Search results for: smart healthcare

Authors: Dosun Shin, Assegid Kidane, Pavan Turaga

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This research project brings together experts in multiple disciplines to bring product design, sensor design, algorithms, and health intervention studies to develop a product and system that helps reduce the amount of time sitting at the workplace. This paper illustrates ongoing improvements to prototypes the research team developed in initial research; including working prototypes with a software application, which were developed and demonstrated for users. Additional modifications were made to improve functionality, aesthetics, and ease of use, which will be discussed in this paper. Extending on the foundations created in the initial phase, our approach sought to further improve the product by conducting additional human factor research, studying deficiencies in competitive products, testing various materials/forms, developing working prototypes, and obtaining feedback from additional potential users. The solution consisted of an aesthetically pleasing seat cover cushion that easily attaches to common office chairs found in most workplaces, ensuring that a wide variety of people can use the product. The product discreetly contains sensors that track when the user sits on their chair, sending information to a phone app that triggers reminders for users to stand up and move around after sitting for a set amount of time. This paper also presents the analyzed typical office aesthetics and selected materials, colors, and forms that complimented the working environment. Comfort and ease of use remained a high priority as the design team sought to provide a product and system that integrated into the workplace. As the research team continues to test, improve, and implement this solution for the sedentary workplace, the team seeks to create a viable product that acts as an impetus for a more active workday and lifestyle, further decreasing the proliferation of chronic disease and health issues for sedentary working people. This paper illustrates in detail the processes of engineering, product design, methodology, and testing results.

Keywords: Anti-sedentary work behavior, new product development, sensor design, health intervention studies.

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Authors: Mikael Soini, Kari Björn

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Metropolia University of Applied Sciences (MUAS) Information and Communication Technology (ICT) Degree Programme provides full-time Bachelor-level undergraduate studies. ICT Degree Programme has seven different major options; this paper focuses on Health Technology. In Health Technology, a significant curriculum change in 2014 enabled transition from fragmented curriculum including dozens of courses to a new integrated curriculum built around three 30 ECTS themes. This paper focuses especially on the second theme called Customer Oriented Software Applications. From students’ point of view, the goal of this theme is to get familiar with existing health related ICT solutions and systems, understand business around health technology, recognize social and healthcare operating principles and services, and identify customers and users and their special needs and perspectives. This also acts as a background for health related web application development. Built web application is tested, developed and evaluated with real users utilizing versatile user centred development methods. This paper presents experiences obtained from the first implementation of Customer Oriented Software Applications theme. Student feedback was gathered with two questionnaires, one in the middle of the theme and other at the end of the theme. Questionnaires had qualitative and quantitative parts. Similar questionnaire was implemented in the first theme; this paper evaluates how the theme-based integrated curriculum has progressed in Health Technology major by comparing results between theme 1 and 2. In general, students were satisfied for the implementation, timing and synchronization of the courses, and the amount of work. However there is still room for development. Student feedback and teachers’ observations have been and will be used to develop the content and operating principles of the themes and whole curriculum.

Keywords: Engineering education, integrated and theme-based curriculum, learning experience, student centred learning.

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Authors: Abdelhalim. N. Mohammed, Mohammed. Y. Esmail

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In the course of recent decades, medical imaging has been dominated by the use of costly film media for review and archival of medical investigation, however due to developments in networks technologies and common acceptance of a standard digital imaging and communication in medicine (DICOM) another approach in light of World Wide Web was produced. Web technologies successfully used in telemedicine applications, the combination of web technologies together with DICOM used to design a web-based and open source DICOM viewer. The Web server allowance to inquiry and recovery of images and the images viewed/manipulated inside a Web browser without need for any preinstalling software. The dynamic site page for medical images visualization and processing created by using JavaScript and HTML5 advancements. The XAMPP ‘apache server’ is used to create a local web server for testing and deployment of the dynamic site. The web-based viewer connected to multiples devices through local area network (LAN) to distribute the images inside healthcare facilities. The system offers a few focal points over ordinary picture archiving and communication systems (PACS): easy to introduce, maintain and independently platforms that allow images to display and manipulated efficiently, the system also user-friendly and easy to integrate with an existing system that have already been making use of web technologies. The wavelet-based image compression technique on which 2-D discrete wavelet transform used to decompose the image then wavelet coefficients are transmitted by entropy encoding after threshold to decrease transmission time, stockpiling cost and capacity. The performance of compression was estimated by using images quality metrics such as mean square error ‘MSE’, peak signal to noise ratio ‘PSNR’ and compression ratio ‘CR’ that achieved (83.86%) when ‘coif3’ wavelet filter is used.

