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Literature Review

A kidney stone is also called as urolithiasis or renal calculus, a solid component formed in the kidneys from minerals contained in urine (Thomson et al., 2016). Traditionally kidney stone disease is known as a painful, benign and isolated condition (Sakhaee, 2008). Typically kidney stones leave the system in the urine stream and a small stone may pass without causing symptoms. When the stone is growing in size, it can block the ureter, which will result in pain, which normally begins with flank or lower back pain (Moore et al., 2013).

All over the globe, a large number of people suffer due to  urinary stone problems. Kidney stone is common and affects people generally between the ages of 30-60. Urolithiasis affects women less than men, and has estimated lifetime incidence of 12% (Sofia and Walter, 2016). The causes of kidney stones can be both the result of environmental problem and metabolic problem (Lee et al., 2016). Since 2015, nephrolithiasis has become as a leading cause of morbidity (Gee et al., 2016). It is a frequent cause of surgical procedure, hospitalizations and emergency room visits (Trinchieri, 2016). In economically developed countries, stones of calcium and phosphate account for around 70% renal stones (Saxena and Sharma, 2010).The gold standard investigation for urolithiasis is non-contrast CT-KUB (Kennish et al., 2008; Preminger et al., 1998).

Diagnosing Modalities

Traditionally acute renal colic or ureteric colic (acute, colicky flank pain radiating to the groin with or without hematuria) has been the hallmark for diagnosing Urolithiasis clinically. Over the years, the diagnosis urolithiasis has moved from a clinical (signs and symptoms) based to an imaging based one. Recent developments in non-invasive imaging technology have ensured that an accurate diagnosis of even very small stones is easily made. Over the years the presenting symptoms in case of ureteric stone/kidney stones have not changed, but diagnostic modalities have been refined better day by day to become more specific and less invasive.

Analysis of urine is a simple diagnostic test, which can be done at bedside. It is non-invasive and very informative and results are available immediately. It is easy to do the interpretation by clinician with good practical skills in an ambulatory or in a hospital setting. In combination with a good patient history and physical examination, the analysis of urine plays a vital role in diagnosing urolithiasis and gives some additional clue about the risk factors and the type of stone. pH Greater than 7.5 is compatible with infection lithiasis (stone), whereas pH less than 5.5 favors uric acid lithiasis (Wanger and Mohebbi, 2010). pH is a measure of hydrogen ion concentration. Normal urine pH of human is less than 7.

Microscopic hematuria is seen in approximately 85% of patients who is suffering from Urolithiasis. A retrospective study done by (Bove et al., 1999) found that 67% of patient with urolithiasis diagnosed using gold standard CT–KUB had more than 5 red blood cells/HPF in the urine and 89% patient had more than 0 red blood cells/hpf in the urine. The sensitivity increased to 94.5% when the patient had both microscopy and dipstick urine analysis (Press et al., 1995).

Imaging modalities plays an important role in diagnosing urolithiasis. Various imaging modalities are available for the diagnosis of acute renal colic, such as Abdominal Radiography (KUB), Intravenous Pyelogram (IVP), Intravenous Urography (IVU), Ultrasound Scan (US) and Computed Tomography (CT) scans, each having their own advantages and limitations (Dhar et al., 2009).

Methodology & Algorithm Sample
Quick sort - Left Median Filter (Q-LMF)

The basic algorithm to sort an array A consists of consists of the following four easy steps: the following four easy steps:

New product development in various industries in India
a) Indian automotive sector

The new product development strategies in automotive sector consist of various stages such as:

i) Product line strategy

Product lines are set of products that belong to a specific company brand. A product line strategy is the measures taken by the company to launch a specific product under the brand and to expand its market size. Initially when a new product is introduced little consideration is given by larger group company , only few only a few people will experiment with the new product (Johnson & Myatt, 2003), product line is one of the marketing strategy used by companies to sell their products (Krishnamurthi, 2007). Products in the product line are categorized in accordance to the market and customers (Neubauer, Steffen & Margaria, 2003).

Product bundling is entirely different as compared to product lining, where bundling is the process of selling two similar products together; lining is the process of selling similar products individually (Chen, 1997). The Products in product lining are characterized and differentiated by size, color, quality and price ( Kekre & Srinivas, 1990). The success of categorizing in product line depends upon the people identifying the product. Customer’s previous experience also plays a vital role in the success of new product (Krishnamurthi, 2007).

ii) Technology and new product strategy

The AUTO SIM technique which is been recently used in automotive industry, this technique helps to build a better structure and analyzing regarding the fluid usage.

