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Clinical investigators, health professionals and managers are often interested in developing criteria for clustering patients into clinically meaningful groups according to their expected length of stay. In this paper, we propose two novel types of survival trees; phase-type survival trees and mixed distribution survival trees, which extend previous work on exponential survival trees. The trees are used to cluster the patients with respect to length of stay where partitioning is based on covariates such as gender, age at the time of admission and primary diagnosis code. Likelihood ratio tests are used to determine optimal partitions. The approach is illustrated using nationwide data available from the English Hospital Episode Statistics (HES) database on stroke-related patients, aged 65 years and over, who were discharged from English hospitals over a 1-year period. [ABSTRACT FROM AUTHOR]

A low-complexity algorithm for the computation of the geometrical moments of binary images has been developed and implemented on the limited CPU and RAM resources available in current low-cost on-chip CMOS cameras. This moment-based approach can be used to find the position and orientation of objects in the image plane, which has a wide range of applications from networked embedded robotics to the medical care field. In medical care applications it is envisioned that camera systems with on-chip processing algorithms, such as the one described in this paper, can be used to determine the posture of a human body, e.g. standing or lying down. By processing only binary images on the camera chip and then transmitting numbers related to the geometrical moments, security and privacy concerns can be taken care using simple procedures. It is expected that this type of camera systems will work in conjunction with a wireless body area network (WBAN) that measures vital signs. The final goal is to provide cost effective and timely information to the medical personnel responsible for the care of the patients. [ABSTRACT FROM AUTHOR]

This expository paper describes an innovative Scripps designed supported employment program, using an evidence-based practice model based on recovery by Scripps Behavioral Health Services staff to fill a gap in the continuum of care for Behavioral Health Services. The A-Visions Program was also developed to increase offerings to mental health consumers (typically those with serious and persistent mental illness) struggling to find help in an under funded, fragmented mental health system of care. The program has grown since its inception and has received commendations from external stakeholders. This paper reviews the prevalence of mental illness in the United States, a review of the classic and recent evidence-based literature, a comprehensive description of the program (including analyses of outcome measures), a plan to spread this innovation across the Scripps enterprise, and conclusions. Due to the success of the program in providing essential services to individuals with serious mental illness, the authors recommend replication in other Scripps facilities. The author makes a strong case for the spread of this innovation, as these services typically are not a part of the mental health care continuum. These program development strategies are replicable in other mental health programs. [ABSTRACT FROM AUTHOR]

This paper addresses the application of a principal component analysis (PCA) of categorical data prior to diagnosing a patients dataset using a case-based reasoning (CBR) system. The particularity is that the standard PCA techniques are designed to deal with numerical attributes, but our medical dataset contains many categorical data and alternative methods such as RS-PCA are required. Thus, we propose to hybridize RS-PCA (regular simplex PCA) and a simple CBR system. Results show how the hybrid system, when diagnosing a medical dataset, produces results similar to the ones obtained when using the original attributes. These results are quite promising since they allow diagnosis with less computation effort and memory storage. [ABSTRACT FROM AUTHOR]

Nailfold capillary microscopy examination has been used since late 1950s as a non-invasive in-vivo technique for diagnosing and monitoring connective tissue disease in adults. Disorders such as Primary Raynaud's phenomenon, progressive systemic sclerosis, and rheumatoid arthritis were detected in more than 80% of adult patients, by analyzing such high resolution images. Internet computing and grid technologies have changed the way we tackle complex scientific problems. Grid computing environments are characterized by interconnecting a number of heterogeneous resources in geographically distributed domains. They enable large-scale aggregation and sharing of computational, data and other resources across institutional boundaries. In this paper, we discuss and develop a framework for nailfold capillary microscope image acquisition and analysis, using computational power provided by grid platforms. In this way, not only useful medical information can be extracted from large amount of history anamneses in an efficient way, with the use of a number of adequate techniques and methods in high performance computing, but also to diagnose abnormal nailfold capillary in far shorter time, to diagnose patient's disease in real-time basis. Based on the results of the classification, analysis of history anamneses are done to discover updated health information possibly hidden in patients' medical records. [ABSTRACT FROM AUTHOR]

