The dissertation aims to examine the potential for diabetes self-management education (DSME) technology interventions to be used by underserved adults in routine clinical practice and issues regarding its use that may be unique to this population. In Chapter One, the problems of providing sufficient access and appropriate DSME to underserved adults with type 2 diabetes mellitus (T2DM) is introduced and their significance is described. In Chapter Two, a systematic review of the literature and meta-analysis synthesizes data from 3,257 subjects that participated in 13 randomized controlled trials that examined the effect of health information technology (HIT) DSME interventions on glycemic control in medically underserved adults. Chapter Three presents the general and technology-related characteristics of the urban, underserved sample of adults with type 2 diabetes mellitus from eight federally qualified health centers who participated in the Mobile Diabetes Detective (MoDD) randomized controlled trial. It also describes the technology training required to support use and engagement during the MoDD intervention period. In Chapter Four, the potential for broad dissemination of a novel HIT DSME intervention, MoDD, into everyday clinical practice is examined using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). In Chapter Five the findings of these studies are summarized and the overarching conclusions are presented, which include the strengths, limitations and implications for practice, policy and future.

Catheter ablation therapy attempts to restore sinus rhythm in arrhythmia patients by producing site-specific tissue modification along regions which cause abnormal electrical activity. This treatment, though widely used, often requires repeat procedures to observe long-term therapeutic benefits. This limitation is driven in part by challenges faced by conventional schemes in validating lesion adequacy at the time of the procedure. Optical techniques are well-suited for the interrogation and characterization of biological tissues. In particular, optical coherence tomography (OCT) relies on coherence gating of singly-scattered light to enable high-resolution structural imaging for tissue diagnostics and procedural guidance. Alternatively, optical reflectance spectroscopy (ORS) is a point measurement technique which makes use of incoherent, multiply-scattered light to probe tissue volumes and derive important data from its optical signature. ORS relies on the fact that light-tissue interactions are regulated by absorption and scattering, which directly relate to the intrinsic tissue biochemistry and cellular organization. In this thesis, we explore the integration of these modalities into ablation catheters for obtaining procedural metrics which could be utilized to guide catheter ablation therapy. We first present the development of an accelerated computational light transport model and its application for guiding ORS catheter design. A custom ORS-integrated ablation catheter is then implemented and tested within porcine specimens in vitro. A model is proposed for real-time estimation of lesion size based on changes in spectral morphology acquired during ablation. We then fabricated custom integrated OCT M-mode RF catheters and present a model for detecting contact status based on deep convolutional neural networks trained on endomyocardial images. Additionally, we demonstrate for the first time, tracking of RF-induced lesion formation employing OCT Doppler micro-velocimetry; this response is shown to be commensurate with the degree of treatment. We further demonstrate for the first time spectroscopic tracking of kinetics related to the heme oxidation cascade during thermal treatment, which are linked to tissue denaturation. The pairing of these modalities into a single RF catheter was also validated for guiding lesion delivery in vitro and within live pigs. Finally, we conclude with a proof-of-concept demonstration of ORS as a mapping tool to guide epicardial ablation in human donor hearts. These results showcase the vast potential of ORS and OCT empowered RF catheters for aiding intraprocedural guidance of catheter ablation procedures which could be utilized alongside current practices.

In this work, a versatile electrochemical biosensing platform was developed based on graphene/zinc oxide (G/ZnO) nanocomposite. For the synthesis of G/ZnO nanocomposite, two facile and green approaches were employed to eradicate the issues associated with conventional methods, which use harsh chemicals and high temperature. The G/ZnO nanocomposite synthesised via low temperature hydrothermal growth method exhibited approximate 58 times improvement in terms of sensitivity as compared to the G/ZnO nanocomposite synthesised via the mechanical stirring method. Therefore, the G/ZnO nanocomposite with higher sensitivity was employed for the following work. Results from cyclic voltammetry and amperometry showed that the G/ZnO-modified electrode displayed a wide linear range up to 15 mM for the detection of H2O2 and sensitivity improvements of 200% in comparison to the control sample. Subsequently, an electrochemical genosensor based on G/ZnO nanocomposite was fabricated for the detection of Avian Influenza H5N1 virus. The G/ZnO-based genosensor displayed its potential in replacing the conventional detection method, with result showing higher sensitivity and efficiency. The G/ZnO-based genosensor was further applied for the detection of Coconut Cadang-Cadang Viroid disease (CCCVd) single stranded RNA (ssRNA). Promising results were obtained with high specificity in discriminating the target from mismatched ssRNA sequences.

