Search results for: remote patient monitoring system

Authors: Sheng-Chi Tseng, Der-Ming Liou

Abstract:

The health record in the Electronic Health Record (EHR) system is more sensitive than demographic. It raises the important issue for the EHR requirement in privacy, security, audit trail, patient access, and archiving and data retention. The studies about the EHR system security are deficient. The aim of this study is to build a security environment for the EHR system by Integrating the Healthcare Enterprise (IHE) Audit Trail and Node Authentication Security (ATNA) profile. The CDAs can be access in a secure EHR environment.

Keywords: IHE ATNA, EHR security.

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Authors: Andrey V. Timofeev, Dmitry V. Egorov, Viktor M. Denisov

Abstract:

This paper presents development results of usage of C-OTDR monitoring systems for rail traffic management. The COTDR method is based on vibrosensitive properties of optical fibers. Analysis of Rayleigh backscattering radiation parameters changes which take place due to microscopic seismoacoustic impacts on the optical fiber allows to determine seismoacoustic emission source positions and to identify their types. This approach proved successful for rail traffic management (moving block system, weigh- in-motion system etc.).

Keywords: C-OTDR systems, moving block-sections, rail traffic management, Rayleigh backscattering, weigh-in-motion.

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Authors: Hyen Ki Kim

Abstract:

This paper describes the design and implementation of cyber video consultation systems(CVCS) using hybrid P2P for video consultation between remote sites. The proposed system is based on client-server and P2P(Peer to Peer) architecture, where client-server is used for communication with the MCU(Multipoint Control Unit) and P2P is used for the cyber video consultation. The developed video consultation system decreases server traffic, and cuts down network expenses, as the multimedia data decentralizes to the client by hybrid P2P architecture. Also the developed system is tested by the group-type video consultation system using communication protocol and application software through Ethernet networks.

Keywords: Consultation, Cyber, Hybrid, Peer-to-Peer

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Authors: S. Vanker, A. Aaver, A. Roio, L. Nuut

Abstract:

To be sure about the effective and less effective/ineffective approaches to course instruction, we hold the opinion that the faculty members need regular feedback from their students in order to be aware of how well or unwell their teaching styles have worked when instructing the courses. It can be confirmed without a slightest hesitation that undergraduate students’ motivated-ness can be sustained when continually improving the quality of teaching and properly sequencing the academic courses both, in the curricula and timetables. At Estonian Aviation Academy, four different forms of feedback are used: Lecture monitoring, questionnaires for all students, study information system subject monitoring and direct feedback received by the lecturer. Questionnaires for all students are arranged once during a study year and separately for the first year and senior students. The results are discussed in academic departments together with student representatives, analyzed with the teaching staff and, if needed, improvements are suggested. In addition, a monitoring system is planned where a lecturer acts in both roles – as an observer and as the lecturer. This will foster better exchange of experience and through this help to make the whole study process more interesting.

Keywords: Student support, learner motivation, feedback, undergraduate education.

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Authors: Zheng-Yan Ruan, Chien-Hao Wang, Hong-Jen Lin, Chien-Peng Huang, Ying-Hao Chen, En-Cheng Yang, Chwan-Lu Tseng, Joe-Air Jiang

Abstract:

Bees play a vital role in pollination. This paper focuses on the weighing process of honey. Honey is usually stored at the comb in a hive. Bee farmers brush bees away from the comb and then collect honey, and the collected honey is weighed afterward. However, such a process brings strong negative influences on bees and even leads to the death of bees. This paper therefore presents an Internet of Things-based weight monitoring system which uses weight sensors to measure the weight of honey and simplifies the whole weighing procedure. To verify the system, the weight measured by the system is compared to the weight of standard weights used for calibration by employing a linear regression model. The R² of the regression model is 0.9788, which suggests that the weighing system is highly reliable and is able to be applied to obtain actual weight of honey. In the future, the weight data of honey can be used to find the relationship between honey production and different ecological parameters, such as bees’ foraging behavior and weather conditions. It is expected that the findings can serve as critical information for honey production improvement.

