Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 142

World Academy of Science, Engineering and Technology

[Health and Medical Engineering]

Online ISSN : 1307-6892

142 An Approach for the Prediction of Cardiovascular Diseases

Authors: Nebi Gedik


Regardless of age or gender, cardiovascular illnesses are a serious health concern because of things like poor eating habits, stress, a sedentary lifestyle, hard work schedules, alcohol use, and weight. It tends to happen suddenly and has a high rate of recurrence. Machine learning models can be implemented to assist healthcare systems in the accurate detection and diagnosis of cardiovascular disease (CVD) in patients. Improved heart failure prediction is one of the primary goals of researchers using the heart disease dataset. The purpose of this study is to identify the feature or features that offer the best classification prediction for CVD detection. The support vector machine classifier is used to compare each feature's performance. It has been determined which feature produces the best results.

Keywords: Cardiovascular disease, feature extraction, supervised learning, support vector machine.

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141 Knowledge of Operation Rooms’ Staff Toward Sources, Prevention and Control of Fires at Governmental Hospitals in Sana'a, Yemen

Authors: A. Ahmed Haza’a, M. Ali Odhah, S. Ahmed Al-Ahdal, A. Saleh Al-Jaradi, G. Ghaleb Alrubaiee


Patient safety in hospitals is an essential professional indicator that should be noticed. The threat of fires is potentially the most dangerous risk that could harm patients and personnel. The aim of the study is to assess the knowledge of operating room (OR) staff toward prevention and control sources of fires. Data collection was done between March 1 and March 30, 2022. A descriptive cross-sectional study was conducted. The sample of the study consisted of 89 OR staff from different governmental hospitals. Convenient sampling was applied to select the sample size. Official approvals were obtained from selected settings for start collection data. Data were collected using a close-ended questionnaire and tested for knowledge. This study was conducted in four governmental hospitals in Sana'a, Yemen. Most of the OR staff were male. Of these, 50.6% of them were operation technician professionals. More than two-thirds of OR staff have less than ten years of experience; 93% of OR staff had inadequate knowledge of sources of fires, and inadequate knowledge toward control and prevention of fires (73%, 79.8%), respectively; 77.5% of OR staff had inadequate knowledge of prevention and control sources of fires. The study concluded that most of OR staff had inadequate knowledge of sources, controls, and prevention of fires, while 22.5% of them had adequate knowledge of prevention and control sources of fires. We recommended the implementation of training programs toward sources, controls, and prevention of fires or related workshops in their educational planning for OR staff of hospitals.

Keywords: Staff, fire source, operation room safety.

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140 IRIS: An Interactive Video Game for Children with Long-Term Illness in Hospitals

Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria


Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialized software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarize and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, re-evaluate their perceptions about hospitalization, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalized peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective-taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimize escapism and feelings of exclusion and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: Hospitalized children, interactive games, long-term illness, cognitive enhancement, socioemotional development.

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139 Positivity Rate of Person under Surveillance among Institut Jantung Negara’s Patients with Various COVID-19 Vaccination Status in the First Quarter of 2022, Malaysia

Authors: M. Izzat Md. Nor, N. Jaffar, N. Zaitulakma Md. Zain, N. Izyanti Mohd Suppian, S. Balakrishnan, G. Kandavello


During the Coronavirus (COVID-19) pandemic, Malaysia has been focusing on building herd immunity by introducing vaccination programs into the community. Hospital Standard Operating Procedures (SOP) were developed to prevent inpatient transmission. In this study, we focus on the positivity rate of inpatient Person Under Surveillance (PUS) becoming COVID-19 positive and compare this to the national rate in order to see the outcomes of the patient who becomes COVID-19 positive in relation to their vaccination status. This is a retrospective observational study carried out from 1 January until 30 March 2022 in Institut Jantung Negara (IJN). There were 5,255 patients admitted during the time of this study. Pre-admission Polymerase Chain Reaction (PCR) swab was done for all patients. Patients with positive PCR on pre-admission screening were excluded. The patients who had exposure to COVID-19-positive staff or patients during hospitalization were defined as PUS and were quarantined and monitored for potential COVID-19 infection. Their frequency and risk of exposure (WHO definition) were recorded. On the final day of quarantine, a second PCR swab was performed on PUS patients who exhibit clinical deterioration, whether or not they exhibit COVID-19 symptoms. The severity of COVID-19 infection was defined as category 1-5A. All patients' vaccination status was recorded, and they were divided into three groups: fully immunised, partially immunised, and unvaccinated. We analysed the positivity rate of PUS patients becoming COVID-positive, outcomes, and correlation with the vaccination status. The ratio of positive inpatient PUS to the total inpatient PUS is 492; only 13 became positive, giving a positivity rate of 2.6%. Eight (62%) had multiple exposures. The majority, 8/13(72.7%), had a high-risk exposure, and the remaining 5 had medium-risk exposure. Four (30.8%) were boosted, 7(53.8%) were fully vaccinated, and 2(15.4%) were partial/unvaccinated. Eight patients were in categories 1-2, whilst 38% were in categories 3-5. Vaccination status did not correlate with COVID-19 Category (P = 0.641). One (7.7%) patient died due to COVID-19 complications and sepsis. Within the first quarter of 2022, our institution's positivity rate (2.6%) is significantly lower than the country's (14.4%). High-risk exposure and multiple exposures to positive COVID-19 cases increased the risk of PUS becoming COVID-19 positive despite their underlying vaccination status.

