Search results for: care pathways

Authors: Rafayel A. Azizyan, Aram E. Gevogyan, Valeri B. Arakelyan, Emil S. Gevorgyan

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The mathematical modeling of different biological processes is usually used to predict or assess behavior of systems in which these processes take place. This study deals with mathematical and computer modeling of bi-substrate enzymatic reactions with ping-pong mechanism, which play an important role in different biochemical pathways. Besides that, three models of competitive inhibition were designed using different software packages. The main objective of this study is to represent the results from in silico investigation of bi-substrate enzymatic reactions with ordered pingpong mechanism in the presence of competitive inhibitors, as well as to describe in details the inhibition effects. The simulation of the models with certain kinetic parameters allowed investigating the behavior of reactions as well as determined some interesting aspects concerning influence of different cases of competitive inhibition. Simultaneous presence of two inhibitors, competitive to the S1 and S2 substrates have been studied. Moreover, we have found the pattern of simultaneous influence of both inhibitors.

Keywords: Mathematical modeling, bi-substrate enzymatic reactions, ping-pong mechanism, competitive inhibition.

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Authors: Ines Hamdi, Mohamed Ben Ahmed

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The understanding of the system level of biological behavior and phenomenon variously needs some elements such as gene sequence, protein structure, gene functions and metabolic pathways. Challenging problems are representing, learning and reasoning about these biochemical reactions, gene and protein structure, genotype and relation between the phenotype, and expression system on those interactions. The goal of our work is to understand the behaviors of the interactions networks and to model their evolution in time and in space. We propose in this study an ontological meta-model for the knowledge representation of the genetic regulatory networks. Ontology in artificial intelligence means the fundamental categories and relations that provide a framework for knowledge models. Domain ontology's are now commonly used to enable heterogeneous information resources, such as knowledge-based systems, to communicate with each other. The interest of our model is to represent the spatial, temporal and spatio-temporal knowledge. We validated our propositions in the genetic regulatory network of the Aarbidosis thaliana flower

Keywords: Ontological model, spatio-temporal modeling, Genetic Regulatory Networks (GRNs), knowledge representation.

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Authors: Chia-Jou Hsieh, Feng-Chuan Pan

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Oral health is particular important to the hospitalized patients with chronic schizophrenia for an extreme high potential of the respiratory infections. Due to the degeneration of physical capability, patients of this kind typically fall dependent in the activity of daily living (ADL). A very high percentage of patients had dental problems of which mostly could be easily avoid by easy regular tooth brushing. Purpose of the project is to develop a mechanism in helping the schizophrenia patients in rebuilding a tooth-cleaning habit. The project observed and evaluated the tooth-cleaning behavior of 100 male patients in a psychiatric hospital, and found the majority of them ignored such an activity in a three-month period of time. In the meantime, the primary care-givers were not aware or not convinced the importance of such a need of dental hygiene, and thus few if any tooth cleaning training or knowledge on dental hygiene were given to the patients. The project then developed a program based on the numerous observations and discussions. The improvement program included patients- group education, care-givers- training, and a tool-kit for tooth-brush holding was erected. The project launched with some incentive package. The outcomes were encouraging with 87% of the patients had rebuilt their tooth-brushing habits against previous 22%, and the tooth cleaning kits were 100% kept against 22% in the past. This project had significantly improved the oral health of the patients. The project, included the procedure and the tool-kit holder specific for this purpose, was a good examples for psychiatric hospitals.

Keywords: Schizophrenia, dental hygiene, tool-kit holder, health education

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Authors: A. I. Augie, M. Saleh, A. A. Gado

