Recognising human activity in free-living using multiple body-worn accelerometers

Objectives: Recognising human activity is very useful for an investigator about a patient's behaviour and can aid in prescribing activity in future recommendations. The use of body worn accelerometers has been demonstrated to be an accurate measure of human activity, however research looking at the use of multiple body worn accelerometers in a free living environment to recognise a wide range of activities is not evident. This study aimed to successfully recognise activity and sub-category activity types through the use of multiple body worn accelerometers in a free living environment. Method: Ten participants (Age = 23.1 ± 1.7 years, height =171.0 ± 4.7 cm, mass = 78.2 ± 12.5 Kg) wore nine body-worn accelerometers for a day of free living. Activity type was identified through the use of a wearable camera, and sub category activities were quantified through a combination of free-living and controlled testing. A variety of machine learning techniques consisting of pre-processing algorithms, feature and classifier selections were tested, accuracy and computing time were reported. Results: A fine k-nearest neighbour classifier with mean and standard deviation features of unfiltered data reported a recognition accuracy of 97.6%. Controlled and free-living testing provided highly accurate recognition for sub-category activities (>95.0%). Decision tree classifiers and maximum features demonstrated to have the lowest computing time. Conclusions: Results show recognition of activity and sub-category activity types is possible in a free living environment through the use of multiple body worn accelerometers. This method can aid in prescribing recommendations for activity and sedentary periods for healthy living

A sEMG-driven Musculoskeletal Model to Control Exoskeleton Robot Used in Lower Extremity Rehabilitation

A control system framework of lower extremity rehabilitation exoskeleton robot is presented. It is based on the Neuro-Musculo-Skeletal biological model. Its core composition module, the motion intent parser part, mainly comprises of three distinct parts. The first part is signal acquisition of surface electromyography (sEMG) that is the summation of motor unit action potential (MUAP) starting from central nervous system (CNS).sEMG can be used to decode action intent of operator to make the patient actively participate in specific training .As another composition part, a muscle dynamics model that is comprised of activation and contraction dynamic model is developed. It is mainly used to calculate muscle force. The last part is the skeletal dynamic model that is simplified as a linked segment mechanics. Combined with muscle dynamic model, the joint torque exerted by internal muscles can be exported, which can be used to do a exoskeleton controller design. The developed control framework can make exoskeleton offer assistance to operators during rehabilitation by guiding motions on correct training rehabilitation trajectories, or give force support to be able to perform certain motions. Though the presentation is orientated towards the lower extremity exoskeleton, it is generic and can be applied to almost any part of the human body

Modernizing the Emergency Medical Treatment & Labor Act to Harmonize with the Affordable Care Act to Improve Equality, Quality and Cost of Emergency Care

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal statute passed almost 30 years ago which was designed to ensure equal access to emergency treatment and to halt the practice of “patient dumping.” Patient dumping is a situation where some patients—typically uninsured, disabled, and minority individuals—receive inferior emergency medical care or are denied emergency medical treatment altogether. The goal of EMTALA is to ensure that everyone coming to the emergency room will receive equal care. Unfortunately, despite EMTALA, the practice of patient dumping has continued to this day. The most recent case in the news is the haunting story of a psychiatric hospital, Rawson-Neal in Las Vegas, that purportedly prematurely discharged patients and bussed them out of state. Starting in 2008, the facility allegedly bused nearly 1,500 patients out of state over several years. According to one major class action lawsuit filed in 2013, when patients were placed on a bus, they were given a small amount of food and medication for trips that sometimes lasted for days. They were then told to dial 911 or find a shelter upon their arrival in their new city. One of the allegations in the lawsuit is that hospital officials did not reach out to make arrangements for patient care at these new destinations prior to putting these patients on buses bound for new locations. The news media labeled this practice “Greyhound Therapy.” This practice of patient dumping is of great concern to all patients, but particularly for those in our society who are the most vulnerable—children, many elders, and the physically and mentally disabled—as many of these individuals do not have the ability to engage in self-protection. Of particular concern is that the number of elders with mental disabilities, including dementia and Alzheimer’s, will be growing as our population ages. The dated and flawed EMTALA statute needs to be modernized as it currently negatively impacts the quality and cost of healthcare without any positive trade-off for the equality of healthcare. In fact, there are four ways that EMTALA may actually be having an affirmatively negative impact on equality of care. First, EMTALA encourages the practice of customary treatment choices and discourages the transition to modern day, evidence-based treatment choices. Many customary care treatment choices lead to the provision of unequal, poor quality and costly care. Second, by encouraging customary treatment choices and discouraging the transition to evidence-based treatment choices, EMTALA works against the quality and equality improvement efforts of the Affordable Care Act, Medicare, and Medicaid, and other government programs. Most particularly, EMTALA discourages the adoption of written, evidence-based, emergency protocols that have significant life-saving potential and that ensure equality of care for all. Third, by promoting customary treatment choices, EMTALA perpetuates the use of bias and stereotypes in clinical decision-making. This problem is of particular concern in emergency care. Fourth, by relying on customary care as the exclusive proxy for equality of care, EMTALA renders itself ineffective as an anti-patient dumping tool by facilitating the wide use of procedural tactics to dismiss EMTALA cases before courts can reach the merits. This Article will propose a very simple, two-step way to modernize EMTALA to deal with this cascade of problems. This solution converts EMTALA into a powerful tool to enhance equal access to healthcare while at the same time changing EMTALA so that it works in tandem with, instead of against, the efforts of the Affordable Care Act, Medicare and Medicaid to improve healthcare quality, cost and equal access