Keywords: Internet of Things, weight, honey, bee.

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Authors: M. Daoud-Marrakchi, S. Fendri-Elouze, Ch. Ill, B. Bejar-Ghadhab

Abstract:

The aim of this research is to propose a Measurement Scale for Patient Satisfaction (MSPS) in the context of Tunisian private clinics. This scale is developed using value management methods and is validated by statistic tools with SPSS.

Keywords: Functional analysis, Patient satisfaction, Questionnaire, Reliability, Validity.

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Authors: Othon Kamariotis

Abstract:

This paper provides a flexible way of controlling Variable-Bit-Rate (VBR) of compressed digital video, applicable to the new H264 video compression standard. The entire video sequence is assessed in advance and the quantisation level is then set such that bit rate (and thus the frame rate) remains within predetermined limits compatible with the bandwidth of the transmission system and the capabilities of the remote end, while at the same time providing constant quality similar to VBR encoding. A process for avoiding buffer starvation by selectively eliminating frames from the encoded output at times when the frame rate is slow (large number of bits per frame) will be also described. Finally, the problem of buffer overflow will be solved by selectively eliminating frames from the received input to the decoder. The decoder detects the omission of the frames and resynchronizes the transmission by monitoring time stamps and repeating frames if necessary.

Keywords: H264, CBR, VBR, Video Streaming, Digital Video, Multimedia, Buffering, Encoding, Decoding, Compression, Video-On-Demand

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Authors: Mohsen Shirani, Micaela Demichela

Abstract:

Food supply chain is one of the most complex supply chain networks due to its perishable nature and customer oriented products, and food safety is the major concern for this industry. IT system could help to minimize the production and consumption of unsafe food by controlling and monitoring the entire system. However, there have been many issues in adoption of IT system in this industry specifically within SMEs sector. With this regard, this study presents a novel approach to use IT and tractability systems in the food supply chain, using application of RFID and central database.

Keywords: Food Supply Chain, IT System, Food Safety, SME.

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Authors: Inayat Ur Rehman, Georgia Sakellari

Abstract:

Cloud computing has evolved into a vital technology for businesses, offering scalability, flexibility, and cost-effectiveness. However, maintaining high availability and optimal performance in the cloud is crucial for reliable services. This paper explores the significance of cloud monitoring and performance optimization in sustaining the high availability of cloud-based systems. It discusses diverse monitoring tools, techniques, and best practices for continually assessing the health and performance of cloud resources. The paper also delves into performance optimization strategies, including resource allocation, load balancing, and auto-scaling, to ensure efficient resource utilization and responsiveness. Addressing potential challenges in cloud monitoring and optimization, the paper offers insights into data security and privacy considerations. Through this thorough analysis, the paper aims to underscore the importance of cloud monitoring and performance optimization for ensuring a seamless and highly available cloud computing environment.

Keywords: Cloud computing, cloud monitoring, performance optimization, high availability.

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Authors: M. Hammerton, J. Trevathan, T. Myers, W. Read

Abstract:

The transfer rate of messages in distributed sensor network applications is a critical factor in a system's performance. The Sensor Abstraction Layer (SAL) is one such system. SAL is a middleware integration platform for abstracting sensor specific technology in order to integrate heterogeneous types of sensors in a network. SAL uses Java Remote Method Invocation (RMI) as its connection method, which has unsatisfying transfer rates, especially for streaming data. This paper analyses different connection methods to optimize data transmission in SAL by replacing RMI. Our results show that the most promising Java-based connections were frameworks for Java New Input/Output (NIO) including Apache MINA, JBoss Netty, and xSocket. A test environment was implemented to evaluate each respective framework based on transfer rate, resource usage, and scalability. Test results showed the most suitable connection method to improve data transmission in SAL JBoss Netty as it provides a performance enhancement of 68%.

Keywords: Wireless sensor networks, remote method invocation, transmission time.