Keywords: COVID-19, boosted, high risk, Malaysia, quarantine, vaccination status.

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138 The Role of Mobile Technology in Surveillance of Adverse Events Following Immunization during New Vaccines Introduction in Cameroon: A Cross-Sectional Study

Authors: A. A. Njoh, S. T. Ndoula, A. Adidja, G. N. Menan, A. Mengue, E. Mboke, H. B. Bachir, S. C. Nchinjoh, L. Adisso, Y. Saidu, L. Cleenewerck de Kiev


Vaccines serve a great deal in protecting the population globally. Vaccine products are subject to rigorous quality control and approval before use to ensure safety. Even if all actors take the required precautions, some people could still have adverse events following immunization (AEFI) caused by the vaccine composition or an error in its administration. AEFI underreporting is pronounced in low-income settings like Cameroon. The Country introduced electronic platforms to strengthen surveillance. With the introduction of many novel vaccines, like COVID-19 and the novel Oral Polio Vaccine (nOPV) 2, there was a need to monitor AEFI in Cameroon. A cross-sectional study was conducted from July to December 2022. Data on AEFI per region of Cameroon were reviewed for the previous five years. Data were analyzed with MS Excel, and the results were presented in proportions. AEFI reporting was uncommon in Cameroon. With the introduction of novel vaccines in 2021, the health authorities engaged in new tools and training to capture cases. AEFI detected almost doubled using the open data kit (ODK) compared to previous platforms, especially following the introduction of the nOPV2 and COVID-19 vaccines. The AEFI rate was 1.9 and 160 per administered 100,000 doses of nOPV2 and COVID-19 vaccines, respectively. This mobile tool captured individual information for people with AEFI from all regions. The platform helped to identify common AEFI following the use of these new vaccines. The ODK mobile technology was vital in improving AEFI reporting and providing data to monitor the use of new vaccines in Cameroon.

Keywords: Adverse events following immunization, AEFI, Cameroon, COVID-19 vaccines, novel oral polio vaccine 2, open data kit.

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137 Machine Learning Framework: Competitive Intelligence and Key Drivers Identification of Market Share Trends among Healthcare Facilities

Authors: A. Appe, B. Poluparthi, L. Kasivajjula, U. Mv, S. Bagadi, P. Modi, A. Singh, H. Gunupudi, S. Troiano, J. Paul, J. Stovall, J. Yamamoto


The necessity of data-driven decisions in healthcare strategy formulation is rapidly increasing. A reliable framework which helps identify factors impacting a healthcare provider facility or a hospital (from here on termed as facility) market share is of key importance. This pilot study aims at developing a data-driven machine learning-regression framework which aids strategists in formulating key decisions to improve the facility’s market share which in turn impacts in improving the quality of healthcare services. The US (United States) healthcare business is chosen for the study, and the data spanning 60 key facilities in Washington State and about 3 years of historical data are considered. In the current analysis, market share is termed as the ratio of the facility’s encounters to the total encounters among the group of potential competitor facilities. The current study proposes a two-pronged approach of competitor identification and regression approach to evaluate and predict market share, respectively. Leveraged model agnostic technique, SHAP (SHapley Additive exPlanations), to quantify the relative importance of features impacting the market share. Typical techniques in literature to quantify the degree of competitiveness among facilities use an empirical method to calculate a competitive factor to interpret the severity of competition. The proposed method identifies a pool of competitors, develops Directed Acyclic Graphs (DAGs) and feature level word vectors, and evaluates the key connected components at the facility level. This technique is robust since it is data-driven, which minimizes the bias from empirical techniques. The DAGs factor in partial correlations at various segregations and key demographics of facilities along with a placeholder to factor in various business rules (for e.g., quantifying the patient exchanges, provider references, and sister facilities). Identified are the multiple groups of competitors among facilities. Leveraging the competitors' identified developed and fine-tuned Random Forest Regression model to predict the market share. To identify key drivers of market share at an overall level, permutation feature importance of the attributes was calculated. For relative quantification of features at a facility level, incorporated SHAP, a model agnostic explainer. This helped to identify and rank the attributes at each facility which impacts the market share. This approach proposes an amalgamation of the two popular and efficient modeling practices, viz., machine learning with graphs and tree-based regression techniques to reduce the bias. With these, we helped to drive strategic business decisions.

Keywords: Competition, DAGs, hospital, healthcare, machine learning, market share, random forest, SHAP.

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136 Hand Hygiene Habits of Ghanaian Youths in Accra, Ghana

Authors: Timothy B. Oppong, Haiyan Yang, Cecilia Amponsem-Boateng, Guangcai Duan


The human palm has been identified as one of the richest habitats for human microbial accommodation making hand hygiene essential to primary prevention of infection. Since the hand is in constant contact with fomites which have been proven to be mostly contaminated, building hand hygiene habits is essential for the prevention of infection. This research was conducted to assess the hand hygiene habits of Ghanaian youths in Accra. This study used a survey as a quantitative method of research. The findings of the study revealed that out of the 254 participants who fully answered the questionnaire, 22% had the habit of washing their hands after outings while only 51.6% had the habit of washing their hands after using the bathroom. However, about 60% of the participants said they sometimes ate with their hands while 28.9% had the habit of eating with the hand very often, a situation that put them at risk of infection from their hands since some participants had poor handwashing habits; prompting the need for continuous education on hand hygiene.

