Search results for: remote patient monitor.

Authors: Carmen Grigoraş, Victor Grigoraş, Daniela Boişteanu

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The standard investigational method for obstructive sleep apnea syndrome (OSAS) diagnosis is polysomnography (PSG), which consists of a simultaneous, usually overnight recording of multiple electro-physiological signals related to sleep and wakefulness. This is an expensive, encumbering and not a readily repeated protocol, and therefore there is need for simpler and easily implemented screening and detection techniques. Identification of apnea/hypopnea events in the screening recordings is the key factor for the diagnosis of OSAS. The analysis of a solely single-lead electrocardiographic (ECG) signal for OSAS diagnosis, which may be done with portable devices, at patient-s home, is the challenge of the last years. A novel artificial neural network (ANN) based approach for feature extraction and automatic identification of respiratory events in ECG signals is presented in this paper. A nonlinear principal component analysis (NLPCA) method was considered for feature extraction and support vector machine for classification/recognition. An alternative representation of the respiratory events by means of Kohonen type neural network is discussed. Our prospective study was based on OSAS patients of the Clinical Hospital of Pneumology from Iaşi, Romania, males and females, as well as on non-OSAS investigated human subjects. Our computed analysis includes a learning phase based on cross signal PSG annotation.

Keywords: Artificial neural networks, feature extraction, obstructive sleep apnea syndrome, pattern recognition, signalprocessing.

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Authors: Orkide Donma, Mustafa M. Donma

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Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Keywords: Basal metabolic rate, body mass index, children, diagnostic obesity notation model assessment index, obesity.

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Authors: Ravi Kiran Pothamsetty, Radha Rani Ghosh, Baby Paul Thaliath

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Radiation therapy has undergone many advancements and evloved from 2D to 3D. Recently, with rapid pace of drug discoveries, cutting edge technology, and clinical trials has made innovative advancements in computer technology and treatment planning and upgraded to intensity modulated radiotherapy (IMRT) which delivers in homogenous dose to tumor and normal tissues. The present study was a hospital-based experience comparing two different conformal radiotherapy techniques for brain tumors. This analytical study design has been conducted at Regional Cancer Centre, India from January 2014 to January 2015. Ten patients have been selected after inclusion and exclusion criteria. All the patients were treated on Artiste Siemens Linac Accelerator. The tolerance level for maximum dose was 6.0 Gyfor lenses and 54.0 Gy for brain stem, optic chiasm and optical nerves as per RTOG criteria. Mean and standard deviation values of PTV98%, PTV 95% and PTV 2% in IMRT were 93.16±2.9, 95.01±3.4 and 103.1±1.1 respectively; for 3DCRT were 91.4±4.7, 94.17±2.6 and 102.7±0.39 respectively. PTV max dose (%) in IMRT and 3D-CRT were 104.7±0.96 and 103.9±1.0 respectively. Maximum dose to the tumor can be delivered with IMRT with acceptable toxicity limits. Variables such as expertise, location of tumor, patient condition, and TPS influence the outcome of the treatment.

Keywords: IMRT, 3D CRT, Brain, tumors, OARs, RTOG.

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Authors: V. R. Ahire, A. Kumar, B. N. Pandey, K. P. Mishra, G. R. Kulkarni

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Radiation therapy is an effective vital strategy used globally in the treatment of cervical cancer. However, radiation efficacy principally depends on the radiosensitivity of the tumor, and not all patient exhibit significant response to irradiation. A radiosensitive tumor is easier to cure than a radioresistant tumor which later advances to local recurrence and metastasis. Herbal polyphenols are gaining attention for exhibiting radiosensitization through various signaling. Current work focuses to study the radiosensitization effect of ellagic acid (EA), on HeLa cells. EA intermediated radiosensitization of HeLa cells was due to the induction γ-H2AX foci formation, G1 phase cell cycle arrest, and loss of reproductive potential, growth inhibition, drop in the mitochondrial membrane potential and protein expression studies that eventually induced apoptosis. Irradiation of HeLa in presence of EA (10 μM) to doses of 2 and 4 Gy γ-radiation produced marked tumor cytotoxicity. EA also demonstrated radio-protective effect on normal cell, NIH3T3 and aided recovery from the radiation damage. Our results advocate EA to be an effective adjuvant for improving cancer radiotherapy as it displays striking tumor cytotoxicity and reduced normal cell damage instigated by irradiation.

Keywords: Apoptotic radiosensitivity, ellagic acid, mitochondrial potential, cell-cycle arrest.

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Authors: Intan Maisarah Abd Rahim, Herlina Abdul Rahim, Rashidah Ghazali

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Diabetes is a medical condition that can lead to various diseases such as stroke, heart disease, blindness and obesity. In clinical practice, the concern of the diabetic patients towards the blood glucose examination is rather alarming as some of the individual describing it as something painful with pinprick and pinch. As for some patient with high level of glucose level, pricking the fingers multiple times a day with the conventional glucose meter for close monitoring can be tiresome, time consuming and painful. With these concerns, several non-invasive techniques were used by researchers in measuring the glucose level in blood, including ultrasonic sensor implementation, multisensory systems, absorbance of transmittance, bio-impedance, voltage intensity, and thermography. This paper is discussing the application of the near-infrared (NIR) spectroscopy as a non-invasive method in measuring the glucose level and the implementation of the linear system identification model in predicting the output data for the NIR measurement. In this study, the wavelengths considered are at the 1450 nm and 1950 nm. Both of these wavelengths showed the most reliable information on the glucose presence in blood. Then, the linear Autoregressive Moving Average Exogenous model (ARMAX) model with both un-regularized and regularized methods was implemented in predicting the output result for the NIR measurement in order to investigate the practicality of the linear system in this study. However, the result showed only 50.11% accuracy obtained from the system which is far from the satisfying results that should be obtained.

