention components. However, there is a paucity of detail on for whom, under what conditions, and how training mechanism are effective in practice. The purpose of this research was to explore the questions related to the research, theory, and practice of training. For research, a mixed-methods exploration of delivery personnel characteristics and perceived barriers and facilitators before and after program delivery or non-delivery was conducted. For theory, a systematic review of physical activity trainings for community-based delivery personnel was conducted in the literature to determine the characteristics of those who were trained, the structural and mechanistic components of said trainings, and the effectiveness of these trainings. For practice, a case-study of existing training in a community based setting was conducted to determine training processes that are likely to be successful in the real world and to evaluate the feasibility of an observational tool for physical activity trainings. The results of this dissertation show that delivery personnel characteristics and skillset may impact the acceptability, appropriateness, and effectiveness of training. They also provide preliminary support for the inclusion and importance of peer support within physical activity trainings to increase the number and representativeness of people trained and increase comfort with the training material. Further, descriptions of training for in-person physical activity programs in community settings are vague and inadequate making them difficult to replicate. Taken together, these studies provide avenues for future research and practice to develop an evidence-base for training mechanisms.
- Implementing Root Cause Analysis and Action: Integrating Human Factors to Create Strong Interventions and Reduce Risk of Patient HarmWolf, Laurie; Gorman, Kristen; Clark, Joshua; Gleason, Jonathan; Parker, Sarah H. (Wolters Kluwer Health, 2022-05-25)Objectives: The goal of this study was to develop a systems approach for root cause analysis and action to achieve strong, sustainable interventions. The team integrated human factors principles into the design of interventions to ensure solutions maintain compatibility with human capabilities and limitations resulting in stronger solutions to prevent reoccurrence. Methods: This study was conducted at a 7-hospital health system located in southwestern Virginia. Including human factors in a new root cause analysis and action process allowed the team to design strong interventions. To assess the results of this process, a team evaluated all interventions over a 4-year period (2.75-y preimplementation and 1.4-y postimplementation). Interventions were initially blind coded and then consensus coding was executed to finalize the strength of each intervention according to the VA National Center for Patient Safety evaluation tool. Results: The new process resulted in an efficient method to address adverse events with increased staff satisfaction and interventions more resilient to human error. The number of events with strong interventions increased from 43% to 69% after implementation of the new process. Conclusions: Tailoring an event investigation process to an organizational culture is critical to implementation success. Adding human factors into the design of interventions helped facilitate intervention implementation and sustainability. Blinded ratings showed that with the integration of human factors, there was improved strength of interventions. This indicates that a focus on strong system improvement (rather than weaker individual human-based solutions) will lead to improved staff satisfaction and patient safety.
- Inclusion of Clinicians in the Development and Evaluation of Clinical Artificial Intelligence Tools: A Systematic Literature ReviewJesso, Stephanie Tulk; Kelliher, Aisling; Sanghavi, Harsh; Martin, Thomas; Parker, Sarah H. (Frontiers, 2022-04-07)The application of machine learning (ML) and artificial intelligence (AI) in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five articles met criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle (82%, 19/24 design studies). We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process (22%, 5/24). A third (15/45) of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process.
- Leadership During Action Team Formation: The Influence of Shared Leadership Among Team Members During the Perioperative ProcessZagarese, Vivian (Virginia Tech, 2020)There are many leadership theories that dominate the field of Industrial and Organizational Psychology, however there is a lack of understanding as to which leadership processes may be most appropriate for action teams in high stress environments. Previous research has articulated leadership behaviors, but has largely ignored the temporal processes of leadership, and how it changes throughout the operating team’s tenure. The proposed study investigates two types of leadership, namely shared and autocratic leadership, that take place during critical steps of the perioperative process and relates these leadership behaviors to team dynamics and psychological processes. Specifically, this study builds upon other studies by testing how leadership behaviors are related to levels of psychological safety and the optimization of teamwork and communication among team members. We were also interested in understanding if the surgeon’s perception of past performance of their team has an impact on the amount of trust the leader has in his/her team and if this in turn, has an impact on the type of leadership utilized during the team’s tenure. As an exemplar environment, we explored these dynamics in the operating theater, which is a high stakes environment requiring both technical and non-technical skills, such as leadership, communication, and teamwork. Results show that the correlation between the surgeon’s perceived past performance of the team and the trust the surgeon has in his/her team and the relationship between team’s trust and teamwork and communication were significant at the alpha =.1 level. All other relationships were non-significant.
