Search results for: Patient record data

Authors: Aljabryn Dalal Hamad

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The present explanatory study concerns with the relation between Diabetes Mellitus and Food Balance in the Kingdom of Saudi Arabia during 2005-2010, using published data. Results illustrated that Saudi citizen daily protein consumption (DPC) during 2005-2007 (g/capita/day) is higher than the average global consumption level of protein with 15.27%, daily fat consumption (DFC) with 24.56% and daily energy consumption (DEC) with 16.93% and increases than recommended level by International Nutrition Organizations (INO) with 56% for protein, 60.49% for fat and 27.37% for energy. On the other hand, DPC per capita in Saudi Arabia decreased during the period 2008-2010 from 88.3 to 82.36 gram/ day. Moreover, DFC per capita in Saudi Arabia decreased during the period 2008-2010 from 3247.90 to 3176.43 Cal/capita/ day, and daily energy consumption (DEC) of Saudi citizen increases than world consumption with 16.93%, while increases with 27.37% than INO. Despite this, DPC, DFC and DEC per capita in Saudi Arabia still higher than world mean. On the other side, results illustrated that the number of diabetic patients in Saudi Arabia during the same period (2005-2010). The curve of diabetic patient’s number in Saudi Arabia during 2005-2010 is regular ascending with increasing level ranged between 7.10% in 2005 and 12.44% in 2010. It is essential to devise Saudi National programs to educate the public about the relation of food balances and diabetes so it could be avoided, and provide citizens with healthy dietary balances tables.

Keywords: Diabetes mellitus, food balance, energy, fat, protein, Saudi Arabia

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Authors: Sana Hamdi, Emna Bouazizi, Sami Faiz

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In recent years, real-time spatial applications, like location-aware services and traffic monitoring, have become more and more important. Such applications result dynamic environments where data as well as queries are continuously moving. As a result, there is a tremendous amount of real-time spatial data generated every day. The growth of the data volume seems to outspeed the advance of our computing infrastructure. For instance, in real-time spatial Big Data, users expect to receive the results of each query within a short time period without holding in account the load of the system. But with a huge amount of real-time spatial data generated, the system performance degrades rapidly especially in overload situations. To solve this problem, we propose the use of data partitioning as an optimization technique. Traditional horizontal and vertical partitioning can increase the performance of the system and simplify data management. But they remain insufficient for real-time spatial Big data; they can’t deal with real-time and stream queries efficiently. Thus, in this paper, we propose a novel data partitioning approach for real-time spatial Big data named VPA-RTSBD (Vertical Partitioning Approach for Real-Time Spatial Big data). This contribution is an implementation of the Matching algorithm for traditional vertical partitioning. We find, firstly, the optimal attribute sequence by the use of Matching algorithm. Then, we propose a new cost model used for database partitioning, for keeping the data amount of each partition more balanced limit and for providing a parallel execution guarantees for the most frequent queries. VPA-RTSBD aims to obtain a real-time partitioning scheme and deals with stream data. It improves the performance of query execution by maximizing the degree of parallel execution. This affects QoS (Quality Of Service) improvement in real-time spatial Big Data especially with a huge volume of stream data. The performance of our contribution is evaluated via simulation experiments. The results show that the proposed algorithm is both efficient and scalable, and that it outperforms comparable algorithms.

Keywords: real-time spatial big data, quality of service, vertical partitioning, horizontal partitioning, matching algorithm, hamming distance, stream query

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Authors: P. Venu, Joeju M. Issac

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Quality Function Deployment (QFD) is a systematic technique that creates a platform where the customer responses can be positively converted to design attributes. The accuracy of a QFD process heavily depends on the data that it is handling which is captured from customers or QFD team members. Customized computer programs that perform Quality Function Deployment within a stipulated time have been used by various companies across the globe. These programs heavily rely on storage and retrieval of the data on a common database. This database must act as a perfect source with minimum missing values or error values in order perform actual prioritization. This paper introduces a missing/error data handler module which uses Genetic Algorithm and Fuzzy numbers. The prioritization of customer requirements of sesame oil is illustrated and a comparison is made between proposed data handler module-based deployment and manual deployment.