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Authors: Madiajagan Muthaiyan, Neha Goel, Deepti Sunder Prakash

Abstract:

This paper discusses about an intelligent system to be installed in ambulances providing professional support to the paramedics on board. A video conferencing device over mobile 4G services enables specialists virtually attending the patient being transferred to the hospital. The data centre holds detailed databases on the patients past medical history and hospitals with the specialists. It also hosts various software modules that compute the shortest traffic –less path to the closest hospital with the required facilities, on inputting the symptoms of the patient, on a real time basis.

Keywords: 4G mobile services, cloud computing, data centre, intelligent system, optimization, real time traffic reporting, SaaS, video conferencing.

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

Abstract:

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: M. Javid, R. Hassan, J. DeSilva

Abstract:

In this exploratory case study, a 37-year-old male patient who previously terminated treatment after four months of therapy with a different therapist begins anew with a 38-year-old female therapist and undergoes a similar cycle of premature termination, with added discourse caused by erotic transference. Process notes and records of the therapy treatment indicate that during the short course of treatment, the patient explored his difficulties navigating personal relationships, both current and past, and his difficulties coping with hypochondriasis. The therapist becomes tasked with not only navigating the patient’s inner conflict but also how she relates to the patient in the countertransference process while maintaining professional boundaries. This includes empathizing with the patient while also experiencing discomfort in the erotic transference from a professional standpoint. When the patient terminates once more, the therapist reflects on the possible reasons for termination. This includes the patient’s difficulties with tolerating interpretations, which cause him to blame himself for past events. These interpretations were also very frequent, contributing to the emotional burden the patient experienced. The therapist reflected on the use of interpretation versus exploration of the patient’s feelings and how exploring his feelings, including his feelings towards her, would have allowed for an opportunity to explore the emotions that troubled him more deeply. This includes exploring the patient’s anger and fear, which stem from unresolved conflicts from his childhood. Moreover, the erotic transference served as an enactment of previous experiences in which the patient feared losing what he loved, leading him to opt for premature termination instead of losing his ability to control the relationship and experience loss.

Keywords: Countertransference, erotic transference, premature termination, therapist-client boundaries, transference.

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Authors: A. Almasi

Abstract:

Reciprocating compressors are flexible to handle wide capacity and condition swings, offer a very efficient method of compressing almost any gas mixture in wide range of pressure, can generate high head independent of density, and have numerous applications and wide power ratings. These make them vital component in various units of industrial plants. In this paper optimum reciprocating compressor configuration regarding interstage pressures, low suction pressure, non-lubricated cylinder, speed of machine, capacity control system, compressor valve, lubrication system, piston rod coating, cylinder liner material, barring device, pressure drops, rod load, pin reversal, discharge temperature, cylinder coolant system, performance, flow, coupling, special tools, condition monitoring (including vibration, thermal and rod drop monitoring), commercial points, delivery and acoustic conditions are presented.

Keywords: Design, optimum, reciprocating compressor.

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Authors: Pradeep Kumar, Shibashish Chakraborty, Sasadhar Bera

Abstract:

In the anticipation of demand fluctuations, services cannot be inventoried and hence it creates a difficult problem in marketing of services. The inability to meet customers (patients) requirements in healthcare context has more serious consequences than other service sectors. In order to meet patient requirements in the current uncertain environment, healthcare organizations are seeking ways for improved service delivery. Flexibility provides a mechanism for reducing variability in service encounters and improved performance. Flexibility is defined as the ability of the organization to cope with changing circumstances or instability caused by the environment. Patient satisfaction is an important performance outcome of healthcare organizations. However, the paucity of information exists in healthcare delivery context to examine the impact of flexibility on patient satisfaction and behavioral intention. The present study is an attempt to develop a conceptual foundation for investigating overall impact of flexibility on patient satisfaction and behavioral intention. Several dimensions of flexibility in healthcare context are examined and proposed to have a significant impact on patient satisfaction and intention. Furthermore, the study involves a critical examination of determinants of patient satisfaction and development of a comprehensive view the relationship between flexibility, patient satisfaction and behavioral intention. Finally, theoretical contributions and implications for healthcare professionals are suggested from flexibility perspective.