Keywords: Hand hygiene, hand hygiene habits, hand washing, hand sanitizer use.

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135 Decision Support System for Hospital Selection in Emergency Medical Services: A Discrete Event Simulation Approach

Authors: D. Tedesco, G. Feletti, P. Trucco


The present study aims to develop a Decision Support System (DSS) to support operational decisions in Emergency Medical Service (EMS) systems regarding the assignment of medical emergency requests to Emergency Departments (ED). This problem is called “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of a first phase of review of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a mission. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the travelling time and to free-up the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs also considering the expected time performance in the subsequent phases of the process, such as the case mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to compare different hospital selection policies. The model was implemented with the AnyLogic software and finally validated on a realistic case. The hospital selection policy that returned the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, based on a retrospective estimation of the TTP, and a dynamic approach, focused on a predictive estimation of the TTP which is determined with a constantly updated Winters forecasting model. Findings reveal that considering the minimization of TTP is the best hospital selection policy. It allows to significantly reducing service throughput times in the ED with a negligible increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms on TTP estimation, than a retrospective approach. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: Emergency medical services, hospital selection, discrete event simulation, forecast model.

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134 A Comprehensive Key Performance Indicators Dashboard for Emergency Medical Services

Authors: G. Feletti, D. Tedesco, P. Trucco


The present study aims to develop a dashboard of Key Performance Indicators (KPI) to enhance information and predictive capabilities in Emergency Medical Services (EMS) systems, supporting both operational and strategic decisions of different actors. The employed research methodology consists of a first phase of revision of the technical-scientific literature concerning the indicators currently in use for the performance measurement of EMS. It emerges that current studies focus on two distinct areas and independent objectives: the ambulance service, a fundamental component of pre-hospital health treatment, and the patient care in the Emergency Department (ED). Conversely, the perspective proposed by this study is to consider an integrated view of the ambulance service process and the ED process, both essential to ensure high quality of care and patient safety. Thus, the proposal covers the end-to-end healthcare service process and, as such, allows considering the interconnection between the two EMS processes, the pre-hospital and hospital ones, connected by the assignment of the patient to a specific ED. In this way, it is possible to optimize the entire patient management. Therefore, attention is paid even to EMS aspects that in current literature tend to be neglected or underestimated. In particular, the integration of the two processes enables to evaluate the advantage of an ED selection decision having visibility on EDs’ saturation status and therefore considering, besides the distance, the available resources and the expected waiting times. Starting from a critical review of the KPIs proposed in extant literature, the design of the dashboard was carried out: the high number of analyzed KPIs was reduced by eliminating firstly the ones not in line with the aim of the study and then the ones supporting a similar functionality. The KPIs finally selected were tested on a realistic dataset, which draw us to exclude additional indicators due to unavailability of data required for their computation. The final dashboard, that was discussed and validated by experts in the field, includes a variety of KPIs able to support operational and planning decisions, early warning, and citizens’ awareness on EDs accessibility in real time. The association of each KPI to the EMS phase it refers to enabled the design of a well-balanced dashboard, covering both efficiency and effectiveness performance objectives of the entire EMS process. Indeed, just the initial phases related to the interconnection between ambulance service and patient care are covered by traditional KPIs. Future developments could be directed to building a hierarchical dashboard, composed by a high-level minimal set of KPIs for measuring the basic performance of the EMS system, at an aggregate level, and lower levels of KPIs that bring additional and more detailed information on specific performance dimensions or EMS phases.

Keywords: Emergency Medical Services, Key Performance Indicators, Dashboard, Decision Support.

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133 Evaluation of the Analytic for Hemodynamic Instability as A Prediction Tool for Early Identification of Patient Deterioration

Authors: Bryce Benson, Sooin Lee, Ashwin Belle


Unrecognized or delayed identification of patient deterioration is a key cause of in-hospitals adverse events. Clinicians rely on vital signs monitoring to recognize patient deterioration. However, due to ever increasing nursing workloads and the manual effort required, vital signs tend to be measured and recorded intermittently, and inconsistently causing large gaps during patient monitoring. Additionally, during deterioration, the body’s autonomic nervous system activates compensatory mechanisms causing the vital signs to be lagging indicators of underlying hemodynamic decline. This study analyzes the predictive efficacy of the Analytic for Hemodynamic Instability (AHI) system, an automated tool that was designed to help clinicians in early identification of deteriorating patients. The lead time analysis in this retrospective observational study assesses how far in advance AHI predicted deterioration prior to the start of an episode of hemodynamic instability (HI) becoming evident through vital signs? Results indicate that of the 362 episodes of HI in this study, 308 episodes (85%) were correctly predicted by the AHI system with a median lead time of 57 minutes and an average of 4 hours (240.5 minutes). Of the 54 episodes not predicted, AHI detected 45 of them while the episode of HI was ongoing. Of the 9 undetected, 5 were not detected by AHI due to either missing or noisy input ECG data during the episode of HI. In total, AHI was able to either predict or detect 98.9% of all episodes of HI in this study. These results suggest that AHI could provide an additional ‘pair of eyes’ on patients, continuously filling the monitoring gaps and consequently giving the patient care team the ability to be far more proactive in patient monitoring and adverse event management.

