Search results for: medical diagnosis

Authors: S. Lecheb, A. Nour, A. Chellil, H. Mechakra, N. Hamad, H. Kebir

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This study concerned the dynamic behavior of the wind turbine rotor. Before all we have studied the loads applied to the rotor, which allows the knowledge their effect on the fatigue, also studied the rotor with longitudinal crack in order to determine stress, strain and displacement. Firstly we compared the first six modes shapes between cracking and uncracking of HAWT rotor. Secondly we show show evolution of first six natural frequencies with longitudinal crack propagation. Finally we conclude that the residual change in the natural frequencies can be used as in shaft crack diagnosis predictive maintenance.

Keywords: Wind turbine rotor, natural frequencies, longitudinal crack growth, life time.

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Authors: George Karkavitsas, Maria Rangoussi

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We present a genetic algorithm application to the problem of object registration (i.e., object detection, localization and recognition) in a class of medical images containing various types of blood cells. The genetic algorithm approach taken here is seen to be most appropriate for this type of image, due to the characteristics of the objects. Successful cell registration results on real life microscope images of blood cells show the potential of the proposed approach.

Keywords: Genetic algorithms, object registration, pattern recognition, blood cell microscope images.

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Authors: Agnieszka Danek, Rafał Pokrzywa

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Approximate tandem repeats in a genomic sequence are two or more contiguous, similar copies of a pattern of nucleotides. They are used in DNA mapping, studying molecular evolution mechanisms, forensic analysis and research in diagnosis of inherited diseases. All their functions are still investigated and not well defined, but increasing biological databases together with tools for identification of these repeats may lead to discovery of their specific role or correlation with particular features. This paper presents a new approach for finding approximate tandem repeats in a given sequence, where the similarity between consecutive repeats is measured using the Hamming distance. It is an enhancement of a method for finding exact tandem repeats in DNA sequences based on the Burrows- Wheeler transform.

Keywords: approximate tandem repeats, Burrows-Wheeler transform, Hamming distance, suffix array

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Authors: Olga V. Lebedinskaya, Irina N. Kabanovskaya, Anna S. Lasareva, Nelly K. Akhmatova, Anatoliy P. Godovalov, Andrey V. Horinko, Mikhail V. Kiselevsky

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The nature, prevalence, cellular composition of leukocyte infiltrates and immunohistochemical characteristics of their constituent cells in the liver of patients with chronic viral hepatitis B and C were investigated. It was found that the area of distribution and cellular composition of infiltrates depended on the virus type and process activity. The expediency of immunohistochemical study using leukocyte infiltrates from liver biopsies of patients with viral hepatitis aimed at clarifying diagnosis, making prognosis, and choice of optimal treatment with elements of immune correction is emphasized.

Keywords: Viral hepatitis, leukocyte infiltration, immunohistochemical characteristics, immunosupression.

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Authors: Jeroen S. de Bruin, Karin Schindler, Christian Schuh

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With increasingly more mobile health applications appearing due to the popularity of smartphones, the possibility arises that these data can be used to improve the medical diagnostic process, as well as the overall quality of healthcare, while at the same time lowering costs. However, as of yet there have been no reports of a successful combination of patient-generated data from smartphones with data from clinical routine. In this paper we describe how these two types of data can be combined in a secure way without modification to hospital information systems, and how they can together be used in a medical expert system for automatic nutritional classification and triage.

Keywords: Data integration, disease-related malnutrition, expert systems, mobile health.

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Authors: Ali Al-Ataby , Fawzi Al-Naima

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Symbolic Circuit Analysis (SCA) is a technique used to generate the symbolic expression of a network. It has become a well-established technique in circuit analysis and design. The symbolic expression of networks offers excellent way to perform frequency response analysis, sensitivity computation, stability measurements, performance optimization, and fault diagnosis. Many approaches have been proposed in the area of SCA offering different features and capabilities. Numerical Interpolation methods are very common in this context, especially by using the Fast Fourier Transform (FFT). The aim of this paper is to present a method for SCA that depends on the use of Wavelet Transform (WT) as a mathematical tool to generate the symbolic expression for large circuits with minimizing the analysis time by reducing the number of computations.

Keywords: Numerical Interpolation, Sparse Matrices, SymbolicAnalysis, Wavelet Transform.