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In this research, Self-Potential (SP) method was employed to locate anomalous electrical conductivity located in Goronyo area and also to determine the condition of the embankment of the dam. SP data were plotted against distance along with the profile and spacing of electrode using surfer software (version 12). High and low zones of SP values were identified along the right and left abutments of the dam reservoir. The regions with high SP values were described to be high tendency of fluid flow associate with wet sandy soil. These zones have the SP values ranging from 200 mV and above. High SP values were due to the high moisture content that may lead to the seepage of water leaking through this zone. The zones with high SP values occupied Profiles S1, S2, S3, S4 and S5 indicating the presence of potential seepage paths within the subsurface of the embankment. These regions of seepage were identified as weak zones and potential pathways through which water could be lost from the dam reservoir. The SP values for the regions range from 250 m to 400 m (S1), 306 m to 400 m (S2), 192 m to 400 m (S3), 48 m to 200 m (S4) and 7 m to 170 m (S5) with their corresponding maximum depths of 30 m, 28 m, 28 m, 30 m and 26 m respectively. However, zones of low SP values in the overburden were observed which shows the presence of intact regions, which may be due to the compactness and dryness around the dam. The weak zones were considered as geological features (such as fractures, joints, and faults) that have undermined the integrity of the dam structure, which has led to the abnormal seepage.

Keywords: Self-potential, subsurface, seepage, condition and dam.

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Authors: Dalyah Y. Al-Jamal, Maryam H. Eshtaiwi, Liyakathunisa Syed

Abstract:

Connecting health services with technology has a huge demand as people health situations are becoming worse day by day. In fact, engaging new technologies such as Internet of Things (IOT) into the medical services can enhance the patient care services. Specifically, patients suffering from chronic diseases such as cardiac patients need a special care and monitoring. In reality, some efforts were previously taken to automate and improve the patient monitoring systems. However, the previous efforts have some limitations and lack the real-time feature needed for chronic kind of diseases. In this paper, an improved process model for patient monitoring system specialized for cardiac patients is presented. A survey was distributed and interviews were conducted to gather the needed requirements to improve the cardiac patient monitoring system. Business Process Model and Notation (BPMN) language was used to model the proposed process. In fact, the proposed system uses the IOT Technology to assist doctors to remotely monitor and follow-up with their heart patients in real-time. In order to validate the effectiveness of the proposed solution, simulation analysis was performed using Bizagi Modeler tool. Analysis results show performance improvements in the heart monitoring process. For the future, authors suggest enhancing the proposed system to cover all the chronic diseases.

Keywords: Business process model and notation, cardiac patient, cardiac monitoring, heart monitoring, healthcare, internet of things, remote patient monitoring system, process model, telemedicine, wearable sensors.

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Authors: Shanthi Thomas

Abstract:

This research paper presents the current practices of teacher professional development, perceived as beneficial by teachers themselves, in a private secondary school in Brunei Darussalam. This is part of the findings of a larger qualitative study on teacher empowerment, using ethnographic methods for data collection, i.e. participant observation, interviews and document analysis. The field work was carried out over a period of six months in 2013. An analysis of the field data revealed multiple pathways of teacher professional development existing in the school. The results indicate that school leaders, the teacher community in the school, students, and the teachers themselves were the agents in a school that facilitated teacher empowerment. Besides contributing to the knowledge base on teacher professional development, the results of this study provide directions for educational policy makers in their efforts to enhance professional development in secondary schools of similar characteristics. For school leaders and the teacher community, these findings offer guidelines for maximizing the opportunities for these professional development practices, by strengthening collegiality and by using the existing structures optimally for the benefit of all concerned.

Keywords: Colleagues and the wider teacher community, school leaders, self-driven professional development, teacher professional development.

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Authors: B. Muhammadani

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Health workforce is a fundamental component of health system and plays a significant role in delivering effective health care services. However, there is a crucial shortage of skilled personnel which make them prone to work in stressful conditions. In spite of excessively high workload and burnout among the staff, little attention is given to their job satisfaction level which has serious implications on the productivity and effective performance of staff to achieve organizational goals. Therefore, this study aims to explore the job satisfaction of midwives working in the labor ward of the Lady Dufferin Hospital, Karachi. A cross-sectional survey was conducted. The short version of Minnesota Job Satisfaction Questionnaire was administered on a convenient sample group of 22 midwives to gather information on their job satisfaction. The results demonstrated that midwives were overall satisfied with their job. The level of job satisfaction was however found different in various positions within midwifery cadre. The head of midwives was highly satisfied as compared to midwifery staff who works under the supervision of head. The level of satisfaction of team leaders fall between the head and staff of midwifery. Similar trends were observed for both intrinsic and extrinsic job satisfaction. Such evidences on these issues are essential and useful as it helps explore the attitudes of individuals towards work which has direct implications on access to quality care services. Strategic interventions are required at organizational level to provide motivators and satisfiers to health workers for their work related satisfaction and enhanced motivation.

