In the past decade, mobile communication services such as cell phones and other types of hand-held devices have become relatively cheap, affordable and accessible, especially in developing countries, including Peru. The applications of mobile devices in health, or mHealth, are surfacing and have the potential to improve the delivery and quality of health by eliminating the distance barriers; permitting the availability and retrieval of data in a timely manner; educating the public on prevention; supporting the management of diseases, and promoting patient empowerment to the population, including those that are socially stigmatized. Equally important, in conjunction with technology, training is another important factor to build a critical mass of professionals to develop and evaluate mHealth strategies. In order to take advantage of the technology at hand, health professionals must be able to know how to use these tools that are available to them. The purpose of the study is to explore the research and training, and mHealth strategies being developed in Peru. The study has the following aims: • To examine the process, progress and lessons learned of a) the mobile health initiatives of Peru through the lens of the Cell-POS project, and b) the training initiatives on mHealth in Peru through the lens of the QUIPU project; • To discover how people with HIV can achieve patient empowerment and involvement in managing their own health through the use of cell phones. For the mobile health project (Cell-POS) both quantitative and qualitative data collection was gathered, which resulted in an in-depth research analysis evaluating the efforts and initiatives of mHealth solutions in Peru, with a focus on how the use of mobile technology can help people with HIV feel empowered. In addition, it was explored how mobile health is being positioned in the area of training through the lens of the QUIPU project. A two-day expert meeting which took place on March 26 and March 27, 2010 in Lima, Peru resulted in insightful discussions of the problems and necessities regarding training in Biomedical and Health Informatics; specific issues about the curricula and the level of multidisciplinary were also discussed. Through the QUIPU project it was found that the challenges and needs are very similar across Latin America; however, through collaboration and partnerships, global health initiatives are on a rise. The Cell-POS project examined the feasibility, acceptability, perceived ease of use, and usefulness towards mHealth in relation with patient empowerment. The primary finding was that participants were satisfied and accepted the Cell-POS platform quickly and without difficulty. After six months of use, the results demonstrated that the participants perceived that the messages were clear, effective, and understandable and it was easy to incorporate the Cell-POS system to their daily activities. Most participants perceived that Cell-POS enhanced their knowledge related to HIV treatment and improved their ability to take their medications correctly and on time. Through proper planning, research initiatives and collaborative work, a successful project can be achieved. Peru has great potential, which is already starting to show through the research and work that is currently taken place. This study examines selected mHealth initiatives in the context of research and training of mHealth in Peru. / Graduate

In public safety, geography plays a significant role. One of the most important front-line elements of public safety is an efficient emergency transport and care system. The capacity to access and process information rapidly and organize resources where needed can be critically important in an emergency situation. Information about the locality of an event or a disaster is often vital in knowing how to respond. A significant operation in handling emergency situations is the routing of ambulances to incident sites and then to the closest appropriate hospitals. One of the important steps to survival in an emergency is quick response time. The aim of this thesis study is to build an immediate, rapid and efficient emergency medical transport system prototype, called Ambulance Routing Service Application Prototype (ARSAP), to be used in Middle East Technical University (METU) Emergency Service, Ankara, Turkey. In the study, geographical information systems (GIS) technology is used in assisting the development and implementation of an emergency medical service (EMS) response system. In this prototype, while choosing a proper facility, the available quantity of beds, respiratory equipments and doctors in a hospital&#039 / s intensive care room and the best traffic routes to the hospital in hand are also considered. The ARSAP is expected to shorten the commuting time and hence to reduce the damage to the patient to the lowest level and allow the ambulance staff to perform their task better. The results generated using the ARSAP are validated and analyzed by comparing with currently practiced emergency call paths data collected with the help of METU Emergency Service ambulance drivers.

