Ebook Proceedings of The Future Technologies Conference FTC 2020 Volume 3 Kohei Arai Online PDF All Chapter

Proceedings of the Future
Technologies Conference FTC 2020

Volume 3 Kohei Arai
Visit to download the full and correct content document:
https://ebookmeta.com/product/proceedings-of-the-future-technologies-conference-ftc
-2020-volume-3-kohei-arai/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Proceedings of the Future Technologies Conference FTC

2020 Volume 2 Kohei Arai
https://ebookmeta.com/product/proceedings-of-the-future-
technologies-conference-ftc-2020-volume-2-kohei-arai/
Intelligent Computing: Proceedings of the 2021

Computing Conference, Volume 1 1st Edition Kohei Arai
https://ebookmeta.com/product/intelligent-computing-proceedings-
of-the-2021-computing-conference-volume-1-1st-edition-kohei-arai/
Intelligent Computing Proceedings of the 2021 Computing

Conference Volume 3 Lecture Notes in Networks and
Systems 285 Kohei Arai (Editor)
of-the-2021-computing-conference-volume-3-lecture-notes-in-
networks-and-systems-285-kohei-arai-editor/
Intelligent Computing Proceedings of the 2021 Computing

Conference Volume 2 Lecture Notes in Networks and
Systems 284 Kohei Arai (Editor)
of-the-2021-computing-conference-volume-2-lecture-notes-in-
networks-and-systems-284-kohei-arai-editor/
Intelligent Systems and Applications Proceedings of the
2021 Intelligent Systems Conference IntelliSys Volume 1
294 Lecture Notes in Networks and Systems Kohei Arai
(Editor)
https://ebookmeta.com/product/intelligent-systems-and-
applications-proceedings-of-the-2021-intelligent-systems-
conference-intellisys-volume-1-294-lecture-notes-in-networks-and-
systems-kohei-arai-editor/
IoT Technologies for HealthCare 7th EAI International

Conference HealthyIoT 2020 Viana do Castelo Portugal
December 3 2020 Proceedings Rossitza Goleva
https://ebookmeta.com/product/iot-technologies-for-
healthcare-7th-eai-international-conference-
healthyiot-2020-viana-do-castelo-portugal-
december-3-2020-proceedings-rossitza-goleva/
Techno Societal 2020 Proceedings of the 3rd

International Conference on Advanced Technologies for
Societal Applications Volume 1 Prashant M. Pawar
(Editor)
https://ebookmeta.com/product/techno-societal-2020-proceedings-
of-the-3rd-international-conference-on-advanced-technologies-for-
societal-applications-volume-1-prashant-m-pawar-editor/
Proceedings of the 21st EANN (Engineering Applications

of Neural Networks) 2020 Conference: Proceedings of the
EANN 2020 Lazaros Iliadis
https://ebookmeta.com/product/proceedings-of-the-21st-eann-
engineering-applications-of-neural-networks-2020-conference-
proceedings-of-the-eann-2020-lazaros-iliadis/
Emerging Technologies in Computing Third EAI

International Conference iCETiC 2020 London UK August
19 20 2020 Proceedings Mahdi H. Miraz
https://ebookmeta.com/product/emerging-technologies-in-computing-
third-eai-international-conference-icetic-2020-london-uk-
august-19-20-2020-proceedings-mahdi-h-miraz/
Advances in Intelligent Systems and Computing 1290
Kohei Arai
Supriya Kapoor
Rahul Bhatia Editors
Proceedings
of the Future
Technologies
Conference
(FTC) 2020,
Volume 3
Advances in Intelligent Systems and Computing
Volume 1290
Series Editor
Janusz Kacprzyk, Systems Research Institute, Polish Academy of Sciences,
Warsaw, Poland
Advisory Editors
Nikhil R. Pal, Indian Statistical Institute, Kolkata, India
Rafael Bello Perez, Faculty of Mathematics, Physics and Computing,
Universidad Central de Las Villas, Santa Clara, Cuba
Emilio S. Corchado, University of Salamanca, Salamanca, Spain
Hani Hagras, School of Computer Science and Electronic Engineering,
University of Essex, Colchester, UK
László T. Kóczy, Department of Automation, Széchenyi István University,
Gyor, Hungary
Vladik Kreinovich, Department of Computer Science, University of Texas
at El Paso, El Paso, TX, USA
Chin-Teng Lin, Department of Electrical Engineering, National Chiao
Tung University, Hsinchu, Taiwan
Jie Lu, Faculty of Engineering and Information Technology,
University of Technology Sydney, Sydney, NSW, Australia
Patricia Melin, Graduate Program of Computer Science, Tijuana Institute
of Technology, Tijuana, Mexico
Nadia Nedjah, Department of Electronics Engineering, University of Rio de Janeiro,
Rio de Janeiro, Brazil
Ngoc Thanh Nguyen , Faculty of Computer Science and Management,
Wrocław University of Technology, Wrocław, Poland
Jun Wang, Department of Mechanical and Automation Engineering,
The Chinese University of Hong Kong, Shatin, Hong Kong
The series “Advances in Intelligent Systems and Computing” contains publications
on theory, applications, and design methods of Intelligent Systems and Intelligent
Computing. Virtually all disciplines such as engineering, natural sciences, computer
and information science, ICT, economics, business, e-commerce, environment,
healthcare, life science are covered. The list of topics spans all the areas of modern
intelligent systems and computing such as: computational intelligence, soft comput-
ing including neural networks, fuzzy systems, evolutionary computing and the fusion
of these paradigms, social intelligence, ambient intelligence, computational neuro-
science, artificial life, virtual worlds and society, cognitive science and systems,
Perception and Vision, DNA and immune based systems, self-organizing and
adaptive systems, e-Learning and teaching, human-centered and human-centric
computing, recommender systems, intelligent control, robotics and mechatronics
including human-machine teaming, knowledge-based paradigms, learning para-
digms, machine ethics, intelligent data analysis, knowledge management, intelligent
agents, intelligent decision making and support, intelligent network security, trust
management, interactive entertainment, Web intelligence and multimedia.
The publications within “Advances in Intelligent Systems and Computing” are
primarily proceedings of important conferences, symposia and congresses. They
cover significant recent developments in the field, both of a foundational and
applicable character. An important characteristic feature of the series is the short
publication time and world-wide distribution. This permits a rapid and broad
dissemination of research results.
** Indexing: The books of this series are submitted to ISI Proceedings,
EI-Compendex, DBLP, SCOPUS, Google Scholar and Springerlink **
More information about this series at http://www.springer.com/series/11156

Kohei Arai Supriya Kapoor
• •
Rahul Bhatia
Editors
Proceedings of the Future

Technologies Conference
(FTC) 2020, Volume 3
123
Editors
Kohei Arai Supriya Kapoor
Faculty of Science and Engineering The Science and Information
Saga University (SAI) Organization
Saga, Japan Bradford, West Yorkshire, UK
Rahul Bhatia
The Science and Information
(SAI) Organization
Bradford, West Yorkshire, UK
ISSN 2194-5357 ISSN 2194-5365 (electronic)

Advances in Intelligent Systems and Computing
ISBN 978-3-030-63091-1 ISBN 978-3-030-63092-8 (eBook)
https://doi.org/10.1007/978-3-030-63092-8
© Springer Nature Switzerland AG 2021
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, expressed or implied, with respect to the material contained
herein or for any errors or omissions that may have been made. The publisher remains neutral with regard
to jurisdictional claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editor’s Preface
With the aim of providing a worldwide forum, where the international participants
can share their research knowledge and ideas, the 2020 Future Technologies
Conference (FTC) was held virtually on November 5–6, 2020. FTC 2020 focuses
on recent and latest technological breakthroughs in the areas of computing, elec-
tronics, AI, robotics, security and communications and map out the directions for
future researchers and collaborations.
The anarchic spirit and energy of inquiry found in our community always help
researchers to produce brilliant technological advances which continue to restruc-
ture entire computing community. FTC see participation from such researchers,
academics and technologists from leading universities, research firms, government
agencies and companies to submit their latest research at the forefront of technology
and computing.
We are pleased to review and select a volume of high-qualified papers from all
submissions during the conference. We hope these papers which have been gone
through the double-blind review process can provide helpful reference for all
readers and scholars. In these proceedings, we finally selected 210 full papers
including six poster papers to publish.
We would like to express our gratitude and appreciation to all of the reviewers
who helped us maintaining the high quality of manuscripts included in this con-
ference proceedings. We would also like to extend our thanks to the members of the
organizing team for their hard work. We are tremendously grateful for the contri-
butions and support received from authors, participants, keynote speakers, program
committee members, session chairs, steering committee members and others in their
various roles. Their valuable support, suggestions, dedicated commitment and hard
work have made FTC 2020 a success.
We hope that all the participants of FTC 2020 had a wonderful and fruitful time
at the conference!
Kind Regards,
Kohei Arai
v
Contents
Biofluid-Biostructure Interaction Analyses Using Comprehensive

Patient-Specific Geometries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Milan Toma and Rosalyn Chan-Akeley
Usability Evaluation of Low-Cost Smart Pill Dispenser by Health
Care Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Gift Arnold Mugisha, Christine Muhumuza, Faith-Michael Uzoka,
Chinyere Nwafor-Okoli, Joletta Nabunje, Melody Arindagye,
and Justine N. Bukenya
Dynamic Causality Knowledge Graph Generation for Supporting
the Chatbot Healthcare System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Hong Qing Yu
Healthcare Emergency Room Optimization Using a Process
Learning Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Soraia Oueida and Yehia Kotb
Federated Learning Approach to Support Biopharma and Healthcare
Collaboration to Accelerate Crisis Response . . . . . . . . . . . . . . . . . . . . . 64
Arijit Mitra, Abrar Rahman, and Fuad Rahman
Ethical Analysis on the Application of Neurotechnology for Human
Augmentation in Physicians and Surgeons . . . . . . . . . . . . . . . . . . . . . . . 78
Soaad Qahhar Hossain and Syed Ishtiaque Ahmed
Virtual Reality Application to Teach Dangerous Over Exposure
to UV Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Edgard Vargas-Solís, Daniel Cárdenas-Salas, Juan Gutierrez-Cardenas,
and Vilma S. Romero-Romero
Detecting Invasive Ductal Carcinoma with Semi-supervised
Conditional GANs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Jeremiah W. Johnson
vii
viii Contents
Computation of Incline Barriers via Smartphone Sensors

in the Mobile App WheelScout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Bettina Harriehausen-Mühlbauer
Sensor Networks and Personal Health Data Management:
Software Engineering Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Xiang Zhang, Jialu Zhang, Matthew Pike, Nasser M. Mustafa,
Dave Towey, and Vladimir Brusic
Utilizing Digitized Surveys for Data Collection:
The Case of Developing Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Abdullah Sarhan, Omar Addam, Jone Rokne, and Reda Alhajj
Towards Better Remote Healthcare Experiences: An mHealth Video
Conferencing System for Improving Healthcare Outcomes . . . . . . . . . . 180
El Sayed Mahmoud, Edward R. Sykes, Blake Eram, Sandy Schwenger,
Jimmy Poulin, and Mark Cheers
Volume Visualization and Beams Towards Computational Cancer
Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Ismail Bahkali and Sudhanshu Kumar Semwal
Virtual Reality and Visualization of 3D Reconstructed Medical
Imaging: Learning Variations Within Detailed Human Anatomies . . . . 217
Erik N. Gaasedelen, Alex J. Deakyne, Alexander R. Mattson,
Lars M. Mattison, Mikayle A. Holm, Jorge D. Zhingre Sanchez,
Megan M. Schmidt, Michael G. Bateman, Tinen L. Iles, and Paul A. Iaizzo
Development of a Socially Assistive Robot Controlled by Emotions
Based on Heartbeats and Facial Temperature of Children with
Autistic Spectrum Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Teodiano Bastos, Lucas Lampier, Christiane Goulart, Vinicius Binotte,
Guilherme Baldo, Carlos Valadão, Eliete Caldeira, and Denis Delisle
Framework for an Integrated Ehealth Platform with Smart Diagnostic
Engine for Improved Healthcare Access for Rural Dwellers . . . . . . . . . 240
Francis E. Idachaba and Ejura Mercy Idachaba
Medical Visualization Using 3D Imaging and Volume Data:
A Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Ismail Bahkali and Sudhanshu Kumar Semwal
Matching System for Animal-Assisted Therapy Based
on the Levenshtein and Gale-Shapley Algorithms . . . . . . . . . . . . . . . . . 262
Giuliana Gutiérrez-Rondón and Juan Gutiérrez-Cárdenas
The ICT Design for Modern Education Technology
and Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Stefan Svetsky, Oliver Moravcik, Dariusz Mikulowski,
and Mariya Shyshkina
Contents ix
RiWAArch Style: An Architectural Style for Rich

Web-Based Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Nalaka R. Dissanayake and G. K. A. Dias
Digitalization of the Oil and Gas Industry: Practical Lessons
Learned from Digital Responses During the First Stage
of the COVID-19 Outbreak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Trung Nguyen, Raymond G. Gosine, and Peter Warrian
Code Complexity Metrics Derived from Software Design:
A Framework and Theoretical Evaluation . . . . . . . . . . . . . . . . . . . . . . . 326
Omar Masmali and Omar Badreddin
Does Context Matter? Assessing the Current State of Quality Practice
During Software Development in Small Software Companies . . . . . . . . 341
Micheal Tuape, Phemelo Ntebane, and Pulafela Majoo
Research on Various Software Development Lifecycle Models . . . . . . . . 357
Nabeel Asif Khan
Usability Engineering Process for Medical Devices . . . . . . . . . . . . . . . . 365
Momina Shaheen, Tayyaba Anees, Muhammad Junaid Anjum,
and Aimen Anum
Evolution of Push-Communication Towards the Rich
Web-Based Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Nalaka R. Dissanayake, Dharshana Kasthurirathna,
and Shantha Jayalal
SAI: Sports Analysis and Informatics . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Archit RamanaSai Kambhamettu and Chandra Kambhamettu
Theoretically Validated Complexity Metrics for UML State
Machine Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Omar Masmali and Omar Badreddin
The New Role of Cloud Technologies in Management Information
Systems Implementation Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Patryk Morawiec and Anna Sołtysik-Piorunkiewicz
Design and Experimental Study of a Device that Allows Urban
Gardeners to Understand What Their Plants May Be “Feeling” . . . . . . 442
Osvaldo Luiz de Oliveira and Waldinei Bispo de Lima
Optimal Polynomial Backoff for IEEE 802.11 DCF . . . . . . . . . . . . . . . . 460
Bader A. Aldawsari and J. Haadi Jafarian
Aware Diffusion Routing Protocol with Reliable Data
Delivery Provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Kamil Samara and Hossein Hosseini
x Contents
Exploration of Network Slice Charging in 5G Networks . . . . . . . . . . . . 482

