Search results for: Medical
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 595

Search results for: Medical

355 Antibiotic Prescribing in the Acute Care in Iraq

Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

Abstract:

Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, antibiotic misuse, Iraq, prescribing.

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354 Health Hazards Related to Computer Use: Experience of the National Institute for Medical Research in Tanzania

Authors: V. P. Mvungi, J. Mcharo, M. E. Mmbuji, L. E. Mgonja, A. Y. Kitua

Abstract:

This paper is based on a study conducted in 2006 to assess the impact of computer usage on health of National Institute for Medical Research (NIMR) staff. NIMR being a research Institute, most of its staff spend substantial part of their working time on computers. There was notion among NIMR staff on possible prolonged computer usage health hazards. Hence, a study was conducted to establish facts and possible mitigation measures. A total of 144 NIMR staff were involved in the study of whom 63.2% were males and 36.8% females aged between 20 and 59 years. All staff cadres were included in the sample. The functions performed by Institute staff using computers includes; data management, proposal development and report writing, research activities, secretarial duties, accounting and administrative duties, on-line information retrieval and online communication through e-mail services. The interviewed staff had been using computers for 1-8 hours a day and for a period ranging from 1 to 20 years. The study has indicated ergonomic hazards for a significant proportion of interviewees (63%) of various kinds ranging from backache to eyesight related problems. The authors highlighted major issues which are substantially applicable in preventing occurrences of computer related problems and they urged NIMR Management and/or the government of Tanzania opts to adapt their practicability.

Keywords: Computers ergonomic hazards, computer usagehealth hazards.

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353 Developing of Knowledge-Based System for the Medical Treatment with Herbs

Authors: Rujijan Vichivanives

Abstract:

This research aims to create a knowledge-based system as a database for self-healthcare analysis, diagnosis of simple illnesses, and the use of Thai herbs instead of modern medicine by using principles of Thai traditional medication theory. These were disseminated by website network programs within Suan Sunandha Rajabhat University. The population used in this study was divided into two groups: the first group consisted of four experts of Thai traditional medication and the second group was 300 website users. The methods used for collecting data were paper questionnaires and poll questionnaires on the website. The statistics used for analyzing data was at an average level. The results were divided into three parts: the first part was the development of a knowledge-based system and the second part was applied programs on website. Both parts could be fulfilled and achieved according to the set goal. The third part was the evaluation of the study: The evaluation of the viewpoints of the experts towards website designs were evaluated at a good level of 4.20. The satisfaction evaluation of the users was found at a good level of average satisfactory level at 4.24. It was found that the young population of those under the age of 16 had less cares about their health than the population of other teenagers, working age adults and those of older age. The research findings should be extended in order to encourage the lifestyle modifications to people of all ages by using the self-healthcare principles.

Keywords: Developing, Herbs, Knowledge-based system, Medical treatment.

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352 Prospects for Sustainable Chemistry in South Africa: A Plural Healthcare System

Authors: Ntokozo C. Mthembu

Abstract:

The notion of sustainable chemistry has become significant in the discourse for a global post-colonial era, including South Africa, especially when it comes to access to the general health system and related policies in relation to disease or ease of human life. In view of the stubborn vestiges of coloniality in the daily lives of indigenous African people in general, the fundamentals of present Western medical and traditional medicine systems and related policies in the democratic era were examined in this study. The situation of traditional healers in relation to current policy was also reviewed. The advent of democracy in South Africa brought about a variety of development opportunities and limitations, particularly with respect to indigenous African knowledge systems such as traditional medicine. There were high hopes that the limitations of previous narrow cultural perspectives would be rectified in the democratic era through development interventions, but some sections of society, such as traditional healers, remain marginalised. The Afrocentric perspective was explored in dissecting government interventions related to traditional medicine. This article highlights that multiple medical systems should be adopted and that health policies should be aligned in order to guarantee mutual respect and to address the remnants of colonialism in South Africa, Africa and the broader global community.

Keywords: Traditional healing system, healers, pluralist healthcare system, post-colonial era.

