Health informatics system using machine learning techniques

A global pandemic is the cause of concern for humanity. The data collection and their analytics are a critical part of research and clinical studies for decision-making activities in the healthcare sector. Healthcare informatics systems and analytics (HCI&A) is a rapidly emerging technology in the medical domain that could be explored for analyzing pandemics like coronavirus disease 2019 (COVID-19). The ethical, legal, and privacy issues to be considered during data collection for research activities. Data governance and data stewardship are required to be addressed during interoperability and interpretation while sharing and reusing the data in collaborative research. The sharing of comprehensive records of clinical data collected by EHRs, also known as electronic health records, to be stored and analyzed on a time-to-time basis. The emerging area of information technology, represented by big data and artificial intelligence (AI) technology, has been widely studied in recent circumstances like COVID-19 for pandemic management. The possibility of using machine learning is explored for better predictive diagnostics and treatment. This chapter discusses the application of artificial intelligence in pandemic management including prevention, diagnosis, treatment, and also critical policy decisions in the COVID-19 pandemic. The methods to collect the digital data of health records are categorized along with few constraints as most of the electronic records related to clinical and epidemiological data are obtained through a shared database such as national and international collaborative informatics infrastructure. The necessity of digital technologies for pandemic emergencies including medical infrastructure reorganization and data workflow model is highlighted. A comparative study of different machine learning models is discussed in the subsequent sections. The digital healthcare informatics envisage a decentralized network architecture and better privacy and security such as blockchain and heterogeneous data collection with machine learning capability are also emphasized. © 2022 River Publishers.

Machine Learning for Diabetes, Heart Disease, Pneumonia, and Covid-19 Diagnostics

Machine Learning, a part of artificial intelligence which is applied in numerous health-related sector which includes the development of innovative medical procedures, the treatment of chronic diseases and the management of medical data. If a patient can recognize the disease at an early stage from the ease of home, they can start their medication sooner and consult a doctor accordingly for their treatment. This paper attempts to detect various diseases in the healthcare field such as Covid-19 and Pneumonia using Image processing technique with the help of Convolutional Neural Network, and other diseases such as Heart Disease and Diabetes using Random Forest, XGBoost, Support Vector Machine and K-Nearest Neighbour Classifiers. © 2022 IEEE.

Addressing the impact of COVID-19 on dairy value chains: evidence from Punjab, India

The COVID-19 pandemic has adversely affected dairy farmers with the demand shrinking due to income losses of the consumers, disruptions in the supply chains reduc-ing supply, raising costs and increasing wastage. The present study examined such disruptions in Punjab, India, with the primary survey covering dairy farmers, intermediaries, consumers and other stakeholders in the dairy industry. The results reveal a significant fall in farmgate milk prices, disruption in transporting milk within the supply chains, labour shortages, rise in pro-duction costs and lack of operating capital. The demand for milk and milk products declined sharply during the pandemic. To dispose of the excess milk supply, dairy farmers turned to localized value chains catering directly to consumer households. Approximately half of the far-mers lost almost one-third of their income from processed milk products like ghee and butter. The dairy farmers agreed to strengthen the dairy value chains through better integration of the stakeholders. The inability of the farmers to quickly shift to digital platforms for sales of milk and milk products during the pandemic calls for special capacity-building efforts © 2023, Current Science.All Rights Reserved.

