Chronic Patients- Prescription Refill Intentions

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

Privacy Issues in Pervasive Healthcare Monitoring System: A Review

Privacy issues commonly discussed among researchers, practitioners, and end-users in pervasive healthcare. Pervasive healthcare systems are applications that can support patient-s need anytime and anywhere. However, pervasive healthcare raises privacy concerns since it can lead to situations where patients may not be aware that their private information is being shared and becomes vulnerable to threat. We have systematically analyzed the privacy issues and present a summary in tabular form to show the relationship among the issues. The six issues identified are medical information misuse, prescription leakage, medical information eavesdropping, social implications for the patient, patient difficulties in managing privacy settings, and lack of support in designing privacy-sensitive applications. We narrow down the issues and chose to focus on the issue of 'lack of support in designing privacysensitive applications' by proposing a privacy-sensitive architecture specifically designed for pervasive healthcare monitoring systems.

Medical Image Segmentation Using Deformable Model and Local Fitting Binary: Thoracic Aorta

This paper presents an application of level sets for the segmentation of abdominal and thoracic aortic aneurysms in CTA datasets. An important challenge in reliably detecting aortic is the need to overcome problems associated with intensity inhomogeneities. Level sets are part of an important class of methods that utilize partial differential equations (PDEs) and have been extensively applied in image segmentation. A kernel function in the level set formulation aids the suppression of noise in the extracted regions of interest and then guides the motion of the evolving contour for the detection of weak boundaries. The speed of curve evolution has been significantly improved with a resulting decrease in segmentation time compared with previous implementations of level sets, and are shown to be more effective than other approaches in coping with intensity inhomogeneities. We have applied the Courant Friedrichs Levy (CFL) condition as stability criterion for our algorithm.

Development of Circulating Support Environment of Multilingual Medical Communication using Parallel Texts for Foreign Patients

The need for multilingual communication in Japan has increased due to an increase in the number of foreigners in the country. When people communicate in their nonnative language, the differences in language prevent mutual understanding among the communicating individuals. In the medical field, communication between the hospital staff and patients is a serious problem. Currently, medical translators accompany patients to medical care facilities, and the demand for medical translators is increasing. However, medical translators cannot necessarily provide support, especially in cases in which round-the-clock support is required or in case of emergencies. The medical field has high expectations from information technology. Hence, a system that supports accurate multilingual communication is required. Despite recent advances in machine translation technology, it is very difficult to obtain highly accurate translations. We have developed a support system called M3 for multilingual medical reception. M3 provides support functions that aid foreign patients in the following respects: conversation, questionnaires, reception procedures, and hospital navigation; it also has a Q&A function. Users can operate M3 using a touch screen and receive text-based support. In addition, M3 uses accurate translation tools called parallel texts to facilitate reliable communication through conversations between the hospital staff and the patients. However, if there is no parallel text that expresses what users want to communicate, the users cannot communicate. In this study, we have developed a circulating support environment for multilingual medical communication using parallel texts. The proposed environment can circulate necessary parallel texts through the following procedure: (1) a user provides feedback about the necessary parallel texts, following which (2) these parallel texts are created and evaluated.

Data Mining for Cancer Management in Egypt Case Study: Childhood Acute Lymphoblastic Leukemia

Data Mining aims at discovering knowledge out of data and presenting it in a form that is easily comprehensible to humans. One of the useful applications in Egypt is the Cancer management, especially the management of Acute Lymphoblastic Leukemia or ALL, which is the most common type of cancer in children. This paper discusses the process of designing a prototype that can help in the management of childhood ALL, which has a great significance in the health care field. Besides, it has a social impact on decreasing the rate of infection in children in Egypt. It also provides valubale information about the distribution and segmentation of ALL in Egypt, which may be linked to the possible risk factors. Undirected Knowledge Discovery is used since, in the case of this research project, there is no target field as the data provided is mainly subjective. This is done in order to quantify the subjective variables. Therefore, the computer will be asked to identify significant patterns in the provided medical data about ALL. This may be achieved through collecting the data necessary for the system, determimng the data mining technique to be used for the system, and choosing the most suitable implementation tool for the domain. The research makes use of a data mining tool, Clementine, so as to apply Decision Trees technique. We feed it with data extracted from real-life cases taken from specialized Cancer Institutes. Relevant medical cases details such as patient medical history and diagnosis are analyzed, classified, and clustered in order to improve the disease management.