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351 Dynamic Features Selection for Heart Disease Classification

Authors: Walid MOUDANI

Abstract:

The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the Coronary Heart Disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts- knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: Multi-Classifier Decisions Tree, Features Reduction, Dynamic Programming, Rough Sets.

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350 Shannon-Weaver Biodiversity of Neutrophils in Fractal Networks of Immunofluorescence for Medical Diagnostics

Authors: N.E.Galich

Abstract:

We develop new nonlinear methods of immunofluorescence analysis for a sensitive technology of respiratory burst reaction of DNA fluorescence due to oxidative activity in the peripheral blood neutrophils. Histograms in flow cytometry experiments represent a fluorescence flashes frequency as functions of fluorescence intensity. We used the Shannon-Weaver index for definition of neutrophils- biodiversity and Hurst index for definition of fractal-s correlations in immunofluorescence for different donors, as the basic quantitative criteria for medical diagnostics of health status. We analyze frequencies of flashes, information, Shannon entropies and their fractals in immunofluorescence networks due to reduction of histogram range. We found the number of simplest universal correlations for biodiversity, information and Hurst index in diagnostics and classification of pathologies for wide spectra of diseases. In addition is determined the clear criterion of a common immunity and human health status in a form of yes/no answers type. These answers based on peculiarities of information in immunofluorescence networks and biodiversity of neutrophils. Experimental data analysis has shown the existence of homeostasis for information entropy in oxidative activity of DNA in neutrophil nuclei for all donors.

Keywords: blood and cells fluorescence in diagnostics ofdiseases, cytometric histograms, entropy and information in fractalnetworks of oxidative activity of DNA, long-range chromosomalcorrelations in living cells.

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349 Image Analysis for Obturator Foramen Based on Marker-Controlled Watershed Segmentation and Zernike Moments

Authors: Seda Sahin, Emin Akata

Abstract:

Obturator Foramen is a specific structure in Pelvic bone images and recognition of it is a new concept in medical image processing. Moreover, segmentation of bone structures such as Obturator Foramen plays an essential role for clinical research in orthopedics. In this paper, we present a novel method to analyze the similarity between the substructures of the imaged region and a hand drawn template as a preprocessing step for computation of Pelvic bone rotation on hip radiographs. This method consists of integrated usage of Marker-controlled Watershed segmentation and Zernike moment feature descriptor and it is used to detect Obturator Foramen accurately. Marker-controlled Watershed segmentation is applied to separate Obturator Foramen from the background effectively. Then, Zernike moment feature descriptor is used to provide matching between binary template image and the segmented binary image for final extraction of Obturator Foramens. Finally, Pelvic bone rotation rate calculation for each hip radiograph is performed automatically to select and eliminate hip radiographs for further studies which depend on Pelvic bone angle measurements. The proposed method is tested on randomly selected 100 hip radiographs. The experimental results demonstrated that the proposed method is able to segment Obturator Foramen with 96% accuracy.

Keywords: Medical image analysis, marker-controlled watershed segmentation, segmentation of bone structures on hip radiographs, pelvic bone rotation rate, zernike moment feature descriptor.

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348 Chronic Patients- Prescription Refill Intentions

Authors: Ching - Yi Lee, I-Hsiung Tseng, Feng-Chuan Pan

Abstract:

Environment today is featured with aging population, increasing prevalence of chronic disease and complex of medical treatment. Safe use of pharmaceutics relied very much on the efforts made by both the health- related organizations and as well as the government agencies. As far as the specialization concern in providing health services to the patients, the government actively issued and implemented the divisions of medical treatment and pharmaceutical to improve the quality of care and to reduce medication errors and ensure public health. Pharmaceutical sub-sector policy has been implemented for 13 years. This study attempts to explore the factors that affect the patients- behavior intention of refilling a prescription from a NHIB pharmacy. Samples were those patients refilling their prescriptions with the case NHIB pharmacies. A self-administered questionnaire was used to collect respondents- information while the patients or family members visit the pharmacy for the refilling. 1,200 questionnaires were dispatched in 37 pharmacies that randomly selected from Pingtung City, Dongkang, Chaozhou, Hengchun areas. 732 responses were gained with 604 valid samples for further analyses. Results of data analyses indicated that respondents- attitude, subjective norm, perceived behavior control and behavior intentions toward refilling behavior varied from some demographic variables to another. This research also suggested adding actual behavior, either by a self-report or observed, into the research.