Keywords: Diabetes, glucose level, linear, near-infrared (NIR), non-invasive, prediction system.

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Authors: Nadir A. Carreón, Christa Sonderer, Aakarsh Rao, Roman Lysecky

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With the advent of complex software and increased connectivity, security of life-critical medical devices is becoming an increasing concern, particularly with their direct impact to human safety. Security is essential, but it is impossible to develop completely secure and impenetrable systems at design time. Therefore, it is important to assess the potential impact on security and safety of exploiting a vulnerability in such critical medical systems. The common vulnerability scoring system (CVSS) calculates the severity of exploitable vulnerabilities. However, for medical devices, it does not consider the unique challenges of impacts to human health and privacy. Thus, the scoring of a medical device on which a human life depends (e.g., pacemakers, insulin pumps) can score very low, while a system on which a human life does not depend (e.g., hospital archiving systems) might score very high. In this paper, we present a Medical Vulnerability Scoring System (MVSS) that extends CVSS to address the health and privacy concerns of medical devices. We propose incorporating two new parameters, namely health impact and sensitivity impact. Sensitivity refers to the type of information that can be stolen from the device, and health represents the impact to the safety of the patient if the vulnerability is exploited (e.g., potential harm, life threatening). We evaluate 15 different known vulnerabilities in medical devices and compare MVSS against two state-of-the-art medical device-oriented vulnerability scoring system and the foundational CVSS.

Keywords: Common vulnerability system, medical devices, medical device security, vulnerabilities.

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Authors: Jing Jia, Shanqing Huang, Fang Liu, Qiang Ren, Gui Li, Mengyun Cheng, Chufeng Jin, Yican Wu

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Medical image registration is the key technology in image guided radiation therapy (IGRT) systems. On the basis of the previous work on our IGRT prototype with a biorthogonal x-ray imaging system, we described a method focused on the 2D/2D rigid-body registration using multiresolution pyramid based mutual information in this paper. Three key steps were involved in the method ： firstly, four 2D images were obtained including two x-ray projection images and two digital reconstructed radiographies（DRRs ） as the input for the registration ； Secondly, each pair of the corresponding x-ray image and DRR image were matched using multiresolution pyramid based mutual information under the ITK registration framework ； Thirdly, we got the final couch offset through a coordinate transformation by calculating the translations acquired from the two pairs of the images. A simulation example of a parotid gland tumor case and a clinical example of an anthropomorphic head phantom were employed in the verification tests. In addition, the influence of different CT slice thickness were tested. The simulation results showed that the positioning errors were 0.068±0.070, 0.072±0.098, 0.154±0.176mm along three axes which were lateral, longitudinal and vertical. The clinical test indicated that the positioning errors of the planned isocenter were 0.066, 0.07, 2.06mm on average with a CT slice thickness of 2.5mm. It can be concluded that our method with its verified accuracy and robustness can be effectively used in IGRT systems for patient setup.

Keywords: 2D/2D registration, image guided radiation therapy, multi resolution pyramid, mutual information.

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Authors: Cleto J. Sauer Jr

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Introduction: Brazil’s new national curriculum guidelines (NCG) for medical education were published in 2014, presenting active learning methodologies as a cornerstone. Simulation was initially applied for aviation pilots’ training and is currently applied in health sciences. The high-fidelity simulator replicates human body anatomy in detail, also reproducing physiological functions and its use is increasing in medical schools. Realistic Simulation (RS) has pedagogical aspects that are aligned with Brazil’s NCG teaching concepts. The main objective of this study is to carry on a narrative review on RS’s aspects that are aligned with Brazil’s new NCG teaching concepts. Methodology: A narrative review was conducted, with search in three databases (PubMed, Embase and BVS) of studies published between 2010 and 2020. Results: After systematized search, 49 studies were selected and divided into four thematic groups. RS is aligned with new Brazilian medical curriculum as it is an active learning methodology, providing greater patient safety, uniform teaching, and student's emotional skills enhancement. RS is based on reflective learning, a teaching concept developed for adult’s education. Conclusion: RS is a methodology aligned with NCG teaching concepts and has potential to assist in the implementation of new Brazilian medical school’s curriculum. It is an immersive and interactive methodology, which provides reflective learning in a safe environment for students and patients.

Keywords: Curriculum, high-fidelity simulator, medical education, realistic simulation.