Keywords: hybrid data handler, QFD, prioritization, module-based deployment

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Authors: Phill-Seung Jung, Dae-Yeon Kim

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Objectives: In young, especially nulliparous women, it is not easy to decide on excisional therapy for cervical intraepithelial neoplasia (CIN). We aimed to evaluate how effective topical imiquimod is in the treatment of high-grade CIN so that excisional therapy can be avoided in young women. Methods: Patients with CIN were allocated to this pilot study. They did not want excisional therapy and agreed with topical imiquimod therapy, which required once-a-week hospital visit for 8 weeks for the application of imiquimod to the cervix by a gynecologic oncologist. If the lesion got worse during treatment, it was decided to convert imiquimod therapy to excisional therapy. Results: A total of 36 patients with a median age of 29 years (range, 22–41 years) agreed to receive topical imiquimod therapy. Of these, 32 patients (88.9%) were positive for high-risk human papillomavirus (HR HPV). Twenty-five patients (69.4%) had low-grade squamous intraepithelial lesion (LSIL), and 11 (30.6%) had high-grade squamous intraepithelial lesion (HSIL) on their initial LBC. Twenty-eight patients underwent punch biopsy, which showed CIN 1 in 7 (19.4%), CIN 2 in 11 (30.6%), and CIN 3 in 10 (27.8%) patients. Twenty patients finished the 8-week imiquimod therapy. Among them, 14 patients had CIN 2 or 3, and 6 patients had CIN 1. HR HPV was positive in 12 patients. On the last examination, 14 patients (70.0%) had negative intraepithelial lesions, 3 (15.0%) had atypical squamous cells of undetermined significance, and 1 (5.0%) had LSIL. Two patients had persistent HSIL: 1 patient underwent loop electrosurgical excision procedure, resulting in CIN 3 with positive resection margin, and the other patient underwent punch biopsy, resulting in intermediate cells and restarted imiquimod therapy. Only 7 patients were negative for HR HPV. Conclusions: This study showed that topical imiquimod therapy was effective for the treatment of high-grade CIN, with a histologic regression rate of 85.7% (14/20) and HPV eradication rate of 25.0% (8/32). Based on our findings, topical imiquimod therapy might have a successful therapeutic effect in young women with CIN 2-3 so that they can avoid excisional therapy. In addition, it could be a more reassuring treatment option for CIN 1 than just follow-up after few months. To confirm its efficacy, a phase II study with larger cohort would be needed.

Keywords: Imiquimod, Cervical Intraepthelial Neoplasia, Cervical Dysplasia, Human Papillomavirus

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Authors: Chang Yu Chuan

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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.

Keywords: body-turning and positioning, incidence density, nursing, pressure sore

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Authors: Nelomi Anandagoda, Leanne J. Eveson

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During the COVID-19 pandemic, the surge in in-patient admissions across the medical directorate of a district general hospital necessitated the implementation of an incident rota. Conscious of the impact on training and professional development, the idea of developing a virtual teaching programme was conceived. The programme initially aimed to provide junior doctors, specialist nurses, pharmacists, and allied healthcare professionals from medical specialties and those re-deployed from other specialties (e.g., ophthalmology, GP, surgery, psychiatry) the knowledge and skills to manage the deteriorating patient with COVID-19. The programme was later developed to incorporate the general internal medicine curriculum. To facilitate continuing medical education whilst maintaining social distancing during this period, a virtual platform was used to deliver teaching to junior doctors across two large district general hospitals and two community hospitals. Teaching sessions were recorded and uploaded to a common platform, providing a resource for participants to catch up on and re-watch teaching sessions, making strides towards reducing discrimination against the professional development of less than full-time trainees. Thus, creating a learning environment, which is inclusive and accessible to adult learners in a self-directed manner. The negative impact of the pandemic on the well-being of healthcare professionals is well documented. To support the multi-disciplinary team, the virtual teaching programme evolved to included sessions on well-being, resilience, and work-life balance. Providing teaching for learners across the multi-disciplinary team (MDT) has been an eye-opening experience. By challenging the concept that learners should only be taught within their own peer groups, the authors have fostered a greater appreciation of the strengths of the MDT and showcased the immense wealth of expertise available within the trust. The inclusive nature of the teaching and the ease of joining a virtual teaching session has facilitated the dissemination of knowledge across the MDT, thus improving patient care on the frontline. The weekly teaching programme has been running for over eight months, with ongoing engagement, interest, and participation. As described above, the teaching programme has evolved to accommodate the needs of its learners. It has received excellent feedback with an appreciation of its inclusive, multi-disciplinary, and holistic nature. The COVID-19 pandemic provided a catalyst to rapidly develop novel methods of working and training and widened access/exposure to the virtual technologies available to large organisations. By merging pedagogical expertise and technology, the authors have created an effective online learning environment. Although the authors do not propose to replace face-to-face teaching altogether, this model of virtual multidisciplinary team, cross-site teaching has proven to be a great leveler. It has made high-quality teaching accessible to learners of different confidence levels, grades, specialties, and working patterns.