Keywords: Healthcare, flexibility, patient satisfaction, behavioral intention.

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Authors: Leila Jafari, Viliam Makis, Akram Khaleghei G.B.

Abstract:

In this paper, we present a maintenance model of a two-unit series system with economic dependence. Unit#1 which is considered to be more expensive and more important, is subject to condition monitoring (CM) at equidistant, discrete time epochs and unit#2, which is not subject to CM has a general lifetime distribution. The multivariate observation vectors obtained through condition monitoring carry partial information about the hidden state of unit#1, which can be in a healthy or a warning state while operating. Only the failure state is assumed to be observable for both units. The objective is to find an optimal opportunistic maintenance policy minimizing the long-run expected average cost per unit time. The problem is formulated and solved in the partially observable semi-Markov decision process framework. An effective computational algorithm for finding the optimal policy and the minimum average cost is developed, illustrated by a numerical example.

Keywords: Condition-Based Maintenance, Semi-Markov Decision Process, Multivariate Bayesian Control Chart, Partially Observable System, Two-unit System.

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Authors: Ibrahim A. Alkali

Abstract:

There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: Caregiving, Inpatient setting, Integration, Patient Families.

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Authors: Qasim Khan, Furkan Ahmad, Asfar A. Khan, M. Saad Alam, Faiz Ahmad

Abstract:

In this paper, partial discharge analysis is performed in cavities artificially created in insulation. The setup is according with Cigre-II Method. Circular Samples created from Perspex Sheet with different configuration with changing number of cavities. Assessment of insulation health can be performed by Partial Discharge measurement as this has been found to be important means of condition monitoring. The experiments are done using MPD 540, which is a modern partial discharge measurement system. By analyzing the PD activity obtained for various voids/cavities, it is observed that the PD voltages show variation for cavity’s diameter, depth even for its ratios. This can be employed for scrutiny of insulation system.

Keywords: Partial discharges, condition monitoring, MPD 540, cavities/defects, degradation and corrosion, PMMA.

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Authors: Ahmad Rouhani, Masoud Jabbari, Sima Honarmand

Abstract:

This paper introduces a method to optimal design of a hybrid Wind/Photovoltaic/Fuel cell generation system for a typical domestic load that is not located near the electricity grid. In this configuration the combination of a battery, an electrolyser, and a hydrogen storage tank are used as the energy storage system. The aim of this design is minimization of overall cost of generation scheme over 20 years of operation. The Matlab/Simulink is applied for choosing the appropriate structure and the optimization of system sizing. A teaching learning based optimization is used to optimize the cost function. An overall power management strategy is designed for the proposed system to manage power flows among the different energy sources and the storage unit in the system. The results have been analyzed in terms of technical and economic. The simulation results indicate that the proposed hybrid system would be a feasible solution for stand-alone applications at remote locations.

Keywords: Hybrid energy system, optimum sizing, power management, TLBO.

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Authors: Stepan Kuchar, Martin Golasowski, Radim Vavrik, Michal Podhoranyi, Boris Sir, Jan Martinovic

Abstract:

The main goal of this article is to describe the online flood monitoring and prediction system Floreon+ primarily developed for the Moravian-Silesian region in the Czech Republic and the basic process it uses for running automatic rainfall-runoff and hydrodynamic simulations along with their calibration and uncertainty modeling. It takes a long time to execute such process sequentially, which is not acceptable in the online scenario, so the use of a high performance computing environment is proposed for all parts of the process to shorten their duration. Finally, a case study on the Ostravice River catchment is presented that shows actual durations and their gain from the parallel implementation.

Keywords: Flood prediction process, High performance computing, Online flood prediction system, Parallelization.