Chin Hsuan Chen, Fuchun Joseph Lin, Chia-Hsuan Yu, and Wan-Hsun Hu
Pervasive Information Architecture in Service Design Blueprints:
Walking Tours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502
Camila Meira, Mariana Bittencourt, Julia Souza, Ana Ribeiro,
Katharina Poll, and Adriano Bernardo Renzi
Cluster Merging Scheme in VANETs . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Osama AlQahtani, Frederick T. Sheldon, Axel Krings, and Julie Beeston
Use of High Mobility Nodes to Improve Connectivity in Wireless
Sensor Networks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Lucas dos Santos, Paulo Nascimento, Lucila Bento, Raphael Machado,
Paolo Ferrari, and Claudio Amorim
Message Routing and Link Maintenance Augmentation for Robotic
Network Connectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
Mustafa Ayad and Richard Voyles
A Machine Learning-Based Migration Strategy for Virtual Network
Function Instances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Dimitrios Michael Manias, Hassan Hawilo, and Abdallah Shami
Optimizing Connectivity for the Internet of Vehicles . . . . . . . . . . . . . . . 578
Sumanjit Gill, Robert Wong, Shahab Tayeb, Fletcher Trueblood,
and Matin Pirouz
On Testing Microservice Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
Arne Koschel, Irina Astrova, Mirco Bartels, Mark Helmers,
and Marcel Lyko
Development of an IoT Based Smart Campus: Wide Shuttle
Tracking System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610
Francis E. Idachaba
Bringing the QR Code to Canada: The Rise of AliPay and WeChatPay
in Canadian e-Commerce Markets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 622
Geneva Nam
2D Vector Map Fragile Watermarking with RST Invariance
and Region Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Nana Wang, Xiaohui Guo, and Jilong Bian
Quantifying Information Exposure by Web Browsers . . . . . . . . . . . . . . 648
Fadi Mohsen, Mohamed Shehab, Maxamilliano Lange,
and Dimka Karastoyanova
Deception Detection in Videos Using Robust Facial Features . . . . . . . . . 668
Anastasis Stathopoulos, Ligong Han, Norah Dunbar, Judee K. Burgoon,
and Dimitris Metaxas
Contents xi
Ethereum Blockchain Enabled Secure and Transparent E-Voting . . . . . 683

Vishakh Rao, Ankur Singh, and Bhawana Rudra
RECO-DryGASCON: Re-configurable Lightweight
DryGASCON Engine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
Robert Herndon, Rafed El-Issa, Daniel Heer, Jinjun Xiong, Wen-Mei Hwu,
and Mohamed El-Hadedy
Techniques Implemented in Software Protectors: A Journey with DBI
Through What Protectors Use to Detect Bad Guys . . . . . . . . . . . . . . . . 722
Federico Palmaro and Luisa Franchina
A Self-reliant Trust Management Model for VANETs . . . . . . . . . . . . . . 738
Ibrahim Abdo Rai, Riaz Ahmed Shaikh, and Syed Raheel Hassan
Edge Crypt-Pi: Securing Internet of Things with Light and Fast
Crypto-Processor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749
Mohamed El-Hadedy, Xinfei Guo, Kevin Skadron, and Wen-Mei Hwu
Sybil Attack Detection and Prevention in VANETs: A Survey . . . . . . . . 762
Yunpeng Zhang, Bidit Das, and Fengxiang Qiao
Lightweight Cryptography for the Internet of Things . . . . . . . . . . . . . . 780
Alaa Hassan
A Study on Soft-Core Processor Configurations for Embedded
Cryptography Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 796
Benjamin Kueffler, Wen-Mei Hwu, and Mohamed El-Hadedy
Classification Method for Malware Detection on Android Devices . . . . . 810
Arthur Fournier, Franjieh El Khoury, and Samuel Pierre
Social Structure Construction from the Forums Using
Interaction Coherence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 830
Kazuaki Kashihara, Jana Shakarian, and Chitta Baral
Relationship Between Facial Recognition, Color Spaces, and Basic
Image Manipulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844
Giuliano Millan, Anas Salah Eddin, Jinjun Xiong, Wen-Mei Hwu,
and Mohamed El-Hadedy
Proposing Recommendations for Improving the Reliability
and Security of Information Systems in Governmental Organizations
in the Republic of Kazakhstan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 854
Askar Boranbayev, Seilkhan Boranbayev, Yerzhan Seitkulov,
and Askar Nurbekov
An Application of Metacyclic and Miller-Moreno p-Groups
to Generalization of Diffie-Hellman Protocol . . . . . . . . . . . . . . . . . . . . . 869
Ruslan Skuratovskii
xii Contents
A Systematic Literature Review of Smart Contract Applications . . . . . . 877

Eghbal Ghazizadeh and Tong Sun
A Framework of Signature-Matching-Algorithms for IoT Intrusion
Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889
Menachem Domb
Suspected Software-Code Restoration Using a Dictionary
Led System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 899
Menachem Domb and Guy Leshem
Hypervisor Based IDS Solution Approach Using Hybrid Anomaly
Detection Model in Cloud Computing Environment . . . . . . . . . . . . . . . . 909
Frances Osamor and Anteneh Girma
Security and Performance Considerations of Improved Password
Authentication Algorithm, Based on OTP and Hash-Chains . . . . . . . . . 921
Ivaylo Chenchev, Ognian Nakov, and Milena Lazarova
Audiouth: Multi-factor Authentication Based on Audio Signal . . . . . . . 935
Muhammad Ali Fauzi and Bian Yang
Zero Trust in the Context of the Utility Industry . . . . . . . . . . . . . . . . . . 947
Nikhil Kumar and Noah LaRoy
Secure Shared Processing on a Cluster of Trust-Anchors . . . . . . . . . . . 968
Keith Mayes
The Development Process of a Tooth Brushing App on Android Using
Movement Direction Detection with OpenCV . . . . . . . . . . . . . . . . . . . . . 985
Radu-Stefan Ricman, Roland Szabo, and Aurel Gontean
Co-creative Robotic Arm for Differently-Abled Kids: Speech, Sketch
Inputs and External Feedbacks for Multiple Drawings . . . . . . . . . . . . . 998
Shama Zabeen Shaik, Vidhushini Srinivasan, Yue Peng, Minwoo Lee,
and Nicholas Davis
LightCloud: Future of Dynamic Lighting in the Shared Space . . . . . . . 1008
Elena C. Kodama, Nan Zhao, and Joseph A. Paradiso
Developing Blockchain Supported Collective Intelligence in
Decentralized Autonomous Organizations . . . . . . . . . . . . . . . . . . . . . . . 1018
Aelita Skarzauskiene, Monika Maciuliene, and Daniel Bar
A Software Platform for Use Case Driven Human-Friendly Factory
Interaction Using Domain-Specific Assets . . . . . . . . . . . . . . . . . . . . . . . . 1032
Felix Brandt, Eric Brandt, David Heik, Dirk Reichelt, and Javad Ghofrani
Contents xiii
Asset Administration Shell: Domain Specific Language Approach

to Integrate Heterogeneous Device Endpoints . . . . . . . . . . . . . . . . . . . . 1044
Felix Brandt, Eric Brandt, Javad Ghofrani, David Heik, and Dirk Reichelt
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1053

Biofluid-Biostructure Interaction
Analyses Using Comprehensive
Patient-Specific Geometries
Milan Toma1(B) and Rosalyn Chan-Akeley2

1
Department of Osteopathic Manipulative Medicine, College of Osteopathic
Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA
tomamil@tomamil.eu
2
Lang Research Center, NewYork-Presbyterian Queens, Flushing, NY 11355, USA
http://www.tomamil.com
Abstract. A multitude of imaging modalities are used to acquire

patient-specific geometries. The extracted 3D patient-specific models are
then typically simplified. The most common reason is to increase the
speed of subsequent calculations. However, it can be argued that these
simplifications nullify the reason for calling these geometries patient-
specific. This argument is supported by the fact that, once modified, the
geometry no longer accurately represents the patient it was extracted
from. Moreover, biomedical applications do not just include complex
geometries, they also include large deformations of their solid domains.
The present paper shows the use of a next-generation SPH method that
allows the user to gain results in a timely manner without the need to
simplify the geometry. SPH is used to simulate the fluid domain, which is
combined with a high-order finite element method used to simulate the
solid domain, thus creating an ideal combination of methods to simulate
fluid-structure interaction. The utilization of these methods is especially
advantageous when complex geometries are to be included.
Keywords: Computer models · Patient-specific computational

modeling · Fluid-structure interaction
1 Introduction
This section is two-fold. First, advantages and disadvantages of computational
and experimental methods are discussed. Second, since not every numerical
method is suitable for calculations that include patient-specific geometries, the
process of choosing the right numerical methods is examined.
1.1 Simulations and Experiments

Human patient-specific geometries are usually of a complex nature. It is chal-
lenging to conduct fluid-structure interaction (FSI) analyses while preserving all
c Springer Nature Switzerland AG 2021
K. Arai et al. (Eds.): FTC 2020, AISC 1290, pp. 1–16, 2021.
https://doi.org/10.1007/978-3-030-63092-8_1
2 M. Toma and R. Chan-Akeley
the small-scale features of the geometries used, e.g. the gyri and sulci of the
brain (in layman’s terms, the folds and indentations in the brain that give it
its wrinkled appearance). The gyri and sulci of the brain greatly increase the
brain’s surface area, a phenomenon commonly observed in other parts of the
human body. Cerebrospinal fluid (CSF) fills the skull and surrounds the brain.
It acts as a shock absorber for the central nervous system (CNS), cushioning
the brain within the skull [1–3]. Due the increased surface area created by the
gyri and sulci, the actual contact area between the brain and CSF is also larger.
The complicated anatomy of the brain and the physiology of its relationship
with CSF, for example how they interact in trauma or how the relationship
changes in response to the brain’s unique form, makes the task of conducting an
FSI analysis of said relationship inherently formidable. Understandably, many
FSI laboratories choose to circumvent these intrinsic issues by simplifying the
brain geometry into a single smooth mass placed in the center of another simpli-
fied geometry representing skull. The reliability of results achieved utilizing this
simplified format are questionable, especially in the context of practicality and
clinical applicability. Results that are unable to reflect, at least in some part, a
close mirror of the true physiologic process cannot be used by physicians in a
clinical setting to inform clinical decision-making.
Validating computational models and frameworks is a common practice, but
numerical simulations are still not preferred above actual experiments. There
has been a worldwide benchmark Food and Drug Administration (FDA) study
to standardize computational fluid dynamics (CFD) techniques used to assess
the safety of medical devices [4], which was replicated also by our group with a
special focus on mesh sensitivity analysis [5]. The benchmark flow model used
for this study consists of a nozzle with a concentrator and sudden expansion,
i.e. the geometry used is simpler than those used in patient-specific simulations.
Moreover, CFD is numerically also more straightforward than FSI methods.
Over 40 groups (self-ascribed as beginner, intermediate or expert) delivered their
results. The results of the FDA study show that CFD results always need to be
validated even when produced by experts. It was found that even the worst
‘beginner’ was actually closer to the experimental measurements than the worst
‘expert’; and some ‘beginners’ matched the experimental results better than
some ‘experts’ [4].
While validations are performed on every model published, the input param-
eters (e.g. material properties, boundary/initial conditions, and so forth) are
usually ‘calibrated’ in order to reach the desired results. Our group at the Geor-
gia Institute of Technology has previously shown that it is possible to achieve
computational results equivalent to the experimental ones, utilizing comprehen-
sive patient-specific geometries that function without the need to ‘calibrate’ the
material models used (i.e. the material parameters acquired from the tissue sam-
ples can be used directly). We have shown this in simulations and experiments
conducted to mimic mitral valve (MV) function during systole and diastole in
order to study it in both healthy and diseased states [6–13]. Other groups have
BioFSI using Patient-Specific Geometries 3
also reached the same conclusion when analyzing clinical data quality and how
it affects FSI simulations of patient-specific stenotic aortic valve models [14].
Ideally, we would investigate the biofluids interacting with the solid
deformable domain using experimental in-vivo methods. To make it affordable
and realistic would require the use of an invasive method, which would not be
morally feasible. To make it affordable and non-invasive would not yield realistic
results. To make it realistic and non-invasive would not be affordable or, in this
case, even possible. As such, in situations where experimental methods cannot
be used, a computational model is a viable alternative. However, computational
methods have drawbacks as well. The use of complex patient-specific geometry
often requires simplifications in the numerical algorithms used. Similarly, a com-
putation with high-precision numerical algorithms and comprehensive patient-
specific geometry could take even months to complete. Furthermore, the risk
and occurrence of numerical errors must be considered when complex long cal-
culations are involved. Thus, as the three constraints are interdependent (none
of them can be altered without affecting one or both of the others) the triple
constraint model can be applied here, as depicted in Fig. 1.
tal
Realistic
en
rim
pe
Ex
Non-invasive Cost
l
na
Complex
tio
Geometry
uta
mp
Co
Precision Time
Fig. 1. The triple constraint summarizing the drawbacks of both the experimental and
computational methods.
1.2 Choosing Numerical Methods
Computer simulations provide virtual hands-on experience when actual hands-