INTRODUCTION: Electronic health resources are becoming prevalent. However, consumer health information is still predominantly text based. Relying on text alone to deliver health information may not be the most effective way to promote learning or sufficient to meet consumer needs. OBJECTIVES: This study assessed a) whether adding images to text and/or replacing text with narration influenced memory for Consumer Medication Information (CMI), b) if participants perceived CMI formats differently in terms of comprehensibility, utility, or design quality, and if they preferred one format overall c) what participants’ information needs were with respect to CMI. METHODS: Participants’ (N = 36) remembered CMI presented in three formats: 1) Text, 2) Text + Images, and 3) Narration + Images. Additionally, participants rated the three CMI formats in terms of comprehensibility, utility, design quality and overall preference. Semi-structured interviews were used to investigate participants’ opinions and preferences regarding the CMI formats, as well as their experiences with CMI and information needs. RESULTS: No significant differences in memory were observed, F(2, 70) = 0.1, p = 0.901. Thus, this study did not find evidence that Mayer’s (2001) multimedia or modality principles apply to CMI. Despite the absence of effects on memory, CMI format impacted perceptions of the material. Participants rated the Text + Images format highest in terms of comprehensibility, X2(2) = 26.5, p < .001 and design quality, X2(2) = 35.69, p < .001. However, after correcting for multiple comparisons, no significant differences in utility ratings between the three formats were observed, X2(2) = 8.21, p < .016. Further, overall preferences revealed that the most participants’ chose the Text + Images format as their favourite (n = 27, 75%) and Text as their least favourite (n = 23, 63.8%). Directed and conventional content analysis were used to explore participants’ CMI preferences and information needs. Various aspects related to provision, comprehensibility, utility, and design quality all appeared to affect perceptions of CMI and whether or not participants used or would use it. Results of this analysis, paired with evidence from other studies, were used to develop a model proposing factors that influence CMI use. CONCLUSION: This study investigated the potential impact of design and distribution changes on perceptions of CMI. Despite the lack of differences in memory, participants’ perceptions of the formats differed. Findings from this study could be used to inform future research on how CMI could be designed to better suit the needs of consumers and potentially increase the likelihood it is used. / Graduate

abstract: Bayesian phylogeography is a framework that has enabled researchers to model the spatiotemporal diffusion of pathogens. In general, the framework assumes that discrete geographic sampling traits follow a continuous-time Markov chain process along the branches of an unknown phylogeny that is informed through nucleotide sequence data. Recently, this framework has been extended to model the transition rate matrix between discrete states as a generalized linear model (GLM) of predictors of interest to the pathogen. In this dissertation, I focus on these GLMs and describe their capabilities, limitations, and introduce a pipeline that may enable more researchers to utilize this framework. I first demonstrate how a GLM can be employed and how the support for the predictors can be measured using influenza A/H5N1 in Egypt as an example. Secondly, I compare the GLM framework to two alternative frameworks of Bayesian phylogeography: one that uses an advanced computational technique and one that does not. For this assessment, I model the diffusion of influenza A/H3N2 in the United States during the 2014-15 flu season with five methods encapsulated by the three frameworks. I summarize metrics of the phylogenies created by each and demonstrate their reproducibility by performing analyses on several random sequence samples under a variety of population growth scenarios. Next, I demonstrate how discretization of the location trait for a given sequence set can influence phylogenies and support for predictors. That is, I perform several GLM analyses on a set of sequences and change how the sequences are pooled, then show how aggregating predictors at four levels of spatial resolution will alter posterior support. Finally, I provide a solution for researchers that wish to use the GLM framework but may be deterred by the tedious file-manipulation requirements that must be completed to do so. My pipeline, which is publicly available, should alleviate concerns pertaining to the difficulty and time-consuming nature of creating the files necessary to perform GLM analyses. This dissertation expands the knowledge of Bayesian phylogeographic GLMs and will facilitate the use of this framework, which may ultimately reveal the variables that drive the spread of pathogens. / Dissertation/Thesis / Doctoral Dissertation Biomedical Informatics 2017

