Search results for: patient engagement.

Authors: M. Gooroochurn, M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

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A registration framework for image-guided robotic surgery is proposed for three emergency neurosurgical procedures, namely Intracranial Pressure (ICP) Monitoring, External Ventricular Drainage (EVD) and evacuation of a Chronic Subdural Haematoma (CSDH). The registration paradigm uses CT and white light as modalities. This paper presents two simulation studies for a preliminary evaluation of the registration protocol: (1) The loci of the Target Registration Error (TRE) in the patient-s axial, coronal and sagittal views were simulated based on a Fiducial Localisation Error (FLE) of 5 mm and (2) Simulation of the actual framework using projected views from a surface rendered CT model to represent white light images of the patient. Craniofacial features were employed as the registration basis to map the CT space onto the simulated intraoperative space. Photogrammetry experiments on an artificial skull were also performed to benchmark the results obtained from the second simulation. The results of both simulations show that the proposed protocol can provide a 5mm accuracy for these neurosurgical procedures.

Keywords: Image-guided Surgery, Multimodality Registration, Photogrammetry, Preoperative to Intraoperative Registration.

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Authors: Dutescu Adriana, Amariei Corneliu, Sahlian Daniela, Stanila Aurelian, Stanila Oana

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20 years of dentistry was a period of transition from communist to market economy but Romanian doctors have insufficient management knowledge. Recently, the need for modern management has increased due to technologies and superior materials appearance, as patient-s demands. Research goal is to increase efficiency by evaluating dental medical office cost categories in real pricing procedures. Empirical research is based on guided study that includes information about the association between categories of cost perception and therapeutic procedures commonly used in dental offices. Due to the obtained results to identify all the labours that make up a settled procedure costs were determined for each procedure. Financial evaluation software was created with the main functions: introducing and maintaining patient records, treatment and appointments made, procedures cost and monitoring office productivity. We believe that the study results can significantly improve the financial management of dental offices, increasing the effectiveness and quality of services.

Keywords: costs, financial methods, management.

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: Critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team.

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Authors: Rajashekar Patil, S. Mohan Kumar, Shreya Ajmera

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To understand complex living system an effort has made by mechanical engineers and dentists to deliver prompt products and services to patients concerned about their aesthetic look. Since two decades various bracket systems have designed involving techniques like milling, injection molding which are technically not flexible for the customized dental product development. The aim of this paper to design, develop a customized system which is economical and mainly emphasizes the expertise design and integration of engineering and dental fields. A custom made selfadjustable lingual bracket and customized implants are designed and developed using computer aided design (CAD) and rapid prototyping technology (RPT) to improve the smiles and to overcome the difficulties associated with conventional ones. Lengthy orthodontic treatment usually not accepted by the patients because the patient compliance is lost. Patient-s compliance can be improved by facilitating faster tooth movements by designing a localized dental vibrator using advanced engineering principles.

Keywords: Orthodontics, Prosthodontics, Lingual bracket, Implants, Dental vibrator, Computer aided design, Rapid prototyping technology.

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Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: Culture, help-seeking, integrated care, PTSD.

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Authors: Luz Janeth Ospina M.

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The fourth industrial revolution is changing the role of education substantially and, therefore, the role of instructors and learners at all levels. Education 4.0 is an imminent response to the needs of a globalized world where humans and technology are being aligned to enable endless possibilities, among them the need for students, as digital natives, to communicate effectively in at least one language besides their mother tongue, and also the requirement of developing theirs. This is an exploratory study in which a control group (N = 21), all of the students of Spanish as a foreign language at the university level, after taking a Spanish class, responded to an online questionnaire about the engagement, atmosphere, and environment in which their course was delivered. These aspects considered in the survey were relative to the instructor’s teaching style, including: (a) active, hands-on learning; (b) flexibility for in-class activities, easily switching between small group work, individual work, and whole-class discussion; and (c) integrating technology into the classroom. Strongly believing in these principles, the instructor deliberately taught the course in a SCALE-UP room, as it could facilitate such a positive and encouraging learning environment. These aspects are trends related to Education 4.0 and have become integral to the instructor’s pedagogical stance that calls for a constructive-affective role, instead of a transmissive one. As expected, with a learning environment that (a) fosters student engagement and (b) improves student outcomes, the subjects were highly engaged, which was partially due to the learning environment. An overwhelming majority (all but one) of students agreed or strongly agreed that the atmosphere and the environment were ideal. Outcomes of this study are relevant and indicate that it is about time for teachers to build up a meaningful correlation between humans and technology. We should see the trends of Education 4.0 not as a threat but as practices that should be in the hands of critical and creative instructors whose pedagogical stance responds to the needs of the learners in the 21st century.