The Impact of COVID-19 on Same-Day LARC Initiation Among Adolescents

Background: Same-day long-acting reversible contraception (LARC) is cost-effective and convenient. There have been no studies on how the COVID-19 pandemic impacted same-day LARC for adolescents. We aimed to determine the patient- and provider-level factors associated with same-day LARC placement for adolescents 12 months before and after COVID-19 protocols started on 3/15/2020. Method(s): This retrospective cohort study analyzed existing electronic health records from a large healthcare system in the Southeastern U.S. Adolescents included (N=954) were 10-19 years old and received outpatient LARC from 3/15/2019 to 3/14/2021. A logistic regression model determined the relationship of multiple variables on receipt of same day LARC before and during COVID-19. An interrupted time series examined changes in same-day LARC initiation during the 12 months before and after 3/15/2020. Our institutional IRB approved the study. Result(s): While more adolescents initiated same-day LARC (61%) compared to those who did not (39%), fewer adolescents received same-day LARC during the pandemic (58%) compared to before (64%). Only county concordance was associated with same-day LARC both before and during the pandemic (aOR=2.31 and 1.83 respectively, both p< 0.05) (Table 1). During the pandemic, a few factors reduced the odds of same-day LARC:1) public insurance (aOR=0.52, p< 0.01, vs. private insurance), 2) non-OBGYN providers (pediatrics [aOR=0.34, p< 0.01], family medicine [aOR=0.53, p< 0.01] or internal medicine [aOR=0.13, p< 0.05], vs. OBGYN), and 3) advanced practice practitioners (aOR=0.46, p< 0.001, vs. physicians). There was no significant change in average monthly same-day LARC insertions before and after 3/15/2020 (p>0.05) (Figure 1). Conclusion(s): We identified differences in adolescent same-day LARC initiation during the pandemic by county concordance, insurance status, provider specialty, and provider type. Some potential explanations include barriers to accessing clinical care, such as fewer in-person appointments, reduced public transportation, or limited parental ability to transport their adolescent due to difficulties in childcare for other children. Additionally, fewer same-day LARC by providers in general pediatrics and medicine during the pandemic may suggest that non-LARC concerns took priority during in-person visits. Findings from this study may guide policy and programmatic interventions to improve access to same-day LARC for all adolescent populations. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-1-ANY(1).docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-2-ANY(2).docxCopyright © 2023

Electrophysiological approaches to study cystic fibrosis transmembrane conductance regulator function from human induced pluripotent stem cell-derived airway basal cells

Background: Induced pluripotent stem cells (iPSCs), self-renewable and reprogrammed from somatic cells using different transcription factors, are considered an ideal resource for regenerative medicine to replace diseased or damaged tissues. Airway basal cells not only serve as precursors for secretory and multiciliated cells, but also contribute to maintenance and regeneration of the airway epithelial barrier. Recently, it was reported that induced basal cells (iBCs) from human iPSCs recapitulate molecular and functional features from human iPSCs of airway basal cells, including selfrenewal and multilineage differentiation [1]. iBCs as in vitro model can be used in research on diseases affecting the airway, including COVID-19, influenza, asthma, and cystic fibrosis, although despite these advantages in generating iBCs, this is insufficient to support electrophysiological evidence. Our goal in this study is to define CFTR function in iPSCderived iBCs using electrophysiological methods. Method(s): An iPSC line containing dual reporter NKX2.1GFP and TP63tdTOMATO were used to generate iBCs according to a previously published protocol [1]). iBCs were differentiated into ciliated cells using air-liquid interface (ALI) culture. Short-circuit current measurements were taken on the cells cultured in ALI culture using an Ussing chamber using a previously described protocol [2]). To measure CFTR current using electrophysiological studies, fully differentiated monolayers on filters were dissociated into single cells, which were fixed onto a collagencoated cover glass using cytospin. Whole-cell patch-clamp recordingswere performed according to a previous published protocol [3]. Result(s): We generated proximal airway iBCs from iPSCs with the dualfluorescent reporter system of green fluorescent protein (marks lung progenitors) and tdTomato (marks subsequent airway progenitor) (Figure 1a). These cells on ALI culture demonstrated CFTR function using short-circuit current measurements (Figure 1b). We also measured CFTRdependent currents in iPSC-airway basal cells using whole-cell patchclamp recording (Figure 2). Conclusion(s): We identified CFTR function in electrophysiological experiments using airway iBCs in vitro from iPSCs. Therefore, our study helps advance the field of regenerative medicine, benefiting airway and lung diseases. This may ultimately allowfor development of individual, diseasespecific airway basal stem cells, leading to drug development and a platform on which targeted drug approaches can be tested. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Impact of tele rehabilitation on clinical outcomes in patients recovering from COVID-19: a preliminary investigation