A informática e as Tecnologias da informação e comunicação (TICs) tem grande impacto na atualização dos profissionais da saúde, exigindo que os mesmos estejam cada vez mais preparados para acompanhar o uso das tecnologias, buscando conhecimentos teóricos relacionados a essa temática, a fim de promover a convergência entre o desenvolvimento humano e tecnológico, bem como propiciar a utilização da tecnologia de forma humanizada. Nesse sentido, realizou-se um estudo exploratório descritivo e documental, com os objetivos de identificar e analisar os planos das disciplinas de informática em enfermagem dos cursos de graduação de enfermagem da cidade de Brasília- DF e das Universidades do Município de São Paulo-SP, e caracterizar o perfil acadêmico dos professores que as ministram. Para a coleta de dados utilizou-se o sistema eletrônico, e-MEC, de acompanhamento dos processos educacionais nacionais, estruturado pelo Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (INEP) para identificar as Instituições de Ensino Superior (IES) que possuíam disciplina de informática em enfermagem na grade curricular dos curso de enfermagem. Fizeram parte do estudo 3 (três) 11% (IES) que possuiam disciplinas relacionadas a informática em enfermagem, que eram ministradas regularmente. Os planos de disciplinas foram analisados à luz de referenciais teóricos sobre educação e informática em enfermagem pesquisados nacional e internacionalmente, e a análise do perfil acadêmico dos professores foi realizada após estes terem respondido um questionário que visava identificar qual a formação acadêmica, especializações cursadas, tempo de formado, tempo de experiência profissional, tempo de experiência na área de ensino, e tempo em que ministra a disciplina pesquisada. Os resultados revelaram que o plano de disciplinas ministrados apresenta objetivos e conteúdos voltado, predominantemente, para aspectos de uso básico do computador sem articular a informática com o processo de trabalho do enfermeiro. As disciplinas, foco deste estudo, apresentam uma carga horária, com média de 40,3 horas. Com relação ao semestre em que a disciplina é ministrada, duas são ministradas no 3º semestre e uma no 1º semestre e apenas 1 disciplina tem caráter obrigatório. Com relação aos professores que ministram as disciplinas de informática em enfermagem, os resultados mostraram que estes não são da área de enfermagem ou saúde, e isso nos remete a realidade de que os profissionais da saúde, precisam buscar essa formação fora do seu campo de atuação e poucos cursos formais sobre essa temática são oferecidos no país. Concluí-se que a Informática em Enfermagem deva estar presente na formação do enfermeiro de modo a oferecer aos graduandos conhecimentos sobre a aplicação do uso da informática na assistência, na administração, no ensino e na pesquisa. Denota-se que urge a necessidade de uma reflexão nacional conjuntas das instituições de ensino e dos órgaos de classe sobre as competências e habilidades de informática em enfermagem, considerando os modelos e as experiências de capacitação dos enfermeiros propostos internacionalmente. Acredita-se, ainda, que o processo ensino aprendizagem de informática em enfermagem deve estar fundamentado em abordagens inovadoras, com a utilização das novas tecnologias da informação e comunicação, bem como embasado em experiências concretas da prática profissional. / Computing and Information and Communications Techonology (ICTs) has a great impact on utilization of health care professionals, requiring that they are increasinglyprepared to accompany the use of technology, seeking theoretical knowledge related to this issue in order to promote convergence between the human and technological development as well as enabling the use of technology in a humane way. Thus, this study is an exploratory study and documentation, with the objectives of identifying and analyzing the plans of the disciplines of nursing informatics for undergraduate nursing of Brasilia-DF and the University of São Paulo-SP And characterize the academic profile of teachers who teach. To collect data we used the electronic system, e-MEC, the national monitoring of educational processes, structured by the National Institute of Educational Studies Teixeira (INEP) to identify the Higher Education Institutions who had discipline of nursing informatics in the curriculum of the nursing program. The study group 3 (three) 11% (IES) who possessed disciplines related to nursing informatics, and which were held regularly. The plans of subjects were analyzed based on theoretical frameworks on education and nursing informatics surveyed nationally and internationally, and analysis of the academic profile of teachers was carried out after they answered a questionnaire that aimed to identify which academic specializations attended, time trained, professional experience, length of experience in teaching, and time in administering the discipline studied. The results revealed that the plan presents objectives and disciplines taught content focused predominantly on aspects of basic computer use without linking the computer with the process of nursing work. Disciplines, the focus of this study, have a heavy workload, with an average of 40.3 hours. With respect to the semester in which the discipline is taught, are taught in two three and a half in the 1st half and only one discipline has character. With respect to teachers who teach the disciplines of nursing informatics, the results showed they are not in the nursing area, and this leads us to the reality that health professionals need to seek such training outside their field of action and few formal courses on this topic are offered throughout the country. We concluded that the nursing informatics should be present in nursing education in order to offer knowledge to undergraduates on the application of information technology in care, administration, teaching and research. Denotes that there is urgent need for a joint reflection of the national educational institutions and the organs of class on the skills and abilities of nursing informatics, considering the models and experiences of training of nurses offered internationally. It is believed also that the learning process of nursing informatics should be based on innovative approaches to the use of new information technologies and communication as well as grounded in practical experience of professional practice.

Human wellbeing, in a large component, relies on the harmony between the body and the mind. Unfortunately, we often miss or ignore important signals from our bodies, and sometimes this can negatively impact our health. Therefore, the use of intelligent systems that grasp such signals and convey them in an intuitive manner to our minds can result in great health benefits. In this Thesis, we introduce a family of multimedia technologies and techniques aimed at realizing such systems. We call them: Ubiquitous Biofeedback Multimedia Systems. Although the notion of clinical biofeedback has been around for years, we introduce the concept of Ubiquitous Biofeedback where the biofeedback operation is given geographical and temporal ubiquity attributes. A Ubiquitous Biofeedback reference model is introduced in the Thesis to provide an abstract structural representation of the various components at play in a typical non-clinical biofeedback environment. Two systems that implement the reference model’s components are presented. These systems implement the concept of Ubiquitous Biofeedback through the introduction of innovative stress management methods. An important component of these systems guides users through a relaxation routine. Therefore, a mathematical model is developed in the goal of personalizing the relaxation process. Its objective is to suggest relaxation techniques to a user during a stressful episode based on her or his preferences, history of what worked well and appropriateness for the context. The mental stress monitoring mechanism built into the Ubiquitous Biofeedback systems presented in this Thesis relies on the measurement of Heart Rate Variability (HRV). Therefore, HRV based methods for tracking mental stress accumulation and acute manifestations during long term monitoring have been devised. Also, since HRV signals can be plagued by artifacts, several algorithms are contributed to the effort of correcting such occurrences.