Keywords: Separation of dispensing and prescribing, prescriptions refill slip, NHIB contracted pharmacy, drug safety, theory of planned behavior.

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347 Computer Countenanced Diagnosis of Skin Nodule Detection and Histogram Augmentation: Extracting System for Skin Cancer

Authors: S. Zith Dey Babu, S. Kour, S. Verma, C. Verma, V. Pathania, A. Agrawal, V. Chaudhary, A. Manoj Puthur, R. Goyal, A. Pal, T. Danti Dey, A. Kumar, K. Wadhwa, O. Ved

Abstract:

Background: Skin cancer is now is the buzzing button in the field of medical science. The cyst's pandemic is drastically calibrating the body and well-being of the global village. Methods: The extracted image of the skin tumor cannot be used in one way for diagnosis. The stored image contains anarchies like the center. This approach will locate the forepart of an extracted appearance of skin. Partitioning image models has been presented to sort out the disturbance in the picture. Results: After completing partitioning, feature extraction has been formed by using genetic algorithm and finally, classification can be performed between the trained and test data to evaluate a large scale of an image that helps the doctors for the right prediction. To bring the improvisation of the existing system, we have set our objectives with an analysis. The efficiency of the natural selection process and the enriching histogram is essential in that respect. To reduce the false-positive rate or output, GA is performed with its accuracy. Conclusions: The objective of this task is to bring improvisation of effectiveness. GA is accomplishing its task with perfection to bring down the invalid-positive rate or outcome. The paper's mergeable portion conflicts with the composition of deep learning and medical image processing, which provides superior accuracy. Proportional types of handling create the reusability without any errors.

Keywords: Computer-aided system, detection, image segmentation, morphology.

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346 Evaluation of Residual Stresses in Human Face as a Function of Growth

Authors: M. A. Askari, M. A. Nazari, P. Perrier, Y. Payan

Abstract:

Growth and remodeling of biological structures have gained lots of attention over the past decades. Determining the response of living tissues to mechanical loads is necessary for a wide range of developing fields such as prosthetics design or computerassisted surgical interventions. It is a well-known fact that biological structures are never stress-free, even when externally unloaded. The exact origin of these residual stresses is not clear, but theoretically, growth is one of the main sources. Extracting body organ’s shapes from medical imaging does not produce any information regarding the existing residual stresses in that organ. The simplest cause of such stresses is gravity since an organ grows under its influence from birth. Ignoring such residual stresses might cause erroneous results in numerical simulations. Accounting for residual stresses due to tissue growth can improve the accuracy of mechanical analysis results. This paper presents an original computational framework based on gradual growth to determine the residual stresses due to growth. To illustrate the method, we apply it to a finite element model of a healthy human face reconstructed from medical images. The distribution of residual stress in facial tissues is computed, which can overcome the effect of gravity and maintain tissues firmness. Our assumption is that tissue wrinkles caused by aging could be a consequence of decreasing residual stress and thus not counteracting gravity. Taking into account these stresses seems therefore extremely important in maxillofacial surgery. It would indeed help surgeons to estimate tissues changes after surgery.

Keywords: Finite element method, growth, residual stress, soft tissue.