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Authors: Hariton N. Costin, Sorin Puscoci, Cristian Rotariu, Bogdan Dionisie, Marinela C. Cimpoesu

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TELMES project aims to develop a securized multimedia system devoted to medical consultation teleservices. It will be finalized with a pilot system for a regional telecenters network that connects local telecenters, having as support multimedia platforms. This network will enable the implementation of complex medical teleservices (teleconsulations, telemonitoring, homecare, urgency medicine, etc.) for a broader range of patients and medical professionals, mainly for family doctors and those people living in rural or isolated regions. Thus, a multimedia, scalable network, based on modern IT&C paradigms, will result. It will gather two inter-connected regional telecenters, in Iaşi and Piteşti, Romania, each of them also permitting local connections of hospitals, diagnostic and treatment centers, as well as local networks of family doctors, patients, even educational entities. As communications infrastructure, we aim to develop a combined fixmobile- internet (broadband) links. Other possible communication environments will be GSM/GPRS/3G and radio waves. The electrocardiogram (ECG) acquisition, internet transmission and local analysis, using embedded technologies, was already successfully done for patients- telemonitoring.

Keywords: Healthcare, telemedicine, telemonitoring, ECG analysis.

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Authors: Amir Moslemi, Amir Movafeghi, Shahab Moradi

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One of the most important challenging factors in medical images is nominated as noise. Image denoising refers to the improvement of a digital medical image that has been infected by Additive White Gaussian Noise (AWGN). The digital medical image or video can be affected by different types of noises. They are impulse noise, Poisson noise and AWGN. Computed tomography (CT) images are subjects to low quality due to the noise. Quality of CT images is dependent on absorbed dose to patients directly in such a way that increase in absorbed radiation, consequently absorbed dose to patients (ADP), enhances the CT images quality. In this manner, noise reduction techniques on purpose of images quality enhancement exposing no excess radiation to patients is one the challenging problems for CT images processing. In this work, noise reduction in CT images was performed using two different directional 2 dimensional (2D) transformations; i.e., Curvelet and Contourlet and Discrete Wavelet Transform (DWT) thresholding methods of BayesShrink and AdaptShrink, compared to each other and we proposed a new threshold in wavelet domain for not only noise reduction but also edge retaining, consequently the proposed method retains the modified coefficients significantly that result good visual quality. Data evaluations were accomplished by using two criterions; namely, peak signal to noise ratio (PSNR) and Structure similarity (Ssim).

Keywords: Computed Tomography (CT), noise reduction, curve-let, contour-let, Signal to Noise Peak-Peak Ratio (PSNR), Structure Similarity (Ssim), Absorbed Dose to Patient (ADP).

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Authors: S. Usha, S. Arumugam

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Cancer affects people globally with breast cancer being a leading killer. Breast cancer is due to the uncontrollable multiplication of cells resulting in a tumour or neoplasm. Tumours are called ‘benign’ when cancerous cells do not ravage other body tissues and ‘malignant’ if they do so. As mammography is an effective breast cancer detection tool at an early stage which is the most treatable stage it is the primary imaging modality for screening and diagnosis of this cancer type. This paper presents an automatic mammogram classification technique using wavelet and Gabor filter. Correlation feature selection is used to reduce the feature set and selected features are classified using different decision trees.

Keywords: Breast Cancer, Mammogram, Symlet Wavelets, Gabor Filters, Decision Trees

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Authors: Alexandru George Floares

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Chronic hepatitis B can evolve to cirrhosis and liver cancer. Interferon is the only effective treatment, for carefully selected patients, but it is very expensive. Some of the selection criteria are based on liver biopsy, an invasive, costly and painful medical procedure. Therefore, developing efficient non-invasive selection systems, could be in the patients benefit and also save money. We investigated the possibility to create intelligent systems to assist the Interferon therapeutical decision, mainly by predicting with acceptable accuracy the results of the biopsy. We used a knowledge discovery in integrated medical data - imaging, clinical, and laboratory data. The resulted intelligent systems, tested on 500 patients with chronic hepatitis B, based on C5.0 decision trees and boosting, predict with 100% accuracy the results of the liver biopsy. Also, by integrating the other patients selection criteria, they offer a non-invasive support for the correct Interferon therapeutic decision. To our best knowledge, these decision systems outperformed all similar systems published in the literature, and offer a realistic opportunity to replace liver biopsy in this medical context.