Use of Item Response Theory in Medical Surgical Nursing Achievement Examination

Medical Surgical Nursing is one of the major subjects in nursing. This study examined the validity and reliability of the achievement examination utilizing the Classical Test Theory and Item Response Theory. The study answered the following objectives specifically : ( a) To establish the validity and reliability of the achievement examination utilizing Classical Test Theory and Item Response Theory ; ( b ) To determine the dimensionality measure of items and ( c ) to compare the item difficulty and item discrimination of the Medical Surgical Nursing Achievement examination using Classical Test Theory ( CTT ) and Item Response Theory ( IRT ). The developed instrument was administered to fourth year nursing students (N= 136) of a private university in Manila. The findings yielded the following results: The achievement examination is reliable both using CTT and IRT. The findings indicate person and item statistics from two frameworks are quite alike. The achievement examination formed a unidimensional construct.

Study of Chest Pain and its Risk Factors in Over 30 Year-Old Individuals

Chest pain is one of the most prevalent complaints among adults that cause the people to attend to medical centers. The aim was to determine the prevalence and risk factors of chest pain among over 30 years old people in Tehran. In this cross-sectional study, 787 adults took part from Apr 2005 until Apr 2006. The sampling method was random cluster sampling and there were 25 clusters. In each cluster, interviews were performed with 32 over 30 years old, people lived in those houses. In cases with chest pain, extra questions asked. The prevalence of CP was 9% (71 cases). Of them 21 cases (6.5%) were in 41-60 year age ranges and the remainders were over 61 year old. 19 cases (26.8%) mentioned CP in resting state and all of the cases had exertion onset CP. The CP duration was 10 minutes or less in all of the cases and in most of them (84.5%), the location of pain mentioned left anterior part of chest, left anterior part of sternum and or left arm. There was positive history of myocardial infarction in 12 cases (17%). There was significant relation between CP and age, sex and between history of myocardial infarction and marital state of study people. Our results are similar to other studies- results in most parts, however it is necessary to perform supplementary tests and follow up studies to differentiate between cardiac and non-cardiac CP exactly.

EPR Hiding in Medical Images for Telemedicine

Medical image data hiding has strict constrains such as high imperceptibility, high capacity and high robustness. Achieving these three requirements simultaneously is highly cumbersome. Some works have been reported in the literature on data hiding, watermarking and stegnography which are suitable for telemedicine applications. None is reliable in all aspects. Electronic Patient Report (EPR) data hiding for telemedicine demand it blind and reversible. This paper proposes a novel approach to blind reversible data hiding based on integer wavelet transform. Experimental results shows that this scheme outperforms the prior arts in terms of zero BER (Bit Error Rate), higher PSNR (Peak Signal to Noise Ratio), and large EPR data embedding capacity with WPSNR (Weighted Peak Signal to Noise Ratio) around 53 dB, compared with the existing reversible data hiding schemes.

A Multimedia Telemonitoring Network for Healthcare

TELMES project aims to develop a securized multimedia system devoted to medical consultation teleservices. It will be finalized with a pilot system for a regional telecenters network that connects local telecenters, having as support multimedia platforms. This network will enable the implementation of complex medical teleservices (teleconsulations, telemonitoring, homecare, urgency medicine, etc.) for a broader range of patients and medical professionals, mainly for family doctors and those people living in rural or isolated regions. Thus, a multimedia, scalable network, based on modern IT&C paradigms, will result. It will gather two inter-connected regional telecenters, in Iaşi and Piteşti, Romania, each of them also permitting local connections of hospitals, diagnostic and treatment centers, as well as local networks of family doctors, patients, even educational entities. As communications infrastructure, we aim to develop a combined fixmobile- internet (broadband) links. Other possible communication environments will be GSM/GPRS/3G and radio waves. The electrocardiogram (ECG) acquisition, internet transmission and local analysis, using embedded technologies, was already successfully done for patients- telemonitoring.