Keywords: Active learning, education 4.0, higher education, pedagogical stance.

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Authors: Reza Ariaeinejad, Norm Archer

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Self-management is becoming a new emphasis for healthcare systems around the world. But there are many different problems with adoption of new health-related intervention systems. The situation is even more complicated for chronically ill patients with disabilities, illiteracy, and impairment in judgment in addition to their conditions, or having multiple co-morbidities. Providing online decision support to manage patient health and to provide better support for chronically ill patients is a new way of dealing with chronic disease management. In this study, the importance of mobile technology through an m-Health system that supports self-management interventions including the care provider, family and social support, education and training, decision support, recreation, and ongoing patient motivation to promote adherence and sustainability of the intervention are discussed. A proposed theoretical model for adoption and sustainability of system use is developed, based on UTAUT2 and IS Continuance of Use models, both of which have been pre-validated through longitudinal studies. The objective of this paper is to show the importance of using mobile technology in adoption and sustainability of use of an m-Health system which will result in commercially sustainable self-management support for chronically ill patients.

Keywords: M-health, e-health, self-management, disease.

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Authors: Alireza Vafaei Sadr, Vida Abedi, Jiang Li, Ramin Zand

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Missing data is a common challenge in medical research and can lead to biased or incomplete results. When the data bias leaks into models, it further exacerbates health disparities; biased algorithms can lead to misclassification and reduced resource allocation and monitoring as part of prevention strategies for certain minorities and vulnerable segments of patient populations, which in turn further reduce data footprint from the same population – thus, a vicious cycle. This study compares the performance of six imputation techniques grouped into Linear and Non-Linear models, on two different real-world electronic health records (EHRs) datasets, representing 17864 patient records. The mean absolute percentage error (MAPE) and root mean squared error (RMSE) are used as performance metrics, and the results show that the Linear models outperformed the Non-Linear models in terms of both metrics. These results suggest that sometimes Linear models might be an optimal choice for imputation in laboratory variables in terms of imputation efficiency and uncertainty of predicted values.

Keywords: EHR, Machine Learning, imputation, laboratory variables, algorithmic bias.

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Authors: Mingyang Sun, Guozheng Yan, Dasheng Liu, Lei Yang

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Driven by the demand of intelligent monitoring in rehabilitation centers or hospitals, a high accuracy real-time location system based on UWB (ultra-wideband) technology was proposed. The system measures precise location of a specific person, traces his movement and visualizes his trajectory on the screen for doctors or administrators. Therefore, doctors could view the position of the patient at any time and find them immediately and exactly when something emergent happens. In our design process, different algorithms were discussed, and their errors were analyzed. In addition, we discussed about a , simple but effective way of correcting the antenna delay error, which turned out to be effective. By choosing the best algorithm and correcting errors with corresponding methods, the system attained a good accuracy. Experiments indicated that the ranging error of the system is lower than 7 cm, the locating error is lower than 20 cm, and the refresh rate exceeds 5 times per second. In future works, by embedding the system in wearable IoT (Internet of Things) devices, it could provide not only physical parameters, but also the activity status of the patient, which would help doctors a lot in performing healthcare.

Keywords: Intelligent monitoring, IoT devices, real-time location, smart healthcare, ultra-wideband technology.

