<p> The American Recovery and Reinvestment Act (ARRA) requires the adoption of Electronic Medical Records (EMRs) for seventy percent of the primary care provider population by 2014. Furthermore, by 2015 providers are expected to be utilizing EHR in compliance with &ldquo;meaningful use&rdquo;[28] definition or they can face financial penalties under Medicare. In addition to this momentous task, EMR data has stringent security requirements. It is largely due to these security requirements that medical information is being digitized. However, sharing to entitled information is often slow or non-existent because of information silos. Fast Healthcare Interoperability Resources (FHIR) is an emerging information sharing standard that is designed to aid in the tearing down of these silos. The focus of this thesis is to show how FHIR can be further improved by allowing for cellular level security. Additionally, this thesis will introduce novel ways that vast amounts of FHIR resources can be stored and queried in real-time with Accumulo. It will do so by utilizing and improving on Dynamic Distributed Dimensional Data Model (D4M) [9] Schema to better allow for &ldquo;real-time&rdquo; REST queries of FHIR compliant data. Pagination is necessary for it to remain a real-time system since some queries can have millions or even billions of positive hits. To satisfy this requirement a new approach to Accumulo pagination is laid out that increases performance, flexibility and control. All tests are performed against a M4.2xlarge Amazon Machine Image.</p>

<p> Context-aware systems are a component of a ubiquitous computing or pervasive computing environment. Three important aspects of context include the following: where you are, who you are with, and what resources are nearby. Although location is a primary capability, location-aware does not necessarily capture information of interest that are mobile or changing. Context-aware, in contrast, is used more generally to include nearby people, devices, lighting, noise level, network availability, and even a social situation, such as whether someone is with a family member or a friend from school.</p><p> The purpose of this project is to introduce a healthcare application named &lsquo;Care Taker&rsquo; that facilitates a longitudinal study in which data is gathered from a user&rsquo;s smartphone over a period of time using a context aware application. This data is then analyzed to give a user actionable health related recommendations.</p>

<p> <b>Statement of the problem:</b> The systematic implementation of evidence-based practice through the use of guidelines, checklists and protocols has been shown to mitigate the risks associated with MV, yet variation in practice remains prevalent. Recent advances in MV, physiologic monitoring, device-to-device communication, computer processing and software engineering have allowed for the development of an automated point-of-care access to real-time goal setting and practice variance identification. Our aim was to assess the utility of a computer-aided MV (CAMV) system that displays variances and scores the overall MV course. <b>Methods:</b> A retrospective categorization of the ventilation and oxygenation statuses of patients within our pediatric intensive care unit (PICU) over a 2 '/z years period utilizing 15 rule-based algorithms was initiated as a proof of concept. Goals were predetermined based on generally accepted values. All patient categories were calculated and presented as a percent of recording time. Following the feasibility study, a retrospective observational study (baseline), followed by two sequential interventions made over a 2-month period was conducted. Phase I comprised a survey of goals of MV by clinicians caring for patients being monitored by the CAMV system. Phase II intervention was the setting and monitoring of goals of MV with a web browser based data visualization system (T3). An outcome measurement tool was developed to score each MV course. The MV score (MVS) evaluated four outcomes: (1) acceptable ventilation, (2) acceptable oxygenation, (3) barotrauma free and (4) volutrauma-free states as a percent of recording time. <b>Results:</b> Pilot consisted of 222 patients. The Baseline phase evaluated 130 patients, Phase I enrolled 31 patients and Phase II enrolled 36 patients. There were no differences in demographic characteristics between cohorts. One hundred and seventy-one surveys were completed in Phase I. An increase in the use of T3 by 87% was observed in Phase II from Phase I. MVS improved by 8.4% in Phase I and 11.3% in Phase II from Baseline. The largest improvement was in the volutraumafree category. MVS was 9% higher on average in those who survived. <b>Conclusion:</b> The use of CAMV was associated with an improvement in MVS. Further research is needed to determine if improvements in MVS through a targeted, process-oriented intervention such as CAMV will lead to improved patient outcomes.</p>

<p> The human vagina and the bacterial communities that reside therein exist in a finely balanced mutualistic association. Dysbiotic states of the vaginal microbiota, including bacterial vaginosis (BV), are characterized by a paucity of <i>Lactobacillus</i> spp., the presence of a wide array of strict and facultative anaerobes, and a pH > 4.5. Symptoms such as odor and discharge can accompany these microbial dysbiotic states, however, epidemiologically, vaginal dysbioses have been associated with increased susceptibility to STIs, including chlamydia. The mechanisms by which vaginal microbiota protect or increase the risk to infections remain unknown. This thesis aimed to identify the molecular factors that control host cellular responses to <i>Lactobacillus </i> spp.-dominated and dysbiotic microbiota. Chapter 2 characterized the <i>in vivo</i> host microRNA (miRNA) response to different types of vaginal microbiota to gain insight into host functions that play a role in vaginal homeostasis. Leveraging daily collected vaginal samples in conjunction with a machine learning approach, eight miRNAs were discovered to be differently controlled by vaginal microbiota. Of these, expression of miR-193b, known to regulate host cell proliferation, was increased by <i>Lactobacillus </i> spp.-dominated microbiota. <i>In vitro</i>, vaginal epithelial cells exposed to <i>Lactobacillus</i> spp. culture supernatants exhibited reduced epithelial cell proliferation, high miRNA-193b expression and decreased abundance of cyclin D1. More importantly, epithelial cell proliferation was identified as a requirement for efficient <i>Chlamydia trachomatis </i> infection. Chapter 3 characterized the <i>in vitro</i> transcriptome of epithelial cells exposed to <i>Lactobacillus</i> spp. relative to <i>Gardnerella vaginalis</i>, a surrogate for dysbiotic vaginal microbiota. Immune response and cell cycle pathways were found to be among the most modulated by <i>Lactobacillus</i> spp. Longitudinal gene expression suggested a role of histone deacetylases (HDAC) as an intermediary between immune stimulation and cell proliferation. Additionally, the epidermal growth factor receptor (EGFR), required for <i>C. trachomatis</i> infection, was decreased when epithelial cells were exposed to <i>Lactobacillus </i> spp. These findings contribute to the fundamental understanding of the vaginal microbiota&rsquo;s role in cellular homeostasis as a requirement for resistance to STI agents such as <i>C. trachomatis</i>, and ultimately will lead to improved preventive strategies against STIs through the modulation of vaginal microbiota composition and function.</p><p>