Keywords: cross-site, cross-speciality, inter-disciplinary, multidisciplinary, virtual teaching

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Authors: Faisal Aburub, Wael Hadi

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Data mining is the process of extracting useful or hidden information from a large database. Extracted information can be used to discover relationships among features, where data objects are grouped according to logical relationships; or to predict unseen objects to one of the predefined groups. In this paper, we aim to investigate four well-known data mining algorithms in order to predict groundwater areas in Jordan. These algorithms are Support Vector Machines (SVMs), Naïve Bayes (NB), K-Nearest Neighbor (kNN) and Classification Based on Association Rule (CBA). The experimental results indicate that the SVMs algorithm outperformed other algorithms in terms of classification accuracy, precision and F1 evaluation measures using the datasets of groundwater areas that were collected from Jordanian Ministry of Water and Irrigation.

Keywords: classification, data mining, evaluation measures, groundwater

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Authors: Pankhudi Khandelwal

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The revenue models of digital giants such as Facebook and Google, use targeted advertising for revenues. Such a model requires huge amounts of consumer data. While the data protection law deals with the protection of personal data, however, this data is acquired by the companies on the basis of consent, performance of a contract, or legitimate interests. This paper analyses the role that competition law can play in evading these loopholes for the protection of data and privacy of online consumers. Digital markets have certain distinctive features such as network effects and feedback loop, which gives incumbents of these markets a first-mover advantage. This creates a situation where the winner takes it all, thus creating entry barriers and concentration in the market. It has been also seen that this dominant position is then used by the undertakings for leveraging in other markets. This can be harmful to the consumers in form of less privacy, less choice, and stifling innovation, as seen in the cases of Facebook Cambridge Analytica, Google Shopping, and Google Android. Therefore, the article aims to provide a legal framework wherein the data protection law and competition law can come together to provide a balance in regulating digital markets. The issue has become more relevant in light of the Facebook decision by German competition authority, where it was held that Facebook had abused its dominant position by not complying with data protection rules, which constituted an exploitative practice. The paper looks into the jurisdictional boundaries that the data protection and competition authorities can work from and suggests ex ante regulation through data protection law and ex post regulation through competition law. It further suggests a change in the consumer welfare standard where harm to privacy should be considered as an indicator of low quality.

Keywords: data protection, dominance, ex ante regulation, ex post regulation

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Authors: Mai Ghazal, Ahmed Hammad

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Cost overruns in construction projects are considered as worldwide challenges since the cost performance is one of the main measures of success along with schedule performance. To overcome this problem, studies were conducted to investigate the cost overruns' factors, also projects' historical data were analyzed to extract new and useful knowledge from it. This research is studying and analyzing the effect of some factors causing cost overruns using the historical data from completed construction projects. Then, using these factors to estimate the probability of cost overrun occurrence and predict its percentage for future projects. First, an intensive literature review was done to study all the factors that cause cost overrun in construction projects, then another review was done for previous researcher papers about mining process in dealing with cost overruns. Second, a proposed data warehouse was structured which can be used by organizations to store their future data in a well-organized way so it can be easily analyzed later. Third twelve quantitative factors which their data are frequently available at construction projects were selected to be the analyzed factors and suggested predictors for the proposed model.

Keywords: construction management, construction projects, cost overrun, cost performance, data mining, data warehousing, knowledge discovery, knowledge management

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Authors: Oyvind Nordvik, Peder O. L. Heggdal, Jonas Brannstrom, Flemming Vassbotn, Anne Kari Aarstad, Hans Jorgen Aarstad

