The melanoma cell adhesion molecule defines mesenchymal stromal cells in the human bone marrow that regenerate bone and establish a hematopoietic microenvironment in vivo. The role of the melanoma cell adhesion molecule in primary human mesenchymal stromal cells and the maintenance of hematopoietic stem and progenitor cells during ex vivo culture has not yet been demonstrated. We applied RNA interference or ectopic overexpression of the melanoma cell adhesion molecule in human mesenchymal stromal cells to evaluate the effect of the melanoma cell adhesion molecule on their proliferation and differentiation as well as its influence on co-cultivated hematopoietic stem and progenitor cells. Knockdown and overexpression of the melanoma cell adhesion molecule affected several characteristics of human mesenchymal stromal cells related to osteogenic differentiation, proliferation, and migration. Furthermore, knockdown of the melanoma cell adhesion molecule in human mesenchymal stromal cells stimulated the proliferation of hematopoietic stem and progenitor cells, and strongly reduced the formation of long-term culture-initiating cells. In contrast, melanoma cell adhesion molecule-overexpressing human mesenchymal stromal cells provided a supportive microenvironment for hematopoietic stem and progenitor cells. Expression of the melanoma cell adhesion molecule increased the adhesion of hematopoietic stem and progenitor cells to human mesenchymal stromal cells and their migration beneath the monolayer of human mesenchymal stromal cells. Our results demonstrate that the expression of the melanoma cell adhesion molecule in human mesenchymal stromal cells determines their fate and regulates the maintenance of hematopoietic stem and progenitor cells through direct cell-cell contact.

Thesis (MPhil)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The study reported on here was conducted between December 2003 and April 2004. The aim of the study was to assess the use of Health Channel Broadcast Multimedia (HCBM) in order to maximise its success. The HCBM is an Information Technology method that was used to disseminate health information in public health facilities. HCBM was installed in health facilities and was used as an education tool. This was done by further developing the clinical skills of the health care workers (HCWs) and to inform the patients, including the community members on HIV/AIDS and related communicable diseases. The study was conducted in eight health facilities in seven provinces where HCBM was piloted. Facilities and forty-nine health professionals (HCWs) were selected conveniently and one hundred and twenty-eight patients were sampled using a systematic random method. The convenient sampling method was relevant since these were key facilities with HCBM. There were very few HCWs who did view HCBM and they were drawn into the study. HCBM used programmes disseminating messages in Afrikaans, English, sePedi, seSotho, siSwati, isiXhosa and isiZulu. The Rapid Assessment Response (RAR) approach was used to give a quick appraisal of the study. The report focuses on the cross-sectional reporting of the quantitative technique of the RAR. Of the HCWs, 86% had viewed the broadcast content, 70% were satisfied with the broadcast mode of service delivery; 56% indicated that the messages were good and added educational value to their professional work, while 52% chose to use the IP box content with