In Vitro Study of Coded Transmission in Synthetic Aperture Ultrasound Imaging Systems

In the paper the study of synthetic transmit aperture method applying the Golay coded transmission for medical ultrasound imaging is presented. Longer coded excitation allows to increase the total energy of the transmitted signal without increasing the peak pressure. Moreover signal-to-noise ratio and penetration depth are improved while maintaining high ultrasound image resolution. In the work the 128-element linear transducer array with 0.3 mm inter-element spacing excited by one cycle and the 8 and 16- bit Golay coded sequences at nominal frequency 4 MHz was used. To generate a spherical wave covering the full image region a single element transmission aperture was used and all the elements received the echo signals. The comparison of 2D ultrasound images of the tissue mimicking phantom and in vitro measurements of the beef liver is presented to illustrate the benefits of the coded transmission. The results were obtained using the synthetic aperture algorithm with transmit and receive signals correction based on a single element directivity function.

Building Virtual Reality Environments for Distance Education on the Web: A Case Study in Medical Education

The paper presents an investigation into the role of virtual reality and web technologies in the field of distance education. Within this frame, special emphasis is given on the building of web-based virtual learning environments so as to successfully fulfill their educational objectives. In particular, basic pedagogical methods are studied, focusing mainly on the efficient preparation, approach and presentation of learning content, and specific designing rules are presented considering the hypermedia, virtual and educational nature of this kind of applications. The paper also aims to highlight the educational benefits arising from the use of virtual reality technology in medicine and study the emerging area of web-based medical simulations. Finally, an innovative virtual reality environment for distance education in medicine is demonstrated. The proposed environment reproduces conditions of the real learning process and enhances learning through a real-time interactive simulator.

Pervasive Computing in Healthcare Systems

The hospital and the health-care center of a community, as a place for people-s life-care and health-care settings, must provide more and better services for patients or residents. After Establishing Electronic Medical Record (EMR) system -which is a necessity- in the hospital, providing pervasive services is a further step. Our objective in this paper is to use pervasive computing in a case study of healthcare, based on EMR database that coordinates application services over network to form a service environment for medical and health-care. Our method also categorizes the hospital spaces into 3 spaces: Public spaces, Private spaces and Isolated spaces. Although, there are many projects about using pervasive computing in healthcare, but all of them concentrate on the disease recognition, designing smart cloths, or provide services only for patient. The proposed method is implemented in a hospital. The obtained results show that it is suitable for our purpose.

Image Clustering Framework for BAVM Segmentation in 3DRA Images: Performance Analysis

Brain ArterioVenous Malformation (BAVM) is an abnormal tangle of brain blood vessels where arteries shunt directly into veins with no intervening capillary bed which causes high pressure and hemorrhage risk. The success of treatment by embolization in interventional neuroradiology is highly dependent on the accuracy of the vessels visualization. In this paper the performance of clustering techniques on vessel segmentation from 3- D rotational angiography (3DRA) images is investigated and a new technique of segmentation is proposed. This method consists in: preprocessing step of image enhancement, then K-Means (KM), Fuzzy C-Means (FCM) and Expectation Maximization (EM) clustering are used to separate vessel pixels from background and artery pixels from vein pixels when possible. A post processing step of removing false-alarm components is applied before constructing a three-dimensional volume of the vessels. The proposed method was tested on six datasets along with a medical assessment of an expert. Obtained results showed encouraging segmentations.

Hippocampus Segmentation using a Local Prior Model on its Boundary

Segmentation techniques based on Active Contour Models have been strongly benefited from the use of prior information during their evolution. Shape prior information is captured from a training set and is introduced in the optimization procedure to restrict the evolution into allowable shapes. In this way, the evolution converges onto regions even with weak boundaries. Although significant effort has been devoted on different ways of capturing and analyzing prior information, very little thought has been devoted on the way of combining image information with prior information. This paper focuses on a more natural way of incorporating the prior information in the level set framework. For proof of concept the method is applied on hippocampus segmentation in T1-MR images. Hippocampus segmentation is a very challenging task, due to the multivariate surrounding region and the missing boundary with the neighboring amygdala, whose intensities are identical. The proposed method, mimics the human segmentation way and thus shows enhancements in the segmentation accuracy.