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Authors: G. H. B. Dilhari, A. A. D. T. Saparamadu

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Sri Lanka is one of the prominent countries for the coir production. The coir is one of the by-products of the coconut and the coir industry is considered to be one of the traditional industries in Sri Lanka. Because of the inherent nature of the coir industry, labourers play a significant role in the coir production process. The study has analyzed the determinants of the income of the household level coir yarn labourers. The study was conducted in the Kumarakanda Grama Niladhari division. Simple random sampling was used to generate a sample of 100 household level coir yarn labourers and structured questionnaire, personal interviews, and discussion were performed to gather the required data. The obtained data were statistically analyzed by using Statistical Package for Social Science (SPSS) software. Mann-Whitney U and Kruskal-Wallis test were performed for mean comparison. The findings revealed that the household level coir yarn industry is dominated by the female workers and it was identified that fewer numbers of workers have engaged in this industry as the main occupation. In addition to that, elderly participation in the industry is higher than the younger participation and most of them have engaged in the industry as a source of extra income. Level of education, the methods of engagement, satisfaction, engagement in the industry by the next generation, support from the government, method of government support, working hours per day, employed as a main job, number of completed units per day, suffering from job related diseases and type of the diseases were related with income level of household level coir yarn laboures. The recommendations as to flourish in future includes, technological transformation for coir yarn production, strengthening the raw material base and regulating the raw material supply, introduction of new technologies, markets and training programmes, the establishment of the labourers’ association, the initiation of micro credit schemes and better consideration about the job oriented diseases.

Keywords: Coir, Income, Sri Lanka.

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Authors: Osamah M. Al-Qershi, Khoo Bee Ee

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In recent years image watermarking has become an important research area in data security, confidentiality and image integrity. Many watermarking techniques were proposed for medical images. However, medical images, unlike most of images, require extreme care when embedding additional data within them because the additional information must not affect the image quality and readability. Also the medical records, electronic or not, are linked to the medical secrecy, for that reason, the records must be confidential. To fulfill those requirements, this paper presents a lossless watermarking scheme for DICOM images. The proposed a fragile scheme combines two reversible techniques based on difference expansion for patient's data hiding and protecting the region of interest (ROI) with tamper detection and recovery capability. Patient's data are embedded into ROI, while recovery data are embedded into region of non-interest (RONI). The experimental results show that the original image can be exactly extracted from the watermarked one in case of no tampering. In case of tampered ROI, tampered area can be localized and recovered with a high quality version of the original area.

Keywords: DICOM, reversible, ROI-based, watermarking.

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Authors: Thusitha Mabotuwana, Christopher S. Hall

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Radiologists routinely make follow-up imaging recommendations, usually based on established clinical practice guidelines, such as the Fleischner Society guidelines for managing lung nodules. In order to ensure optimal care, it is important to make guideline-compliant recommendations, and also for patients to follow-up on these imaging recommendations in a timely manner. However, determining such compliance rates after a specific finding has been observed usually requires many time-consuming manual steps. To address some of these limitations with current approaches, in this paper we discuss a methodology to automatically detect finding-specific follow-up recommendations from radiology reports and create a visualization for relevant subsequent exams showing the modality transitions. Nearly 5% of patients who had a lung related follow-up recommendation continued to have at least eight subsequent outpatient CT exams during a seven year period following the recommendation. Radiologist and section chiefs can use the proposed tool to better understand how a specific patient population is being managed, identify possible deviations from established guideline recommendations and have a patient-specific graphical representation of the imaging pathways for an abstract view of the overall treatment path thus far.

Keywords: Follow-up recommendations, care pathways, imaging pathway visualization, follow-up tracking.

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Authors: Alexander V. Libin, Manon Schladen, Assya Pascalev, Nawar Shara, Miriam Philmon, Yuri Millo, Joseph Verbalis

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Chronic conditions carry with them strong emotions and often lead to charged relationships between patients and their health providers and, by extension, patients and health researchers. Persons are both autonomous and relational and a purely cognitive model of autonomy neglects the social and relational basis of chronic illness. Ensuring genuine informed consent in research requires a thorough understanding of how participants perceive a study and their reasons for participation. Surveys may not capture the complexities of reasoning that underlies study participation. Contradictory reasons for participation, for instance an initial claim of altruism as rationale and a subsequent claim of personal benefit (therapeutic misconception), affect the quality of informed consent. Individuals apply principles through the filter of personal values and lived experience. Authentic autonomy, and hence authentic consent to research, occurs within the context of patients- unique life narratives and illness experiences.

