Managing Hospital Care: Data-driven decisions and comparisons

This dissertation focuses on utilizing data-driven approaches to objectively measure variation in the quality of care across different hospitals, understand how physicians make dynamic admission and routing decisions for patients, and propose potential changes in practice to improve the quality of care and patient flow management. This analysis was performed in the context of Intensive Care Units (ICUs) and the Emergency Department (ED). In the first part, we assess variation in the overall quality of care provided by both urban and rural hospitals under the same integrated healthcare delivery system when augmenting administrative data with detailed patient severity scores from the electronic medical records (EMRs). Using a new template matching methodology for more objective comparison, we found that the use of granular EMR data significantly reduces the variation across hospitals in common patient severity-of-illness levels. Further, we found that hospital rankings on 30-day mortality and estimates of length-of-stay (LOS) are statistically different from rankings based on administrative data. In the second part, we study ICU admission decision-making dynamically throughout a patient’s stay in the general ward/the Transitional Care Unit (TCU). We first used an instrumental variable approach and modern multivariate matching methods to rigorously estimate the potential benefits and costs of transferring patients to the ICU based on a real-time risk score for deterioration. We then used the quantified impact to calibrate a comprehensive simulation model to evaluate system performances under various new ICU transfer policies. We show that proactively transferring the most severe patients to the ICU could reduce mortality rates and LOS without increasing ICU congestion and causing other adverse effects. In the third part, we focus on understanding how physicians make ICU admission decisions for patients in the ED. We first used two sets of reduced-form regressions to understand 1) what and how patient risk factors and system controls impact the admission decision from the ED; and 2) what are the potential benefits of admitting patients from the ED to the ICU. We then proposed a dynamic discrete choice structural model to estimate to what extent physicians account for the inter-temporal externalities when deciding to admit a specific patient to the ICU, to the ward or let him/her wait in the ED. Note that the structural model estimation is still an ongoing process and more investigation is required to fine tune the details. Therefore, we will not discuss the structural model estimation results in this chapter, but only present the modeling framework and key estimation strategy

Microdevices and Microsystems for Cell Manipulation

Microfabricated devices and systems capable of micromanipulation are well-suited for the manipulation of cells. These technologies are capable of a variety of functions, including cell trapping, cell sorting, cell culturing, and cell surgery, often at single-cell or sub-cellular resolution. These functionalities are achieved through a variety of mechanisms, including mechanical, electrical, magnetic, optical, and thermal forces. The operations that these microdevices and microsystems enable are relevant to many areas of biomedical research, including tissue engineering, cellular therapeutics, drug discovery, and diagnostics. This Special Issue will highlight recent advances in the field of cellular manipulation. Technologies capable of parallel single-cell manipulation are of special interest

Design Impedance Mismatch Physical Unclonable Functions for IoT Security

We propose a new design, Physical Unclonable Function (PUF) scheme, for the Internet of Things (IoT), which has been suffering from multiple-level security threats. As more and more objects interconnect on IoT networks, the identity of each thing is very important. To authenticate each object, we design an impedance mismatch PUF, which exploits random physical factors of the transmission line to generate a security unique private key. The characteristic impedance of the transmission line and signal transmission theory of the printed circuit board (PCB) are also analyzed in detail. To improve the reliability, current feedback amplifier (CFA) method is applied on the PUF. Finally, the proposed scheme is implemented and tested. The measure results show that impedance mismatch PUF provides better unpredictability and randomness

Economic Burden for Lung Cancer Survivors in Urban China.

BackgroundWith the rapid increase in the incidence and mortality of lung cancer, a growing number of lung cancer patients and their families are faced with a tremendous economic burden because of the high cost of treatment in China. This study was conducted to estimate the economic burden and patient responsibility of lung cancer patients and the impact of this burden on family income.MethodsThis study uses data from a retrospective questionnaire survey conducted in 10 communities in urban China and includes 195 surviving lung cancer patients diagnosed over the previous five years. The calculation of direct economic burden included both direct medical and direct nonmedical costs. Indirect costs were calculated using the human capital approach, which measures the productivity lost for both patients and family caregivers. The price index was applied for the cost calculation.ResultsThe average economic burden from lung cancer was $43,336 per patient, of which the direct cost per capita was$42,540 (98.16%) and the indirect cost per capita was $795 (1.84$30,277 per capita, which accounted for 171% of the household annual income, a percentage that fell to 107% after subtracting the compensation from medical insurance.ConclusionsThe economic burden for lung cancer patients is substantial in the urban areas of China, and an effective control strategy to lower the cost is urgently needed

Measurement of the Usage of Web Clips in Underground Economy

In this paper, we study the ecosystem of the abused Web Clips in underground economy. Through this study, we find the Web Clips is wildly used by perpetrators to penetrate iOS devices to gain profit. This work starts with 1,800 user complaint documents about cyber crimes over Web Clips. We firstly look into the ecosystem of abused Web Clips and point out the main participants and workflow. In addition, what is the Web Clips used for is demystified. Then the main participants, including creators, distributors, and operators are deeply studied based on our dataset. We try to reveal the prominent features of the illicit Web Clips and give some mitigation measures. Analysis reveals that 1) SSL certificate is overwhelmingly preferred for signing Web Clips instances compared with certificate issued by Apple. The wildly used SSL certificates can be aggregated into a limited group. 2) The content of the abused Web Clips falls into a few categories, `Gambling', `Fraud', and `Pornography' are among the top categories. 3) Instant messenger (IM) and live streaming platform are the most popular medium to trick victims into deploying the Web Clips. 4) The Web Clips are operated by a small amount of perpetrators, and the perpetrators tend to evade detection by taking technical approach, such as registering domain names through oversea domain name service provider, preferring easy-to-acquire new gTLD (global Top Level Domain), and deploying anti-crawler tricks. Our study gives hints on investigation of cyber crime over Web Clips, we hope that this work can help stakeholders to stay ahead of the threat

A Roughness Study of Ytterbium-Doped Potassium Yttrium Tungstate (YB: KYW) Thin-Disk Femtosecond Ablated Dentin

Introduction: The aim of this study was to evaluate the morphological changes and quantitatively assess the roughness of dentin after the ablation with a Ytterbium-Doped Potassium Yttrium Tungstate (YB: KYW) thin-disk femtosecond pulsed laser of different fluences, scanning speeds and scanning distances.Method: Twelve extracted human premolars were sectioned into crowns and roots along the cementum-enamel junction, and then the crowns were cut longitudinally into sheets about 1.5 mm thick with a cutting machine. The dentin samples were fixed on a stage at focus plane. The laser beam was irradiated onto the samples through a galvanometric scanning system, so rectangular movement could be achieved. After ablation, the samples were examined with a scanning electron microscope and laser three-dimensional profile measurement microscope for morphology and roughness study.With increasing laser fluence, dentin samples exhibited more melting and resolidification of dentin as well as debris-like structure and occluded parts of dentinal tubules.Results: When at the scanning speed of 2400mm/s and scanning distance of 24μm, the surface roughness of dentin ablated with femtosecond pulsed laser decreased significantly and varied between values of dentin surface roughness grinded with two kinds of diamond burs with different grits. When at the scanning speed of 1200mm/s and scanning distance of 12μm, the surface roughness decreased slightly, and the surface roughness of dentin ablated with femtosecond pulsed laser was almost equal to that grinded with a low grit diamond bur.Conclusion: This study showed that increased laser influence may lead to more collateral damage and lower dentin surface roughness, while scanning speed and scanning distance were also negatively correlated with surface roughness. Adequate parameters should be chosen to achieve therapeutic benefits, and different parameters can result in diverse ablation results