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345 Post-Traumatic Stress Disorder: Management at the Montfort Hospital

Authors: Kay-Anne Haykal, Issack Biyong

Abstract:

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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344 Flipped Classroom in Bioethics Education: A Blended and Interactive Online Learning Courseware that Enhances Active Learning and Student Engagement

Authors: Molly P. M. Wong

Abstract:

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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343 Evaluation of the Effect of Nursing Services Provided in a Correctional Institution on the Physical Health Levels and Health Behaviors of Female Inmates

Authors: Şenay Pehli̇van, Gülümser Kublay

Abstract:

Female inmates placed in a Correctional Institution (CI) have more physical health problems than other women and their male counterparts. Thus, they require more health care services in the CI and nursing services in particular. CI nurses also have the opportunity to teach behaviors which will protect and improve their health to these women who are difficult to reach in the community. The aim of this study was to evaluate effect of nursing services provided in a CI on the physical health levels and health behaviors of female inmates. The study has a quasi-experimental design. The study was done in Female Closed CI in Ankara, Turkey. The study was conducted on 30 female inmates. Before the implementation of nursing interventions in the initial phase of the study, female inmates were evaluated in terms of physical health problems and health behavior using forms, a physical examination, medical history, health files (file containing medical information related to prisons) and the Omaha System (OS). Findings obtained from evaluations were grouped and symptoms-findings were expressed with OS diagnosis codes. Knowledge, behavior and status scores of prisoners in relation to health problems were determined. After the implementation of the nursing interventions, female inmates were evaluated in terms of physical health problems and health behavior using OS. The research data were collected using the Female Evaluation Form developed by the researcher and the OS. It was found that knowledge, behavior and status scores of prisoners significantly increased after the implementation of nursing interventions (p < 0.05).

Keywords: Correctional institution, correctional nursing, prison nursing, female inmates, physical health problems, health behaviors.

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342 Integrating Geographic Information into Diabetes Disease Management

Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

Abstract:

Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: Geocoding, chronic disease management, quality of diabetes care, rate ratio.

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341 Arriving at an Optimum Value of Tolerance Factor for Compressing Medical Images

Authors: Sumathi Poobal, G. Ravindran

Abstract:

Medical imaging uses the advantage of digital technology in imaging and teleradiology. In teleradiology systems large amount of data is acquired, stored and transmitted. A major technology that may help to solve the problems associated with the massive data storage and data transfer capacity is data compression and decompression. There are many methods of image compression available. They are classified as lossless and lossy compression methods. In lossy compression method the decompressed image contains some distortion. Fractal image compression (FIC) is a lossy compression method. In fractal image compression an image is coded as a set of contractive transformations in a complete metric space. The set of contractive transformations is guaranteed to produce an approximation to the original image. In this paper FIC is achieved by PIFS using quadtree partitioning. PIFS is applied on different images like , Ultrasound, CT Scan, Angiogram, X-ray, Mammograms. In each modality approximately twenty images are considered and the average values of compression ratio and PSNR values are arrived. In this method of fractal encoding, the parameter, tolerance factor Tmax, is varied from 1 to 10, keeping the other standard parameters constant. For all modalities of images the compression ratio and Peak Signal to Noise Ratio (PSNR) are computed and studied. The quality of the decompressed image is arrived by PSNR values. From the results it is observed that the compression ratio increases with the tolerance factor and mammogram has the highest compression ratio. The quality of the image is not degraded upto an optimum value of tolerance factor, Tmax, equal to 8, because of the properties of fractal compression.

Keywords: Fractal image compression, IFS, PIFS, PSNR, Quadtree partitioning.

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340 Real-time Haptic Modeling and Simulation for Prosthetic Insertion

Authors: Catherine A. Todd, Fazel Naghdy

Abstract:

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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339 A Numerical Strategy to Design Maneuverable Micro-Biomedical Swimming Robots Based on Biomimetic Flagellar Propulsion

Authors: Arash Taheri, Meysam Mohammadi-Amin, Seyed Hossein Moosavy

Abstract:

Medical applications are among the most impactful areas of microrobotics. The ultimate goal of medical microrobots is to reach currently inaccessible areas of the human body and carry out a host of complex operations such as minimally invasive surgery (MIS), highly localized drug delivery, and screening for diseases at their very early stages. Miniature, safe and efficient propulsion systems hold the key to maturing this technology but they pose significant challenges. A new type of propulsion developed recently, uses multi-flagella architecture inspired by the motility mechanism of prokaryotic microorganisms. There is a lack of efficient methods for designing this type of propulsion system. The goal of this paper is to overcome the lack and this way, a numerical strategy is proposed to design multi-flagella propulsion systems. The strategy is based on the implementation of the regularized stokeslet and rotlet theory, RFT theory and new approach of “local corrected velocity". The effects of shape parameters and angular velocities of each flagellum on overall flow field and on the robot net forces and moments are considered. Then a multi-layer perceptron artificial neural network is designed and employed to adjust the angular velocities of the motors for propulsion control. The proposed method applied successfully on a sample configuration and useful demonstrative results is obtained.

Keywords: Artificial Neural Network, Biomimetic Microrobots, Flagellar Propulsion, Swimming Robots.

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338 Scatterer Density in Edge and Coherence Enhancing Nonlinear Anisotropic Diffusion for Medical Ultrasound Speckle Reduction

Authors: Ahmed Badawi, J. Michael Johnson, Mohamed Mahfouz

Abstract:

This paper proposes new enhancement models to the methods of nonlinear anisotropic diffusion to greatly reduce speckle and preserve image features in medical ultrasound images. By incorporating local physical characteristics of the image, in this case scatterer density, in addition to the gradient, into existing tensorbased image diffusion methods, we were able to greatly improve the performance of the existing filtering methods, namely edge enhancing (EE) and coherence enhancing (CE) diffusion. The new enhancement methods were tested using various ultrasound images, including phantom and some clinical images, to determine the amount of speckle reduction, edge, and coherence enhancements. Scatterer density weighted nonlinear anisotropic diffusion (SDWNAD) for ultrasound images consistently outperformed its traditional tensor-based counterparts that use gradient only to weight the diffusivity function. SDWNAD is shown to greatly reduce speckle noise while preserving image features as edges, orientation coherence, and scatterer density. SDWNAD superior performances over nonlinear coherent diffusion (NCD), speckle reducing anisotropic diffusion (SRAD), adaptive weighted median filter (AWMF), wavelet shrinkage (WS), and wavelet shrinkage with contrast enhancement (WSCE), make these methods ideal preprocessing steps for automatic segmentation in ultrasound imaging.

Keywords: Nonlinear anisotropic diffusion, ultrasound imaging, speckle reduction, scatterer density estimation, edge based enhancement, coherence enhancement.

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337 Manipulator Development for Telediagnostics

Authors: Adam Kurnicki, Bartłomiej Stanczyk, Bartosz Kania

Abstract:

This paper presents development of the light-weight manipulator with series elastic actuation for medical telediagnostics (USG examination). General structure of realized impedance control algorithm was shown. It was described how to perform force measurements based mainly on elasticity of manipulator links.

Keywords: Telediagnostics, elastic manipulator, impedance control, force measurement.

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336 Advanced Stochastic Models for Partially Developed Speckle

Authors: Jihad S. Daba (Jean-Pierre Dubois), Philip Jreije

Abstract:

Speckled images arise when coherent microwave, optical, and acoustic imaging techniques are used to image an object, surface or scene. Examples of coherent imaging systems include synthetic aperture radar, laser imaging systems, imaging sonar systems, and medical ultrasound systems. Speckle noise is a form of object or target induced noise that results when the surface of the object is Rayleigh rough compared to the wavelength of the illuminating radiation. Detection and estimation in images corrupted by speckle noise is complicated by the nature of the noise and is not as straightforward as detection and estimation in additive noise. In this work, we derive stochastic models for speckle noise, with an emphasis on speckle as it arises in medical ultrasound images. The motivation for this work is the problem of segmentation and tissue classification using ultrasound imaging. Modeling of speckle in this context involves partially developed speckle model where an underlying Poisson point process modulates a Gram-Charlier series of Laguerre weighted exponential functions, resulting in a doubly stochastic filtered Poisson point process. The statistical distribution of partially developed speckle is derived in a closed canonical form. It is observed that as the mean number of scatterers in a resolution cell is increased, the probability density function approaches an exponential distribution. This is consistent with fully developed speckle noise as demonstrated by the Central Limit theorem.