- Leadership, Psychological Safety, Team Trust, and Performance: A Study of Surgical TeamsZagarese, Vivian Joy (Virginia Tech, 2023-02-14)Within the growing literature on team leadership, there is a lack of understanding which leadership process may be most reflective of intratsk leadership. In study 1, I explored leadership behaviors throughout the operating team's OR tasks and if a shared leadership approach is related to psycho-social attitudes and performance of the team. I also investigate surgical teams' engagement in safety related behaviors and if these are related to the team's workflow disruptions. As an exemplar environment, I chose to observe these dynamics in the operating theater, which is a high-stakes environment that necessitates the team to use both technical and non-technical skills. In study 2, I investigate whether a brief targeted leadership coaching sessions with residents in a simulated environment results in different (increase or decrease) leadership behaviors at an interval of 6 months. Multiple hypothesized models were tested in Study 1. The results of model 1 show that psychological safety and team trust are significantly correlated to each other (r=.704, p= <.001). The results show that psychological safety (β= -.505 p=.049) is related to performance (time of patient on bypass), while team trust (β= .177 p=.303) does not predict performance. The results of model 2 show that more extensive shared leadership behaviors are not significantly correlated with psychological safety (r=.087 p=.250) and performance (r=-.085, p =.295); however, the results show that there is a significant correlation with shared leadership and team trust (r=.260 p =.023), indicating that a more extensive shared leadership approach is related to higher team trust in a surgical team. The results of model 3 show that the length of the time-out (a safety critical behavior) does not mediate the relationship between perceptions of the usefulness of the time-out and frequency with which the circulating nurse leaves the operating room (OR). However, there is a strong relationship between the perceptions of the time-out and the number of times the circulating nurse leaves the OR (β = -.425, p<.001), indicating that for every unit increase in the perceptions of the usefulness of the time-out, the nurse leaves the OR .45 fewer times. In study 2, a paired sample t-test was conducted to understand if leadership behaviors post-coaching session are more frequent than pre-coaching session. The results show that there is no significant difference in the frequency of leadership behaviors at time 1 (M =.113, SD=.040) and the leadership behaviors at time 2 (M= .127, SD= .041); t (6)= -1.216, p = .270.
- A Longitudinal Investigation of the Interactional Process Mechanisms of Leadership Emergence in DyadsMcCusker, Maureen E. (Virginia Tech, 2018-07-11)The purpose of the following study was to advance the science of leadership emergence by taking a process-oriented approach to understand the dyadic micro-level interacts that underlie the emergence of leader-follower relationship. While most leadership emergence research focuses mainly on attributes, behaviors, or perceptions of individuals and neglects the multi-level, temporal and contextual of the emergence leaders, this study focuses on dyads' attributes, behaviors and perceptions and considers the teams, over time, and in situ. Individuals worked together in teams over the course of four weeks to accomplish a task, and their verbal interactions were recorded and coded. Attributes of dyads and dyadic perceptions of leader-follower relationship emergence were collected. Results showed dyads that were more similar in leadership self-efficacy were more likely to engage in symmetrical types of interactions. Furthermore, the more dyads engaged in such symmetrical exchanges, the more likely they were to both see each other as leaders, than to both not see each as leaders. Contrary to expectations, no significant results were found for the effect of dyadic dissimilarity on dyadic interactions, or for the effect of complementary interactions of leader-follower relationship emergence. Implications of these findings are discussed.