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Authors: Jefrey Pilusa, Tumisang Seodigeng

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This research discusses a South African case study for the potential of utilizing refuse-derived fuel (RDF) obtained from non-burn treatment of health care risk waste (HCRW) as potential feedstock for green energy production. This specific waste stream can be destroyed via non-burn treatment technology involving high-speed mechanical shredding followed by steam or chemical injection to disinfect the final product. The RDF obtained from this process is characterised by a low moisture, low ash, and high calorific value which means it can be potentially used as high-value solid fuel. Due to the raw feed of this RDF being classified as hazardous, the final RDF has been reported to be non-infectious and can blend with other combustible wastes such as rubber and plastic for waste to energy applications. This study evaluated non-burn treatment technology as a possible solution for on-site destruction of HCRW in South African private and public health care centres. Waste generation quantities were estimated based on the number of registered patient beds, theoretical bed occupancy. Time and motion study was conducted to evaluate the logistics viability of on-site treatment. Non-burn treatment technology for HCRW is a promising option for South Africa, and successful implementation of this method depends upon the initial capital investment, operational cost and environmental permitting of such technology; there are other influencing factors such as the size of the waste stream, product off-take price as well as product demand.

Keywords: Autoclave, disposal, fuel, incineration, medical waste.

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Authors: Adile Shaqiri, Arjeta Shaqiri Latifi

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Domestic violence, trafficking with human beings especially violence against children, is a worldwide problem. Hence, it remains one of the most widespread forms of violence in Kosovo and which often continues to be described as a "closed door issue". Recognition, acceptance and prioritization of cases of domestic violence definitely require a much greater awareness of individuals in institutions for the risks, consequences and costs that the lack of such a well-coordinated response brings to the country. Considering that children are the future and the wealth of the country, violence and neglect against them should be treated as carefully as possible. The purpose of this paper is to identify steps towards prevention of the domestic violence and trafficking with human beings, so that the reflection of the consequences and the psychological flow do not reflect to a large extent in society. In this study is described: How is the phenomenon of domestic violence related to trafficking in human beings? The methods used are: historical, comparative, qualitative. Data derived from the relevant institutions were presented, i.e., by the actors who are the first reactors as well as the policy makers. Although these phenomena are present in all countries of the world, Kosovo is no exception and therefore comparisons of the development of child abuse have been made with other countries in the region as well. Since Kosovo is a country in transition, a country with a relatively high level of education, low economic development, high unemployment, political instability, dysfunctional legal infrastructure, it can be concluded that the potential for the development of negative phenomena is present and inevitable. Thus, during the research, the stages of development of these phenomena are analyzed, determining the causes and consequences which come from abuse, neglect of children and the impact on trafficking in human beings. The Kosovar family (parental responsibility), culture and religion, social services, the dignity of the abused child, etc. were analyzed. The review was also done on the legislation, educational institutions (curricula), governmental and non-governmental institutions their responsibilities and cooperation towards combating child abuse and trafficking. It is worth noting that during the work on paper, recommendations and conclusions have been drawn where it is concluded that we need an environment with educational reforms, stability in the political environment, economic development, a review of social policies, greater awareness of society, more adequate information through media, so that information and awareness could penetrate even in the most remote places of Kosovo society.

Keywords: Awareness, education, information, society, violence.

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Authors: Mojiri M, Ghazi Khanloo Sani K, Moghim Beigi A

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The aim of this study was to compare the sensitometric properties of commonly used radiographic films processed with chemical solutions in different workload hospitals. The effect of different processing conditions on induced densities on radiologic films was investigated. Two accessible double emulsions Fuji and Kodak films were exposed with 11-step wedge and processed with Champion and CPAC processing solutions. The mentioned films provided in both workloads centers, high and low. Our findings displays that the speed and contrast of Kodak filmscreen in both work load (high and low) is higher than Fuji filmscreen for both processing solutions. However there was significant differences in films contrast for both workloads when CPAC solution had been used (p=0.000 and 0.028). The results showed base plus fog density for Kodak film was lower than Fuji. Generally Champion processing solution caused more speed and contrast for investigated films in different conditions and there was significant differences in 95% confidence level between two used processing solutions (p=0.01). Low base plus fog density for Kodak films provide more visibility and accuracy and higher contrast results in using lower exposure factors to obtain better quality in resulting radiographs. In this study we found an economic advantages since Champion solution and Kodak film are used while it makes lower patient dose. Thus, in a radiologic facility any change in film processor/processing cycle or chemistry should be carefully investigated before radiological procedures of patients are acquired.

Keywords: Sensitometry, densitometry, Radiographic film, processing solution

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Authors: Kay-Anne Haykal, Issack Biyong

