Search results for: patient outcomes

Authors: M. Johnson, R. Faggian, V. Sposito

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A participatory and engaged approach is key in connecting agricultural managers to sustainable agricultural systems to support and optimize production in Victoria’s food bowl. A sustainable intensification (SI) approach is well documented globally, but participation rates amongst Victorian farmers is fragmentary, and key outcomes and implementation strategies are poorly understood. Improvement in decision-support management tools and a greater understanding of the productivity gains available upon implementation of SI is necessary. This paper reviews the current understanding and uptake of SI practices amongst farmers in one of Victoria’s premier food producing regions, the Goulburn Broken; and it spatially analyses the potential for this region to adapt to climate change and optimize food production. A Geographical Information Systems (GIS) approach is taken to develop an interactive decision-support tool that can be accessible to on-ground agricultural managers. The tool encompasses multiple criteria analysis (MCA) that identifies factors during the construction phase of the tool, using expert witnesses and regional knowledge, framed within an Analytical Hierarchy Process. Given the complexities of the interrelations between each of the key outcomes, this participatory approach, in which local realities and factors inform the key outcomes and help to strategies for a particular region, results in a robust strategy for sustainably intensifying production in key food producing regions. The creation of an interactive, locally embedded, decision-support management and education tool can help to close the gap between farmer knowledge and production, increase on-farm adoption of sustainable farming strategies and techniques, and optimize farm productivity.

Keywords: Agriculture, decision-support management tools, GIS, sustainable intensification.

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Authors: S.S.Mohanavalli, Sheila Anand

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This paper proposes a novel architecture for At- Home medical care which enables senior citizens, patients with chronic ailments and patients requiring post- operative care to be remotely monitored in the comfort of their homes. This architecture is implemented using sensors and wireless networking for transmitting patient data to the hospitals, health- care centers for monitoring by medical professionals. Patients are equipped with sensors to measure their physiological parameters, like blood pressure, pulse rate etc. and a Wearable Data Acquisition Unit is used to transmit the patient sensor data. Medical professionals can be alerted to any abnormal variations in these values for diagnosis and suitable treatment. Security threats and challenges inherent to wireless communication and sensor network have been discussed and a security mechanism to ensure data confidentiality and source authentication has been proposed. Symmetric key algorithm AES has been used for encrypting the data and a patent-free, two-pass block cipher mode CCFB has been used for implementing semantic security.

Keywords: data confidentiality, integrity, remotemonitoring, source authentication

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Authors: S. M. Abdul Khader, Anurag Ayachit, Raghuvir Pai, K. A. Ahmed, V. R. K. Rao, S. Ganesh Kamath

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The numerical simulation has made tremendous advances in investigating the blood flow phenomenon through elastic arteries. Such study can be useful in demonstrating the disease progression and hemodynamics of cardiovascular diseases such as atherosclerosis. In the present study, patient specific case diagnosed with partially stenosed complete right ICA and normal left carotid bifurcation without any atherosclerotic plaque formation is considered. 3D patient specific carotid bifurcation model is generated based on CT scan data using MIMICS-4.0 and numerical analysis is performed using FSI solver in ANSYS-14.5. The blood flow is assumed to be incompressible, homogenous and Newtonian, while the artery wall is assumed to be linearly elastic. The two-way sequentially coupled transient FSI analysis is performed using FSI solver for three pulse cycles. The hemodynamic parameters such as flow pattern, Wall Shear Stress, pressure contours and arterial wall deformation are studied at the bifurcation and critical zones such as stenosis. The variation in flow behavior is studied throughout the pulse cycle. Also, the simulation results reveal that there is a considerable increase in the flow behavior in stenosed carotid in contrast to the normal carotid bifurcation system. The investigation also demonstrates the disturbed flow pattern especially at the bifurcation and stenosed zone elevating the hemodynamics, particularly during peak systole and later part of the pulse cycle. The results obtained agree well with the clinical observation and demonstrates the potential of patient specific numerical studies in prognosis of disease progression and plaque rupture.

Keywords: Fluid-Structure Interaction, arterial stenosis, Wall Shear Stress, Carotid Artery Bifurcation.