Keywords: Health workforce, job satisfaction, motivation, workload, burnout, midwives, health system.

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Authors: Vahid Aryanpur , Ehsan Shafiei

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This paper presents an environmental and technoeconomic evaluation of light duty vehicles in Iran. A comprehensive well-to-wheel (WTW) analysis is applied to compare different automotive fuel chains, conventional internal combustion engines and innovative vehicle powertrains. The study examines the competitiveness of 15 various pathways in terms of energy efficiencies, GHG emissions, and levelized cost of different energy carriers. The results indicate that electric vehicles including battery electric vehicles (BEV), fuel cell vehicles (FCV) and plug-in hybrid electric vehicles (PHEV) increase the WTW energy efficiency by 54%, 51% and 46%, respectively, compared to common internal combustion engines powered by gasoline. On the other hand, greenhouse gas (GHG) emissions per kilometer of FCV and BEV would be 48% lower than that of gasoline engines. It is concluded that BEV has the lowest total cost of energy consumption and external cost of emission, followed by internal combustion engines (ICE) fueled by CNG. Conventional internal combustion engines fueled by gasoline, on the other hand, would have the highest costs.

Keywords: Well-to-Wheel analysis, Energy Efficiency, GHG emissions, Levelized cost of energy, Alternative fuel vehicles.

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Authors: Sharmina Begum, M. G. Rasul, Delwar Akbar

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Solid waste can be considered as an urban burden or as a valuable resource depending on how it is managed. To meet the rising demand for energy and to address environmental concerns, a conversion from conventional energy systems to renewable resources is essential. For the sustainability of human civilization, an environmentally sound and techno-economically feasible waste treatment method is very important to treat recyclable waste. Several technologies are available for realizing the potential of solid waste as an energy source, ranging from very simple systems for disposing of dry waste to more complex technologies capable of dealing with large amounts of industrial waste. There are three main pathways for conversion of waste material to energy: thermo chemical, biochemical and physicochemical. This paper investigates the thermo chemical conversion of solid waste for energy recovery. The processes, advantages and dis-advantages of various thermo chemical conversion processes are discussed and compared. Special attention is given to Gasification process as it provides better solutions regarding public acceptance, feedstock flexibility, near-zero emissions, efficiency and security. Finally this paper presents comparative statements of thermo chemical processes and introduces an integrated waste management system.

Keywords: Gasification, Incineration, Pyrolysis, Thermo chemical conversion.

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Authors: Shahad Nagoor, Lucy Hederman, Kevin Koidl, Annalina Caputo

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Doctors’ notes reflect their impressions, attitudes, clinical sense, and opinions about patients’ conditions and progress, and other information that is essential for doctors’ daily clinical decisions. Despite their value, clinical notes are insufficiently researched within the language processing community. Automatically extracting information from unstructured text data is known to be a difficult task as opposed to dealing with structured information such as physiological vital signs, images and laboratory results. The aim of this research is to investigate how Natural Language Processing (NLP) techniques and machine learning techniques applied to clinician notes can assist in doctors’ decision making in Intensive Care Unit (ICU) for coronavirus disease 2019 (COVID-19) patients. The hypothesis is that clinical outcomes like survival or mortality can be useful to influence the judgement of clinical sentiment in ICU clinical notes. This paper presents two contributions: first, we introduce COVID_ICU_BERT, a fine-tuned version of a clinical transformer model that can reliably predict clinical sentiment for notes of COVID patients in ICU. We train the model on clinical notes for COVID-19 patients, ones not previously seen by Bio_ClinicalBERT or Bio_Discharge_Summary_BERT. The model which was based on Bio_ClinicalBERT achieves higher predictive accuracy than the one based on Bio_Discharge_Summary_BERT (Acc 93.33%, AUC 0.98, and Precision 0.96). Second, we perform data augmentation using clinical contextual word embedding that is based on a pre-trained clinical model to balance the samples in each class in the data (survived vs. deceased patients). Data augmentation improves the accuracy of prediction slightly (Acc 96.67%, AUC 0.98, and Precision 0.92).

