Browsing by Author "Srinivas, Preethi"
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Item Addressing People and Place Microenvironments in Weight Loss Disparities (APP-Me): Design of a randomized controlled trial testing timely messages for weight loss behavior in low income black and white women(Elsevier, 2018) Clark, Daniel O.; Srinivas, Preethi; Bodke, Kunal; Keith, NiCole; Hood, Sula; Tu, Wanzhu; Medicine, School of MedicineBackground Behavioral interventions for weight loss have been less effective in lower income and black women. These poorer outcomes may in part be related to these women having more frequent exposures to social and physical situations that are obesogenic, i.e., eating and sedentary cues or situations. Objectives Working with obese, lower income black and white women, Addressing People and Place Microenvironments (APP-Me) was designed to create awareness of self-behavior at times and places of frequent eating and sedentary behavior. Design APP-Me is being evaluated in a randomized controlled trial with 240 participants recruited from federally qualified health centers located in a single Midwestern city. All participants complete four weeks of ecological momentary assessments (EMA) of situations and behavior. At the end of the four weeks, participants are randomized to enhanced usual care (UC) or UC plus APPMe. Methods APP-Me is an automated short messaging system (SMS). Messages are text, image, audio, or a combination, and are delivered to participants’ mobile devices with the intent of creating awareness at the times and places of frequent eating or sedentary behavior. The EMA data inform the timing of message deliveries. Summary This project aims to create and test timely awareness messages in a subpopulation that has not responded well to traditional behavioral interventions for weight loss. Novel aspects of the study include the involvement of a low income population, the use of data on time and place of obesogenic behavior, and message delivery time tailored to an individual’s behavioral patterns.Item The appearance, speech, and motion of synthetic humans influences our empathy toward them(Office of the Vice Chancellor for Research, 2011-04-08) MacDorman, Karl F.; Ho, Chin-Chang; Lu, Amy S.; Mitchell, Wade J.; Patel, Himalaya; Srinivas, Preethi; Schermerhorn, Paul W.; Scheutz, MatthiasHumanoid robots and computer-generated humans can elicit responses that people usually direct toward each other. As a result these humanlike entities may stand in for human actors during experiment-driven research in the social and psychological sciences as well as in some branches of neuroscience. Such research concerns factors like facial appearance, physical embodiment, speech quality, fluidity of motion, and contingent interactivity. A goal of this research is to understand why some humanlike entities are more successful than others at eliciting people’s empathy. Pursuing this goal informs new principles for creating synthetic humans that seem more believable in narratives and narrative-based interventions.Item 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, AnthonyBackground: 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.Item Building Healthy Social Media for All: Investigating How Different Cultures Seek and Process Health Information(Office of the Vice Chancellor for Research, 2016-04-08) Ansah-Koi, Kate; Faiola, Anthony; Srinivas, Preethi; Strzeszkowski, Deborah; Gross, MikaylahThe percentage of people accessing online health information in the U.S. has created a spike in knowledge that continues to impact personal health outcomes. Three events that have amplified interest in accessing such information have been: (1) Local/national programs promoting healthy life-styles and disease prevention, (2) The effects of increasing immigration to North America, and (3) The passing of the Affordable Care-Act. Aligning with these factors are health statistics that show African Americans with the highest mortality rate of any racial/ethnic group for all cancers combined—contributing to the lowest life expectancy of any ethnic group. Second, there are 55.2M Spanish speakers in the U.S., of which 20% (7.2M) say their level of English proficiency is fair-to-non-existent. This research is an investigation (in two-parts) into the role of cultural cognitive preferences in the design of online health social media and its potential for improving the health and well-being—with a focus on African-American and Latino populations. This study focuses on the former. Ten African Americans, ages 40 to 60, participated in phone open-ended interviews to identify their perception of the quality and availability of online health information. The interview consisted of 14 questions and lasted for approximately 15 minutes. Findings suggest that participants seek health information from a wide array of sources, with a preference for people as the source rather than online, e.g., physicians, health clinics, family and friends, co-workers, campus events, and church. While none of the interviewees answered yes to a question about whether they participated in online health networks, most did have knowledge of the dissemination of health information through social media, which most had experience using. Finally, the most mentioned factor regarding satisfaction with online health information was related to trust and verifying the sources, which most interviewees said they do through their personal physician.Item Clinicians as Secondary Users of Patient-Centered Mobile Technology in Complex Healthcare Settings(IEEE, 2015-10) Tunnell, Harry D., IV; Faiola, Anthony J.; Haggstrom, David A.; Srinivas, Preethi; Department of Human-Centered Computing, School of Informatics and ComputingThis paper describes the preliminary research findings and prototype development of a Personal Health Record mobile application. A pilot study about patient-clinician interaction guided by common ground theory was performed. The goal of the pilot study was to gather requirements to support development of a smartphone application to be used in a future experimental study. Findings from the pilot study suggest that smartphones could be used to manage health information considered important for a successful healthcare consultation.Item Extreme mediation: Observing mental and physical health in everyday life(2014-09) Faiola, Anthony; Srinivas, PreethiThe excessive use of smartphones resulting in extreme mediation has been identified to result in psychological problems including