on experience is not possible. To use these simulations in medical science, they
need to be able to predict the behavior of actual processes using actual patient-
specific geometries with no simplifications. The most common numerical method
used to perform FSI analyses is the Arbitrary Lagrangian-Eulerian (ALE) for-
mulation. The accuracy of ALE methods depends on the use of meshes with
high density, which can be a problem when modeling small gaps between the
solid and fluid domains, especially when the solid domain is meant to repre-
sent a comprehensive patient-specific geometry of high complexity. In models
involving detailed anatomy, the use of ALE brings additional complications. For
example, ALE methods are either strongly coupled or weakly coupled. Weakly
coupled ALE methods are known for accuracy issues when compared to strongly
coupled methods and have difficulty performing well when attempting to paral-
lelize the algorithms. Strongly coupled ALE methods yield large ill-conditioned
system matrices, i.e. system matrices that are prone to large numerical errors
with each system-solving iteration within each non-linear iteration within each
time-step. They require additional algorithms to be implemented alongside the
ALE algorithm just to keep well conditioned. Consequently, increasing numer-
ical operations yields more numerical errors, thus making it nearly impossible
to perform effective parallelization of the entire framework [15]. As the ALE
methods rely on the use of meshes with high density, the users tend to use
simplified geometries to decrease the number of elements necessary for stable
calculations. This is done in an attempt to cut processing time down to weeks
instead of months, all the while running on supercomputers utilizing thousands
of processors while facing convergence issues.
The combination of Smoothed-Particle Hydrodynamics (SPH) methods, used
to simulate the fluid domain flow, with a high-order finite element method used
to simulate the solid domain deformations, is ideal for simulating FSI, especially
when complex geometries are included. Using SPH methods provides numerical
stability because the contact between the solid and fluid domains is easily treated
numerically. Moreover, SPH is highly parallelizable. That being the case, it is
possible to run FSI simulations that are numerically stable, precise, parallelized
on a standard GPU workstation (as opposed to large supercomputers), which
do not require the use of simplified geometries, and possess a runtime of hours
or days rather than weeks and months.
2 Methods
Two critical points are addressed in this section. First, when preserving the
smallest details of complex patient-specific geometries the proper image pro-
cessing techniques need to be used. Second, for the computational methods to
handle the complex geometries, next-generation algorithms need to be chosen.
2.1 Creating Patient-Specific Geometries
Medical imaging is mainly used to create visual representations of the organs

for clinical analysis and/or a visual representation of their function. There are
numerous software packages available to create 3D printable anatomic models
from medical scans. Patient-specific models are used with increasing frequency to
plan and optimize surgical procedures. Other uses include training simulators for
educational purposes, verification and validation of new medical devices, and/or
computational simulations and analyses.
Non-invasive MRI, CT or 3D ultrasound testing generates patient-specific
imaging scans. Digital Imaging and Communications in Medicine (DICOM) is
a standard for storing and transmitting medical images. The DICOM output
provides a series of 2D images (slices) that are then reconstructed in 3D. The
first step is to isolate the anatomy of interest (i.e. segmentation) and generate
a surface stereolithography (STL) file. The resulting STL file can be used for
rapid prototyping, 3D printing, computer-aided manufacturing, and/or creating
volume mesh. The volume mesh can then be used for computer simulations. A
variety of commercial, freeware, and open-source software packages are available
to perform the segmentation.
The first step in developing patient-specific models is to obtain DICOM data.
All medical imaging devices that support the DICOM standard will export files
readable by the editing software of choice. The human body is geometrically com-
plex with multiple layers of varying densities. Thus, several imaging modalities
are typically used for diagnostics and prognostics. One or more of the following
modalities are used:
– MRI (Magnetic Resonance Imaging) uses a strong magnetic field that excites
hydrogen atoms in the body. The scanner then detects the radio frequency
emitted by the hydrogen atoms. It is used for imaging soft structures in the
body because hydrogen atoms exist in large quantities in humans, especially
in areas with high concentrations of water and/or fat. Additionally, it does
not expose the patient to radiation.
– CT (Computed Tomography) uses a series of X-rays taken from different
angles. In the resulting images, the brighter areas are denser than dark areas,
e.g. a bone is brighter than the surrounding connective tissues. This method
is quick and provides high resolution, but it is not as accurate for soft tissues
and results in radiation exposure.
– 3D ultrasound uses high-frequency sound waves sent into the body at different
angles. As they reflect back, the receiving device displays them to produce
a live 3D image of the internal organs. The method is cheap, provides a live
image, and has no radiation exposure. However it is of low resolution and
does not show internal structures.
The software packages used to display DICOM images range from open-
source software to enterprise-level solutions with FDA clearance. There are
dozens of options available. The data set must be segmented to separate the
z
y x
Fig. 2. Original (yellow) surface from the threshold segmentation compared to the final
surface mesh (green) after smoothing techniques applied. Zoom-in to an attachment
points between the chords and leaflets is shown to demonstrate the complexity of the
geometry.
Fig. 3. The depiction of the entire head model with skull, cerebrum, cerebellum, pitu-
itary gland and brainstem, respectively. The subarachnoid space and other cavities are
filled with fluid particles (blue dots surrounding the brain model in the lower right
corner). The entire model with half the skull is also displayed (lower left).
area of interest from the surrounding tissues. Segmentation is done by marking

the relevant data and discarding the surrounding data.
Cutting-edge software solutions use advanced algorithms to automatically, or
semi-automatically, separate specific organs from the surrounding tissues. Some
of the methods used for automatic segmentation include region growing [16],
region competition [17], digital subtraction [18], and seed growing [19]. In recent
years, the method of applying machine learning, especially deep learning, to med-
ical imaging has risen in popularity, due to its ability to achieve state-of-the-art
performance in image analysis and processing [20]. In numerous instances, AI-
based segmentation algorithms have successfully outperformed human experts
[21]. Such endeavors are actively transforming the field of medical image pro-
cessing.
In scans where a certain anatomy has a very distinct set of pixel values,
thresholding can be used, especially where high contrast is present. For example,
in the case of CT images, the pixel values represent the density. Hence, keeping
only the brighter pixels leaves only the bone. The pixel values are set within a
certain range, with a minimum value as black and a maximum value as white.
Values in between make up the different shades of gray. Setting the threshold
maximum and minimum manually to a given range isolates a user-defined region.
Our groups used μCT to create and validate fully comprehensive FSI MV
and Tricuspid Valve models with 3D chordal structures [6–13]. Using MRI data
available online [22] we were able to create and validate a fully comprehensive FSI
head/brain model [23–28]. Figure 2 shows an example of MV geometry created
by thresholding segmentation from DICOM images and produced using μCT
and subsequent smoothing. An example of head/brain geometry created from
DICOM images and produced using MRI and subsequent surface processing is
shown in Fig. 3.
Figure 2 and 3 demonstrate how small-scale details need to and can be pre-
served if the patient-specific geometry is to reflect and retain the target’s original
intricacy. To reiterate, in order to keep the simulations clinically relevant the
patient-specific geometry cannot be simplified. With simplifications it does not
represent the patient it was acquired from.
2.2 Computer Simulations
In the studies presented here, the fluid motion and boundary interaction calcu-
lations are solved with the IMPETUS Afea γSPH Solver R
(IMPETUS Afea AS,
Norway), while large deformations in the solid parts are taken care of by the
IMPETUS Afea Solver R
. The γSPH solver uses a next-generation SPH method
with increased accuracy. Both solvers use a commodity GPU for parallel pro-
cessing. All solid elements are fully integrated, thus removing the possibilities of
hourglass modes and element inversion, occurrences that plague classic under-
integrated elements. Both fluid and solid domains, as well as their interaction,
are solved with an explicit integration scheme.
The contact, i.e. particle to structure contact, is very simple, which is why γSPH
is ideal for these complex applications. It can easily account for movement in any
direction, unlike finite element fluid solvers which involve more complicated con-
tact and usually require re-meshing of the fluid domain during the simulation. The
ability of IMPETUS to achieve a very high resolution in terms of particle density
results in a very accurate particle to structure contact, especially in regards to a
structure as detailed and complex as the brain. The other critical part of the simu-
lation is the structural model. The IMPETUS Aset R
Element Technology provides
high order tetrahedron elements that are accurate for nonlinear dynamic response.
This allows the automeshing of complicated structures, such as those found in
biomedical applications. The accuracy of these elements has been demonstrated
in many commercial applications when compared with hexahedron elements. In
addition, they are also very accurate in bending and plasticity.
All simulations shown are solved on a standard workstation. Parallel acceler-
ation was achieved with a Tesla K40 GPU with 12 GB of Graphic DDR memory
and 2880 CUDA Cores. To confirm that convergence was reached, h-refinement
of the finite element mesh is performed, and the solution is found to be equiv-
alent. Similarly, a smaller number of fluid particles are used to obtain results
within 5% of the values obtained with the higher number. This confirmed that
the results converged. Our prior publication describes the SPH equations in
greater detail [9]. To reiterate, the SPH method is chosen for this study because
traditional FSI techniques can be computationally expensive and challenging
regarding their parallelization [15]. In order to use traditional FSI techniques,
geometrical simplifications would be needed, thus necessitating the sacrifice of
anatomical accuracy. Moreover, in recent years the SPH has been increasingly
used in biomedical applications [29].
3 Results
Following the two examples shown above, i.e. MV and brain geometries, both
scenarios are similarly discussed in the results section. MV closure validation
is shown and subsequently the blood dynamics of MV closure are described.
Additionally, an example of traumatic brain injury is simulated and shown.
3.1 Mitral Valve Closure
The results of the FSI simulations using the MV geometry and its material proper-
ties have been validated against experimental data in two ways. Firstly, the direc-
tion and magnitudes of papillary muscle forces were compared with experimental
measurements [11] and, secondly, the coaptation line between the anterior and pos-
terior leaflets at closure has been compared with the μCT images (Fig. 4) [10].
y z
(a) µCT (b) FSI
µCT FSI
Fig. 4. Closed leaflets reconstructed from µCT images compared to the results of FSI
simulations. The curves represent the coaptation line where the posterior and anterior
leaflets are in contact [10].
Since the FSI analysis can provide additional fluid-related results, it is possible
to observe the movement of mitral valve leaflets in relation to the cardiac cycle.
The Fig. 5 shows the regurgitant volume measured as the mass of the fluid particles
crossing the area at the level of the MV annulus [9]. No regurgitation is observed
from the point when both the leaflets come in contact together, i.e. T = 0.75·Tsys ,
whereas the highest level of regurgitation is observed at time point T = 0.3·Tsys .
The closure of the MV leaflets is initiated at around T = 0.1·Tsys . Tracking the fluid
particles up to this time point allows us to observe the mechanism that initiates the
closure, i.e. the occurrence of the eddies demonstrated by Henderson and Johnson
in 1912 [30].
0.08
z
0.06 x y
Mass [g]
0.04
0.02
0.00
0.00 0 .2 5 0 .5 0 0 . 75 1 . 00
Time/Tsys
Fig. 5. Regurgitant volume measured as the mass of the fluid particles crossing the
area at the level of the MV annulus [9].
3.2 Fluid Dynamics of Mitral Valve Closure

The Fig. 6 shows the trajectory of the fluid particles, and their evolution in
time from the beginning of the systole to T = 0.1·Tsys , originating at the plane
close to the annulus, denoted by the red dotted line. The black dotted line in
Fig. 6(f) shows downward trajectory. Four pressure waves, behind each leaflet,
develop quickly at the beginning of the cycle, before T = 0.020·Tsys , and provide
the initial impulse to the leaflets causing their partial closure. This is directly
followed by ventricular systole with the immediate rise of the intra-ventricular
pressure, starting at T = 0.080·Tsys .
z
(a) T = 0.001·Tsys (b) T = 0.020·Tsys
y x
(c) T = 0.040·Tsys x y (d) T = 0.060·Tsys
(e) T = 0.080·Tsys (f) T = 0.100·Tsys
Fig. 6. Fluid particles traced in time originating at plane close to the annulus (red
dotted line).
3.3 Traumatic Brain Injuries
Structurally, brain geometry is even more complex than that of the MV. A mul-
titude of possible traumatic scenarios can be simulated. One such scenario is
abusive head trauma (AHT), which includes the phenomenon commonly known
as Shaken Baby Syndrome. AHT is the leading cause of fatal brain injuries in
children younger than 2 years old [31]. Children who are victims of AHT can
suffer irreversible neurological damage, resulting in development delay and dis-
ability. Therefore it is imperative that better modalities are created to both
study its effects and predict patient outcomes. In this model we have replicated
the CSF’s cushioning effect for multiple cycles [27]. In the first shake, CSF trav-
eled to the sites of hyperextension and hyperflexion, providing the anticipated
cushioning effect. However, during hyperflexion on the second shake, the fluid
did not have enough time to reach the affected areas. In other words, following
the first shake, the CSF was unable to prevent the brain from colliding with
the skull, suggesting that the fluid offers no protection at repeated frequencies
(Fig. 7).
Occipital view Frontal view