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Background: Hearing Loss (HL) is a condition that may affect people in all stages of life, but the prevalence increases with age, mostly because of age-related HL, generally referred to as presbyacusis. As human speech is related to relatively high frequencies, even a limited hearing loss at high frequencies may cause impaired speech intelligibility. Being diagnosed with, treated for and living with a chronic condition such as HL, must for many be a disabling and stressful condition that put ones coping resources to test. Stress is a natural part of life and most people will experience stressful events or periods. Chronic diseases, such as HL, are risk factor for distress in individuals, causing anxiety and lowered mood. How an individual cope with HL may be closely connected to the level of distress he or she is experiencing and to personality, which can be defined as those characteristics of a person that account for consistent patterns of feelings, thinking, and behavior. Thus, as to distress in life, such as illness or disease, available coping strategies may be more important than the challenge itself. The same line of arguments applies to level of experienced health-related quality of life (HRQoL). Aim: The aim of this study was to investigate the relationship between distress, HRQoL, reported hearing loss, personality and coping in patients with HL. Method: 158 adult (aged 18-78 years) patients with HL, referred for hearing aid (HA) fitting at Haukeland University Hospital in western Norway, participated in the study. Both first-time users, as well as patients referred for HA renewals were included. First-time users had been pre-examined by an ENT-specialist. The questionnaires were answered before the actual HA fitting procedure. The pure-tone average (PTA; frequencies 0.5, 1, 2, and 4 kHz) was determined for each ear. The Eysenck personality inventory, neuroticism and lie scales, the Theoretically Originated Measure of the Cognitive Activation Theory of Stress (TOMCATS) measuring active coping, hopelessness and helplessness, as well as distress (General Health Questionnaire (GHQ) - 12 items) and the EORTC Quality of Life Questionnaire general part were answered. In addition, we used a revised and shortened version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) as a measure of patient-reported hearing loss. Results: Significant correlations were determined between APHAB (weak), HRQoL scores (strong), distress scores (strong) on the one side and personality and choice of coping scores on the other side. As measured by stepwise regression analyses, the distress and HRQoL scores were scored secondary to the obtained personality and coping scores. The APHAB scores were as determined by regression analyses scored secondary to PTA (best ear), level of neuroticism and lie score. Conclusion: We found that reported employed coping style, distress/HRQoL and personality are closely connected to each other in this patient group. Patient-reported HL was associated to hearing level and personality. There is need for further investigations on these questions, and how these associations may influence the clinical context.

Keywords: coping, distress, hearing loss, personality

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Authors: Temiloluwa J. Akinyemi, Denis W. Aheto, Wisdom Akpalu

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Capture fisheries in developing countries provide significant animal protein and directly supports the livelihoods of several communities. However, the misperception of biophysical dynamics owing to a lack of adequate scientific data has contributed to the suboptimal management in marine capture fisheries. This is because yield and catch potentials are sensitive to the quality of catch and effort data. Yet, studies on fisheries data collection practices in developing countries are hard to find. This study investigates the data collection methods utilized by fisheries technical officers within the four fishing regions of Ghana. We found that the officers employed data collection and sampling procedures which were not consistent with the technical guidelines curated by FAO. For example, 50 instead of 166 landing sites were sampled, while 290 instead of 372 canoes were sampled. We argue that such sampling errors could result in the over-capitalization of capture fish stocks and significant losses in resource rents.

Keywords: Fisheries data quality, fisheries management, Ghana, Sustainable Fisheries

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Authors: Shideh Mohseni Movahed, Mansoureh Safari

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Intelligent drug delivery systems (IDDS) are innovative technological innovations and clinical way to advance current treatments. These systems differ in technique of therapeutic administration, intricacy, materials and patient compliance to address numerous clinical conditions that require different pharmacological therapies. IDDS capable of releasing an active molecule at the proper site and at a amount that adjusts in response to the progression of the disease or to certain functions/biorhythms of the organism is particularly appealing. In this paper, we describe the most recent advances in the development of intelligent drug delivery systems.

Keywords: drug delivery systems, IDDS, medicine, health

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Authors: Maksim Barsakov

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Introduction. In modern plastic surgery, there are a large number of breast lift techniques.Due to the spreading information about the "side effects" of silicone implants, interest in implant-free mastopexy is increasing year after year. However, despite the variety of techniques, patients sometimes do not get full satisfaction from the results of mastopexy because of the unexpressed filling of the upper pole, extended anchoring postoperative scars and sometimes because of obtaining an aesthetically unattractive breast shape. The stability of the result after mastopexy depends on many factors, including postoperative rehabilitation. Stability of weight and hormonal background, stretchability of tissues. The high recurrence rate of ptosis and short-term aesthetic effect of mastopexy indicate the urgency of improving surgical techniques and increasing the stabilization of breast tissue. Purpose of the study. To develop and introduce into practice a technique of mastopexy based on the use of a modified Ribeiro flap, as well as elements of tissue movement and fixation designed to increase the stability of postoperative mastopexy. In addition, to give indications for the application of this surgical technique. Materials and Methods. it operated on 103 patients aged 18 to 53 years from 2019 to 2023 according to the reported method. These were patients with primary mastopexy, secondary mastopexy, and also patient with implant removal and one-stage mastopexy. The patients were followed up for 12 months to assess the stability of the result. Results and their discussion. Observing the patients, we noted greater stability of the breast shape and upper pole filling compared to the conventional classical methods. We did not have to resort to anchoring scars. In 90 percent of cases, a inverted T-shape scar was used. In 10 percent, the J-scar was used. The quantitative distribution of complications identified among the operated patients is as follows: worsened healing of the junction of vertical and horizontal sutures at the period of 1-1.5 months after surgery - 15 patients; at treatment with ointment method healing was observed in 7-30 days; permanent loss of NAC sensitivity - 0 patients; vascular disorders in the area of NAC/areola necrosis - 0 patients; marginal necrosis of the areola-2 patients. independent healing within 3-4 weeks without aesthetic defects. Aesthetically unacceptable mature scars-3 patients; partial liponecrosis of the autoflap unilaterally - 1 patient. recurrence of ptosis - 1 patient (after weight loss of 12 kg). In the late postoperative period, 2 patients became pregnant, gave birth, and no lactation problems were observed. Conclusion. Thus, in the world of plastic surgery methods of breast lift continue to improve, which is especially relevant in modern times, due to the increased attention to this operation. The author's proposed method of mastopexy with glandular autoflap allows obtaining in most cases a stable result, a fuller breast shape, avoiding the presence of extended anchoring scars, and also preserves the possibility of lactation. The author of this article has obtained a patent for invention for this method of mastopexy.