Motes (coin-sized sensors) have the potential to transform the way in which people live and work where computing occurs without human interaction so that data may be pre-processed and made available on demand. Motes may potentially transform the workplace into a Mobile Enterprise (m-Enterprise) especially in the healthcare sector. Motes are being trialed for emergency triaging, patient profiling and monitoring and education. Sensor networks could provide healthcare workers with a macroscopic view; they may be able to observe and interact with physical phenomena in real time with a high degree of fidelity. This paper examines the current health areas that are attempting to transform their operations using wireless sensor technology. The researchers report on issues that arose whilst working with Mica2 motes in a test bed environment during 2004, and their efforts to understand how these devices could usefully be adapted to the healthcare sector. [ABSTRACT FROM AUTHOR]

For medical services, in particular hospital services, it is very difficult to separate price and volume changes. In theory, the unit of production should be "the treatment". However, the practical implementation of this principle is not straightforward. This paper describes the development of a volume index for hospital care based on the national Hospital Discharge Register (HDR). Partial volume indicators are based on the number of discharges per diagnosis/age group. As much as 7000 diagnosis/age groups are distinguished, resulting from cross-classifying 1000 ICD (International Classification of Diseases) diagnoses and 7 age groups. The number of discharges from clinical and day treatment per group is counted. Weighting factors are approximated by the total number of hospitalisation days per group because no price information per treatment was available. The paper discusses the assumptions made and the problems related to the application of the volume index in the National Accounts. [ABSTRACT FROM AUTHOR]

The scientific progress in neuro-prostheses during the last ten years has led to a number of clinical applications that are being introduced in the health care system. Whereas the research so far has been carried out in the biomedical research environment it now enters the clinical area. This clinical research leads to new challenges concerned with clinical effectiveness, decisions on prescription to patients and economic value. In relation to the latter it is important to realize that health care budgets are under pressure world wide. For instance, in the Netherlands and the USA health care expenses are estimated to be US$27,8 billion (2000) and US$1149 billion (1998) respectively. It is expected that health care growth in the Netherlands will be about 6% of which approximately 75% will be caused by technological advances. From this point of view it is not surprising that, in addition to clinical evaluation, cost-effectiveness research increasingly receives attention. This paper gives an overview of the principles and methodology of economic evaluation, the role of economic modeling and the challenge of assessing outcomes in economic appraisals. It is concluded that it is worthwhile to include economic evaluations in earlier stages of technology introduction. From a methodological point of view it is concluded that outcome measurement is especially important, since one has to show the relative gain of the neuro-prosthesis while a reduction in costs is not very likely. Outcome assessment and valuation can typically be performed using approaches like multi-attribute utility instruments, direct utility assessment (standard gamble), contingent valuation or choice modeling experiments. Each of the methods will be discussed. Finally, some conclusions will be drawn regarding economic evaluations in general and directions for the future. [ABSTRACT FROM AUTHOR]

One of the most important problems with rule induction methods is that they cannot extract rules, which plausibly represent expert decision processes. In this paper, the characteristics of experts' rules are closely examined and a new approach to extract plausible rules is introduced, which consists of the following three procedures. First, the characterization of decision attributes (given classes) is extracted from databases and the concept hierarchy for given classes is calculated. Second, based on the hierarchy, rules for each hierarchical level are induced from data. Then, for each given class, rules for all the hierarchical levels are integrated into one rule. The proposed method was evaluated on a medical database, the experimental results of which show that induced rules correctly represent experts' decision processes. [ABSTRACT FROM AUTHOR]

In the last years there has been a growing interest worldwide in the application of agent technology for providing dynamic, flexible, and compound services. In this paper we report the design and implementation of a multi-agent system that provides health care-related services to the citizens and visitors of a city. The agents of the system allow the user to access his/her medical record, to find out information about the medical centres of the city, and to make a booking to be visited by a particular kind of doctor. Doctors may access and update the medical record of the patient during a visit, and they may also request the performance of clinical tests on the patient. The results of the tests are automatically stored in the patient's medical record, so that they can be accessed by the doctor in the next visit. Two key issues in the design and implementation of the system are discussed: the definition of a basic medical ontology and the implementation of security measures that preserve the confidentiality of sensitive medical information. [ABSTRACT FROM AUTHOR]