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Authors: Kai-Ying A. Chan, Leon A.G. Oerlemans, Marthinus W. Pretorius

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Science parks are often established to drive regional economic growth, especially in countries with emerging economies. However, mixed findings regarding the performances of science park firms are found in the literature. This study tries to explain these mixed findings by taking a relational approach and exploring (un)intended knowledge transfers between new technology-based firms (NTBFs) in the emerging South African economy. Moreover, the innovation outcomes of these NTBFs are examined by using a multi-dimensional construct. Results show that science park location plays a significant role in explaining innovative sales, but is insignificant when a different indicator of innovation outcomes is used. Furthermore, only for innovations that are new to the firms, both science park location and intended knowledge transfer via informal business relationships have a positive impact; whereas social relationships have a negative impact.

Keywords: knowledge flows, innovative performances, science parks, new technology-based firms

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Authors: R. Kalantari, G. Hafeez

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The paper presents outcomes of the numerical research performed on standard and dovetail corner joints under lateral loads. An overview of the past research on log shear walls is also presented. To the authors’ best knowledge, currently, there are no specific design guidelines available in the code for the design of log shear walls, implying the need to investigate the performance of log shear walls. This research explores the performance of the log shear wall corner joint system of standard joint and dovetail types using numerical methods based on research available in the literature. A parametric study is performed to study the effect of gap size provided between two orthogonal logs and the presence of wood and steel dowels provided as joinery between log courses on the performance of such a structural system. The research outcomes are the force-displacement curves. Variability of 8% is seen in the reaction forces with the change of gap size for the case of the standard joint, while a variation of 10% is observed in the reaction forces for the dovetail joint system.

Keywords: dovetail joint, finite element modelling, log shear walls, standard joint

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Authors: O. Grinchuk, E. Motakis, V. Kuznetsov

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Sense-antisense gene pair (SAGP) is a pair of two oppositely transcribed genes sharing a common region on a chromosome. In the mammalian genomes, SAGPs can be organized in more complex sense-antisense gene architectures (CSAGA) in which at least one gene could share loci with two or more antisense partners. Many dozens of CSAGAs can be found in the human genome. However, CSAGAs have not been systematically identified and characterized in context of their role in human diseases including cancers. In this work we characterize the structural-functional properties of a cluster of 5 genes –TMEM97, IFT20, TNFAIP1, POLDIP2 and TMEM199, termed TNFAIP1 / POLDIP2 module. This cluster is organized as CSAGA in cytoband 17q11.2. Affymetrix U133A&B expression data of two large cohorts (410 atients, in total) of breast cancer patients and patient survival data were used. For the both studied cohorts, we demonstrate (i) strong and reproducible transcriptional co-regulatory patterns of genes of TNFAIP1/POLDIP2 module in breast cancer cell subtypes and (ii) significant associations of TNFAIP1/POLDIP2 CSAGA with amplification of the CSAGA region in breast cancer, (ii) cancer aggressiveness (e.g. genetic grades) and (iv) disease free patient-s survival. Moreover, gene pairs of this module demonstrate strong synergetic effect in the prognosis of time of breast cancer relapse. We suggest that TNFAIP1/ POLDIP2 cluster can be considered as a novel type of structural-functional gene modules in the human genome.

Keywords: Sense-antisense gene pair, complex genome architecture, TMEM97, IFT20, TNFAIP1, POLDIP2, TMEM199, 17q11.2, breast cancer, transcription regulation, survival analysis, prognosis.

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

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

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

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Authors: Moustafa Osman Mohammed

