Progressive Pulmonary Fibrosis in Connective Tissue Disease

Interstitial lung disease (ILD) is a relatively common complication observed in autoimmune connective tissue disease (CTD). Diagnosis, risk stratification and management are challenging because of the heterogeneous clinical presentation and the unclear underlying pathogenetic mechanisms. This thesis aimed to identify risk factors and biomarkers associated with progressive pulmonary fibrosis (PPF) and mortality in CTD-ILD patients. Factors such as older age, smoking, extent of fibrosis on imaging, and poor lung function were linked to higher mortality. In our cohort primarily consisting of systemic sclerosis (SSc) patients with extensive fibrosis, steroid use, elevated C-reactive protein, and PPF were also associated with mortality. Moreover, we identified risk factors for development of PPF in patients with CTD. Furthermore, three criteria for defining PPF were compared in this thesis. Although different definitions and criteria for PPF are used in literature, we found they have similar prognostic performance. However, the performance of these criteria in predicting mortality was better in certain patient groups. Mortality risk increased in the first 3 years after PPF occurred and plateaued thereafter. So, when establishing PPF in a patient, treatment will be intensified most likely. The use of different PPF criteria may therefore impact treatment decisions. Furthermore, it limits comparison of studies that have used different criteria. The thesis also explored serum biomarkers in CTD-ILD patients, revealing associations between decreased biomarker concentrations (CXCL11, CTGF and KL-6) and improved pulmonary outcomes. Biomarkers were influenced more by the underlying CTD than the lung progression. In primary Sjögren syndrome, we identified KL-6 as a valuable biomarker for preclinical ILD. Lastly, this thesis delved into the treatment landscape for systemic sclerosis associated ILD, considering intensive immunomodulation such as hematopoietic stem cell transplantation (HSCT) for patients with rapid progression. The potential benefits and risks of early HSCT in diffuse cutaneous SSc with ILD are being investigated in the ongoing randomized UPSIDE trial. In the context of SSc, profibrotic mechanisms in skin biopsies were explored. Cellular senescence is a biological process, which can be seen in aging and stress condition, with stopping cell cycle and producing fibro-inflammatory molecules. Endothelial-to-mesenchymal transition (EndMT) ia another profibrotic biological process that endothelial cells transform into active myofibroblast-like condition. The abundance of fibroblast senescence was correlated with EndMT, dermal fibrosis, and inflammation, highlighting potential targets for intervention. Overall, this thesis contributes valuable insights into the complexity of CTD-ILD, identifying risk factors, biomarkers, and potential treatment strategies for better patient outcomes

Learning-based auditory encoding for robust speech recognition

This paper describes ways of speeding up the optimization process for learning physiologically-motivated components of a feature computation module directly from data. During training, word lattices generated by the speech decoder and conjugate gradient descent were included to train the parameters of logistic functions in a fashion that maximizes the a posteriori probability of the correct class in the training data. These functions represent the rate-level nonlinearities found in most mammalian auditory systems. Experiments conducted using the CMU SPHINX-III system on the DARPA Resource Management and Wall Street Journal tasks show that the use of discriminative training to estimate the shape of the rate-level nonlinearity provides better recognition accuracy in the presence of background noise than traditional procedures which do not employ learning. More importantly, the inclusion of conjugate gradient descent optimization and a word lattice to reduce the number of hypotheses considered greatly increases the training speed, which makes training with much more complicated models possible. Index Terms — automatic speech recognition, discriminative training, auditory models, data analysis 1

The Information-Leveling Role of Voluntary Disclosure Quality in Facilitating Investment Efficiency

This study examines whether and under what conditions voluntary disclosure quality plays an information-leveling role in facilitating investment efficiency. Measuring voluntary disclosure quality as the (inverse) standard deviation of managers’ prior earnings forecast errors (i.e., management forecast consistency), we document a positive association between management forecast consistency and investment efficiency that strengthens when the information environment becomes more constrained and when there are negative shocks to financial reporting quality. We also find that the management forecast consistency/investment efficiency association strengthens when firms are younger, faster growing, and financially constrained, but not when firms are weakly governed and financially unconstrained, which suggests that voluntary disclosure quality facilitates investment efficiency by mitigating adverse selection (but not moral hazard) frictions. Last, when we employ a changes-based model, we find that increases in management forecast consistency are associated with increases in investment efficiency, which mitigates concerns that voluntary disclosure quality’s empirical link to investment efficiency is purely driven by managers’ inherent forecasting abilities. Overall, we show that voluntary disclosure quality can facilitate investment efficiency when financial reporting and other elements of the information environment are constrained in their ability to mitigate market frictions that impede efficiency