Due to an ageing population and improved treatment possibilities, a shortage in hospital beds is a fact in many countries. Home healthcare schemes using information technology (IT) are under development as a response to this and with the intention to produce a more cost-effective care. So far it has been shown that home healthcare is beneficial to certain patient groups. The trend is a widening of the criteria for admission to home healthcare, which means treatment in the home of more severe conditions that otherwise would require in-hospital care. Home informatics has the potential to become a means of providing good care at home. In this process, it is important to consider what new risks will be encountered when placing electronic equipment in the home care environment. Continuous assessment and guidance is important in order to achieve a safe and effective care. Based on a review of current knowledge this paper presents an inventory of risks and adverse events specific to this area. It was found that risks and adverse events could stem from technology in itself, from human-technology interaction conditions or from the environment in which the technology is placed. As a result from the risk inventory, this paper proposes guidelines for the planning and assessment of IT-based hospital-at-home schemes . These assessment guidelines are specifically aimed at performance improvement and thus to be considered a complement to the more general guidelines on telehomecare adopted by the American Telemedicine Association (ATA) in October 2002. [ABSTRACT FROM AUTHOR]

This paper analyzes the SSL/TLS procedures and defines the functionality of a monitoring/auditing entity running in parallel with the protocol, which is decoding, checking the certificate and permitting session establishment based on the decoded certificate information, the network addresses of the endpoints and a predefined access list. Finally, this paper discusses how such a facility can be used for detection impersonation attempts in Health Care applications and provides case studies to show the effectiveness and applicability of the proposed method. [ABSTRACT FROM AUTHOR]

This paper examines whether and to what extent the amount of Social Security benefits of older survey respondents in the Health and Retirement Study (HRS) are reported accurately. Inaccurate reporting leads to biased estimates of gross Social Security benefits, affecting estimates of elderly well-being, including the proportion of beneficiaries classified as poor or near poor. Our findings indicate that 73% of HRS respondents report only the net amount of Social Security benefits they receive, excluding Medicare premiums. The implication is that Social Security benefits in the HRS are underestimates of the true gross benefits. Therefore, the HRS data overestimate the proportion of the elderly respondents who are poor or nearly poor. Finally, even after correcting for gross benefits, Social Security income comprises at least 50% of the total family income for about half of elderly respondents. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to render an account of the experience of a group of healthcare providers and to propose innovative solutions for patients with Spina Bifida (SB) in Argentina. Based on our practice, patients reach specialists too late (40% already undergoing chronic kidney disease stage 1). However, several strategies were implemented in order to reverse this trend, among which were: the setting up of a professional network (via emails and Google groups), team training at different locations, videoconferences, and calling the Ministry of Health to action. Additionally, we developed a project through telemedicine to inform patients and empower caregivers throughout Argentina. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we investigated the recovery of the lactate level, muscular fatigue, and heart rate recovery (HRR) with respect to whole body vibration (WBV) during the rest stage after a gait exercise.Methods: A total of 24 healthy subjects with no medical history of exercise injury participated. The participants were divided into a training group with vibration during rest and a control group with the same conditions but without vibration. The subjects performed a gait exercise with a slope of 15% and velocity of 4 km/h to consume 450 kcal in 30 min. Then, they rested on a vibrating chair or on a chair without vibrations for 30 min. The vibration protocol consists of a frequency of 10 Hz and amplitude of 5 mm. To estimate the recovery effect, we measured the lactate levels in blood, spectral edge frequency (SEF) of MVIC, and HRR before, immediately after exercise, and after rest.Results: The results showed that the lactate level in the training group decreased more (93.8%) than in the control group (32.8%). Also, HRR showed a similar trend with a recovery of 88.39% in the training group but 64.72% in the control group. We considered that whole-body vibrations during rest would help remove lactic acid by improving the level of lactic acid oxidation with stimulated blood vessels in the muscles and by helping to maintain blood flow. Also, WBV would lead to compensation to actively decrease the fast excess post-exercise oxygen consumption from blood circulation.Conclusions: We suggest that whole-body vibrations during rest can provide fast, efficient fatigue recovery as a cool down exercise for women, the elderly, and patients without other activity after intense exercise. [ABSTRACT FROM AUTHOR]