Pulmonary rehabilitation has proven to be an effective therapeutic intervention for people with chronic respiratory disease. Considering the highly contagious nature of coronavirus disease (COVID-19), it becomes imperative to develop a method which can effectively improve clinical disease outcomes of these patients without any physical contact. The purpose of the study was to investigate the impact of tele rehabilitation on dyspnoea, endurance and quality-of-life in patients recovering from COVID 19. Thirty-two participants (age: 42.5 +/- 13.94, height: 165.8 +/- 10.06, weight: 68.5 +/- 9.63, body mass index: 25.0 +/- 3.61) who are recovering from COVID-19 were recruited as per the eligibility criteria. They were randomly allocated into two groups, Tele rehabilitation (n=16) and Control (n=16) by lottery method. All the selected participants were assessed at baseline for perceived dyspnoea, endurance and quality-of-life. Patients in the Tele rehabilitation group received 14 sessions of rehabilitation on alternate days online via google meet over a period of 28 days. Control group received usual care during the study period. Standard statistical tests were employed to test the study hypothesis. Results suggested a significant improvement in both dyspnoea (P=0.001) and endurance (P<0.001) in response to tele rehabilitation. Domains of quality-of-life such as physical role (P=0.02), vitality (P=0.04), emotional role (P=0.03), mental health (P=0.02) and physical components score (P=0.007) also showed significant improvement with tele rehabilitation in patients recovering from COVID-19. Findings of this preliminary study concludes that tele rehabilitation may be considered a treatment of choice in patients recovering from COVID-19 for improving outcomes of dyspnoea, endurance and quality-of-life.

Bedside echocardiographic diagnosis of Pericardial effusion in the critically ill patient and prevention of catastrophic hemodynamic compromise

Introduction: In recent years, the use of ultrasound in critical care has revolutionized the bedside assessment of ICU patients. Though operator dependent, the advantage of repeatability and being relatively inexpensive makes it imperative for critical care physicians to stay updatedwith thismodality. The purpose of this report is to describe an incidental finding of pericardial effusion in a patent admitted with respiratory distress. Main body: A 26 years old female was admitted with shortness of breath and increase in oxygen requirements. She had a background of cerebral palsy, tracheostomized since 2009 after being operated for scoliosis and had a vagal nerve stimulator in situ. On admission, her 1st covid swab was negative. She normally required home ventilation only at night, however 2 days prior to admission, she required 24 hours of ventilator support. A large leak was noted on the ventilator and had a non-cuffed tracheostomy tube in situ, which was later changed to a cuffed one. A quick bedside FICE (Focused Intensive Care Echocardiography) revealed a large circumferential pericardial effusion with fibrin strands. There was no haemodynamic compromise on admission, however the large pericardial effusion could have been an attributing factor to her severe respiratory distress. She progressively started deteriorating hemodynamically, requiring intravenous fluids and vasopressor support. A definitive ECHO done by the cardiologist confirmed the findings of FICE. There was a rapid change in her condition post-pericardiocentesis. As per the institute protocol, a second covid swab was sent for her, which reported positive. Covid-19 RTPCR testing was not validated on pericardial fluid, hence was not undertaken. The culture of pericardial fluid revealed staphylococcus aureus, but there was a high index of suspicion of COVID and bacterial pericarditis was unlikely. Conclusion: Echocardiographic evaluation of Pericardial effusion is of paramount importance for timely and appropriate diagnosis. In view of quick bed side diagnosis with ultrasound, our patient was able to survive this life-threatening condition and treatment was initiated promptly. If left undiagnosed based on clinical presentation, it could have been catastrophic for a completely treatable cause. Brief description of ultrasound video: Pericardial effusion appears as an echo-free space between the 2 layers of pericardium. This video shows a 4-chamber echocardiographic view suggestive of a globular pericardial effusion with fibrin strands. An element of hemodynamic compromise was visible on 4-chambered view as well as para-sternal long axis view.

Mathematical Insight of COVID-19 Infection—A Modeling Approach

Application of mathematics has gotten progressively abundant in epidemic disease research. The complexity of disease is appropriate to quantitative methodologies as it gives difficulties and chances to new turns of events. Thusly, computational modeling demonstrating to epidemiology research by assisting with clarifying components and by giving quantitative expectations that can be approved. The ongoing extension of quantitative models tends to numerous inquiries with respect to Epidemic disease (COVID-19) inception, and treatment reactions and opposition. These models have allowed researchers to better understand the physical phenomena. Computational models can supplement exploratory and clinical investigations, yet additionally challenge flow standards, reclassify our comprehension of systems driving epidemiology and shape future research. © 2021 Scrivener Publishing LLC.

