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Big Data Analytics and Machine
Intelligence in Biomedical and Health

Informatics Sunil Kuma Dhal
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Intelligence in Biomedical
and Health Informatics
Scrivener Publishing
100 Cummings Center, Suite 541J
Beverly, MA 01915-6106
Publishers at Scrivener
Martin Scrivener ([email protected])
Phillip Carmical ([email protected])
Intelligence in Biomedical
and Health Informatics
Concepts, Methodologies,
Tools and Applications
Edited by
Sunil Kumar Dhal
Subhendu Kumar Pani
Srinivas Prasad
and
Sudhir Kumar Mohapatra

This edition first published 2022 by John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
and Scrivener Publishing LLC, 100 Cummings Center, Suite 541J, Beverly, MA 01915, USA
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Contents
Preface xiii
1 An Introduction to Big Data Analytics Techniques in Healthcare 1
Anil Audumbar Pise
1.1 Introduction 1
1.2 Big Data in Healthcare 3
1.3 Areas of Big Data Analytics in Medicine 5
1.3.1 Genomics 6
1.3.2 Signal Processing 7
1.3.3 Image Processing 8
1.4 Healthcare as a Big Data Repository 9
1.5 Applications of Healthcare Big Data 10
1.5.1 Electronic Health Records (EHRs) 10
1.5.2 Telemedicine 11
1.5.3 NoSQL Database 12
1.5.4 Framework for Reconstructing Epidemiological
Dynamics (FRED) 12
1.5.5 Advanced Risk and Disease Management 13
1.5.6 Digital Epidemiology 13
1.5.7 Internet of Things (IoT) 13
1.5.7.1 IoT for Health Insurance Companies 14
1.5.7.2 IoT for Physicians 14
1.5.7.3 IoT for Hospitals 15
1.5.7.4 IoT for Patients 15
1.5.8 Improved Supply Chain Management 16
1.5.9 Developing New Therapies and Innovations 16
1.6 Challenges in Big Data Analytics 16
1.7 Big Data Privacy and Security 17
1.8 Conclusion 18
1.9 Future Work 18
References 18
v
vi Contents
2 Identify Determinants of Infant and Child Mortality Based

Using Machine Learning: Case Study on Ethiopia 21
Sudhir Kumar Mohapatra, Srinivas Prasad,
Getachew Mekuria Habtemariam and Mohammed Siddique
2.1 Introduction 22
2.2 Literature Review 23
2.3 Methodology and Data Source 25
2.3.1 Study Area 26
2.3.2 Source of Data 26
2.3.3 Variables Included in the Study 26
2.3.4 Building a Predictive Model 26
2.4 Implementation and Results 28
2.4.1 Missing Value Handling 30
2.4.2 Feature Selection Methods 30
2.4.3 Features Importance Rank 31
2.4.4 Data Split 31
2.4.5 Imbalanced Data Handling 33
2.4.6 Make Predictions on Unseen Test Data 35
2.4.6.1 Naïve Bayes Classifier: Prediction on Test Data 35
2.4.6.2 C5.0 Classifier on Train Dataset 37
2.4.6.3 Rules From Decision Trees 38
2.4.6.4 SVM Classifier: Unbalanced and Balanced
Train Dataset 39
2.4.6.5 Random Forest Model: On Train Dataset 41
2.4.7 Evaluation 42
2.5 Conclusion 44
References 44
3 Pre-Trained CNN Models in Early Alzheimer’s Prediction
Using Post-Processed MRI 47
Kalyani Gunda and Pradeepini Gera
3.1 Introduction 48
3.1.1 Background 48
3.2 Experimental Study 51
3.2.1 OASIS Longitudinal Data 51
3.2.1.1 Feature Characteristics 52
3.2.2 Alzheimer’s 4-Class-MRI-Dataset 54
3.3 Data Exploration 55
3.3.1 Features Description 55
3.4 OASIS Dataset Pre-Processing 61
Contents vii
3.4.1 Features Selection 62

3.4.2 Feature Transform 62
3.4.2.1 MinMaxScaler 63
3.4.3 Model Selection 64
3.4.3.1 Decision Tree Classification 64
3.4.3.2 Ensemble Machine Learning 65
3.4.3.3 Random Forest Classifier 65
3.4.4 Model Fitting 66
3.4.5 Evaluation Metric/Model Evaluation 67
3.5 Alzheimer’s 4-Class-MRI Features Extraction 69
3.6 Alzheimer 4-Class MRI Image Dataset 69
3.6.1 Image Processing 69
3.6.2 Classification of 4-CLASS-MRI 71
3.6.2.1 AlexNet 74
3.6.2.2 VGG-16 75
3.6.2.3 Inception (GoogLeNet) 76
3.6.2.4 Residual Network (“RESNET”) 77
3.6.2.5 MobileNetV2 78
3.6.2.6 NASANet (Neural Architecture Search
Network) 79
3.7 RMSProp (Root Mean Square Propagation) 80
3.8 Activation Function 81
3.9 Batch Normalization 81
3.10 Dropout 81
3.11 Result—I 82
3.11.1 Result—II 84
3.12 Conclusion and Future Work 89
Acknowledgement 89
References 90
4 Robust Segmentation Algorithms for Retinal Blood Vessels,
Optic Disc, and Optic Cup of Retinal Images in Medical Imaging 97
Birendra Biswal, Raveendra T., Dwiti Krishna Bebarta,
Geetha Pavani P. and P.K. Biswal
4.1 Introduction 98
4.2 Basics of Proposed Methods 100
4.3 Experimental Results and Discussion 107
4.4 Conclusion 115
References 116
viii Contents
5 Analysis of Healthcare Systems Using Computational

Approaches 119
Hemanta Kumar Bhuyan and Subhendu Kumar Pani
5.1 Introduction 120
5.1.1 Diagnosis Process in Healthcare Systems 120
5.1.2 Issues of Healthcare 120
5.1.3 Clinical Diagnosis Based on Soft Computing 122
5.1.3.1 Neural Network and Fuzzy Healthcare
Systems 122
5.1.3.2 Systems of Fuzzy-Genetic Algorithms
(F-GA) 123
5.1.3.3 Genetic Algorithm Systems and Neural
Networks (NNGA) 123
5.1.3.4 Genetic Algorithm, Fuzzy Logic and Neural
Network (NN-FL-GA) 123
5.1.3.5 Tool for Big Data Analytics 124
5.2 AI & ML Analysis in Health Systems 124
5.3 Healthcare Intellectual Approaches 127
5.3.1 AI and ML Roles in the Healthcare System 127
5.3.2 Medical ML Medicine 129
5.3.3 Clinical System Growth 130
5.3.4 Clinical Data Development Using AI 130
5.3.5 EHR Disease Detection 130
5.3.6 Cognitive Cancer Approaches 130
5.3.7 Effective EHR Operations 131
5.3.8 Deep Learning Approach (DL) in the Clinical System 131
5.3.9 Healthcare Data Transformation 131
5.3.10 Prediction of Cancer 133
5.4 Precision Approaches to Medicine 133
5.4.1 EMR Analysis Medicine 133
5.4.2 AI-Based Medicine Accuracy 134
5.4.3 Tumor Cell Visual Evaluation 134
5.5 Methodology of AI, ML With Healthcare Examples 134
5.6 Big Analytic Data Tools 136
5.6.1 Hadoop-Based Health Industry Tools 138
5.6.2 Healthcare System Architecture 138
5.7 Discussion 141
5.8 Conclusion 142
References 143
Contents ix
6 Expert Systems in Behavioral and Mental Healthcare:

Applications of AI in Decision-Making and Consultancy 147
Shrikaant Kulkarni
6.2 AI Methods 149
6.2.1 Machine Learning & Artificial Neural Networks
(ML & ANN) 149
6.2.2 Natural Language Processing (NLP) 151
6.2.3 Machine Perception & Sensing 152
6.2.4 Affective Computing 152
6.2.5 Virtual & Augmented Reality (VR & AR) 153
6.2.6 Cloud Computing & Wireless Technology 154
6.2.7 Robotics 154
6.2.8 Brain–Computer Interfaces (BCIs) 154
6.2.9 Supercomputing & Simulation of Brain 155
6.3 Turing Test 156
6.4 Barriers to Technologies 157
6.5 Advantages of AI for Behavioral & Mental Healthcare 157
6.6 Enhanced Self-Care & Access to Care 158
6.6.1 Care Customization 158
6.6.2 Economic Benefits 159
6.7 Other Considerations 160
6.8 Expert Systems in Mental & Behavioral Healthcare 161
6.8.1 Historical Perspectives 162
6.9 Dynamical Approaches to Clinical AI and Expert Systems 165
6.9.1 Temporal Modeling 165
6.9.2 Practical Global Clinical Applications 165
6.9.3 Multi-Agent Model Dedicated to Personalized
Medicine 167
6.9.4 Technology-Enabled Clinicians 168
6.9.5 Overview of Dynamical Approaches 168
6.9.6 Cognitive Computing in Healthcare 169
6.9.7 Emerging Technologies & Clinical AI 171
6.9.8 Ethics and Futuristic Challenges 172
6.10 Conclusion 173
6.11 Future Prospects 175
References 176
x Contents
7 A Mathematical-Based Epidemic Model to Prevent

and Control Outbreak of Corona Virus 2019 (COVID-19) 187
Shanmuk Srinivas Amiripalli, Vishnu Vardhan Reddy Kollu,
Ritika Prasad and Mukkamala S.N.V. Jitendra
7.1.1 Corona Viruses 188
7.1.2 Epidemiological Modeling Using Graph Theory 189
7.2 Related Work 189
7.3 Proposed Frameworks 190
7.3.1 Infection Spreading Model 190
7.3.2 Relation between Recovery Time and Interaction
of Antivirus Nodes 191
7.3.3 Proposed Algorithm 192
7.3.4 Detail Explanation of Algorithm 193
7.4 Results and Discussion 194
7.5 Conclusion 201
References 201
8 An Access Authorization Mechanism for Electronic Health
Records of Blockchain to Sheathe Fragile Information 205
Sowjanya Naidu K. and Srinivasa L. Chakravarthy
8.1.1 Basics of Blockchain Technology 206
8.1.2 Distributed Consensus Protocol 209
8.1.3 Smart Contracts 211
8.1.3.1 How Do Smart Contracts Work? 211
8.1.4 Ethereum and Smart Contracts 212
8.3 Need for Blockchain in Healthcare 216
8.4 Proposed Frameworks 219
8.5 Use Cases 223
8.6 Discussions 229
8.7 Challenges and Limitations 231
8.8 Future Work 231
8.9 Conclusion 232
References 233
9 An Epidemic Graph’s Modeling Application to the COVID-19
Outbreak 237
Hemanta Kumar Bhuyan and Subhendu Kumar Pani
Contents xi