China has attracted increasing amounts of foreign investment since it opened its doors to the world and whilst many researchers have focused on foreign investment in popular areas, little has been written about medical device market. The medical device market is one of the most profitable areas in the global economy. With the development of China's economy, the Chinese medical device market is experiencing significant growth, and has become the second largest market in the world. The research in this thesis extracted foreign direct investment theory and summarized the current situation of the global medical device market and the Chinese medical device market. Analysis of the status of the Chinese medical device market from the perspective of the healthcare industry and its important market drivers, reveals that the medical device market has significant growth potential. The research methods such as: regression analysis; location quotient, which revealed the Chinese medical device market status, provides suggestions for investors who are interested in entering the Chinese market. Investors or companies who want to enter the Chinese market need to understand the regulatory environment, comparison of the medical device regulations with the US and EU regulations provide investors with a clear understanding of the Chinese medical device regulatory regime. The research in this thesis contributes to medical device market investment and regional economy in medical device industry, and make a clear statement of the changing medical device regulations in China, which came into force on 2014. The contribution of this thesis, bridges the research gap between investment theory and medical device market development.

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM's iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO's capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch's syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations.

The goal of this dissertation is to demonstrate the utility of portable, small-scale diffuse optical spectroscopic (DOS) systems for the diagnosis and treatment monitoring of various diseases. These systems employ near-infrared light (wavelength range of 650nm to 950nm) to probe human tissue and are sensitive to changes in scattering and absorption properties of tissues. The absorption is mainly influenced by the components of blood, namely oxy- and deoxy-hemoglobin (HbO2 and Hb) and parameters that can be derived from them (e.g. total hemoglobin concentration [THb] and oxygen saturation, StO2). Therefore, I focused on diseases in which these parameters change, which includes vascular diseases such as Peripheral Atrial Disease (PAD) and Infantile Hemangiomas (IH) as well as musculoskeletal autoimmune diseases such as Rheumatoid Arthritis (RA). In each of these specific diseases, current monitoring techniques are limited by their sensitivity to disease progression or simply do not exist as a quantitative metric. As part of this project, I first designed and built a wireless handheld DOS device (WHDD) that can perform DOS measurements at various tissue depths. This device was used in a 15-patient pilot study for infantile hemangiomas (IH) to differentiate diseased skin from normal skin and monitor the vascular changes during intervention. In another study, I compare the ultra-small form- factor WHDD’s ability to monitor synovitis and disease progression during a patient’s treatment of RA against the capabilities of a proven frequency domain optical tomographic (FDOT) system that has shown to differentiate patients with and without RA. Learning from clinical utility of the WHDD from these two studies, I adapted the WHDD technology to develop a compact multi- channel DOS measurement system to monitor perfusion changes in the lower extremities before and after surgical intervention for patients with peripheral artery disease (PAD). Using this multi- channel system, which we called the vascular optical spectroscopic measurement (VOSM) system, our group conducted a 20-subject pilot study to quantify its ability to monitor blood perfusion before and after revascularization of stenotic arteries in the lower extremities. This proof-of- concept study demonstrated how DOS may help vascular surgeons perform revascularization procedures in the operating room and assists in post-operative treatment monitoring of vascular diseases.