Keywords: mastopexy, mammoplasty, autoflap, personal technique

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Authors: V. Durmus, M. Uydaci

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In order to prevent overburdened courts, rising costs of litigation, and lengthy trial resolutions, the Law on Mediation for Civil Disputes was enacted, which was aimed at defining the procedure and guiding principles for dispute resolutions under Civil Law, in 2012. This “Mediation Code” also applies for civil healthcare disputes in Turkey. Aside from mediation, reconciliation, governed by Articles 253-255 of Criminal Procedure Law, has emerged as an alternative way to resolve criminal medical disputes, but the difference between mediation and conciliation is mostly procedural. This article deals with mediation in Turkish health law and aspect of medical malpractice mediation in Turkey. In addition, this study examines the issue of mediation in health law from both a legal and normative point of view, including codes of mediation which regulate both the structural and professional practice of mediation providers. As a result, although there is not official record about success rate of medical malpractice litigations and malpractice mediation in Turkey, it is widely accepted that the success rate for medical malpractice cases is relatively low compared to other personal injury cases even if it is generally considered that medical malpractice case filings have gradually increased recently. According to the Justice Ministry’s Department of Mediation in Turkey, 719 civil disputes have referred to mediators since 2013 (when the first mediation law came into force) with a 98% success rate.

Keywords: malpractice mediation, medical disputes, reconciliation, health litigation, Turkish health law

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Authors: Sumitra Sharma, Christina Parker, Kathleen Finlayson, Clint Douglas, Niall Higgins

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Background: Telehealth services have potential to increase accessibility, utilization, and effectiveness of healthcare services. As the telehealth services are yet to integrate within regular hospital services in Nepal, the use of the telehealth services among adults with diabetes is scarce. Prior to implementation of telehealth services for adults with diabetes, it is necessary to examine influencing factors of telehealth services. Objective: This study aimed to investigate factors influencing telehealth services for diabetes care in Nepal. Methods: This study used a mixed-method study design which included a cross-sectional survey among adults with diabetes and semi-structured interviews among key healthcare professionals of Nepal. The study was conducted in a medical out-patient department of a tertiary hospital of Nepal. The survey adapted a previously validated questionnaire, while semi-structured questions for interviews were developed from literature review and experts consultation. All interviews were audio-recorded, and inductive content analysis was used to code transcripts and develop themes. For a survey, a descriptive analysis, chi-square test, and Mann Whitney U test were used to analyze the data. Results: One hundred adults with diabetes were participated in a survey, and seven healthcare professionals were recruited for interviews. In a survey, just over half of the participants (53%) were male, and others were female. Almost all participants (98%) owned a mobile phone, and 67% of them had a computer with internet access at home. Majority of participants had experience in using Facebook messenger (95%), followed by Viber (60%) and Zoom (26%). Almost all of the participants (96%) were willing to use telehealth services. There were significant associations between female sex and participants living 10 km away from the hospital with their willingness to use telehealth services. There was a significant association between participants' self-perception of good health status with their willingness to use video-conference calls and phone calls to use telehealth services. Seven themes were developed from interview data which are related to predisposing, reinforcing, and enabling factors influencing telehealth services for diabetes care in Nepal. Conclusion: In summary, several factors were found to influence the use of telehealth services for diabetes care in Nepal. For effective implementation of a sustainable telehealth services for adults with diabetes in Nepal, these factors need to be considered.

