Theoretical and Experimental Tools for Clinical Translation of Quantitative Tissue Optical Sensing.

Quantitative tissue optical spectroscopy has been considered as a promising method for clinical diagnosis, owing to its ability to non-invasively give an objective assessment of biological tissues at cellular and sub-cellular levels. In spite of recent advances in optics and the computational power, not many quantitative tissue optical sensing technologies have been translated into clinical practice. In order to translate this technology in the clinics, we need to further improve the technology. To name a few, we need accurate and rapid quantification method for a real-time diagnostic feedback. Next, we need computational methods for complex tissue-optics problems. Also, we need a novel approach in probe design for the inaccessible organs. This dissertation focuses on the development, verification and validation of theoretical (mathematical and computational) and experimental (instrumental) tool set to promote the translation of quantitative tissue optical spectroscopy into clinical diagnostic applications. For the mathematical tool, a direct-fit photon tissue interaction (DF-PTI) model that could rapidly and accurately extract the parameters associated biophysical features was developed and validated to characterize the precursor lesions of pancreatic cancer. A rapid scattering model on pancreatic tissue reflectance based on principal components analysis (PCA) results was also developed. The diagnostic capability of scattering properties obtained was demonstrated on an 18-patient data set using a rigorous statistical method, which implied the potential of reflectance spectroscopy for real-time detection of pancreatic cancer. For the computational tool, a ray-traced Monte Carlo (RTMC) simulation for the design of fluorescence spectroscopy or imaging system utilizing complex optics to probe turbid biological tissues was devised. This new method was verified computationally with epithelial tissue models and experimentally using tissue-simulating optical phantoms. For the instrumental tool, the design and development of minimally-invasive diagnostic technologies employing optoelectronic components were discussed. In this dissertation, we focused on detection of pancreatic cancer, which has the worst prognosis among other major cancers. Pancreatic tissues were employed as our model system to validate our developed tools. The developed technology and tools can be applied to a variety of other human tissue sites to help in the translation of quantitative tissue optical sensing in a clinical setting.PhDBiomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111401/1/paulslee_1.pd

Proactive Coordination In Healthcare Service Systems Through Near Real-Time Analytics

The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved \u27work-flow\u27 coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time operational intelligence of service networks that promote efficiency and quality of operations in a proactive manner. In particular, we leverage operations research and predictive analytics techniques to develop proactive coordination mechanisms and decision methods to improve the operational efficiency of bed management service in the network spanning the emergency department (ED) to inpatient units (IUs) in a hospital, a key component of healthcare in most hospitals. The purpose of this study is to deepen our knowledge on proactive coordination empowered by predictive analytics in dynamic healthcare environments populated by clinically heterogeneous patients with individual information changing throughout ED caregiving processes. To enable proactive coordination for improved resource allocation and patient flow in the ED-IU network, we address two components of modeling/analysis tasks, i.e., the design of coordination mechanisms and the generation of future state information for ED patients. First, we explore the benefits of early task initiation for the service network spanning the emergency department (ED) and inpatient units (IUs) within a hospital. In particular, we investigate the value of proactive inpatient bed request signals from the ED to reduce ED patient boarding. Using data from a major healthcare system, we show that the EDs suffer from severe crowding and boarding not necessarily due to high IU bed occupancy but due to poor coordination of IU bed management activity. The proposed proactive IU bed allocation scheme addresses this coordination requirement without requiring additional staff resources. While the modeling framework is designed based on the inclusion of two analytical requirements, i.e., ED disposition decision prediction and remaining ED length of stay (LoS) estimation, the framework also accounts for imperfect patient disposition predictions and multiple patient sources (besides ED) to IUs. The ED-IU network setting is modeled as a fork-join queueing system. Unlike typical fork-join queue structures that respond identically to a transition, the proposed system exhibits state-dependent transition behaviors as a function of the types of entities being processed in servers. We characterize the state sets and sequences to facilitate analytical tractability. The proposed proactive bed allocation strategy can lead to significant reductions in bed allocation delay for ED patients (up to ~50%), while not increasing delays for other IU admission sources. We also demonstrate that benefits of proactive coordination can be attained even in the absence of highly accurate models for predicting ED patient dispositions. The insights from our models should give confidence to hospital managers in embracing proactive coordination and adaptive work flow technologies enabled by modern health IT systems. Second, we investigate the quantitative modeling that analyzes the patterns of decreasing uncertainty in ED patient disposition decision making throughout the course of ED caregiving processes. The classification task of ED disposition decision prediction can be evaluated as a hierarchical classification problem, while dealing with temporal evolution and buildup of clinical information throughout the ED caregiving processes. Four different time stages within the ED course (registration, triage, first lab/imaging orders, and first lab/imaging results) are identified as the main milestone care stages. The study took place at an academic urban level 1 trauma center with an annual census of 100,000. Data for the modeling was extracted from all ED visits between May 2014 and April 2016. Both a hierarchical disposition class structure and a progressive prediction modeling approach are introduced and combined to fully facilitate the operationalization of prediction results. Multinomial logistic regression models are built for carrying out the predictions under three different classification group structures: (1) discharge vs. admission, (2) discharge vs. observation unit vs. inpatient unit, and (3) discharge vs. observation unit vs. general practice unit vs. telemetry unit vs. intensive care unit. We characterize how the accumulation of clinical information for ED patients throughout the ED caregiving processes can help improve prediction results for the three-different class groups. Each class group can enable and contribute to unique proactive coordination strategies according to the obtained future state information and prediction quality, to enhance the quality of care and operational efficiency around the ED. We also reveal that for different disposition classes, the prediction quality evolution behaves in its own unique way according to the gain of relevant information. Therefore, prediction and resource allocation and task assignment strategies can be tailored to suit the unique behavior of the progressive information accumulation for the different classes of patients as a function of their destination beyond the ED