Keywords: DICOM, discrete wavelet transform, PACS, HIS, LAN.

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Authors: Hritwik Ghosh, Irfan Sadiq Rahat, Sachi Nandan Mohanty, J. V. R. Ravindra, Abdus Sobur

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In the rapidly evolving landscape of medical diagnostics, the early detection and accurate classification of skin cancer remain paramount for effective treatment outcomes. This research delves into the transformative potential of artificial intelligence (AI), specifically deep learning (DL), as a tool for discerning and categorizing various skin conditions. Utilizing a diverse dataset of 3,000 images, representing nine distinct skin conditions, we confront the inherent challenge of class imbalance. This imbalance, where conditions like melanomas are over-represented, is addressed by incorporating class weights during the model training phase, ensuring an equitable representation of all conditions in the learning process. Our approach presents a hybrid model, amalgamating the strengths of two renowned convolutional neural networks (CNNs), VGG16 and ResNet50. These networks, pre-trained on the ImageNet dataset, are adept at extracting intricate features from images. By synergizing these models, our research aims to capture a holistic set of features, thereby bolstering classification performance. Preliminary findings underscore the hybrid model's superiority over individual models, showcasing its prowess in feature extraction and classification. Moreover, the research emphasizes the significance of rigorous data pre-processing, including image resizing, color normalization, and segmentation, in ensuring data quality and model reliability. In essence, this study illuminates the promising role of AI and DL in revolutionizing skin cancer diagnostics, offering insights into its potential applications in broader medical domains.

Keywords: Artificial intelligence, machine learning, deep learning, skin cancer, dermatology, convolutional neural networks, image classification, computer vision, healthcare technology, cancer detection, medical imaging.

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Authors: Shankar Subramanian Iyer

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The vocational education, enhanced by technology and Recognition of Prior Learning (RPL) is going to be the main ingredient of the future of education. This is coming from the various issues of the current educational system like cost, time, type of course, type of curriculum, unemployment, to name the major reasons. Most millennials like to perform and learn rather than learning how to perform. This is the essence of vocational education be it any field from cooking, painting, plumbing to modern technologies using computers. Even a more theoretical course like entrepreneurship can be taught as to be an entrepreneur and learn about its nuances. The best way to learn accountancy is actually keeping accounts for a small business or grocer and learn the ropes of accountancy and finance. The purpose of this study is to investigate the relationship between vocational skills, RPL and new technologies with future employability. This study implies that individual's knowledge and skills are essential aspects to be emphasized in future education and to give credit for prior experience for future employability. Virtual reality can be used to stimulate workplace situations for vocational learning for fields like hospitality, medical emergencies, healthcare, draughtsman ship, building inspection, quantity surveying, estimation, to name a few. All disruptions in future education, especially vocational education, are going to be technology driven with the advent of AI, ML, IoT, VR, VI etc. Vocational education not only helps institutes cut costs drastically, but allows all students to have hands-on experiences, rather than to be observers. The earlier experiential learning theory and the recent theory of knowledge and skills-based learning modified and applied to the vocational education and development of skills is the proposed contribution of this paper. Apart from secondary research study on major scholarly articles, books, primary research using interviews, questionnaire surveys have been used to validate and test the reliability of the suggested model using Partial Least Square- Structural Equation Method (PLS-SEM), the factors being assimilated using an existing literature review. Major findings have been that there exists high relationship between the vocational skills, RPL, new technology to the future employability through mediation of future employability skills.