Keywords: contributing factors, diabetes mellitus, developing countries, telemedicine, telecare

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Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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Authors: Abdulrahman M. Alhowikan, Nadra E. Elamin, Sarah S. Aldayel, Sara A. AlSiddiqi, Fai S. Alrowais, Laila Y. Al-Ayadhi

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Background: A growing body of research has suggested that physical activities (PA) have important implications for improving the performance of ASD children. They revealed that the physiological, cognitive, psychological, and behavioral functioning had improved after performing some physical activities. Methods: We compared the sedentary behavior and physical activities between children with autism spectrum disorder (n=21) and age-matched control group (n=30), using the ActiGraph GT3X+ for the assessments. Results: Our results revealed that the total time spent in sedentary activity and the total sedentary activity counts were highly significant in the control group compared to the ASD group (p < 0.001, p=0.001, respectively). ASD spent a significantly longer time than the controls engaging on vigorous physical activity (VPA) (p=0.017). The results also indicated that there were no significant differences between both groups for the total counts and time spent in light physical activity (LPA) and moderate physical activity (MPA). Conclusion: The finding highlights the importance of physical activity intervention for ASD children, using accurate and precise measurement tools to record all activities.

Keywords: Autism spectrum disorders, motor skills, physical activity, ActiGraph GT3X+, moderate-to vigorous-intensity physical activity

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Authors: Khaled Ahmed Kadouh, Kamal Ali Albashiri

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This paper presents a designed algorithm involves improvement of transferring data over Simple Object Access Protocol (SOAP). The aim of this work is to establish whether using SOAP in exchanging XML messages has any added advantages or not. The results showed that XML messages without SOAP take longer time and consume more memory, especially with binary data.

Keywords: JAX-WS, SMTP, SOAP, web service, XML

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Authors: Joseph Udofia, Isaac Olufadewa

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Everyday, the size of Electronic Health Records data keeps increasing as new patients visit health practitioner and returning patients fulfil their appointments. As these data grow, so is their susceptibility to cyber-attacks from criminals waiting to exploit this data. In the US, the damages for cyberattacks were estimated at $8 billion (2018), $11.5 billion (2019) and $20 billion (2021). These attacks usually involve the exposure of PII. Health data is considered PII, and its exposure carry significant impact. To this end, an enhancement of Health Policy and Standards in relation to data security, especially among patients and their clinical providers, is critical to ensure ethical practices, confidentiality, and trust in the healthcare system. As Clinical accelerators and applications that contain user data are used, it is expedient to have a review and revamp of policies like the Payment Card Industry Data Security Standard (PCI DSS), the Health Insurance Portability and Accountability Act (HIPAA), the Fast Healthcare Interoperability Resources (FHIR), all aimed to ensure data protection and security in healthcare. FHIR caters for healthcare data interoperability, FHIR caters to healthcare data interoperability, as data is being shared across different systems from customers to health insurance and care providers. The astronomical cost of implementation has deterred players in the space from ensuring compliance, leading to susceptibility to data exfiltration and data loss on the security accuracy of protected health information (PHI). Though HIPAA hones in on the security accuracy of protected health information (PHI) and PCI DSS on the security of payment card data, they intersect with the shared goal of protecting sensitive information in line with industry standards. With advancements in tech and the emergence of new technology, it is necessary to revamp these policies to address the complexity and ambiguity, cost barrier, and ever-increasing threats in cyberspace. Healthcare data in the wrong hands is a recipe for disaster, and we must enhance its protection and security to protect the mental health of the current and future generations.

Keywords: cloud security, healthcare, cybersecurity, policy and standard

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Authors: Peristera Baziana

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In this paper, we present a network configuration for a WDM LANs of passive star topology that assume that the set of data WDM channels is split into two separate sets of channels, with different access rights over them. Especially, a synchronous transmission WDMA access algorithm is adopted in order to increase the probability of successful transmission over the data channels and consequently to reduce the probability of data packets transmission cancellation in order to avoid the data channels collisions. Thus, a control pre-transmission access scheme is followed over a separate control channel. An analytical Markovian model is studied and the average throughput is mathematically derived. The performance is studied for several numbers of data channels and various values of control phase duration.