Keywords: Clinical deterioration prediction, decision support system, early warning system, hemodynamic status, physiologic monitoring.

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132 Efficacy of Recovery Tech Virtual Reality Rehabilitation System for Shoulder Impingement Syndrome

Authors: Kasra Afsahi, Maryam Soheilifar, Nazanin Vahed, Omid Seyed Esmaeili, S. Hossein Hosseini


The most common cause of shoulder pain occurs when rotator cuff tendons become trapped under the bony area in the shoulder. This pilot study was performed to evaluate the feasibility of Virtual Reality based rehabilitation of shoulder impingement syndrome in athletes. Three consecutive patients with subacromial impingement syndrome were enrolled. The participants were rehabilitated for 5 times a week for 4 weeks, 20 sessions in total (with duration of each session being 60 minutes). In addition to the conventional rehabilitation program, a 10-minute game-based virtual reality exercise was administered. Primary outcome measures were range of motion evaluated with goniometer, pain sensation, disability intensity using ‘The Disabilities of the Arm, Shoulder and Hand Questionnaire’, muscle strength using ‘dynamometer’; pain threshold with 'algometer' and level of satisfaction. There were significant improvements in the range of motion, pain sensation, disability, pain threshold and muscle strength compared to basis (P < 0.05). There were no major adverse effects. This study showed the usefulness of VR therapy as an adjunct to conventional physiotherapy in improving function in patients with shoulder impingement syndrome.

Keywords: Shoulder impingement syndrome, VR therapy, feasibility, rehabilitation.

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131 Automatic Classification of Lung Diseases from CT Images

Authors: Abobaker Mohammed Qasem Farhan, Shangming Yang, Mohammed Al-Nehari


Pneumonia is a kind of lung disease that creates congestion in the chest. Such pneumonic conditions lead to loss of life due to the severity of high congestion. Pneumonic lung disease is caused by viral pneumonia, bacterial pneumonia, or COVID-19 induced pneumonia. The early prediction and classification of such lung diseases help reduce the mortality rate. We propose the automatic Computer-Aided Diagnosis (CAD) system in this paper using the deep learning approach. The proposed CAD system takes input from raw computerized tomography (CT) scans of the patient's chest and automatically predicts disease classification. We designed the Hybrid Deep Learning Algorithm (HDLA) to improve accuracy and reduce processing requirements. The raw CT scans are pre-processed first to enhance their quality for further analysis. We then applied a hybrid model that consists of automatic feature extraction and classification. We propose the robust 2D Convolutional Neural Network (CNN) model to extract the automatic features from the pre-processed CT image. This CNN model assures feature learning with extremely effective 1D feature extraction for each input CT image. The outcome of the 2D CNN model is then normalized using the Min-Max technique. The second step of the proposed hybrid model is related to training and classification using different classifiers. The simulation outcomes using the publicly available dataset prove the robustness and efficiency of the proposed model compared to state-of-art algorithms.

Keywords: CT scans, COVID-19, deep learning, image processing, pneumonia, lung disease.

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130 Malaria Prone Zones of West Bengal: A Spatio-Temporal Scenario

Authors: Meghna Maiti, Utpal Roy


In India, till today, malaria is considered to be one of the significant infectious diseases. Most of the cases regional geographical factors are the principal elements to let the places a unique identity. The incidence and intensity of infectious diseases are quite common and affect different places differently across the nation. The present study aims to identify spatial clusters of hot spots and cold spots of malaria incidence and their seasonal variation during the three periods of 2012-2014, 2015-2017 and 2018-20 in the state of West Bengal in India. As malaria is a vector-borne disease, numbers of positive test results are to be reported by the laboratories to the Department of Health, West Bengal (through the National Vector Borne Disease Control Programme). Data on block-wise monthly malaria positive cases are collected from Health Management Information System (HMIS), Ministry of Health and Family Welfare, Government of India. Moran’s I statistic is performed to assess the spatial autocorrelation of malaria incidence. The spatial statistical analysis mainly Local Indicators of Spatial Autocorrelation (LISA) cluster and Local Geary Cluster are applied to find the spatial clusters of hot spots and cold spots and seasonal variability of malaria incidence over the three periods. The result indicates that the spatial distribution of malaria is clustered during each of the three periods of 2012-2014, 2015-2017 and 2018-20. The analysis shows that in all the cases, high-high clusters are primarily concentrated in the western (Purulia, Paschim Medinipur districts), central (Maldah, Murshidabad districts) and the northern parts (Jalpaiguri, Kochbihar districts) and low-low clusters are found in the lower Gangetic plain (central-south) mainly and northern parts of West Bengal during the stipulated period. Apart from this seasonal variability inter-year variation is also visible. The results from different methods of this study indicate significant variation in the spatial distribution of malaria incidence in West Bengal and high incidence clusters are primarily persistently concentrated over the western part during 2012-2020 along with a strong seasonal pattern with a peak in rainy and autumn. By applying the different techniques in identifying the different degrees of incidence zones of malaria across West Bengal, some specific pockets or malaria hotspots are marked and identified where the incidence rates are quite harmonious over the different periods. From this analysis, it is clear that malaria is not a disease that is distributed uniformly across the state; some specific pockets are more prone to be affected in particular seasons of each year. Disease ecology and spatial patterns must be the factors in explaining the real factors for the higher incidence of this issue within those affected districts. The further study mainly by applying empirical approach is needed for discerning the strong relationship between communicable disease and other associated affecting factors.

