Moving Beyond Hastiness and Superficiality: Being an Ethical Technical Communicator via Digital Communication Technologies in Health Care

This thesis examines digital technologies used by technical communicators in healthcare settings. I show that technical communicators, who function as users, advocators and evaluators, need a useable framework for ethical engagement with digital technologies, which integrally affect the physician-patient relationship. Therefore, I apply rhetorical methodology by producing useable knowledge and phenomenological methodology by examining lived experiences of technical communicators. Substantiation comes from theories spanning technical communication, philosophy, and composition studies. Evidence also emerges from qualitative interviews with communication professionals working in healthcare; my concerns arise from personal experiences with electronic recordkeeping in the exam room. This thesis anticipates challenging the presumed theory-practice divide while encouraging greater disciplinary reciprocity. Because technical communication infuses theory into productive capacity, this thesis presents the tripartite summons of the ethical technical communicator: to exercise critically-reflective action that safeguards the physician-patient relationship by ways of using digital technologies, advocating for audiences, and evaluating digital technologies.

Water and sanitation accessibility and the health of rural Ugandans

The lack of access to sufficient water and sanitation facilities is one of the largest hindrances towards the sustainable development of the poorest 2.2 billion people in the world. Rural Uganda is one of the areas where such inaccessibility is seriously hampering their efforts at development. Many rural Ugandans must travel several kilometers to fetch adequate water and many still do not have adequate sanitation facilities. Such poor access to clean water forces Ugandans to spend an inordinate amount of time and energy collecting water - time and energy that could be used for more useful endeavors. Furthermore, the difficulty in getting water means that people use less water than they need to for optimal health and well-being. Access to other sanitation facilities can also have a large impact, particularly on the health of young children and the elderly whose immune systems are less than optimal. Hand-washing, presence of a sanitary latrine, general household cleanliness, maintenance of the safe water chain and the households’ knowledge about and adherence to sound sanitation practices may be as important as access to clean water sources. This report investigates these problems using the results from two different studies. It first looks into how access to water affects peoples’ use of it. In particular it investigates how much water households use as a function of perceived effort to fetch it. Operationally, this was accomplished by surveying nearly 1,500 residents in three different districts around Uganda about their water usage and the time and distance they must travel to fetch it. The study found that there is no statistically significant correlation between a family’s water usage and the perceived effort they must put forth to have to fetch it. On average, people use around 15 liters per person per day. Rural Ugandan residents apparently require a certain amount of water and will travel as far or as long as necessary to collect it. Secondly, a study entitled “What Works Best in Diarrheal Disease Prevention?” was carried out to study the effectiveness of five different water and sanitation facilities in reducing diarrheal disease incidences amongst children under five. It did this by surveying five different communities before and after the implementation of improvements to find changes in diarrheal disease incidences amongst children under five years of age. It found that household water treatment devices provide the best means of preventing diarrheal diseases. This is likely because water often becomes contaminated before it is consumed even if it was collected from a protected source.

ANKLE IMPEDANCE AND ANKLE ANGLES DURING STEP TURN AND STRAIGHT WALK: IMPLICATIONS FOR THE DESIGN OF A STEERABLE ANKLE-FOOT PROSTHETIC ROBOT

During locomotion, turning is a common and recurring event which is largely neglected in the current state-of-the-art ankle-foot prostheses, forcing amputees to use different steering mechanisms for turning, compared to non-amputees. A better understanding of the complexities surrounding lower limb prostheses will lead to increased health and well-being of amputees. The aim of this research is to develop a steerable ankle-foot prosthesis that mimics the human ankle mechanical properties. Experiments were developed to estimate the mechanical impedance of the ankle and the ankles angles during straight walk and step turn. Next, this information was used in the design of a prototype, powered steerable ankle-foot prosthesis with two controllable degrees of freedom. One of the possible approaches in design of the prosthetic robots is to use the human joints’ parameters, especially their impedance. A series of experiments were conducted to estimate the stochastic mechanical impedance of the human ankle when muscles were fully relaxed and co-contracting antagonistically. A rehabilitation robot for the ankle, Anklebot, was employed to provide torque perturbations to the ankle. The experiments were performed in two different configurations, one with relaxed muscles, and one with 10% of maximum voluntary contraction (MVC). Surface electromyography (sEMG) was used to monitor muscle activation levels and these sEMG signals were displayed to subjects who attempted to maintain them constant. Time histories of ankle torques and angles in the lateral/medial (LM) directions, inversion-eversion (IE), and dorsiflexionplantarflexion (DP) were recorded. Linear time-invariant transfer functions between the measured torques and angles were estimated providing an estimate of ankle mechanical impedance. High coherence was observed over a frequency range up to 30 Hz. The main effect of muscle activation was to increase the magnitude of ankle mechanical impedance in all degrees of freedom of the ankle. Another experiment compared the three-dimensional angles of the ankle during step turn and straight walking. These angles were measured to be used for developing the control strategy of the ankle-foot prosthesis. An infrared camera system was used to track the trajectories and angles of the foot and leg. The combined phases of heel strike and loading response, mid stance, and terminal stance and pre-swing were determined and used to measure the average angles at each combined phase. The Range of motion (ROM) in IE increased during turning while ML rotation decreased and DP changed the least. During the turning step, ankle displacement in DP started with similar angles to straight walk and progressively showed less plantarflexion. In IE, the ankle showed increased inversion leaning the body toward the inside of the turn. ML rotation initiated with an increased medial rotation during the step turn relative to the straight walk transitioning to increased lateral rotation at the toe off. A prototype ankle-foot prosthesis capable of controlling both DP and IE using a cable driven mechanism was developed and assessed as part of a feasibility study. The design is capable of reproducing the angles required for straight walk and step turn; generates 712N of lifting force in plantarflexion, and shows passive stiffness comparable to a nonload bearing ankle impedance. To evaluate the performance of the ankle-foot prosthesis, a circular treadmill was developed to mimic human gait during steering. Preliminary results show that the device can appropriately simulate human gait with loading and unloading the ankle joint during the gait in circular paths.