Keywords: BERT fine-tuning, clinical sentiment, COVID-19, data augmentation.

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Authors: Nahlah Abbas, Saleh A. Wasimi, Nadhir Al-Ansari

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The Greater Zab and Lesser Zab are the major tributaries of Tigris River contributing the largest flow volumes into the river. The impacts of climate change on water resources in these basins have not been well addressed. To gain a better understanding of the effects of climate change on water resources of the study area in near future (2049-2069) as well as in distant future (2080-2099), Soil and Water Assessment Tool (SWAT) was applied. The model was first calibrated for the period from 1979 to 2004 to test its suitability in describing the hydrological processes in the basins. The SWAT model showed a good performance in simulating streamflow. The calibrated model was then used to evaluate the impacts of climate change on water resources. Six general circulation models (GCMs) from phase five of the Coupled Model Intercomparison Project (CMIP5) under three Representative Concentration Pathways (RCPs) RCP 2.6, RCP 4.5, and RCP 8.5 for periods of 2049-2069 and 2080-2099 were used to project the climate change impacts on these basins. The results demonstrated a significant decline in water resources availability in the future.

Keywords: Tigris River, climate change, water resources, SWAT.

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Authors: M. Ahmadi Baseri, R. Mokhtari Malekabadi, A. Gandomkar

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Nowadays, one of the most important problems of the metropolises and the world large cities is the habitant traffic difficulty and lack of sufficient parking site for the vehicles. Esfahan city as the third metropolis of Iran has encountered with the vehicles parkingplace problems in the most parts of fourteen regions of the city. The non principled and non systematic dispersal and lack of parking sites in the city has created an unfavorable status for its traffic and has caused the air and sound pollutions increase; in addition, it wastes the most portions of the citizenship and travelers' charge and time in urban pathways and disturbs their mental and psychical calmness, thus leads to their intensive dissatisfaction. In this study, by the usage of AHP model in GIS environment, the effective criteria in selecting the public parking sites have been combined with each other, and the results of the created layers overlapping represent the parking utilitarian vastness and widths. The achieved results of this research indicate the pretty appropriate public parking sites selection in region number 3 of Esfahan; but inconsequential dispersal and lack of these parking sites in this region have caused abundant transportation problems in Esfahan city.

Keywords: Public parking lots, Parking site selection, Geographical Information System (GIS), Hierarchical Analysis Model, Isfahan city.

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Authors: Yi-Ting Liu, Pei-Ying Wen

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In order to improve the overall safety of chemotherapy, safety-protecting netwas established for the whole process from prescribing by physicians, transcribing by nurses, dispensing by pharmacists to administering by nurses. The information system was used to check and monitorwhole process of administration and related sheets were computerized to simplify the paperwork.

Keywords: Chemotherapy, Bar Code Medication Administration (BCMA), Medication Safety.

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Authors: Rafayel A. Azizyan, Aram E. Gevorgyan, Valeri B. Arakelyan, Emil S. Gevorgyan

Abstract:

Currently, mathematical and computer modeling are widely used in different biological studies to predict or assess behavior of such a complex systems as a biological are. This study deals with mathematical and computer modeling of bi-substrate enzymatic reactions, which play an important role in different biochemical pathways. The main objective of this study is to represent the results from in silico investigation of bi-substrate enzymatic reactions in the presence of uncompetitive inhibitors, as well as to describe in details the inhibition effects. Four models of uncompetitive inhibition were designed using different software packages. Particularly, uncompetitive inhibitor to the first [ES₁] and the second ([ES₁S₂]; [FS₂]) enzyme-substrate complexes have been studied. The simulation, using the same kinetic parameters for all models allowed investigating the behavior of reactions as well as determined some interesting aspects concerning influence of different cases of uncompetitive inhibition. Besides, it has been shown that uncompetitive inhibitors exhibit specific selectivity depending on mechanism of bi-substrate enzymatic reaction. 