Drive override system: This helps the vehicle to drive on its own without the command of the human. Self-decision making technique.

Bio-metric system : This helps to lock and unlock the vehicle just by using finger print.

Comprehensive vehicle tracking: It is used to track the lost or theft vehicle by using the sensor fitted in it through any of our electronic gadget.

Active health monitoring: It is specially used to monitor the health condition of the driver through sensor and will inform to the paramedic.

iii) Manufacturing strategy

Regarding manufacturing strategy the Indian companies have used a safe approach and concentrated less with the channel partners in their last two decades (Dangayach &Deshmukh 2006). Manufacturing strategy should be used as a competitive tool against the rivals (Skinner, 1969). At the same time this manufacturing strategy should have a link with the overall strategy for better result (Cox and Blackstone 1998).

iv) Distribution strategy

According to the global manufacturers the basic distribution strategy followed by them is to produce the final product separately and then assembling them, then frequently distributing the ordered vehicles in small quantities. Global manufacturers feel that frequently shipping the product direct to other markets is preferable but at the same time they also feel it as bit costly (Hines, 2002).

The Hub and Spoke distribution method followed in global automotive sector where the local airports carry the few products to the foreign markets. Experts felt that there is a lots of advantage available in hub and spoke distribution strategy

• The improved availability of transport can be well utilized to ship a large quantity of goods.
• It also affects the cost factor positively so that the spending between the channel partners in distribution can be shared.

Depending upon the distribution policy between the manufacturer and receiver the speed of the transportation it also affects the cost factor (Abrahamson, 1998). In the hub and spoke distribution the number of vehicles moved is considered first as compared with other factors (Drewery, 1999).

v) Marketing Strategy

Marketing strategy always keep changing and it finally designed based on the customers. Earlier the manufacturers designed the products on their own, but now they must know about the customer needs and then concentrate on designing the product (Tafler, 2004). One of the marketing strategy is the method of analyzing the consumer behavior the consumer can change their mind even at the last minute without knowing their inner intention ( Kotler &Keller, 2009).

It is necessary for the manufacturer to understand the customer’s needs, market environment and also the competitors who produce an efficient and cost effective product (Dodgson, 1989 & Storey, 1994). Marketing strategy is basically defined as the concept of steps taken by any organization to make their target customers to buy their product (Kotler & Armstrong, 2008).

The idea about the product has been changed in the minds of customer nowadays where they are willing to pay more depends upon the quality of the product (Kotler & Armstrong, 2008). Marketing strategy comprises of various steps taken by a company like making a product, distributing through proper channels, promoting the product and selling in the right market (Sharma, 2012).

The initial step taken in the marketing strategy is finding the right market and preparing the proper marketing mix for the product (Kurtz, Mackenzie & Snow, 2009). If a company wants to increase its market share it can approach various methods like decreasing the price, concentrating more on promotion of the product ( Jennat & Hennessey, 2001).

Hospital management values

Elder et al., 2003 reported that this study would suggest the importance of organizational culture and its impact on health care providers and patients care because of work environment. Total health care quality depends on team approach including members such as nurse, doctor, therapist and work environment. This group approached and identified as part of health care culture. Especially the term “organizational culture” in health care organizations are referred as a complex term includes characteristics among the people belong to same organisations. It also includes beliefs, values, routines, norms of behavior, sense making and traditions followed.

Patient view

In patient view, the quality was framed based on patient’s condition. In addition to work load, other factors such as ineffective communication, inadequate supplies also taken into account to enhance the health care quality.

Condition analysis

According to current situation, the importance of following factors were described regarding workload like Poor physical structures in the (wards) hospitals, many family needs, and ineffective communication.

Based on research report generated by Aiken et al., (2002), fewer License Practicing Nurse (LPN) hours could increase additional burdens on the Registered Nursing (RN) staff. This situation would rise, when LPNs are not available to provide patient care and to fill a supportive role in patient-care delivery. Then RN will have to handle the above mentioned extra responsibilities to her professional duties, in addition to other auxiliary duties.