1st Hyperflexion
(a) (d)
Hyperextension
(b) (e)
2nd Hyperflexion
(c) (f )
Fig. 7. Shaken baby syndrome principal stress (Max - red: 3 MPa, Min - blue: 0 MPa)
shown at the peaks of the three phases, i.e. 1st hyperflexion, hyperextension and 2nd
hyperflexion; occipital and frontal views of the right hemisphere [27].
4 Conclusion
The above examples and discussion emphasize the importance of preserving the
geometry of anatomy for the patient-specific organ being studied. For exam-
ple, the study of fluid dynamics of MV closure is incomplete if simplified MV
geometry is used. This is clear when observing the reaction of fluid particles
to pressure in relation to MV closure. The way fluid particles react in order to
cause MV closure will change with different MV geometries. When a geometry
that does not represent the MV in its entirety is used, the fluid particles form
different trajectories. Naturally, using a simplified MV geometry will yield differ-
ent fluid particle trajectories than when using a comprehensive patient-specific
MV geometry. Hence, it can be argued that the results of studies that do not
use comprehensive patient-specific geometries cannot be conclusive enough to
be considered truly representative of the processes intended to be studied.
The brain is the most complex organ in the human body. Because of this,
computational models of the human brain are inherently challenging. As most
computational models available in the literature are not based on an FSI anal-
ysis, they do not simulate the interaction between the CSF and cerebral cortex.
Those models treat the CSF as if it was solid. However, as seen in our results, the
fluid particles do not remain confined in a stagnant state in the space between
the skull and brain. The AHT results displayed above show that during the
first shake there are fluid particles between the skull and brain (best visible in
Fig. 7(a)) providing a cushioning effect to protect the brain. However, during the
second shake (2nd hyperflexion), no fluid particles can be found in the occipital
region between the brain and skull (Fig. 7(c)), thus resulting in direct contact
between the skull and brain. If the CSF is modeled using solid elements, the
model would fail to correctly yield such a basic yet crucial conclusion. Even if in
models where FSI algorithms are used, the brain geometry is simplified in order
to make the calculations less computationally expensive and/or to avoid conver-
gence issues. However it should be emphasized that with simplified geometries
the fluid particle trajectories are different and therefore not representative.
5 Discussion
The generally accepted concept regarding the movement of the MV leaflets is
that when the left atrium contracts it forces a small quantity of blood into the
relaxed left ventricle. This raises the intra-ventricular pressure by a very small
value but the change is large enough to form eddies behind the leaflets, causing
their approximation or partial closure. This is then followed by ventricular systole
and an immediate rise in intra-ventricular pressure. When the intra-ventricular
pressure exceeds the intra-atrial pressure, complete closure of the valve occurs
and regurgitation is prevented [32].
At the beginning of the twentieth century, Henderson and Johnson demon-
strated experimentally the importance of the “breaking of the jet” phenomenon
at the end of atrial systole, as well as the occurrence of eddies, or vortex forma-
tion, behind the atrioventricular valves, to initiate of mitral valve closure [30].
They show that normal atrial activity can initiate the closure of the atrioventric-
ular valves before the onset of ventricular systole [30,32]. Early work on mitral
valve action indicated a relatively wide range of movement for the leaflets dur-
ing the cardiac cycle, including with a pre-systolic flick and bulging back into
the atrium during ventricular systole [32]. Now, a hundred years later, we too
have observed the occurrence of the eddies behind the mitral valve leaflets [30]
and the pre-systolic flick [32] in our FSI simulations as well. Other groups have
already confirmed the occurrence of the eddies computationally long before us
[33,34]. However, they used simplified geometries. The mitral valve is consid-
ered to have two primary leaflets: the anterior and the posterior. Located in the
posterior part of the aortic root, the anterior leaflet has a semicircular shape
and is both larger and thicker than the posterior leaflet [35]. It consists of two
zones: the rough zone and the clear zone. During systole, the position of the
rough zone is adjacent to the posterior leaflet [36,37]. The posterior leaflet, on
the other hand, is crescentic with a long circumferential base. Like the anterior
leaflet, it can be divided into lateral, central, and medial scallops (referred to
as A1, A2, and A3, for the anterior leaflet, and P1, P2, and P3 for the poste-
rior leaflet) [38]. Additional leaflet tissue, known as commissural tissue, can be
found at the anterolateral and posteromedial commissures [38]. Previous stud-
ies generally confirm the occurrence of the two largest eddies behind the two
largest leaflets. In our studies, due to the use of comprehensive patient-specific
geometries, we have observed the occurrence of an additional two smaller eddies
behind the commissural leaflet tissue as well.
AHT is defined by the Centers for Disease Control (CDC) as “an injury to
the skull or intracranial contents of an infant or young child (under 5 years of
age) due to inflicted blunt impact and/or violent shaking” [31]. The incidence
of AHT occurring in the first year of life is estimated to be approximately 35
cases per 100,000 [39]. From 1999–2014, AHT resulted in approximately 2,250
deaths amongst children under 5 years old in the United States [40]. AHT is
a serious condition with significant morbidity and mortality. 65% of victims
have significant neurological disabilities, and 5% to 35% of infants die from their
injuries [39]. The majority of survivors suffer permanent cognitive and neurologic
impairment [39]. However, the long-term effects of AHT are often difficult to
diagnose and predict. Computational simulations can help physicians visualize
the true impact of AHT which an then assist them in formulating an accurate
prognosis. However, existing simulations are insufficient, as they portray the fluid
as an elastic solid and fail to replicate the intricate brain anatomy and how it
interacts with CSF. In our previous study, we address these deficiencies, using
a more precise simulation that reveals that the protection of CSF may last only
for a single shake [27].
We do not wish to claim that this SPH approach is better suited for modeling
the CSF than the more commonly used solid elements found in other models.
However, there may be cases where it might be necessary to study the behavior
of the fluid in a model using an actual fluid domain. For example, when studying
the effect of CSF drainage via ventriculoperitoneal shunt as a form of treatment
for hydrocephalus [26], models that utilize solid elements to study the behavior
of CSF would not be useful. However, in other more straightforward scenarios,
such as traumatic brain injury where a single blow to the head is studied, the
use of solid elements is justified when properly validated. It is certainly less
computationally expensive than using traditional FSI techniques in order to
represent the CSF using a fluid domain. Though, compared to the methods
used in this study, the use of solid elements to model the CSF does not provide
significant advantage in terms of computational cost.
Funding
This study was supported by a grant from the National Heart Lung and Blood
Institute (R01-HL092926) and a donation from New York Thoroughbred Horse-
men’s Association. No benefits in any form have been or will be received from a
commercial party related directly or indirectly to the subject of this manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
Data Availability
Data are available upon reasonable request.
Ethical Approval
This article does not contain any studies with human participants or animals
performed by any of the authors.
References
1. Bothwell, S.W., Janigro, D., Patabendige, A.: Cerebrospinal fluid dynamics and
intracranial pressure elevation in neurological diseases. Fluids Barriers CNS 16(1),
9 (2019). https://doi.org/10.1186/s12987-019-0129-6
2. Rengachary, S.S., Ellenbogen, R.G.: Principles of Neurosurgery. Elsevier Mosby,
Edinburgh (2012). https://doi.org/10.1016/C2014-0-02313-1
3. Linninger, A.A., Tangen, K., Hsu, C.Y., Frim, D.: Cerebrospinal fluid mechanics
and its coupling to cerebrovascular dynamics. Annu. Rev. Fluid Mech. 48, 219–257
(2016). https://doi.org/10.1146/annurev-fluid-122414-034321
4. Stewart, S.F.C., et al.: Results of FDA’s first interlaboratory computational study
of a nozzle with a sudden contraction and conical diffuser. Cardiovasc. Eng. Tech-
nol. 4, 374–391 (2013). https://doi.org/10.1007/s13239-013-0166-2
5. Toma, M.: Computational fluid dynamics simulations using FDA’s idealized med-
ical device demonstrating the importance of model validation. Biomed. Res. Rev.
1(1), 1–3 (2018). https://doi.org/10.31021/brr.20181104
6. Singh-Gryzbon, S., Sadri, V., Toma, M., Pierce, E.L., Wei, Z.A., Yoganathan, A.P.:
Development of a computational method for simulating tricuspid valve dynamics.
Ann. Biomed. Eng. 47, 1422–1434 (2019). https://doi.org/10.1007/s10439-019-
02243-y
7. Bloodworth, C.H., et al.: Ex Vivo methods for informing and validating compu-
tational models of the mitral valve. Ann. Biomed. Eng. 45(2), 496–507 (2017).
https://doi.org/10.1007/s10439-016-1734-z
8. Toma, M., et al.: Fluid-structure interaction analysis of ruptured mitral chordae

tendineae. Ann. Biomed. Eng. 45(3), 619–631 (2017). https://doi.org/10.1007/
s10439-016-1727-y
9. Toma, M., Einstein, D.R., Bloodworth, C.H., Cochran, R.P., Yoganathan, A.P.,
Kunzelman, K.S.: Fluid-structure interaction and structural analyses using a com-
prehensive mitral valve model with 3D chordal structure. Int. J. Numer. Meth.
Biomed. Eng. 33(4), e2815 (2017). https://doi.org/10.1002/cnm.2815
10. Toma, M., et al.: High resolution subject-specific mitral valve imaging and model-
ing: experimental and computational methods. J. Biomech. Model. Mechanobiol.
15(6), 1619–1630 (2016). https://doi.org/10.1007/s10237-016-0786-1
11. Toma, M., Jensen, M.O., Einstein, D.R., Yoganathan, A.P., Cochran, R.P., Kun-
zelman, K.S.: Fluid-structure interaction analysis of papillary muscle forces using
a comprehensive mitral valve model with 3D chordal structure. Ann. Biomed. Eng.
44(4), 942–953 (2016). https://doi.org/10.1007/s10439-015-1385-5
12. Toma, M., et al.: Fluid-structure interaction analysis of subject-specific mitral
valve regurgitation treatment with an intra-valvular spacer. Prosthesis 2(2), 65–75
(2020). https://doi.org/10.3390/prosthesis2020007
13. Toma, M., et al.: Effect of edge-to-edge mitral valve repair on chordal strain:
fluid-structure interaction simulations. Biology 9(7), 173 (2020). https://doi.org/
10.3390/biology9070173
14. Luraghi, G., et al.: Does clinical data quality affect fluid-structure interaction sim-
ulations of patient-specific stenotic aortic valve models? J. Biomech. 94, 202–210
(2019). https://doi.org/10.1016/j.jbiomech.2019.07.047
15. Toma, M., Oshima, M., Takagi, S.: Decomposition and parallelization of strongly
coupled fluid-structure interaction linear subsystems based on the Q1/P0
discretization. Comput. Struct. 173, 84–94 (2016). https://doi.org/10.1016/j.
compstruc.2016.06.001
16. Zucker, S.W.: Region growing: childhood and adolescence. Comput. Graph. Image
Process. 5(3), 382–399 (1976). https://doi.org/10.1016/S0146-664X(76)80014-7
17. Zhu, S.C., Yuille, A.: Region competition: unifying snakes, region growing, and
Bayes/MDL for multiband image segmentation. IEEE Trans. Pattern Anal. Mach.
Intell. 18(9), 884–900 (1996). https://doi.org/10.1109/34.537343
18. Balter, S., Ergun, D., Tschnoll, E., Buchmann, F., Verhoeven, L.: Digital subtrac-
tion angiography: fundamental noise characteristics. Radiology 152(1), 195–198
(1984). https://doi.org/10.1148/radiology.152.1.6374758
19. Adams, R., Bischof, L.: Seeded region growing. IEEE Trans. Pattern Anal. Mach.
Intell. 16(6), 641–647 (1994). https://doi.org/10.1109/34.295913
20. Lakhani, P., Gray, D.L., Prett, C.R., Nagy, P., Shih, G.: Hello world deep learning
in medical imaging. J. Digit. Imaging 31(3), 283–289 (2018). https://doi.org/10.
1007/s10278-018-0079-6
21. Prevedello, L.M., et al.: Challenges related to artificial intelligence research in
medical imaging and the importance of image analysis competitions. Radiol. Artif.
Intell. 1(1), e180031 (2019). https://doi.org/10.1148/ryai.2019180031
22. Warner, A., Tate, J., Burton, B., Johnson, C.R.: A high-resolution head and brain
computer model for forward and inverse EEG simulation, bioRxiv (2019). https://
doi.org/10.1101/552190
23. Toma, M., Nguyen, P.D.H.: Fluid-structure interaction analysis of cerebrospinal
fluid with a comprehensive head model subject to a rapid acceleration and decel-
eration. Brain Inj. 32(12), 1576–1584 (2018). https://doi.org/10.1080/02699052.
2018.1502470
24. Toma, M.: Predicting concussion symptoms using computer simulations. Adv.
Intell. Syst. Comput. 880, 557–568 (2019). https://doi.org/10.1007/978-3-030-
02686-8 42
25. Toma, M., Nguyen, P.D.H.: Coup-contrecoup brain injury: fluid-structure interac-
tion simulations. Int. J. Crashworthiness 25(2), 175–182 (2020). https://doi.org/
10.1080/13588265.2018.1550910
26. Toma, M., Kuo, S.-H.: Computational Assessment of Risk of Subdural Hematoma
Associated with Ventriculoperitoneal Shunt Placement, Computer Methods,
Imaging and Visualization in Biomechanics and Biomedical Engineering, vol.
36. Springer Nature Switzerland AG (2020). https://doi.org/10.1007/978-3-030-
43195-2 4
27. Toma, M., Dehesa-Baeza, A., Chan-Akeley, R., Nguyen, P.D.H., Zwibel, H.: Cere-
brospinal fluid interaction with cerebral cortex during pediatric abusive head
trauma. J. Pediatr. Neurol. (2020). https://doi.org/10.1055/s-0040-1708495
28. Toma, M., Chan-Akeley, R., Lipari, C., Kuo, S.-H.: Mechanism of coup and con-
trecoup injuries induced by a knock-out punch. J. Math. Comput. Appl. 25(2)
(2020). https://doi.org/10.3390/mca25020022
29. Toma, M.: The emerging use of SPH in biomedical applications. Signif. Bioeng.
Biosci. 1(1), SBB.000502 (2017). https://doi.org/10.31031/SBB.2017.01.000502
30. Henderson, Y., Johnson, F.E.: Two modes of closure of the heart valves. Heart
4(69) (1912)
31. Parks, S.E., Annest, J.L., Hill, K.A., Karch, D.L.: Pediatric Abusive Head Trauma:
Recommended Definitions for Public Health Surveillance and Research. Centers for
Disease Control and Prevention, Atlanta (GA) (2012)
32. Dean Jr., A.L.: The movement of mitral valve cusps in relation to the cardiac cycle.
Amer. J. Physiol. 40, 206–217 (1916). https://doi.org/10.1152/ajplegacy.1916.40.
2.206
33. Peskin, C.S.: Numerical analysis of blood flow in the heart. J. Comput. Phys.
25(3), 220–252 (1977). https://doi.org/10.1016/0021-9991(77)90100-0
34. Lau, K., Diaz, V., Scambler, P., Burriesci, G.: Mitral valve dynamics in structural
and fluid-structure interaction models. Med. Eng. Phys. 32(9), 1057–1064 (2010).
https://doi.org/10.1016/j.medengphy.2010.07.008
35. Sanchez Vaca, F., Bordoni, B.: Anatomy, thorax, mitral valve. In: StatPearls. Stat-
Pearls Publishing, Treasure Island (FL) (2020). https://www.ncbi.nlm.nih.gov/
books/NBK549884/. Accessed 21 Oct 2019
36. Schubert, S.A., Mehaffey, J.H., Charles, E.J., Kron, I.L.: Mitral valve repair: the
French correction versus the American correction. Surg. Clin. North Am. 97(4),
867–888 (2017). https://doi.org/10.1016/j.suc.2017.03.009
37. Carpentier, A.F., et al.: The “physio-ring”: an advanced concept in mitral valve
annuloplasty. Ann. Thorac. Surg. 60(5), 1177–1185(discussion 1185–1186) (1995).
https://doi.org/10.1016/0003-4975(95)00753-8
38. Dal-Bianco, J.P., Levine, R.A.: Anatomy of the mitral valve apparatus: role of 2D
and 3D echocardiography. Cardiol. Clin. 31(2), 151–64 (2013). https://doi.org/10.
1016/j.ccl.2013.03.001
39. Joyce T., Huecker M.R.: Pediatric abusive head trauma (shaken baby syndrome).
In: StatPearls. StatPearls Publishing, Treasure Island (FL) (2020). https://www.
ncbi.nlm.nih.gov/books/NBK499836/. Accessed 11 Feb 2019
40. Spies E.L., Klevens J.: Fatal abusive head trauma among children aged under 5
Years – United States, 1999–2014. Morb. Mortal. Wkly. Rep. (MMWR) 65, 505–
509 (2016). https://doi.org/10.15585/mmwr.mm6520a1
Usability Evaluation of Low-Cost Smart Pill
Dispenser by Health Care Practitioners
Gift Arnold Mugisha1 , Christine Muhumuza2 , Faith-Michael Uzoka3(B) ,