Keywords: Mathematical modeling, bi-substrate enzymatic reactions, sequential mechanism, ping-pong mechanism, uncompetitive inhibition.

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Authors: Orly Sarid, Yana Shraga

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Purpose: To compare attitudes and perceptions of Israeli native born mothers versus former Soviet Union (FSU) immigrant mothers regarding the physical health of their infant. Methodology: cross-sectional design. A convenience sample of 50 participants was recruited by face to face and snowball technique. A questionnaire was constructed according to the instructions of the Ministry of Health for the care and treatment of infants. The main areas explored were: sources of knowledge that the young mother acquired regarding the care of her infant, ways of caring for the infant, hygiene and sanitary habits, and the pattern of referral to health professionals. The last topic relates to emotions mothers might experience towards their infant. Results: Mothers from both cultural groups present some similar caring behaviors, which may express a universal aspect of mothers' behavior towards their infants. However, immigrant mothers differ significantly from native born by relying less on their mothers' and grandmothers' experience, they wean their infants from diapers earlier, they are stricter about hygiene and sanitary habits and they tend to consult a physician when their infant has low fever. Native born and immigrant mothers differ in their expressions of pride and wonder. Immigrant mothers report of a lesser degree of these emotions towards their infants than native born mothers. Conclusion: The theoretical model of socialization and acculturation of immigrant mothers is employed as an explanatory model for the current findings Young immigrant mothers undergo a complex acculturation process and adapt behavioral patterns in various areas to comply with Israeli norms and values, demonstrating assimilation. In other areas they adhere to the norms of their original culture.

Keywords: Attitudes, immigrant mothers, infant, physical health

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Authors: A. Sherif, H. Sabry, A. Elzafarany, M. Gadelhak, R. Arafa, M. Aly

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This paper addresses the design of hospital Intensive Care Unit windows for the achievement of visual comfort and energy savings. The aim was to identify the window size and shading system configurations that could fulfill daylighting adequacy, avoid glare and reduce energy consumption. The study focused on addressing the effect of utilizing different shading systems in association with a range of Window-to-Wall Ratios (WWR) in different orientations under the desert clear-sky of Cairo, Egypt. The results of this study demonstrated that solar penetration is a critical concern affecting the design of ICU windows in desert locations, as in Cairo, Egypt. Use of shading systems was found to be essential in providing acceptable daylight performance and energy saving. Careful positioning of the ICU window towards a proper orientation can dramatically improve performance. It was observed that ICU windows facing the north direction enjoyed the widest range of successful window configuration possibilities at different WWRs. ICU windows facing south enjoyed a reasonable number of configuration options as well. By contrast, the ICU windows facing the east orientation had a very limited number of options that provide acceptable performance. These require additional local shading measures at certain times due to glare incidence. Moreover, use of horizontal sun breakers and solar screens to protect the ICU windows proved to be more successful than the other alternatives in a wide range of Window to Wall Ratios. By contrast, the use of light shelves and vertical shading devices seemed questionable.

Keywords: Daylighting, Desert, Energy Efficiency, Shading.

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Authors: Li-Ping Hsiao, Feng-Chuan Pan