Tumour grading and discrimination based on class assignment and quantitative texture analysis techniques

Medical imaging represents the utilisation of technology in biology for the purpose of noninvasively revealing the internal structure of the organs of the human body. It is a way to improve the quality of the patient's life through a more precise and rapid diagnosis, and with limited side-effects, leading to an effective overall treatment procedure. The main objective of this thesis is to propose novel tumour discrimination techniques that cover both micro and macro-scale textures encountered in computed tomography (CI') and digital microscopy (DM) modalities, respectively. Image texture can provide significant information on the (ab)normality of tissue, and this thesis expands this idea to tumour texture grading and classification. The fractal dimension (FO) as a texture measure was applied to contrast enhanced CT lung tumour images in an aim to improve tumour grading accuracy from conventional CI' modality, and quantitative performance analysis showed an accuracy of 83.30% in distinguishing between advanced (aggressive) and early stage (non-aggressive) malignant tumours. A different approach was adopted for subtype discrimination of brain tumour OM images via a set of statistical and model-based texture analysis algorithms. The combined Gaussian Markov random field and run-length matrix texture measures outperformed all other combinations, achieving an overall class assignment classification accuracy of 92.50%. Also two new histopathological multi resolution approaches based on applying the FO as the best bases selection for discrete wavelet packet transform, and when fused with the Gabor filters' energy output improved the accuracy to 91.25% and 95.00%, respectively. While noise is quite common in all medical imaging modalities, the impact of noise on the applied texture measures was assessed as well. The developed lung and brain texture analysis techniques can improve the physician's ability to detect and analyse pathologies leading for a more reliable diagnosis and treatment of disease

Content Based Image Retrieval (CBIR) in Remote Clinical Diagnosis and Healthcare

Content-Based Image Retrieval (CBIR) locates, retrieves and displays images alike to one given as a query, using a set of features. It demands accessible data in medical archives and from medical equipment, to infer meaning after some processing. A problem similar in some sense to the target image can aid clinicians. CBIR complements text-based retrieval and improves evidence-based diagnosis, administration, teaching, and research in healthcare. It facilitates visual/automatic diagnosis and decision-making in real-time remote consultation/screening, store-and-forward tests, home care assistance and overall patient surveillance. Metrics help comparing visual data and improve diagnostic. Specially designed architectures can benefit from the application scenario. CBIR use calls for file storage standardization, querying procedures, efficient image transmission, realistic databases, global availability, access simplicity, and Internet-based structures. This chapter recommends important and complex aspects required to handle visual content in healthcare.Comment: 28 pages, 6 figures, Book Chapter from "Encyclopedia of E-Health and Telemedicine

Treatment of cholelithiasis and acute cholecystitis : surgical safety in gallstone surgery