BACKGROUND: Activity monitors have been introduced in the last years to objectively measure physical activity to help physicians in the management of musculoskeletal patients. OBJECTIVE: This systematic review aimed at describing the assessment of physical activity by commercially available portable activity monitors in patients with musculoskeletal disorders. METHODS: PubMed, Embase, PEDro, Web of Science, Scopus and CENTRAL databases were systematically searched from inception to June 11 th , 2020. We considered as eligible observational studies with: musculoskeletal patients; physical activity measured by wearable sensors based on inertial measurement units; comparisons performed with other tools; outcomes consisting of number of steps/day, activity/inactivity time, or activity counts/day. RESULTS: Out of 595 records, after removing duplicates, title/abstract and full text screening, 10 articles were included. We noticed a wide heterogeneity in the wearable devices, that resulted to be 10 different types. Patients included suffered from rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, polymyalgia rheumatica, and fibromyalgia. Only 3 studies compared portable activity trackers with objective measurement tools. CONCLUSIONS: Taken together, this systematic review showed that activity monitors might be considered as useful to assess physical activity in patients with musculoskeletal disorders, albeit, to date, the high device heterogeneity and the different algorithms still prevent their standardization. [ABSTRACT FROM AUTHOR]

The ability to perform basic activities of everyday life is increasingly being proposed by policy makers as a key criterion in eligibility determination for long-term care services. As a result, the assessment and estimation of this population becomes critical for planning purposes. This paper illustrates the issues and potential limitations of measuring functional status using an Activities of Daily Living measurement approach and addresses the implications of these issues for making national estimates of functional disability. Data from the 1987 National Medical Expenditure Survey indicate that significant proportions (31-66%) of the elderly report improvement in functioning over a one year period. The patterns of change reported in this paper, not unlike those found in other national surveys, call into question the reliability of reported ADL measures and point to the need to examine correlates of patterns of change, particularly improvement, over time. Findings indicate that while decline can be predicted reasonably well by demographic and health characteristics of the person, improvement tends to be more a function of methodological factors. [ABSTRACT FROM AUTHOR]

The paper describes SIPP data elements pertaining to health and disability, examines broad policy needs for health and disability issues from the perspective of the Department of Health and Human Services, and contains recommendations for future SIPP design. Specific health and disability items described include health insurance, health care utilization, participation in Federal disability programs, functional disability (i.e. ADLs and IADLs), work disability, and children's disability. The paper contains recommendations to more consistently collect health and disability data in SIPP. Although the goals of SIPP are to study the dynamics of Federal program participation and describe the income distribution of the population, since program participation and income are so closely influenced by health and disability, SIPP's goals cannot be fully met until health and disability data are collected more consistently. [ABSTRACT FROM AUTHOR]

Background: Determining unmet need patterns and associated factors in primary care can potentially specify assessment batteries and tailor interventions in dementia more efficiently. Objective: To identify latent unmet healthcare need patterns and associated sociodemographic and clinical factors. Methods: This Latent Class Analysis (LCA) includes n = 417 community-dwelling people living with dementia. Subjects completed a comprehensive, computer-assisted face-to-face interview to identify unmet needs. One-hundred-fifteen predefined unmet medical, medication, nursing, psychosocial, and social care needs were available. LCA and multivariate logistic regressions were performed to identify unmet needs patterns and patient characteristics belonging to a specific pattern, respectively. Results: Four profiles were identified: [1] "few needs without any psychosocial need" (n = 44 (11%); mean: 7.4 needs), [2] "some medical and nursing care needs only" (n = 135 (32%); 9.7 needs), [3] "some needs in all areas" (n = 139 (33%); 14.3 needs), and [4] "many medical and nursing needs" (n = 99 (24%); 19.1 needs). Whereas the first class with the lowest number of needs comprised younger, less cognitively impaired patients without depressive symptoms, the fourth class had the highest number of unmet needs, containing patients with lower health status, less social support and higher comorbidity and depressive symptoms. Better access to social care services and higher social support reduced unmet needs, distinguishing the second from the third class (9.7 versus 14.3 needs). Conclusions: Access to the social care system, social support and depressive symptoms should be assessed, and the patient's health status and comorbidities monitored to more comprehensively identify unmet needs patterns and more efficiently guide tailored interventions. [ABSTRACT FROM AUTHOR]

