Browsing by Author "Koval, Olesia"

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    Augmenting Consciousness through Invasive Technologies: How Do Cochlear Implant Patients Engage Activity in the World?
    (Office of the Vice Chancellor for Research, 2014-04-11) Finch, RJ; Srinivas, Preethi; Karanam, Yamini; Koval, Olesia; Faiola, Anthony
    Background: Our ability to understand the mind has focused primarily on the explanation of behavior, leaving the question of conscious experience untouched and quite enigmatic [1]. The psychology of consciousness pertains to functional notions of the inner state of being and intrinsic internal governing structures such as self-inwardness, self-awareness, attention, voluntary control, knowledge, etc [2]. Vygotsky stated that the: “social dimension of consciousness is primarily in time and in fact,” where “individual consciousness is derivative and secondary” [3]. He held to the philosophical grounding of the theory of activity [4], arguing that to adequately understand the individual, one must recognize the societal implications related to individual lives and their conscious engagement with the social world. Based on his “cultural-historical activity theory” (CHAT), he posited that cognitive operations are specifically sociocultural structures and processes [5] that incorporate cultural artifacts into activity or the cultural mediation of action. As such, CHAT can be used to observe the socially embodied self [6, 7], where consciousness is augmented by fusing minds and tools or technologies, what Dourish stated as embodied experiences of what we “see and understand” [8]. Within this sociocultural model, consciousness can be mediated through invasive technologies. For example, human-machine augmentation (HMA) exists in corrective medical procedures that implant technologies that restore, enhance, or correct the human function of hearing, vision, or cognition. In each case, these enhancements have the potential to make our lives better, while also being augmented and increasingly artificial. Problem: Surgically inserted into the inner ear, cochlear implants provide access to sound to the deaf by stimulating nerve fibers through auditory information received from the external world [9]. Studies have shown that after six months of implantation, children have a significant enhancement in mental shifting aptitude, picture vocabulary capability, working memory, and psychomotor speed [10]. While children with cochlear implants appreciate the opportunities afforded them through the implants, they still seem to suffer from social difficulties involving friendship and “fitting in” especially during adolescence. In some instances, studies have shown that adolescents with cochlear implants began to feel alienated and depressed because they perceive themselves as different from their peers [11]. Adult patients also experienced feelings of estrangement after implantation. One phenomenological study of a 50-year-old deaf woman (after a cochlear implantation) suggested that her embodied world experience of consciousness became distorted, while manifesting signs of paranoia, fear, anxiety, and danger [12]. Due to increasing use of augmenting technologies (such as cochlear implants), we argue that consciousness is being transformed by means of extending bodies and minds [13, 14]. We also hold that the blurring of the boundaries between natural consciousness and artificial systems is an evolutionary transition from mere humancomputer interaction to HMA. As such, we ask, if, and to what degree are invasive technologies changing self-awareness and the inner life of consciousness in the context of human activity? Are augmenting technologies positively impacting the evolution of consciousness and enhancing the sociocultural experience of implant recipients? Methods: Participants will include 30 adults between the ages of 18 and 50: 15 with cochlear implants and 15 without. The study will involve three methods of data collection: (1) A controlled in-lab study will include virtual 3D animated scenes in a CAVE, ranging from a calm natural environment with progressive degrees of complex change in the images and sounds, (2) A one-week observation using the Experience Sampling Method (7x per day cognitive/emotional logging), and (3) Post-test face-to-face interviews and questionnaire. We will also compare participants using physiological bio-sensory tracking during all three methods, including: heart rate (cardiac trends), galvanic skin response (moisture/electrical conductivity, skin temperature (body temp patterns), and heat flux (heat dissipation). Data analysis will help to determine patterns and correlations between cognitive activity, consciousness of surrounding (persons, things, and context) and physiological bio-readings. Broader Impact: The last two decades have seen the exponential emergence of mediational change in human consciousness due to the ubiquitous use of information technology. The intertwining nature of technology is profoundly influencing our relationship to the world. We argue that the synthesis of mind with technology (as psychological tool) is facilitating a different construction of consciousness: a product of an artificially assimilated system that convergences natural and artificial bodies and minds. This study hopes to identify significant differences in the affects of invasive technology on consciousness between users and non-users of cochlear implants.
