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Description
Surgery as a profession requires significant training to improve both clinical decision making and psychomotor proficiency. In the medical knowledge domain, tools have been developed, validated, and accepted for evaluation of surgeons' competencies. However, assessment of the psychomotor skills still relies on the Halstedian model of apprenticeship, wherein surgeons are

Surgery as a profession requires significant training to improve both clinical decision making and psychomotor proficiency. In the medical knowledge domain, tools have been developed, validated, and accepted for evaluation of surgeons' competencies. However, assessment of the psychomotor skills still relies on the Halstedian model of apprenticeship, wherein surgeons are observed during residency for judgment of their skills. Although the value of this method of skills assessment cannot be ignored, novel methodologies of objective skills assessment need to be designed, developed, and evaluated that augment the traditional approach. Several sensor-based systems have been developed to measure a user's skill quantitatively, but use of sensors could interfere with skill execution and thus limit the potential for evaluating real-life surgery. However, having a method to judge skills automatically in real-life conditions should be the ultimate goal, since only with such features that a system would be widely adopted. This research proposes a novel video-based approach for observing surgeons' hand and surgical tool movements in minimally invasive surgical training exercises as well as during laparoscopic surgery. Because our system does not require surgeons to wear special sensors, it has the distinct advantage over alternatives of offering skills assessment in both learning and real-life environments. The system automatically detects major skill-measuring features from surgical task videos using a computing system composed of a series of computer vision algorithms and provides on-screen real-time performance feedback for more efficient skill learning. Finally, the machine-learning approach is used to develop an observer-independent composite scoring model through objective and quantitative measurement of surgical skills. To increase effectiveness and usability of the developed system, it is integrated with a cloud-based tool, which automatically assesses surgical videos upload to the cloud.
ContributorsIslam, Gazi (Author) / Li, Baoxin (Thesis advisor) / Liang, Jianming (Thesis advisor) / Dinu, Valentin (Committee member) / Greenes, Robert (Committee member) / Smith, Marshall (Committee member) / Kahol, Kanav (Committee member) / Patel, Vimla L. (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Objectives Through a cross-sectional observational study, this thesis evaluates the relationship between food insecurity and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress as it relates to predominantly Hispanic/Latino parents in Phoenix, Arizona. The purpose of this study was to address gaps in

Objectives Through a cross-sectional observational study, this thesis evaluates the relationship between food insecurity and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress as it relates to predominantly Hispanic/Latino parents in Phoenix, Arizona. The purpose of this study was to address gaps in the literature by examining differences in "healthy" and "unhealthy" eating behaviors, foods available in the home, how time and low energy impact meal preparation, and the level of stress between food security groups. Methods Parents, 18 years or older, were recruited during two pre-scheduled health fairs, from English as a second language classes, or from the Women, Infants, and Children's clinic at a local community center, Golden Gate Community Center, in Phoenix, Arizona. An interview, electronic, or paper survey were offered in either Spanish or English to collect data on the variables described above. In addition to the survey, height and weight were collected for all participants to determine BMI and weight status. One hundred and sixty participants were recruited. Multivariate linear and logistic regression models, adjusting for weight status, education, race/ethnicity, income level, and years residing in the U.S., were used to assess the relationship between food security status and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress. Results Results concluded that food insecurity was more prevalent among parents reporting lower income levels compared to higher income levels (p=0.017). In adjusted models, higher perceived cost of fruits (p=0.004) and higher perceived level of stress (p=0.001) were associated with food insecurity. Given that the sample population was predominately women, a post-hoc analysis was completed on women only. In addition to the two significant results noted in the adjusted analyses, the women-only analysis revealed that food insecure mothers reported lower amounts of vegetables served with meals (p=0.019) and higher use of fast-food when tired or running late (p=0.043), compared to food secure mothers. Conclusion Additional studies are needed to further assess differences in stress levels between food insecure parents and food insecure parents, with special consideration for directionality and its relationship to weight status.
ContributorsVillanova, Christina (Author) / Bruening, Meg (Thesis advisor) / Ohri-Vachaspati, Punam (Committee member) / Vega-Lopez, Sonia (Committee member) / Arizona State University (Publisher)
Created2014
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Description
It is widely recognized that dietary protein induces greater satiety compared to carbohydrate and fat. Two separate trials were conducted to assess the use of protein as a dietary approach to manage energy intake (EI). The first, crossover trial, examined 24– hour EI after consuming a high protein bar (HP)