HIV/AIDS topics. Ninety-two percent of HCWs stated that HCBM targeted patients and young people, 48% said HCBM had the ability to convey information and 48% said it was capable of addressing health problem. When HCBM was being set up, 62% HCWs engaged in decision making. Patients mentioned that HCBM as a method of information dissemination was educative (62%) and informative (52%). They reported that they did hear messages on HIV/AIDS telling them that medication was available for free to treat within 72 hours after being raped (72%); they had the right to say no to unsafe sex (92%); and 76% said the broadcast had the ability to change people’s behaviour. Respondents reported that the messages were easily understood (44%). The conclusion is that the findings will be useful to inform the government and managers of HCBM programmes on how to maximise the success of HCBM, especially at the implementation phase. / AFRIKAANSE OPSOMMING: Hierdie verslag doen verslag oor die resultate van ’n ondersoek wat tussen Desember 2003 en April 2004 onderneem is. Die doel van die verslag is om die doeltreffendheid van die gebruik van ’n multimedia gesondheidsuitsendingkanaal, Health Channel Broadcast Multimedia (HCBM) te bepaal. Hierdie is nuwe tegnologie wat gebruik word om gesondheidsinligting slegs in die openbare gesondheidsektor te versprei. Die studie is by agt openbare gesondheidsfasiliteite in sewe provinsies waar die HCBM volledig gevestig was, onderneem. Nege-en-veertig gesondheidskundiges (HPW’s) is volgens ’n gerieflikheidsteekproef geselekteer, en 128 pasiënte is met behulp van ’n sistematiese ewekansige steekproef geselekteer. Die HCBM het programme gebruik wat boodskappe in Afrikaans, Engels, sePedi, seSotho, siSwati, isiXhosa en isiZulu uitgesaai het. ’n Benadering bekend as die Rapid Assessment Response (RAR) is gebruik om ’n vinnige evaluering van die studie te maak. Die verslag konsentreer op die deursneerapportering van die kwantitatiewe tegniek van die RAR. Van die HPW’s het 85% na die inhoud van die uitsending gekyk, 70% was tevrede met die uitsendingmodus van dienslewering, 56% het aangedui dat die boodskappe goed was en van opvoedkundige waarde in hulle professionele werk, terwyl 52% verkies het om die Internet Platform-inhoud met MIV/Vigs-temas te gebruik. Twee-en-negentig persent van die HPW’s het te kenne gegee die HCBM is gerig op pasiënte en die jeug, 48% het gesê HCBM het die vermoë om inligting oor te dra, en 48% het gesê dit is geskik om na die gesondheidsprobleem om te sien. Tydens die instelling van die HCBM het 62% HPW’s aan besluitneming deelgeneem. Van die pasiënte met grade 0–6 as opvoedingspeil het 75% verkies om brosjures te gebruik bo enige ander massamedia, en 72% mans en 67% vrouens het na boodskappe oor die behandeling van MIV/Vigs-simptome geluister. Inligting oor vrywillige berading en toetsing voor swangerskap is deur 66% van die vrouens gehoor. Meer as 90% van hulle was bewus van die reg om nee te sê vir seks of onveilige seks. Pasiënte oor die hele residensiële gebied was dit eens dat die taalgebruik in die uitsendings maklik verstaanbaar was. Oor al die opvoedkundige grade heen is saamgestem dat die HCBM die voorgenome boodskap oorgedra het. Die gevolgtrekking is dat die bevindings waardevol is om die regering en bestuurders van die uitsendingsprogram in te lig oor hoe om die ander fases te verbeter. Dit sluit Fase 2 in, wat die uitvoering van die HCBM behels.

Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.

In order to make technology easier to handle for its users, the field of HCI (Human- Computer Interaction) has recently often turned the environment and the context of use. In this thesis the focus is on the relation between the user and the technology. More specifically, this thesis explores how roles and professional identity effects the use and views of the technology used. The exploration includes two different domains, a clinical setting and a media production setting, where the focus is on the clinical setting. These are domains that have strong professional identities in common, in the clinical setting neurosurgeons and physicists, and the media setting journalists. These settings also have a strong technological profile, in the clinical setting the focus has been on a specific neurosurgical tool called Leksell GammaKnife and in the journalistic setting the introduction of new media technology in general has been in focus. The data collection includes interviews, observations and participatory design oriented workshops. The data collected were analyzed with qualitative methods inspired by grounded theory. The work with the Leksell GammaKnife showed that there were two different approaches towards the work, the tool and development, depending on the work identity. Depending on if the user were a neurosurgeon or a physicist, the definition of the work preformed was inline with their identity, even if the task preformed was the same. When it comes to the media production tool, the focus of the study was a participatory design oriented development process. The outcome of the process turned out to be oriented towards the objectives that were inline with the users identity, more than with the task that were to be preformed. At some level, even the task was defined from the user dentity.

The concentration on healthcare information technology has never been determined than it is today. This awareness arises from the efforts to accomplish the extreme utilization of Electronic Health Record (EHR). Due to the greater mobility of the population, EHR will be constructed and continuously updated from the contribution of one or many EPRs that are created and stored at different healthcare locations such as acute Hospitals, community services, Mental Health and Social Services. The challenge is to provide healthcare professionals, remotely among heterogeneous interoperable systems, with a complete view of the selective relevant and vital EPRs fragments of each patient during their care. Obtaining extensive EPRs at the point of delivery, together with ability to search for and view vital, valuable, accurate and relevant EPRs fragments can be still challenging. It is needed to reduce redundancy, enhance the quality of medical decision making, decrease the time needed to navigate through very high number of EPRs, which consequently promote the workflow and ease the extra work needed by clinicians. These demands was evaluated through introducing a system model named SVSEPRS (Searching and Viewing Segments of Electronic Patient Records Service) to enable healthcare providers supply high quality and more efficient services, redundant clinical diagnostic tests. Also inappropriate medical decision making process should be avoided via allowing all patients‟ previous clinical tests and healthcare information to be shared between various healthcare organizations. Multidimensional data model, which lie at the core of On-Line Analytical Processing (OLAP) systems can handle the duplication of healthcare services. This is done by allowing quick search and access to vital and relevant fragments from scattered EPRs to view more comprehensive picture and promote advances in the diagnosis and treatment of illnesses. SVSEPRS is a web based system model that helps participant to search for and view virtual EPR segments, using an endowed and well structured Centralised Multidimensional Search Mapping (CMDSM). This defines different quantitative values (measures), and descriptive categories (dimensions) allows clinicians to slice and dice or drill down to more detailed levels or roll up to higher levels to meet clinicians required fragment.

This thesis describes research into the facilitation of mediated communication of health updates and support needs across the social network, on behalf of individuals experiencing acute or chronic health problems. This led to the user-centred design, development and evaluation of a prototype software tool. Investigatory applied research was conducted with the parents of sick newborn infants who were (or had previously been) cared for in a Neonatal Unit, and their social networks of family, friends, colleagues and neighbours. The thesis makes contributions to knowledge within Social Networks, Health Informatics, Adaptive Systems and User Modelling. The user-centred research was conducted using a Grounded Theory approach, progressively focussing on developing themes. An iterative approach was taken to evaluation of the resulting theory. In the Social Networks domain, a novel, intuitive mechanism for capturing the membership and structure of an individual’s personal social network has been defined and developed, grounded in the work of evolutionary anthropologist Robin Dunbar. Use of the highly visual mechanism requires low levels of literacy and computer skills. It is cross-culturally applicable, and makes no prior assumptions about an individual’s relationships. In the domains of Health Informatics, Adaptive Systems and User Modelling, a model has been defined for adaptive information sharing across the personal social network. This model provides a number of new insights about information sharing choices made by an individual experiencing a health crisis (the ego) and their supporters (alters).

Background: Tobacco smoke exposure (TSE) is unequivocally harmful to children's health, yet up to 48% of children who visit the pediatric emergency department (PED) and urgent care setting are exposed to tobacco smoke. The incorporation of clinical decision support systems (CDSS) into the electronic health records (EHR) of PED patients may improve the rates of screening and brief TSE intervention of caregivers and result in decreased TSE in children. Objective: We propose a study that will be the first to develop and evaluate the integration of a CDSS for Registered Nurses (RNs) into the EHR of pediatric patients to facilitate the identification of caregivers who smoke and the delivery of TSE interventions to caregivers in the urgent care setting. Methods: We will conduct a two-phase project to develop, refine, and integrate an evidence-based CDSS into the pediatric urgent care setting. RNs will provide input on program content, function, and design. In Phase I, we will develop a CDSS with prompts to: (1) ASK about child TSE and caregiver smoking, (2) use a software program, Research Electronic Data Capture (REDCap), to ADVISE caregivers to reduce their child's TSE via total smoking home and car bans and quitting smoking, and (3) ASSESS their interest in quitting and ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (eg, Quitline, SmokefreeTXT, or SmokefreeGOV) during the urgent care visit. We will create reports to provide feedback to RNs on their TSE counseling behaviors. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our CDSS on changes in RNs' TSE-related behaviors, and child and caregiver outcomes. Results: This trial is currently underway with funding support from the National Institutes of Health/National Cancer Institute. We have completed Phase I. The CDSS has been developed with input from our advisory panel and RNs, and pilot tested. We are nearing completion of Phase II, in which we are conducting the feasibility trial, analyzing data, and disseminating results. Conclusions: This project will develop, iteratively refine, integrate, and pilot test the use of an innovative CDSS to prompt RNs to provide TSE reduction and smoking cessation counseling to caregivers who smoke. If successful, this approach will create a sustainable and disseminable model for prompting pediatric practitioners to apply tobacco-related guideline recommendations. This systems-based approach has the potential to reach at least 12 million smokers a year and significantly reduce TSE-related pediatric illnesses and related costs.