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Integration sustainability outcomes give attention to construction ecology in the design review of urban environments to comply with Earth’s System that is composed of integral parts of the (i.e., physical, chemical and biological components). Naturally, exchange patterns of industrial ecology have consistent and periodic cycles to preserve energy flows and materials in Earth’s System. When engineering topology is affecting internal and external processes in system networks, it postulated the valence of the first-level spatial outcome (i.e., project compatibility success). These instrumentalities are dependent on relating the second-level outcome (i.e., participant security satisfaction). The construction ecology-based topology (i.e., as feedback energy system) flows from biotic and abiotic resources in the entire Earth’s ecosystems. These spatial outcomes are providing an innovation, as entails a wide range of interactions to state, regulate and feedback “topology” to flow as “interdisciplinary equilibrium” of ecosystems. The interrelation dynamics of ecosystems are performing a process in a certain location within an appropriate time for characterizing their unique structure in “equilibrium patterns”, such as biosphere and collecting a composite structure of many distributed feedback flows. These interdisciplinary systems regulate their dynamics within complex structures. These dynamic mechanisms of the ecosystem regulate physical and chemical properties to enable a gradual and prolonged incremental pattern to develop a stable structure. The engineering topology of construction ecology for integration sustainability outcomes offers an interesting tool for ecologists and engineers in the simulation paradigm as an initial form of development structure within compatible computer software. This approach argues from ecology, resource savings, static load design, financial other pragmatic reasons, while an artistic/architectural perspective, these are not decisive. The paper described an attempt to unify analytic and analogical spatial modeling in developing urban environments as a relational setting, using optimization software and applied as an example of integrated industrial ecology where the construction process is based on a topology optimization approach.

Keywords: Construction ecology, industrial ecology, urban topology, environmental planning.

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

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

Keywords: costs, financial methods, management.

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

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

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

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Authors: Pranee Suecharoen, Jaturat Kanpittaya

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Background: The incidence of adverse reactions to iodinated contrast media has risen. The dearth of reports on reactions to the administration of iso- and low-osmolar contrast media should be addressed. We, therefore, studied the profile of adverse reactions to iodinated contrast media; viz., (a) the body systems affected (b) causality, (c) severity, and (d) preventability. Objective: To study adverse reactions (causes and severity) to iodinated contrast media at Srinagarind Hospital. Method: Between March and July, 2015, 1,101 patients from the Department of Radiology were observed and interviewed for the occurrence of adverse reactions. The patients were classified per Naranjo’s algorithm and through use of an adverse reactions questionnaire. Results: A total of 105 cases (9.5%) reported adverse reactions (57% male; 43% female); among whom 2% were iso-osmolar vs. 98% low-osmolar. Diagnoses included hepatoma and cholangiocarcinoma (24.8%), colorectal cancer (9.5%), breast cancer (5.7%), cervical cancer (3.8%), lung cancer (2.9%), bone cancer (1.9%), and others (51.5%). Underlying diseases included hypertension and diabetes mellitus type 2. Mild, moderate, and severe adverse reactions accounted for 92, 5 and 3%, respectively. The respective groups of escalating symptoms included (a) mild urticaria, itching, rash, nausea, vomiting, dizziness, and headache; (b) moderate hypertension, hypotension, dyspnea, tachycardia and bronchospasm; and (c) severe laryngeal edema, profound hypotension, and convulsions. All reactions could be anticipated per Naranjo’s algorithm. Conclusion: Mild to moderate adverse reactions to low-osmolar contrast media were most common and these occurred immediately after administration. For patient safety and better outcomes, improving the identification of patients likely to have an adverse reaction is essential.

Keywords: Adverse reactions, contrast media, computed tomography, iodinated contrast agents.

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

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

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

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Authors: Jean Berger, Mohamed Barkaoui

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Discrete search path planning in time-constrained uncertain environment relying upon imperfect sensors is known to be hard, and current problem-solving techniques proposed so far to compute near real-time efficient path plans are mainly bounded to provide a few move solutions. A new information-theoretic –based open-loop decision model explicitly incorporating false alarm sensor readings, to solve a single agent military logistics search-and-delivery path planning problem with anticipated feedback is presented. The decision model consists in minimizing expected entropy considering anticipated possible observation outcomes over a given time horizon. The model captures uncertainty associated with observation events for all possible scenarios. Entropy represents a measure of uncertainty about the searched target location. Feedback information resulting from possible sensor observations outcomes along the projected path plan is exploited to update anticipated unit target occupancy beliefs. For the first time, a compact belief update formulation is generalized to explicitly include false positive observation events that may occur during plan execution. A novel genetic algorithm is then proposed to efficiently solve search path planning, providing near-optimal solutions for practical realistic problem instances. Given the run-time performance of the algorithm, natural extension to a closed-loop environment to progressively integrate real visit outcomes on a rolling time horizon can be easily envisioned. Computational results show the value of the approach in comparison to alternate heuristics.

Keywords: Search path planning, false alarm, search-and-delivery, entropy, genetic algorithm.