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The post-traumatic stress disorder (PTSD) rises from exposure to a traumatic event and appears by a persistent experience of this event. Several psychiatric co-morbidities are associated with PTSD and include mood disorders, anxiety disorders, and substance abuse. The main objective was to compare the criteria for PTSD according to the literature to those used to diagnose a patient in a francophone hospital and to check the correspondence of these two criteria. 700 medical charts of admitted patients on the medicine or psychiatric unit at the Montfort Hospital were identified with the following diagnoses: major depressive disorder, bipolar disorder, anxiety disorder, substance abuse, and PTSD for the period of time between April 2005 and March 2006. Multiple demographic criteria were assembled. Also, for every chart analyzed, the PTSD criteria, according to the Manual of Mental Disorders (DSM) IV were found, identified, and grouped according to pre-established codes. An analysis using the receiver operating characteristic (ROC) method was elaborated for the study of data. A sample of 57 women and 50 men was studied. Age was varying between 18 and 88 years with a median age of 48. According to the PTSD criteria in the DSM IV, 12 patients should have the diagnosis of PTSD in opposition to only two identified in the medical charts. The ROC method establishes that with the combination of data from PTSD and depression, the sensitivity varies between 0,127 and 0,282, and the specificity varies between 0,889 and 0,917. Otherwise, if we examine the PTSD data alone, the sensibility jumps to 0.50, and the specificity varies between 0,781 and 0,895. This study confirms the presence of an underdiagnosed and treated PTSD that causes severe perturbations for the affected individual.

Keywords: Post-Traumatic Stress Disorder, diagnosis, co-morbidities, mental health disorders.

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Authors: Tausif A. Ishtiaque, Zarrin T. Tasin, Kazi S. Akter

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Current trend of urban expansion, especially in the developing countries has caused significant changes in land cover, which is generating great concern due to its widespread environmental degradation. Energy consumption of the cities is also increasing with the aggravated heat island effect. Distribution of land surface temperature (LST) is one of the most significant climatic parameters affected by urban land cover change. Recent increasing trend of LST is causing elevated temperature profile of the built up area with less vegetative cover. Gradual change in land cover, especially decrease in vegetative cover is enhancing the Urban Heat Island (UHI) effect in the developing cities around the world. Increase in the amount of urban vegetation cover can be a useful solution for the reduction of UHI intensity. LST and Normalized Difference Vegetation Index (NDVI) have widely been accepted as reliable indicators of UHI and vegetation abundance respectively. Chittagong, the second largest city of Bangladesh, has been a growth center due to rapid urbanization over the last several decades. This study assesses the intensity of UHI in Chittagong city by analyzing the relationship between LST and NDVI based on the type of land use/land cover (LULC) in the study area applying an integrated approach of Geographic Information System (GIS), remote sensing (RS), and regression analysis. Land cover map is prepared through an interactive supervised classification using remotely sensed data from Landsat ETM+ image along with NDVI differencing using ArcGIS. LST and NDVI values are extracted from the same image. The regression analysis between LST and NDVI indicates that within the study area, UHI is directly correlated with LST while negatively correlated with NDVI. It interprets that surface temperature reduces with increase in vegetation cover along with reduction in UHI intensity. Moreover, there are noticeable differences in the relationship between LST and NDVI based on the type of LULC. In other words, depending on the type of land usage, increase in vegetation cover has a varying impact on the UHI intensity. This analysis will contribute to the formulation of sustainable urban land use planning decisions as well as suggesting suitable actions for mitigation of UHI intensity within the study area.

Keywords: Land cover change, land surface temperature, normalized difference vegetation index, urban heat island.

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Authors: Molly P. M. Wong

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In this study, a blended and interactive e-learning Courseware that our team developed will be introduced, and our team’s experiences on how the e-learning Courseware and the flipped classroom benefit student learning in bioethics in the medical program will be shared. This study is a continuation of the previously established study, which provides a summary of the well-developed e-learning Courseware in a blended learning approach and an update on its efficiency and efficacy. First, a collection of animated videos capturing selected topics of bioethics and related ethical issues and dilemma will be introduced. Next, a selection of problem-based learning videos (“simulated doctor-patient role play”) with pop-up questions and discussions will be further discussed. Our findings demonstrated that these activities launched by the Courseware strongly engaged students in bioethics education and enhanced students’ critical thinking and creativity. Moreover, the educational benefits of the online art exhibition, art jamming and competition will be discussed, through which students could express bioethics through arts and enrich their learning in medical research in an interactive, fun and entertaining way, strengthening their interests in bioethics. Furthermore, online survey questionnaires and focus group interviews were conducted. Our results indicated that implementing the e-learning Courseware with a flipped classroom in bioethics education enhanced both active learning and student engagement. In conclusion, our Courseware not only reinforces education in art, bioethics and medicine, but also benefits students in understanding and critical thinking in socio-ethical issues, and serves as a valuable learning tool in bioethics teaching and learning.

Keywords: Bioethics, courseware, e-learning, flipped classroom.

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Authors: Ritwik Dutta, Marilyn Wolf

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This paper describes the tradeoffs and the design from scratch of a self-contained, easy-to-use health dashboard software system that provides customizable data tracking for patients in smart homes. The system is made up of different software modules and comprises a front-end and a back-end component. Built with HTML, CSS, and JavaScript, the front-end allows adding users, logging into the system, selecting metrics, and specifying health goals. The backend consists of a NoSQL Mongo database, a Python script, and a SimpleHTTPServer written in Python. The database stores user profiles and health data in JSON format. The Python script makes use of the PyMongo driver library to query the database and displays formatted data as a daily snapshot of user health metrics against target goals. Any number of standard and custom metrics can be added to the system, and corresponding health data can be fed automatically, via sensor APIs or manually, as text or picture data files. A real-time METAR request API permits correlating weather data with patient health, and an advanced query system is implemented to allow trend analysis of selected health metrics over custom time intervals. Available on the GitHub repository system, the project is free to use for academic purposes of learning and experimenting, or practical purposes by building on it.