A Decision Modeling For Phasor Measurement Unit Location Selection In Smart Grid Systems

As a key technology for enhancing the smart grid system, Phasor Measurement Unit (PMU) provides synchronized phasor measurements of voltages and currents of wide-area electric power grid. With various benefits from its application, one of the critical issues in utilizing PMUs is the optimal site selection of units. The main aim of this research is to develop a decision support system, which can be used in resource allocation task for smart grid system analysis. As an effort to suggest a robust decision model and standardize the decision modeling process, a harmonized modeling framework, which considers operational circumstances of component, is proposed in connection with a deterministic approach utilizing integer programming. With the results obtained from the optimal PMU placement problem, the advantages and potential that the harmonized modeling process possesses are assessed and discussed

Balancing between prejudice and fact for Gaming Disorder: Does the existence of alcohol use disorder stigmatize healthy drinkers or impede scientific research?

The inclusion of Gaming Disorder (GD) criteria in the 11th Revision of the International Classification of Diseases (ICD-11) beta draft was recently criticized, and an argument was made for its removal to “avoid a waste of public resources.” However, these misleading statements are believed to be based on under estimation of this ever-growing problem. Such claims may endanger public health and the psychosocial well-being of affected individuals. Thus, the seriousness of the problem was briefly emphasized in our response paper. We provided an overview of how debates of this kind were developed in our region. In addition, we addressed the arguments made on research and children’s rights. The accusation that GD exerts negative impacts on children’s freedom and stigmatizes healthy gamers may arise from a false belief that this new digital media is benign or not addictive. Such statements could be true in some, but not all, cases. Unwillingness to recognize the addictive potential of gaming, as well as insistence on treating GD simply as an individual problem, are reminiscent of the era in which alcoholism was viewed as a personality problem. These dangerous views place affected individuals at greater health risk and further stigmatize them. Formalization of the disorder is also expected to help in standardization of research and treatment in the field. The inclusion of GD in the upcoming ICD-11 is a responsible step in the right direction

Current and Future Perspectives for Improving Ovarian Tissue Cryopreservation and Transplantation Outcomes for Cancer Patients

Although advances in cancer treatment and early diagnosis have significantly improved cancer survival rates, cancer therapies can cause serious side effects, including ovarian failure and infertility, in women of reproductive age. Infertility following cancer treatment can have significant adverse effects on the quality of life. However, established methods for fertility preservation, including embryo or oocyte cryopreservation, are not always suitable for female cancer patients because of complicated individual conditions and treatment methods. Ovarian tissue cryopreservation and transplantation is a promising option for fertility preservation in pre-pubertal girls and adult patients with cancer who require immediate treatment, or who are not eligible to undergo ovarian stimulation. This review introduces various methods and strategies to improve ovarian tissue cryopreservation and transplantation outcomes, to help patients and clinicians choose the best option when considering the potential complexity of a patient’s situation. Effective multidisciplinary oncofertility strategies, involving the inclusion of a highly skilled and experienced oncofertility team that considers cryopreservation methods, thawing processes and devices, surgical procedures for transplantation, and advances in technologies, are necessary to provide high-quality care to a cancer patient

Association among cultural orientation, Nunchi, and interpersonal relationships with Korean adolescent athletes