INTRODUCTION: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures worldwide, with nearly 14,000 operations per year in Sweden alone. Recurrent biliary colic or acute cholecystitis are indications for surgery. Despite being a standardized procedure, complications occur in more than 10% of all operations. This thesis includes five research papers, all of which focus on different aspects of surgical safety in gallstone surgery. PAPER 1: The recommended treatment of acute cholecystitis is acute cholecystectomy during the first hospital admission, but the optimal timing is still under discussion. The aim of the first study was to analyse whether the timing of surgery for acute cholecystitis affects complication rates. A registry-based study, based on the Swedish National Registry for Gallstone Surgery and Endoscopic Retrograde Pancreatography (GallRiks) was performed. We included 87,108 patients undergoing cholecystectomy from 2006 to 2014. Of these operations, 15,760 (18.1%) were performed due to acute cholecystitis. We analysed differences in outcomes related to timing of surgery. The results showed that intra-and postoperative complications, bile duct injuries and 30-and 90-day mortality increased with longer delays. The conclusion is that the optimal timing of surgery seems to be within two days of hospital admission. PAPER 2: Increasing hospital and surgeon volumes have been associated with better outcomes for more complicated procedures. However, it is still unknown whether the annual volume of cholecystectomies affects surgical outcomes. The aim of this study was to investigate whether the surgeon’s and hospital’s annual volume of cholecystectomies has an impact on complication rates and operating time. A registry-based study was conducted based on all cholecystectomies registered in GallRiks between 2006 and 2019. A total of 154,934 patients were analysed: 101,221 (65.3%) elective procedures and 53,713 (34.7%) acute procedures. Low volume was defined as <211 operations per hospital per year and <20 operations per surgeon per year. The correlation between annual volumes and different outcomes was calculated. The conclusion is that high volume hospitals and surgeons have more favourable outcomes in both elective and acute cholecystectomy. PAPER 3: Female and male physicians practice medicine differently but it is still unknown whether female and male surgeons produce different outcomes. The aim of this study was to analyse whether female and male surgeons differ in complication rates and operating times in both elective and acute cholecystectomies. A registry-based study was performed based on all cholecystectomies registered in GallRiks between 2006 and 2019. In total, 150,509 patents were included: 97,755 (64.9%) were elective and 52,754 (35.1%) were acute operations. Procedures were performed by 2,553 surgeons: 849 (33.3%) female surgeons and 1,704 (67.7%) male surgeons. Differences in outcomes and operating times were analysed. The results showed that patients operated on by male surgeons had more surgical complications overall (Odds Ratio (OR) 1.29, 95% CI 1.19- 1.40) including more bile duct injures in elective surgery (OR 1.69, 95% CI 1.22-2.34). In addition, female surgeons had longer operating times; converted less frequently to open surgery in the acute setting and their patients had overall shorter hospital stays. The conclusion is that female surgeons have more favourable outcomes but operate more slowly than male surgeons, in elective and acute cholecystectomies. PAPER 4: An alternative to electrocautery dissection is ultrasonic dissection, which has proven favourable in elective cholecystectomies. The aim of this study was to evaluate the learning curve for ultrasonic fundus-first dissection, in elective laparoscopic cholecystectomy. Surgeons with no previous experience of the technique could participate. Patients were recruited between 2017 and 2019. Sixteen residents and specialists, from eight Swedish hospitals, performed 15 operations each and 240 patients were included. The primary endpoint was dissection time with secondary endpoints being complication rate and the surgeon’s self-assessed performance level. In addition, five of the operations were recorded and the videos were graded by two external surgeons. Associations between the procedural number and the different outcomes were analysed. The results showed that dissection time decreased as experience increased (p=0.001). The technique had a complication rate of 5.8%, comparable to the traditional technique. No correlation between the number of performed procedures and the video-assessment score could be demonstrated. The self-assessed performance level was rated lower in more complicated procedures (p=<0.001). The conclusion is that ultrasonic fundus-first dissection is easy to learn and safe during the learning curve, for both residents and specialists. PAPER 5: Ultrasonic dissection seems to be a safe alternative in elective cholecystectomy, but it is still unclear whether the technique is favourable in acute operations. The aim of this study was to compare electrocautery to ultrasonic dissection in patients with acute cholecystitis. A multicentre, randomized, controlled trial was conducted at eight Swedish hospitals. Eligible participants were patients ≥18 years old, with acute cholecystitis with a duration of ≤7 days. Patients were randomly assigned to either traditional electrocautery or ultrasonic dissection, with a 1:1 allocation. Patients, postoperative caregivers, and follow-up personnel were masked to group assignment. The primary endpoint was the total complication rate with analyses according to intention-to-treat. From September 30, 2019, until March 22, 2023, a total of 300 patients was randomized to electrocautery dissection (n=148) or ultrasonic dissection (n=152). No difference in complication rate was seen between the groups (risk difference (RD) 1.6%, 95% CI − 7.2% to 10.4%, p=0.72). Haemostatic agents were used in 40 (27.0%) of patients assigned to electrocautery and 27 (17.8%) of patients assigned to ultrasonic dissection, (RD 10.6%, 95% CI 1.3%-19.8%, p=0.025). In 13 (8.8%) operations in the electrocautery group the surgeon chose to use ultrasonic dissection mostly due to the perceived higher complexity of the operation. The conclusion is that ultrasonic and electrocautery dissection have comparable risks for total complications in patients with acute cholecystitis. Ultrasonic dissection can be used as an alternative to electrocautery dissection, or as a complement in complicated cases

Assessment of monthly rain fade in the equatorial region at C & KU-band using measat-3 satellite links

C & Ku-band satellite communication links are the most commonly used for equatorial satellite communication links. Severe rainfall rate in equatorial regions can cause a large rain attenuation in real compared to the prediction. ITU-R P. 618 standards are commonly used to predict satellite rain fade in designing satellite communication network. However, the prediction of ITU-R is still found to be inaccurate hence hinder a reliable operational satellite communication link in equatorial region. This paper aims to provide an accurate insight by assessment of the monthly C & Ku-band rain fade performance by collecting data from commercial earth stations using C band and Ku-band antenna with 11 m and 13 m diameter respectively. The antennas measure the C & Ku-band beacon signal from MEASAT-3 under equatorial rain conditions. The data is collected for one year in 2015. The monthly cumulative distribution function is developed based on the 1-year data. RMSE analysis is made by comparing the monthly measured data of C-band and Ku-band to the ITU-R predictions developed based on ITU-R’s P.618, P.837, P.838 and P.839 standards. The findings show that Ku-band produces an average of 25 RMSE value while the C-band rain attenuation produces an average of 2 RMSE value. Therefore, the ITU-R model still under predicts the rain attenuation in the equatorial region and this call for revisit of the fundamental quantity in determining the rain fade for rain attenuation to be re-evaluated