Several reports have been proposed based on studies relevant to the relationship between nurse staffing and quality nursing care. Most of the results were not same and have contradictory; hence individual assessment regarding each health care parameter is still required. For example, most of the studies in early 1992, revealed that increasing nurse staffing in number was indirectly proportional to mortality (Marcin et al., 2005). This assertion was highly contradicted by Silber, Rosenbaum, and Ross in 1995. They concluded that when there were high number of RNs in response to number of patients, Rather it had led to an increase in the number of patients who experienced more complications and injury.

In 1980s, Patient Assessment and Information System (PAIS) were proposed in Victoria Hospital, Australia (Hovenga, 1996). This study is conducted based on hours of nursing for given PAIS category. From a number of works sampling studies with included time details for administrative work and indirect nursing care activities were taken as subject. The proposed particular nursing care groups were involved in 15 activities viz., direct patient care and indirect nursing care such as documentation. Within the PAIS model another study conducted by Gomez et al., 2008, 2003, dealt with patients categorization based on shift, daily, weekly, monthly, random or (Ad Hoc) basis to reflect the workload at a particular point in time, Software packages, such as E-care and Trend Care, involve nurses using care plans or clinical pathways, determining the time necessary for each unit of care and establishing patient requirements from these parameters.

A study from Blanchet et al., (2012) described a positive work environment would reflect on cordial relationships between staff, team work, autonomy, job satisfaction and low risk of burnout. For the past few years, according to De Lucia and Rengo, (2009) conclusion, there was a serious shortage of nurses. The main reason is the work environment where the nurses practices. Also the empirical human factors and ergonomic literature specific to nursing performance identified that nurses were working generally in poor environmental conditions. They concluded that nursing profession is overloaded and there was a nursing shortage. Individual nurses were overloaded. The other contributing factors for nurse shortage was due to technology and efficiency policies that extend the length of stay and nurses who have complex patient load (Birch et al., 2003).

Also an increased turnover of patients or “churn” had intensified the nursing workload even more. He found that after hospital restructuring in Ontario (Canada) patient throughput increased by 12% and inpatient episodes per bed increased by over 25%. (Unruh, 2000) reported that patient turnover (in their sample size of 205 hospitals) significantly increased from 1994 to 2001. Admission and discharge of patients mean extra documentation, patient education, general nursing and organizational duties, thereby increasing further nursing workload. The movement of patients within wards was considered as an additional factor contributing nursing workload. As a solution prescribed by the above study, it was necessary to move patients from one area to the other on a regular basis was recommended (e.g. from high to low acute areas).

Health Equity

Rokosova et al., (2005) demonstrated about the parameters must be followed for health equity in health care units. Health equity is the definite irreplaceable dimension in health care management, it includes race, ethnicity, age, gender, social class, culture, and ability to pay. Previously reported issues regarding persistent and unacceptable gap in health care access usage, also outcomes by race and ethnicity raises many questions on equity and social justice. This hospital equity had been considered as the biggest challenge in enhancing health care system in SHCOs to huge organisations. They also pointed out some of the mile stones need to be faced for hospital equity as followed,

• To increase and create awareness on hospital equity especially in clinical operations, provider practices, and in best care
• To create a cultural transformation an important element of hospital equity.
• To integrate the concept of equity throughout health care operations and
• Followed by in all other STEEEP dimensions for quality improvement and health care practices
• To eliminate health care inequities

Some of the challenges are prescribed by Corrigan et al., (2001) for the health care system improvement. Likewise in health care and academic organizations and purchasers of health care should pursue six major aims of health care viz., (i) Safety to avoid injuries to patients during health care, (ii) Timeliness to reduce waiting and unusual delays that can harm those who really need care at an emergency, (iii) Effectiveness to provide services mainly based on scientific knowledge who could benefit and refrain from providing services. (iv) Efficiency to avoid waste, including waste of equipment, supplies, ideas, and energy. (v) Equity to provide quality care that must not vary due to personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status (SES), (vi) Patient-centeredness is to provide care based on individual patient preferences and response, needs, and values, also ensuring the patient’s value in all the provided clinical decisions.