9.3 Theoretical Approaches 240
9.3.1 Graph Convolutional Networks 241
9.3.2 Recurrent Neural Networks 241
9.3.3 Epidemic Modeling 242
9.4 Frameworks 243
9.4.1 Use the Data Model 243
9.4.2 Problem Formulation 244
9.4.3 Proposed Architecture 244
9.5 Evaluation of COVID-19 Outbreak 246
9.5.1 Used Datasets 246
9.5.2 Evolving an Epidemic 246
9.5.3 Predicted Analysis of the Infected Individuals 250
9.6 Conclusions and Future Works 250
References 252
10 Big Data and Data Mining in e-Health: Legal Issues
and Challenges 257
Amita Verma and Arpit Bansal
Object of Study 257
10.2 Big Data and Data Mining in e-Health 260
10.3 Big Data and e-Health in India 262
10.4 Legal Issues Arising Out of Big Data and Data Mining
in e-Health 263
10.4.1 Right to Privacy 264
10.4.2 Data Privacy Laws 265
10.4.3 Liability of the Intermediary 270
10.5 Big Data and Issues of Privacy in e-Health 271
10.6 Conclusion and Suggestions 272
References 273
11 Basic Scientific and Clinical Applications 275
Manna Sheela Rani Chetty and Kiran Babu C. V.
11.2 Case Study-1: Continual Learning Using ML for Clinical
Applications 283
11.3 Case Study-2 286
11.4 Case Study-3: ML Will Improve the Radiology Patient
Experience 289
xii Contents
11.5 Case Study-4: Medical Imaging AI with Transition from

Academic Research to Commercialization 292
11.6 Case Study-5: ML will Benefit All Medical Imaging ‘ologies’ 295
11.7 Case Study-6: Health Providers will Leverage Data Hubs
to Unlock the Value of Their Data 298
11.8 Conclusion 300
References 301
12 Healthcare Branding Through Service Quality 305
Saraju Prasad and Sunil Dhal
12.1 Introduction to Healthcare 305
12.2 Quality in Healthcare 307
12.2.1 Developing Countries Healthcare Service Quality 308
12.2.2 Affordability of Quality in Healthcare 308
12.2.3 Dimensions of Healthcare Service 309
12.2.4 Healthcare Brand Image 309
12.2.5 Patients’ Satisfaction 310
12.2.6 Patients’ Loyalty 310
12.3 Service Quality 311
12.3.1 Patient Loyalty with Service Quality in Healthcare 312
12.3.2 Healthcare Policy 313
12.4 Conclusion and Road Ahead 315
References 316
Index 321
Preface
Introduction
The novel applications of Big Data Analytics and machine intelligence in
biomedical and healthcare sector can be regarded as an emerging field in
computer science, medicine, biology application, natural environmental
engineering, and pattern recognition. The use of various Data Analytics
and intelligence techniques are nowadays successfully implemented in
many healthcare sectors. Biomedical and Health Informatics is a new era
that brings tremendous opportunities and challenges due to easily avail-
able plenty of biomedical data. Machine learning presenting tremendous
improvement in accuracy, robustness, and cross-language generalizabil-
ity over conventional approaches. The aim of healthcare informatics is to
ensure the high-quality, efficient healthcare, better treatment and quality
of life by efficiently analyzing the abundant biomedical, and healthcare
data. Earlier, it was common requirements to have a domain expert to
develop a model for biomedical or healthcare; but now the patterns are
learned automatically for prediction. Due to the rapid advances in intel-
ligent algorithms have established the growing significance in health-
care data analytics. The IoT focuses to the common idea of things that
is recognizable, readable, locatable, controllable, and addressable via the
Internet. Intelligent Learning aims to provide computational methods for
accumulating, updating and changing knowledge in the intelligent systems
and particularly learning mechanisms that help us to induce knowledge
from the data. It is helpful in cases where direct algorithmic solutions are
unavailable, there is lack of formal models, or the knowledge about the
application domain is inadequately defined. In Future Big data analytics
has the impending capability to change the way we work and live. With the
influence and the development of the Big Data, IoT concept, the need for
xiii
xiv Preface
AI (Artificial Intelligence) techniques has become more significant than

ever. The aim of these techniques is to accept imprecision, uncertainties
and approximations to get a rapid solution. However, recent advance-
ments in representation of intelligent system generate a more intelligent
and robust system providing a human interpretable, low-cost, approximate
solution. Intelligent systems have demonstrated great performance to a
variety of areas including big data analytics, time series, biomedical and
health informatics etc.
This book covers the latest advances and developments in health infor-
matics, data mining, machine learning and artificial intelligence, fields
which to a great extent will play a vital role in improving human life. All
the researchers and practitioners will be highly benefited those are work-
ing in field of biomedical, health informatics, Big Data Analytics, IoT and
Machine Learning. This book would be a good collection of state-of-the-
art approaches for Big Data and Intelligent based biomedical and health
related applications. It will be very beneficial for the new researchers and
practitioners working in the field to quickly know the best performing
methods. They would be able to compare different approaches and can
carry forward their research in the most important area of research which
has direct impact on betterment of the human life and health. This book
would be very useful because there is no book in the market which pro-
vides a good collection of state-of-the-art methods of Big Data, machine
learning and IoT in Biomedical and Health Informatics. Various models
for biomedical and health informatics is recently emerged and very un-
matured field of research in biomedical and healthcare. This book would
be very useful because there is no book in the market which provides a
good collection of state-of-the-art methods of for Big data analytics based
models for healthcare.
Organization of the Book

The 12 chapters of this book present scientific concepts, frameworks and
ideas on biomedical data analytics from the different biomedical domains.
The Editorial Advisory Board and expert reviewers have ensured the high
caliber of the chapters through careful refereeing of the submitted papers.
For the purpose of coherence, we have organized the chapters with respect
to similarity of topics addressed, ranging from issues pertaining to the
internet of things for biomedical engineering and health informatics, com-
putational intelligence for medical data processing and Internet of medical
things.
Preface xv
In Chapter 1, “An Introduction to Big Data Analytics Techniques in

Healthcare”. Anil Audumbar Pise presents the use of big data analytics in
medicine and healthcare which is incredibly powerful, productive, inter-
esting, and diverse. It integrates heterogeneous data like medical records,
experimental, electronic health, and social data in order to explore the
relations among the different characteristics and traces of data points like
diagnoses and medication dosages, along with information such as public
chatter to derive conclusions about outcomes. More diverse data needs to
be combined into big data analysis, such as bio-sciences, sensor informat-
ics, medical informatics, bioinformatics, and health computational bio-
medicine to get the truth out of its information.
In Chapter 2, “Identify Determinants of Infant and Child Mortality
Based Using Machine Learning: Case Study on Ethiopia” Sudhir Kumar
Mohapatra, Srinivas Prasad, Getachew Mekuria Habtemariam, Mohammed
Siddique developed predictive models using four supervised machine
learning techniques namely C5.0 Decision tree, Random Forest, Support
Vector Machine and Naïve Bayes algorithms using the 2016 EDHS data-
set of 10,641 records. The Ethiopian government doing for the past two
decades for attaining millennium development goals agenda for prevent-
ing childhood mortality by improving the child health’s to change the
country image to the rest of the world in reduction of childhood mortal-
ity. This study contributes some values in the improvement of childhood
health by analyzing the determinants infant and child mortality by using
machine learning techniques. Different reports indicate that the distribu-
tion of childhood mortality differs in the world.
In Chapter 3, “Pre-Trained CNN Models in Early Alzheimer’s Prediction
Using Post-Processed MRI” Kalyani Gunda and Pradeepini Gera test MRI
Scan with Dementia or Not by Non-image MRI Evidence using Random
Forest Classifier which obtained 87% accuracy without false prediction and
also by predicting Alzheimer’s Progression using advanced CNN models.
Gentle Dementia is more focused to train the Early Detection by omitting
converted MRI Sessions. Various Transfer Learning Deep Neural Networks
like Residual Network (ResNet50), GoogleNet, VGG19 (Visual Geometric
Group), MobileNet, AlexNet is compared to classify Alzheimer’s. Model
comparison evaluated to explicate model efficacy.
In Chapter 4, “Robust Segmentation Algorithms for Retinal Blood
Vessels, Optic Disc, and Optic Cup of Retinal Images in Medical Imaging”
Birendra Biswal, Raveendra T., Dwiti Krishna Bebarta, Geetha Pavani P. and
P.K. Biswal discussed the several robust segmentation algorithms such as
a new statistical-based Kurtosis test, a novel hybrid active contour method
with a new pre-processing technique is applied to fundus images of human
xvi Preface
eyes for observing the changes in Retinal Blood Vessels and Optic Disc &
Optic Cup to classify as healthy or diseased eyes.For validating all these
robust segmentation algorithms standard metrics are used in evaluating
the performance of segmentation models. Consequently, the experimen-
tal result and comparison analysis are presented to estimate the efficacy
of the proposed algorithm. As a result, standard metrics of the proposed
algorithm were compared with many other previous methods suggested by
various researchers and it is confirmed as to attain better efficacy values.
In Chapter 5, “Analysis of Healthcare Systems Using Computational
Approaches” Hemanta Kumar Bhuyan and Subhendu Kumar Pani high-
light recent contributions and efficiency of AI and ML in computer sys-
tems development for better healthcare and precision medicine. Despite
various traditional and AI-based solutions, current healthcare constraints
and challenges include uneven distribution of resources towards the future
of digital healthcare. Unmet clinical research and data analytics requires
the development of intelligent and secure systems to support the transfor-
mation of practices for the worldwide application of precision medicine.
Overarching goals include new multifunctional platforms that incorporate
heterogeneous clinical data from multiple platforms based on clinical, AI,
and technical premises. It must address possible challenges that continue
to slow the progress of this breakthrough approach.
In Chapter 6, “Expert Systems in Behavioral and Mental Healthcare:
Applications of AI in Decision-Making and Consultancy” Shrikaant
Kulkarni Present the latest technological advancements so as to showcase
futuristic challenges and a glance at potential innovations on the hori-
zon. The treatise enumerates the expert systems in behavioral and mental
healthcare areas. It also further discusses the benefits AI can offer to behav-
ioral and mental healthcare.
In Chapter 7, “A Mathematical-Based Epidemic Model to Prevent and
Control Outbreak of Corona Virus 2019 (COVID-19)” Shanmuk Srinivas
Amiripalli, Vishnu Vardhan Reddy Kollu, Ritika Prasad, Mukkamala
S.N.V. Jitendra provide a preliminary evolutionary graph theory based
mathematical model was designed for control and prevention of COVID-
19. In the proposed model, well known technique of social distancing with
different variations are implemented. Lockdown by many countries leads
to the decrease of Gross Domestic Product (GDP) and increase in mental
problems in citizens. These two problems can be solved by the administra-
tion of antivirus in some form to the public as a counterpart to the virus.
This model works more effectively with high percolation of antiviral nodes
in a population and over a period of time. There should be an exponential
growth of antivirus nodes to heal the infected population.
Preface xvii
In Chapter 8, “An Access Authorization Mechanism for Electronic