Chinyere Nwafor-Okoli4 , Joletta Nabunje5 , Melody Arindagye6 ,
and Justine N. Bukenya2
1 Shenyang Aerospace University, Shenyang, China
2 School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
3 Department of Math and Computing, Mount Royal University, Calgary, Canada
fuzoka@mtroyal.ca
4 Canadian Institute for Innovation and Development, Calgary, Canada
5 School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
6 Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
Abstract. Several health complications arise from non-adherence to medica-

tions. Most existing tools lack the ability to facilitate communication between the
patient and their healthcare worker, especially in critical situations. We developed
a smart pill dispenser/medical assistant to help address some adherence changes.
This innovation is equipped with intelligent remote communication capabilities
between the patient and a medical professional, and can be used in many settings
such as hospital and home facilities to assist in dispensing of medications. The pur-
pose of this study was to explore the user perception and attitudes towards the smart
pill dispenser in addressing drug dispensing challenges in hospitals in Kampala,
Uganda. This was a pilot study that employed qualitative data collection methods
among health providers in four hospitals, involving 17 key informant interviews.
The findings revealed that the prototype was easy to use and very acceptable to
many health workers. In particular, the respondents rated the prototype highly
based on supporting features such camera, video enabled two-way communica-
tion and water dispenser. However, some modifications were proposed such as
decreasing the size, and increasing the number of dispensing channels. This study
provides the impetus for an agile improvement strategy that includes prototype
refinement and further acceptance study among users in more health facilities.
Keywords: Automated healthcare assistant · Pill dispenser
1 Introduction
Medication administration is a crucial aspect of patient care, whether the medication is
administered by self, or by health practitioners. Procedural and clinical errors could be
dangerous to the patient, affecting overall treatment process, recovery, immune system,
and possibly fatal effects [1–3]. Several health complications arise from non-adherence
to medications, which is more prevalent among patients with cognitive impairments

https://doi.org/10.1007/978-3-030-63092-8_2
18 G. A. Mugisha et al.
and those from low-income, less educated families who may not afford existing med-
ication adherence tools. In addition, most existing tools lack the ability to facilitate
communication between the patient and their doctor, especially in critical situations that
are time-bound such as emergencies. Medication administration is a crucial aspect of
patient care, whether the medication is administered by self, or by health practition-
ers. A number of studies have pointed to the adverse consequences of procedural and
clinical errors in medication administration, which could include hospital readmission
[4] and antimicrobial resistance [5] among others. Poor medication adherence could be
dangerous to the patient, affecting overall treatment process, recovery, immune system,
and possibly fatal effects [1, 6]. In addition, it has the socio-economic consequence
of increasing health costs and making higher demands on health emergency response
systems [7]. This risk of improper medication adherence becomes more exacerbated in
self-administered medications, especially in patients with some known distractive dis-
orders, such as Dementia [8]. Medication adherence is critical for patient recovery and
overall reduction in treatment costs. Disease-related medical costs and hospitalization
rates could be significantly reduced with proper medication adherence [9].
The challenge of medication adherence cuts across various demographic strata, but
tends to be more prevalent in the following groups: i) cognitively impaired [8]; ii) younger
people [10, 11]; and iii) people in the lower socio-economic stratum [12]. [13] found a
concave relationship between age and medication adherence, with adherence being the
lowest with the very young and the very old. They also found cost elements, such as
copayments, to have negative impact on medication adherence.
Mechanical and automatic pill dispensers have been found to improve medication
protocols and adherence. For example, [14] reported that automatic pill dispensers could
reduce medication error by 64.7%. A number of researchers (e.g. [15] believe that while
there is tremendous progress in designing interventions for medication adherence (espe-
cially pill dispensing systems), the level of adherence to medications is still not accept-
able, especially in low income among less educated individuals. The burden of medical
administration puts pressure on the thinly stretched medical workers in the low-income
countries. The World Health Organization recommends a density of about 2.28 health
workers per 1,000 people in order to make good progress towards Universal Health
coverage [16]. This is reflected in the Global Health Workforce Alliance, Health work-
force 2030 – towards a global strategy on human resources [16]. This translates into
about 23 health workers to serve 10,000 people. According to [16], in 2013, there were
average of 33 nurses/midwives and 5 pharmaceuticals personal per 10,000 population.
Africa had a precariously low number of (12 nurses/midwives and one pharmaceutical
personnel per 10,000 populations). This underscores the need to have technology to
assist the few available health workers when delivering services [17]. Emphasized the
need for pharmaceutical care practices during pandemics (e.g. Covid-19) to reduce the
burden on already weakened health systems in low-to-middle income countries. The pill
dispenser could help in pharmaceutical care and also assist in the reduction of infec-
tions during epidemics/pandemics. It is important to understand the challenges faced by
individuals in developing countries when taking prescribed drug regimes, which include
poor power supply, low-to- moderate education on medication sensitivity, and inability
to afford expensive medical care services. These challenges underscore the need for
Usability Evaluation of Low-Cost Smart Pill Dispenser by Health Care Practitioners 19
low cost, efficient and effective medical technologies (including medication dispensing
system) that will suit the needs and economic abilities of low-income countries.
There is need to develop usable and affordable medication intervention systems
that would possess enhanced capabilities to facilitate patient-physician interaction. We
developed an initial prototype of an automatic pill dispensing system that would address
these needs [18]. Our current system architecture consists of the following functional
components: audio module (programmed to send person-specific reminders); messag-
ing module (uses GSM capabilities for bidirectional communication); video module
(programmed to use a smart 360-degree camera for video communication); emergency
module (to assist in distress response); and dispensing module (for dispensing pills and
water. Our initial design was meant to dispense two different sets of pills from two
independent chambers.
This study aimed at evaluating the acceptability and usability of the prototype by
medical practitioners such as physicians, nurses, and pharmacists. The focus of our
research was to explore the user perception and attitudes towards the newly developed
smart pill dispenser in addressing drug adherence challenges. This study was conducted
in Kampala, Uganda, which is a developing country context. In Sect. 2, we show our
pill dispenser and its features, while Sect. 3 presents the study methodology. The results
are presented in Sect. 4, while discussion of results is in Sect. 5. Some conclusions are
drawn in Sect. 6.
2 The Pill Dispenser

The architecture of the pill dispensing system is shown in Fig. 1. It is based on the
following design principles:
a. Simplicity, which enhances upgradability and maintainability.

b. Affordability, which is a crucial characteristic of any system that has the potential
of high utility in low-income environments.
c. Flexibility, a characteristic that enables the system to adapt to new user requirements
through the addition of new functionalities and system characteristics. In addition,
this system is powered by rechargeable batteries.
d. Scalability, which extends the flexibility characteristic to include an ability to accom-
modate multiple users in future extensions of the current design. Our initial design
was meant to dispense two different sets of pills from two independent chambers.
Our initial system functioned effectively with crude materials, with the ability to
provide user notification, and dispense pills at the appropriate time, in accordance with
programming instructions. The implementation of our current design takes advantage of
the ubiquity of micro-processor systems and utilizes antimicrobial plastic components
for the pill dispensing unit, to make the system smarter and more hygienic. Sustainable
medical practices are growing and re-usable plastics components help keep hazardous
materials out of landfills, thereby protecting the environment. Antibacterial plastics also
have the potential of keeping medical devices and instruments in service longer, and
reduce the possibility of product failures attributable to corrosion. In addition, plastics
Medicine
window
speaker
LCD
display
bu ons
speaker
trough
pathway
Water
reservoir
Stand
Fig. 1. a. System Blueprint, b. Functional System
are affordable, flexible, and come in different sizes, colours and shapes, especially with
the advent of 3-D printing technology [19].
Our current design includes a water reservoir, which is used in lieu of the water supply
from the water mains. This helps improve portability. In addition, the water supply has
a two-stage control. First, by automatic program control, then followed by pressing a
button upon discretion of the user. This gives the user an ability to control the quantity
of water supply. Other features include the LCD display and multiple pill holders with a
single pathway. The LCD display is programmatically connected to most components to
provide status indicator for each component. Our system has some smart abilities through
the following modules: i) Audio module, which relays information from the memory
card, in the language of the patient, applying varying emotional structures that target
different age groups, to reduce the level of anxiety associated with taking medicine,
especially in children; ii) Messaging module, is equipped with GSM capabilities to
provide notifications to patients as well as allowing bi-directional messaging between
the patient and the medical practitioner; iii) Emergency module, which is activated by the
press of a button, and sends a pre-recorded distress message to the medical practitioner
in the event of an emergency iv) Visual module, consisting of a camera setup with audio
talk back that enables the doctor to directly talk to the patient. The doctor receives live
videos from the patient, which helps in determining the adherence behaviour of the
patient, especially in a hospital setting. With on-board motion sensors, the device can
send an alarm to the medical practitioner in the event of a fall or some type of emergency.
In addition to the camera, the system has a colour coded light indicator for the auditory
impaired.
Figure 1(b) shows the first functional prototype of the system. The wooden case
provides us with a reliable sandbox for the initial concept development, though we
recognize weight challenges associated with wood, and are working on finding light
weight affordable alternatives.
3 Research Methodology
3.1 Study Design and Population
This was designed as a qualitative study to inform the design of a follow-on quantitative
survey that will quantify the attributes identified in this formative study and dig into
the design of the innovation using existing usability models. This study employed key
informant interviews (KIIs) to gain opinions from experts involved in the dispensing
of drugs. Key informant interviews are “qualitative, in-depth interviews of 15 to 35
people selected for their first-hand knowledge about a topic of interest. The interviews
are loosely structured, relying on a list of issues to be discussed” [20]. The study was
conducted in four hospitals including two public and two private, not-for profit referral
hospitals in Kampala city in Uganda. These health facilities included Naguru general
hospital, Mulago Hospital-cancer institute, Kibuli and Mengo hospitals. The hospitals
provide care for patients with chronic conditions such as HIV, cancer, diabetes mellitus,
and hypertension that require long term treatment. In this study, health workers who dis-
pense drugs from both in- and out-patient departments were interviewed. These included
pharmacists, dispensers and any other cadre who dispense drugs.
3.2 Data Collection and Analysis
Key informant interviews were conducted with relevant health workers at the four health
facilities in Kampala city to identify key issues related to the smart dispenser innova-
tion. The initial study design proposed a purposeful sampling to conduct six KIIs per
facility. The targeted key informants included at least two trained health workers in the
following health professionals: pharmacist, nurse, and physician. The respondents were
interviewed using an interview guide that captured data on dispensing experiences and
challenges faced by health workers, non compliance, consequences of not adhering to
prescribed medicines, strategies to improve drug dispensing and administration as well
opinions about usability and feasibility of the dispenser when used in different settings.
However, we did not obtain the expected number of participants from all the health
facilities, as staff were busy and not available for the interviews during the study period.
On a positive note, we obtained a good professional representation in the field of nursing,
pharmacy and clinical medicine. Table 1 shows the locations and designations of the
health practitioners that participated in our study.
Table 1. Participants’ professional demographics.
Medical Facility Number Profession Number

Kibuli Hospital 5 Nursing 8
Mengo Hospital 6 Pharmacy 4
Naguru Hospital 5 Physician 5
Mulago Hospital Cancer institute 1
Total 17 17
The prototype of the pill dispenser was demonstrated to each participant prior to
the interview. The participant was also granted an opportunity to independently utilize
the pill dispenser, to personally explore the features and ask relevant questions on the
features and functionalities of the prototype. The KII interviews followed each prototype
demonstration. The prototype demonstration and KII interview took place on the same
day for each participant. A maximum of two participants were interviewed each day.
The semi-structured interview questions focused mainly on the participants’ understand-
ing of patient’s medication adherence behaviours and their assessment of usability and
feasibility of the smart pill dispenser. The interviews were conducted in English, and
covered questions on challenges during dispensing drugs, effects of non-compliances
with dosage instructions, questions about whether the participants (or the health facil-
ity) had measures to ensure medication adherence, and questions about attitudes and
medication preferences. All interviews were digitally recorded with consent of health
workers, then transcribed verbatim by two trained research assistants. The transcripts
were read several times and codes were summarised manually in excel per themes that
were determined a priori as per the semi- structured interview guide.
3.3 Quality Control

Measures were put in place to ensure good quality of data and increase the reliability of
the study results. Research assistants were deliberately chosen, focusing on individuals
with working knowledge of qualitative research methods. In addition, they underwent
a half-day training on the testing of the pill dispenser and the procedure for conducting
post evaluation interviews. The interview questions were also pre tested and adjusted
prior to data collection.
3.4 Ethical Considerations
Ethical clearances were obtained from the Makerere University School of Social Sci-
ences Research and Ethics Committee MAKSS REC 03.19.277. Written permission to
carry out the research was also obtained from the management of the respective health
facilities. The objectives, benefits and risks of the study were explained to the prospec-
tive study participants and informed consent sought before interviews. Confidentiality
was observed when collecting and handling data and anonymous identifiers were used
in the transcribed data.
4 Results
The essence of the pill dispenser is to make medication administration more effective,
thus reducing the risks associated with poor adherence, both in the hospital and at home.
We examined the challenges faced by the medical practitioners in medication adminis-
tration to determine the need or otherwise, for an aid to make medication administration
more effective. Many (43%) of the participants indicated that time was a major con-
straint as they have so many patients to attend to, so a system that would assist them in
reducing the time spent per patient would be desirable. In addition, 25% indicated that
contamination of dispensers was a major issue due to multiple use of one dispenser. The
solution to this could be sterilization or the use of some disposable materials.
The following comments buttress some of the challenges faced by the healthcare
providers as summarized in Table 2:
Table 2. The Logistic challenges when dispensing medications.
Challenge Number of respondents

Time constraints – so many patients to attend to 7
Compliance issues 2
Contamination from use of same dispenser for multiple drugs 4
Drugs not available in the wards 2
None 1
“wrong calculation leading to wrong dose or even wrong drug. This could be as a
result of work overload” (Health worker, Kibuli Hospital)
“use one tray to count different types of drugs at the same time” (Health worker,
Nagulu Hospital)
“contamination of drugs from use of contaminated tools; mixture of similar drugs
could occur if drugs look alike, (Health worker, Mengo Hospital)
Patient’s medication adherence behavior was a major issue highlighted by the study
participants. Virtually all participants highlighted patient non-compliance as a major
behavioral challenge in medication administration. This non-compliance has adverse
effects on the individual and on the health system. The study participants identified
prolonged periods of recovery and resistance to drugs, which ultimately leads to higher
cost of treatment – as expressed below:
“non compliance, which will lead to prescription of more expensive drugs; wrong
prescription due to patients attitude makes doctors contribute indirectly to development
of drug resistance” (Health worker, Kibuli Hospital)
The study showed that the primary means of encouraging adherence is the use of
reminders; however, only about 35% of the study participants sent reminders to patients,
others did nothing to encourage adherence. A common theme that emanated from the
study is the focus of nurses on what is considered their primary function in medication
administration, which is:
“to create medication schedule which organizes drugs to be administered in the
morning, afternoon, etc. depending on the SIG (signature, or “let it be labeled.”) of the
prescription” (health worker from Naguru hospital)
The participants indicated that their patients preferred herbal alternatives due to high
costs of conventional drugs (Fig. 2).
9
8
7
6
5
4
3
2
1
0
Prefer herbal General apathy Concerned about Indifferent or good
alterna ves towards drugs costs of drugs a tude
Fig. 2. Respondent’s perception of patients’ general attitude to medication
“…tired of taking drugs, financial constraints, then herbal alternative medicine.”