Keywords: Flask, Java, JavaScript, health monitoring, long term care, Mongo, Python, smart home, software engineering, webserver.

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

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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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Authors: Mohd Sidek Ahmad, Zainon Mohd Noor, Zaidah Zainal Ariffin

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Fibrin degradation is an important part in prevention or treatment of intravascular thrombosis and cardiovascular diseases. Plasmin like fibrinolytic enzymes has given new hope to patient with cardiovascular diseases by treating fibrin aggregation related diseases with traditional plasminogen activator which have many side effects. Various researches involving wide range of sources for production of fibrinolytic proteases, from bacteria, fungi, insects and fermented foods. But few have looked into endophytic fungi as a potential source. Sixteen (16) endophytic fungi were isolated from Hibiscus sp. leaves from six different locations in Shah Alam, Selangor. Only two endophytic fungi, FH3 and S13 showed positive fibrinolytic protease activities. FH3 produced 5.78cm and S13 produced 4.48cm on Skim Milk Agar after 4 days of incubation at 27°C. Fibrinolytic activity was observed; 3.87cm and 1.82cm diameter clear zone on fibrin plate of FH3 and S13 respectively. 18srRNA was done for identification of the isolated fungi with positive fibrinolytic protease. S13 had the highest similarity (100%) to that of Penicillium citrinum strain TG2 and FH3 had the highest similarity (99%) to that of Fusarium sp. FW2PhC1, Fusarium sp. 13002, Fusarium sp. 08006, Fusarium equiseti strain Salicorn 8 and Fungal sp. FCASAn-2. Media composition variation showed the effects of carbon nitrogen on protein concentration, where the decrement of 50% of media composition caused drastic decrease in protease of FH3 from 1.081 to 0.056 and also S13 from 2.946 to 0.198.

Keywords: Isolation, identification, fibrinolytic protease, endophytic fungi, Hibiscus leaves.

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Authors: D. Bheenick, M. Young, M. Elmussareh, A. Ali

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Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. To conduct the study, retrospective data of patients presenting acutely to the urology department were collected between January 13 to March 22, 2020 (pre-lockdown period) and March 23 to May 31, 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Included in the study were 1092 patients. The results show that an overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. The results of the study concluded that the admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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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: Mannan Mridha, Usama Gazay, Kosovare V. Aslani, Hugo Linder, Alice Ravizza, Carmelo de Maria

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In most developing countries, although the vast majority of the people are living in the rural areas, the qualified medical doctors are not available there. Health care workers and paramedics, called village doctors, informal healthcare providers, are largely responsible for the rural medical care. Mishaps due to wrong diagnosis and inappropriate medication have been causing serious suffering that is preventable. While innovators have created many devices, the vast majority of these technologies do not find applications to address the needs and conditions in low-resource settings. The primary motive is to address the acute lack of affordable medical technologies for the poor people in low-resource settings. A low cost smart medical device that is portable, battery operated and can be used at any point of care has been developed to detect breathing rate, electrocardiogram (ECG) and arterial pulse rate to improve diagnosis and monitoring of patients and thus improve care and safety. This simple and easy to use smart medical device can be used, managed and maintained effectively and safely by any health worker with some training. In order to empower the health workers and village doctors, our device is being further developed to integrate with ICT tools like smart phones and connect to the medical experts wherever available, to manage the serious health problems.

Keywords: Healthcare for low resources settings, health awareness education, improve patient care and safety, smart and affordable medical device.

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Authors: Sheikh Shams Azam, Manoj Raju, Venkatesh Pagidimarri, Vamsi Kasivajjala

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Over the past decade, there has been a steep rise in the data-driven analysis in major areas of medicine, such as clinical decision support system, survival analysis, patient similarity analysis, image analytics etc. Most of the data in the field are well-structured and available in numerical or categorical formats which can be used for experiments directly. But on the opposite end of the spectrum, there exists a wide expanse of data that is intractable for direct analysis owing to its unstructured nature which can be found in the form of discharge summaries, clinical notes, procedural notes which are in human written narrative format and neither have any relational model nor any standard grammatical structure. An important step in the utilization of these texts for such studies is to transform and process the data to retrieve structured information from the haystack of irrelevant data using information retrieval and data mining techniques. To address this problem, the authors present Q-Map in this paper, which is a simple yet robust system that can sift through massive datasets with unregulated formats to retrieve structured information aggressively and efficiently. It is backed by an effective mining technique which is based on a string matching algorithm that is indexed on curated knowledge sources, that is both fast and configurable. The authors also briefly examine its comparative performance with MetaMap, one of the most reputed tools for medical concepts retrieval and present the advantages the former displays over the latter.

Keywords: Information retrieval (IR), unified medical language system (UMLS), Syntax Based Analysis, natural language processing (NLP), medical informatics.