Health Records of Blockchain to Sheathe Fragile Information” Sowjanya
Naidu K. and Srinivasa L. Chakravarthy focuses on maintaining the
patient records in the blockchain immutable ledger which allows the doc-
tors to upload the patient records and give access to other doctors and
also impose certain rights to the patients to revoke the access to everyone
which provides security to the patient’s records. This can also be extended
to the insurance providers where they use the immutable ledger of the
Electronic Health Records chain to check the patient’s records and pay-
ments. Block chain technology allows the patients to assign access rules
for their medical data. Block chain technology is expected to improve the
Electronic Health records management and the claim process by the insur-
ance agencies also. Not only does the Blockchain enhance the security of
the data but it also helps to reduce the long and tedious process of the
interhospital transfers and simplifies the process of record keeping of the
Electronic Health Records. This work is beneficial to many stakeholders
who are related to the medical system to carry better health services and
provide security to the user’s rights of protecting the data. An attempt has
been made to design a framework for the individuals to access the data on
the blockchain. The frameworks propose a layered approach for accessing
the data of the patient by different stakeholders.
In Chapter 9, “An Epidemic Graph’s Modeling Application to the
COVID-19 Outbreak” Hemanta Kumar Bhuyan and Subhendu Kumar
Pani present a novel machine learning approach that can estimate any
epidemiological model’s parameters based on two types of information:
either static or dynamic. It primarily utilizes the Graph model using deep
learning approaches and Long-term memories (LSTMs) to obtain mobility
data’s spatial and temporal properties of SIR and SIRD models. It runs and
simulates using data on the Italian COVID dynamics and compares the
model predictions to previously observed epidemics.
In Chapter 10, “Big Data and Data Mining in e-Health: Legal Issues and
Challenges” Amita Verma and Arpit Bansal focus on the legal framework
with respect to privacy in India and a comparison of the same with other
countries. E-Health is a rising industry. At a time when physical healthcare
facilities are full of COVID19 patients, the e-Health Industry has become
even more diverse and is being resorted to as primary healthcare system
specially to treat regular health problems.The health data of millions of
patients is being stored online. The same is done through the concept of
Big Data and Data Mining in e-Health. In India, National Digital Health
Mission is aimed towards the use of this technique to simplify e-Health
services.
xviii Preface
In Chapter 11, “Basic Scientific and Clinical Applications” Manna Sheela

Rani Chetty and Kiran Babu C. V. discuss the various applications and its
significant advancements in medicine and health care. Appling the princi-
ples of computer science and information science to the advancement of
research in the area of life sciences, health professions education, public
health, patient care, etc. can be considered as biomedical and health infor-
matics (HI). The integrative field and multidisciplinary focuses on health
information technologies, and involves the computer, cognitive, and social
sciences. Informatics is one of the sciences which reflects how to use data,
information and knowledge to improve human health and the delivery of
health care services. HI studies the effective use of probabilistic informa-
tion for decision making. The combination of both has greatest potential to
rise quality, efficacy and efficiency of treatment and care.
In Chapter 12, “Healthcare Branding Through Service Quality” Saraju
Prasad and Sunil Dhal offer a deep insight into the service quality model
dimensions in healthcare. In India the healthcare services can be divided
into two categories like public and private healthcare services. The Public
Healthcare System (PHC) which is under the control of government is
available in cities and rural areas and provides services mostly primary
services. Majority of the private sector healthcare service providers are in
metropolis, capital cities and few others cities of the country mostly focused
on secondary and tertiary services. India got the competitive advantages
in maximum number of experienced medical practitioners.
Concluding Remarks
The chapters of this book were written by eminent professors, researchers
and those involved in the industry from different countries. The chapters
were initially peer reviewed by the editorial board members, reviewers, and
those in the industry, who themselves span many countries. The chapters
are arranged to all have the basic introductory topics and advancements as
well as future research directions, which enable budding researchers and
engineers to pursue their work in this area.
Big Data Analytics and machine intelligence in biomedical and health
informatics is so diversified that it cannot be covered in a single book.
However, with the encouraging research contributed by the researchers
in this book, we (contributors), editorial board members, and reviewers
tried to sum up the latest research domains, developments in the data
analytics field, and applicable areas. First and foremost, we express our
heartfelt appreciation to all the authors. We thank them all for considering
Preface xix
and trusting this edited book as the platform for publishing their valuable
work. We also thank all the authors for their kind co-operation extended
during the various stages of processing of the manuscript. This edited
book will serve as a motivating factor for those researchers who have spent
years working as crime analysts, data analysts, statisticians, and budding
researchers.
Dr. Sunil Kumar Dhal

Professor IT, Sri Sri University, Odisha, India
Dr. Subhendu Kumar Pani
Principal, Krupajal Computer Academy, BPUT, India
Dr. Srinivas Prasad
GITAM Institute of Technology, Visakhapatnam Campus, India
Dr. Sudhir Kumar Mohapatra
Addis Ababa Science and Technology University,
Addis Ababa, Ethiopia
March 2022
1
An Introduction to Big Data Analytics
Techniques in Healthcare
Anil Audumbar Pise *
University of the Witwatersrand, Johannesburg, South Africa
Abstract
There is a notable rise in the amount of data being generated in the healthcare
industries. Trying to improve the health outcomes and cut the costs derived from
better utilization of healthcare data has been of great interest to healthcare provid-
ers (and the abundance of the data has brought that about big change), whereas the
nature of healthcare data presents specific problems when it comes to processing
and looking at big data, particularly, as well as analyzing the abundance of it. Some
new ideas about how to deal with these problems are discussed in this chapter.
According to this chapter, there are two ways in which advances in processing
healthcare data have been made in the last 10 years that may make generating bet-
ter predictions from the medical data feasible. Firstly by using advancing techno-
logical methods of analysis and secondly developing novel models that can handle
large quantities of data.
Keywords: Healthcare analytics, predictive analytics, healthcare informatics,

big data
1.1 Introduction
Big Data has the potential to transform all sorts of business sectors, from
the wellness of individuals to the provision of healthcare. For the pur-
poses of most current day, Big Data is defined as “storing, arranging,
and processing, the current huge amounts of heterogeneous data, getting
results, and then reorganized and measured data is called Clean/Big Data”.
Email: [email protected]
Sunil Kumar Dhal, Subhendu Kumar Pani, Srinivas Prasad and Sudhir Kumar Mohapatra (eds.)
Big Data Analytics and Machine Intelligence in Biomedical and Health Informatics: Concepts,
Methodologies, Tools and Applications, (1–20) © 2022 Scrivener Publishing LLC
1
2 Big Data Analytics in Health Informatics
This pattern emerges because businesses are using technology to accom-

plish more and to help customers generate more data which creates a
greater volume of data that consumers then produce, who generate bigger
volumes of data in social networks. A variety of new developments involv-
ing more modern sources and different ways of processing data is currently
emerging in the healthcare and medical industries. One thing is clear from
the research point of view is the field of ‘omics’ in which previously used,
pre-owned data offers new approaches to e-health records, open data, and
the ‘quantified self ’ methodologies for enhancing data analytics. We have
made tremendous advances in text data extraction, which unlocks a lot of
information in the medical records for analytics. On the other hand, big
data use in healthcare, adoption of new medical and healthcare practices
are moving more slowly than people may be expected. These difficulties can
be found to their varying levels of data complexity, to issues regarding data,
organization, and regulations, and also issues concerning ethical issues. It
is very likely that new ideas and better practices for data acquisition and
data analysis will emerge from larger scales of the accumulation of big data
and the best practices. This paper takes a comprehensive look at the possi-
bilities of Big Data holds for the medical and healthcare professions.
Although big data analytics is relatively new in its role in-flux in health-
care, it is nevertheless having a significant impact in practices and research.
The system has given healthcare researchers the ability to gather, store, and
manage disparate, structured, and unstructured data generated by current
healthcare systems, as well as data sets for analysis. Larger databases and
powerful computer software have recently been used in medical research
to help with delivery and disease exploration. Some of the most basic big
data principles cannot be escaped, even though advances have been made;
as long as there are these limitations, they may persist in preventing further
development in this sector. A concern that we wanted to tackle in this paper
is the obstacles we encounter in three exciting new and emergent medi-
cal research areas: Genomic Data Analysis, Signal Detection, and Medical
Image Processing. In the most recent studies, the focus has been on employ-
ing high volume data of medical information, which integrates multimodal
information from diverse sources. In order to evaluate the capabilities and
opportunities for healthcare delivery, research focuses on areas with the
ability to make a positive difference as well as well as potential.
The remainder of this chapter is organized as follows. In Section 1.2, a
brief idea of Big Data in Healthcare is explained with basic introduction and
concept of the five Vs of big data with aspects that explore the use of big data
in medical field. In Section 1.3, Areas of Big Data Analytics in medicine are
discussed. In Section 1.4, the Concept of Healthcare a Big Data Repository
An Introduction to Big Data Analytics 3
is briefly explained. Then, Section 1.5 presents Applications of Healthcare

Big Data with examples and in Section 1.6 Challenges in Big Data Analytics
are provided. Big Data Privacy and Security policies are explained in Section
1.7. The remaining sections provide a conclusion and future work.
1.2 Big Data in Healthcare

The term “Big Data” refers to the volume, velocity, and variety of data
generated over time by healthcare providers and containing information
pertinent to a patient’s care, such as demographics, diagnoses, medical pro-
cedures, medications, vital signs, immunizations, laboratory results, and
radiology images. Figure 1.1 depicts above mentioned healthcare entities.
Optimizing ER Admissions Learning & Development

Self-Harm Prevention Developing New Therapies
B
Reducing I Smart
Fraud G Staffing
Predictive Improved Strategic
Analytics D Planning
A
T
A
Improved Patients’ I Risk & Disease

Predictions N Management
H
E
A
L
Improved T
Supply-chain H Telemedicine
EHRs C Medical
A Imaging
R
E
Prevent Opioid Abuse Aument Cancer Treatments

Enhancing Patient Engagement Real-Time Alearting
Figure 1.1 Big data in healthcare.

