Dia-Continua: An Information System for Type 1 Diabetes Consultation. (Interoperability, Privacy, and Information Quality on a FHIR-Based Information System for Type 1 Diabetes Consultations based on Patient-Generated Health Data)

Patient-generated health data (PGHD) is required to monitor chronic conditions like Type 1 Diabetes (T1D). This data includes information from medical devices like insulin pumps and continuous glucose monitors and lifestyle insights from commercial wearables devices such as smartwatches. To improve the quality of medical consultations, we need a unified information system that can integrate PGHD. Designing such a system will pose several challenges. The system should be able to navigate through fragmented information and the complexities of various data formats, proprietary interfaces, and storage methods while ensuring robust security, privacy, and adherence to data ownership principles. It should also enable controlled data sharing with healthcare providers (HCPs) and external entities such as national registries and informal caregivers. This dissertation details designing, developing, and testing an information system for individuals with T1D. The project involved integrative research in health informatics, collaboration with international projects, and collaboration with experienced users and HCPs to address three research questions. These questions focused on interoperability, the security and privacy of the information collected, and the quality of the information presented during consultations. The result is Dia-Continua, a Fast Healthcare Interoperability Resources (FHIR)-based information system with a microservices architecture orchestrated through Kubernetes on an Infrastructure as a Service (IaaS) platform. The system integrates data from various diabetes management devices, questionnaires, and PGHD. Furthermore, using SMART on FHIR for authorization and authentication enables data sharing and reuse with national registries and informal caregivers. Eleven interviews with HCPs evaluated Dia-Continua's new functionalities and information quality. Despite the limitations due to proprietary device systems, the system was assessed positively by HCPs, highlighting the need for a system like Dia-Continua that includes physical activity, sleep, and stress in medical consultations. Dia-Continua is a significant step for a patient-centred model for consultations in T1D. Future work should expand the system's model to other chronic diseases.Utviklingen av medisinske konsultasjoner for kroniske tilstander, spesifikt Type 1 Diabetes (T1D), avhenger i stor grad av pasientgenererte helsedata (PGHD). Disse dataene inkluderer informasjon fra medisinsk utstyr slik som insulinpumper, CGM, samt livsstils data fra kommersielt utstyr som sensorer på smartklokker og smarte ringer. Et helhetlig informasjonssystem som kan integrere PGHD er nødvendig for å forbedre informasjonskvalitet under medisinske konsultasjoner. Imidlertid bør et slikt system være i stand til å la brukeren navigere gjennom fragmentert informasjon og komplekse heterogene dataformater, proprietære grensesnitt og lagringsmetoder, samtidig som systemet sikrer robust sikkerhet, personvern og ivaretakelse av prinsipper for eierskap til data. Systemet bør også muliggjøre kontrollert deling av data med helsepersonell og eksterne aktører slik som nasjonale registre (Noklus) og pasientens omsorgspersoner. Denne avhandlingen beskriver design, utvikling, testing og evaluering av et nytt informasjonssystem for T1D basert på pasientens egne data. Prosjektet har involvert ulike samarbeidspartnere og profesjoner, samt samarbeid med internasjonale prosjekter, erfarne brukere og HP for å adressere de tre forskningsspørsmålene i prosjektet. Ett av resultatene er systemet Dia-Continua, et Fast Healthcare Interoperability Resources (FHIR)-basert informasjonssystem med en Microservice arkitektur orkestrert gjennom Kubernetes på en infrastruktur som en tjenesteplattform (Azure). Systemet integrerer data fra ulike diabetesenheter, spørreskjemaer og andre sensorer. Videre, ved å bruke «SMART on FHIR» for autorisasjon og autentisering, muliggjøres deling og gjenbruk av data med nasjonale registre og uformelle omsorgspersoner. Elleve intervjuer med helsepersonell ble gjort for å evaluere Dia-Continua sine nye funksjonaliteter, samt dets informasjonskvalitet. Til tross for begrensningene på grunn av proprietære standarder, ble systemet positivt mottatt av HP. Informantene understreket behovet for et system som Dia-Continua som inkluderer fysisk aktivitet, søvn og stress i medisinske konsultasjoner. Dia-Continua er et betydelig skritt fram mot en pasientsentrert modell for konsultasjoner i T1D. Fremtidig arbeid bør utvide systemets modell til andre kroniske sykdommer

Health State Estimation

Life's most valuable asset is health. Continuously understanding the state of our health and modeling how it evolves is essential if we wish to improve it. Given the opportunity that people live with more data about their life today than any other time in history, the challenge rests in interweaving this data with the growing body of knowledge to compute and model the health state of an individual continually. This dissertation presents an approach to build a personal model and dynamically estimate the health state of an individual by fusing multi-modal data and domain knowledge. The system is stitched together from four essential abstraction elements: 1. the events in our life, 2. the layers of our biological systems (from molecular to an organism), 3. the functional utilities that arise from biological underpinnings, and 4. how we interact with these utilities in the reality of daily life. Connecting these four elements via graph network blocks forms the backbone by which we instantiate a digital twin of an individual. Edges and nodes in this graph structure are then regularly updated with learning techniques as data is continuously digested. Experiments demonstrate the use of dense and heterogeneous real-world data from a variety of personal and environmental sensors to monitor individual cardiovascular health state. State estimation and individual modeling is the fundamental basis to depart from disease-oriented approaches to a total health continuum paradigm. Precision in predicting health requires understanding state trajectory. By encasing this estimation within a navigational approach, a systematic guidance framework can plan actions to transition a current state towards a desired one. This work concludes by presenting this framework of combining the health state and personal graph model to perpetually plan and assist us in living life towards our goals.Comment: Ph.D. Dissertation @ University of California, Irvin