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Authors: Roohi Shabrin S., Devi Prasad B., Prabu D., Pallavi R. S., Revathi P.

Abstract:

Due to memory leaks, often-valuable system memory gets wasted and denied for other processes thereby affecting the computational performance. If an application-s memory usage exceeds virtual memory size, it can leads to system crash. Current memory leak detection techniques for clusters are reactive and display the memory leak information after the execution of the process (they detect memory leak only after it occur). This paper presents a Dynamic Memory Monitoring Agent (DMMA) technique. DMMA framework is a dynamic memory leak detection, that detects the memory leak while application is in execution phase, when memory leak in any process in the cluster is identified by DMMA it gives information to the end users to enable them to take corrective actions and also DMMA submit the affected process to healthy node in the system. Thus provides reliable service to the user. DMMA maintains information about memory consumption of executing processes and based on this information and critical states, DMMA can improve reliability and efficaciousness of cluster computing.

Keywords: Dynamic Memory Monitoring Agent (DMMA), Cluster Computing, Memory Leak, Fault Tolerant Framework, Dynamic Memory Leak Detection (DMLD).

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Authors: M. Hammerton, J. Trevathan, T. Myers, W. Read

Abstract:

The transfer rate of messages in distributed sensor network applications is a critical factor in a system's performance. The Sensor Abstraction Layer (SAL) is one such system. SAL is a middleware integration platform for abstracting sensor specific technology in order to integrate heterogeneous types of sensors in a network. SAL uses Java Remote Method Invocation (RMI) as its connection method, which has unsatisfying transfer rates, especially for streaming data.  This paper analyses different connection methods to optimize data transmission in SAL by replacing RMI.  Our results show that the most promising Java-based connections were frameworks for Java New Input/Output (NIO) including Apache MINA, JBoss Netty, and xSocket. A test environment was implemented to evaluate each respective framework based on transfer rate, resource usage, and scalability. Test results showed the most suitable connection method to improve data transmission in SAL JBoss Netty as it provides a performance enhancement of 68%.

Keywords: Wireless sensor networks, remote method invocation, transmission time.

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Authors: St. Karagiannis, A. I. Dounis, T. Chalastras, P. Tiropanis, D. Papachristos

Abstract:

This work presents the design of an expert system that aims in the procurement of patient medial background and in the search for suitable skin test selections. Skin testing is the tool used most widely to diagnose allergies. The language of expert systems CLIPS is used as a tool of designing. Finally, we present the evaluation of the proposed expert system which was achieved with the import of certain medical cases and the system produced with suitable successful skin tests.

Keywords: Artificial intelligence, expert system - CLIPS, allergy and skin test.

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Authors: Faisal AlShammari, Abdulmajid Addali

Abstract:

Monitoring the conditions of rotating machinery, such as bearings, is important in order to improve the stability of work. Acoustic Emission (AE) and vibration analysis are some of the most accomplished techniques used for this purpose. Acoustic emission has the ability to detect the initial phase of component degradation. Moreover, it has been observed that vibration analysis is not as successful at low rotational speeds (below 100 rpm). This because the energy generated within this speed region is not detectable using conventional vibration. From this perspective, this paper has presented a brief review of using acoustic emission techniques for monitoring bearing conditions.

Keywords: Condition monitoring, stress wave analysis, low-speed bearings, bearing defect diagnosis.

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Authors: R. Nouri, M.R. Jafari, M. Arain., F. Feizi

Abstract:

The Mahin area is a part of Tarom- Hashtjin zone that located in west of Qazvin province in northwest of Iran. Many copper and base metals ore deposits are hosted by this zone. High potential localities identification in this area is very necessary. The objective of this research, is finding hydrothermal alteration zones by remote sensing methods and best processing technique of Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) data. Different methods such as band ratio, Principal Component Analysis (PCA), Minimum Noise Fraction (MNF) and Least Square Fit (LS-Fit) were used for mapping hydrothermal alteration zones.