Veriety Veracity
1. Multifactor
2. Unstructured 1. Accountability
3. Structured 2. Authenticity
4. Probabilistic 3. Trustworthiness
4. Reputation
5 Vs of Big Data
1. Terabytes 1. Events
2. Arch/Records 2. Correlations
3. Transactions 3. Statistical
4. Files/Tables 4. Hypothetical
Velocity
Volume Value
1. Batch
2. Near/Real-Time
3. Streams
4. Processes
Figure 1.2 Five vs of big data.
According to Thota et al. [1], electronic health sources such as sensor

devices, streaming machines, and high-throughput instruments are accu-
mulating more data as medical data collection advances. This big data in
healthcare is used for a variety of purposes, including diagnosis, drug dis-
covery, precision medicine, and disease prediction. Big data has been crit-
ical in a variety of fields, including healthcare, scientific research, industry,
social networking, and government administration [1]. The five Vs of big
data are as follows as shown in the Figure 1.2 for better understanding:
1. Variety: Without a doubt, the variety of data represents

big data. For instance, among the various data formats are
database, excel, and CSV, all of which can be stored in a
plain text file. Additionally, structured, unstructured, and

semi-structured health data exist. Clinical data is an exam-
ple of structured information; however, unstructured or
semi-structured data includes doctor notes, paper prescrip-
tions, office medical records, images, and radio-graph films.
2. Veracity: This data’s legitimacy in the form of veracity can be
challenged only if it is inaccurate. It is not about the accu-
racy of the data; it is about the capacity to process and inter-
pretation of data. In healthcare, the trustworthiness function
gives details on correct diagnosis, treatment, appropriate
prescriptions, or otherwise established health outcomes.
3. Volume: Without a doubt, the large volume represents large
amounts of data. To process massive amounts of data such
as text, audio, video, and large-format images, existing data
processing platforms and techniques must be strengthened.
Personal information, radiology images, personal medical
records, genomics, and biometric sensor readings, among
other things, are gradually integrated into a healthcare data-
base. All of this information adds significantly to the data-
base’s size and complexity.
4. Velocity: Big data is completely represented by the amount of
information produced every second is considered as veloc-
ity. The information burst of social media has brought about
a wide range of new and interesting data. Data on overall
health condition and growth of the plant size and food bac-
teria are stored on paper, as well as various X-ray images and
written reports, is up dramatically.
5. Value: Big data truly embodies the value of data. When it
comes to big data analytics, the benefits and costs of analyz-
ing and collecting big data are more important. In health-
care, the creation of value for patients should dictate how
all other actors in the system are compensated. The primary
goal of healthcare delivery must be to maximize value for
patients.
1.3 Areas of Big Data Analytics in Medicine

It is of critical importance to pay attention to a multitude of events that
impact the health, both physiologically and pathologically. Occurring at
once and expressed in various ways (systemic) aspects of the body lead
A B
Genomics Signal Processing Image Processing
Figure 1.3 Areas of big data analytics in medicine.
to interaction between different cardiovascular parameters (i.e. such as

minute ventilation and blood pressure) which results in accurate clinical
evaluation. As a result, understanding and predicting diseases necessitate
an integrated data collection of both structured and unstructured meth-
ods that draw on the enormous spectrum of clinical and non-clinical data
to create a more thorough picture of disease depiction. Big data analyt-
ics has recently made its entrance into the healthcare industry, medical
researchers are excited about an entirely new aspect of this research known
as incorporating the newer concepts. Researchers are conducting research
on healthcare data pertaining to both the data itself and the taxonomy of
useful analytics that can be done on it.
Expanding on this one would include three areas of big data analytics
in medicine which is discussed in this chapter. These three research areas
do not comprehensively showcase the many ways big data analytics are
applied in medicine; instead, they provide a collection of loosely defined
use cases where big data analytics is being employed as shown in Figure
1.3.
1.3.1 Genomics
In [2] the author suggested that the estimated price of sequencing the
human DNA (the “combing cost” of) has dropped significantly in the
past few years [cost to combing the 30,000 to 35,000 gene map is now
inversely proportional to how many genes are found] on the grand scale,
and as it is to computational biology, developing genome-scale solutions
that are applied to the field of public health can have implications for cur-
rent and future public health policies and services. In 2013 [3] researcher
claimed that, the most important factor in making recommendations in

a clinical setting is the cost and time to put them in place. Prospective/
preventive, and proctical health-focused strategies aim to acquire infor-
mation on 100,000 individuals for more than two decades, known as
P4-predicted (stating only if it is possible); research using the predictive-
targeted, or integrated omics, referred to as personalomics (using your
personal data). In [4] the author suggested to include seeking solutions
over with regard to the following four aspects such as:
1. Developing scalable genome-scale data states

2. Use of tools
3. Clinical states
4. Data challenges in target validation, and integration, a big
data project.
Project (P4) is making strides by acquiring tools to help with handling

massive datasets, and then, following this, they have developed continuous
monitoring tools that aid in understanding a subject’s condition, as well as
obtaining new information, and they are moving forward in their search for
medication delivery and analytical tools. Everything that is known about a
person’s physiology and his/her physiological states in-based person well-
ness is summarized and is added to person omics (usage-driven genomics
methods) which are used to identify and detail the subject’s medical state
[5]. Although an actionable course of action at the level of care may be
one of the most difficult aspects, many improvements at the clinical level
can be pursued (even though it may be arduous). According to [6], a lot
of high-resolution data is required for exploration, discovery, and imple-
menting novel approaches. These two aspects of big data necessitate the
use of novel data analytics.
1.3.2 Signal Processing

Medical signals like medical images present volume and velocity challenges,
most notably during continuous, high-resolution acquisition and storage
from a plethora of monitors connected to each patient. Additionally, the
problem of size is posed by physiological signals in that they possess a size/
physical dimension in time and space. In order to derive the most useable
and appropriate responses from physiological data, an individual must be
aware of the circumstances that are affecting the measurements and have
continual monitoring to be established in place to assure effective use and
robustness, rigorous monitoring of those variables is required.
Currently, healthcare systems rely on a patchwork of disparate and con-

tinuous monitoring devices that use single physiological waveform data or
discretized vital information to generate alerts in the event of over events
[7]. However, such uncomplicated approaches to developing and imple-
menting alarm systems are inherently unreliable, and their sheer volume
may result in “alarm fatigue” for care givers and patients alike [8, 9]. In this
context, the capacity for new medical knowledge discovery is constrained
by prior knowledge that has frequently fallen short of fully exploiting
high-dimensional time series data. In [10] Jphan et al. suggested the reason
these alarm mechanisms frequently fail is that they rely on isolated sources
of information and lack context regarding the patients’ true physiologi-
cal conditions from a broader and more comprehensive perspective. As a
result, improved and more comprehensive approaches to studying inter-
actions and correlations between multimodal clinical time series data are
required. This is critical because research consistently demonstrates that
humans are unable to reason about changes affecting more than two sig-
nals [11, 12].
1.3.3 Image Processing

Medical images are a valuable source of data that are frequently used
for diagnosis, treatment evaluation, and planning [13]. Computed
Tomography (CT), Magnetic Resonance Imaging (MRI), Photoacoustic
Imaging (PI), Molecular Imaging (MI), Positron Emission Imaging (PEI),
and Sonography are all examples of established clinical imaging tech-
niques. However, medical image data will often have up to hundreds of
megabytes (e.g., up to 2,500+ scans [14]) for one study (in one study, for
example, histology data), or even thousands of megabytes (a large num-
ber of scans in a thin-slice CT study, e.g., proctology). Data needs a large
storage area to be held for extended periods of time. While any decision
support needs to be completed on the fly, they must be quick and precise
algorithms in order to have practical benefits. Even though these patients’
overall and individual medical data are often acquired for each of giving
additional information, as well as for their diagnoses, prognoses, treatment
procedures, and outcomes, the development of storage and methodologies
capable of gathering and maintaining relevant medical data is additionally
challenged.
Despite current healthcare systems’ enormous expenditures, clinical
outcomes remain sub-optimal, particularly in the United States of America,
where 96 people per 100,000 die annually from treatable conditions [15]. A
significant contributor to such inefficiencies is healthcare systems’ inability
to effectively collect, share, and use more comprehensive data [16]. This
creates an opportunity for big data analytics to play a more significant role
in assisting the exploration and discovery process. Improving care delivery,
assisting in the design and planning of healthcare policy, and providing a
means of comprehensively measuring and evaluating the complicated and
convoluted healthcare data. More importantly, the adoption of insights
gleaned from big data analytics has the potential to save lives, improve care
delivery, expand access to healthcare, align payment with performance,
and aid in containing the perplexing growth of healthcare costs.
1.4 Healthcare as a Big Data Repository

Healthcare is a multi-dimensional system established with the sole aim for
the prevention, diagnosis, and treatment of health-related issues or impair-
ments in human beings. These are the main parts of a healthcare system;
you have the medical personnel (doctors and nurses), which supports the
healthcare facilities (clinics and hospitals for delivering medicine and tech-
nologies), and then you have financing supporting them. The physicians
who practice in different areas of healthcare, such as dentistry, midwifery,
and psychology are health professionals known as so-aspirants. Since there
are so many issues with healthcare, it depends on the level of urgency and
extent of treatment to expand. The professional first; their clientele receives
it from a variety of treatment options, complex and invasive conditions,
both from non-professional physicians and private hospitals, and as well
as from the general medical community (non-specialized as well as well
as private) (quaternary care) [17]. A doctor, nurse, researcher, radiolo-
gist, and lab technician are all needed to have separate needs and are held
responsible for a number of different types of information. For example,
that of patient history (diagnosis and prescriptions), other medical and
clinical (data obtained from imaging and laboratory tests), and personal
history (all those that may apply), data on other medical issues as opposed
to previous record keeping methods that typically utilized handwritten or
typed case notes, in which these medical records were stored. This earlier
method was not done, this could be compared to the results of a medical
tests which are traditionally kept in an inadequate electronic systems. For
reference, an ancient papyrus from Egypt suggests that this was standard
practice even a figure in the time of 1600 BC [18]. In Stanley Reiser’s opin-
ion [19], the medical case histories do an excellent job of recording every-
thing in relation to the story of the patient, the family, and the physician,
while preserving the dynamics of the illness.
Although digital systems have long been commonplace in healthcare,

the implementation of more complex medical records is considered
modern—a “means” today for generating an expanded comprehension
of the available data sets and further learning about that health and
illness. In 2003, the Institute of Medicine, a division of the National
Academies of Sciences, Engineering, and Medicine, coined the term
“Electronic Health Records” to refer to records maintained for the
purpose of improving the healthcare sector for the benefit of patients
and clinicians. As defined by Murphy, Hanken, and Waters, Electronic
Health Records (EHRs) are computerized medical records for patients
that contain information about an individual’s past, present, or future.
Physical/mental health or condition that is stored in electronic sys-
tems that are used to capture, transmit, receive, store, retrieve, link,
and manipulate multimedia data for the primary purpose of providing
healthcare.
1.5 Applications of Healthcare Big Data

There are new applications that can make use of big data sets to explore
various avenues of knowledge, and there are methods to refine health-
care delivery to be derived from these discoveries (crucial uses, noxerous
applications). Some critically important ones include the application of
public health, clinical use, medicine based on scientific evidence, and
medical diagnosis, and verification, analysis, and patient monitoring.
These are the various healthcare frameworks and healthcare storage sys-
tems that were briefly explained to explore applications of healthcare big
data below.
1.5.1 Electronic Health Records (EHRs)