Program and Proceedings: The Nebraska Academy of Sciences 1880-2023. 142th Anniversary Year. One Hundred-Thirty-Third Annual Meeting April 21, 2023. Hybrid Meeting: Nebraska Wesleyan University & Online, Lincoln, Nebraska

AERONAUTICS & SPACE SCIENCE Chairperson(s): Dr. Scott Tarry & Michaela Lucas HUMANS PAST AND PRESENT Chairperson(s): Phil R. Geib & Allegra Ward APPLIED SCIENCE & TECHNOLOGY SECTION Chairperson(s): Mary Ettel BIOLOGY Chairpersons: Lauren Gillespie, Steve Heinisch, and Paul Davis BIOMEDICAL SCIENCES Chairperson(s): Annemarie Shibata, Kimberly Carlson, Joseph Dolence, Alexis Hobbs, James Fletcher, Paul Denton CHEM Section Chairperson(s): Nathanael Fackler EARTH SCIENCES Chairpersons: Irina Filina, Jon Schueth, Ross Dixon, Michael Leite ENVIRONMENTAL SCIENCE Chairperson: Mark Hammer PHYSICS Chairperson(s): Dr. Adam Davis SCIENCE EDUCATION Chairperson: Christine Gustafson 2023 Maiben Lecturer: Jason Bartz 2023 FRIEND OF SCIENCE AWARD TO: Ray Ward and Jim Lewi

Brain Waves, A Cultural History: Oscillations of Neuroscience, Technology, Telepathy, and Transcendence

This project proceeds from a narrow question: What, if anything, is a brain wave? Beguiling in its simplicity, this question prompts a cultural-historical investigation that spans over 150 years of science, technology, and society. Proposed in 1869, the original theory of brain waves cites etheric undulations to explain reports of apparent thought transference. Though most modern thinkers no longer believe in outright telepathy, I argue that dreams of thought transmission and other mental miracles subtly persist—not in obscure and occult circles, but at the forefront of technoscience. A hybrid of science and fiction, brain waves represent an ideal subject through which to explore the ways in which technical language shrouds spiritual dreams. Today, the phrase “brain waves” often function as shorthand for electrical changes in the brain, particularly in the context of technologies that purport to “read” some aspect of mental function, or to transmit neural data to a digital device. While such technologies appear uniquely modern, the history of brain waves reveals that they are merely the millennial incarnation of a much older hope—a hope for transmission and transcendence via the brain’s emanations

Sleep homeostasis in the European jackdaw (<i>Coloeus monedula</i>):Sleep deprivation increases NREM sleep time and EEG power while reducing hemispheric asymmetry

Introduction: Sleep is a wide-spread phenomenon that is thought to occur in all animals. Yet, the function of it remains an enigma. Conducting sleep experiments in different species may shed light on the evolution and functions of sleep. Therefore, we studied sleep architecture and sleep homeostatic responses to sleep deprivation in the European jackdaw (Coloeus monedula).Methods: A total of nine young adult birds were implanted with epidural electrodes and equipped with miniature data loggers for recording movement activity (accelerometery) and electroencephalogram (EEG). Individually-housed jackdaws were recorded under controlled conditions with a 12:12-h light-dark cycle.Results: During baseline, the birds spent on average 48.5% of the time asleep (39.8% non-rapid eye movement (NREM) sleep and 8.7% rapid eye movement (REM) sleep). Most of the sleep occurred during the dark phase (dark phase: 75.3% NREM sleep and 17.2% REM sleep; light phase 4.3% NREM sleep and 0.1% REM sleep). After sleep deprivation of 4 and 8 h starting at lights off, the birds showed a dose-dependent increase in NREM sleep time. Also, NREM sleep EEG power in the 1.5–3 Hz frequency range, which is considered to be a marker of sleep homeostasis in mammals, was significantly increased for 1-2 h after both 4SD and 8SD. While there was little true unihemispheric sleep in the Jackdaws, there was a certain degree of hemispheric asymmetry in NREM sleep EEG power during baseline, which reduced after sleep deprivation in a dose-dependent manner.Conclusion: In conclusion, jackdaws display homeostatic regulation of NREM sleep and sleep pressure promotes coherence in EEG power

Smart and Pervasive Healthcare

Smart and pervasive healthcare aims at facilitating better healthcare access, provision, and delivery by overcoming spatial and temporal barriers. It represents a shift toward understanding what patients and clinicians really need when placed within a specific context, where traditional face-to-face encounters may not be possible or sufficient. As such, technological innovation is a necessary facilitating conduit. This book is a collection of chapters written by prominent researchers and academics worldwide that provide insights into the design and adoption of new platforms in smart and pervasive healthcare. With the COVID-19 pandemic necessitating changes to the traditional model of healthcare access and its delivery around the world, this book is a timely contribution

eHealth in Chronic Diseases

This book provides a review of the management of chronic diseases (evaluation and treatment) through eHealth. Studies that examine how eHealth can help to prevent, evaluate, or treat chronic diseases and their outcomes are included