106GBaud (200G PAM4) CWDM EML for 800G/1.6T Optical Networks and AI Applications

We report ultrahigh speed 106GBaud (200G PAM4) electro-absorption modulated laser (EML) for 800G and 1.6T optical transmission. Four CWDM EMLs of 1271, 1291, 1311 and 1331nm in 800G FR4 optical transceivers show clear eye diagram after 2km. Our 106GBaud EMLs show high bandwidth, high extinction ratio, low threshold current and high power, making it a suitable source laser for 800G/1.6T and AI applications.&nbsp

Emotion and Concentration Integrated System: Applied to the Detection and Analysis of Consumer Preference

With the expansion of consumer market, the appearance becomes an important issue when consumers make decisions under the situation of similar qualities and contents. Accordingly, to attract consumers, companies cost and take much attention on product appearance. Compared to using questionnaires individually, obtaining humans’ thoughts directly from their brains can accurately grasp the actual preference of consumers, which can provide effective and precious decisions for companies. \ In this study, consumers’ brainwaves which are related to concentration and emotion are extracted by wearing a portable and wireless Electroencephalography (EEG) device. The extracted EEG data are then trained by using perceptron learning algorithm (PLA) to make the judgments of concentration and emotion work well with each subject. They are then applied to the detection and analysis of consumer preference. Finally, the questionnaires are also performed and used as the reference on training process. They are integrated with brainwaves data to create one prediction model which can improve the accuracy significantly. The Partial Least Squares is used to compare the correlation between different factors in the model, to ensure the test can accurately meet consumers’ thoughts

Predicting the suitability of lateritic soil type for low cost sustainable housing with image recognition and machine learning techniques

From a sustainability point of view, laterites-compressed earth bricks (LCEB) are a promising substitute for building structures in place of the conventional concrete masonry units. On the other hand, techniques for identifying and classifying laterites soil for compressed earth bricks (CEB) production are still relying on direct human expertise or ‘experts’. Human experts exploit direct visual inspection and other basic senses such as smelling, touching or nibbling to generate a form of binomial classification, i.e. suitable or unsuitable. The source of predictive power is otherwise supposed to be found in color, scent, texture or combinations of these. Lack of clarity regarding the actual method and the possible explanatory mechanisms lead to 1) difficulties to train other people into the skills and 2) might also add to apathy to using CEB masonry units for housing. Here we systematize the selection method of experts. We chose imaging analysis techniques based on 1) easiness in image acquisition (Digital Camera) and 2) availability of machine learning and statistical techniques. We find that most of the predictive power of the ‘expert’ can be packed into visual inspection by demonstrating that with image analysis alone we get a 98% match. This makes it practically unnecessary the study of any other ‘expert’ skills and provides a method to alleviate the housing problems dealing with material construction in the developing world

Costs of Biopsy and Complications in Patients with Lung Cancer

PURPOSE: To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer. PATIENTS AND METHODS: Observational study using data from IBM Marketscan(®) Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies. RESULTS: The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40-80%. Complications account for 13% of total costs. CONCLUSION: Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs

Effect of diabetes on mortality and length of hospital stay in patients with renal or perinephric abscess

OBJECTIVES: We compared the risk of in-hospital mortality and the length of hospital stay between diabetic and non-diabetic patients hospitalized for renal or perinephric abscess. METHOD: The data analyzed in this study were retrieved from Taiwan's National Health Insurance claims. The risk of in-hospital mortality and the length of hospital stay were compared between 1,715 diabetic patients, hospitalized because of renal or perinephric abscess in Taiwan between 1997 and 2007, and a random sample of 477 non-diabetes patients with renal or perinephric abscess. RESULTS: The in-hospital mortality rates from renal or perinephric abscess for the diabetic patients and the non-diabetic patients were not different, at 2.3% and 3.4%, respectively. However, diabetes was significantly associated with a longer length of hospital stay among patients with renal abscess, by 3.38 days (95% confidence interval [CI]: 1.59-5.17). CONCLUSIONS: Diabetes does not increase the risk of in-hospital mortality from renal or perinephric abscess. Nevertheless, appropriate management of patients with diabetes and concurrent renal or perinephric abscess is essential to reduce the length of hospital stay