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Application of Agent-Based Simulation and Game Theory in Evaluating Implementation of Whole Genome Sequencing in Treating Lung Cancer
Get PDFCancer, particularly lung cancer, presents significant diagnostic and economic challenges globally. Timely diagnosis and cost management play pivotal roles in treatment success. A biomarker is any measurable molecule in blood, bodily fluids, or tissues, indicating the potential presence of an abnormal bodily process, condition, or disease. Biomarker testing is a laboratory test in oncology that is used in the selection of targeted cancer treatments and to help avoid ineffective treatments. Whole Genome Sequencing (WGS), is a biomarker test which while more comprehensive, comes at a higher cost. This study proposes an agent-based simulation model within a game-theoretic framework to examine the benefits of prioritizing WGS in the diagnostic process for lung cancer across various hospital settings. The typical diagnostic pathway for lung cancer, involving tests like PD-L1, ALK, EGFR, KRAS, BRAF, and ROS1, can lead to time-consuming referrals and potentially higher costs due to unsuccessful standard of care (SOC) tests. This thesis scrutinizes these pathways and evaluates the impacts of different referral scenarios on the number of diagnosed patients and treatment costs, drawing on a system dynamics model. Initial findings suggest that uniform referral strategies are not universally optimal and can result in delayed WGS testing results. Aiming to establish a refined strategy for each hospital type and determine the optimal timing for WGS, an agent-based simulation is proposed to emulate the diagnostic journey. The model considers costs, success rates, and diagnostic timeframes, while a game theoretic approach assesses each hospital\u27s decision-making regarding WGS access. The goal is to facilitate the earliest and most cost-effective treatment for patients. Objectives of this thesis include developing an agent-based model to mirror current pathways, evaluating referral scenarios, formulating a game-theoretic analysis, and understanding the sensitivity of various parameters crucial to decision-making. The research will culminate in actionable insights for healthcare providers and policymakers, specifically in enhancing WGS utilization in lung cancer diagnosis and treatment.
Anticipated outcomes include a versatile model for strategizing referral practices, yielding an optimal approach for a given health center constellation. The broader implications of this work extend beyond lung cancer, offering a template for enhancing diagnostic efficiency in various cancers and other sectors where strategic decisions regarding shared resources are vital. The study stands to influence patient care positively by improving diagnostic accuracy and economic efficiency in healthcare delivery
A Comparative Effectiveness Study of Bipolar and Linked Quadripolar Techniques for Eliciting Transcranial Motor Evoked Potentials During Spine Surgery
No full textProblem: Linked quadripolar stimulation (LQP) is a technique used within the field of intraoperative neurophysiology to elicit a transcranial motor evoked potential (TcMEP). However, the technique has not been experimentally validated as being superior in eliciting TcMEPs or reducing patient movement during surgery. LQP also incurs higher supply costs, increased set up times, and increases the risk of needle stick injury and infection; because the technique requires the use of more needle electrodes than more traditional approaches.
Purpose: TcMEPs are a practice regularly employed by surgical neurophysiologists and vital in the assessment of corticospinal tract, nerve root, and nerve function during various surgical procedures. Patient movement is an unfortunate byproduct of TcMEP stimulation and can often pose a challenge during surgery. LQP is a recent innovation presented at conferences and claims several advantages over the traditional Bipolar (BP) stimulation. This study aims to compare BP and LQP stimulation to validate the effectiveness of LQP.
Methods: A retrospective chart review of 30 patients was conducted to compare LQP and BP techniques. Following institutional review board approval, a comprehensive analysis of standard response criteria for each technique on available patient data was performed. The Mann-Whitney U test was performed to compare patient movement and compound muscle action potential (CMAP) amplitude, and area under the curve values (AUC) for data collected using LQP and BP techniques; p \u3c .05. The Pearson correlation coefficient was used to assess relationships between the observed variables; p \u3c .05. In all cases, the neuromonitoring was performed by a singular board-certified neurophysiologist.
Results: The study sample consisted of 30 patients consisting of 14 males and 16 females (mean age: 55, range: 29-86). A Mann-Whitney U test was used to compare patient movement, amplitude, and AUC values between BP and LQP stimulation approaches, and showed no statistically significant difference in any variable. A Pearson Correlation test was used to evaluate the relationship between patient movement and stimulation intensity, and amplitude and AUC values. No correlation was found between patient movement and stimulation; however, a strong correlation (\u3e.7) was found in all comparisons between amplitude and AUC.