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    Reducing Diagnostic Error in the ICU: A Novel Approach to Clinical Workflow—Visualization-Communication Integration
    (Office of the Vice Chancellor for Research, 2014-04-11) Faiola, Anthony; Srinivas, Preethi; Karanam, Yamini; Koval, Olesia
    Background and Aim: The ICU holds the critically ill who require continuous and coordinated monitoring and frequent intervention. ICUs have the highest annual mortality rate of any hospital unit (12-22%), impacting nearly one-quarter of all admissions [1, 2]. Although ICU patients are the most monitored, tested, and examined of all hospital patients, medical conditions are missed. Studies consistently demonstrate that the complexities of ICU clinical workflow and decision-making directly impact patient safety [3], in spite of the advances in health information technology (HIT) such as clinical decision support (CDS) and smart bedside devices. The ICU is an intensely challenging and complex clinical environment, with each provider being inundated with thousands of independent pieces of information daily from multiple sources [4] including HIT and electronic medical records (EMR) systems [5]. Previous research identifies nearly 80% of HIT “user error” from cognitive overload [6], resulting in incorrect use or user error in analyzing medical data and 91% of all medical mishaps resulting from inefficient team collaboration and communication among the intensivists [7]. Although the key factor of user error can be attributed to poor or inadequately designed system interfaces or interaction sequences, research shows that without a comprehensive understanding of the context in which care occurs, it is improbable that systemic factors leading to error will be adequately understood. Hence, it is imperative to understand the underlying mechanisms of workflow error, from which innovative HIT/CDS systems can be designed to more effectively improve ICU care delivery. Although CDS systems have received increasing attention in biomedical informatics and humanfactors engineering literature, none has taken an integrated workflow approach that considers the following five factors as closely interrelated: (1) Patient status, involving continuous monitoring of patient organ function and vital sign function; (2) Patient data, such as that generated from treatment and bedside devices; (3) Medical cognition and cognitive resources of intensivists; (4) Communication among ICU team-members; and (5) Need for collaborative decision-making [8, 9]. The objective of our research is to investigate the root causes of and solutions to ICU error related to the effects of clinical workflow by: Aim 1: Identifying and comparing existing medical cognitive load, workflow, clinician happiness/challenge, and team communication/collaboration in the context of HIT/CDS system use. Aim 2: Constructing and validating several ICU workflow strategies that will be modeled for use with existing CDS systems, but primarily with the proposed novel VizCom technology, MIVA. Aim 3: Designing and building the next stage of the (formally prototyped) VizCom application MIVA that integrates patient data visualization and intensivist inter-communication into a single mobile technology (US Patent 2/4/2014, #8,645,164). Proposed Research: Based on two prior studies [10 11], our future work will identify intensivist cognitive load, workflow, and CDS system use by means of data collection methods that will take place in the ICUs of three Indianapolis hospitals, including: a) rapid ethnography: shadowing and group observation), b) self-reporting: survey, one-on-one interview, and social network analysis, and c) the experience sampling method. We propose a workflow model where MIVA will be used by intensivists who are spread across different zones, defined by location as: inside the ICU (Zone 1), inside the hospital but outside the ICU (Zone 2), and outside the hospital and on-call (Zone 3). According to our model, data will flow from bedside devices to the EMR to MIVA. The MIVA visualization-communication components will enable clinicians across all three zones to collaboratively diagnosis in unison. Broader Impact and Conclusion: Based on the aforementioned research, we believe that clear, rapid, appropriate, and accurate communication is essential to developing human-centered technology that will deliver safe and effective patient care, from which seamless collaboration among clinical professionals is vital [12]. Existing studies consistently suggest that medical cognition should focus on complex social systems that constitute distributed knowledge, collaborative performance and clinical group workflow. Our project will inform the design of a clinical decision support tool that will provide the intensivists with capabilities for greater control of ICU data and inter-communication at the point-of-care.