(Health worker, Kibuli Hospital)
In prescribing drugs to patients, the physicians and other authorized personnel pro-
vide patients with the choice of whether to take pills or injections; in most cases, patients
(especially out-patient ones) prefer pills.
On the overall, the pill dispenser had a very positive review from the study par-
ticipants. Most of the study participants rated the pill dispenser very high in terms of
utility and features such as camera, two-way voice communication, and water dispensing
capability. However, major area of concern was the size of the dispenser, which needs
to be considerably reduced. In addition, respondents suggested increase in the number
of pills dispensed and issues that relate to its smart abilities. The suggested areas of
improvement are shown in Table 3 and in the quotes below:
Table 3. Respondent’s opinions on aspects of the pill dispenser that require improvement
Area of improvement Number of respondents

Reduce size 4
Increase number of prescriptions dispensed 3
Improve user interface (e.g. touch screen) 1
Use air tight dispensing boxes 1
Improve emergency alert sensors 1
Improve audio capabilities 1
Improve software ability 1
Create reminders for healthcare providers (nurses, etc.) 1
Include solar power to mitigate lack of electricity 1
Water dispensing should be from the mains 1
Create a syrup dispensing ability 1
Nothing to improve upon 3
“power to include solar due to lack of electricity in some areas”. (health worker from
Kibuli hospital)
“make it less bulky; make it a touch screen; Some drugs are hydroscopic and need
air tight containers so the storage chamber needs to be air tight. However, some jobs
cannot be replaced by a machine so nurses/attendants still needed. (Health worker from
Mengo hospital)
5 Discussion
In this paper we explored the challenges faced by the medical practitioners while admin-
istering medicine. The key challenges were time constraints, heavy workload, contami-
nation of same trays used for multiple drug dispensing and non-compliance issues with
patients. We also sought opinions from health workers regarding the usability of the
prototype. The respondents rated the prototype highly, especially with respect to the
camera, water dispenser, user friendliness and high utility.
Respondents also discussed risks associated with medication non-compliance. Poor
medication adherence has been attributed to a number of reasons such as forgetful-
ness, memory impairment, confusion, heath status, socio-economic status and literacy
[21]. Our study showed that the primary means of encouraging adherence is the use of
reminders but few study participants reported to have sent reminders to patients. A num-
ber of medical practitioners do not consider reminders and other medication adherence
efforts to be part of their responsibilities. This problem is compounded by the high cost
of phone communication to out-patients, especially in developing countries. Our study
also confirmed previous studies that forgetfulness and revealed that some patients do not
comply with medication instructions due to forgetfulness and being medication weary.
In addition, we found out that most patients value reminders as a means of overcoming
non-compliance. In view of this the automated dispenser we believe comes in handy to
address the challenge of sending prompt reminders.
Medication compliance is a major unsatisfied need, especially in developing coun-
tries. The World Health Organization’s [6] life expectancy report indicates that life
expectancy in Africa is growing at a fast pace (currently at 60), which implies that
the population of the aged (65 and above) will likely increase significantly in the very
near future. This increases the shift toward in-home and group home car, and opens
opportunities for medication adherence assistance devices, especially to the aged and
the cognitively impaired. The potential value derivable from automated pill dispensers,
especially in the developing world cannot be overemphasized. According to Future Mar-
ket Insights [22] the use of medication dispensers is expected to grow at a fast rate in
developing regions of the world by the year 2020. This growth will be fuelled by rapid
improvement in healthcare services, increase in awareness, and affordability of pill dis-
pensers. There are only very few companies in Africa that focus on the manufacture of
pill dispensing systems, and the penetration of automated pill dispensers is extremely
low.
The study further revealed that patients preferred herbal alternatives. This poses a
challenging dimension to the adherence question. If patients show apathy toward hospital
prescribed drugs and go for herbal alternatives instead, there might be risk of overdosage
and use of wrong medications, the risks of which are high and unpredictable. The use
of automated dispenser will assist in monitoring of taking of prescribed drugs and any
variance will be promptly noticed by health workers to counsel the patient accordingly.
The drug dispenser can be a remedy to some challenges associated with medication
administration However, this brings us to the question of whether the pill dispenser could
provide a cost-effective solution for medication administration in a manner that would
address patient forgetfulness, drug weariness, apathy and cost concerns. Obviously, the
cost element may only be controlled through pharmaceutical companies; however, the
smart capabilities of our pill dispenser provide the patient with reminders, and user-
friendly interface.
6 Conclusion
Our study revealed the need to find ways to re-engineer distribution of medication in
busy facility settings. One way this can be accomplished is through the use of a smart
pill dispenser that provides the health workers with reminders and other value-added
support that would reduce the anxiety and apathy toward medication adherence among
patients. Nurses and other support medical practitioners are in short supply in the devel-
oping countries. Taking on the responsibility sending patient reminders would add to
the workload of the nurses and limit the number of patients they could attend to. A
pill dispenser, equipped with automated reminder capabilities will increase the nurse’s
efficiency in medication administration and also improve patient’s adherence to medi-
cations, which will in turn reduce re-hospitalizations, drug resistance and other negative
effects of non-adherence.
Based on the findings from our study participants, we intend to: 1) further refine the
pill dispenser to make it more portable, while maintaining affordability and local content
- exploring the possibilities of utilizing stainless steel or wood/plastic composites that
are lighter and more durable; 2) utilizing the power of 3-D printing in producing some
components – taking advantage of flexibility and scalability of production; 3) partner-
ing with investors and industry to produce the first set of commercial grade dispensers
based on our refined design; 4) testing and conducting further acceptability studies on
the product among both health worker and patients within health facilities and home set-
ting; and 5) engaging in full scale commercial production. In refining the pill dispenser
to a number of factors would be considered, including but not limited to: 1). Clinical
level quality consideration: Most studies have focused on individual level factors that
could impact on medication adherence; however, [23] emphasized the need for payor,
pharmaceuticals and clinical level system level considerations. The use of smart pill
dispenser in medication administration could be considered at both the individual (in
private homes) and system levels (in hospitals and other medical facilities); 2). Consider-
ation for user physiological characteristics such as visual and auditory impairment, and
age-related characteristics [24]; 3) Monitoring: every medication management system
requires proper monitoring to ensure adherence and avoid complications resulting from
non-adherence. The Internet of Things (IoT) age makes it possible for monitoring capa-
bilities into healthcare systems [25]; building this capability into the smart pill dispenser
would greatly enhance usability of the system.
While it is possible to gain insight into patient medication adherence from the view-
points of experienced health workers who have been attending to patients in big hospitals,
it may not be a good representation of patient medication attitudes. We recommend addi-
tional patient consultation in the design stage of the follow-up prototype to ensure the
consideration of patient-desirable features.
References
1. Westbrook, J.I., Woods, A., Rob, M.I., Dunsmuir, W.T., Day, R.O.: Association of interrup-
tions with an increased risk and severity of medication administration errors. Arch. Internal
Med. 170(8), 683–690 (2010)
2. Ghaleb, M.A., Barber, N., Franklin, B.D., Wong, I.C.: The incidence and nature of prescribing
and medication administration errors in paediatric inpatients. Arch. Dis. Child. 95, 113–118
(2010). https://doi.org/10.1136/adc.2009.158485
3. Cousins, D.H., Gerrett, D., Warner, B.: A review of medication incidents reported to the
National Reporting and Learning System in England and Wales over 6 years (2005–2010).
British J. Clin. Pharmacol. 74(4), 597–604 (2012)
4. Roughead, E.E., Semple, S.J., Rosenfeld, E.: The extent of medication errors and adverse
drug reactions throughout the patient journey in acute care in Australia. Int. J. Evidence-Based
Healthcare 14(3), 113–122 (2016)
5. Theuretzbacher, U.: Global antibacterial resistance: the never-ending story (Review). J. Global
Antimicrobial Resistance, 1(2), 63–69 (2013)
6. World Health Organization. Antimicrobial resistance: global report on surveillance 2014.
http://www.who.int/drugresistance/documents/surveillancereport/en/. Accessed 18 Dec 2016
7. Huang, J., Li, S., Li, L., Wang, X., Yao, Z., Ye, X.: Alarming regional differences in prevalence
and antimicrobial susceptibility of group B streptococci in pregnant women: a systematic
review and meta-analysis. J. Global Antimicrobial Resist. 7, 169–177 (2016). https://doi.org/
10.1016/j.jgar.2016.08.010
8. Arlt, S., Lindner, R., Rösler, A., von Renteln-Kruse, W.: Adherence to medication in patients
with dementia. Drugs Aging 25(12), 1033–1047 (2008)
9. Sokol, M.C., McGuigan, K.A., Verbrugge, R.R., Epstein, R.S.: Impact of medication
adherence on hospitalization risk and healthcare cost. Med. Care 43(6), 521–530 (2005)
10. Krueger, K., Botermann, L., Schorr, S.G., Griese-Mammen, N., Laufs, U., Schulz, M.: Age-
related medication adherence in patients with chronic heart failure: a systematic literature
review. Int. J. Cardiol. 184, 728–735 (2005)
11. Anderson, G.J.M., Farr, P.W., Kelly, A.M.: Medicament Dispenser: US Patent No.
2005/0172964A1 (2015)
12. Jasti, S., Siega-Riz, A.M., Cogswell, M.E., Hartzema, A.G., Bentley, M.E.: Pill count adher-
ence to prenatal multivitamin/mineral supplement use among low-income women. J. Nutrition
135(5), 1093–1101 (2005)
13. Gast, A., Mathes, T.: Medication adherence influencing factors—an (updated) overview of
systematic reviews. Syst. Rev. 8(1), 112 (2019)
14. Fanning, L., Jones, N., Manias, E.: Impact of automated dispensing cabinets on medication
selection and preparation error rates in an emergency department: a prospective and direct
observational before-and-after study. J. Eval. Clin. Practice 22(2), 156–163 (2015)
15. Santiago, J.M.: The need for theory in addressing nonadherence to treatment. J. Clin.
Psychiatry 77(10), 1348–1349 (2016)
16. World Health Organization: Global Health Observatory Data: Life Expectancy (2015). http://
www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/. Accessed
25 Feb 2017
17. Kretchy, I.A., Asiedu-Danso, M., Kretchy, J.P.: Medication management and adherence during
the COVID-19 pandemic: Perspectives and experiences from LMICs. Research in Social and
Administrative Pharmacy (2020)
18. Mugisha, G.A., Uzoka, F-M., Nwafor-Okoli, C.E.: A framework for low cost automatic pill
dispensing unit for medication management. In: Cunningham, P., Cunningham, M. (eds.) Pro-
ceedings of the conference IST-Africa (2017). IIMC International Information Management
Corporation (2017). ISBN: 978-1-5386-3837-8
19. Primec: Six advantages plastic has over metals. http://www.primexfits.com/hvacventing/6-
advantages-plastic-has-over-metal/. Accessed 15 Dec 2016
20. USAID Center for Development Information and Evaluation (1996) Conducting Key Infor-
mant Interviews Performance Monitoring & Evaluation TIPS. Washington DC, USAID. http://
pdf.usaid.gov/pdf_docs/PNABS541.pdf
21. Harrison, E.: The cost of not taking our medicine: the complex causes and effects of low
medication adherence, the American J. Accountable Care, 6(4), e11–e13 (2003)
22. Future Market Insights, Medication Dispenser Market: Global Industry Analysis and Oppor-
tunity Assessment 2016–2026. http://www.futuremarketinsights.com/reports/medication-dis
penser-market. Accessed 4 March 2017
23. Dean, L.T., George, M., Lee, K.T., Ashing, K.: Why individual-level interventions are not
enough: Systems-level determinants of oral anticancer medication adherence. Cancer (2020).
https://doi.org/10.1002/cncr/32946
24. Sahlab, N., Sailer, C., Jazdi, N., Weyrich, M.: Designing an elderly-appropriate voice control
for a pill dispenser. Proc. Automat. Med. Eng. 1(1), 30 (2020)
25. Ananda Kumar, S., Mahesh, G.: IoT in smart healthcare system. In: Chakraborty, C., Baner-
jee, A., Kolekar, M.H., Garg, L., Chakraborty, B. (eds.) Internet of Things for Healthcare
Technologies. SBD, vol. 73, pp. 1–19. Springer, Singapore (2021). https://doi.org/10.1007/
978-981-15-4112-4_1
Dynamic Causality Knowledge Graph
Generation for Supporting the Chatbot
Healthcare System
Hong Qing Yu(B)
Institution for Research in Applicable Computing, School of Computer Science and Technology,
University of Bedfordshire, Luton, UK
hongqing.yu@beds.ac.uk
Abstract. With recent viruses across the world affecting millions and millions of
people, the self-healthcare information systems show an important role in help-
ing individuals to understand the risks, self-assessment, and self-educating to
avoid being affected. In addition, self-healthcare information systems can per-
form more interactive tasks to effectively assist the treatment process and health
condition management. Currently, the technologies used in such kind of systems
are mostly based on text crawling from website resources such as text-searching
and blog-based crowdsourcing applications. In this research paper, we introduce
a novel Artificial Intelligence (AI) framework to support interactive and causality
reasoning for a Chatbot application. The Chatbot will interact with the user to
provide self-healthcare education and self-assessment (condition prediction). The
framework is a combination of Natural Language Processing (NLP) and Knowl-
edge Graph (KG) technologies with added causality and probability (uncertainty)
properties to original Description Logic. This novel framework can generate causal
knowledge probability neural networks to perform question answering and condi-
tion prediction tasks. The experimental results from a prototype showed strong pos-
itive feedback. The paper also identified remaining limitations and future research
directions.
Keywords: Causality analysis · Healthcare · Knowledge graph · Natural