Conclusion: No statistically significant difference was observed across patient movement, amplitude, or AUC values between LQP and BP stimulation. Contrary to suggestions made in the limited research available about LQP practices, LQP did not demonstrate reduced movement or improved CMAP data. Due to the increased cost, safety concerns for the neurophysiologist, and set-up time required, and lack of evidence indicating benefits over BP stimulation, future research is warranted and clinicians may consider the use of BP to improve care practices
Establishing New Links Between HRM Practices and Knowledge Workers’ Retention in Healthcare Sector: Knowledge Sharing Generating Moderating Effects
Get PDFKnowledge sharing is the fundamental measure through which knowledge workers can significantly contribute to innovation and eventually the competitive advantage of the organization. Drawing upon the knowledge-based view of firms, the present study aims to examine the moderating role of knowledge sharing on the relationship between HRM practices and knowledge workers’ retention in the healthcare sector. After the COVID impact, healthcare knowledge workers have become a point for wide scholarly discussion and appropriate HRM practices should be implemented to amplify their probability of a longer stay in the organization. Hence, this research has incorporated PLS-SEM for empirical investigation which is based on prior discussions with some healthcare experts. The results propagate that knowledge sharing moderates HRM practices-retention linkage except training and development which is found to be statistically insignificant. The empirical evidence generated could be crucial for researchers and practitioners within the healthcare sector, thereby, extending assistance in establishing world-wide recognition
Firm Type and Unconditional Conservatism: The Indian Experience with IFRS Convergence
Get PDFThis paper investigates how private and public firms vary with respect to unconditional conservatism in financial reporting in the pre and post IFRS worlds. I consider unconditional conservatism (UC) which pre-empts the more commonly studied conditional conservatism, private firms that are differently regulated, IFRS convergence instead of the more uniform IFRS adoption and an emerging market. Using a large Indian sample of 63,000 observations across more than 15,500 firms (~41% are private) over 10 years (2011-2020), I show that private firms are less unconditionally conservative than public firms. Also, contrary to literature, IFRS convergence increases conservatism in India and reduces the conservatism gap between private and public firms. These results hold even after controlling for monitoring, governance, and group-affiliation. This adds significantly to our understanding of how the effect of uniform accounting standards on reporting choices of different firm types varies significantly by and within a context and region
BRICS: The World’s New Emerging Economic Alliance
Get PDFNational Security is ever-changing and evolving. As our nation moves forward in today’s world after the conclusion of the Iraq War and Afghanistan War, and moves into a new modern warfare, our nation must be on alert; searching for the next threat to keep our sovereignty alive and our citizens free and safe. This is especially important when nations who desire to harm our great nation find common interests in others to join forces against the United States of America. While looking at Brazil, Russia, India, China, and South Africa Coalition (BRICS) and what these countries coming together could do to affect national security here in the USA, it can be seen that this coalition has the potential to become a new Axis power which will threaten not only us as a nation, but potentially the world as we know it. We must not only be prepared for what is to come, but also take steps to stop a new Axis power from forming or even prevent it from expanding any further
Risk Transmission and Hedging Strategies Between Chinese Stock Market and Major Trading Partners Along the Belt and Road in COVID-19 Scenario
Get PDFThis paper focuses on the multi-scale spillover and time-varying dependence of Chinese stock market and its important trading partners along the Belt and Road around the COVID-19 crisis. We use multiple methods - the DY (12) and BK (18) connectedness approaches that investigate dynamic and frequency connectedness; the wavelet coherence and the time-varying CoVaR to examine the connection between price lead lags and systemic risk spillovers. Our empirical results show spillovers to be asymmetric, and short-term spillovers dominating. Meanwhile, the level of spillover in the system increased sharply after the COVID-19. In the medium and long-term frequency domains, wavelet coherence reveals strong co-movement between the Chinese market and its major trading partners. We see that the highest level of systematic risk spillovers occurs at the beginning of the COVID-19 outbreak. Finally, the weighting of the Chinese stock market in the effective portfolio rises after the COVID-19 outbreak
Asymmetric Uncertainty Around Earnings Announcements: Evidence from Options Markets