It is widely recognized that dietary protein induces greater satiety compared to carbohydrate and fat. Two separate trials were conducted to assess the use of protein as a dietary approach to manage energy intake (EI). The first, crossover trial, examined 24– hour EI after consuming a high protein bar (HP) vs. a high carbohydrate (HC) bar upon awakening on two separate days and a control, no bar day. Of the 54 participants who entered the trial, 37 subjects completed the study in its entirety. Results showed there was no significant difference in mean EI between the intervention days when the bars were consumed and the control day. The subjects consumed 1752±99 kcal on the control day, and 1846±75 and 1891±110 kcal on the days the HP and HC bars were consumed, respectively (P=0.591). However, compared to the control day, snack bar ingestion was significantly related to an increase in EI for the subjects who self-reported high weekly physical activity levels (n=11) (+22%; P=0.038 and +45%; P=0.030, HP and HC bars, respectively). These data suggest that individuals who have moderate to low physical activity levels compensate for the ingestion of energy bars (regardless of protein content) over a 24–hour period. The second parallel-arm, pilot trial examined the effect of 6 g daily gelatin ingestion vs. control on EI and weight change in healthy, overweight and obese women who initiated a walking program. Of the 37 women who entered the trial, 28 completed the six week trial. The results showed activity level (steps/d) increased in both groups (+ 22%, P=0.022). There was a significant group difference in mean EI at week 6 vs. baseline (–174±612 kcal/d and +197±320 kcal/d, P=0.001; gelatin and control groups, respectively). However, there was no significant between group difference for changes in weight, percent body fat and waist circumference. Those subjects having baseline Disinhibition scores of ≥12 gained significantly more weight throughout the study vs. those scoring <12 (P=0.004). These results indicate that daily gelatin ingestion may be a practical strategy for controlling EI among overweight and obese women initiating an exercise program.
ContributorsTrier, Catherine M (Author) / Johnston, Carol S. (Thesis advisor) / Swan, Pamela D. (Committee member) / Mayol-Kreiser, Sandra N. (Committee member) / Appel, Christy L. (Committee member) / Gaesser, Glenn A. (Committee member) / Arizona State University (Publisher)
Created2012
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Description
Background: Previous research suggests a healthy eater schema (i.e., identifying yourself as a healthy eater) may be a useful concept to target in interventions. A "stealth" intervention that discussed the moral issues related to food worked better at promoting healthful eating than an intervention focused on the health benefits. No

Background: Previous research suggests a healthy eater schema (i.e., identifying yourself as a healthy eater) may be a useful concept to target in interventions. A "stealth" intervention that discussed the moral issues related to food worked better at promoting healthful eating than an intervention focused on the health benefits. No research has explored the relationship between moral foundations, a theoretical model focused on delineating core "foundations" for making a moral decision, and healthy eater self-identity or self-efficacy. Purpose: We explored the relationship between moral foundations (i.e., harm/care, fairness/reciprocity, in-group/loyalty, authority/respect, & purity/sanctity) and health eater self-identity and fruit and vegetable self-efficacy (FVSE). Methods: 542 participants completed an online cross-sectional survey, which included moral foundations (i.e., MFQ), political views, healthy eater self-identity (i.e., HESS), and FVSE measures. Logistic regression was used to assess the relationship between moral foundations between healthy eater self-identity after controlling for age, gender, major, BMI, and political beliefs. OLS regression was used to explore the relationship between self-efficacy and the moral foundations after controlling for the covariates. Results: 75.6% of the sample were college students, with a mean age of 25.27 (SD=8.61). 25.1% of students were nutrition majors. Harm/care, authority/respect, and ingroup/loyalty were significantly associated with healthy eater schema, (i.e., OR=1.7, p<.001, OR=1.5, p=.009, and OR=1.4, p=.027, respectively). Ingroup/loyalty, authority/respect, and purity/sanctity were related to FVSE (p=.006, p=.002, p=.04, respectively). Conclusion: Among college students, harm/care and authority/respect were associated with a healthy eater schema. Future research should explore possible uses of these moral foundations in interventions (e.g., a plant-based diet based on reduced harm to animals or eating fewer processed views based on "traditional" values).
ContributorsKiser, Sarah (Author) / Hekler, Eric B. (Thesis advisor) / Ohri-Vachaspati, Punam (Committee member) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Johnston, Carol (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Effective modeling of high dimensional data is crucial in information processing and machine learning. Classical subspace methods have been very effective in such applications. However, over the past few decades, there has been considerable research towards the development of new modeling paradigms that go beyond subspace methods. This dissertation focuses