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Leave of absence is important in maintaining a good status of human resource quality. Allowing the employees temporarily free from the routine assignments can vitalize the workers- morality and productivity. This is particularly critical to secure a satisfactory service quality for healthcare professionals of which were typically featured with labor intensive and complicated works to perform. As one of the veteran hospitals that were found and operated by the Veteran Department of Taiwan, the nursing staff of the case hospital was squeezed to an extreme minimum level under the pressure of a tight budgeting. Leave of absence on schedule became extremely difficult, especially for the intensive care units (ICU), in which required close monitoring over the cared patients, and that had more easily driven the ICU nurses nervous. Even worse, the deferred leaves were more than 10 days at any time in the ICU because of a fluctuating occupancy. As a result, these had brought a bad setback to this particular nursing team, and consequently defeated the job performance and service quality. To solve this problem and accordingly to strengthen their morality, a project team was organized across different departments specific for this. Sufficient information regarding jobs and positions requirements, labor resources, and actual working hours in detail were collected and analyzed in the team meetings. Several alternatives were finalized. These included job rotating, job combination, leave on impromptu and cross-departmental redeployment. Consequently, the deferred leave days sharply reduced 70% to a level of 3 or less days. This improvement had not only provided good shelter for the ICU nurses that improved their job performance and patient safety but also encouraged the nurses active participating of a project and learned the skills of solving problems with colleagues.

Keywords: Information, job rotating, human resource, intensive care unit.

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Authors: M. Emmanouilidou

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The Internet of Things (IoT) is a disruptive technological paradigm that is at the center of the digital evolution by integrating physical and virtual worlds leading to the creation of extended interconnected ecosystems that are characterized as smart environments. The concept of the IoT has a broad range of applications in different industries including the healthcare sector. The Internet of Healthcare Things (IoHT), a branch of the IoT, is expected to bring promising benefits to all involved stakeholders and accelerate the revolution of the healthcare sector through a transition towards preventive and personalized medicine. The socio-economic challenges that the healthcare sector is facing further emphasize the need for a radical transformation of healthcare systems in both developed and developing countries with the role of pervasive technological innovations, such as IoHT, recognized as key to counteract the relevant challenges. Besides the number of potential opportunities that IoHT presents, there are fundamental ethical concerns that need to be considered and addressed in relation to the application of IoHT. This paper contributes to the discussion of the emerging topic of IoHT by providing an overview of the role and potential of IoHT, highlighting the characteristics of the current and future healthcare landscape, reporting on the up-to-date status of IoHT in Europe and reflecting upon existing research in the ethics of IoHT by incorporating additional ethical dimensions that have been ignored which can provide pathways for future research in the field.

Keywords: Ethics, Europe, healthcare, internet of things.

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

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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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Authors: Yah-Ling Hung

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eHealth is undoubtedly emerging as a promising vehicle to provide information for individual self-care management. However, the accessing ability, reading strategies and navigating behavior between higher literacy users and lower literacy users are significantly different. Yet, ways to tailor audiences’ health literacy and develop appropriate eHealth to feed their need become a big challenge. The purpose of this study is to compare the educational effectiveness of eHealth to deliver health knowledge between higher literacy users and lower literacy users, thus establishing useful design strategies of eHealth for users with different level of health literacy. The study was implemented in four stages, the first of which developed a website as the testing media to introduce health care knowledge relating to children’s allergy. Secondly, a reliability and validity test was conducted to make sure that all of the questions in the questionnaire were good indicators. Thirdly, a pre-post knowledge test was conducted with 66 participants, 33 users with higher literacy and 33 users with lower literacy respectively. Finally, a usability evaluation survey was undertaken to explore the criteria used by users with different levels of health literacy to evaluate eHealth. The results demonstrated that the eHealth Intervention in both groups had a positive outcome. There was no significant difference between the effectiveness of eHealth intervention between users with higher literacy and users with lower literacy. However, the average mean of lower literacy group was marginally higher than the average mean of higher literacy group. The findings also showed that the criteria used to evaluate eHealth could be analyzed in terms of the quality of information, appearance, appeal and interaction, but the users with lower literacy have different evaluation criteria from those with higher literacy. This is an interdisciplinary research which proposes the sequential key steps that incorporate the planning, developing and accessing issues that need to be considered when designing eHealth for patients with varying degrees of health literacy.

Keywords: eHealth, health intervention, health literacy, usability evaluation.