Electronic Health Records (EHRs) is by far the most prevalent use of big
data in medicine. Each patient has his or her own digital record, which con-
tains demographic information, medical history, allergies, and laboratory
test results, among other things. Records are shared securely via informa-
tion systems and are accessible to both public and private sector providers.
Each record is composed of a single modifiable file, which enables doctors
to make changes over time without incurring additional paperwork or risk
of data replication.
Additionally, EHRs can generate alerts and reminders when a patient
requires a new lab test or track prescriptions to ensure the patient is following
doctors’ orders. While EHRs are an excellent idea, many countries have yet
to fully implement them. The United States has made significant strides,
with 94% of hospitals adopting EHRs, according to this HITECH research,
but the European Union continues to lag behind. However, an ambitious
directive being drafted by the European Commission is intended to alter
that situation.
Kaiser Permanente is setting the standard in the United States and may
serve as a model for the EU. They’ve fully implemented a system called
Health Connect, which allows data to be shared across all of their locations
and simplifies the use of EHRs. According to a McKinsey report on big
data healthcare, the integrated system has improved cardiovascular disease
outcomes and saved an estimated $1 billion through reduced office visits
and lab tests.
1.5.2 Telemedicine
Television conferences, smartphones, and other wireless devices, and
wearables being able to provide on-the-demand healthcare have recently
brought about a major advancements in medical field using “Telemedicine”.
A “Telemedicine” term is used to describe healthcare and treatment facil-
ity via electronic devices. Electronic or satellite technologies are used for
the delivery of clinical services that are not close to where patients are
located.
Physicians use it for primary consultations, for early detection, for the
development of disease, and for educating their colleagues, and as a tool
for remote monitoring. While some uses, like robotic surgery, tele-surgery,
allow them to operate at a quicker pace with high-resolution data feedback,
these do not require the doctor and patient to be in the same location;
others like ultrasonography allow for the use of wider applications like
fast-molecular imaging/live motion, still apply the principle of real-time
feedback.
Clinicians deliver highly personalized treatment plans as well as helping
to keep patients out of the hospital. Prior to this most healthcare orga-
nizations had used analytical techniques such as demographics, maps,
databases, and graphical presentations in conjunction with predictive ana-
lytics to investigate issues related to healthcare delivery system growth and
geographical issues. Additionally, by making early judgments on how the
patient will respond to changes in his or her condition, this helps clinicians
predict acute illnesses before they become worse.
By keeping patients away from hospitals, telemedicine helps greatly and
reduces the cost while improving service quality. Patients don’t have to wait
in line and doctors don’t make time wasting in line or dealing with unnec-
essary paperwork a priority. Telemedicine particularly improves access to
care, since monitoring of patients’ physical conditions is now possible no
matter where they are, at any time.
1.5.3 NoSQL Database

Nowadays, much information is given to all databases, with the end
result that it exists in multiple locations for purposes that are general in
nature. There is no relationship between the tabular and non-relational
schema in a NoSQL database. To those of you are not aware, there are
many different NoSQL databases that are categorized into four main
types:
1. Those based on the keys (Key-value).

2. In-memory (Family) in which column-store (file-family).
3. Document-store (Data-memory).
4. Graph-store (Data in memory).
It’s good for simple data that is only read rarely, but has the potential
to expand to contain more data because of its expandability. It keeps vast
amounts of data in one column family; in other words, the column fam-
ily database stores huge numbers of individual columns all at once. The
semi-structured data contains vast amounts of information pertaining to
document formats, with regard to the documents in it, or data (opinions,
theories, opinions, or interpretations). The last thing on the graph is the
inversion of an N-to-M relationship, which is a Q-to-M relationship which
is recorded as an N-to-entry database.
1.5.4 Framework for Reconstructing Epidemiological

Dynamics (FRED)
It is an open-source modeling that can apply to a wide variety of disease
patterns. Every resident, office holder, owner, and entity location (enti-
ties which hold locations or locations which hold entities) is listed in the
regional economic data system FRED. Each agent is distinguished by both
by their personal sociodemographic features (such as whether they are
working, have a sex, and reside in a particular residence) and their daily
activities (their occupational, for example). The experimental populations
that are used in the FRED simulation to work out the potential spread of
disease are called artificial populations.
1.5.5 Advanced Risk and Disease Management

The hospitalization risk for a specific patient could be tackled using big
data and healthcare; it is something we cannot avoid. It is also an excellent
way to preserve the original. The use of more general information is readily
available to any institution, like the type of medication used. The number
of illnesses and the amount of visits enable healthcare providers to provide
more precise treatments and ultimately reduces the rate of hospitalization.
While space and resources will be available for the healthiest patients, this
degree of risk calculation will also mean that expenses will be kept down
for in-house and thus enhance the chances of maintaining our practice’s
financial security. This is a real-world demonstration of how analytics in
healthcare can be used to help and save lives.
Measuring and identifying factors such as genes, proteins, cell mem-
brane and organ systems, the immunology of specific diseases, and epi-
demiology can also expand their capacity for care by reducing operating
more economically while improving the quality of data management costs
across the healthcare field.
1.5.6 Digital Epidemiology

There is a form of epidemiology known as Digital Epidemiology that
incorporates digital methods from data collection to analyze data. It boosts
epidemiological methods, such as case reports, control group studies, and
ecologic studies. It makes use of case studies, ecological studies, and cross-
type studies that include cases in its investigation and a mix of controlled
trials and cohort studies, such as separate cohorts and ecological case stud-
ies. It also makes use of data sourced from other sectors such as data sets
that were originally developed for health purposes or information sets.
1.5.7 Internet of Things (IoT)

There was previously only one model for patients interacting with doctors
i.e. in person and via telephone or tele and text messaging. There was no
way that doctors and hospitals could monitor patient health continuously,
and thus be able to give prescriptions appropriately.
Innovations that can assist patients and clinicians in the ability to keep
them safe and enhance care with smart equipment enabled by the Internet
of Things (IoT) offers new possibilities for monitoring people in the medi-
cal field. At the same time, it has resulted in patient engagement and satis-
faction because physician and patient communications have become more
straightforward. Furthermore, patients’ health can be tracked and there-

fore, reduces their length of stay and lowers their likelihood of having to
return to the hospital after discharge. Widespread implementation of the
IoT can help lower healthcare costs and increase treatment effectiveness.
It is almost certain that the healthcare industry will be changed by how
it connects with devices and the physical bodies of people by means of
Internet of Things. It has applications in the healthcare industry, as well
as being beneficial to patients, family members, physicians and hospitals.
1.5.7.1 IoT for Health Insurance Companies

Healthcare devices are rapidly becoming more connected, and thus many
approaches are necessary to deal with the various scenarios that may arise
from that. A health-monitoring device can be used to assist in insurance
under writing and operational tasks, for example, is it possible for insur-
ance companies to leverage that data providing this information will help
them detect and evaluate potential clients’ claims of fraud as well as iden-
tify those who could benefit from this method of treatment.
Insurance Information Technologies (IIT) have another significant
benefit for customers. Not only are they utilized for introducing standard
under writing, pricing, but they are also utilized for risk assessment. Better
visibility means customers can view the information used in every deci-
sion, fostering data driven decisions. This allows companies to conduct
in-based thinking in all aspects of their organization, which increases cus-
tomers’ comprehension of the thought behind every decision.
Many insurance companies are researching incentives that would
reward customers for utilizing and contributing to the health data gen-
erated by IoT (Internet of Things) devices. There are various potential
approaches for better treatment compliance and more substantially com-
pliant customers who use IoT devices. They could offer these services
in exchange for their measured activity, which is something they have
control over. This will also assist insurance companies, as they work to
reduce their liability claims. As with the devices that collect data from the
Internet of Things, this type may also handle claims for insurance compa-
nies, as it is feasible that they can prove payment claims for the insurance
firms’ involvement.
1.5.7.2 IoT for Physicians

Instead of relying on health-measuring wearables and health-monitoring
wearables are used, both, for more accurate recording of the patient’s
health. Commercially available recordable clinical interventions can iden-

tify whether the patient is meeting their treatment goals as well as identify
when they are receiving care. This expanded role for healthcare workers in
healthcare delivery provides the potential for new patterns of interactions
with patients because of the IoT. The collected data from the devices assists
healthcare professionals in formulating suggestions for their patients and
leads to outcomes that can be anticipated.
1.5.7.3 IoT for Hospitals

Many patients in the healthcare facilities will benefit from IoT, but there
are also many things that will be more intricately tracked, such as well-
ness and medical issues, which can be effectively maintained with IoT
implementation. It is One Instrument/Remotely-transitioning devices,
like wheelchairs, nebulizers, and blood sensors that are useful for locat-
ing these kinds of equipment on the one time scale, as they can be moni-
tored and tracked real time, time with sensors such as the Sensor Modules.
Doctors, patients, sensors, and access to state-of-the-art equipment tech-
nology such as X-ray imaging can get quick, accurate results, regardless of
their distance from one another.
Patients should be aware of the potential infection spread because it
is significant. Useful in providing a hygienic (safe) patient monitoring
devices or associated with a hygienic (prophylactic) hygiene reduces infec-
tion. Asset items such as smartphones and environmental control are fre-
quently used for things like checking temperatures and humidity levels, for
instance, for example
1.5.7.4 IoT for Patients

How the Internet of Things has helped the elderly stay in control of their
health conditions 24/7 and has changed their lives. Most importantly, it
affects people’s lives, including those who are single, as well as their fam-
ilies. If a patient is discharged from the hospital or goes home, an alert is
issued to their family and concerned healthcare providers so they can be
located and admitted in case they require attention.
Fitness bands and other wirelessly connected devices like BP cuffs,
blood pressure, as well as glucose sensors allow patients to monitor their
condition and keep up with their personal health better-being via apps on
their phones or other devices. These devices are designed to count calories,
keep track of physical activity, measure your blood pressure, and perform
several other functions; they can be adjusted to remember everything.
1.5.8 Improved Supply Chain Management

Patients will not receive the proper care, if the supply of medical institu-
tions is weakened or destroyed. In addition, hospitals’ financing will also
become unstable, as well as other aspects of their operations, such as treat-
ment and long-term care. Next area of exploration is in the realm of big
data in healthcare which involves the value of analytics to keep the supply
chain efficient and fluent from beginning to end.
By using analytics tools to track supply chain metrics and making data
driven decisions, they can save the hospitals $10 million a year. Descriptive
and Predictive Analytics methods may assist in both formulating pricing
and curbing the range of possible variations in product, as well as opti-
mizing the ordering procedures. By expanding in the long term, this way,
institutions are able to handle numerous snags and glitches that could lead
to long wait times or failure for the patient population, while still helping
to ensure their survival.
1.5.9 Developing New Therapies and Innovations

More importantly, the last example is a call to action in healthcare analyt-
ics is to reach beyond our current limitations in healthcare to make the
world a better place. It has the ability to help research and development of
new therapies and medicinal treatments through powerful data analysis of
health records. Using a combination of historical, real-time, and predictive
metrics with a more unified visualization of data. Using healthcare pro-
cesses and visual analytics techniques, these healthcare experts can provide
an enhanced vision of emerging strengths and weaknesses before running
any more complex experiments.
Furthermore, the new genetic and biomedical technologies can allow us
to discover new drug therapies and assist in responding to medical emer-
gencies as they arise, which is how the data can make these expansive big
data analyses essential. These three aspects of data analytics have the ability
to unclog, innovate, streamline, and protect lives. Confidence and clarity
are both given to someone when they know the route ahead of time, before
the journey begins.
1.6 Challenges in Big Data Analytics