Effective modeling of high dimensional data is crucial in information processing and machine learning. Classical subspace methods have been very effective in such applications. However, over the past few decades, there has been considerable research towards the development of new modeling paradigms that go beyond subspace methods. This dissertation focuses on the study of sparse models and their interplay with modern machine learning techniques such as manifold, ensemble and graph-based methods, along with their applications in image analysis and recovery. By considering graph relations between data samples while learning sparse models, graph-embedded codes can be obtained for use in unsupervised, supervised and semi-supervised problems. Using experiments on standard datasets, it is demonstrated that the codes obtained from the proposed methods outperform several baseline algorithms. In order to facilitate sparse learning with large scale data, the paradigm of ensemble sparse coding is proposed, and different strategies for constructing weak base models are developed. Experiments with image recovery and clustering demonstrate that these ensemble models perform better when compared to conventional sparse coding frameworks. When examples from the data manifold are available, manifold constraints can be incorporated with sparse models and two approaches are proposed to combine sparse coding with manifold projection. The improved performance of the proposed techniques in comparison to sparse coding approaches is demonstrated using several image recovery experiments. In addition to these approaches, it might be required in some applications to combine multiple sparse models with different regularizations. In particular, combining an unconstrained sparse model with non-negative sparse coding is important in image analysis, and it poses several algorithmic and theoretical challenges. A convex and an efficient greedy algorithm for recovering combined representations are proposed. Theoretical guarantees on sparsity thresholds for exact recovery using these algorithms are derived and recovery performance is also demonstrated using simulations on synthetic data. Finally, the problem of non-linear compressive sensing, where the measurement process is carried out in feature space obtained using non-linear transformations, is considered. An optimized non-linear measurement system is proposed, and improvements in recovery performance are demonstrated in comparison to using random measurements as well as optimized linear measurements.
ContributorsNatesan Ramamurthy, Karthikeyan (Author) / Spanias, Andreas (Thesis advisor) / Tsakalis, Konstantinos (Committee member) / Karam, Lina (Committee member) / Turaga, Pavan (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Image understanding has been playing an increasingly crucial role in vision applications. Sparse models form an important component in image understanding, since the statistics of natural images reveal the presence of sparse structure. Sparse methods lead to parsimonious models, in addition to being efficient for large scale learning. In sparse

Image understanding has been playing an increasingly crucial role in vision applications. Sparse models form an important component in image understanding, since the statistics of natural images reveal the presence of sparse structure. Sparse methods lead to parsimonious models, in addition to being efficient for large scale learning. In sparse modeling, data is represented as a sparse linear combination of atoms from a "dictionary" matrix. This dissertation focuses on understanding different aspects of sparse learning, thereby enhancing the use of sparse methods by incorporating tools from machine learning. With the growing need to adapt models for large scale data, it is important to design dictionaries that can model the entire data space and not just the samples considered. By exploiting the relation of dictionary learning to 1-D subspace clustering, a multilevel dictionary learning algorithm is developed, and it is shown to outperform conventional sparse models in compressed recovery, and image denoising. Theoretical aspects of learning such as algorithmic stability and generalization are considered, and ensemble learning is incorporated for effective large scale learning. In addition to building strategies for efficiently implementing 1-D subspace clustering, a discriminative clustering approach is designed to estimate the unknown mixing process in blind source separation. By exploiting the non-linear relation between the image descriptors, and allowing the use of multiple features, sparse methods can be made more effective in recognition problems. The idea of multiple kernel sparse representations is developed, and algorithms for learning dictionaries in the feature space are presented. Using object recognition experiments on standard datasets it is shown that the proposed approaches outperform other sparse coding-based recognition frameworks. Furthermore, a segmentation technique based on multiple kernel sparse representations is developed, and successfully applied for automated brain tumor identification. Using sparse codes to define the relation between data samples can lead to a more robust graph embedding for unsupervised clustering. By performing discriminative embedding using sparse coding-based graphs, an algorithm for measuring the glomerular number in kidney MRI images is developed. Finally, approaches to build dictionaries for local sparse coding of image descriptors are presented, and applied to object recognition and image retrieval.
ContributorsJayaraman Thiagarajan, Jayaraman (Author) / Spanias, Andreas (Thesis advisor) / Frakes, David (Committee member) / Tepedelenlioğlu, Cihan (Committee member) / Turaga, Pavan (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Food system and health characteristics were evaluated across the last Waorani hunter-gatherer group in Amazonian Ecuador and a remote neighboring Kichwa indigenous subsistence agriculture community. Hunter-gatherer food systems like the Waorani foragers may not only be nutritionally, but also pharmaceutically beneficial because of high dietary intake of varied plant phytochemical