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Authors: Qian Liu, Steve Furber

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To explore how the brain may recognise objects in its general,accurate and energy-efficient manner, this paper proposes the use of a neuromorphic hardware system formed from a Dynamic Video Sensor (DVS) silicon retina in concert with the SpiNNaker real-time Spiking Neural Network (SNN) simulator. As a first step in the exploration on this platform a recognition system for dynamic hand postures is developed, enabling the study of the methods used in the visual pathways of the brain. Inspired by the behaviours of the primary visual cortex, Convolutional Neural Networks (CNNs) are modelled using both linear perceptrons and spiking Leaky Integrate-and-Fire (LIF) neurons. In this study’s largest configuration using these approaches, a network of 74,210 neurons and 15,216,512 synapses is created and operated in real-time using 290 SpiNNaker processor cores in parallel and with 93.0% accuracy. A smaller network using only 1/10th of the resources is also created, again operating in real-time, and it is able to recognise the postures with an accuracy of around 86.4% - only 6.6% lower than the much larger system. The recognition rate of the smaller network developed on this neuromorphic system is sufficient for a successful hand posture recognition system, and demonstrates a much improved cost to performance trade-off in its approach.

Keywords: Spiking neural network (SNN), convolutional neural network (CNN), posture recognition, neuromorphic system.

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Authors: Sanvidhan G. Suke

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This article briefly reviews the role of Indian Pharmacopoeia Commission (IPC) for publications of Indian Pharmacopoeia (IP) and National formulary of India (NFI) to some of these anticipated changes, informs constituents about how they can remain updated about progress and upcoming modifications to official texts, and invites participation in the standards-setting process, which are helpful to the practitioners, researchers, educators and policy makers in the field of health care profession.

Keywords: Addendum, Indian Pharmacopoeia, Monograph, National Formulary of India.

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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: Fatema-Tuz-Zohra Khanam, Ali Al-Naji, Asanka G. Perera, Kim Gibson, Javaan Chahl

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Conventional contact-based vital signs monitoring sensors such as pulse oximeters or electrocardiogram (ECG) may cause discomfort, skin damage, and infections, particularly in neonates with fragile, sensitive skin. Therefore, remote monitoring of the vital sign is desired in both clinical and non-clinical settings to overcome these issues. Camera-based vital signs monitoring is a recent technology for these applications with many positive attributes. However, there are still limited camera-based studies on neonates in a clinical setting. In this study, the heart rate (HR) and respiratory rate (RR) of eight infants at the Neonatal Intensive Care Unit (NICU) in Flinders Medical Centre were remotely monitored using a digital camera applying color and motion-based computational methods. The region-of-interest (ROI) was efficiently selected by incorporating an image decomposition method. Furthermore, spatial averaging, spectral analysis, band-pass filtering, and peak detection were also used to extract both HR and RR. The experimental results were validated with the ground truth data obtained from an ECG monitor and showed a strong correlation using the Pearson correlation coefficient (PCC) 0.9794 and 0.9412 for HR and RR, respectively. The root mean square errors (RMSE) between camera-based data and ECG data for HR and RR were 2.84 beats/min and 2.91 breaths/min, respectively. A Bland Altman analysis of the data also showed a close correlation between both data sets with a mean bias of 0.60 beats/min and 1 breath/min, and the lower and upper limit of agreement -4.9 to + 6.1 beats/min and -4.4 to +6.4 breaths/min for both HR and RR, respectively. Therefore, video camera imaging may replace conventional contact-based monitoring in NICU and has potential applications in other contexts such as home health monitoring.

Keywords: Neonates, NICU, digital camera, heart rate, respiratory rate, image decomposition.

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Authors: Diana Flores Galindo, Richard Gil Herrera