anxiety, depression, and an overall neural change that is impacting people of all ages on many levels. An exploratory study using Experience Sampling Method (ESM) concluded a significant increase in positive mood, conscious awareness of the surrounding environment, and an increased number of participants self-reporting physical activity lasting 15 minutes on days without smartphone use. Results suggest the need to avoid increased use of noninvasive technology such as smartphones resulting in deterioration of mental and physical health.Item Human factors analysis, design, and evaluation of Engage, a consumer health IT application for geriatric heart failure self-care(Taylor & Francis:, 2017) Srinivas, Preethi; Cornet, Victor; Holden, Richard; BioHealth Informatics, School of Informatics and ComputingHuman factors and ergonomics (HFE) and related approaches can be used to enhance research and development of consumer-facing health IT systems, including technologies supporting the needs of people with chronic disease. We describe a multiphase HFE study of health IT supporting self-care of chronic heart failure by older adults. The study was based on HFE frameworks of "patient work" and incorporated the three broad phases of user-centered design: study or analysis; design; and evaluation. In the study phase, data from observations, interviews, surveys, and other methods were analyzed to identify gaps in and requirements for supporting heart failure self-care. The design phase applied findings from the study phase throughout an iterative process, culminating in the design of the Engage application, a product intended for continuous use over 30 days to stimulate self-care engagement, behavior, and knowledge. During the evaluation phase, we identified a variety of usability issues through expert heuristic evaluation and laboratory-based usability testing. We discuss the implications of our findings regarding heart failure self-care in older adults and the methodological challenges of rapid translational field research and development in this domain.Item The human likeness of computer-generated characters predicts altercentric intrusion during a counting task (Alternative title: An uncanny valley of visual perspective taking: A study of the effects of character human likeness and eeriness on altercentric intrusion during a counting task)(Office of the Vice Chancellor for Research, 2011-04-08) Srinivas, Preethi; Patel, Himalaya; Ho, Chin-Chang; MacDorman, Karl F.Abstract: Perceivers lose empathy for synthetic human characters when the characters' nonhuman features elicit an eerie feeling. This phenomenon, termed the uncanny valley, may specifically diminish the likelihood of understanding these characters' perspective. Such perspective taking should rely on a more fundamental ability to infer a character's visual perspective merely by looking at the character. Based on this assumption, a dot-counting task was undertaken by 268 undergraduate students in which they either took or ignored the apparent field of vision of computer-drawn characters with varying human likeness. It was predicted that for characters that appear more humanlike, task trials with a similar visual perspective between participant and character would predict shorter response times and higher accuracy, whereas task trials with dissimilar visual perspectives would predict longer response times and lower accuracy. Although these predictions were supported, trials with dissimilar visual perspectives also yielded longer response times when they included certain photorealistic inanimate objects (e.g., a chair). Future studies will ascertain whether such perspective taking ability is similarly affected when the synthetic human characters are more photorealistic.Item Mediating ICU patient situation-awareness with visual and tactile notifications(2016-03-29) Srinivas, Preethi; Bolchini, Davide; Faiola, Anthony; Brady, Erin; Khan, Babar; Doebbeling, BradleyHealthcare providers in hospital intensive care units (ICUs) maintain patient situation awareness by following task management and communication practices. They create and manipulate several paper-based and digital information sources, with the overall aim to constantly inform themselves and their colleagues of dynamically evolving patient conditions. However, when increased communication means that healthcare providers potentially interrupt each other, enhanced patient-situation awareness comes at a price. Prior research discusses both the use of technology to support increased communication and its unintended consequence of (wanted and unwanted) notification interruptions. Using qualitative research techniques, I investigated work practices that enhance the patient-situation awareness of physicians, fellows, residents, nurses, students, and pharmacists in a medical ICU. I used the Locales Framework to understand the observed task management and communication work practices. In this study, paper notes were observed to act as transitional artifacts that are later digitized to organize and coordinate tasks, goals, and patient-centric information at a team and organizational level. Non digital information is often not immediately digitized, and only select information is communicated between certain ICU team members through synchronous mechanisms such as face-to-face or telephone conversations. Thus, although ICU providers are exceptionally skilled at working together to improve a critically ill patient’s condition, the use of paper-based artifacts and synchronous communication mechanisms induces several interruptions while contextually situating a clinical team for patient care. In this dissertation, I also designed and evaluated a mobile health technology tool, known as PANI (Patient-centered Notes and Information Manager), guided by the Locales framework and the participatory involvement of ICU healthcare providers as co designers. PANI-supported task management induces minimal interruptions by: (1) rapidly generating, managing, and sharing clinical notes and action-items among clinicians and (2) supporting the collaboration and communication needs of clinicians through a novel visual and tactile notification system. The long-term contribution of this research suggests guidelines for designing mobile health technology interventions that enhance ICU patient situation-awareness and reduce unwanted interruptions to clinical workflow.Item 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, OlesiaBackground 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.