Keywords: Vocational education, vocational skills, competencies, modern technologies, Recognition of Prior Learning, RPL.

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Authors: Sven Borén, Lisiana Nurhadi, Henrik Ny

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From a theoretical perspective, electric buses can be more sustainable and can be cheaper than fossil fuelled buses in city traffic. The authors have not found other studies based on actual urban public transport in Swedish winter climate. Further on, noise measurements from buses for the European market were found old. The aims of this follow-up study was therefore to test and possibly verify in a real-life environment how energy efficient and silent electric buses are, and then conclude on if electric buses are preferable to use in public transport. The Ebusco 2.0 electric bus, fitted with a 311 kWh battery pack, was used and the tests were carried out during November 2014-April 2015 in eight municipalities in the south of Sweden. Six tests took place in urban traffic and two took place in more of a rural traffic setting. The energy use for propulsion was measured via logging of the internal system in the bus and via an external charging meter. The average energy use turned out to be 8% less (0,96 kWh/km) than assumed in the earlier theoretical study. This rate allows for a 320 km range in public urban traffic. The interior of the bus was kept warm by a diesel heater (biodiesel will probably be used in a future operational traffic situation), which used 0,67 kWh/km in January. This verified that electric buses can be up to 25% cheaper when used in public transport in cities for about eight years. The noise was found to be lower, primarily during acceleration, than for buses with combustion engines in urban bus traffic. According to our surveys, most passengers and drivers appreciated the silent and comfortable ride and preferred electric buses rather than combustion engine buses. Bus operators and passenger transport executives were also positive to start using electric buses for public transport. The operators did however point out that procurement processes need to account for eventual risks regarding this new technology, along with personnel education. The study revealed that it is possible to establish a charging infrastructure for almost all studied bus lines. However, design of a charging infrastructure for each municipality requires further investigations, including electric grid capacity analysis, smart location of charging points, and tailored schedules to allow fast charging. In conclusion, electric buses proved to be a preferable alternative for all stakeholders involved in public bus transport in the studied municipalities. However, in order to electric buses to be a prominent support for sustainable development, they need to be charged either by stand-alone units or via an expansion of the electric grid, and the electricity should be made from new renewable sources.

Keywords: Sustainability, Electric, Bus, Noise, GreenCharge.

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of COVID-19 infection. Understanding novel treatment approaches is important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with VR included. This game-based VR technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with COVID-19 related CVA. The safety of developed instruments for such cases provides approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: COVID-19, stroke, virtual reality, rehabilitation.

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Authors: Boris Barbolyas, Kristina Buckova, Tomas Volensky, Cyril Belavy, Ladislav Dedik

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Background: Based on statokinezigram, the human balance control is often studied. Approach to human postural reaction analysis is based on a combination of stabilometry output signal with retroreflective marker data signal processing, analysis, and understanding, in this study. The study shows another original application of Method of Developed Statokinesigram Trajectory (MDST), too. Methods: In this study, the participants maintained quiet bipedal standing for 10 s on stabilometry platform. Consequently, bilateral vibration stimuli to Achilles tendons in 20 s interval was applied. Vibration stimuli caused that human postural system took the new pseudo-steady state. Vibration frequencies were 20, 60 and 80 Hz. Participant's body segments - head, shoulders, hips, knees, ankles and little fingers were marked by 12 retroreflective markers. Markers positions were scanned by six cameras system BTS SMART DX. Registration of their postural reaction lasted 60 s. Sampling frequency was 100 Hz. For measured data processing were used Method of Developed Statokinesigram Trajectory. Regression analysis of developed statokinesigram trajectory (DST) data and retroreflective marker developed trajectory (DMT) data were used to find out which marker trajectories most correlate with stabilometry platform output signals. Scaling coefficients (λ) between DST and DMT by linear regression analysis were evaluated, too. Results: Scaling coefficients for marker trajectories were identified for all body segments. Head markers trajectories reached maximal value and ankle markers trajectories had a minimal value of scaling coefficient. Hips, knees and ankles markers were approximately symmetrical in the meaning of scaling coefficient. Notable differences of scaling coefficient were detected in head and shoulders markers trajectories which were not symmetrical. The model of postural system behavior was identified by MDST. Conclusion: Value of scaling factor identifies which body segment is predisposed to postural instability. Hypothetically, if statokinesigram represents overall human postural system response to vibration stimuli, then markers data represented particular postural responses. It can be assumed that cumulative sum of particular marker postural responses is equal to statokinesigram.