Keywords: ethical dilemmas, open source technology, patient education, psychology of decision making

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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: E. Irankhah, M. Zarif, E. Mazrooei Rad, K. Ghandehari

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Alzheimer's prevalence is on the rise, and the disease comes with problems like cessation of treatment, high cost of treatment, and the lack of early detection methods. The pathology of this disease causes the formation of protein deposits in the brain of patients called plaque amyloid. Generally, the diagnosis of this disease is done by performing tests such as a cerebrospinal fluid, CT scan, MRI, and spinal cord fluid testing, or mental testing tests and eye tracing tests. In this paper, we tried to use the Medial Temporal Atrophy (MTA) method and the Leave One Out (LOO) cycle to extract the statistical properties of the three Fz, Pz, and Cz channels of ERP signals for early diagnosis of this disease. In the process of CT scan images, the accuracy of the results is 81% for the healthy person and 88% for the severe patient. After the process of ERP signaling, the accuracy of the results for a healthy person in the delta band in the Cz channel is 81% and in the alpha band the Pz channel is 90%. In the results obtained from the signal processing, the results of the severe patient in the delta band of the Cz channel were 89% and in the alpha band Pz channel 92%.

Keywords: Alzheimer's disease, image and signal processing, medial temporal atrophy, LOO Cycle.

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Authors: Farbod Behnaminia, Saeed Samet

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The COVID-19 pandemic has paralyzed many lives until a vaccine has been available, which caused the so-called "new normal". COVID-19 is an infectious disease. It can cause significant illness or death in anyone. Governments and health officials tried to impose rules and regulations to avoid and slow down transmission. Therefore, software engineers worldwide developed applications to trace and track patients’ movements and notify others, mainly using Bluetooth. In this way, everyone could be informed whether they came in close contact with someone who has COVID-19 and take proper safety precautions. Because most of the applications use technologies that can potentially reveal the user’s identity and location, researchers have debated privacy preservation and how to improve user privacy during such pandemics. We conducted a comprehensive evaluation of the literature by looking for papers in the relevant field and dividing them into pre- and post-pandemic systems. Additionally, we discussed the many uses of blockchain technology in pandemic control. We found that two major obstacles facing blockchain implementation across many healthcare systems are scalability and privacy. The Polkadot platform is presented, along with a review of its efficacy in tackling current concerns. A more scalable healthcare system is achievable in near future using Polkadot as well as a much more privacy-preserving environment.

Keywords: Blockchain, Electronic Record Management, EHR, Privacy-Preserving, patient tracking, COVID-19, trust and confidence, Polkadot.

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Authors: Vahid Nademi

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In response to widely used wearable medical devices equipped with a continuous glucose monitor (CGM) and insulin pump, the advanced control methods are still demanding to get the full benefit of these devices. Unlike costly clinical trials, implementing effective insulin-glucose control strategies can provide significant contributions to the patients suffering from chronic diseases such as diabetes. This study deals with a key role of two-layer insulin-glucose regulator based on model-predictive-control (MPC) scheme so that the patient’s predicted glucose profile is in compliance with the insulin level injected through insulin pump automatically. It is achieved by iterative optimization algorithm which is called an integrated perturbation analysis and sequential quadratic programming (IPA-SQP) solver for handling uncertainties due to unexpected variations in glucose-insulin values and body’s characteristics. The feasibility evaluation of the discussed control approach is also studied by means of numerical simulations of two case scenarios via measured data. The obtained results are presented to verify the superior and reliable performance of the proposed control scheme with no negative impact on patient safety.

Keywords: Blood glucose monitoring, insulin pump, optimization, predictive control, diabetes disease.