Keywords: Interferon, chronic hepatitis B, intelligent virtualbiopsy.

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Authors: Liang Zhao, Jili Zhang, Chongquan Zhong

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Energy consumption data, in particular those involving public buildings, are impacted by many factors: the building structure, climate/environmental parameters, construction, system operating condition, and user behavior patterns. Traditional methods for data analysis are insufficient. This paper delves into the data mining technology to determine its application in the analysis of building energy consumption data including energy consumption prediction, fault diagnosis, and optimal operation. Recent literature are reviewed and summarized, the problems faced by data mining technology in the area of energy consumption data analysis are enumerated, and research points for future studies are given.

Keywords: Data mining, data analysis, prediction, optimization, building operational performance.

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Authors: Chang, Chun-Lang, Liu, Chun-Kai

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This study, for its research subjects, uses patients who had undergone total knee replacement surgery from the database of the National Health Insurance Administration. Through the review of literatures and the interviews with physicians, important factors are selected after careful screening. Then using Cross Entropy Method, Genetic Algorithm Logistic Regression, and Particle Swarm Optimization, the weight of each factor is calculated and obtained. In the meantime, Excel VBA and Case Based Reasoning are combined and adopted to evaluate the system. Results show no significant difference found through Genetic Algorithm Logistic Regression and Particle Swarm Optimization with over 97% accuracy in both methods. Both ROC areas are above 0.87. This study can provide critical reference to medical personnel as clinical assessment to effectively enhance medical care quality and efficiency, prevent unnecessary waste, and provide practical advantages to resource allocation to medical institutes.

Keywords: Total knee replacement, Case Based Reasoning, Cross Entropy Method, Genetic Algorithm Logistic Regression, Particle Swarm Optimization.

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Authors: Jian-hua Yeh, Shi-yi Kuo

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This paper discusses the classification process for medical data. In this paper, we use the data from ACM KDDCup 2008 to demonstrate our classification process based on latent topic discovery. In this data set, the target set and outliers are quite different in their nature: target set is only 0.6% size in total, while the outliers consist of 99.4% of the data set. We use this data set as an example to show how we dealt with this extremely biased data set with latent topic discovery and noise reduction techniques. Our experiment faces two major challenge: (1) extremely distributed outliers, and (2) positive samples are far smaller than negative ones. We try to propose a suitable process flow to deal with these issues and get a best AUC result of 0.98.

Keywords: classification, latent topics, outlier adjustment, feature scaling

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Authors: M. Sinecen, M. Makinacı

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The purpose of this paper is to assess the value of neural networks for classification of cancer and noncancer prostate cells. Gauss Markov Random Fields, Fourier entropy and wavelet average deviation features are calculated from 80 noncancer and 80 cancer prostate cell nuclei. For classification, artificial neural network techniques which are multilayer perceptron, radial basis function and learning vector quantization are used. Two methods are utilized for multilayer perceptron. First method has single hidden layer and between 3-15 nodes, second method has two hidden layer and each layer has between 3-15 nodes. Overall classification rate of 86.88% is achieved.

Keywords: Artificial neural networks, texture classification, cancer diagnosis.

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Authors: Hanane Ondella, Pierre Ladet, David Ferrand, Pat Sloan

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In the micro and nano-technology industry, the «clean-rooms» dedicated to manufacturing chip, are equipped with the most sophisticated equipment-tools. There use a large number of resources in according to strict specifications for an optimum working and result. The distribution of «utilities» to the production is assured by teams who use a supervision tool. The studies show the interest to control the various parameters of production or/and distribution, in real time, through a reliable and effective supervision tool. This document looks at a large part of the functions that the supervisor must assure, with complementary functionalities to help the diagnosis and simulation that prove very useful in our case where the supervised installations are complexed and in constant evolution.

Keywords: Control-Command, evolution, non regression, performances, real time, simulation, supervision.

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Authors: B. R. Tapas Bapu, K. Thanigaivelu, A. Rajkumar

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Wireless Sensor Networks (WSNs) have wide variety of applications and provide limitless future potentials. Nodes in WSNs are prone to failure due to energy depletion, hardware failure, communication link errors, malicious attacks, and so on. Therefore, fault tolerance is one of the critical issues in WSNs. We study how fault tolerance is addressed in different applications of WSNs. Fault tolerant routing is a critical task for sensor networks operating in dynamic environments. Many routing, power management, and data dissemination protocols have been specifically designed for WSNs where energy awareness is an essential design issue. The focus, however, has been given to the routing protocols which might differ depending on the application and network architecture.