- The order in which you cope matters: An examination of the moderating role of coping sequence on the impact of stressor type on affectMinton, Brandon Tyler (Virginia Tech, 2023-05-08)To date, few studies have sought to investigate whether the sequence in which individuals engage in coping strategies could impact the effectiveness of those strategies. The present study utilizes an EMA data collection approach to obtain a sample of N = 93 student participants to investigate this potential impact. I analyzed the data with a type of multilevel structural equation model (MSEM) called a cross-lagged panel model (CLPM), where the individual served as the higher level and surveys collected at various time points (three per day for five consecutive days) served as the lower level nested within those individuals. Autoregressive, cross-lagged, and moderation paths were tested to see which constructs at time point T-1 were significantly related to positive affect and negative affect at time point T. Findings indicated more significant relationships for positive affect at time point T than negative affect at time point T. Among these were moderation effects of coping strategy on the relationship between the presence of an interpersonal stressor and positive affect, such that emotion-focused coping buffers that effect and problem-focused coping amplifies it.
- People with active opioid use disorder as first responders to opioid overdoses: Improving implementation intentions to administer naloxoneEdwards, George Franklin III (Virginia Tech, 2023-08-08)The ongoing opioid crisis presents a significant public health challenge particularly for people who use opioids (PWUO). Naloxone is an opioid antagonist crucial to reducing opioid overdose mortality. Inconsistencies exist among PWUO in obtaining, carrying, discussing, and administering naloxone. Using sequential mixed methods, this study was aimed at investigating the use of implementation intentions on naloxone use among PWUO. Semi-structured interviews were conducted with 83 PWUO to gather individual experiences with using naloxone and contextual details regarding its use. An essentialist thematic analysis with inductive coding revealed valuable insights into where, for whom, and when naloxone is implemented. The analysis identified major themes such as caring for others' needs, knowledge gaps, reinforcement through overdose experiences, duality of overdose and compassion, and stigma. Minor themes related to syringe services program implementation and drug use were identified. Building on these qualitative findings a quantitative analysis determined the impact of implementation intentions on naloxone implementation. Participants were randomly assigned to develop implementation intentions or goal intentions for the use of naloxone. Follow-up surveys assessed changes in participants' intentions to obtain, carry, discuss, and administer naloxone and their actual implementation over a 6-month period. At the 3-month follow-up the experimental condition exhibited statistically significant positive intentions to obtain naloxone and engage in discussions about naloxone in social contexts of drug use. Changes in the magnitude of naloxone implementation were observed at the 3- and 6-month timepoints. Specifically, the self-reported discussion of naloxone showed noticeable changes in implementation frequency over time. This suggests that while implementation intentions may not have statistically significant effects on the use of naloxone it had some influence on the frequency of discussing naloxone prior to drug use. This work makes a valuable contribution to the existing literature because of its attempt to apply the Theory of Planned Behavior and implementation intentions in a novel way. Though the experimental hypothesis was not supported statistically significant observations were made for some behaviors at the 3-month follow-up. The pragmatic nature of the setting enhances the relevance of the findings and provides valuable insights for future interventions supporting PWUO.
- Reconceptualizing Flow from a Self-Regulatory FrameworkArun, Nikita (Virginia Tech, 2016-12-22)The flow experience refers to a state characterized by complete involvement in a task. According to flow theory, the flow state is preceded by three antecedents, skill-task match, goals, and feedback. These antecedents lead to a flow state, which is exemplified by six components, merging of action and awareness, centering of attention, loss of self-consciousness, temporal distortion, sense of control, and autotelic nature. In a flow state, individuals persist on a task without regard or awareness of themselves or their surroundings. Currently, flow is a two-stage model in which the three antecedents lead to a flow state. Flow theory is severely limited as no mediating processes have been specified between flow antecedents and the flow state. The missing mediating processes in flow theory do not allow for empirically examining testable a priori predictions. Further, failure to specify a mediator brings into question the current flow antecedents and components. The aim of this study was to recast flow theory within a self-regulation framework to ameliorate these issues. I borrow from the self-regulation literature and propose that “feeling right” mediates the relationship between flow antecedents and components. Feeling right is a positive cognitive experience that arises from successful regulatory fit. I further posit that the antecedents of flow are the antecedents of feeling right, motivational orientation and goal pursuit strategies. Finally, I propose that the flow state only be characterized by four components, merging of action and awareness, centering of attention, loss of self-consciousness, and temporal distortion. Thus, in my revised model of flow, alignment between motivational orientation and goal pursuit will lead to feeling right, which will then lead to a flow state, characterized by the four aforementioned components. A secondary goal of this study was to examine the relationship between flow and task performance. I hypothesized that individuals in a state of regulatory fit would experience flow, operationalized by intense concentration, time distortion, and loss of self-consciousness. I further hypothesized that flow would mediate the relationship between regulatory fit and performance and that type of fit would influence performance quality or quantity. I utilized an experiment design to test this revised flow model in the context of a computer game. A path model was conducted to test these predictions. Results revealed that individuals in a state of regulatory fit exhibited greater time distortion and loss of self-consciousness. However, flow did not mediate the relationship between fit and performance. Based on these results, flow can successfully be applied to a self-regulatory framework. There is initial evidence that motivational orientation and goal pursuit, i.e., regulatory fit, are causal antecedents to a flow state. There was stronger evidence for the relationship between regulatory fit and flow when behavioral flow indicators were used. Future research should focus on identifying behavioral flow indicators and continue to explore the flow construct within a self-regulatory framework.