Keywords: access algorithm, channels division, collisions avoidance, wavelength division multiplexing

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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Authors: Coline Bretz, Andrea Vaccaro, Dario Leumann

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The food, personal care, and cosmetic industries are seeing increased consumer demand for more sustainable and innovative ingredients. When developing new formulations incorporating such ingredients, stability is one of the first criteria that must be assessed, and it is thus of great importance to have a method that can detect instabilities early and quickly. Diffusing Wave Spectroscopy (DWS) is a light scattering technique that probes the motion,i.e., the mean square displacement (MSD), of colloids, such as nanoparticles in a suspension or droplets in emulsions. From the MSD, the rheological properties of the surrounding medium can be determined via the so-called microrheology approach. In the case of purely viscous media, it is also possible to obtain information about particle size. DWS can thus be used to monitor the size evolution of particles, droplets, or bubbles in aging dispersions, emulsions, or foams. In the context of early instability detection in emulsions, DWS offers considerable advantages, as the samples are measured in a contact-free manner, using only small quantities of samples loaded in a sealable cuvette. The sensitivity and rapidity of the technique are key to detecting and following the ageing of emulsions reliably. We present applications of DWS focused on the characterization of emulsions. In particular, we demonstrate the ability to record very subtle changes in the structural properties early on. We also discuss the various mechanisms at play in the destabilization of emulsions, such as coalescence or Ostwald ripening, and how to identify them through this technique.

Keywords: instrumentation, emulsions, stability, DWS

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Authors: D. I. George Amalarethinam, A. Emima

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Educational Data Mining (EDM) is one of the newest topics to emerge in recent years, and it is concerned with developing methods for analyzing various types of data gathered from the educational circle. EDM methods and techniques with machine learning algorithms are used to extract meaningful and usable information from huge databases. For scientists and researchers, realistic applications of Machine Learning in the EDM sectors offer new frontiers and present new problems. One of the most important research areas in EDM is predicting student success. The prediction algorithms and techniques must be developed to forecast students' performance, which aids the tutor, institution to boost the level of student’s performance. This paper examines various classification techniques in prediction methods and data mining tools used in EDM.

Keywords: classification technique, data mining, EDM methods, prediction methods

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Authors: Geum Yeon Sim, Tyler Pigott, Julio Vasquez

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A 38-year-old obese female with no apparent past medical history presented with left knee pain. Six months ago, she sustained a left knee dislocation in a motor vehicle accident that was managed with a skin graft over the left lower extremity without any reconstructive surgery. She developed persistent pain and stiffness in her left knee that worsened with walking and stair climbing. Examination revealed healed extensive skin graft over the left lower extremity, including the left knee. Palpation showed moderate tenderness along the superior border of the patella, exquisite tenderness over MCL, and mild tenderness on the tibial tuberosity. There was normal sensation, reflexes, and strength in her lower extremities. There was limited active and passive range of motion of her left knee during flexion. There was instability noted upon the valgus stress test of the left knee. Left knee magnetic resonance imaging showed high-grade (grade 2-3) injury of the proximal superficial fibers of the MCL and diffuse thickening and signal abnormality of the cruciate ligaments, as well as edema-like subchondral marrow signal change in the anterolateral aspect of the lateral femoral condyle weight-bearing surface. There was also notable extensive scarring and edema of the skin, subcutaneous soft tissues, and musculature surrounding the knee. The patient was managed with left knee immobilization for five months, which was complicated by limited knee flexion. Physical therapy consisting of quadriceps, hamstrings, gastrocnemius stretching and strengthening, range of motion exercises, scar/soft tissue mobilization, and gait training was given with marked improvement in pain and range of motion. The patient experienced a further reduction in pain as well as an improvement in function with home exercises consisting of continued strengthening and stretching.