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Authors: Ilma Robo, Saimir Heta, Greta Plaka, Vera Ostreni

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Purpose: Drug gingival hyperplasia is an uncommon pathology encountered during routine work in dental units. The purpose of this paper is to present the clinical appearance of gingival hyperplasia caused by medications. There are already three classes of medications that cause hyperplasia and based on data from the literature, the clinical cases encountered and included in this study have been compared. Materials and Methods: The study was conducted in a total of 311 patients, out of which 182 patients were included in our study, meeting the inclusion criteria. After each patient's history was recorded and it was found that patients were in their knowledge of chronic illness, undergoing treatment of gingivitis hypertrophic drugs was performed with a clinical examination of oral cavity and assessment by vertical and horizontal evaluation according to the periodontal indexes. Results: Of the data collected during the study, it was observed that 97% of patients with gingival hyperplasia are treated with nifedipine. 84% of patients treated with selected medicines and gingival hyperplasia in the oral cavity has been exposed at time period for more than 1 year and 1 month. According to the GOI, in the first rank of this index are about 21% of patients, in the second rank are 52%, in the third rank are 24% and in the fourth grade are 3%. According to the horizontal growth index of gingival hyperplasia, grade 1 included about 61% of patients and grade 2 included about 39% of patients with gingival hyperplasia. Bacterial index divides patients by degrees: grading 0 - 8.2%, grading 1 - 32.4%, grading 2 - 14% and grading 3 - 45.1%. Conclusions: The highest percentage of gingival hyperplasia caused by drugs is due to dosing of nifedipine for a duration of dosing and application for systemic healing for more than 1 year.

Keywords: Drug gingival hyperplasia, horizontal growth index, vertical growth index.

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Authors: D. Hilton

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The importance and significance of this research is based upon the fundamental knowledge reported in the scientific literature that physical activity is inversely associated with obesity. In addition, it is recognized there is a global epidemic of sedentariness while at the same time it is known that morbidity and mortality are associated with physical inactivity and as a result of overweight or obesity. Hence this small study in school students is an important area of research in our community. An application submitted in 2005 for the inaugural Public Health Education Research Trust [PHERT] Post Graduate Research Scholarship scheme organized by the Public Health Association of Australia [PHAA] was awarded 3rd place within Australia. The author and title was: D. Hilton, Methods to increase physical activity in school aged children [literature review, a trial using pedometers and a policy paper]. Third place is a good result, however this did not secure funding for the project, as only first place received $5000 funding. Some years later within Australia, a program commenced called the Global Children's Challenge [GCC]. Given details of the 2005 award above were included an application submission prepared for Parkhill Primary School [PPS] which is located in Victoria, Australia was successful. As a result, an excited combined grade 3/ 4 class at the school [27 students] in 2012 became recipients of these free pedometers. Ambassadors for the program were Mrs Catherine Freeman [OAM], Olympic Gold Medalist – Sydney 2000 [400 meters], while another ambassador was Mr Colin Jackson [CBE] who is a Welsh former sprint and hurdling athlete. In terms of PPS and other schools involved in 2012, website details show that the event started on 19th Sep 2012 and students were to wear the pedometer every day for 50 days [at home and at school] aiming for the recommended 15,000 steps/day recording steps taken in a booklet provided. After the finish, an analysis of the average step count for this school showed that the average steps taken / day was 14, 003 [however only a small percentage of students returned the booklets and units] as unfortunately the dates for the program coincided with school holidays so some students either forgot or misplaced the units / booklets. Unfortunately funding for this program ceased in 2013, however the lasting impact of the trial on student’s knowledge and awareness remains and in fact becomes a good grounding for students in how to monitor basic daily physical activity using a method that is easy, fun, low cost and readily accessible.

Keywords: Walking, exercise, physical activity [motor activity].

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Authors: M. McHugh, D. Lillis

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Mobile applications are being used to perform a wide variety of tasks in day-to-day life, ranging from checking email to controlling your home heating. Application developers have recognized the potential to transform a smart device into a medical device, by using a mobile medical application i.e. a mobile phone or a tablet. When initially conceived these mobile medical applications performed basic functions e.g. BMI calculator, accessing reference material etc.; however, increasing complexity offers clinicians and patients a range of functionality. As this complexity and functionality increases, so too does the potential risk associated with using such an application. Examples include any applications that provide the ability to inflate and deflate blood pressure cuffs, as well as applications that use patient-specific parameters and calculate dosage or create a dosage plan for radiation therapy. If an unapproved mobile medical application is marketed by a medical device organization, then they face significant penalties such as receiving an FDA warning letter to cease the prohibited activity, fines and possibility of facing a criminal conviction. Regulatory bodies have finalized guidance intended for mobile application developers to establish if their applications are subject to regulatory scrutiny. However, regulatory controls appear contradictory with the approaches taken by mobile application developers who generally work with short development cycles and very little documentation and as such, there is the potential to stifle further improvements due to these regulations. The research presented as part of this paper details how by adopting development techniques, such as agile software development, mobile medical application developers can meet regulatory requirements whilst still fostering innovation.

Keywords: Medical, mobile, applications, software Engineering, FDA, standards, regulations, agile.