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Authors: Zayed N. Alsulami, Asma F. Aldosseri, Ahmed S. Ezziden, Abdulrahman K. Alonazi

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Children are more susceptible to medication errors than adults. Medication administration process is the last stage in the medication treatment process and most of the errors detected in this stage. Little research has been undertaken about medication errors in children in the Middle East countries. This study was aimed to evaluate how the paediatric nurses adhere to the medication administration policy and also to identify any medication preparation and administration errors or any risk factors. An observational, prospective study of medication administration process from when the nurses preparing patient medication until administration stage (May to August 2014) was conducted in Saudi Arabia. Twelve paediatric nurses serving 90 paediatric patients were observed. 456 drug administered doses were evaluated. Adherence rate was variable in 7 steps out of 16 steps. Patient allergy information, dose calculation, drug expiry date were the steps in medication administration with lowest adherence rates. 63 medication preparation and administration errors were identified with error rate 13.8% of medication administrations. No potentially life-threating errors were witnessed. Few logistic and administrative factors were reported. The results showed that the medication administration policy and procedure need an urgent revision to be more sensible for nurses in practice. Nurses’ knowledge and skills regarding to the medication administration process should be improved.

Keywords: Double checking, Medication administration errors, Medication safety, Nurses.

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Authors: Salwa Hagag Abdelaziz, Dorria Salem, Hoda Zaki, Suzan Atteya

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Early detection of breast cancer saves many thousands of lives each year via application of mammography and genetic screening and many more lives could be saved if nurses are involved in breast care screening practices. So, the aim of the study was to identify nurse's role in early detection of breast cancer through mammography and genetic screening and its impact on patient's outcome. In order to achieve this aim, 400 women above 40 years, asymptomatic were recruited for mammography and genetic screening. In addition, 50 nurses and 6 technologists were involved in the study. A descriptive analytical design was used. Five tools were utilized: sociodemographic, mammographic examination and risk factors, women's before, during and after mammography, items relaying to technologists, and items related to nurses were also obtained. The study finding revealed that 3% of women detected for malignancy and 7.25% for fibroadenoma. Statistically significant differences were found between mammography results and age, family history, genetic screening, exposure to smoke, and using contraceptive pills. Nurses have insufficient knowledge about screening tests. Based on these findings the present study recommended involvement of nurses in breast care which is very important to in force population about screening practices.

Keywords: Early detection, Genetic Screening, Mammography.

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Authors: V. Thulasi Bai, Srivatsa S. K.

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Deaths from cardiovascular diseases have decreased substantially over the past two decades, largely as a result of advances in acute care and cardiac surgery. These developments have produced a growing population of patients who have survived a myocardial infarction. These patients need to be continuously monitored so that the initiation of treatment can be given within the crucial golden hour. The available conventional methods of monitoring mostly perform offline analysis and restrict the mobility of these patients within a hospital or room. Hence the aim of this paper is to design a Portable Cardiac Telemedicine System to aid the patients to regain their independence and return to an active work schedule, there by improving the psychological well being. The portable telemedicine system consists of a Wearable ECG Transmitter (WET) and a slightly modified mobile phone, which has an inbuilt ECG analyzer. The WET is placed on the body of the patient that continuously acquires the ECG signals from the high-risk cardiac patients who can move around anywhere. This WET transmits the ECG to the patient-s Bluetooth enabled mobile phone using blue tooth technology. The ECG analyzer inbuilt in the mobile phone continuously analyzes the heartbeats derived from the received ECG signals. In case of any panic condition, the mobile phone alerts the patients care taker by an SMS and initiates the transmission of a sample ECG signal to the doctor, via the mobile network.

Keywords: WET, ECG analyzer, Bluetooth, mobilecellular network, high risk cardiac patients.