language processing · Chatbot · Artificial intelligent
1 Introduction
Self-healthcare information system interventions became an important component to
improve all range individual’s capabilities on self-health management, testing and aware-
ness [1]. Our research focus is on self-awareness area, especially applying knowledge
and NLP based AI technologies to provide a potential solution to self-education and
self-testing. If every individual can gain pre-knowledge of health conditions, such as
symptoms and potential risks to others, then the healthcare outcomes to the individual
and publics in the community will be improved. Not surprisingly, research results have
supported the above hypothesis, e.g. [2] suggested that health education could improve

https://doi.org/10.1007/978-3-030-63092-8_3
Dynamic Causality Knowledge Graph Generation 31
patient engagement and treatment outputs. Moreover, self-education could also play a
unique role in chronic disease management [3].
From the scientific point of view, our research aims are to provide a novel frame-
work for supporting efficient machine-oriented health knowledge study and causality
reasoning. There are currently many open remaining issues around these two areas.
For example, most of the machine knowledge study processes are treated as the clas-
sic machine learning processes to mostly studying relational raw data, which leads to
learning probability distributions of the raw dataset. As a result, the learning results are
difficult to transfer as knowledge to human users. In the knowledge presentation domain,
the most advanced KG (Knowledge Graph) framework has a high capability to represent
knowledge. However, KG data are difficult to be the direct inputs for machine learn-
ing algorithms without encoding steps. The encoding will destroy most the knowledge
constructive properties. The major reason of adapting machine learning process with
KG together is that the current KG standards have lacks of uncertainty and causality
supported reasoning. Therefore, a novel framework that can support KG retrieval with
uncertainty and causality reasoning facilities will build the foundation for us to develop
an AI embedded self-health care awareness system.
In this paper, we will illustrate a Causal Probability Description Logic (CPDL)
framework to provide novel reasoning capabilities with uncertainty and causality. Then,
a health domain Causality Knowledge Neural Network (CKNN) can be generated based
on CPDL. Besides, we introduce a Chatbot interactive environment to allow users to set
up the learning topics and accessing the knowledge as self-education. In the meantime,
the Chatbot can provide symptom-based predictions according to the knowledge to
support self-diagnosis process.
The paper is structured as:
Section 2 discusses the related research work in the healthcare domain. Section 3
explains the CPDL framework with key terminologies and computation algorithms.
Section 4 introduces the working process of Chatbot application in detail. Section 5
presents the evaluation and future research directions. Section 6 concludes the research.
2 Related Work
Machine Learning (ML) technologies are widely applied in healthcare and medicine
domain recently. The areas covered from fatal disease early identification to drug dis-
covery and manufacturing. There was a lot of promising results suggested that the ML
approach provided huge benefits to healthcare professionals. For example, most of the
ML algorithms can provide more than 90% accuracy on breast cancer detection tasks
and MLP (Multilayer Perceptron) algorithm can achieve 99.4% accuracy [4] worked
on the Wisconsin diagnostic dataset1 . The other example is Deep Learning-based ML
approach e.g. a deep learning-based automatic detection algorithm (DLAD) was devel-
oped for detecting chest radiographs [5] that can achieve 95% accuracy as well as a
neural network based deep learning classification algorithm for skin cancer detection by
Stanford research team [6]. There are many other research works focused on individual
1 https://www.kaggle.com/uciml/breast-cancer-wisconsin-data#data.csv
32 H. Q. Yu
but different types of diseases [7–13]. However, at the current state of art, there are two
major limitations of these ML and Deep Learning (DL) approaches according to our
research goals:
1. These approaches only work on the raw experienced clinical data for a certain pre-
diction or classification task without creating fundamental inferable knowledge.
Therefore, the outcomes are purely the statistical fitting models that cannot pro-
vide explanations and traceable evidences. However, the explanations are extremely
crucial for self-care system to enable individuals to understand insight of the health
condition for achieving education and awareness goals.
2. The learning datasets are isolated to each different health model without any relations.
In healthcare domain, there are many important relations can affect diagnosis such
family health history, pre-conditions and life-style may all have relationships to each
other, especially and importantly the causal relations among them. However, these
relations cannot be expressed by isolated single dataset without a comprehensive
knowledge linking framework.
To address these two major limitations, the causality based knowledge generation
framework is required as the base for developing a self-healthcare system. In fact, causal
relations analysis is widely used in health, social and behavioural research since Neyman-
Rubin causal inference theory was published in 1986 [14]. However, the concepts of
causal and association or correlation are always been mixed or misunderstood until the
formal mathematics models are represented in 2010 by Pearl in [15]. The model applies
probability joint distribution computation on the directional graph that satisfying the
back-door criterion and a changing function of do(X=x) rather than a random x to have a
probability prediction on Y based on statistic knowledge. In simplified terms, the causal
relation can be observed if one property is modified, then the other property of a proba-
bility distribution will also change. Therefore, we can distinct associational relations and
causal relations. Most recently, this idea has been applied on top of the Reinforcement
learning process by the DeepMind team [16]. On a separate note, introducing probability
concepts into knowledge graphs is another path to express knowledge with belief rating
thresholds. Based on this idea, a Probabilistic Description Logic (PDL) was explained
in 2017 [17] to deal with subjective uncertainty. The PDL extended Tbox and Abox
definitions in the classic Description Logic (DL) in Eq. (1) and (2) with probabilistic
thresholds notations as P∼n over concepts and individual instances, where ~ can be oper-
ated from ≤, <, =, >, ≥ and n defines the thresholds value. However, the extended PDL
requires manually encoding the default probability thresholds that are hard to implement
in a dynamic knowledge learning system.
T :: = C, D | C D | ∈ r. (C) | P∼n C | (1)
A :: = A | A ∧ A | r(a, b) | P∼n A | (2)
In this paper, we will introduce a novel knowledge description framework with a

combination of causal probability analysis and KG for supporting the health Chatbot
application. As a result, the user will have an interactive learning environment with the
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Rautalammin
runoniekan Albert Kukkosen runoja
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
ebook or online at www.gutenberg.org. If you are not located in the
United States, you will have to check the laws of the country where
you are located before using this eBook.
Title: Rautalammin runoniekan Albert Kukkosen runoja
Author: Albert Kukkonen
Release date: October 8, 2023 [eBook #71833]
Language: Finnish
Original publication: Porvoo: WSOY, 1913
Credits: Tuula Temonen
*** START OF THE PROJECT GUTENBERG EBOOK

RAUTALAMMIN RUNONIEKAN ALBERT KUKKOSEN RUNOJA ***
RAUTALAMMIN RUNONIEKAN ALBERT KUKKOSEN RUNOJA
Kirj.
Albert Kukkonen
Porvoossa, Werner Söderström Osakeyhtiö, 1913.
SISÄLLYS:
Runoilijan alkulause.
Johdanto.
Eero Varis Albert Kukkoselle
Runoilija Pentti Lyytisen patsasta paljastaissa.
Nykyinen aika.
Kansanjuhlassa Rautalammilla.
Kansanopistolla Äänekoskella lukuvuotta alkaissa.
Vanhan miehen miettehiä Lomakurssien lopussa.
Nuorisoseuran kokouksessa.
Vielä virttä viinan töistä.
Maamiespäivillä Rautalammilla.
Pellervon päivillä Helsingissä.
Valtiopäiväin avaamisesta.
Keisari Aleksanterin kuolinpäivästä.
Kiistelystä kielen päältä valtiopäivillä.
Suomenkielen asia ritari- ja aatelisäädyssä valtiopäivillä.
Hiljaiset Valtiopäivät.
Nuorisollen neuvoksi välttämähän väkijuomat.
Entisistä ja nykyisistä ajoista.
Rautatie-kokouksessa Pieksämäellä.
Muistelmia Iisalmen näyttelyssä käynnistä.
Teaterihuoneella juhlassa kylvettäjäin hyväksi Kuopiossa.
Kirurgisessa sairaalassa olostani Helsingissä.
Muistelmia vuosisadan vaihteessa.
RUNOILIJAN ALKULAUSE.
Tähän runokokoelmaani on valittu vanhempana tehtyjä runojani,

mitähän milloinkin on sattunut syntymään. Kun minua on vaadittu
niitä lausumaan useissa tilaisuuksissa, joita en edeltäpäin osannut
ollenkaan ajatella, ja kun olin herkkä rupeemaan, olivat ne sitten
kiireellä kyhättävät. Nuorempana tehdyt runoni eivät tulleet talteen
pannuiksi, sanomalehdissäkin niitä aina oli, ja niin jäi niitä koko
joukko hukkateille ja ijäti unholaan. Ensimäisiä runojani aloin
tekemään noin 28 vuotiaana, vaan ne olivat enemmän leikkisiä ja
rakkauden lauluja. Kun nyt olen jo elänyt elämäni ehtopuoleen, niin
rupesin näitä teoksiani, mitä niistä vielä oli saatavissa, kokoomaan
kirjaan. Päämääränä olen aina koettanut pitää runoudessani sitä
henkeä, että niissä olisi nuorelle kansalle oppimista, erittäinkin mitä
raittiusasiaan tulee, ja että nuoret aina valitsisivat tovereja ja
karttaisivat pahoja seuroja, joihin nuori, kasvava kansa on herkkä
rupeamaan. Jos siis näissä runoissani on jotakin opettavaista,
olkoon se ihmiselämän ja kaiken siihen kuuluvan hyvän ohjeena.
Missä taas ei mitään hyvää ole, jääköön se unholaan.
JOHDANTO.
Kirjoittanut Kaarle Krohn.
Rautalampi on kieltämättä ihanan luontonsa puolesta

merkillisimpiä seutuja Keski-Suomessa. Mutta se on merkillinen
toisessakin suhteessa: keskuksena sille talonpoikaisrunoudelle, jolla
1800 luvun alkupuolella oli kukoistusaikansa. Rautalammilla eli
tämän runouden kuuluisin edustaja Paavo Korhonen. Kustavi
Grotenfeltin julkaisussa Kahdeksantoista runoniekkaa on näytteitä
viiden Rautalampilaisen runoista. Viimeisenä ja kaikista nuorimpana
siinä esiintyy Albert Kukkonen, joka vielä elää Rautalammilla
Hinkkalan talon isäntänä ja jonka myöhempiä runoja tarjona oleva
kokoelma sisältää.
Konneveden rannalla Kivisalmen eteläpuolella kauniin lahden

pohjukassa on Hinkkalan talo, jossa Albert Kukkonen syntyi 14 p.
helmik. 1835. Hänen isänsä Gabriel Eerikinpoika Kukkonen (k. 1873)
oli Vihtori Lounasmaan kuvauksen mukaan, joka vuonna 1863
kolmen muun ylioppilaan kera asui Hinkkalassa hyvää suomenkieltä
oppiakseen, arvokas, älykäs ja kirjallisuutta harrastava mies.
Ylioppilaat olivat pahemmassa kuin pulassa isännän kanssa
keskustellessaan, sillä hän muisti kaikki, mitä oli lukenut, ja
valtiollisista sekä yhteiskunnallisista asioista oli hänellä selvemmät ja
kypsyneemmät mielipiteet kuin heillä. —Ajatuksensa hän lausui —
selvästi, sujuvasti ja pontevasti. Olisi valittu tuomiokunnan
edustajaksi valtiopäiville, mutta kieltäytyi heikon terveytensä vuoksi.
Äiti Helena Gustaava, omaa sukua Närhi (k. 1851) mainitaan

Lounasmaan muistelmissa hyväntahtoiseksi emännäksi, joka
ylioppilaita kohteli kuin omia poikiaan.
Hinkkalan asukkaita on myös Julius Krohn, joka viittä vuotta

aikaisemmin V. Öhbergin kera oli asettunut Rautalammille samassa
tarkoituksessa, kirjeessä vanhemmilleen (20/9 1858) kuvaillut.
»Ensin läksimme Hinkkalaan, missä Sanmark ja muut (neljä
viipurilaista ylioppilasta) olivat kesää viettäneet. Ihmisiä tapasimme
siellä sellaisia, ettei parempia voi itselleen toivoa: kohtelijaita,
ystävällisiä ja teeskentelemättömiä. Kaikki talossa oli hollantilaiseen
tapaan puhdasta ja huolellisesti järjestettyä. Isäntä puhui
mieltymyksellä hänen luonaan asuneista rakkaista herroistaan.» —
Myöhemmässä kirjeessään toisen talon isäntää kiittäessään hän
lisää: »vaan Hinkkalan vanhuksen veroinen hän ei ole likimainkaan.»
Yhdenikäisen Albert Kukkosen oli Julius Krohn saanut hyväksi

ystäväkseen, jonka kanssa käsitysten kävi vierailuilla. Erityisenä
ystävänään hänet mainitsee myös Lounasmaa. »Hän jo silloinkin
runoja sepitteli ja joutoaikoina uutterasti luki kirjoja ja sanomalehtiä,
isällä kun oli jotenkin runsasvarainen kirjasto ja taloon tuli Suometar
sekä ainakin kolme muuta sanomalehteä. Yhdessä me haaveilimme
suomalaisuuden edistyksestä ja kansamme tulevaisuudesta.»
Sitä vaikutusta, joka ylioppilaista jäi nuoren Albert Kukkosen

mieleen, on hän kuvannut runossa »Nuorille oppilaisille, jotka v.
1858 Hinkkalassa kortteeria pitivät», joka usean aikaisemman runon
kera on säilynyt Julius Krohnin kokoelmissa. — Heitä, jotka eivät ole
menneet herrain huoneisiin, isoisiin ystäviin, hän on oppinut
tuntemaan:
Siinä seurassa samassa,