Keywords: Resiliency, Self-diagnosis, Smart Grid, TinyOS, WSANs.

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Authors: Rumena D. Stancheva, Ilona I. Iatcheva

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In working mode some unexpected changes could be arise in inner structure of electromagnetic device. They influence modification in electromagnetic field propagation map. The field values at an observed boundary are also changed. The development of the process has to be watched because the arising structural changes would provoke the device to be gone out later. The probabilistic assessment of the state is possible to be made. The numerical assessment points if the resulting changes have only accidental character or they are due to the essential inner structural disturbances. The presented application example is referring to the 200MW turbine-generator. A part of the stator core end teeth zone is simulated broken. Quasi three-dimensional electromagnetic and temperature field are solved applying FEM. The stator core state diagnosis is proposed to be solved as an identification problem on the basis of a statistical criterion.

Keywords: Identification, structural disturbance, statistical criterion.

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Authors: Shayan Rezvanigilkolaei, Shayesteh Vefaghnematollahi

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Electrical impedance tomography is a non-invasive medical imaging technique suitable for medical applications. This paper describes an electrical impedance tomography device with the ability to navigate a robotic arm to manipulate a target object. The design of the device includes various hardware and software sections to perform medical imaging and control the robotic arm. In its hardware section an image is formed by 16 electrodes which are located around a container. This image is used to navigate a 3DOF robotic arm to reach the exact location of the target object. The data set to form the impedance imaging is obtained by having repeated current injections and voltage measurements between all electrode pairs. After performing the necessary calculations to obtain the impedance, information is transmitted to the computer. This data is fed and then executed in MATLAB which is interfaced with EIDORS (Electrical Impedance Tomography Reconstruction Software) to reconstruct the image based on the acquired data. In the next step, the coordinates of the center of the target object are calculated by image processing toolbox of MATLAB (IPT). Finally, these coordinates are used to calculate the angles of each joint of the robotic arm. The robotic arm moves to the desired tissue with the user command.

Keywords: Electrical impedance tomography, EIT, Surgeon robot, image processing of Electrical impedance tomography.

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Authors: M. Bastanfard, B. Jalaeian, S. Jafari

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Sonogram images of normal and lymphocyte thyroid tissues have considerable overlap which makes it difficult to interpret and distinguish. Classification from sonogram images of thyroid gland is tackled in semiautomatic way. While making manual diagnosis from images, some relevant information need not to be recognized by human visual system. Quantitative image analysis could be helpful to manual diagnostic process so far done by physician. Two classes are considered: normal tissue and chronic lymphocyte thyroid (Hashimoto's Thyroid). Data structure is analyzed using K-nearest-neighbors classification. This paper is mentioned that unlike the wavelet sub bands' energy, histograms and Haralick features are not appropriate to distinguish between normal tissue and Hashimoto's thyroid.

Keywords: Sonogram, thyroid, Haralick feature, wavelet.

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Authors: Yu-Ting Tsai, Yu-da Lee, Jin H. Huang

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The nonlinear damping behavior is usually ignored in the design of a miniature moving-coil loudspeaker. But when the loudspeaker operated in air, the damping parameter varies with the voice-coil displacement corresponding due to viscous air flow. The present paper presents an identification model as inverse problem to identify the nonlinear damping parameter in the lumped parameter model for the loudspeaker. Theoretical results for the nonlinear damping are verified by using laser displacement measurement scanner. These results indicate that the damping parameter has the greatly different nonlinearity between in air and vacuum. It is believed that the results of the present work can be applied in diagnosis and sound quality improvement of a miniature loudspeaker.

Keywords: Miniature loudspeaker, non-linear damping, system identification, Lumped parameter model.

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Authors: Chau-Kuang Chen, John Hughes, Jr., A. Dexter Samuels

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The prediction models for the United States Medical Licensure Examination (USMLE) Steps 1 and 2 performances were constructed by the Monte Carlo simulation modeling approach via linear regression. The purpose of this study was to build robust simulation models to accurately identify the most important predictors and yield the valid range estimations of the Steps 1 and 2 scores. The application of simulation modeling approach was deemed an effective way in predicting student performances on licensure examinations. Also, sensitivity analysis (a/k/a what-if analysis) in the simulation models was used to predict the magnitudes of Steps 1 and 2 affected by changes in the National Board of Medical Examiners (NBME) Basic Science Subject Board scores. In addition, the study results indicated that the Medical College Admission Test (MCAT) Verbal Reasoning score and Step 1 score were significant predictors of the Step 2 performance. Hence, institutions could screen qualified student applicants for interviews and document the effectiveness of basic science education program based on the simulation results.