Keywords: Center of pressure (CoP), a method of developed statokinesigram trajectory (MDST), a model of postural system behavior, retroreflective marker data.

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Authors: Abdullah Faqihi, John Hedley

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Biosensors play a significant role in the healthcare sectors, scientific and technological progress. Developing electrodes that are easy to manufacture and deliver better electrochemical performance is advantageous for diagnostics and biosensing. They can be implemented extensively in various analytical tasks such as drug discovery, food safety, medical diagnostics, process controls, security and defence, in addition to environmental monitoring. Development of biosensors aims to create high-performance electrochemical electrodes for diagnostics and biosensing. A biosensor is a device that inspects the biological and chemical reactions generated by the biological sample. A biosensor carries out biological detection via a linked transducer and transmits the biological response into an electrical signal; stability, selectivity, and sensitivity are the dynamic and static characteristics that affect and dictate the quality and performance of biosensors. In this research, a developed experimental study for laser scribing technique for graphene oxide inside a vacuum chamber for processing of graphene oxide is presented. The processing of graphene oxide (GO) was achieved using the laser scribing technique. The effect of the laser scribing on the reduction of GO was investigated under two conditions: atmosphere and vacuum. GO solvent was coated onto a LightScribe DVD. The laser scribing technique was applied to reduce GO layers to generate rGO. The micro-details for the morphological structures of rGO and GO were visualised using scanning electron microscopy (SEM) and Raman spectroscopy so that they could be examined. The first electrode was a traditional graphene-based electrode model, made under normal atmospheric conditions, whereas the second model was a developed graphene electrode fabricated under a vacuum state using a vacuum chamber. The purpose was to control the vacuum conditions, such as the air pressure and the temperature during the fabrication process. The parameters to be assessed include the layer thickness and the continuous environment. Results presented show high accuracy and repeatability achieving low cost productivity.

Keywords: Laser scribing, LightScribe DVD, graphene oxide, scanning electron microscopy.

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Authors: Ibrahim Abubakar Alkali, Abubakar Sarkile Kawuwa, Ibrahim Sani Khalil

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The concept of space and function forms the bedrock for spatial configuration in architectural design. Thus, the effectiveness and functionality of an architectural product depends their cordial relationship. This applies to all buildings especially to a hospital ward setting designed to accommodate various complex and diverse functions. Health care facilities design, especially an inpatient setting, is governed by many regulations and technical requirements. It is also affected by many less defined needs, particularly, response to culture and the need to provide for patient families’ presence and participation. The spatial configuration of the hospital ward setting in developing countries has no consideration for the patient’s families despite the significant role they play in promoting recovery. Attempts to integrate facilities for patients’ families have always been challenging, especially in developing countries like Nigeria, where accommodation for inpatients is predominantly in an open ward system. In addition, the situation is compounded by culture, which significantly dictates healthcare practices in Africa. Therefore, achieving such a hospital ward setting that is patient and family-centered requires careful assessment of family care actions and transaction spaces so as to arrive at an evidence based solution. Therefore, the aim of this study is to identify how hospital ward spaces can be reconfigured to provide for sustainable family integration. In achieving this aim, a qualitative approach using the principles of behavioral mapping was employed in male and female medical wards of the Federal Teaching Hospital (FTH) Gombe, Nigeria. The data obtained was analysed using classical and comparative content analysis. Patients’ families have been found to be a critical component of hospital ward design that cannot be undermined. Accordingly, bedsides, open yards, corridors and foyers have been identified as patient families’ transaction spaces that require design attention. Arriving at sustainable family integration can be achieved by revisiting the design requirements of the family transaction spaces based on the findings in order to avoid the rowdiness of the wards and uncoordinated sprawl.