Structural health monitoring plays a crucial role in maintaining the long lifespan of large-scale infrastructure. In this paper, a new type of sensing technique for localized structural damage is proposed. This technology can be adopted to measure cracks by using a transparent capacitive sensor. The capacitive sensor is fabricated using a dielectric elastomer with attached stretchable transparent electrodes. The electrodes are ionic conductors. The materials of the sensor are transparent and inexpensive, which make the sensory sheets a feasible application for large surfaces without impeding optical signals. The performance transparency of the sensor is beneficial to visually detect the expansion of cracks through other non-destructive testing technologies. An experiment was conducted to determine the robustness of the capacitive sensor. Tests on perspex sheet and over-reinforced concrete beam demonstrated the ability of the sensor to detect strains and cracks over the surface that it covered. [ABSTRACT FROM AUTHOR]

Education Management Information System (EMIS) is a widely acceptable and developing technology within the Information Technology field. The advancement in technology in this century is being collaborated with scientific invention or explorer and information strengthening or development. This paper presents the results and experiences gained from applying students oriented EMIS for monitoring and managing mental health. The Mental Health of students depends on the acquiring adequate knowledge on basic concepts within a time period or academic schedule. It's obviously significance to evaluate and appraise the stress stimulators as a challenge or threat. The theoretical framework for the study was designed for analyzing the stress stimulators, academic performance and EMIS accessibility. The sample examined in this study was stratified random sample from 75 students specifically all engineering college in Dindigul District of Tamilnadu. The primary factor is the academic stress stimulators that form one module of EMIS for each of the key variable such as curriculum & instruction related stressors, placement related, teamwork related and assessment related. The Mental Health related stress stimulators namely curriculum & syllabus, placement related, assessment related and team work related have a significant influence on academic performance by students in various institution. The important factor leading to the EMIS application in monitoring stress stimulators is curriculum & syllabus related and assessment related. [ABSTRACT FROM AUTHOR]

BACKGROUND: The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. OBJECTIVE: This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. METHODS: The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. RESULTS: The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. CONCLUSIONS:The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost. [ABSTRACT FROM AUTHOR]

BACKGROUND: Programmes providing self-management support for patients and families are gaining attention and have shown promising outcomes with regards to reducing long-term unmet needs post stroke. However, notions of what good self-management support looks like can differ depending on professional opinion, individual preferences, skills and experiences of patients and their families as well as on how care and rehabilitation is organised in a particular healthcare setting. This resonates with the perspective of patient-centred care, according to which the meaning of good care is not universal, but rather jointly shaped between healthcare professionals and patients in everyday interactions. While self-management support is continuously co-produced in care and rehabilitation practices, most self-management programmes are typically provided as an 'add-on' to existing statutory care. OBJECTIVE: This paper aims to deepen the understanding of how self-management support can be made an integral part of everyday care and rehabilitation using Bridges methodology. METHODS: The authors provide a self-reflective account on 'Bridges' an integrated approach to self-management support, which is used by healthcare professionals within acute and community stroke rehabilitation across the UK, and in some parts of New Zealand and Australia. RESULTS: Bridges is based on self-efficacy principles, but has a central aim of professionals sharing decision-making and expertise with patients and families in every healthcare interaction. Methodologically, the co-production of a Bridges support package with local healthcare professionals and patients is critical. The authors present the values articulated by the support package and how it engages professionals, patients and Bridges training facilitators in a continuous process of adjusting and re-adjusting situated self-management support practices. CONCLUSIONS: Our reflections reveal the need to consider development and implementation of self-management support as one and the same on-going process, if we are to facilitate successful engagement and interest from healthcare professionals as well as their patients and families. [ABSTRACT FROM AUTHOR]