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Nowadays, Lean Manufacturing and Industry 4.0 are very important in every country. One of the main benefits is continued market presence. It has been identified that there is a need to change existing educational programs, as well as update the knowledge and skills of existing employees. It should be borne in mind that behind each technological improvement, there is a human being. Human talent cannot be neglected. The main objectives of this article are to review the link between Lean Manufacturing, the incorporation of Industry 4.0 and the steps to follow to implement it; analyze the current situation and study the implications and benefits of this new trend, with a particular focus on Mexico. Lean Manufacturing and Industry 4.0 implementation waves must always take care of the most important capital – intellectual capital. The methodology used in this article comprised the following steps: reviewing the reality of the fourth industrial revolution, reviewing employees’ skills on the journey to become world-class, and analyzing the situation in Mexico. Lean Manufacturing and Industry 4.0 were studied not as exclusive concepts, but as complementary ones. The methodological framework used is focused on motivating companies’ collaborators to guarantee common results, innovate, and remain in the market in the face of new requirements from company stakeholders. The key findings were that both trends emphasize the need to improve communication across the entire company and incorporate new technologies into everyday work, from the shop floor to administrative staff, to help improve processes. Taking care of people, activities and processes will bring a company success. In the specific case of Mexico, companies in all sectors need to be aware of and implement technological improvements according to their specific needs. Low-cost labor represents one of the most typical barriers. In conclusion, companies must build a roadmap according to their strategy and needs to achieve their short, medium- and long-term goals.

Keywords: Lean management, lean manufacturing, industry 4.0, motivation, SWOT analysis, Hoshin Kanri.

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Authors: Pawel Sowa, Joachim Bargiel

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This paper presents modern solutions of distributed generation in rural communities aiming at the improvement of energy and environmental security, as well as power supply reliability to important customers (e.g. health care, sensitive consumer required continuity). Distributed sources are mainly gas and biogas cogeneration units, as well as wind and photovoltaic sources. Some examples of their applications in a selected Silesian community are given.

Keywords: Energy security, power supply reliability, power engineering, mini energy centers.

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Authors: Tony Austin, Shanghua Sun, Nathan Lea, Steve Iliffe, Dipak Kalra, David Ingram, David Patterson

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Computer-based decision support (CDSS) systems can deliver real patient care and increase chances of long-term survival in areas of chronic disease management prone to poor control. One such CDSS, for the management of warfarin, is described in this paper and the outcomes shown. Data is derived from the running system and show a performance consistently around 20% better than the applicable guidelines.

Keywords: "Decision Support", "Anticoagulant Control"

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Authors: Srikanth Pandurangi, Basheer Mohammed, Nezar Al Sayegh

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In order to meet the increasing demand for housing care for Kuwaiti citizens, the government authorities in Kuwait are undertaking a series of projects in the form of new large cities, outside the current urban area. Al Mutlaa City located to the north-west of the Kuwait Metropolitan Area is one such project out of the 15 planned new cities. The city accommodates a wide variety of residential developments, employment opportunities, commercial, recreational, health care and institutional uses. This paper examines the application of comprehensive transportation demand modeling works undertaken in VISUM platform to understand the future intracity and intercity travel distribution patterns in Kuwait. The scope of models developed varied in levels of detail: strategic model update, sub-area models representing future demand of Al Mutlaa City, sub-area models built to estimate the demand in the residential neighborhoods of the city. This paper aims at offering model update framework that facilitates easy integration between sub-area models and strategic national models for unified traffic forecasts. This paper presents the transportation demand modeling results utilized in informing the planning of multi-modal transportation system for Al Mutlaa City. This paper also presents the household survey data collection efforts undertaken using GPS devices (first time in Kuwait) and notebook computer based digital survey forms for interviewing representative sample of citizens and residents. The survey results formed the basis of estimating trip generation rates and trip distribution coefficients used in the strategic base year model calibration and validation process.

Keywords: GPS based household surveys, transportation infrastructure, origin-destination trip matrices, traffic forecasts, transportation demand modeling, travel behavior patterns.

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Authors: Juan P. Zamora, Wilson Adarme, Laura Palacios

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This paper shows a traceability framework for supply risk monitoring, beginning with the identification, analysis, and evaluation of the supply chain risk and focusing on the supply operations of the Health Care Institutions with oncology services in Bogota, Colombia. It includes a brief presentation of the state of the art of the Supply Chain Risk Management and traceability systems in logistics operations, and it concludes with the methodology to integrate the SCRM model with the traceability system.

Keywords: Supply risk, risk monitoring, supply chain risk management, cancer drugs, traceability systems.

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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