Some difficult issues should be considered when collecting large amounts
of data. The cost of experimental measurements is a factor in obtaining
high throughput ‘omics’ data. Prior to integrating these heterogeneous data

and employing data mining methods, it is necessary to consider the het-
erogeneity of the data sources, the noise in the experimental ‘omics’ data,
and the variety of experimental techniques, environmental conditions, and
biological nature. On these heterogeneous biomedical data sets, various
data mining techniques can be applied, including anomaly detection, clus-
tering, classification, association rules, as well as summarization and visu-
alization of those large data sets.
These flaws may result in the unreliability of individual data points,
such as missing values or outliers. Despite these limitations of ‘omics’ data,
EHRs data are heavily influenced by the staff who entered the patient’s
data, which can result in the entry of missing values or incorrect data due
to human error, misunderstanding, or incorrect interpretation of the orig-
inal data [20]. Integrating data from disparate databases and standardizing
laboratory protocols and values continue to be difficult issues [21].
The high dimensionality of the ‘omics’ data means that it contains many
more dimensions or features than the number of samples, whereas the
EHRs data, which contains information about individuals/patients, makes
data mining techniques more difficult to apply.
The following stage is data pre-processing, which typically entails deal-
ing with noisy data, outliers, missing values, as well as data transforma-
tion and normalization. This data pre-processing enables the application
of statistical techniques and data mining methods, thereby improving the
quality and outcomes of big data analytics and potentially resulting in
the discovery of novel knowledge. This novel knowledge obtained through
the integration of ‘omics’ and EHRs data should result in enhanced health-
care delivery to patients as well as advanced decision-making by healthcare
policymakers.
1.7 Big Data Privacy and Security

In the survey paper [22] Archenaa et al. clearly mentioned that two critical
issues in the healthcare and medical analytics sphere in regard to big data
are the privacy of patients and the protection of personal data and informa-
tion. While each country views this information as having a rightful claim
to medical data, medical data are indeed very private and confidential, and
no information is really safe [23]. A solution to these difficulties, which
means the software should be used advanced and able to obfuscate identity
data, needs to use effective encryption algorithms and, alternatively, ano-
nymize itation. In order to achieve all of these goals, software should offer
enhanced security and strict access controls that give the end users/clients
the appropriate levels of protection, it must also have excellent governance
controls that make sure user privacy and control is maintained.
1.8 Conclusion
The use of big data analytics in medicine and healthcare is incredibly
powerful, productive, interesting, and diverse. It integrates heterogeneous
data like medical records, experimental, electronic health, and social data
in order to explore the relations among the different characteristics and
traces of data points like diagnoses and medication dosages, along with
information such as public chatter to derive conclusions about outcomes.
More diverse data needs to be combined into big data analysis, such as bio-
sciences, sensor informatics, medical informatics, bioinformatics, and
health computational biomedicine to get the truth out of its information.
1.9 Future Work

As a future endeavor, the characteristics of big data provide an excellent
foundation for developing applications that can handle big data in med-
icine and healthcare using promising software platforms. One such plat-
form is Apache Hadoop Map Reduce, an open-source distributed data
processing platform that makes use of massive parallel processing (MPP).
These applications should enable data mining techniques to be applied to
these heterogeneous and complex data in order to uncover hidden pat-
terns and novel knowledge. Recent advancements in processor technol-
ogy, newer types of memories, and network architecture will reduce the
time required to transfer data from storage to the processor in a distrib-
uted environment.
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2
Identify Determinants of Infant and
Child Mortality Based Using Machine
Learning: Case Study on Ethiopia
Sudhir Kumar Mohapatra1*, Srinivas Prasad2, Getachew Mekuria Habtemariam3
and Mohammed Siddique4
Faculty of Emerging Technologies, Sri Sri University, Cuttack, India

1
2
GITAM University, Vishakapatnam, India
3
Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
4
Department of Mathematics, Centurion University of Technology and Management,
Odisha, India
Abstract
The Ethiopian government doing for the past two decades for attaining millen-
nium development goals agenda for preventing childhood mortality by improving
the child health’s to change the country image to the rest of the world in reduction
of childhood mortality. This study contributes some values in the improvement
of childhood health by analyzing the determinants infant and child mortality by
using machine learning techniques. Different reports indicate that the distribution
of childhood mortality differs in the world. According to the United Nations Inter-
Agency Group, 2017 noted the nationwide young child fatality ratio dropped into
56 percentages starting from 1990 to 2016. In 1990 the deaths per 1,000 live births
were 93 percent as well as in 2016 counted 41 percent. Ethiopian demographic and
health survey 2016 report of 2017 indicates that for the previous 5 years review, the
young child fatality ratio was 67 deaths per 1,000 live births, beside this, the neo-
nate mortality ratio was 48 deaths per 1,000 live births. The purposes of research
aimed to identify factors and developed predictive models using four supervised
machine learning techniques using the 2016 EDHS dataset of 10,641 records.
Keywords: Child mortality, EDHS, SVM, RF, C5.0, Naïve Bayes models,
sampling techniques
*Corresponding author: [email protected]
Sunil Kumar Dhal, Subhendu Kumar Pani, Srinivas Prasad and Sudhir Kumar Mohapatra (eds.)
Big Data Analytics and Machine Intelligence in Biomedical and Health Informatics: Concepts,
Methodologies, Tools and Applications, (21–46) © 2022 Scrivener Publishing LLC
21
2.1 Introduction
Ethiopia is one of the developing countries and working on different policies
to reach and join a developed country. One of these policies is the improve-
ment of infant and child health’s and reducing child mortality rate. For the
past two decades the Ethiopian government has been trying to attain mil-
lennium development goals agenda for preventing childhood mortality by
improving children’s health. This improvement of children’s health by the
government helps for the achievement of the government policy and a good
image of the country to the rest of the world. This chapter contributes some
values in the improvement of childhood health by analyzing the determi-
nants of infant and child mortality by using machine learning techniques.
Different reports indicate that the distribution of childhood mortality dif-
fers in the world. Infant and child mortality is defined according to Ethiopia
Demographic and Health surveys as the death of babies between births to
the fifth birthday and mortality rate (MR) was ration of total number of
infant and child deaths per 1,000 live births in a stipulated period of time [1].
When we look at the distribution of childhood mortality, different reports
indicated that there was still a big issue in the case of infant and child mor-
tality. Globally, an estimated 6.6 million children under five died in 2012,
where 18,000 children under five were dying every day. From this 3.2 mil-
lion of the children did not reach their fifth birthday in 2012 which most
died as a result of easily preventable infectious diseases in Africa continent’s
[2]. According to the United Nations Inter-Agency Group’s 2017 report [3]
the global under-five mortality rate declined by 56% starting from 1990 to
2016. In 1990 the deaths per 1,000 live births were 93% and in 2016 counted
41%. The burden of under-five deaths remains unevenly distributed. About
80% of under-five deaths occur in two regions, sub-Saharan Africa and
Southern Asia. Six countries account for half of the worldwide under-five
deaths, namely, India, Nigeria, Pakistan, Congo, Ethiopia, and China. The
report indicates child mortality still remains one of the great wrongs of our
modern world. According to the 2017 status report on Maternal Newborn
Child and Adolescent Health [4] in 2015, 79 countries globally have an
under-five mortality rate above 25, and 47 of them did not meet the pro-
posed sustainable development goal (SDG) target of 25 deaths per 1,000 live
births by 2030 if they continue their current trends in reducing under-five
mortality. The report indicates that in 2015 under-five mortality rate for
the continent was 76 deaths per 1,000 live births, which is 67% above the
recommended SDG target of 25 deaths per 1,000.
Ethiopian Infant and Child Mortality Using ML 23
Coming to Africa excluding North Africa 54% in under-five mortality

from 180 deaths per 1,000 live births to 83 deaths per 1,000 live births from
1990 to 2015 was recorded. A great reduction in under-five mortality of
64% (73 per 1,000 in 1990 to 24 per 1,000 in 2015) was recorded in North
Africa. The target goal of the SDG in 2030, in the annual rate of reduc-
tion of under-five mortality, should be 4.5% or more. According to this,
only six countries in Africa have under-five mortality rates at or below the
SDG target of 25 per 1,000 live births. These are Libya, Tunisia, Seychelles,
Mauritania, Egypt and Cape Verde [4].
2.2 Literature Review

A lot of studies have been conducted in the determinants of childhood
mortality in different socio-economic settings. The factors determine
childhood mortality depending on the socio-economic and environmental
situations. In this chapter, the researcher reviews different related work to
this chapter and added value in the area.
Shegaw et al. use data mining techniques to predict the risk of child mor-
tality based upon community-based epidemiological datasets gathered by
the BRHP (Butajira Rural Health Project) epidemiological study. The data
was gained from the ten years’ surveillance dataset of the BRHP epidemi-
ological study. Neural network and decision tree data mining techniques
were employed to build and test the models on sample dataset consisting
of 1,100 records taken randomly from the two classes of children (i.e. alive
and died) of the ten-year surveillance dataset of the BRHP epidemiological
study which contains a total of 64,077 records was used to build and test
both neural network and decision tree models. In features selection, the
researcher has been used consultation with public health specialists, pedia-
tricians, and researchers who have good knowledge and experience on the
data set of BRHP database [5].
The other study done by Desta et al. is in between 2000 and 2005. They
identified the bio-demographic and socioeconomic determinants of infant
and child mortality in Ethiopia. Logistic regression was applied in their
research to determine the impact of bio-demographic and socioeconomic
determinants on infant and child mortality. The results show clearly that
among bio-demographic factors marital status, birth order, type of birth
and preceding birth interval are the important proximate determinants for
both infant and child mortalities. One of the significant findings was in
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of Cortés, that he had come of his own free-will, and at the intimation
of the gods, to stay awhile with his guests. He told them to calm the
people with this assurance, and to disperse the gathering.
FOOTNOTES
[490] They had now been four days in Mexico, without going farther than the
palace, says Bernal Diaz. A page named Orteguilla, who had already acquired a
smattering of Aztec, was sent with the interpreters to ask this favor. Hist. Verdad.,
69.
[491] Soldiers who had been in Rome and Constantinople declared that never had
they seen so large and orderly a market, with so large an attendance. Bernal Diaz
indicates the site of the plaza to have been where the church of Santiago de
Tlatelulco was erected, and this still remains under the same name, over a mile
north-west-by-north of the central plaza of Mexico. Hist. Verdad., 70-1. The old
maps of Mexico already spoken of give the same site, and Alaman’s investigations
point out correctly the street which led and leads to it, although he has failed to
notice the above authorities, which give the very site. Disert., ii. 282-5.
[492] It has been generally accepted that the temple in the centre of the city was
visited, but Bernal Diaz, who is the only narrator of this excursion, states distinctly,
in several places, that the pyramid ascended was situated in the Tlatelulco
market-place, ‘adonde está aora señor Santiago, que se dize el Tlatelulco.’ Hist.
Verdad., 70-1. The description of the temple court and interior is somewhat
confused, and evidently combines points which belong to the central temple.
[493] Hence the contradictions between descriptions and views furnished by

different chroniclers, which have so greatly puzzled modern writers.
[494] Bernal Diaz, Hist. Verdad., 70-1. Sigüenza y Góngora, the well-known
Mexican scholar of the seventeenth century, follows Bernal Diaz. Anotaciones
Crit., MS., 1-2.
[495] ‘No dexarian de quedar aprobechados ... y satisfacer a su necesidad,’ says