Severe acute respiratory syndrome (SARS)-CoV-2 emerged in late 2019, then became an unprecedented public health crisis. Hundreds of millions of people have been affected. What is worse, many researchers have revealed that COVID-19 may have long-term effects on varieties of organs even after recovery. Consequently, there is a need for the study of its sequelae. The purpose of this project is to use machine learning algorithms to study the relationship between patients’ EMR data and long-term sequelae, especially kidney diseases. Inspired by a recent learning disentangled representation for recommendation work, this project proposes a method that (i) predicts the development trend of the kidney disease; (ii) learn representations that uncover and disentangle factors related to kidney diseases. The major contribution is that this model has high interpretability which enables medical works to infer the development of patients' condition.

Indiana University-Purdue University Indianapolis (IUPUI) / The emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.

Background: Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, alterations in function (e.g. impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and high rates of depression. Patients may suffer undue anxiety because they find treatment incomprehensible, which is partially a function of limited, understandable information. This can be particularly challenging for patients with limited health literacy. Furthermore, a globalized world consisting of cultural differences increases the need to enhance transparent communication of risk. Research on risk literacy and medical decision-making validates that across different cultures, people often have severe obstacles in grasping a host of prerequisite concepts for understanding health-related risk information such as numbers, graphs, and basic medical facts. Patients’ perceptions of having obtained adequate information prior and during treatment are predictive of positive outcomes. Providing patient-centered decision-support, utilizing visual images, may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. A scoping review was conducted on electronic, decision aids (DAs) for oncology patients that returned 4217 articles, but only 167 for HNC, with 12 meeting the inclusion criteria. Three themes were identified: (1) both patients and physicians valued the DA; (2) DAs should be visually supported by images; and (3) use of a DA lessened decisional conflict and anxiety while improving knowledge, satisfaction and shared decision-making. This informed the design of a prototype DA. Semi-structured interviews were conducted with 12 survivors of HNC who completed treatment at BC Cancer- Victoria on their experiences, feedback on the utility of a DA, and insights into design features. Thematic analysis resulted in 12 themes that were organized into 3 categories. The first category, “the patient experience,” included three themes: “patients have high, through varying information needs”; “an emotional experience”; and “stories of coping, strength and resiliency.” The second category, “electronic DAs and decision support,” also included three themes: “familiarity with decision aids”; “support of concept: usefulness and of visual aids”; and “versatility of the prototype.” The last category, “evaluation of prototype”, contained six themes: “reaction to prototype”; “favourited features”; “complexity”; “preference for customizability”; “suggestions for improvement”; and “presentation device.” Key Message: The use of DAs have been shown to better inform and increase patients’ knowledge, accuracy of risk perception, and congruency between informed values and care choices allowing them to take part in active decision-making, compared to usual care. Survivors of HNC were in unanimous support of using visual images to help explain treatment and assist in decision making on treatment options. Furthermore, they contributed invaluable feedback on the prototype design, demonstrating the value of a co-design methodologies. / Graduate

Aim: Public health systems have embraced health informatics and information technology as a potential transformational tool to improve real-time surveillance systems, communication, and sharing of information among various agencies. Global pandemic outbreaks like Zika and Ebola were quickly controlled due to electronic surveillance systems enabling efficient information access and exchange. However, there is the need for a more robust technology to enhance adequate epidemic forecasting, data sharing, and effective communication. The purpose of this review was to examine the use of informatics and information technology tools and its impact on public health delivery. Method: Investigators searched six electronic databases. These were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Database of Systematic Reviews, COMPENDEX, Scopus, and Academic Search Premier from January 2000 to 31 March 2016. Results: A total of 60 articles met the eligibility criteria for inclusion. These studies were organized into three areas as (1) definition of the term public health informatics; (2) type of public health surveillance systems and implications for public health; and (3) electronic surveillance systems functionality, capability, training, and challenges. Our analysis revealed that due to the growing expectations to provide real-time response and population-centered evidence-based public health in this information-driven age there has been a surge in informatics and information technology adoption. Education and training programs are now available to equip public health students and professionals with skills in public health informatics. However, obstacles including interoperability, data standardization, privacy, and technology transfer persist. Conclusion: Re-engineering the delivery of public health is necessary to meet the demands of the 21st century and beyond. To meet this expectation, public health must invest in workforce development and capacity through education and training in informatics.