Keywords: Malaria, infectious diseases, spatial statistics, spatial autocorrelation, LISA.

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129 Using Machine Learning Techniques for Autism Spectrum Disorder Analysis and Detection in Children

Authors: Norah Alshahrani, Abdulaziz Almaleh


Autism Spectrum Disorder (ASD) is a condition related to issues with brain development that affects how a person recognises and communicates with others which results in difficulties with interaction and communication socially and it is constantly growing. Early recognition of ASD allows children to lead safe and healthy lives and helps doctors with accurate diagnoses and management of conditions. Therefore, it is crucial to develop a method that will achieve good results and with high accuracy for the measurement of ASD in children. In this paper, ASD datasets of toddlers and children have been analyzed. We employed the following machine learning techniques to attempt to explore ASD: Random Forest (RF), Decision Tree (DT), Na¨ıve Bayes (NB) and Support Vector Machine (SVM). Then feature selection was used to provide fewer attributes from ASD datasets while preserving model performance. As a result, we found that the best result has been provided by SVM, achieving 0.98% in the toddler dataset and 0.99% in the children dataset.

Keywords: Autism Spectrum Disorder, ASD, Machine Learning, ML, Feature Selection, Support Vector Machine, SVM.

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128 Virtual Reality in COVID-19 Stroke Rehabilitation: Preliminary Outcomes

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini


Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of COVID-19 infection. Understanding novel treatment approaches is important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with VR included. This game-based VR technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with COVID-19 related CVA. The safety of developed instruments for such cases provides approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: COVID-19, stroke, virtual reality, rehabilitation.

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127 A Machine Learning-based Analysis of Autism Prevalence Rates across US States against Multiple Potential Explanatory Variables

Authors: Ronit Chakraborty, Sugata Banerji


There has been a marked increase in the reported prevalence of Autism Spectrum Disorder (ASD) among children in the US over the past two decades. This research has analyzed the growth in state-level ASD prevalence against 45 different potentially explanatory factors including socio-economic, demographic, healthcare, public policy and political factors. The goal was to understand if these factors have adequate predictive power in modeling the differential growth in ASD prevalence across various states, and, if they do, which factors are the most influential. The key findings of this study include (1) there is a confirmation that the chosen feature set has considerable power in predicting the growth in ASD prevalence, (2) the most influential predictive factors are identified, (3) given the nature of the most influential predictive variables, an indication that a considerable portion of the reported ASD prevalence differentials across states could be attributable to over and under diagnosis, and (4) Florida is identified as a key outlier state pointing to a potential under-diagnosis of ASD.

Keywords: Autism Spectrum Disorder, ASD, clustering, Machine Learning, predictive modeling.

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126 Safe, Effective, and Cost-Efficient Air Cleaning for Populated Rooms and Entire Buildings Based on the Disinfecting Power of Vaporized Hypochlorous Acid

Authors: D. Boecker, R. Breves, F. Herth, Z. Zhang, C. Bulitta


Pathogen-carrying aerosol particles are recognized as important infection carriers like those in the current Corona pandemic. This infection route is often underestimated yet represents the infection route that has been least systematically countered to date. Particularly, the transmission indoors is of the highest concern but current indoor safety measures (e.g.: distancing, masks, filters) provide only limited protection. Inhalation of hypochlorous acid (HOCl) containing aerosols may become an alternate route to attack the incubating microbes in-situ and so potentially lead to a reduction of symptoms of already infected individuals. We investigated a facility-wide air-disinfection concept utilizing the potential of vaporized HOCl to become a disinfecting agent for populated indoor atmospheres. Aerosolized bacterial microbes were used as surrogates for a viral contamination, particularly the enveloped coronavirus. For the room air purification tests we aerosolized bacterial suspensions into lab chambers preloaded with vaporized HOCl solutions. Concentration of ‘free active chlorine’ in the test chamber atmosphere was determined with a special gas sensor system (Draeger AG, Lübeck, Germany) controlling the amount of vaporized HOCl via an aerosolis® device (oji Europe GmbH, Nauen, Germany). We could confirm the disinfecting power of HOCl in suspensions and determined the high efficacy of vaporized HOCl to disinfect atmospheres of populated indoor places at safe and non-irritant levels.

Keywords: Hypochlorous acid, HOCl, indoor air cleaning, infection control, microbial air burden, protective atmosphere.