Get PDFWe use the Indian stock options market to study the evolution of uncertainty and asymmetric uncertainty around earnings announcements (EAs). We find that uncertainty (implied volatility) and asymmetric uncertainty (options skew) increase monotonically before the EA day and decrease after EA. Options volume (relative to spot and to futures) also exhibits similar behavior, suggesting that informed investors prefer options markets to spot and futures markets. Both options skew and put-to-call volume ratio can predict the sign of the EA surprise one day before EA, indicating that price discovery and information assimilation happen in the options market
Art and Environmentalism: How Art and Nature have kept each other Alive
No full textVisual art and societal attitudes are deeply interconnected, and cultural movements are often synonymous with thematic and stylistic changes within the world of art. By observing artworks that have been inspired by the environment, and assessing the extent to which artists connect to their environmnet through their artwork, it is easier to understand the ways in which art has fostered an appreciation for nature, and how nature has inspired countless artists throughout history. With the ever-changing state of our climate and a societal disregard for the materialist and capitalist structures that are at the root of environmental neglect, it is imperative to look towards the arts and other creative outlets for insight on how to move forward in addressing these issues. Whether it be to cope with the ways in which society has failed them, or to create space for the voices and perspectives that would otherwise go unheard, visual artists have been continually resilient in the face of both personal and interpersonal conflict. By reflecting an appreciation for landscape and acknowledging the countless ways in which environment shapes personal identity, the artwork that has emerged from this project builds upon the tradition of fostering an appreciation of nature through art. These paintings, collectively titled Nature and Identity, resemble a love letter to the environment that has shaped me and the profound impact that natural subjects have had on my development as both an artist and a person
Effect of Borrelia burgdorferi Outer Membrane Vesicles on Inflammatory Markers of Breast Cancer Cells
No full textBreast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death among women. Emerging studies have reported that infections by microorganisms, including bacterial spirochetes like Borrelia burgdorferi, are associated with breast cancer and correspond to poor prognosis. Previous research by the Lyme disease research lab has demonstrated B. burgdorferi’s ability to infect MDA-MB-231 breast cancer cells and alter their tumorigenic properties. Similar cellular changes were observed in neuronal cells infected with B. burgdorferi or co-cultured with outer membrane vesicles (OMVs) isolated from this pathogen. The OMVs released from B. burgdorferi have been observed to possibly contain virulence factors that may have a role in B. burgdorferi infection in human cells. These OMVs, potentially carrying virulence factors, prompted this study to investigate whether B. burgdorferi OMVs can induce the expression of inflammatory and/or tissue remodeling genes in breast cancer cells similar to those caused by direct spirochete infection.
This study explored various methods for isolating B. burgdorferi OMVs, including the ExoBacteriaTM kit method and qEV size-exclusion column chromatography. The Bb-OMVs were characterized through transmission electron microscopy and OMV-specific markers like the outer surface membrane proteins OspA and OspC were detected. The analysis of 16S rDNA expression to prove the purity of the Bb-OMVs samples yielded interesting results, demonstrating that the ExoBacteriaTM kit was superior to the alternative isolation method we tested. Further, the effects of OMV co-culture with spirochete infection were compared on the expression of previously studied cancer-associated genes (CXCL8, CXCL10, CCL20, PTGS2) and tissue remodeling markers (MMP1, MMP9, TIMP1, TIMP2) in MDA-MB-231 breast cancer cells using RT-qPCR. The cancer-associated inflammatory markers were reported to have lower levels of expression in Bb-OMV co-cultured cells compared to the direct infection of B. burgdorferi in MDA-MB-231 cells. Lastly, similar reduced expression levels of tissue remodeling markers, MMPs and TIMPs were observed in Bb-OMV co-cultured MDA-MB-231 cells.
Our results in this study suggest that Bb-OMVs can enhance the expression of inflammatory and tumorigenic factors in breast cancer cells, providing insights into the hostpathogen relationship and the potential role of B. burgdorferi in breast cancer development
Feasibility Study and Application of Electric Energy Storage Systems Embedded in HVDC and STATCOM Systems
No full textThe integration of Energy Storage (ES) Systems, like batteries and supercapacitors, in power systems is accelerating globally due to their ability to enhance the flexibility and efficiency required to integrate intermittent renewable energy sources. ES systems embedded in HVDC and STATCOM devices can enhance network resilience and ancillary services. This brochure provides insights on converter topologies, modeling, integration options, ancillary services, benefits, and challenges of ES integration in HVDC/STATCOM systems