Keywords: Doubly stochastic filtered process, Poisson point process, segmentation, speckle, ultrasound

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335 Wound Healing Dressing and Some Composites Such as Zeolite, TiO2, Chitosan and PLGA: A Review

Authors: L. B. Naves, L. Almeida

Abstract:

The development of Drugs Delivery System (DDS) has been widely investigated in the last decades. In this paper, first a general overview of traditional and modern wound dressing is presented. This is followed by a review of what scientists have done in the medical environment, focusing on the possibility to develop a new alternative for DDS through transdermal pathway, aiming to treat melanoma skin cancer.

Keywords: Cancer Therapy, Dressing Polymers, Melanoma, wound healing.

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334 Some Properties of IF Rough Relational Algebraic Operators in Medical Databases

Authors: Chhaya Gangwal, R. N. Bhaumik, Shishir Kumar

Abstract:

Some properties of Intuitionistic Fuzzy (IF) rough relational algebraic operators under an IF rough relational data model are investigated and illustrated using diabetes and heart disease databases. These properties are important and desirable for processing queries in an effective and efficient manner.

 

Keywords: IF Set, Rough Set, IF Rough Relational Database, IF rough Relational Operators.

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333 A Comprehensive Key Performance Indicators Dashboard for Emergency Medical Services

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

Abstract:

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

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

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332 Decreasing Power Consumption of a Medical E-textile

Authors: E. Shahhaidar

Abstract:

In this paper we present a novel design of a wearable electronic textile. After defining a special application, we used the specifications of some low power, tiny elements including sensors, microcontrollers, transceivers, and a fault tolerant special topology to have the most reliability as well as low power consumption and longer lifetime. We have considered two different conditions as normal and bodily critical conditions and set priorities for using different sensors in various conditions to have a longer effective lifetime.

Keywords: ECG, E-Textile, Fault Tolerance, Powerconsumption.

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

Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

Abstract:

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

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

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

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

Abstract:

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

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

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329 Architecture Integrating Wireless Body Area Networks with Web Services for Ubiquitous Healthcare Service Provisioning

Authors: Ogunduyile O. Oluwgbenga

Abstract:

Recent advancements in sensor technologies and Wireless Body Area Networks (WBANs) have led to the development of cost-effective healthcare devices which can be used to monitor and analyse a person-s physiological parameters from remote locations. These advancements provides a unique opportunity to overcome current healthcare challenges of low quality service provisioning, lack of easy accessibility to service varieties, high costs of services and increasing population of the elderly experienced globally. This paper reports on a prototype implementation of an architecture that seamlessly integrates Wireless Body Area Network (WBAN) with Web services (WS) to proactively collect physiological data of remote patients to recommend diagnostic services. Technologies based upon WBAN and WS can provide ubiquitous accessibility to a variety of services by allowing distributed healthcare resources to be massively reused to provide cost-effective services without individuals physically moving to the locations of those resources. In addition, these technologies can reduce costs of healthcare services by allowing individuals to access services to support their healthcare. The prototype uses WBAN body sensors implemented on arduino fio platforms to be worn by the patient and an android smart phone as a personal server. The physiological data are collected and uploaded through GPRS/internet to the Medical Health Server (MHS) to be analysed. The prototype monitors the activities, location and physiological parameters such as SpO2 and Heart Rate of the elderly and patients in rehabilitation. Medical practitioners would have real time access to the uploaded information through a web application.

Keywords: Android Smart phone, Arduino Fio, Web application server, Wireless Body Area Networks.

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328 In silico Simulations for DNA Shuffling Experiments

Authors: Luciana Montera

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DNA shuffling is a powerful method used for in vitro evolute molecules with specific functions and has application in areas such as, for example, pharmaceutical, medical and agricultural research. The success of such experiments is dependent on a variety of parameters and conditions that, sometimes, can not be properly pre-established. Here, two computational models predicting DNA shuffling results is presented and their use and results are evaluated against an empirical experiment. The in silico and in vitro results show agreement indicating the importance of these two models and motivating the study and development of new models.