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125 Sexuality Education Training Program Effect on Junior Secondary School Students’ Knowledge and Practice of Sexual Risk Behavior

Authors: B. O. Diyaolu, O. O. Oyerinde


This study examined the effect of sexuality education training programs on the knowledge and practice of sexual risk behavior among secondary school adolescents in Ibadan North Local Government area of Oyo State. A total of 105 students were sampled from two schools in the Local Government area. 70 students constituted the experimental group while 35 constituted the control group. Pretest-Posttest control group quasi-experimental design was adopted. A self-developed questionnaire was used to test participants’ knowledge and practice of sexual risk behavior before and after the training (α = .62, .82 and .74). Analysis indicated a significant effect of sexuality education training on participants’ knowledge and practice of sexual risk behavior, a significant gender difference in knowledge of sexual risk behavior but no significant age and gender difference in the practice of sexual risk behavior. It was thus concluded that sexuality education should be taught in schools and emphasized at homes with no age or gender restrictions.

Keywords: Early adolescent, health risk, sexual risk behavior, sexuality education.

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124 Literature-Based Discoveries in Lupus Treatment

Authors: Oluwaseyi Jaiyeoba, Vetria Byrd


Systemic lupus erythematosus (aka lupus) is a chronic disease known for its chameleon-like ability to mimic symptoms of other diseases rendering it hard to detect, diagnose and treat. The heterogeneous nature of the disease generates disparate data that are often multifaceted and multi-dimensional. Musculoskeletal manifestation of lupus is one of the most common clinical manifestations of lupus. This research links disparate literature on the treatment of lupus as it affects the musculoskeletal system using the discoveries from literature-based research articles available on the PubMed database. Several Natural Language Processing (NPL) tools exist to connect disjointed but related literature, such as Connected Papers, Bitola, and Gopalakrishnan. Literature-based discovery (LBD) has been used to bridge unconnected disciplines based on text mining procedures. The technical/medical literature consists of many technical/medical concepts, each having its  sub-literature. This approach has been used to link Parkinson’s, Raynaud, and Multiple Sclerosis treatment within works of literature.  Literature-based discovery methods can connect two or more related but disjointed literature concepts to produce a novel and plausible approach to solving a research problem. Data visualization techniques with the help of natural language processing tools are used to visually represent the result of literature-based discoveries. Literature search results can be voluminous, but Data visualization processes can provide insight and detect subtle patterns in large data. These insights and patterns can lead to discoveries that would have otherwise been hidden from disjointed literature. In this research, literature data are mined and combined with visualization techniques for heterogeneous data to discover viable treatments reported in the literature for lupus expression in the musculoskeletal system. This research answers the question of using literature-based discovery to identify potential treatments for a multifaceted disease like lupus. A three-pronged methodology is used in this research: text mining, natural language processing, and data visualization. These three research-related fields are employed to identify patterns in lupus-related data that, when visually represented, could aid research in the treatment of lupus. This work introduces a method for visually representing interconnections of various lupus-related literature. The methodology outlined in this work is the first step toward literature-based research and treatment planning for the musculoskeletal manifestation of lupus. The results also outline the interconnection of complex, disparate data associated with the manifestation of lupus in the musculoskeletal system. The societal impact of this work is broad. Advances in this work will improve the quality of life for millions of persons in the workforce currently diagnosed and silently living with a musculoskeletal disease associated with lupus.

Keywords: Systemic lupus erythematosus, LBD, Data Visualization, musculoskeletal system, treatment.

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123 Patient Perspectives on Telehealth during the Pandemic in the United States

Authors: Manal Sultan Alhussein, Xiang Michelle Liu


Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients’ waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.

Keywords: Telehealth, patient satisfaction, pandemic, healthcare, remote patient monitor.

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122 Development of a Basic Robot System for Medical and Nursing Care for Patients with Glaucoma

Authors: Naoto Suzuki


Medical methods to completely treat glaucoma are yet to be developed. Therefore, ophthalmologists manage patients mainly to delay disease progression. Patients with glaucoma are mainly elderly individuals. In elderly people's houses, having an equipment that can provide medical treatment and care can release their family from their care. For elderly people with the glaucoma to live by themselves as much as possible, we developed a support robot having five functions: elderly people care, ophthalmological examination, trip assistance to the neighborhood, medical treatment, and data referral to a hospital. The medical and nursing care robot should approach the visual field that the patients can see at a speed suitable for their eyesight. This is because the robot will be dangerous if it approaches the patients from the visual field that they cannot see. We experimentally developed a robot that brings a white cane to elderly people with glaucoma. The base part of the robot is a carriage, which is a Megarover 1.1, and it has two infrared sensors. The robot moves along a white line on the floor using the infrared sensors and has a special arm, which does not use electricity. The arm can scoop the block attached to the white cane. Next, we also developed a direction detector comprised of a charge-coupled device camera (SVR41ResucueHD; Sun Mechatronics), goggles (MG-277MLF; Midori Anzen Co. Ltd.), and biconvex lenses with a focal length of 25 mm (Edmund Co.). Some young people were photographed using the direction detector, which was put on their faces. Image processing was performed using Scilab 6.1.0 and Image Processing and Computer Vision Toolbox 4.1.2. To measure the people's line of vision, we calculated the iris's center of gravity using five processes: reduction, trimming, binarization or gray scale, edge extraction, and Hough transform. We compared the binarization and gray scale processes in image processing. The binarization process was better than the gray scale process. For edge extraction, we compared five methods: Sobel, Prewitt, Laplacian of Gaussian, fast Fourier transform, and Canny. The Canny method was the optimal extraction method. We performed the Hough transform to search for the main coordinates from the iris's edge, and we found that the Hough transform could calculate the center point of the iris.