Food system and health characteristics were evaluated across the last Waorani hunter-gatherer group in Amazonian Ecuador and a remote neighboring Kichwa indigenous subsistence agriculture community. Hunter-gatherer food systems like the Waorani foragers may not only be nutritionally, but also pharmaceutically beneficial because of high dietary intake of varied plant phytochemical compounds. A modern diet that reduces these dietary plant defense phytochemicals below levels typical in human evolutionary history may leave humans vulnerable to diseases that were controlled through a foraging diet. Few studies consider the health impact of the recent drastic reduction of plant phytochemical content in the modern global food system, which has eliminated essential components of food because they are not considered "nutrients". The antimicrobial and anti-inflammatory nature of the food system may not only regulate infectious pathogens and inflammatory disease, but also support beneficial microbes in human hosts, reducing vulnerability to chronic diseases. Waorani foragers seem immune to certain infections with very low rates of chronic disease. Does returning to certain characteristics of a foraging food system begin to restore the human body microbe balance and inflammatory response to evolutionary norms, and if so, what implication does this have for the treatment of disease? Several years of data on dietary and health differences across the foragers and the farmers was gathered. There were major differences in health outcomes across the board. In the Waorani forager group there were no signs of infection in serious wounds such as 3rd degree burns and spear wounds. The foragers had one-degree lower body temperature than the farmers. The Waorani had an absence of signs of chronic diseases including vision and blood pressure that did not change markedly with age while Kichwa farmers suffered from both chronic diseases and physiological indicators of aging. In the Waorani forager population, there was an absence of many common regional infectious diseases, from helminthes to staphylococcus. Study design helped control for confounders (exercise, environment, genetic factors, non-phytochemical dietary intake). This study provides evidence of the major role total phytochemical dietary intake plays in human health, often not considered by policymakers and nutritional and agricultural scientists.
ContributorsLondon, Douglas (Author) / Tsuda, Takeyuki (Thesis advisor) / Beezhold, Bonnie L (Committee member) / Hruschka, Daniel (Committee member) / Eder, James (Committee member) / Arizona State University (Publisher)
Created2012
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Description
Objective: Vinegar consumption studies have demonstrated possible therapeutic effects in reducing HbA1c and postprandial glycemia. The purpose of the study was to closely examine the effects of a commercial vinegar drink on daily fluctuations in fasting glucose concentrations and postprandial glycemia, and on HbA1c, in individuals at risk for Type

Objective: Vinegar consumption studies have demonstrated possible therapeutic effects in reducing HbA1c and postprandial glycemia. The purpose of the study was to closely examine the effects of a commercial vinegar drink on daily fluctuations in fasting glucose concentrations and postprandial glycemia, and on HbA1c, in individuals at risk for Type 2 Diabetes Mellitus (T2D). Design: Thirteen women and one man (21-62 y; mean, 46.0±3.9 y) participated in this 12-week parallel-arm trial. Participants were recruited from a campus community and were healthy and not diabetic by self-report. Participants were not prescribed oral hypoglycemic medications or insulin; other medications were allowed if use was stable for > 3 months. Subjects were randomized to one of two groups: VIN (8 ounces vinegar drink providing 1.5 g acetic acid) or CON (1 vinegar pill providing 0.04 g acetic acid). Treatments were taken twice daily immediately prior to the lunch and dinner meals. Venous blood samples were drawn at trial weeks 0 and 12 to measure insulin, fasting glucose, and HbA1c. Subjects recorded fasting glucose and 2-h postprandial glycemia concentrations daily using a glucometer. Results: The VIN group showed significant reductions in fasting capillary blood glucose concentrations (p=0.05) that were immediate and sustained throughout the duration of the study. The VIN group had reductions in 2-h postprandial glucose (mean change of −7.6±6.8 mg/dL over the 12-week trial), but this value was not significantly different than that for the CON group (mean change of 3.3±5.3 mg/dL over the 12-week trial, p=0.232). HbA1c did not significantly change (p=0.702), but the reduction in HbA1c in the VIN group, −0.14±0.1%, may have physiological relevance. Conclusions: Significant reductions in HbA1c were not observed after daily consumption of a vinegar drink containing 1.5 g acetic acid in non-diabetic individuals. However, the vinegar drink did significantly reduce fasting capillary blood glucose concentrations in these individuals as compared to a vinegar pill containing 0.04 g acetic acid. These results support a therapeutic effect for vinegar in T2D prevention and progression, specifically in high-risk populations.
ContributorsQuagliano, Samantha (Author) / Johnston, Carol (Thesis advisor) / Appel, Christy (Committee member) / Dixon, Kathleen (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Objective: The purpose of this randomized parallel arm trial was to demonstrate the effects of daily fish oil supplementation (600mg per day for eight weeks) on body composition and body mass in young healthy women, aged 18-38, at a large southwestern university. Design: 26 non-obese (mean BMI 23.7±0.6 kg/m2), healthy