Medical Negligence Disputes in Malaysia: Resolving through Hazards of Litigation or through Community Responsibilities?

Medical negligence disputes in Malaysia are mainly resolved through litigation by using the tort system. The tort system, being adversarial in nature has subjected parties to litigation hazards such as delay, excessive costs and uncertainty of outcome. The dissatisfaction of the tort system in compensating medically injured victims has created various alternatives to litigation. Amongst them is the implementation of a no-fault compensation system which would allow compensation to be given without the need of proving fault on the medical personnel. Instead, the community now bears the burden of compensating and at the end, promotes collective responsibility. For Malaysia, introducing a no-fault system would provide a tempting solution and may ultimately, achieve justice for the medical injured victims. Nevertheless, such drastic change requires a great deal of consideration to determine the suitability of the system and whether or not it will eventually cater for the needs of the Malaysian population

Ultrasonic Echo Image Adaptive Watermarking Using the Just-Noticeable Difference Estimation

Most of the image watermarking methods, using the properties of the human visual system (HVS), have been proposed in literature. The component of the visual threshold is usually related to either the spatial contrast sensitivity function (CSF) or the visual masking. Especially on the contrast masking, most methods have not mention to the effect near to the edge region. Since the HVS is sensitive what happens on the edge area. This paper proposes ultrasound image watermarking using the visual threshold corresponding to the HVS in which the coefficients in a DCT-block have been classified based on the texture, edge, and plain area. This classification method enables not only useful for imperceptibility when the watermark is insert into an image but also achievable a robustness of watermark detection. A comparison of the proposed method with other methods has been carried out which shown that the proposed method robusts to blockwise memoryless manipulations, and also robust against noise addition.

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

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

A Review of Methods for 2D/3D Registration

2D/3D registration is a special case of medical image registration which is of particular interest to surgeons. Applications of 2D/3D registration are [1] radiotherapy planning and treatment verification, spinal surgery, hip replacement, neurointerventions and aortic stenting. The purpose of this paper is to provide a literature review of the main methods for image registration for the 2D/3D case. At the end of the paper an algorithm is proposed for 2D/3D registration based on the Chebyssev polynomials iteration loop.

Subthreshold Circuit Performance Investigation under Temperature Variations

Ultra-low-power (ULP) circuits have received widespread attention due to the rapid growth of biomedical applications and Battery-less Electronics. Subthreshold region of transistor operation is used in ULP circuits. Major research challenge in the subthreshold operating region is to extract the ULP benefits with minimal degradation in speed and robustness. Process, Voltage and Temperature (PVT) variations significantly affect the performance of subthreshold circuits. Designed performance parameters of ULP circuits may vary largely due to temperature variations. Hence, this paper investigates the effect of temperature variation on device and circuit performance parameters at different biasing voltages in the subthreshold region. Simulation results clearly demonstrate that in deep subthreshold and near threshold voltage regions, performance parameters are significantly affected whereas in moderate subthreshold region, subthreshold circuits are more immune to temperature variations. This establishes that moderate subthreshold region is ideal for temperature immune circuits.

Embedded Throughput Improving of Low-rate EDR Packets for Lower-latency

With increasing utilization of the wireless devices in different fields such as medical devices and industrial fields, the paper presents a method for simplify the Bluetooth packets with throughput enhancing. The paper studies a vital issue in wireless communications, which is the throughput of data over wireless networks. In fact, the Bluetooth and ZigBee are a Wireless Personal Area Network (WPAN). With taking these two systems competition consideration, the paper proposes different schemes for improve the throughput of Bluetooth network over a reliable channel. The proposition depends on the Channel Quality Driven Data Rate (CQDDR) rules, which determines the suitable packet in the transmission process according to the channel conditions. The proposed packet is studied over additive White Gaussian Noise (AWGN) and fading channels. The Experimental results reveal the capability of extension of the PL length by 8, 16, 24 bytes for classic and EDR packets, respectively. Also, the proposed method is suitable for the low throughput Bluetooth.