Keywords: Glaucoma, support robot, elderly people, Hough transform, direction detector, line of vision.

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121 Telehealth Ecosystem: Challenge and Opportunity

Authors: R. Poonsuph


Technological innovation plays a crucial role in virtual healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. As a result, telehealth represents an opportunity to redesign the way health services are delivered. The research objective is to discover a new business model for digital health services and related industries to participate with telehealth solutions. The business opportunity is valuable for healthcare investors as a startup company to further investigations or implement the telehealth platform. The paper presents a digital healthcare business model and business opportunities to related industries. These include digital healthcare services extending from a traditional business model and use cases of business opportunities to related industries. Although there are enormous business opportunities, telehealth is still challenging due to the patient adaption and digital transformation process within a healthcare organization.

Keywords: telehealth, Internet hospital, HealthTech, InsurTech

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120 Save Lives: The Application of Geolocation-Awareness Service in Iranian Pre-Hospital EMS Information Management System

Authors: Somayeh Abedian, Pirhossein Kolivand, Hamid Reza Lornejad, Amin Karampour, Ebrahim Keshavarz Safari


For emergency and relief service providers such as pre-hospital emergencies, quick arrival at the scene of an accident or any EMS mission is one of the most important requirements of effective service delivery. EMS Response time (the interval between the time of the call and the time of arrival on scene) is a critical factor in determining the quality of pre-hospital Emergency Medical Services (EMS). This is especially important for heart attack, stroke, or accident patients that seconds are vital in saving their lives. Location-based e-services can be broadly defined as any service that provides information pertinent to the current location of an active mobile handset or precise address of landline phone call at a specific time window, regardless of the underlying delivery technology used to convey the information. According to research, one of the effective methods of meeting this goal is determining the location of the caller via the cooperation of landline and mobile phone operators in the country. The follow-up of the Communications Regulatory Authority (CRA) organization has resulted in the receipt of two separate secured electronic web services. Thus, to ensure human privacy, a secure technical architecture was required for launching the services in the pre-hospital EMS information management system. In addition, to quicken medics’ arrival at the patient's bedside, rescue vehicles should make use of an intelligent transportation system to estimate road traffic using a GPS-based mobile navigation system independent of the Internet. This paper seeks to illustrate the architecture of the practical national model used by the Iranian EMS organization.

Keywords: response time, geographic location inquiry service, location-based services, emergency medical services information system

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119 Two Class Motor Imagery Classification via Wave Atom Sub-Bants

Authors: Nebi Gedik


The goal of motor image brain computer interface research is to create a link between the central nervous system and a computer or device. The most important signal for brain-computer interface is the electroencephalogram. The aim of this research is to explore a set of effective features from EEG signals, separated into frequency bands, using wave atom sub-bands to discriminate right and left-hand motor imagery signals. Over the transform coefficients, feature vectors are constructed for each frequency range and each transform sub-band, and their classification performances are tested. The method is validated using EEG signals from the BCI competition III dataset IIIa and classifiers such as support vector machine and k-nearest neighbors.

Keywords: motor imagery, EEG, Wave atom transform sub-bands, SVM, k-NN

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118 Curvelet Transform Based Two Class Motor Imagery Classification

Authors: Nebi Gedik


One of the important parts of the brain-computer interface (BCI) studies is the classification of motor imagery (MI) obtained by electroencephalography (EEG). The major goal is to provide non-muscular communication and control via assistive technologies to people with severe motor disorders so that they can communicate with the outside world. In this study, an EEG signal classification approach based on multiscale and multi-resolution transform method is presented. The proposed approach is used to decompose the EEG signal containing motor image information (right- and left-hand movement imagery). The decomposition process is performed using curvelet transform which is a multiscale and multiresolution analysis method, and the transform output was evaluated as feature data. The obtained feature set is subjected to feature selection process to obtain the most effective ones using t-test methods. SVM and k-NN algorithms are assigned for classification.

Keywords: motor imagery, EEG, curvelet transform, SVM, k-NN

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117 Cirrhosis Mortality Prediction as Classification Using Frequent Subgraph Mining

Authors: Abdolghani Ebrahimi, Diego Klabjan, Chenxi Ge, Daniela Ladner, Parker Stride


In this work, we use machine learning and data analysis techniques to predict the one-year mortality of cirrhotic patients. Data from 2,322 patients with liver cirrhosis are collected at a single medical center. Different machine learning models are applied to predict one-year mortality. A comprehensive feature space including demographic information, comorbidity, clinical procedure and laboratory tests is being analyzed. A temporal pattern mining technic called Frequent Subgraph Mining (FSM) is being used. Model for End-stage liver disease (MELD) prediction of mortality is used as a comparator. All of our models statistically significantly outperform the MELD-score model and show an average 10% improvement of the area under the curve (AUC). The FSM technic itself does not improve the model significantly, but FSM, together with a machine learning technique called an ensemble, further improves the model performance. With the abundance of data available in healthcare through electronic health records (EHR), existing predictive models can be refined to identify and treat patients at risk for higher mortality. However, due to the sparsity of the temporal information needed by FSM, the FSM model does not yield significant improvements. Our work applies modern machine learning algorithms and data analysis methods on predicting one-year mortality of cirrhotic patients and builds a model that predicts one-year mortality significantly more accurate than the MELD score. We have also tested the potential of FSM and provided a new perspective of the importance of clinical features.