INTRODUCTION: Conversational agents are of great interest in the field of mental health, often in the news these days as a solution to the problem of a limited number of clinicians per patient. Until very recently, little research was actually done in patients with mental health conditions, but rather, only in healthy controls. Little is actually known if those with mental health conditions would want to use conversational agents, and how comfortable they might feel hearing results they would normally hear from a clinician, instead from a chatbot. OBJECTIVES: We asked patients with mental health conditions to ask a chatbot to read a results document to them and tell us how they found the experience. To our knowledge, this is one of the earliest studies to consider actual patient perspectives on conversational agents for mental health, and would inform whether this avenue of research is worth pursuing in the future. Our specific aims are to first and foremost determine the usability of such conversational agent tools, second, to determine their likely adoption among individuals with mental health disorders, and third, to determine whether those using them would grow a sense of artificial trust with the agent. METHODS: We designed and implemented a conversational agent specific to mental health tracking along with a supporting scale able to measure its efficacy in the selected domains of Adoption, Usability, and Trust. These specific domains were selected based on the phases of interaction during a conversation that patients would have with a conversational agent and adapted for simplicity in measurement. Patients were briefly introduced to the technology, our particular conversational agent, and a demo, before using it themselves and taking the survey with the supporting scale thereafter. RESULTS: With a mean score of 3.27 and standard deviation of 0.99 in the Adoption domain, we see that subjects typically felt less than content with adoption but believe that the conversational agent could become commonplace without complicated technical hurdles. With a mean score of 3.4 and standard deviation of 0.93 in the Usability domain, we see that subjects tended to feel more content with the usability of the conversational agent. With a mean score of 2.65 and standard deviation of 0.95 in the Trust domain, we see that subjects felt least content with trusting the conversational agent. CONCLUSIONS: In summary, though conversational agents are now readily accessible and relatively easy to use, we see there is a bridge to be crossed before patients are willing to trust a conversational agent over speaking directly with a clinician in mental health settings. With increased attention, clinic adoption, and patient experience, however, we feel that conversational agents could be readily adopted for simple or routine tasks and requesting information that would otherwise require time, cost, and effort to acquire. The field is still young, however, and with advances in digital technologies and artificial intelligence, capturing the essence of natural language conversation could transform this currently simple tool with limited use-cases into a powerful one for the digital clinician.

Though several clinical monitoring ways exist and have been applied to detect cardiac atril fibrillation (A-Fib) and other arrhythmia, these medical interventions and the ensuing clinical treatments are after the fact and costly. Current portable healthcare monitoring systems come in the form of Ambulatory Event Monitors. They are small, battery-operated electrocardiograph devices used to record the heart's rhythm and activity. However, they are not energy-aware ; they are not personalized ; they require long battery life, and ultimately fall short on delivering real-time continuous detection of arrhythmia and specifically progressive development of cardiac A-Fib. The focus of this dissertation is the design of a class of adaptive and efficient energy-aware real-time detection models for monitoring, early real-time detection and reporting of progressive development of cardiac A-Fib.... The design promises to have a greater positive public health impact from predicting A-Fib and providing a viable approach to meeting the energy needs of current and future real-time monitoring, detecting and reporting required in wearable computing healthcare applications that are constrained by scarce energy resources. / by Redjem Bouhenguel. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

With the increasing demands of rising medical costs in combination with a boom in elderly patients in need of quality patient care medical practices are being stressed. Patient to nurse ratios are increasing and government spending in the medical domain is at an all-time high threatening the futures of government medical programs such as Medicare and Medicaid. In this thesis we propose a framework for the monitoring of a patient's vital statistics in a home-based setting using a mobile smart device. We believe that in taking advantage of the wireless sensor technology which is readily available today we can provide a solution that is both economically and socially viable offering a solid quality of healthcare in a comfortable and familiar environment. Our framework exposes both 802.11 and Bluetooth wireless protocol transmitting medical sensor devices using an Android platform device as a monitoring hub. / by Mark Conaster. / Thesis (M.S.C.S.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.