Keywords: Caregiving, design basics, family integration, hospital ward, sustainability.

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Authors: Peter Burggräf, Matthias Dannapfel, Hanno Voet, Patrick-Benjamin Bök, Jérôme Uelpenich, Julian Hoppe

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The increasing digitalization of value chains can help companies to handle rising complexity in their processes and thereby reduce the steadily increasing planning and control effort in order to raise performance limits. Due to technological advances, companies face the challenge of smart value chains for the purpose of improvements in productivity, handling the increasing time and cost pressure and the need of individualized production. Therefore, companies need to ensure quick and flexible decisions to create self-optimizing processes and, consequently, to make their production more efficient. Lean production, as the most commonly used paradigm for complexity reduction, reaches its limits when it comes to variant flexible production and constantly changing market and environmental conditions. To lift performance limits, which are inbuilt in current value chains, new methods and tools must be applied. Digitalization provides the potential to derive these new methods and tools. However, companies lack the experience to harmonize different digital technologies. There is no practicable framework, which instructs the transformation of current value chains into digital pervasive value chains. Current research shows that a connection between lean production and digitalization exists. This link is based on factors such as people, technology and organization. In this paper, the introduced method for the determination of digitally pervasive value chains takes the factors people, technology and organization into account and extends existing approaches by a new dimension. It is the first systematic approach for the digital transformation of lean production and consists of four steps: The first step of ‘target definition’ describes the target situation and defines the depth of the analysis with regards to the inspection area and the level of detail. The second step of ‘analysis of the value chain’ verifies the lean-ability of processes and lies in a special focus on the integration capacity of digital technologies in order to raise the limits of lean production. Furthermore, the ‘digital evaluation process’ ensures the usefulness of digital adaptions regarding their practicability and their integrability into the existing production system. Finally, the method defines actions to be performed based on the evaluation process and in accordance with the target situation. As a result, the validation and optimization of the proposed method in a German company from the electronics industry shows that the digital transformation of current value chains based on lean production achieves a raise of their inbuilt performance limits.

Keywords: Digitalization, digital transformation, lean production, Industrie 4.0, value chain.

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Authors: Wolfram Irsa, Lorenz Boruch

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Innovative solutions in additive manufacturing applying material extrusion for functional parts necessitates innovative filaments with persistent quality. Uniform homogeneity and consistent dispersion of particles embedded in filaments generally require multiple cycles of extrusion or well-prepared primal matter by injection molding, kneader machines, or mixing equipment. These technologies commit to dedicated equipment that are rarely at disposal in production laboratories unfamiliar with research in polymer materials. This stands in contrast to laboratories which investigate on complex material topics and technology science to leverage on the potential of 3-D printing. Consequently, scientific studies in labs are often constrained to compositions and concentrations of fillers offered from the market. Therefore, we present a prototypal laboratory methodology scalable to tailored primal matter for extruding ceramic composite filaments with fused filament fabrication (FFF) technology. A desktop single-screw extruder serves as core device for the experiments. Custom-made filament encapsulates the ceramic fillers and serves with polylactide (PLA), which is a thermoplastic polyester, as primal matter and is processed in the melting area of the extruder preserving the defined concentration of the fillers. Validated results demonstrate that this approach enables continuously produced and uniform composite filaments with consistent homogeneity. It is 3-D printable with controllable dimensions, which is a prerequisite for any scalable application. Additionally, digital microscopy confirms steady dispersion of the ceramic particles in the composite filament. This permits a 2D reconstruction of the planar distribution of the embedded ceramic particles in the PLA matrices. The innovation of the introduced method lies in the smart simplicity of preparing the composite primal matter. It circumvents the inconvenience of numerous extrusion operations and expensive laboratory equipment. Nevertheless, it delivers consistent filaments of controlled, predictable, and reproducible filler concentration, which is the prerequisite for any industrial application. The introduced prototypal laboratory methodology seems capable for other polymer matrices and suitable to further utilitarian particle types, beyond and above of ceramic fillers. This inaugurates a roadmap for supplementary laboratory development of peculiar composite filaments, providing value for industries and societies. This low-threshold entry of sophisticated preparation of composite filaments - enabling businesses creating their own dedicated filaments - will support the mutual efforts for establishing 3D printing to new functional devices.