Vetancurt, who knew the avarice of his countrymen too well to believe in denials.
Teatro, pt. iii. 131. Bernal Diaz says that Yañez, as the servant of Velazquez de
Leon and Lugo, revealed the discovery to them, and they told Cortés. The soldiers
all heard of it, and came quietly to gaze on the treasures, which rumor had already
located somewhere in the palace. ‘Being then a young man,’ says the old soldier,
‘and having never seen such wealth, I felt sure that there was not anything like it in
the world.’ Hist. Verdad., 72; Herrera, dec. ii. lib. viii. cap. ii. Tapia and Gomara
state that Cortés discovered the door-way as he was walking in his room one
evening, pondering on his plans for seizing Montezuma. ‘Cerro la puerta ... por no
escandalizar a Motecçuma, no se estoruasse por esso su prisiõ.’ Gomara, Hist.
Mex., 123; Tapia, Rel., in Icazbalceta, Col. Doc., ii. 579. Duran intimates that on
hearing of the existence of treasures in the palace, the Spaniards, including the
‘Santo Clérigo,’ occupied themselves more in searching for them than in
promoting the faith. They did not find them, however, till Montezuma revealed the
hiding-place, under the pressure of questions and, it seems, of hunger. Hist. Ind.,
MS., ii. 445-6.
[496] He refers to this promise in the second letter to the king, saying, ‘porque
certifiqué á V. A. que lo habria preso ó muerto ó súbdito.’ Cortés, Cartas, 52.
[497] ‘En la verdad era así é lo tinien acordado,’ affirms Tapia, Rel., in Icazbalceta,
Col. Doc., ii. 579. ‘Estas nueuas, falsas, o verdaderas,’ is the non-committing
phrase of Gomara. Hist. Mex., 123. Ixtlilxochitl takes firmer ground. ‘According to
an original letter in my possession, signed by the three heads of New Spain, and
written to his Majesty the emperor, our master, they exculpate Motecuhzoma and
the Mexicans of this and other charges, declaring them inventions of the
Tlascaltecs and of some Spaniards who feared that they would never see the hour
when they might leave the city and place in security the riches they had obtained.’
Hist. Chich., 296. Clavigero adopts the view that Cortés called for such testimony
from certain chiefs among his allies, whose dislike of the Mexicans would be sure
to prompt it. ‘Per giustificar vieppiù il suo attentato, e muovere i suoi Spagnuoli ad
eseguirlo, fece chiamar parecchie persone principali de’ suoi alleati (la cui
informazione dovrebbe sempre essergli sospettosa).’ Storia Mess., iii. 90-1.
Vetancurt has a story that, a drought prevailing at the time, the Spaniards induced
the heavens by means of masses and prayers to send rain. This made the priests
and idols jealous, and the emperor was prevailed on to rid himself of the
Spaniards. The Tlascaltecs learned of the plot and reported it. Teatro, pt. iii. 130.
[498] According to Bernal Diaz the members of this council suggested not only the
seizure but the reasons for it. Cortés responded that he had not been oblivious of
the danger, but saw not how the seizure could be effected. The captains proposed
to beguile the prince to their quarter and detain him. If Cortés hesitated they were
willing to undertake the task. The old soldier is evidently misled, as he was in the
scuttling affair, to assume too much credit for himself and his fellow-soldiers.
Cortés had no doubt adopted his common tactics, so frequently admitted by
Bernal Diaz himself, of inspiring his comrades to suggest what he had resolved
on. This is proved by the promise made to the emperor in his first letter, four
months before, to capture Montezuma.
[499] Bernal Diaz, Hist. Verdad., 73, followed by a number of other writers, states
that the letter was received at Mexico the morning after this meeting, but it has
been shown that he must be wrong. He mentions as one of the statements in the
letter that the Totonacs were in revolt, and it is probable that Cortés may have said
so to show the soldiers that retreat was cut off, and that seizure was the only
recourse.
[500] As both Peter Martyr and Gomara call it.
[501] The neglect of this less speedy plan does indicate that the rumors of danger
were credited to a great extent at least.
[502] Hist. Verdad., 74. Cortés in his quiet way writes to the king that, after
passing six days in the great city, and finding that for various reasons ‘it suited the
royal interest and our safety to have this lord in my power, and not wholly at liberty,
lest he change in the proposal and desire manifested to serve Y. H.... I resolved to
seize and place him in the quarter where I was.’ Cartas, 88-9.
[503] ‘Mandó que su gente dos á dos ó cuatro á cuatro se fuesen tras él ... é con
él entramos hasta treinta españoles é los demas quedaban á la puerta de la casa,
é en un patio della,’ says Tapia, who appears to have been one of those who
entered. Rel., in Icazbalceta, Col. Doc., ii. 579.
[504] ‘Cõ armas secretas,’ says Gomara, Hist. Mex., 123, and probably they did
bear extra weapons beneath their cloaks.
[505] ‘Y otras hijas de señores á algunos de mi compañía.’ Cortés, Cartas, 89. But
the customary mark of favor was to give them from his harem. See Native Races,
ii.
[506] ‘Per non dar disgusto al Re, e per avere occasione di farla Cristiana,’ is
Clavigero’s excuse for the acceptance. Storia Mess., iii. 93. Brasseur de
Bourbourg, and some other writers, assume that Cortés declined; but the original
authorities all say or intimate that he accepted. Even Cortés himself writes in his
letter to the emperor, ‘despues ... de haberme él dado algunas joyas de oro y una
hija suya,’ etc. Cartas, 89. ‘Le persuadió,’ says Ixtlilxochitl, Hist. Chich., 290.
Gomara is even more explicit, and Herrera says that Montezuma insisted, ‘porque
queria tener nietos de hombre tan valeroso.’ dec. ii. lib. viii. cap. ii. The affair is
perhaps less important in itself than as index to the character of Cortés, who could
accept so intimate an offer with one hand while he prepared a blow with the other.
It might also be made to indicate that Montezuma could have had no base designs
against him when he made the uncalled-for offer of intrusting a daughter (if such
she was) to his keeping. Still the imperial character would not have suffered had it
been shown that this was but an artifice to lull his intended victim into a false
security.
[507] Some authors, like Herrera and Torquemada, say that he denied all
knowledge of the occurrence, calling it an invention of enemies.
[508] Ixtlilxochitl, Hist. Chich., 297. ‘Q̄ tenia la figura de Vitzilopuchtli,’ Gomara,
123; and so says Bernal Diaz. Tapia states that Montezuma told Cortés to send
two Spaniards with the messengers; but he doubtless declined to risk two lives on
such a trip. Rel., in Icazbalceta, Col. Doc., ii. 583-4.
[509] ‘Ingrato rey!’ exclaims Gallo, in commenting upon this surrender of a devoted
officer. Hombres Ilust. Mex., i. 318.
[510] Bernal Diaz makes Cortés accuse the emperor of perfidy, and of having
instigated the Cholula massacre. Hist. Verdad., 74. But this he would hardly do,
since his purpose was clearly to persuade, not to arouse anger.
[511] ‘No querria començar guerra, ni destruir aquesta Ciudad ... que si alboroto, ò
vozes daua, que luego sereis muerto de aquestos mis Capitanes, que no los
traigo para otro efeto,’ is Bernal Diaz’ blunt version. Hist. Verdad., 74.
[512] ‘Auia tenido platica de su idolo Huichilobos ... que convenia para su salud, y
guardar su vida, estar con nosotros.’ Id., 75.
[513] ‘Estuuieron mas de media hora en estas platicas.’ Id., 74. Tapia and others
say four hours, which is unlikely.
[514] ‘Porque mas vale que desta vez asseguremos nuestras vidas, ò las
perdamos.’ Bernal Diaz, Hist. Verdad., 75.
[515] ‘Era, ó muy falto de ánimo, ó pusilánime, ó muy prudente.’ Oviedo, iii. 289.
‘En él se cumplió lo que de él se decia, que todo hombre cruel es cobarde,
aunque á la verdad, era ya llegada la voluntad de Dios.’ Ixtlilxochitl, Rel., 411.
[516] Bernal Diaz intimates clearly enough that no demonstration was made till
after his arrival. Hist. Verdad., 75. And so does Cortés. ‘Llorando lo tomaron en
ella [the litter] con mucho silencio, y así nos fuimos hasta el aposento donde
estaba, sin haber alboroto en la ciudad, aunque se comenzó á mover. Pero sabido
por el dicho Muteczuma, envió a mandar que no lo hubiese; y así, hubo toda
quietud.’ Cartas, 90. Ixtlilxochitl, however, allows Montezuma to stay long enough
in his palace, after ordering the litter, to enable the lords and nobles to come and
offer their services. A delay like this, which the Spaniards certainly never could
have permitted, might have given time for the tumultuous gathering which he
describes. Hist. Chich., 297. Prescott, in following this version, makes the emperor
so far overstep his usual dignity as to ‘call out’ to the people to disperse. ‘Tambien
detuvieron consigo á Itcuauhtzin, gobernador del Tlatilulco,’ says Sahagun, while
the leading nobles ‘cuando fue preso Mocthecuzoma le desampararon y se
escondieron.’ Hist. Conq., 25.
The seizure has, like the equally prominent episodes of the massacre at
Cholula, and the scuttling of the fleet, aroused no little comment in justification or
condemnation. ‘Now that I am old,’ says Bernal Diaz, ‘I stop to consider the heroic
deeds then performed, and I do say that our achievements were not effected by
ourselves, but were all brought about by God; for what men have existed in the
world who, less than 450 soldiers in number, dared to enter into so strong a city as
Mexico, larger than Venice, and so remote from Castile, to seize so great a lord?’
Hist. Verdad., 76. ‘Never Greek or Roman, nor of other nation, since kings exist,
performed a like deed, only Fernando Cortés, to seize Motecçuma, a king most
powerful, in his own house, in a place most strong, amid an infinity of people,
while possessing but 450 companions.’ Gomara, Hist. Mex., 124. Commenting on
this, Torquemada adds that ‘it was indeed a deed for daring never seen, and must
be attributed to God rather than to human heart.’ i. 458. Solis of course fails not to
extol the genius and daring of his hero, whose deed ‘appears rather in the light of
a fable’ than in consonance with simple history. Hist. Mex., i. 448. ‘A deed which
makes one tremble even to conceive, and much more to carry out. But God had
so determined it.’ Ixtlilxochitl, Hist. Chich., 296. ‘History contains nothing parallel to
this event, either with respect to the temerity of the attempt, or the success of the
execution,’ etc. Robertson’s Hist. Am., ii. 60. ‘An expedient, which none but the
most daring spirit, in the most desperate extremity, would have conceived.’
Prescott’s Mex., ii. 159. ‘An unparalleled transaction. There is nothing like it, I
believe, in the annals of the world.’ Helps’ Cortés, ii. 351. Clavigero is less carried
away by the incident, for he sees therein the hand of God. Nevertheless, he
sympathizes with Montezuma. Storia Mess., iii. 95, etc. Pizarro y Orellana finds
the deed eclipsed by the similar achievement, with a smaller force, under his
namesake Pizarro. Varones Ilvstres, 89-90. And later Mexican writers, like
Bustamante, see, naturally enough, nothing but what is detestable in the incident,
for according to the native records which form their gospel, Montezuma was
guiltless of any base intents. Unfortunately for them, these very records paint him
a blood-thirsty despot who punishes the slightest offence against himself, even
when merely suspected, with the most atrocious cruelty; one who is continually
seeking his aggrandizement at the expense of inoffensive, peace-loving tribes,
who oppresses not only conquered peoples, but his own subjects, with
extortionate taxes and levies to satisfy his inordinate appetite for pomp and for
new conquests. These records also admit that he had repeatedly sent sorcerers, if
not armies, to entrap and destroy the Spaniards. He who looked calmly on
hecatombs of his own subjects, slaughtered before his very eyes, would not
hesitate to condemn strangers for plotting against the throne which was dearer to
him than life itself. The Spaniards may have anticipated events considerably, but
there is no doubt that numerous personages, from Cuitlahuatzin downward, were
bitterly opposed to their enforced guests, and they would sooner or later have
realized the rumors which the allies began to circulate. Placed as he was, Cortés’
duty to himself, to the men intrusted to him, to his king, and to the cause of
religion, as then regarded, required him to give heed to such rumors, and, after
weighing their probability, to take the precautionary measure of seizing the
monarch, since retreat not only appeared fraught with disaster and dishonor, but
would be regarded as a neglect of opportunity and of duty. With Cortés, naught but
the first steps in assuming the conquest, and in usurping certain credit and means,
can be regarded as crimes, and the former of these was forced upon him by
circumstances of his age and surroundings. Every project, then, conceived by him
for the advancement of his great undertaking must redound to his genius as
soldier and leader. Of course, among these projects appear many which did not
advance the great object, and which must be condemned. But where do we find
greatness wholly free from stain?
CHAPTER XVIII.
DOUBLY REFINED DEALINGS.
1519-1520.
Hollow Homage to the Captive King—Montezuma has his Wives and