Objective: The purpose of this randomized parallel arm trial was to demonstrate the effects of daily fish oil supplementation (600mg per day for eight weeks) on body composition and body mass in young healthy women, aged 18-38, at a large southwestern university. Design: 26 non-obese (mean BMI 23.7±0.6 kg/m2), healthy women (18-38y; mean, 23.5±1.1 y) from a southwestern Arizona university campus community completed the study. Subjects were healthy, non-smokers, consuming less than 3.5 oz of fish per week according to self-report. Participants were randomized to one of two groups: FISH (600 mg omega-3 fatty acids provided in one gel capsule per day), or CON (1000 mg coconut oil placebo provided in one gel capsule per day). Body weight, BMI, and percent body fat were measured using a stadiometer and bioelectrical impedance scale at the screening visit and intervention weeks 1, 4, and 8. 24-hour dietary recalls were also performed at weeks 1 and 8. Results: 8 weeks of omega-3 fatty acid supplementation did not significantly alter body weight (p=0.830), BMI (p=1.00), or body fat percentage (p=0.600) as compared to placebo. Although not statistically significant, 24-hour dietary recalls performed at the beginning and end of the intervention revealed a trend towards increased caloric intake in the FISH group and decreased caloric intake in the CON group throughout the course of the study (p=0.069). If maintained, this difference in caloric intake could have physiological relevance. Conclusions: Omega-3 fatty acids do not significantly alter body weight or body composition in healthy young females. These findings do not refute the current recommendations for Americans to consume at least 8 oz of omega-3-rich seafood per week, supplying 250 mg EPA and DHA per day. More research is needed to investigate the potential for omega-3 fatty acids to modulate daily caloric intake.
ContributorsTeran, Bianca (Author) / Johnston, Carol (Thesis advisor) / Johnson, Melinda (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University (Publisher)
Created2013
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Description
With the increase in computing power and availability of data, there has never been a greater need to understand data and make decisions from it. Traditional statistical techniques may not be adequate to handle the size of today's data or the complexities of the information hidden within the data. Thus

With the increase in computing power and availability of data, there has never been a greater need to understand data and make decisions from it. Traditional statistical techniques may not be adequate to handle the size of today's data or the complexities of the information hidden within the data. Thus knowledge discovery by machine learning techniques is necessary if we want to better understand information from data. In this dissertation, we explore the topics of asymmetric loss and asymmetric data in machine learning and propose new algorithms as solutions to some of the problems in these topics. We also studied variable selection of matched data sets and proposed a solution when there is non-linearity in the matched data. The research is divided into three parts. The first part addresses the problem of asymmetric loss. A proposed asymmetric support vector machine (aSVM) is used to predict specific classes with high accuracy. aSVM was shown to produce higher precision than a regular SVM. The second part addresses asymmetric data sets where variables are only predictive for a subset of the predictor classes. Asymmetric Random Forest (ARF) was proposed to detect these kinds of variables. The third part explores variable selection for matched data sets. Matched Random Forest (MRF) was proposed to find variables that are able to distinguish case and control without the restrictions that exists in linear models. MRF detects variables that are able to distinguish case and control even in the presence of interaction and qualitative variables.
ContributorsKoh, Derek (Author) / Runger, George C. (Thesis advisor) / Wu, Tong (Committee member) / Pan, Rong (Committee member) / Cesta, John (Committee member) / Arizona State University (Publisher)
Created2013