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Authors: N. R. N. Idris, S. Baharom

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A meta-analysis may be performed using aggregate data (AD) or an individual patient data (IPD). In practice, studies may be available at both IPD and AD level. In this situation, both the IPD and AD should be utilised in order to maximize the available information. Statistical advantages of combining the studies from different level have not been fully explored. This study aims to quantify the statistical benefits of including available IPD when conducting a conventional summary-level meta-analysis. Simulated meta-analysis were used to assess the influence of the levels of data on overall meta-analysis estimates based on IPD-only, AD-only and the combination of IPD and AD (mixed data, MD), under different study scenario. The percentage relative bias (PRB), root mean-square-error (RMSE) and coverage probability were used to assess the efficiency of the overall estimates. The results demonstrate that available IPD should always be included in a conventional meta-analysis using summary level data as they would significantly increased the accuracy of the estimates.On the other hand, if more than 80% of the available data are at IPD level, including the AD does not provide significant differences in terms of accuracy of the estimates. Additionally, combining the IPD and AD has moderating effects on the biasness of the estimates of the treatment effects as the IPD tends to overestimate the treatment effects, while the AD has the tendency to produce underestimated effect estimates. These results may provide some guide in deciding if significant benefit is gained by pooling the two levels of data when conducting meta-analysis.

Keywords: Aggregate data, combined-level data, Individual patient data, meta analysis.

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Authors: Peter U. Eze, P. Udaya, Robin J. Evans

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Data hiding can be achieved by Steganography or invisible digital watermarking. For digital watermarking, both accurate retrieval of the embedded watermark and the integrity of the cover image are important. Medical image security in Teleradiology is one of the applications where the embedded patient record needs to be extracted with accuracy as well as the medical image integrity verified. In this research paper, the Constant Correlation Spread Spectrum digital watermarking for medical image tamper detection and accurate embedded watermark retrieval is introduced. In the proposed method, a watermark bit from a patient record is spread in a medical image sub-block such that the correlation of all watermarked sub-blocks with a spreading code, W, would have a constant value, p. The constant correlation p, spreading code, W and the size of the sub-blocks constitute the secret key. Tamper detection is achieved by flagging any sub-block whose correlation value deviates by more than a small value, ℇ, from p. The major features of our new scheme include: (1) Improving watermark detection accuracy for high-pixel depth medical images by reducing the Bit Error Rate (BER) to Zero and (2) block-level tamper detection in a single computational process with simultaneous watermark detection, thereby increasing utility with the same computational cost.

Keywords: Constant correlation, medical image, spread spectrum, tamper detection, watermarking.

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Authors: L. Dixon, D. Gavani

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Objective: Sharing devastating news with patients is often considered the most difficult task of doctors. This study aimed to explore patients’ perceptions of receiving bad news including which features improve the experience and which areas need refining. Methods: A questionnaire was written based on the steps of the SPIKES model for breaking bad new. 20 patients receiving treatment for a hematological malignancy completed the questionnaire. Results: Overall, the results are promising as most patients praised their consultation. ‘Poor’ was more commonly rated by women and participants aged 45-64. The main differences between the ‘excellent’ and ‘poor’ consultations include the doctor’s sensitivity and checking the patients’ understanding. Only 35% of patients were asked their existing knowledge and 85% of consultations failed to discuss the impact of the diagnosis on daily life. Conclusion: This study agreed with the consensus of existing literature. The commended aspects include consultation set-up and information given. Areas patients felt needed improvement include doctors determining the patient’s existing knowledge and checking new information has been understood. Doctors should also explore how the diagnosis will affect the patient’s life. With a poorer prognosis, doctors should work on conveying appropriate hope. The study was limited by a small sample size and potential recall bias.

Keywords: Communication, diagnosis, hematology, patients.