Improving endoscopy turnaround time and list efficiency through implementation of a multifaceted improvement plan

Introduction Maximising efficiency in endoscopy in the face of increasing service pressure, demand and complexity of endoscopy is imperative, particularly given the unparalleled impact of the COVID pandemic on service delivery and cancer pathways. Previous attempts to improve turnaround time through introduction of a turnaround nurse have been hindered by inadequate staffing. We aimed to improve list efficiency and improve turnaround time through the application of marginal gains theory and implementation of a multi-faceted improvement plan. Methods Data was collected from electronic patient records and audit entries made by endoscopy staff. List 'actual' start and stop times were audited against 'scheduled' times. Turnaround time was assessed by a Quality Improvement (QI) Fellow, observing the endoscopy list and collecting information in real time. Results were discussed at a departmental meeting and a 4-stage improvement plan was devised and implemented. Re-audit data was collected to determine effect. Results Preliminary audit data revealed 89% of list starts to be delayed. Lists ran beyond scheduled stop times in 73%. The improvement plan saw: 1) Review and re-organisation of the nursing rota. 2) Departmental commissioning of an external 'change agent' to conduct interviews with nursing and endoscopy managers and work with the QI fellow in designing a bespoke team-building day to address communication strategies and brainstorm perceived departmental issues hindering efficiency. 3) Introduction of an in-room debrief tool, to enhance situation awareness and teamwork. 4) Implementation of a multi-modal 'Nurse-led consent' training programme, combining didactic and in-situ scenariobased simulation training, measuring and recording competence using Directly-Observed-Procedural-Skills (DOPS) assessments. Re-audit data revealed improved list finish-times (49% cf. 27%) although delays in start-times remained. Median turnaround time was 10 minutes, a major improvement from a turnaround time in 20.8 minutes in 2018. Conclusions It is recognised that single improvement interventions are unlikely to result in significant, sustainable change. The aggregation of marginal gains theory dictates that small, marginal gains can add up to a remarkable improvement. Our 4-stage improvement plan saw the implementation of a revised nursing rota and a bespoke team-building day in tandem with the introduction of a 'Nurse Consent' training programme and a novel team debrief tool. In this way, we were able to implement change, whilst simultaneously assessing and addressing staff morale, engage key stakeholders and as a result significantly improve turnaround time. We plan to streamline admission and patient preparation processes to further address delayed start times in future cycles of the improvement project.

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

Objective To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. Methods This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month-18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. Results During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Mean hospital stay (patient days) was longer in MIS- C compared to dengue fever (8.6 vs 6.5 days;P=0.014). Conclusions Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

OBJECTIVE: To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. METHODS: This comparative cross-sectional study was done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. RESULTS: During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 cases (44%), MIS-C without shock, 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C. Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days;P=0.014). CONCLUSION: Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

The Covid-19 pandemic and technical efficiency of Russian firms: a stochastic frontier production function approach

Purpose: This paper aims to undertake the efficiency analysis in the form of stochastic frontier to estimate a Cobb–Douglas production function by controlling for the heterogeneity across Russian firms by including firm size, ownership, age, innovation activity and market competition. Design/methodology/approach: During the peak period of Covid-19, certain firms witnessed either a decrease or increase in sales. Using this segregation of firms from World Bank’s Covid-19 impact surveys follow-up to the Enterprise Survey for Russia, this study empirically investigates the determinants of technical efficiency of these firms focusing on the role of government assistance. Findings: The findings suggest that by segregating firms in terms of sales, different internal factors can enable in steering through pandemic situation besides just depending on external assistance. Originality/value: One of the few papers to analyse the impact of the pandemic on Russian firms by considering World Bank Covid Survey. © 2021, Emerald Publishing Limited.

QSAR studies of some pharmacologically important compoundsfor SARS CoV

Currently, the outbreak of the novel human respiratory coronavirus, also popularly known as COVID-19, has sought the attention of the scientific community across the world and stresses on the need for new therapeutic alternatives in order to cease the global health crisis and fight the pandemic. The situation, therefore, calls out for new researchcentred on targeting the pathogen. A number of studies reveal the potential of different chemical moieties that could possibly act against the virus. In our work, we report the semi-empirical based 3D-QSAR 3D-quantitaive structure and activity relationship/QSAR studies of 3 series of compounds viz. Ethacrynic Acid Derivatives (E1-E3), Isatin (2,3-oxindole) Inhibitors (I1-I7) and Flavonoid and Biflavonoid Derivatives (F1-F7) on the basis of their reported activities against SARS Co-V. The studies are carried out on Hyperchem 8.0 version software using AM1 and PM3 methods. Selected QSAR/3D-QSAR equations including different physical parameters of these series are reported.