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Authors: Reza Ariaeinejad, Norm Archer

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

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

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

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

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

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

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

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

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

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

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

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Authors: Sandya Mummullage, Prasanna Egodawatta, Ashantha Goonetilleke, Godwin A. Ayoko

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Urban road dust comprises of a range of potentially  toxic metal elements and plays a critical role in degrading urban  receiving water quality. Hence, assessing the metal composition and  concentration in urban road dust is a high priority. This study  investigated the variability of metal composition and concentrations  in road dust in 4 different urban land uses in Gold Coast, Australia.  Samples from 16 road sites were collected and tested for selected 12  metal species. The data set was analyzed using both univariate and  multivariate techniques. Outcomes of the data analysis revealed that  the metal concentrations inroad dust differs considerably within and  between different land uses. Iron, aluminum, magnesium and zinc are  the most abundant in urban land uses. It was also noted that metal  species such as titanium, nickel, copper and zinc have the highest  concentrations in industrial land use. The study outcomes revealed  that soil and traffic related sources as key sources of metals deposited  on road surfaces.

 

Keywords: Metals build-up, Pollutant accumulation, Stormwater quality, Urban road dust.

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Authors: Thusitha Mabotuwana, Christopher S. Hall

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

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

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Authors: D. Danesh, M. J. Ryan, A. Abbasi

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Project Portfolio Management (PPM) is an essential component of an organisation’s strategic procedures, which requires attention of several factors to envisage a range of long-term outcomes to support strategic project portfolio decisions. To evaluate overall efficiency at the portfolio level, it is essential to identify the functionality of specific projects as well as to aggregate those findings in a mathematically meaningful manner that indicates the strategic significance of the associated projects at a number of levels of abstraction. PPM success is directly associated with the quality of decisions made and poor judgment increases portfolio costs. Hence, various Multi-Criteria Decision Making (MCDM) techniques have been designed and employed to support the decision-making functions. This paper reviews possible options to enhance the decision-making outcomes in organisational portfolio management processes using the Analytic Hierarchy Process (AHP) both from academic and practical perspectives and will examine the usability, certainty and quality of the technique. The results of the study will also provide insight into the technical risk associated with current decision-making model to underpin initiative tracking and strategic portfolio management.

Keywords: Analytic hierarchy process, decision support systems, multi-criteria decision-making, project portfolio management.

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Authors: Dimas T. Anantyo, Zsa-Zsa A. Laksmi, Adhie N. Radityo, Arsita E. Rini, Gatot I. Sarosa

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A six-point-two-magnitude earthquake rocked Mamuju District, West Sulawesi Province, Indonesia, on 15 January 2021, causing significant health issues for the affected community, particularly among vulnerable populations such as neonates and children. The aim of this study is to examine and describe the diseases diagnosed in the pediatric population in Mamuju 14 days after the earthquake. This study uses a prospective observational study of the pediatric population presenting at West Sulawesi Regional Hospital, Mamuju Regional Public Hospital, and Bhayangkara Hospital for the period of 14 days after the earthquake. Demographic and clinical information was recorded. 153 children were admitted to the health center. Children younger than six years old were the highest proportion (78%). Out of 153 children, 82 of them were male (54%). The most frequently diagnosed disease during the first and second weeks after the earthquake was respiratory problems, followed by gastrointestinal problems that showed an increase in incidence in the second week. This study found that age has a correlation with common disease in children after an earthquake. Respiratory and gastrointestinal problems were found to be the most common diseases among the pediatric population in Mamuju after the earthquake.

Keywords: Health outcomes, pediatric population, earthquake, Mamuju.

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

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

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

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Authors: Brittany E. Coff, Tommy K. K. Ngai, Laura A. S. MacDonald