- Reimagining medical workspaces through on-site observations and bodystormingIshida, Aki; Martin, Thomas; Gracanin, Denis; Franusich, David; Buck, Carl; Parker, Sarah H.; Knapp, R. Benjamin; Haley, Vince; Zagarese, Vivian; Tasooji, Reza (2023-01)Clinicians in acute care hospitals experience highly stressful situations daily. They work long, variable hours, complete complex technical tasks, and must also be emotionally engaged with patients and families to meet the caring demands of this profession, which can lead to burnout. In response to these challenges, a multi-disciplinary team from Virginia Tech collaborated with Steelcase to study the impact of medical workspaces on the clinician experience and how those workspaces could be improved to reduce some of the sources of burnout. The team sought to identify conditions that could either aid or hinder clinician workflow and affect burnout rate, then based on interviews and in-situ ethnographic studies, generated design concepts for nurse stations, both centralized and mobile. Using digital and physical full-scale prototypes, we enacted clinical care scenarios to seek feedback and reflect on the design.
- Sitting, Standing and Starting: Detailing Postural Control and Gait Anticipation for Children with Hemiplegic Cerebral PalsyFarah, Hassan-Galaydh Mohamud (Virginia Tech, 2023-10-05)Of all children in the US born with Cerebral Palsy (CP), 30-40% of them will be diagnosed with Hemiplegic CP (HCP), presenting with one side of the body weaker than the other. The resulting asymmetries impede the ability of children with HCP to distribute weight evenly between their lower limbs. This often contributes to poor postural control and 'favoring' of their uninvolved side for stability during balance and gait. Much is still unknown about the biomechanical characteristics of asymmetry in the lower limbs. There are a few previous research studies completed in biomechanics labs that highlight some gaps in knowledge regarding our understanding of posture and balance in this population of children, but the availability of clinical assessments that help inform the implementation and impact of treatment targets for posture and balance are sparse. This dissertation showcases two independent studies aimed at some of the gaps in knowledge for posture and balance in children with HCP. The first study in this dissertation presents and tests the reliability when a clinical measure, the Posture and Postural Ability Scale (PPAS) was modified for use in children with HCP going through a therapeutic process. The PPAS was originally developed and tested with adults in controlled settings, often with individuals being placed in postures for examination. For the study presented here, modifications focused on scoring postures when children with HCP naturally assumed various sitting and standing postures during treatment. Researchers and an experienced therapist video-coded the modified PPAS. Intrarater and interrater reliability was calculated via Cohen's kappa, percent agreement and Intraclass Correlation Coefficients. Although reliability amongst and between researchers were weak (kappas < 0.7), videos were successfully scored, demonstrating the tool is feasible. In addition, some high levels of intrarater reliability was obtained by a more experienced clinician. Suggestive that this modified PPAS could serve as a potential tool for qualified clinicians to collect meaningful posture and postural control data. The second study addressed a specific gap in knowledge about the characteristics of gait anticipation (GA, i.e., expectation of initiating a step) in children with HCP on balance. Balance and limb symmetry metrics were compared during standing in three children with HCP and typically developing (TD) peers that were matched by age and sex, alongside a third (independent) sample of 12 unmatched TD children. Motion capture analysis and force plate technology were utilized to record and follow how center of pressure (COP) and center of mass (COM) move during quiet standing (without anticipating gait) and standing with GA. This study applied a Symmetry Index (SI) to COP displacement and COP velocity allowing for quantification of asymmetries between the lower limbs during standing with and without the anticipation of gait. Children completed multiple standing trials where they were ask to stand for 35 seconds (5 seconds to obtain balance and 30 seconds of data collection). Standing trials, involved sets where children were instructed that they would not walk forward