SAMPLE QUESTIONNAIRE FOR HEALTH CARE
Identification:

1. Name of Hospital...................................
2. Address...............................................
3. Kind of Hospital: Public [ ] Private [ ]
4. Nature of Hospital: General [ ] Special [ ]
5. Teaching Hospital: Yes [ ] No [ ]

Facilities:

6. No of beds available: ---------------------
7. How many AC rooms, Deluxe rooms, Super deluxe rooms do you have? Mention the nos?
a) AC rooms -------------
b) Deluxe rooms -----------
c) Super Deluxe rooms ---------
8. Are these kinds of wards available in the hospital? Kindly tick the answer.
1) Medical wards: a) Yes [ ] b) No [ ]
2) Surgical wards: a) Yes [ ] b) No [ ]
3) Pediatric wards: a) Yes [ ] b) No [ ]
4) Cardiac surgery ward: a) Yes [ ] b) No [ ]
5) Orthopedic ward: a) Yes [ ] b) No [ ]
6) Gynecology labor ward: a) Yes [ ] b) No [ ]
7) Emergency ward: a) Yes [ ] b) No [ ]
8) Neurosurgery ward: a) Yes [ ] b) No [ ]
8) ENT ward: a) Yes [ ] b) No [ ]
9) ICU: a) Yes [ ] b) No [ ]
10) CCU: a) Yes [ ] b) No [ ]
11) Operation theatre: a) Yes [ ] b) No [ ]
12) Others: -------------

STUDY OF IMAGE SEGMENTATION

Segmentation refers to the process of splitting an image into many subparts. The extent of splitting or the way in which the partitioning is done which is based solely on the application of the process or the problem to be solved by the segmentation procedure. The process of segmentation uses certain mathematical algorithms and procedures to segment an image and remove any unwanted or trivial parts from the input image.

Segmentation is one of the popular methods used to detect flaws in cold trap impurities. Generally the flaws that occur are wormholes, inclusion, lack of fusion, porosity, incomplete penetrations, slag line and cracks. This detection of flaws is used extensively in industrial setting besides deciding the quality of cold trap. Generally, there are two types of segmentation techniques; one based on discontinuity property of intensities which is referred to as region based segmentation and the other based on similarity property of intensities. Region growing, split and merge, k-means and watershed segmentation are region based, whereas thresholding is discontinuity based. Various types of segmentation is shown in Figure 1.4.

Region Growing Segmentation

Region growing is a region based segmentation method. This method starts with a single pixel, referred to as seed pixel and the neighboring pixels are added to it based on similarity properties like intensities, model, shape and texture, forming a region which is to be segmented in the image. Selection of seed pixel depends mainly on the problem domain. Only connected pixels are grouped to form a region. If all the regions in an image are to be segmented, then this process is repeated until all the pixels in the image belong to any one of the regions formed. Different regions segmented by this technique should not have any pixel in common. The predicate which is true in one region must not be true in other regions. In cold trap this technique is used to determine several flaws like wormholes, cuts, porosity and incomplete penetrations.

Watershed segmentation

Watershed segmentation technique is a region based segmentation method. It is not applied to the image directly; rather it is applied to the gradient of image. This segmentation divides the image completely and it mainly depends on the mathematical morphology technique.

Thresholding

Thresholding is one of the most common methods used in segmentation due to its simplicity and less computational time. In this method, the segmentation is carried out on the basis of gray levels. Thresholding is mainly categorized into two types, global thresholding and variable thresholding. Variable thresholding is also referred to as local thresholding or adaptive thresholding. In global thresholding, threshold value is the same for all pixels in the image whereas in variable thresholding, threshold value is not same for all pixels in the image and threshold at any pixel depends on the neighborhood properties of the pixel.

K-Means Clustering

Clustering is a segmentation method which analyses an image by segmenting it into different clusters. K means, fuzzy c mean, hierarchical methods fall under the category of clustering based segmentation. Due to its simplicity, K -means comes out to be the most popular and efficient method. K-means Clustering is a segmentation technique which is used to segment an image into k different clusters.

Split and Merge

Split and merge is a region based segmentation method. In this method, a predicate is determined, based on which splitting of the image is done. If the determined predicate is not satisfied by the image, then that image is divided into four quadrants. If any one of these quadrants doesn’t satisfy the predicate, that quadrant is further divided into four quadrants. If the quadrant size is less than a certain predetermined value, there will be no further splitting of the quadrant, even if it doesn’t satisfy the predicate.

Edge based segmentation

Segmentation can also be done by using edge detection techniques. In this technique the boundary is identified to segment. Edges are detected to identify the discontinuities in the image. Edges on the region are traced by identifying the pixel value and it is compared with the neighboring pixels. In this edge based segmentation, there is no need for the detected edges to be closed. There are various edge detectors that are used to segment the image such as canny edge detector, Sobel edge detector, etc.



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