Kun on kulettu yhessä,
Talonpoikien tavalla
Aina puheita puhuttu.
———
Vaan olen tuntenut tukulta,
Ett' on aina alhaisuutta,
Eikä yhtään ylpeyttä
Teissä, aivan oppilaiset.
Minä kiitän mielelläni
Alhaisuuttani alati,
Kun olen nähnyt nöyryytenne.
Alhaisuus on arvon juuri,
Joka säädyssä sopiva;
Vaan ylpeys on yksi niistä
Vihattavista vioista,
Joka Aatamin alensi
Alas onnen kukkulalta.
Ylioppilaitten vaikutus näkyy myös hänen runollisen

harrastuksensa heräämisessä. Se on Rautalammin
talonpoikaisrunouden jatkoa, mutta ulkopuolelle sen piirin
kehittynyttä. Sen kehittäjinä ovat olleet toiselta puolen uudempi
kirjallinen sivistys toiselta puolen vanhempi kansanruno, joka
uudemman sivistyksen edustajain välityksellä kirjallista tietä tuli
tunnetuksi ja ymmärretyksi.
Albert Kukkonen on aikoinaan kirjoittanut »Runon teosta»
sepitelmän, joka selvästi kuvaa hänen kirjallisia vaikutelmiaan.
Rupeaisinpa runollen,
Läksisinpä laulutyöllen,
Kuin ois oppia otsassa,
Tuntoa tuolla tukan alla
Eli taitoa takana;
Vaan olen aivan oppimaton
Kirjoitusta koittamahan,
Paperille piirtämähän.
———
Kuin ois kaunis Kalevala,
Kantelettaret kädessä,
Niissä oppia olisi,
Oivallista ojennusta,
Kaikki kaunista tekoa,
Niissä on runot rustattuna,
Niissä laulut laitettuna,
Sananlaskutkin saneltu,
Kaikki laatunsa mukaiset,
Joka sorttihin sopivat:
llolaulut, surulaulut,
Miesten laulut, naisten laulut,
Vaimojen valituslaulut,
Laulut lapsille hyville,
Laulut päiville pahoille,
Neitosille naitaville,
Kosioillen katsottuna.
Vielä on vanhan Väinämöisen
Loihturunot runsahasti
Kalevalahan koottu,
Joissa on oppi oivallinen,
Kaikki taito tarpeellinen,
Suomen kielellen sopiva
Suomalaisten suosioksi.
———
Kiitän vielä viimeseksi
Niiden herrojen hyvyyttä,
Jotka ylös ottelevat,
Vanhat laulut laittelevat,
Kelpo kirjaksi kyhäävät.
Olkoon kiitos kirjoitettu,
Sanottu Savon ukolta,
Teillen taitavat tekiät,
Hyvät herrat Helsingissä,
Että ootten etsinynnä
Suomesta suloiset laulut.
Niinpä saatamme sanoa
Maamme puolelta puhua:
Ei ne herrat helpommasti
Maata, ruualle rupia,
Jotka kaikki kiertelevät,
Laajaa maata matkustavat,
Suomen sukua hakevat.
Suomella on vähän sukua,
Aivan vähä aatelia,
Vielä on Virossa vähäsen,
Venäjällä veikkosia.
Runossaan »Työn arvosta», joka samoinkuin runo »Entisistä

Rautalammin runoniekoista» on painettuna kokoelmaan
Kahdeksantoista runoniekkaa, Albert Kukkonen kuitenkin lausuu,
että on »kyntömiehellä kynänä aurankurki kämmenpäässä». Jos
uutteralla maanviljelijällä lisäksi on yhteishyvän harrastuksia ja
kunnallisia luottamustoimia, jää runoileminen syrjään, kun hän on
paraissa työvoimissaan. Vasta vanhemmalla iällä pääsevät runolliset
taipumukset jälleen oikeuksiinsa. Sillä välin on kasvanut nuori polvi,
joka kansakoulussa on oppinut panemaan arvoa vanhaan runouteen
ja alkaa vaatia sen viimeistä edustajaa virittämään kanneltansa
juhlatilaisuuksissa. Ulkopuolellakin omaa pitäjää tulee laulajavanhus
tunnetuksi. Pohjois-Hämeen kansanopiston alkajaisissa,
Kylpyvieraitten iltamassa Kuopion teatteritalolla ja Pellervon päivillä
Helsingissä hänen on esiintyminen juhlarunoilijana. Loistokohtana
kuitenkin pysyvät yliopistollisten lomakurssien lopettajaiset 20 p.
elok. 1898. Tästä juhlasta kertoo Uusi Suometar: »Mutta kun iäkäs
rautalampilainen talonisäntä Albert Kukkonen astui puhujalavalle ja
lausui sepittämänsä runon Vanhan miehen miettehiä lomakurssien
lopussa, niin sitten se vasta ilo nousi. Hyvä-huudoista ja
käsientaputuksista ei tahtonut loppua tulla. Nuoret neitoset riistivät
ruusukimput rinnoiltaan ja kiinnittivät ne ukon takin rintapieliin. Sitten
miehet istuttivat äijän tuolille ja riemukulussa kantoivat häntä ympäri
salia toisten laulaessa »Arvon mekin ansaitsemme Suomenmaassa
suuressa». Päivälehti lausuu tapahtumasta: »Illan innostus kohosi
korkeimmilleen, kuin runoilija-vanhus lausui sepittämänsä runon.
Palokunnan sali täyttyi myrskyisistä käsientaputuksista ja hyvä-
huudoista. Eläköön huudettua riensi muutamia naisia ja miehiä
runoilijavanhuksen luo. Pian istui ukko ylhäällä, ja Arvon mekin
ansaitsemme sävelten kaikuessa kannettiin häntä ympäri salia.»
Kenties Albert Kukkonen ei vielä jääkään viimeiseksi runoniekaksi

Rautalammilla, vaan on hänen esimerkkinsä herättävä harrastusta
vanhan runomitan käyttämiseen nousevassa nuorisossa. Hänen
täyttäessään 70 vuotta (14/2 1905) lausui hänen serkunpoikansa
Eero Varis seuraavan hänen kunniakseen sepittämänsä runon.
EERO VARIS ALBERT KUKKOSELLE
Saanko minäkin sanoa,

Poika parraton puhua,
Isännällen ijällisellen,
Hopeahapsellen hyvällen.
Tämän päivän päähän päässyt,
Vuosikaudet vieritellyt,
Täysikymmenten luvussa
Seitsemännen saavuttanna.
Siis on aikaa jo eletty
Albertilla aikalailla,
Tie on pitkä tallustettu,
Polku kaitainen kulettu,
Elon askeleet otettu.
Kuitenkin on kunnialla
Tämä Kukko kulkenunna
Elon teillä ahtahilla.
Ei oo viina vietellynnä,
Eikä polkenna puteli
Miehen mainetta, nimeä.
Ei oo uni uuvuttanna
Virumahan vuotehella,
Lojumahan laiskan lailla.
Ain' oli eellä ensimäissä
Töissä, toimessa todella,
Neuvomassa nuorempia
Työtä vääntämään väellä,
Hiki päässä heilumahan.
Vielä ehti ensimäisnä
Kuntalaisena kävellä,
Kokoukset koplotella,
Joiss' oli aina johtajana,
Puhujana puolestamme.
Vielä virret viimeiseksi
Laittoi aina laulettavat.
Siis nyt suonetten sanoa,

Ilmituoda mun iloni
Kaiken nuorison nimessä,
Kunniani, kiitokseni
Niistä neuvoista jaloista,
Opin oivan antamasta,
Jonka näissä nähdä saapi
Kävellessä katsomassa
Tämän talon tanhuvia;
Niissä ahkeruus näkyypi,
Työ ja toimi tunnetahan
Nuorten neuvoksi jaloksi,
Kansan kasvavan varaksi.
RUNOILIJA PENTTI LYYTISEN PATSASTA PALJASTAISSA 29 p.
heinäk. 1900.
Mistä saisin nyt sanoja,

Lausehia luontevia,
Kun on alkaissa asian
Ajatukset ahtahimmat,
Kun on kielet kankeiksi
Käyneet Väinön kantelessa
Nykyajan asujillen,
Laulun mahti laulajillen
Rautalammin rantasilla.
Toista oli aika ennen,
Kun me katsomme jälellen
Kulunutta aikakautta,
Vuosisadan alkupuolta:
Ei ollut lamassa laulut,
Virret veisaten vähennä,
Ruostununna runon mahti,
Kun ne ukkoset elivät
Rautalammin rantamailla.
Niit' oli nuottue nimeltä,
Kokemass' oli kolme miestä:
Ensin kuulu Korhosemme,
Suurin laulaja Savossa,
Sitten pillit pienen Pentin,
Toimen miehen Toholahden
Kaikuivat joka kylässä;
Vielä virret Ihalaisen,
Jussin juttuja monia
Ompi mielessä monella,
Varsinkin on vanhemmilla.
Ei silloin sivuhun jäänyt,
Mit oli maassa merkillistä,
Se lauluksi laitettuna,
Runopukuhun puettu.
Siis pitäisi Suomen kansan
Muistaa maamme laulajoita,
Antaa näillen suuri arvo
Edesmenneillen monillen,
Runoilijoillen runsahillen.
Se on lahja Luojan lahja,
Se on lahja synnynnäinen;
Niit' ei synny joka päivä,
Ei vielä monta vuodessakaan.
Niinpä ovat nämä hetket
Sitä varten valmistettu,
Pienen Pentin penkereellen
Panna tässä patsas ylös,
Laulajallen muistomerkki
Hautakummun kunniaksi
Sillen maallen siunatullen,
Missä kaikki matkamiehet
Vaivoistamme väsyneenä
Saamme laskea levollen.
Vielä virkkaisin enemmän,
Lausuisinpa laulajoista,
Vaan kun puuttunen puhetta,
Laviampaa lausumista.
Kun ois miehellä minulla
Koppa Paavo Korhoselta,
Täysi tietäjän sanoja,
Eli Pentiltä puheita,
Lyytiseltä lyijypännä,
Ihalaisen innostusta,
Kyllä sitten kuulisitten,
Sanomist' ois sangen paljon.
Vaan on miehet menneet meiltä,
Tulleet turpehen omaksi;
He vaan jättivät jälellen
Perinnöksi poikasillen
Laulut suuret lapsillensa.
Siispä suosi vielä nytkin
Rautalammin rantalainen,
Kansa nuori kasvavainen,
Älä heitä hylkyteillen
Kuihtumahan runokukkaa,
Vaan sä koeta kostutella,
Tainta vielä virkistellä,
Että se eläisi henki,
Mik' oli miesten muinoisien
Eikä jäis mahti maanrakohon,
Vaikka mahtajat menevät.
Niinpä tämän laulajakin
Ompi ollut oppipoika
Pitäjässä runomiesten;
Kun on seutu synnyttännä
Niinkin monta merkillistä,
Laadullista laulajata,
Joitten muistollen mukailin,
Runorivit kirjoittelin
Patsasta nyt paljastaissa,
Itsekki ijän lopussa,
Kohta haudan partahalla.
Ehkä kohta katkeaapi
Senkin kieli kanteleesta.
Kuitenkin tään kirjottelin,
Runomuotohon mukailin,
Kun vielä vaativat minua
Lausumahan lausuntoni
Patsasta nyt paljastaissa.

Ebook Proceedings of The Future Technologies Conference FTC 2020 Volume 3 Kohei Arai Online PDF All Chapter

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ebook Proceedings of The Future Technologies Conference FTC 2020 Volume 3 Kohei Arai Online PDF All Chapter

Uploaded by

Copyright:

Available Formats

Proceedings of the Future

Technologies Conference FTC 2020

Proceedings of the Future Technologies Conference FTC

Intelligent Computing: Proceedings of the 2021

Intelligent Computing Proceedings of the 2021 Computing

Intelligent Computing Proceedings of the 2021 Computing

IoT Technologies for HealthCare 7th EAI International

Techno Societal 2020 Proceedings of the 3rd

Proceedings of the 21st EANN (Engineering Applications

Emerging Technologies in Computing Third EAI

More information about this series at http://www.springer.com/series/11156

Proceedings of the Future

ISSN 2194-5357 ISSN 2194-5365 (electronic)

Bioﬂuid-Biostructure Interaction Analyses Using Comprehensive

Computation of Incline Barriers via Smartphone Sensors

RiWAArch Style: An Architectural Style for Rich

Exploration of Network Slice Charging in 5G Networks . . . . . . . . . . . . 482

Ethereum Blockchain Enabled Secure and Transparent E-Voting . . . . . 683

A Systematic Literature Review of Smart Contract Applications . . . . . . 877

Asset Administration Shell: Domain Speciﬁc Language Approach

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1053

Milan Toma1(B) and Rosalyn Chan-Akeley2

Abstract. A multitude of imaging modalities are used to acquire

Keywords: Computer models · Patient-speciﬁc computational

1.1 Simulations and Experiments

1.2 Choosing Numerical Methods

Computer simulations provide virtual hands-on experience when actual hands-

2.1 Creating Patient-Specific Geometries

Medical imaging is mainly used to create visual representations of the organs

area of interest from the surrounding tissues. Segmentation is done by marking

2.2 Computer Simulations

3.1 Mitral Valve Closure

(a) µCT (b) FSI

3.2 Fluid Dynamics of Mitral Valve Closure

(c) T = 0.040·Tsys x y (d) T = 0.060·Tsys

(e) T = 0.080·Tsys (f) T = 0.100·Tsys

3.3 Traumatic Brain Injuries

Occipital view Frontal view

8. Toma, M., et al.: Fluid-structure interaction analysis of ruptured mitral chordae

Gift Arnold Mugisha1 , Christine Muhumuza2 , Faith-Michael Uzoka3(B) ,

Abstract. Several health complications arise from non-adherence to medica-

Keywords: Automated healthcare assistant · Pill dispenser

© Springer Nature Switzerland AG 2021

2 The Pill Dispenser

a. Simplicity, which enhances upgradability and maintainability.

Fig. 1. a. System Blueprint, b. Functional System

3.1 Study Design and Population

3.2 Data Collection and Analysis

Table 1. Participants’ professional demographics.

Medical Facility Number Profession Number

3.3 Quality Control

3.4 Ethical Considerations

Table 2. The Logistic challenges when dispensing medications.

Challenge Number of respondents

Fig. 2. Respondent’s perception of patients’ general attitude to medication

“…tired of taking drugs, financial constraints, then herbal alternative medicine.”

Area of improvement Number of respondents

Hong Qing Yu(B)

Keywords: Causality analysis · Healthcare · Knowledge graph · Natural

© Springer Nature Switzerland AG 2021

T :: = C, D | C  D | ∈ r. (C) | P∼n C | (1)

A :: = A | A ∧ A | r(a, b) | P∼n A | (2)

In this paper, we will introduce a novel knowledge description framework with a

T :: = C, D | C D | ∈ r. (C) | P∼n C | (1)

A :: = A | A ∧ A | r(a, b) | P∼n A | (2)