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Many organizations in the Water, Sanitation and Hygiene (WASH) sector provide education and training in order to increase the effectiveness of their WASH interventions. A key challenge for these organizations is measuring how well their education and training activities contribute to WASH improvements. It is crucial for implementers to understand the returns of their education and training activities so that they can improve and make better progress toward the desired outcomes. This paper presents information on CAWST’s development and piloting of the evaluation methodology. The Centre for Affordable Water and Sanitation Technology (CAWST) has developed a methodology for evaluating education and training activities, so that organizations can understand the effectiveness of their WASH activities and improve accordingly. CAWST developed this methodology through a series of research partnerships, followed by staged field pilots in Nepal, Peru, Ethiopia and Haiti. During the research partnerships, CAWST collaborated with universities in the UK and Canada to: review a range of available evaluation frameworks, investigate existing practices for evaluating education activities, and develop a draft methodology for evaluating education programs. The draft methodology was then piloted in three separate studies to evaluate CAWST’s, and CAWST’s partner’s, WASH education programs. Each of the pilot studies evaluated education programs in different locations, with different objectives, and at different times within the project cycles. The evaluations in Nepal and Peru were conducted in 2013 and investigated the outcomes and impacts of CAWST’s WASH education services in those countries over the past 5-10 years. In 2014, the methodology was applied to complete a rigorous evaluation of a 3-day WASH Awareness training program in Ethiopia, one year after the training had occurred. In 2015, the methodology was applied in Haiti to complete a rapid assessment of a Community Health Promotion program, which informed the development of an improved training program. After each pilot evaluation, the methodology was reviewed and improvements were made. A key concept within the methodology is that in order for training activities to lead to improved WASH practices at the community level, it is not enough for participants to acquire new knowledge and skills; they must also apply the new skills and influence the behavior of others following the training. The steps of the methodology include: development of a Theory of Change for the education program, application of the Kirkpatrick model to develop indicators, development of data collection tools, data collection, data analysis and interpretation, and use of the findings for improvement. The methodology was applied in different ways for each pilot and was found to be practical to apply and adapt to meet the needs of each case. It was useful in gathering specific information on the outcomes of the education and training activities, and in developing recommendations for program improvement. Based on the results of the pilot studies, CAWST is developing a set of support materials to enable other WASH implementers to apply the methodology. By using this methodology, more WASH organizations will be able to understand the outcomes and impacts of their training activities, leading to higher quality education programs and improved WASH outcomes.

Keywords: Education and training, capacity building, evaluation, water and sanitation.

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Authors: K. Amudha, C. Nelson Kennedy Babu, S. Balu

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The security of the medical images and its related data is the major research area which is to be concentrated in today’s era. Security in the medical image indicates that the physician may hide patients’ related data in the medical image and transfer it safely to a defined location using reversible watermarking. Many reversible watermarking methods had proposed over the decade. This paper enhances the security level in brain tumor images to hide the patient’s detail, which has to be conferred with other physician’s suggestions. The details or the information will be hidden in Non-ROI area of the image by using the block cipher algorithm. The block cipher uses different keys to extract the details that are difficult for the intruder to detect all the keys and to spot the details, which are the key advantage of this method. The ROI is the tumor area and Non-ROI is the area rest of ROI. The Non-ROI should not be spoiled in any cause and the details in the Non-ROI should be extracted correctly. The reversible watermarking method proposed in this paper performs well when compared to existing methods in the process of extraction of an original image and providing information security.

Keywords: Brain tumor images, Block Cipher, Reversible watermarking, ROI.

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Authors: Ali Rashash Alzahrani, Elizabeth Stojanovski

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Data on various aspects of education are collected at the institutional and government level regularly. In Australia, for example, students at various levels of schooling undertake examinations in numeracy and literacy as part of NAPLAN testing, enabling longitudinal assessment of such data as well as comparisons between schools and states within Australia. Another source of educational data collected internationally is via the PISA study which collects data from several countries when students are approximately 15 years of age and enables comparisons in the performance of science, mathematics and English between countries as well as ranking of countries based on performance in these standardised tests. As well as student and school outcomes based on the tests taken as part of the PISA study, there is a wealth of other data collected in the study including parental demographics data and data related to teaching strategies used by educators. Overall, an abundance of educational data is available which has the potential to be used to help improve educational attainment and teaching of content in order to improve learning outcomes. A multivariate assessment of such data enables multiple variables to be considered simultaneously and will be used in the present study to help develop profiles of students based on performance in mathematics using data obtained from the PISA study.

Keywords: Cluster analysis, education, mathematics, profiles.

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

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

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

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Authors: Farbod Behnaminia, Saeed Samet

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

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

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Authors: Vahid Nademi

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

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

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Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

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This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: Antinuclear antibody, Subclinical hypothyroidism, Thyroxin, TPO antibody.

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

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

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

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