Keywords: ligamentous injury, trauma, rehabilitation, knee pain

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Authors: Samuel Carpintero

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Public-private partnerships (PPP) arrangements have emerged all around the world as a response to infrastructure deficits and the need to refurbish existing infrastructure. The motivations of governments for embarking on PPPs for the delivery of public infrastructure are manifold, and include on-time and on-budget delivery as well as access to private project management expertise. The PPP formula has been used by some State governments in United States and Canada, where the participation of private companies in financing and managing infrastructure projects has increased significantly in the last decade, particularly in the transport sector. On the one hand, this paper examines the various ways used in these two countries in the implementation of PPP arrangements, with a particular focus on risk transfer. The examination of risk transfer in this paper is carried out with reference to the following key PPP risk categories: construction risk, revenue risk, operating risk and availability risk. The main difference between both countries is that in Canada the demand risk remains usually within the public sector whereas in the United States this risk is usually transferred to the private concessionaire. The aim is to explore which lessons can be learnt from both models than might be useful for other countries. On the other hand, the paper also analyzes why the Spanish companies have been so successful in winning PPP contracts in North America during the past decade. Contrary to the Latin American PPP market, the Spanish companies do not have any cultural advantage in the case of the United States and Canada. Arguably, some relevant reasons for the success of the Spanish groups are their extensive experience in PPP projects (that dates back to the late 1960s in some cases), their high technical level (that allows them to be aggressive in their bids), and their good position and track-record in the financial markets. The article’s empirical base consists of data provided by official sources of both countries as well as information collected through face-to-face interviews with public and private representatives of the stakeholders participating in some of the PPP schemes. Interviewees include private project managers of the concessionaires, representatives of banks involved as financiers in the projects, and experts in the PPP industry with close knowledge of the North American market. Unstructured in-depth interviews have been adopted as a means of investigation for this study because of its powers to achieve honest and robust responses and to ensure realism in the collection of an overall impression of stakeholders’ perspectives.

Keywords: PPP, concession, infrastructure, construction

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Authors: Akshay Agrawal, Anand K. Srivastava

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The increasing amount of XML datasets available to casual users increases the necessity of investigating techniques to extract knowledge from these data. Data mining is widely applied in the database research area in order to extract frequent correlations of values from both structured and semi-structured datasets. The increasing availability of heterogeneous XML sources has raised a number of issues concerning how to represent and manage these semi structured data. In recent years due to the importance of managing these resources and extracting knowledge from them, lots of methods have been proposed in order to represent and cluster them in different ways.

Keywords: XML, similarity measure, clustering, cluster quality, semantic clustering

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Authors: Hiesik Kim, YongBeum Kim

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Internet of Things (IoT) applications are widely serviced and spread worldwide. Local wireless data transmission technique must be developed to speed up with some technique. Bluetooth wireless data communication is wireless technique is technique made by Special Inter Group(SIG) using the frequency range 2.4 GHz, and it is exploiting Frequency Hopping to avoid collision with different device. To implement experiment, equipment for experiment transmitting measured data is made by using Arduino as Open source hardware, Gas sensor, and Bluetooth Module and algorithm controlling transmission speed is demonstrated. Experiment controlling transmission speed also is progressed by developing Android Application receiving measured data, and controlling this speed is available at the experiment result. it is important that in the future, improvement for communication algorithm be needed because few error occurs when data is transferred or received.

Keywords: Arduino, Bluetooth, gas sensor, internet of things, transmission Speed

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Authors: Sreejith Gopinath, Aspen Olmsted

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This paper is based on our previous work that proposed a risk-transference-based architecture for healthcare systems to store sensitive data outside the system boundary, rendering the system unattractive to would-be bad actors. This architecture also allows a compromised system to be abandoned and a new system instance spun up in place to ensure business continuity without paying a ransom or engaging with a bad actor. This paper delves into the details of various attacks we simulated against the prototype system. In the paper, we discuss at length the time and computational costs associated with storing and retrieving data in the prototype system, abandoning a compromised system, and setting up a new instance with existing data. Lastly, we simulate some analytical workloads over the data stored in our specialized data storage system and discuss the time and computational costs associated with running analytics over data in a specialized storage system outside the system boundary. In summary, this paper discusses the total costs of data storage, access, and analytics incurred with the proposed architecture.

Keywords: cybersecurity, healthcare, ransomware, resilience, risk transference

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Ismayanti Magfirah, Sartohadi Junun, Samodra Guruh

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Landslides are one of the most frequent and devastating natural disasters in Indonesia. Many studies have been conducted regarding this phenomenon. However, there is a lack of attention in the landslide inventory mapping. The natural condition (dense forest area) and the limited human and economic resources are some of the major problems in building landslide inventory in Indonesia. Considering the importance of landslide inventory data in susceptibility, hazard, and risk analysis, it is essential to generate landslide inventory based on available resources. In order to achieve this, the first thing we have to do is identify the landslides' location. The presence of Sentinel-1A and Sentinel-2A data gives new insights into land monitoring investigation. The free access, high spatial resolution, and short revisit time, make the data become one of the most trending open sources data used in landslide mapping. Sentinel-1A and Sentinel-2A data have been used broadly for landslide detection and landuse/landcover mapping. This study aims to generate landslide map by integrating Sentinel-1A and Sentinel-2A data use change detection method. The result will be validated by field investigation to make preliminary landslide inventory in the study area.

Keywords: change detection method, landslide inventory mapping, Sentinel-1A, Sentinel-2A

Procedia PDF Downloads 166