Keywords: Prediction Model, Sensitivity Analysis, Simulation Method, USMLE.

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Authors: Miho Tsukamoto

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Beppu hot spring provides medical treatment as well as comfort visitors and mental easiness for many years. This paper studies hot spring in Beppu and Tōji, medical treatment in hot spring, and investigates how people’s visit to Beppu has changed with Tōji, and how Beppu Tourism Office tries to regain visitors in Beppu. In this paper, firstly, hot spring history in Beppu will be explained especially focusing on Beppu Hattou (eight major hot springs) and Jigoku Meguri (eight major hell hot spring tours). Secondly, Tōji, a long-residential hot spring with the purpose of medical treatment along with the information about chemical efficacy of hot springs will be analyzed. Then, finally, the change of the long-stay type to short-stay Onsen programs with the combination of multiplex tourism resources will be focused along with the decrease of Onsen or hot spring visitors. It is concluded that Tōji is not only physically and mentally cure people but also bring people mental easiness and release them from their stressful life. All in all, it can be concluded that because Onsen is involved in people’s life in Beppu and keep local people united in the community. Tōji’s attraction is shown when local people try to create the new type of Onsen program so as to keep their traditional way of Tōji.

Keywords: Hot spring, Tōji, Treatment.

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Authors: Ambuj Kumar, Sunil Kumar Singh, Shrikant Singh

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Sweep frequency response analysis has been turning out a powerful tool for investigation of mechanical as well as electrical integration of transformers. In this paper various aspect of practical application of SFRA has been studied. Open circuit and short circuit measurement were done on different phases of high voltage and low voltage winding. A case study was presented for the transformer of rating 31.5 MVA for various frequency ranges. A clear picture was presented for sub- frequency ranges for HV as well as LV winding. The main motive of work is to investigate high voltage short circuit response. The theoretical concept about SFRA responses is validated with expert system software results.

Keywords: Frequency deviation, OCT & SCT, SFRA, Transformer winding.

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Authors: Abdelkarim Ait Brik, Abdelaziz Khoukh, Mustapha Jammali, Hamid Chaikhy

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The energy audit is the essential initial step to ensure a good definition of energy control actions. The in-depth study of the various energy-consuming equipments makes it possible to determine the actions and investments with best cost for the company. The analysis focuses on the energy consumption of production equipment and utilities (lighting, heating, air conditioning, ventilation, transport). Successful implementation of this approach requires, however, to take into account a number of prerequisites. This paper proposes a number of useful recommendations concerning the energy audit in order to achieve better results, and a case study concerning the lighting audit of a Moroccan company by showing the gains that can be made through this audit.

Keywords: Energy audit, energy diagnosis, consumption, electricity, energy efficiency, lighting audit.

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Authors: Carlos Huertas, Reyes Juarez-Ramirez

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Public health is one of the most critical issues today; therefore, there is great interest to improve technologies in the area of diseases detection. With machine learning and feature selection, it has been possible to aid the diagnosis of several diseases such as cancer. In this work, we present an extension to the Heat Map Based Feature Selection algorithm, this modification allows automatic threshold parameter selection that helps to improve the generalization performance of high dimensional data such as mass spectrometry. We have performed a comparison analysis using multiple cancer datasets and compare against the well known Recursive Feature Elimination algorithm and our original proposal, the results show improved classification performance that is very competitive against current techniques.

Keywords: Feature selection, mass spectrometry, biomarker discovery, cancer.

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Authors: K. Amudha, C. Nelson Kennedy Babu, S. Balu

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The security of the medical images and its related data is the major research area which is to be concentrated in today’s era. Security in the medical image indicates that the physician may hide patients’ related data in the medical image and transfer it safely to a defined location using reversible watermarking. Many reversible watermarking methods had proposed over the decade. This paper enhances the security level in brain tumor images to hide the patient’s detail, which has to be conferred with other physician’s suggestions. The details or the information will be hidden in Non-ROI area of the image by using the block cipher algorithm. The block cipher uses different keys to extract the details that are difficult for the intruder to detect all the keys and to spot the details, which are the key advantage of this method. The ROI is the tumor area and Non-ROI is the area rest of ROI. The Non-ROI should not be spoiled in any cause and the details in the Non-ROI should be extracted correctly. The reversible watermarking method proposed in this paper performs well when compared to existing methods in the process of extraction of an original image and providing information security.