Keywords: machine learning, liver cirrhosis, subgraph mining, supervised learning

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116 Parameters Influencing Human-Machine Interaction in Hospitals

Authors: Hind Bouami, Patrick Millot


Handling life-critical systems complexity requires to be equipped with appropriate technology and the right human agents’ functions such as knowledge, experience, and competence in problem’s prevention and solving. Human agents are involved in the management and control of human-machine system’s performance. Documenting human agent’s situation awareness is crucial to support human-machine designers’ decision-making. Knowledge about risks, critical parameters and factors that can impact and threaten automation system’s performance should be collected using preventive and retrospective approaches. This paper aims to document operators’ situation awareness through the analysis of automated organizations’ feedback. The analysis of automated hospital pharmacies feedback helps identify and control critical parameters influencing human machine interaction in order to enhance system’s performance and security. Our human machine system evaluation approach has been deployed in Macon hospital center’s pharmacy which is equipped with automated drug dispensing systems since 2015. Automation’s specifications are related to technical aspects, human-machine interaction, and human aspects. The evaluation of drug delivery automation performance in Macon hospital center has shown that the performance of the automated activity depends on the performance of the automated solution chosen, and also on the control of systemic factors. In fact, 80.95% of automation specification related to the chosen Sinteco’s automated solution is met. The performance of the chosen automated solution is involved in 28.38% of automation specifications performance in Macon hospital center. The remaining systemic parameters involved in automation specifications performance need to be controlled. 

Keywords: Life-critical systems, situation awareness, human-machine interaction, decision-making.

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115 The Integration of Patient Health Record Generated from Wearable and Internet of Things Devices into Health Information Exchanges

Authors: Dalvin D. Hill, Hector M. Castro Garcia


A growing number of individuals utilize wearable devices on a daily basis. The usage and functionality of these wearable devices vary from user to user. One popular usage of said devices is to track health-related activities that are typically stored on a device’s memory or uploaded to an account in the cloud; based on the current trend, the data accumulated from the wearable device are stored in a standalone location. In many of these cases, this health related datum is not a factor when considering the holistic view of a user’s health lifestyle or record. This health-related data generated from wearable and Internet of Things (IoT) devices can serve as empirical information to a medical provider, as the standalone data can add value to the holistic health record of a patient. This paper proposes a solution to incorporate the data gathered from these wearable and IoT devices, with that a patient’s Personal Health Record (PHR) stored within the confines of a Health Information Exchange (HIE).

Keywords: Electronic health record, health information exchanges, Internet of Things, personal health records, wearable devices, wearables.

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114 Risk Management Approach for a Secure and Performant Integration of Automated Drug Dispensing Systems in Hospitals

Authors: Hind Bouami, Patrick Millot


Medication dispensing system is a life-critical system whose failure may result in preventable adverse events leading to longer patient stays in hospitals or patient death. Automation has led to great improvements in life-critical systems as it increased safety, efficiency, and comfort. However, critical risks related to medical organization complexity and automated solutions integration can threaten drug dispensing security and performance. Knowledge about the system’s complexity aspects and human machine parameters to control for automated equipment’s security and performance will help operators to secure their automation process and to optimize their system’s reliability. In this context, this study aims to document the operator’s situation awareness about automation risks and parameters involved in automation security and performance. Our risk management approach has been deployed in the North Luxembourg hospital center’s pharmacy, which is equipped with automated drug dispensing systems since 2009. With more than 4 million euros of gains generated, North Luxembourg hospital center’s success story was enabled by the management commitment, pharmacy’s involvement in the implementation and improvement of the automation project, and the close collaboration between the pharmacy and Sinteco’s firm to implement the necessary innovation and organizational actions for automated solutions integration security and performance. An analysis of the actions implemented by the hospital and the parameters involved in automated equipment’s integration security and performance has been made. The parameters to control for automated equipment’s integration security and performance are human aspects (6.25%), technical aspects (50%), and human-machine interaction (43.75%). The implementation of an anthropocentric analysis system before automation would have prevented and optimized the control of risks related to automation.

Keywords: Automated drug delivery systems, hospitals, human-centered automated system, risk management.

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113 Rule-Based Expert System for Headache Diagnosis and Medication Recommendation

Authors: Noura Al-Ajmi, Mohammed A. Almulla


With the increased utilization of technology devices around the world, healthcare and medical diagnosis are critical issues that people worry about these days. Doctors are doing their best to avoid any medical errors while diagnosing diseases and prescribing the wrong medication. Subsequently, artificial intelligence applications that can be installed on mobile devices such as rule-based expert systems facilitate the task of assisting doctors in several ways. Due to their many advantages, the usage of expert systems has increased recently in health sciences. This work presents a backward rule-based expert system that can be used for a headache diagnosis and medication recommendation system. The structure of the system consists of three main modules, namely the input unit, the processing unit, and the output unit.

Keywords: Headache diagnosis system, treatment recommender system, rule-based expert system.

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