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Authors: Catherine A. Todd, Fazel Naghdy

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In this work a surgical simulator is produced which enables a training otologist to conduct a virtual, real-time prosthetic insertion. The simulator provides the Ear, Nose and Throat surgeon with real-time visual and haptic responses during virtual cochlear implantation into a 3D model of the human Scala Tympani (ST). The parametric model is derived from measured data as published in the literature and accounts for human morphological variance, such as differences in cochlear shape, enabling patient-specific pre- operative assessment. Haptic modeling techniques use real physical data and insertion force measurements, to develop a force model which mimics the physical behavior of an implant as it collides with the ST walls during an insertion. Output force profiles are acquired from the insertion studies conducted in the work, to validate the haptic model. The simulator provides the user with real-time, quantitative insertion force information and associated electrode position as user inserts the virtual implant into the ST model. The information provided by this study may also be of use to implant manufacturers for design enhancements as well as for training specialists in optimal force administration, using the simulator. The paper reports on the methods for anatomical modeling and haptic algorithm development, with focus on simulator design, development, optimization and validation. The techniques may be transferrable to other medical applications that involve prosthetic device insertions where user vision is obstructed.

Keywords: Haptic modeling, medical device insertion, real-time visualization of prosthetic implantation, surgical simulation.

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Authors: Mohd Azman Abdul Latif, Erwan Basiron

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A flaw or drift from expected operational performance in one component (NAND, PMIC, controller, DRAM, etc.) may affect the reliability of the entire Solid State Drive (SSD) system. Therefore, it is important to ensure the required quality of each individual component through qualification testing specified using standards or user requirements. Qualification testing is time-consuming and comes at a substantial cost for product manufacturers. A highly technical team, from all the eminent stakeholders is embarking on reliability prediction from beginning of new product development, identify critical to reliability parameters, perform full-blown characterization to embed margin into product reliability and establish control to ensure the product reliability is sustainable in the mass production. The paper will discuss a comprehensive development framework, comprehending SSD end to end from design to assembly, in-line inspection, in-line testing and will be able to predict and to validate the product reliability at the early stage of new product development. During the design stage, the SSD will go through intense reliability margin investigation with focus on assembly process attributes, process equipment control, in-process metrology and also comprehending forward looking product roadmap. Once these pillars are completed, the next step is to perform process characterization and build up reliability prediction modeling. Next, for the design validation process, the reliability prediction specifically solder joint simulator will be established. The SSD will be stratified into Non-Operating and Operating tests with focus on solder joint reliability and connectivity/component latent failures by prevention through design intervention and containment through Temperature Cycle Test (TCT). Some of the SSDs will be subjected to the physical solder joint analysis called Dye and Pry (DP) and Cross Section analysis. The result will be feedbacked to the simulation team for any corrective actions required to further improve the design. Once the SSD is validated and is proven working, it will be subjected to implementation of the monitor phase whereby Design for Assembly (DFA) rules will be updated. At this stage, the design change, process and equipment parameters are in control. Predictable product reliability at early product development will enable on-time sample qualification delivery to customer and will optimize product development validation, effective development resource and will avoid forced late investment to bandage the end-of-life product failures. Understanding the critical to reliability parameters earlier will allow focus on increasing the product margin that will increase customer confidence to product reliability.

Keywords: e2e reliability prediction, SSD, TCT, Solder Joint Reliability, NUDD, connectivity issues, qualifications, characterization and control.

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Authors: Anurag Gaur, Nidhi, Shashi Sharma

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Targeted drug delivery is a method of delivering medication to a patient in a manner that increases the concentration of the medication in some parts of the body relative to others. Targeted drug delivery seeks to concentrate the medication in the tissues of interest while reducing the relative concentration of the medication in the remaining tissues. This improves efficacy of the while reducing side effects. In the present work, we investigate the effect of magnetic field, flow rate and particle concentration on the capturing of magnetic particles transported in a stent implanted fluidic channel. Iron oxide magnetic nanoparticles (Fe3O4) nanoparticles were synthesized via co-precipitation method. The synthesized Fe3O4 nanoparticles were added in the de-ionized (DI) water to prepare the Fe3O4 magnetic particle suspended fluid. This fluid is transported in a cylindrical tube of diameter 8 mm with help of a peristaltic pump at different flow rate (25-40 ml/min). A ferromagnetic coil of SS 430 has been implanted inside the cylindrical tube to enhance the capturing of magnetic nanoparticles under magnetic field. The capturing of magnetic nanoparticles was observed at different magnetic magnetic field, flow rate and particle concentration. It is observed that capture efficiency increases from 47-67% at magnetic field 2-5kG, respectively at particle concentration 0.6mg/ml and at flow rate 30 ml/min. However, the capture efficiency decreases from 65 to 44% by increasing the flow rate from 25 to 40 ml/min, respectively. Furthermore, it is observed that capture efficiency increases from 51 to 67% by increasing the particle concentration from 0.3 to 0.6 mg/ml, respectively.

Keywords: Capture efficiency, Implant assisted-Magnetic drug targeting (IA-MDT), Magnetic nanoparticles, in vitro study.