Keywords: Brain tumor images, Block Cipher, Reversible watermarking, ROI.

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Authors: R. Rajeswari, N. Kamaraj

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In this paper, Wavelet based ANFIS for finding inter turn fault of generator is proposed. The detector uniquely responds to the winding inter turn fault with remarkably high sensitivity. Discrimination of different percentage of winding affected by inter turn fault is provided via ANFIS having an Eight dimensional input vector. This input vector is obtained from features extracted from DWT of inter turn faulty current leaving the generator phase winding. Training data for ANFIS are generated via a simulation of generator with inter turn fault using MATLAB. The proposed algorithm using ANFIS is giving satisfied performance than ANN with selected statistical data of decomposed levels of faulty current.

Keywords: Winding InterTurn fault, ANN, ANFIS, and DWT.

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Authors: Pardeep Singh, Sanjay Sharma

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Content-Based Image Retrieval (CBIR) has been one on the most vivid research areas in the field of computer vision over the last 10 years. Many programs and tools have been developed to formulate and execute queries based on the visual or audio content and to help browsing large multimedia repositories. Still, no general breakthrough has been achieved with respect to large varied databases with documents of difering sorts and with varying characteristics. Answers to many questions with respect to speed, semantic descriptors or objective image interpretations are still unanswered. In the medical field, images, and especially digital images, are produced in ever increasing quantities and used for diagnostics and therapy. In several articles, content based access to medical images for supporting clinical decision making has been proposed that would ease the management of clinical data and scenarios for the integration of content-based access methods into Picture Archiving and Communication Systems (PACS) have been created. This paper gives an overview of soft computing techniques. New research directions are being defined that can prove to be useful. Still, there are very few systems that seem to be used in clinical practice. It needs to be stated as well that the goal is not, in general, to replace text based retrieval methods as they exist at the moment.

Keywords: CBIR, GA, Rough sets, CBMIR

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Authors: Azwin Lubis, Rika Hapsari, Zahrah Hikmah, Anang Endaryanto, Ariyanto Harsono

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Erythema Multiforme Exudativum Major (EMEM) is one of the drug allergy diseases. Drug allergies caused by isoniazid rarely causes EMEM. Cutaneous reactions caused by isoniazid were obtained in 0.98% of patients, but the precise occurrence of Steven Johnson’s Syndrome (SJS) and Toxic Epidermolisis Necrolisis (TEN) due to isoniazid is not known for certain. We present this case to show hypersensitivity of isoniazid in a child. Based on the history of drug intake, physical diagnostic tests, drug elimination and provocation; we established the diagnosis of isoniazid hypersensitivity. The child showed improvement on skin manifestation after stopped isoniazid therapy.

Keywords: Erythema Multiforme Exudativum Major, hypersensitivity, elimination test, provocation test.

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Authors: Chanisada Choosuk, Napisporn Memongkol Runchana Sinthavalai, Fareeda Lambensah

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The objective of this research is to explore the role of actors at the local level in managing the Pre-hospital Emergency Medical Service (EMS) system in Thailand. The research method was done through documentary research, individual interviews, and one forum conducted in each province. This paper uses the case of three provinces located in three regions in Thailand including; Ubon Ratchathani (North-eastern region), Lampang (Northern Region), and Songkhla (Southern Region). The result shows that, recently, the role of the local government in being the service provider for their local people is increasingly concerned. In identifying the key success factors towards the EMS system, it includes; (i) the local executives- vision and influence that the decisions made by them, for both PAO (Provincial Administration Organisation (PAO) and TAO (Tambon Administration Organisation), is vital to address the overall challenges in EMS development, (ii) the administrative system through reforming their working style create the flexibility in running the EMS task, (iii) the network-based management among different agencies at the local level leads to the better EMS practices, and (iv) the development in human resource is very vital in delivering the effective services.

Keywords: Local governments, Management, Emergency Medical Services (EMS), Thailand

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