Keywords: Hydrothermal alteration, Iran, Mahin, Remote sensing

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Authors: Samia Boucherkha, Mohamed Benmohamed

Abstract:

In this paper we investigate the watermarking authentication when applied to medical imagery field. We first give an overview of watermarking technology by paying attention to fragile watermarking since it is the usual scheme for authentication.We then analyze the requirements for image authentication and integrity in medical imagery, and we show finally that invertible schemes are the best suited for this particular field. A well known authentication method is studied. This technique is then adapted here for interleaving patient information and message authentication code with medical images in a reversible manner, that is using lossless compression. The resulting scheme enables on a side the exact recovery of the original image that can be unambiguously authenticated, and on the other side, the patient information to be saved or transmitted in a confidential way. To ensure greater security the patient information is encrypted before being embedded into images.

Keywords: Medical Imaging, Invertible Watermarking, Authentication, Integrity.

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Authors: Saad Mutashar, M. A. Hannan, S. A. Samad, A. Hussain

Abstract:

This paper deals with the modified wireless power transmission system for biomedical implanted devices. The system consists of efficient class-E power amplifier and inductive power links based on spiral circular transmitter and receiver coils. The model of the class-E power amplifier operated with 13.56 MHz is designed, discussed and analyzed in which it is achieved 87.2% of efficiency. The inductive coupling method is used to achieve link efficiency up to 73% depending on the electronic remote system resistance. The improved system powered with 3.3 DC supply and the voltage across the transmitter side is 40 V whereas, cross the receiver side is 12 V which is rectified to meet the implanted micro-system circuit requirements. The system designed and simulated by NI MULTISIM 11.02.

Keywords: Wireless Transmission, inductive coupling, implanted devices, class-E power amplifier, coils design.

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Authors: Hyun-Woo Cho

Abstract:

Real-time or in-line process monitoring frameworks are designed to give early warnings for a fault along with meaningful identification of its assignable causes. In artificial intelligence and machine learning fields of pattern recognition various promising approaches have been proposed such as kernel-based nonlinear machine learning techniques. This work presents a kernel-based empirical monitoring scheme for batch type production processes with small sample size problem of partially unbalanced data. Measurement data of normal operations are easy to collect whilst special events or faults data are difficult to collect. In such situations, noise filtering techniques can be helpful in enhancing process monitoring performance. Furthermore, preprocessing of raw process data is used to get rid of unwanted variation of data. The performance of the monitoring scheme was demonstrated using three-dimensional batch data. The results showed that the monitoring performance was improved significantly in terms of detection success rate of process fault.

Keywords: Process Monitoring, kernel methods, multivariate filtering, data-driven techniques, quality improvement.

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

Abstract:

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: Alfrina Marwan, Erna Sulistyawati

Abstract:

Class III malocclusion shows both skeletal and dentoalveolar component. Sketal Class III malocclusion can have variants in different region, maxilla or mandibular. Skeletal Class III malocclusion during growth period is considered to treat to prevent its severity in adulthood. Orthopedics treatment of skeletal Class III malocclusion in growing patient can be treated by using reverse twin block with expansion screw to modify the growth pattern. The objective of this case report was to describe the functional correction of skeletal Class III maloclussion using reverse twin block with expansion screw in growing patient. A patient with concave profile came with a chief complaint of aesthetic problems. The cephalometric analysis showed that patient had skeletal Class III malocclusion (ANB -5⁰, SNA 75º, Wits appraisal -3 mm) with anterior cross bite and deep bite (overjet -3 mm, overbite 6 mm). In this case report, the patient was treated with reverse twin block appliance with expansion screw. After three months of treatment, the skeletal problems have been corrected (ANB -1°), overjet, overbite and aesthetic were improved. Reverse twin block appliance with expansion screw can be used as orthopedics treatment for skeletal Class III malocclusion in growing patient and can improve the aesthetic with great satisfaction which was the main complaint in this patient.

Keywords: Growing patient, maxilla retrognatism, reverse twin blocks, skeletal Class III malocclusion.

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