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Authors: Nevila Alliu, Saimir Heta, Ilma Robo, Vera Ostreni

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Periodontitis as an oral pathology caused by specific bacterial flora functions as a focal infection for the onset and aggravation of arteriosclerosis. These two distant pathologies, since they affect organs at a distance from each other, communicate with each other with correlation at the level of markers of inflammation in the blood. Fluctuations in the level of fibrinogen in the blood, depending on the active or passive phase of the existing periodontitis, affect the promotion of arteriosclerosis. The study is of the brief communication article type with the aim to analyze the effect of non-surgical periodontal treatment on fluctuations in the level of fibrinogen in the blood. The reduction of fibrinogen's level in blood after non-surgical periodontal treatment of periodontitis in the patient's oral cavity, is a common consequence supported by literature sources. Also, the influence of a high amount of fibrinogen in blood on the occurrence of arteriosclerosis at the same patient, is also another important data that again rely on many sources of literature. Thromboembolism and arteriosclerosis, as risk factors expressed in clinical data, have temporary bacteremia in the blood, which can occur significantly and often between phases of non-surgical periodontal treatment of periodontitis, treatments performed with treatment phases and protocols of predetermined treatment. Arterial thromboembolism has a significant factor, such as high levels of fibrinogen in the blood, which are significantly reduced during the period of non-surgical periodontal treatment.

Keywords: Fibrinogen, refractory periodontitis, atherosclerosis, non-surgical, periodontal treatment.

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Authors: Ali Akbar Sadat Asl

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Diagnosis and deciding about diseases in medical fields is facing innate uncertainty which can affect the whole process of treatment. This decision is made based on expert knowledge and the way in which an expert interprets the patient's condition, and the interpretation of the various experts from the patient's condition may be different. Fuzzy logic can provide mathematical modeling for many concepts, variables, and systems that are unclear and ambiguous and also it can provide a framework for reasoning, inference, control, and decision making in conditions of uncertainty. In systems with high uncertainty and high complexity, fuzzy logic is a suitable method for modeling. In this paper, we use type-2 fuzzy logic for uncertainty modeling that is in diagnosis of leukemia. The proposed system uses an indirect-direct approach and consists of two stages: In the first stage, the inference of blood test state is determined. In this step, we use an indirect approach where the rules are extracted automatically by implementing a clustering approach. In the second stage, signs of leukemia, duration of disease until its progress and the output of the first stage are combined and the final diagnosis of the system is obtained. In this stage, the system uses a direct approach and final diagnosis is determined by the expert. The obtained results show that the type-2 fuzzy expert system can diagnose leukemia with the average accuracy about 97%.

Keywords: Expert system, leukemia, medical diagnosis, type-2 fuzzy logic.

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Authors: P. Pongsumpun, I.M. Tang

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Plasmodium vivax malaria differs from P. falciparum malaria in that a person suffering from P. vivax infection can suffer relapses of the disease. This is due the parasite being able to remain dormant in the liver of the patients where it is able to re-infect the patient after a passage of time. During this stage, the patient is classified as being in the dormant class. The model to describe the transmission of P. vivax malaria consists of a human population divided into four classes, the susceptible, the infected, the dormant and the recovered. The effect of a time delay on the transmission of this disease is studied. The time delay is the period in which the P. vivax parasite develops inside the mosquito (vector) before the vector becomes infectious (i.e., pass on the infection). We analyze our model by using standard dynamic modeling method. Two stable equilibrium states, a disease free state E0 and an endemic state E1, are found to be possible. It is found that the E0 state is stable when a newly defined basic reproduction number G is less than one. If G is greater than one the endemic state E1 is stable. The conditions for the endemic equilibrium state E1 to be a stable spiral node are established. For realistic values of the parameters in the model, it is found that solutions in phase space are trajectories spiraling into the endemic state. It is shown that the limit cycle and chaotic behaviors can only be achieved with unrealistic parameter values.

Keywords: Equilibrium states, Hopf bifurcation, limit cyclebehavior, local stability, Plasmodium Vivax, time delay.

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Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary

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Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.

Keywords: K-nearest neighbor, face detection, vitiligo, bone deformity.