Keywords: Additive manufacturing, ceramic composites, complex filament, industrial application.

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Authors: T. Nagata, S. Xaphakdy, P. Souvannavong, P. Chanthamaly, K. Sithavong, C. H. Lee, S. Phommathat, V. Srithilat, P. Sengdala, B. Phetarnousone, B. Siharath, X. Chemcheng, T. Yamaguchi, A. Suenaga, S. Kashima

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National University of Laos (NUOL) requested Japan International Cooperation Agency (JICA) volunteers to begin a physics experiments class using multi media. However, there are issues. NUOL had no physics experiment class, no space for physics experiments, experiment materials were not used for many years and were scattered in various places, and there is no projector and laptop computer in the unit. This raised the question: How do authors begin the physics experiments class using multimedia? To solve this problem, the JICA took some steps, took stock of what was available and reviewed the syllabus. The JICA then revised the experiment materials to assess what was available and then developed textbooks for experiments using them; however, the question remained, what about the multimedia component of the course? Next, the JICA reviewed Physics teacher Pavy Souvannavong’s YouTube channel, where he and his students upload video reports of their physics classes at NUOL using their smartphones. While they use multi-media, almost all the videos recorded were of class presentations. To improve the multimedia style, authors edited the videos in the style of another YouTube channel, “Science for Lao,” which is a science education group made up of Japan Overseas Cooperation Volunteers (JOCV) in Laos. They created the channel to enhance science education in Laos, and hold regular monthly meetings in the capital, Vientiane, and at teacher training colleges in the country. They edit the video clips in three parts, which are the materials and procedures part including pictures, practice footage of the experiment part, and then the result and conclusion part. Then students perform experiments and prepare for presentation by following the videos. The revised experiment presentation reports use PowerPoint presentations, material pictures and experiment video clips. As for providing textbooks and submitting reports, the students use the e-Learning system of “Moodle” of the Information Technology Center in Dongdok campus of NUOL. The Korean International Cooperation Agency (KOICA) donated those facilities. The authors have passed the process of the revised materials, developed textbooks, the PowerPoint slides presented by students, downloaded textbooks and uploaded reports, to begin the physics experiments class using multimedia. This is the practice research report for beginning a physics experiments class using multimedia in the physics unit at the Department of Natural Science, Faculty of Education, at the NUOL.

Keywords: NUOL, JICA, KOICA, Physics experiment materials, smart phone, Moodle, IT center, Science for Lao.

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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: Ponshano Kaselekela, Simooya O. Oscar, Lunshano Boyd