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Authors: Patricia B. Cruz, Catrina Jean G. Valenzuela, Analyn N. Yumang

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Nearly a hundred per million of the Filipino population is diagnosed with Chronic Kidney Disease (CKD). The early stage of CKD has no symptoms and can only be discovered once the patient undergoes urinalysis. Over the years, different methods were discovered and used for the quantification of the urinary albumin such as the immunochemical assays where most of these methods require large machinery that has a high cost in maintenance and resources, and a dipstick test which is yet to be proven and is still debated as a reliable method in detecting early stages of microalbuminuria. This research study involves the use of the liquid chromatography concept in microfluidic instruments with biosensor as a means of separation and detection respectively, and linear regression to quantify human urinary albumin. The researchers’ main objective was to create a miniature system that quantifies and detect patients’ urinary albumin while reducing the amount of volume used per five test samples. For this study, 30 urine samples of unknown albumin concentrations were tested using VITROS Analyzer and the microfluidic system for comparison. Based on the data shared by both methods, the actual vs. predicted regression were able to create a positive linear relationship with an R² of 0.9995 and a linear equation of y = 1.09x + 0.07, indicating that the predicted values and actual values are approximately equal. Furthermore, the microfluidic instrument uses 75% less in total volume – sample and reagents combined, compared to the VITROS Analyzer per five test samples.

Keywords: Chronic kidney disease, microfluidics, linear regression, VITROS analyzer, urinary albumin.

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Authors: Obaid AlOtaibi, Salman Hussain

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Wind energy is associated with many geographical factors including wind speed, climate change, surface topography, environmental impacts, and several economic factors, most notably the advancement of wind technology and energy prices. It is the fastest-growing and least economically expensive method for generating electricity. Wind energy generation is directly related to the characteristics of spatial wind. Therefore, the feasibility study for the wind energy conversion system is based on the value of the energy obtained relative to the initial investment and the cost of operation and maintenance. In Kuwait, wind energy is an appropriate choice as a source of energy generation. It can be used in groundwater extraction in agricultural areas such as Al-Abdali in the north and Al-Wafra in the south, or in fresh and brackish groundwater fields or remote and isolated locations such as border areas and projects away from conventional power electricity services, to take advantage of alternative energy, reduce pollutants, and reduce energy production costs. The study covers the State of Kuwait with an exception of metropolitan area. Climatic data were attained through the readings of eight distributed monitoring stations affiliated with Kuwait Institute for Scientific Research (KISR). The data were used to assess the daily, monthly, quarterly, and annual available wind energy accessible for utilization. The researchers applied the Suitability Model to analyze the study by using the ArcGIS program. It is a model of spatial analysis that compares more than one location based on grading weights to choose the most suitable one. The study criteria are: the average annual wind speed, land use, topography of land, distance from the main road networks, urban areas. According to the previous criteria, the four proposed locations to establish wind farm projects are selected based on the weights of the degree of suitability (excellent, good, average, and poor). The percentage of areas that represents the most suitable locations with an excellent rank (4) is 8% of Kuwait’s area. It is relatively distributed as follows: Al-Shqaya, Al-Dabdeba, Al-Salmi (5.22%), Al-Abdali (1.22%), Umm al-Hayman (0.70%), North Wafra and Al-Shaqeeq (0.86%). The study recommends to decision-makers to consider the proposed location (No.1), (Al-Shqaya, Al-Dabdaba, and Al-Salmi) as the most suitable location for future development of wind farms in Kuwait, this location is economically feasible.

Keywords: Kuwait, renewable energy, spatial analysis, wind energy.

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Authors: Dwitya Elvira, Eryati Darwin

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Background: Graves’ disease (GD) is an autoimmune thyroid disease. Imbalance of Th1/Th2 cells and T-regulatory (Treg)/Th17 cells was thought to play pivotal role in the pathogenesis of GD. Treg FoxP3 produced TGF-β to maintain regulatory function, and Th17 cells produced IL-17 as cytokines that were thought in mediating several autoimmune diseases. The aim of this study is to assess the role of IL-17 and TGF-β in the pathogenesis of GD and to investigate its correlation with Thyroid Stimulating Hormone Receptor Antibody (TRAb) and Treg FoxP3 expression. Method: 30 GD patients and 27 age and sex-matched controls were enrolled in this study. Diagnosis of GD was based on clinical and biochemical of GD. Serum IL-17, TGF-β, TRAb, and FoxP3 were measured by enzyme-linked immunosorbent assay (ELISA). Data were analyzed by using SPSS 21.0 (SPSS Inc.). Spearman rank correlation test was used for assessment of correlation. The statistical significance was accepted as P<0.05. Result: There was no significant correlation between IL-17 and TGF-β serum with expression of FoxP3 level in GD, but there was significant correlation between TGF-β and TRAb serum level (P<0.05). Serum levels of IL-17 and TGF-β were found to be elevated in patient group compared to control, where mean values of IL-17 were 14.43±2.15 pg/mL and TGF-β were 10.44±3.19 pg/mL in patients group; and in control group, level of IL-17 were 7.1±1.45 pg/mL and TGF-β were 4.95±1.35 pg/mL. Conclusion: Serum Il-17 and TGF-β were elevated in GD patients that reflect the role of inflammatory and regulatory cytokines activation in pathogenesis of GD. There was significant correlation between TGF-β and TRAb, revealing that Treg cytokines may play a role in pathogenesis of GD.

Keywords: IL-17, TGF-β, FoxP3, Graves’ disease.

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