and GA trials where they were asked to stand knowing that a light would indicate they should walk forward. The light also indicated which limb (i.e. right or left) the child should step forward with first. Limb designation for stepping forward was randomly generated. Data was examined across and within (15 second blocks) 30 seconds of standing. We had the following hypotheses: 1) GA would increase COP displacement and COP velocity for children with HCP greater than TD peers who would have no change; 2) children with HCP would have different levels of symmetry between the lower limbs when expecting to walk than TD peers; and 3) children with HCP would have different reaction times based on the limb (i.e., involved versus uninvolved) they were asked to start walking with. The HCP group showed the largest increase in COP displacement when comparing standing with no expectation of walking where they had an average of 22.0 ± 10.0 mm over 30 seconds of standing to an average of 24.5 ±9.90mm during GA. The matched group average was 11.3 ±8.87mm with no expectation of walking and 4.6 ±12.6mm with GA. The TD group's COP displacement remained relatively similar with an average of 8.04 ±6.40mm during when not expecting to walk and an average of 8.29 ±6.70mm with GA. Similar increases were seen for COP velocity. Comparisons for symmetry between limbs showed that COP was displaced more underneath the uninvolved side (first 15s was 79.52%) for children with HCP, and that COP displacement asymmetry switched to become larger underneath the involved side over time (the latter 15s was -82.81%) when there was no expectation for walking. This was inverted during GA, where children with HCP initially had more COP displacement on the involved side (-72.68%) and transitioned to higher levels on the uninvolved side (99.66%) as they prepared for gait initiation. Children with HCP took 0.2 seconds longer to initiate gait with their uninvolved (not preferred) side and also took twice as long to initiate gait overall in comparison to TD peers. Our data suggests that our listed hypotheses may be correct. However, this study has limitations to sample size, demographics and biomechanical metrics. Future studies should replicate these findings and include larger, more diverse samples with further metrics such as load. If findings are confirmed, this data suggests that therapies should consider that children with HCP might change postural strategies during standing when they are anticipating walking forward in comparison to simply standing in place. This dissertation seeks to set a foundation for collaborations between biomechanists and therapists alike, potentially highlighting novel opportunities to develop more innovative treatment options for children with HCP.
- Using a human factors-centric approach to development and testing of a face shield designed for health care workers: A COVID-19 case study for process and outcomesKurtz, Camden E.; Peng, Yuhao; Jesso, Matthew; Sanghavi, Harsh; Kuehl, Damon R.; Parker, Sarah H. (Mosby-Elsevier, 2022-03-01)Background: Face shields are a critical piece of personal protective equipment and their comfort impacts compliant use and thus protectiveness. Optimal design criteria for face shield use in healthcare environments are limited. We attempt to identify factors affecting face shield usability and to test and optimize a face shield for comfort and function in health care settings. Methods: A broad range of workers in a large health care system were surveyed regarding face shield features and usability. Quantitative and qualitative analysis informed the development of iterative prototypes which were tested against existing shields. Iterative testing and redesign utilized expert insight and feedback from participant focus groups to inform subsequent prototype designs. Results: From 1,648 responses, 6 key elements were identified: ability to adjust tension, shifting load bearing from the temples, anti-fogging, ventilation, freedom of movement, and durability. Iterative prototypes received consistently excellent feedback based on use in the clinical environment, demonstrating incremental improvement. Conclusion: We defined elements of face shield design necessary for usability in health care and produced a highly functional face shield that satisfies frontline provider criteria and Emergency Use Authorization standards set by the Food and Drug Administration. Integrating human factors principles into rapid-cycle prototyping for personal protective equipment is feasible and valuable.