Orientador: Alberto Noriyuki Kojima / Coorientador: Eduardo Shigueyuki Uemura / Banca: Alfredo Mikail Melo Mesquita / Banca: Rubens Nisie Tango / Resumo: O primeiro contato de alunos de graduação com a disciplina de Prótese Parcial Fixa ocorre em aulas teóricas e posteriormente em práticas laboratoriais. Na teoria os docentes utilizam de diversas formas para elucidar um preparo de Prótese Parcial Fixa, fotos e vídeos no passo a passo, guias de silicone, guias de redução, marcações coloridas e até mesmo demonstrações ao vivo. Utilizam- se desses métodos a fim de formar um conceito e fixar uma imagem de um preparo ideal obedecendo aos princípios mecânicos e biológicos das reduções estruturais em prótese fixa. O presente estudo teve como objetivo avaliar as principais dificuldades dos alunos de graduação nos preparos coronários em Prótese Parcial Fixa e sugerir ferramentas de ensino para auxiliar aluno e professor, a elucidar e calibrar os alunos nos desgastes coronários. Participaram da pesquisa ao todo 87 alunos matriculados do 3° ano integral, dos anos 2017 e 2018 da disciplina de Prótese Parcial Fixa, da graduação em Odontologia do ICT. Foi desenvolvido um aplicativo de celular com um banco de dados dos principais preparos coronários e com a possibilidade de comparação do preparo finalizado através de fotos. Também foram desenvolvidas, aplicadas e validadas 02 metodologias: Um manequim com esquema de cores que auxiliou o aluno a visualizar os preparos coronários e uma demonstração prática projetada comparou os métodos de ensino teórico e prático. 78,2% dos alunos relatam a quantidade de redução como a principal dificuldade. O... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The first contact of undergraduate students with the discipline of Partial Fixed Prosthesis occurs in theory classes and later in laboratory practices. In theory, teachers use a variety of ways to elucidate a Fixed Partial Prosthesis preparation, step-by-step photos and videos, silicone guides, reduction guides, color markers and even live demonstrations. These methods are used to form a concept and to fix an image of an ideal preparation obeying the mechanical and biological principles of the structural reductions in fixed prosthesis. The present study had as objective to evaluate the main difficulties of undergraduate students in coronary arteries in Fixed Partial Prosthesis and to suggest teaching tools to help students and teachers to elucidate and calibrate students in coronary wear. A total of 87 enrolled students from the 3rd full year, from the years 2017 and 2018 of the discipline of Partial Fixed Prosthesis, from the graduation in Dentistry from the ICT participated in the research. A cellular application was developed with a database of the main coronary preparations and the possibility of comparing the finished preparation with photos. Two methodologies were also developed, applied and validated: a color design mannequin that helped the student to visualize the coronary preparations and a practical demonstration designed to compare the methods of theory and practical teaching. 78.2% of the students report the amount of reduction as the main difficulty. The method ... (Complete abstract click electronic access below) / Mestre

abstract: The biohacker movement is an important and modern form of activism. This study broadly examines how positive-activist-oriented biohackers emerge, organize, and respond to social crises. Despite growing public awareness, few studies have examined biohacking's influence on prevailing notions of organizing and medicine in-context. Therefore, this study examines biohacking in the context of the 2016 EpiPen price-gouging crisis, and explores how biohackers communicatively attempted to constitute counter-narratives and counter-logics about medical access and price through do-it-yourself (DIY) medical device alternatives. Discourse tracing and critical case study analysis are useful methodological frameworks for mapping the historical discursive and material logics that led to the EpiPen pricing crisis, including the medicalization of allergy, the advancement of drug-device combination technologies, and role of public health policy, and pharmaceutical marketing tactics. Findings suggest two new interpretations for how non-traditional forms of organizing facilitate new modes of resistance in times of institutional crisis. First, the study considers the concept of "pop-up maktivism" to conceptualize activism as a type of connective activity rather than collective organizing. Second, findings illustrate how activities such as participation and co-production can function as meaningful forms of institutional resistance within dominant discourses. This study proposes “mirrored materiality” to describe how biohackers deploy certain dominant logics to contest others. Lastly, implications for contributions to the conceptual frameworks of biopower, sociomateriality, and alternative organizing are discussed. / Dissertation/Thesis / Doctoral Dissertation Communication 2019

As part of the current fast growing development of digital technologies, collaborations between professions such as neurosciences, robotics, big data processing and artificial intelligence offer new possibilities for healthcare. For these new technologies to reach clinical practice, there is an increasing need for interdisciplinary organizational work to support decision-making over their introduction. In the field of neurorehabilitation, exoskeletons are an example of a robotic tool that can be used to regain locomotion abilities after a neurological injury. They are part of an umbrella term, Robot-Assisted-Rehabilitation (RAR), that stands for neurological recovery techniques assisted with robotic tools. For these tools, the introduction, evaluation and implementation in clinical practice have not been evaluated. In many cases it is also not taken into account that tools such as rehabilitation robotics are context-dependent. In other words, the needs, opportunities and challenges that come together with working efficiently with this new technology can widely vary between clinics, regions and countries. Lastly, it appears that smaller hospitals consider themselves in need of tools to support their decision-making in the RAR introduction phase. In collaboration with Hälsostaden and Region Skåne, we set out to develop a tool to support Ängelholm Hospital (ÄH) in their decision-making over a test-bed trial of RAR in their clinical setting. A tool that we coined the Co-Strategy Process (CSP), was developed based on identified needs related to this stage of the process, using a blend of interdisciplinary scientific methods. It integrates internal and external interdisciplinary expertise and includes four steps: Preparation, Knowledge Empowerment, Exchange & Development and Synthesis & Report. The current Master thesis presents the development and assessment of the CSP at ÄH. In the present context, it results in a new tool for supporting organizations implementing new technologies, optimized based on its application in a Swedish clinical setting. This tool aims at serving this introductory process, so that new technologies can be implemented meeting the needs of both the clinic and patients. / e Rehab-robotic project in collaboration with Uppsala University, Basel University and ETH Zurich