Cultural aspects and their relationships with social supporters are important to adolescent athletes. Other skills in communication or perception (e.g. Nunchi) might be helpful in getting along with the supporters. The purpose of this study was to identify the association between cultural orientation, Nunchi, and interpersonal relationships with adolescent athletes. With this aim, we surveyed 462 Korean adolescent athletes. Measurement tools comprised questionnaires on cultural orientation, Nunchi, and interpersonal relationships-including coach-athlete, sports friendships, and parent-adolescent-designed to match the research purpose. We analyzed the data using structural equation modeling. Our results are as follows: first, we verified that collectivism is positively related to Nunchi, and Nunchi is positively associated with interpersonal relationships. But we did not verify that individualism is related to Nunchi. Second, in our final model, excluding individualism, Nunchi showed a mediation effect on the association between collectivism and interpersonal relationships. In conclusion, Korean athletes with high collectivism will be positively related to interpersonal relationships through Nunchi. Additionally, we discussed the issues of culture in sport and exercise psychology.Los aspectos culturales y sus relaciones con los seguidores deportivos son importantes para los atletas adolescentes. Otras habilidades de comunicación o percepción (e.g., Nunchi) pueden ser útiles para llevarse bien con los hinchas. El propósito de este estudio fue identificar la asociación entre la orientación cultural, Nunchi, y las relaciones interpersonales con atletas adolescentes. Con este objetivo, hemos encuestado a 462 atletas adolescentes coreanos. Las herramientas de medición comprendían cuestionarios sobre orientación cultural, Nunchi y relaciones interpersonales -incluidos el entrenador-atleta, las amistades deportivas y los padres-adolescentes- diseñados para cumplir con el propósito de la investigación. Los datos se analizaron mediante el uso de modelos de ecuaciones estructurales. Nuestros resultados son los siguientes: primero, verificamos que el colectivismo está positivamente relacionado con Nunchi, y que Nunchi está positivamente asociado con las relaciones interpersonales. Pero no verificamos que el individualismo esté relacionado con Nunchi. En segundo lugar, en nuestro modelo final, excluyendo el individualismo, Nunchi mostró un efecto de mediación sobre la asociación entre colectivismo y relaciones interpersonales. En conclusión, los atletas coreanos con alto colectivismo estarán positivamente relacionados con las relaciones interpersonales a través de Nunchi. Además, discutimos los temas de la cultura en el deporte y la psicología del ejercicio.Aspectos culturais e suas relações com os apoiadores sociais são importantes para os atletas adolescentes. Outras habilidades em comunicação ou percepção (por exemplo, Nunchi) podem ser úteis para se dar bem com os apoiadores. O objetivo deste estudo foi identificar a associação entre orientação cultural, Nunchi e relações interpessoais com atletas adolescentes. Com esse objetivo, foram pesquisados 462 atletas adolescentes coreanos. Os instrumentos de medição incluíam questionários sobre orientação cultural, Nunchi e relações interpessoais - incluindo treinador-atleta, amizades esportivas e pais-adolescente - projetados para corresponder ao objetivo da pesquisa. Analisamos os dados usando modelagem de equações estruturais. Nossos resultados são os seguintes: primeiro, verificamos que o coletivismo está positivamente relacionado ao Nunchi, e Nunchi está positivamente associado às relações interpessoais. Mas não verificamos que o individualismo está relacionado ao Nunchi. Em segundo lugar, em nosso modelo final, excluindo o individualismo, Nunchi mostrou um efeito de mediação na associação entre coletivismo e relações interpessoais. Em conclusão, os atletas coreanos com alto coletivismo estarão positivamente relacionados às relações interpessoais através do Nunchi. Além disso, discutimos as questões da cultura no esporte e na psicologia do exercício

Tensile Behavior and Cracking Pattern of an Ultra-High Performance Mortar Reinforced by Polyethylene Fiber

This paper presents an experimental study of the compressive strength, tensile behavior (including the tensile strength, tensile strain capacity, and toughness), and cracking patterns of an ultra-high performance mortar (UHPM) reinforced by polyethylene (PE) fiber as well as a discussion of the different tensile behaviors of the UHPM according to the types and contents of fibers used. The UHPM reinforced by microsteel fiber of 1.5 vol% and the UHPM reinforced by PE fibers with three different fiber contents were designed and prepared. A series of experiments was undertaken to assess the effect of PE fiber on the properties of the UHPM. The results found a lower strength level, higher tensile strain capacity and toughness, and a larger crack width in the PE fiber-reinforced UHPM compared to microsteel fiber-reinforced UHPM. It was also demonstrated that tensile strain capacity and toughness of 4.05% and 0.454 MPa m/m, respectively, can be attained when using the proposed polyethylene-fiber-reinforced UHPM