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The Copperbelt University Health Services (CBUHS) was designated by the Zambia Medicines Regulatory Authority (ZAMRA), formally the Pharmaceutical Regulatory Authority (PRA) as a regional pharmacovigilance centre to carryout activities of drug safety monitoring in four provinces in Zambia. CBUHS’s mandate included stimulating the reporting of adverse drug reactions (ADRs), as well as collecting and collating ADR reports from health institutions in the four provinces. This report covers the researchers’ experiences from May 2008 to September, 2016. The main objectives are 1) to monitor ADRs in the Zambian population, 2) to disseminate information to all health professionals in the region advising that the CBU health was a centre for reporting ADRs in the region, 3) to monitor polypharmacy as well as the benefit-risk profile of medicines, 4) to generate independent, evidence based recommendations on the safety of medicines, 5) to support ZAMRA in formulating safety related regulatory decisions for medicines, and 6) to communicate findings with all key stakeholders. The methodology involved monthly visits, beginning in early May 2008 to September, 2016, by the CBUHS to health institutions in the programme areas. Activities included holding discussions with health workers, distribution of ADR forms and collection of ADRs reports. These reports, once collected, were documented and assessed at the CBUHS. A report was then prepared for ZAMRA on quarterly basis. At ZAMRA, serious ADRs were noted and recommendations made to the Ministry of Health of the Republic of Zambia. The results show that 2,600 ADRs reports were received at the pharmacovigilance regional centre. Most of the ADRs reports that received were due to antiretroviral drugs, as well as a few from anti-malarial drugs like Artemether/Lumefantrine – Coartem®. Three hundred and twelve ADRs were entered in the Uppsala Monitoring Centre WHO Vigiflow for further analysis. It was concluded that in general, 2008-16 were exciting years for the pharmacovigilance group at CBUHS. From a very tentative beginning, a lot of strides were made and contacts established with healthcare facilities in the region. The researchers were encouraged by the support received from the Copperbelt University management, the motivation provided by ZAMRA and most importantly the enthusiasm of health workers in all the health care facilities visited. As a centre for drug safety in Zambia, the results show it achieves its objectives for monitoring ADRs, Pharmacovigilance (drug safety monitoring), and activities of monitoring ADRs as well as preventing them. However, the centre faces critical challenges caused by erratic funding that prevents the smooth running of the programme.

Keywords: Assessments, evaluation, monitoring, pharmacovigilance.

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Authors: Sotirios Raptis

Abstract:

Health and Social care (HSc) services planning and scheduling are facing unprecedented challenges, due to the pandemic pressure and also suffer from unplanned spending that is negatively impacted by the global financial crisis. Data-driven approaches can help to improve policies, plan and design services provision schedules using algorithms that assist healthcare managers to face unexpected demands using fewer resources. The paper discusses services packing using statistical significance tests and machine learning (ML) to evaluate demands similarity and coupling. This is achieved by predicting the range of the demand (class) using ML methods such as Classification and Regression Trees (CART), Random Forests (RF), and Logistic Regression (LGR). The significance tests Chi-Squared and Student’s test are used on data over a 39 years span for which data exist for services delivered in Scotland. The demands are associated using probabilities and are parts of statistical hypotheses. These hypotheses, as their NULL part, assume that the target demand is statistically dependent on other services’ demands. This linking is checked using the data. In addition, ML methods are used to linearly predict the above target demands from the statistically found associations and extend the linear dependence of the target’s demand to independent demands forming, thus, groups of services. Statistical tests confirmed ML coupling and made the prediction statistically meaningful and proved that a target service can be matched reliably to other services while ML showed that such marked relationships can also be linear ones. Zero padding was used for missing years records and illustrated better such relationships both for limited years and for the entire span offering long-term data visualizations while limited years periods explained how well patients numbers can be related in short periods of time or that they can change over time as opposed to behaviours across more years. The prediction performance of the associations were measured using metrics such as Receiver Operating Characteristic (ROC), Area Under Curve (AUC) and Accuracy (ACC) as well as the statistical tests Chi-Squared and Student. Co-plots and comparison tables for the RF, CART, and LGR methods as well as the p-value from tests and Information Exchange (IE/MIE) measures are provided showing the relative performance of ML methods and of the statistical tests as well as the behaviour using different learning ratios. The impact of k-neighbours classification (k-NN), Cross-Correlation (CC) and C-Means (CM) first groupings was also studied over limited years and for the entire span. It was found that CART was generally behind RF and LGR but in some interesting cases, LGR reached an AUC = 0 falling below CART, while the ACC was as high as 0.912 showing that ML methods can be confused by zero-padding or by data’s irregularities or by the outliers. On average, 3 linear predictors were sufficient, LGR was found competing well RF and CART followed with the same performance at higher learning ratios. Services were packed only when a significance level (p-value) of their association coefficient was more than 0.05. Social factors relationships were observed between home care services and treatment of old people, low birth weights, alcoholism, drug abuse, and emergency admissions. The work found  that different HSc services can be well packed as plans of limited duration, across various services sectors, learning configurations, as confirmed by using statistical hypotheses.

Keywords: Class, cohorts, data frames, grouping, prediction, probabilities, services.

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