<p>Part 1: The bandwidth of the ultrasound Doppler signal is proposed as a classification function of blood and tissue signal in transthoracial echocardiography of the left ventricle. The new echocardiographic mode, Bandwidth Imaging, utilizes the difference in motion between tissue and blood. Specifically, Bandwidth Imaging is the absolute value of the normalized autocorrelation function with lag one. Bandwidth Imaging is therefore linearly dependent on the the square of the bandwidth estimated from the Doppler spectrum. A 2-tap Finite Impulse Response high-pass filter is used prior to autocorrelation calculation to account for the high level of DC clutter noise in the apical regions. Reasonable pulse strategies are discussed and several images of Bandwidth Imaging are included. An in vivo experiment is presented, where the apparent error rate of Bandwidth Imaging is compared with apparent error rate of Second-Harmonic Imaging on 15 healthy men. The apparent error rate is calculated from signal from all myocardial wall segments defined in \cite{Cer02}. The ground truth of the position of the myocardial wall segments is determined by manual tracing of endocardium in Second-Harmonic Imaging. A hypotheses test of Bandwidth Imaging having lower apparent error rate than</p><p>Second-Harmonic Imaging is proved for a p-value of 0.94 in 3 segments of end diastole and 1 segment in end systole on non averaged data. When data is averaged by a structural element of 5 radial, 3 lateral and 4 temporal samples, the numbers of segments are increased to 9 in end diastole and to 6 in end systole. These segments are mostly located in apical and anterior wall regions. Further, a global measure GM is defined as the proportion of misclassified area in the regions close to endocardium in an image. The hypothesis test of Second-Harmonic Imaging having lower GM than Bandwidth Imaging is proved for a p-value of 0.94 in the four-chamber view in end systole in any type of averaging. On the other side, the hypothesis test of Bandwidth Imaging having lower GM than Second-Harmonic Imaging is proved for a p-value of 0.94 in long-axis view in end diastole in any type of averaging. Moreover, if images are averaged by the above structural element the test indicates that Bandwidth Imaging has a lower apparent error rate than Second-Harmonic Imaging in all views and times (end diastole or end systole), except in four-chamber view in end systole. This experiment indicates that Bandwidth Imaging can supply additional information for automatic border detection routines on endocardium.</p><p>Part 2: Knowledge Based Imaging is suggested as a method to distinguish blood from tissue signal in transthoracial echocardiography. This method utilizes the maximum likelihood function to classify blood and tissue signal. Knowledge Based Imaging uses the same pulse strategy as Bandwidth Imaging, but is significantly more difficult to implement. Therefore, Knowledge Based Imaging and Bandwidth Imaging are compared with Fundamental Imaging by a computer simulation based on a parametric model of the signal. The rate apparent error rate is calculated in any reasonable tissue to blood signal ratio, tissue to white noise ratio and clutter to white noise ratio. Fundamental Imaging classifies well when tissue to blood signal ratio is high and tissue to white noise ratio is higher than clutter to white noise ratio. Knowledge Based Imaging classifies also well in this environment. In addition, Knowledge Based Imaging classifies well whenever blood to white noise ratio is above 30 dB. This is the case, even when clutter to white noise ratio is higher than tissue to white noise ratio and tissue to blood signal ratio is zero. Bandwidth Imaging performs similar to Knowledge Based Imaging, but blood to white noise ratio has to be 20 dB higher for a reasonable classification. Also the highpass filter coefficient prior to Bandwidth Imaging calculation is discussed by the simulations. Some images of different parameter settings of Knowledge Based Imaging are visually compared with Second-Harmonic Imaging, Fundamental Imaging and Bandwidth Imaging. Changing parameters of Knowledge Based Imaging can make the image look similar to both Bandwidth Imaging and Fundamental Imaging.</p>