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Authors: Daniele Traversaro

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Problem: Senior citizens have been facing a challenging reality as a result of strict public health measures designed to protect people from the COVID-19 outbreak. These include the risk of social isolation due to the inability of the elderly to integrate with technology. Never before have Information and Communication Technology (ICT) skills become essential for their everyday life. Although third-age ICT education and lifelong learning are widely supported by universities and governments, there is a lack of literature on which teaching strategy/methodology to adopt in an entirely online ICT course aimed at third-age learners. This contribution aims to present an application of the Think-Pair-Share (TPS) learning method in an ICT third-age virtual classroom with an intergenerational approach to conducting online group labs and review activities. Research Question: Is collaborative learning suitable and effective, in terms of student engagement and learning outcomes, in an online ICT course for the elderly? Methods: In the TPS strategy a problem is posed by the teacher, students have time to think about it individually, and then they work in pairs (or small groups) to solve the problem and share their ideas with the entire class. We performed four experiments in the ICT course of the University of the Third Age of Genova (University of Genova, Italy) on the Microsoft Teams platform. The study cohort consisted of 26 students over the age of 45. Data were collected through online questionnaires. Two have been proposed, one at the end of the first activity and another at the end of the course. They consisted of five and three close-ended questions, respectively. The answers were on a Likert scale (from 1 to 4) except two questions (which asked the number of correct answers given individually and in groups) and the field for free comments/suggestions. Results: Groups achieve better results than individual students (with scores greater than one order of magnitude) and most students found TPS helpful to work in groups and interact with their peers. Insights: From these early results, it appears that TPS is suitable for an online third-age ICT classroom and useful for promoting discussion and active learning. Despite this, our work has several limitations. First of all, the results highlight the need for more data to be able to perform a statistical analysis in order to determine the effectiveness of this methodology in terms of student engagement and learning outcomes as future direction.

Keywords: Collaborative learning, information technology education, lifelong learning, older adult education, think-pair-share.

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Authors: Sreejith Jayachandran, Mojtaba Ghodsi, Morteza Mohammadzaheri

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The modern busy world is running behind new embedded technologies based on computers and software meanwhile some people are unable to monitor their health condition and regular medical check-ups. Some of them postpone medical check-ups due to a lack of time and convenience while others skip these regular evaluations and medical examinations due to huge medical bills and hospital expenses. In this research, we present a device in the telemonitoring system capable of monitoring, checking, and evaluating the health status of the human body remotely through the internet for the needs of all kinds of people. The remote health monitoring device is a microcontroller-based embedded unit. The various types of sensors in this device are connected to the human body, and with the help of an Arduino UNO board, the required analogue data are collected from the sensors. The microcontroller on the Arduino board processes the analogue data collected in this way into digital data and transfers that information to the cloud and stores it there; the processed digital data are then instantly displayed through the LCD attached to the machine. By accessing the cloud storage with a username and password, the concerned person’s health care teams/doctors, and other health staff can collect these data for the assessment and follow-up of that patient. Besides that, the family members/guardians can use and evaluate these data for awareness of the patient's current health status. Moreover, the system is connected to a GPS module. In emergencies, the concerned team can be positioning the patient or the person with this device. The setup continuously evaluates and transfers the data to the cloud and also the user can prefix a normal value range for the evaluation. For example, the blood pressure normal value is universally prefixed between 80/120 mmHg. Similarly, the Remote Health Monitoring System (RHMS) is also allowed to fix the range of values referred to as normal coefficients. This IoT-based miniature system 11×10×10 cm3 with a low weight of 500 gr only consumes 10 mW. This smart monitoring system is manufactured for 100 GBP (British Pound Sterling), and can facilitate the communication between patients and health systems, but also it can be employed for numerous other uses including communication sectors in the aerospace and transportation systems.

Keywords: Embedded Technology, Telemonitoring system, Microcontroller, Arduino UNO, Cloud storage, GPS, RHMS, Remote Health Monitoring System, Alert system.

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Authors: Shian Wan, Yi-Chang Wang, Yu-Chien Lin

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This research discussed the various theories of service design, the importance of service design methodology, and the development of transformative service design framework. In this study, transformative service design is applied while building a new brand community service for women, children and infants retailing business. The goal is to enhance the brand recognition and customer loyalty, effectively increase the brand community engagement by embedding the brand community in social network and ultimately, strengthen the impact and the value of the company brand.

Keywords: Service design, transformative service design, brand community.

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