Keywords: Computer simulation, DNA shuffling, in silico andin vitro comparison.

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327 Intellectual Property Rights and Health Rights: A Feasible Reform Proposal to Facilitate Access to Drugs in Developing Countries

Authors: M. G. Cattaneo

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The non-effectiveness of certain codified human rights is particularly apparent with reference to the lack of access to essential drugs in developing countries, which represents a breach of the human right to receive adequate health assistance. This paper underlines the conflict and the legal contradictions between human rights, namely health rights, international Intellectual Property Rights, in particular patent law, as well as international trade law. The paper discusses the crucial links between R&D costs for innovation, patents and new medical drugs, with the goal of reformulating the hierarchies of priorities and of interests at stake in the international intellectual property (IP) law system. Different from what happens today, International patent law should be a legal instrument apt at rebalancing an axiological asymmetry between the (conflicting) needs at stake The core argument in the paper is the proposal of an alternative pathway, namely a feasible proposal for a patent law reform. IP laws tend to balance the benefits deriving from innovation with the costs of the provided monopoly, but since developing countries and industrialized countries are in completely different political and economic situations, it is necessary to (re)modulate such exchange according to the different needs. Based on this critical analysis, the paper puts forward a proposal, called Trading Time for Space (TTS), whereby a longer time for patent exclusive life in western countries (Time) is offered to the patent holder company, in exchange for the latter selling the medical drug at cost price in developing countries (Space). Accordingly, pharmaceutical companies should sell drugs in developing countries at the cost price, or alternatively grant a free license for the sale in such countries, without any royalties or fees. However, such social service shall be duly compensated. Therefore, the consideration for such a service shall be an extension of the temporal duration of the patent’s exclusive in the country of origin that will compensate the reduced profits caused by the supply at the price cost in developing countries.

Keywords: Global health, global justice, patent law reform, access to drugs.

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326 Atherosclerosis Prevalence within Populations of the Southeastern United States

Authors: Samuel P. Prahlow, Anthony Sciuva, Katherine Bombly, Emily Wilson, Shiv Dhiman, Savita Arya

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A prevalence cohort study of atherosclerotic lesions within cadavers was performed to better understand and characterize the prevalence of atherosclerosis among Georgia residents within body donors in the Philadelphia College of Osteopathic Medicine (PCOM) - Georgia body donor program. We procured specimens from cadavers used for medical student, physical therapy student, and biomedical science student cadaveric anatomical dissection at PCOM - South Georgia and PCOM - Georgia. Tissues were prepared using hematoxylin and eosin (H&E) stain as histological slides by Colquitt Regional Medical Center Laboratory Services. One section from each of the following arteries was taken after cadaveric dissection at the site of most calcification palpated grossly (if present): left anterior descending coronary artery, left internal carotid artery, abdominal aorta, splenic artery, and hepatic artery. All specimens were graded and categorized according to the American Heart Association’s Modified and Conventional Standards for Atherosclerotic Lesions using x4, x10, x40 microscopic magnification. Our study cohort included 22 cadavers, with 16 females and 6 males. The average age was 72.54 and median age was 72, with a range of 52 to 90 years old. The cause of death determination listing vascular and/or cardiovascular causes were present on 6 of the 22 death certificates. 19 of 22 (86%) cadavers had at least a single artery grading > 5. Of the cadavers with at least a single artery graded at greater than 5, only 5 of 19 (26%) cadavers had a vascular or cardiovascular cause of death reported. Malignancy was listed as a cause of death on 7 (32%) of death certificates. The average atherosclerosis grading of the common hepatic, splenic and left internal carotid arteries (2.15, 3.05, and 3.36 respectively) were lower than the left anterior descending artery and the abdominal aorta (5.16 and 5.86 respectively). This prevalence study characterizes atherosclerosis found in five medium and large systemic arteries within cadavers from the state of Georgia.

Keywords: Atherosclerosis, cardiovascular, histology, pathology.

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