Nobles—He Rules his Kingdom through the Spaniards—The Playful
Page—Liberality of the Monarch—The Sacred Treasures—Cortés
Resents the Insults of the Guard—Diversions—Quauhpopoca, his Son
and Officers, Burned Alive—Plantations Formed—Villa Rica Affairs—
Vessels Built—Pleasure Excursions.
A pompous reception was accorded the imperial prisoner. With

no small ceremony was he conducted to apartments adjoining those
of Cortés, as selected by himself, and there surrounded by all
accustomed comforts and every show of greatness. At hand were
his favorite wives, his most devoted servants; he held court daily,
received ambassadors, issued orders, and with the aid of his learned
jurists administered justice. To outward appearance the monarch
was as absolute as ever; yet Montezuma knew that his glory had
departed, that the continued forms of greatness were hollow, and
that his power was but the power of a puppet. He was wise enough
to know that a strong man is not to be trusted who is officiously kind
to a weak one.
Henceforth the power of the nation, in the hands of these
insidious strangers, was to be directed against himself. It was a
cunning policy, craftily conceived and deftly executed.
Cortés took care that everything round the prisoner should move
smoothly, and that his presence in the Spanish quarters should
appear to the natives a voluntary rather than an enforced visit. To his
more intimate lords and subjects, however, who knew better his
condition, and who sometimes urged him to return to his palace, the
poor captive would say, “Ah, no! it is the will of the gods that I remain
with these men and be guided by their counsel.” But on no account
must the imperial influence be allowed for the present to decline
before the people. The deception must be continued, and the dignity
of the sovereign upheld by a deferential attention as profound as that
which was shown before his imprisonment. Daily, after prayers, the
Spanish general came to pay his respects, attended by several of his
captains, more frequently Alvarado, Velazquez, and Ordaz, and to
receive the imperial commands with respect to his comforts,
pleasures, and duties. On these occasions, and indeed whenever he
appeared before the emperor, says Bernal Diaz, Cortés set the
example to his followers by doffing his hat and bowing low, and
never did he presume to sit in the royal presence until requested to
do so.
Yet a most unpleasant reminder to the monarch of his
circumscribed authority was the ever present guard in and around
his apartments.[517] This was under the command of Juan Velazquez
de Leon, who enforced the strictest watch, particularly when it
became known that Montezuma’s courtiers lost no opportunity to
urge escape, and that he lent them a not unwilling ear, despite the
professed desire to remain with the Spaniards. Among the several
schemes with this object are mentioned bored walls, tunnels beneath
the palace, and an attempt by the emperor himself to leap from the
summit of the building into a safe receptacle prepared for him.[518]
Espionage was also established on the emperor in his
intercourse with courtiers, by placing in the apartment the page
Orteguilla, who had acquired a fair knowledge of Aztec. Of
prepossessing appearance, agreeable and sprightly in manner, the
youth became a favorite with the captive king. Among other things,
the little spy gave the monarch an insight into Spanish customs and
proceedings at home and abroad, into the power and grandeur of the
Castilian king, and into the mysteries of the faith. Being constantly
together they grew familiar, Montezuma delighting to play pranks on
the boy, throwing aloft his hat, and laughing at his efforts to regain it.
These tricks were always followed by a liberal reward.[519]
Montezuma was indeed most liberal with all who came in contact
with him, as became the character of a great and rich prince. Not
only jewels, robes, and curiosities, but male and female slaves, were
freely dispensed, partly no doubt with a view to secure good
treatment from the guard. A considerate thoughtfulness and gentle
manner added to his popularity, and “whenever he ordered,” says
the old soldier, “we flew to obey.” The inconsiderate pride and
selfishness of the independent monarch seems to have disappeared
in the prisoner, yet like the captive hawk he was submissive only to
his masters. Orteguilla kept him informed of the rank and character
of the men, and became the recognized medium for his favors. He
represented, for instance, that Bernal Diaz longed to be the master
of a pretty maiden, and Montezuma, having noticed the exceeding
deference of the soldier, called him, saying that he would bestow on
him a fine young woman, whom he must treat well, for she was the
daughter of a chief. He also gave him three quoits of gold and two
loads of robes.[520] The gift came from the emperor’s harem, from
which he frequently drew to please those whom he delighted to
honor. The vacancies thus created were filled from noble families,
who like those of more advanced countries regarded it an honor for a
daughter to occupy the position of royal concubine. After his
imprisonment Montezuma seems to have disposed of his wives quite
rapidly, a number of them falling to leading Spaniards.[521] To Cortés
he offered for the second time a daughter, prettier than the one given
him on the day of his capture, but in this instance the gift was
declined in favor of Olid, who accepted her, together with any
number of presents, and was henceforth treated as a relative by her
imperial father. Both she and the sister with Cortés were baptized.
[522]
The soldiers generally were by no means forgotten in the

distribution of women and other gifts, and in course of time the
quarter became so crowded with male and female attendants that
Cortés found it necessary to issue an order reducing the number to
one female servant for each man. Informed of this, Montezuma
instructed his mayordomo to provide good accommodation and
sustenance for them elsewhere.[523]
Encouraged by this generosity, Cortés approached him one day
regarding the secreted treasures, which had been so long respected,
but which he desired to have in his possession. He regretted to say
that his graceless soldiers had come upon the treasure-chamber,
and regardless of his instructions had abstracted a number of jewels.
The emperor hastened to reassure him; perhaps he understood the
hint. The contents of the chamber belonged to the gods, he said; but
the gold and silver might freely be taken so long as the rest was left.
[524] He would give more, if required. Cortés did not scruple to avail
himself of the permission, by appropriating for himself and his
intimate friends a large share. So charged the discontented soldiers,
but the main portion appears to have been reserved for the general
distribution not long after. Although the most valuable part of this
collection had been freely surrendered, the soldiers hesitated not to
seize also upon other effects, such as liquid amber and several
hundred loads of cotton fabrics. Cortés wished to restore them, but
Montezuma declined, saying that he never received anything back.
[525]
On another occasion the Spaniards discovered the imperial
warehouse for cacao beans, the most common currency of the
country, and for some time made nightly raids on it with their Indian
carriers. Cortés proposed to mete out punishment for this, but finding
that Alvarado was a leading culprit, he dropped the matter with a
private reprimand.[526]
Montezuma’s good nature was imposed upon in more ways than
one, and with all his kindness he could not command consideration
from the rougher soldiers and sailors. One of the guard, after being
requested, with a gift, to discontinue certain unseemly acts, repeated
the offence in the hope of receiving another bribe; but Montezuma
now reported him to his captain, and he was removed. Cortés, who
was determined to enforce respect for the captive, inflicted severe
punishment on offenders in this respect. Tired of patrol duty, Pedro
Lopez said one day in the hearing of Montezuma, “Confusion on this
dog! By guarding him constantly, I am sick at stomach unto death!”
Told of this, the general had the man lashed in the soldiers’ hall, and
this regardless of his standing as a good soldier and an archer of
great skill. Another who showed insolence to the emperor was
ordered hanged, but escaped with a lashing at the intercession of
the captains and of Montezuma.[527] This strictness insured respect
not only for the emperor, but for Cortés, so that the quarter became
most exemplary for its good order.[528]
The Spaniards united heartily with the native courtiers to
entertain the captive and to remove so far as possible whatever
might remind him of his lost liberty. He found great delight in their
military exercises, which recalled the faded prowess of his youth and
exhibited the tactics which contributed so powerfully to Spanish
supremacy over native arms. He also enjoyed sports, and among
games the totoloque was his favorite. This consisted in throwing
small golden balls at pieces of the same metal set up as targets at a
certain distance. Five points won the stakes. Cortés often played it
with him, and Alvarado, who kept count for the general, usually
marked more points than he was entitled to. Montezuma playfully
protested against such marking, although what Cortés won he gave
to the Mexican attendants, while Montezuma presented his gains to
the Spanish guard.[529]
Montezuma was at times allowed to visit his palaces, and to
enjoy the hunting-field, but these trips were of rare occurrence,
owing to the danger of popular demonstrations.[530] On such
occasions, says Cortés, the escort of prominent Mexicans numbered
at least three thousand. The first time Montezuma requested this
privilege it was for the purpose of offering prayer and sacrifice at the
great temple, as required by his gods, he said; and although Cortés
did not like the arrangement, his prisoner convinced him that this
public demonstration was necessary, in order to show the people
that he was not kept in compulsory confinement, but remained with
the strangers at the order of the deity he was about to consult. Four
captains were appointed to escort him with a guard of one hundred
and fifty soldiers, and he was warned that any attack upon them, or
any attempt at rescue, would result in his own death. He was carried
in a rich litter, attended by a brilliant procession of nobles, and
preceded, according to custom, by a dignitary bearing the triple
wand which indicated that the emperor was approaching and
demanded loyal veneration.
On reaching the temple the imperial worshipper stepped forth,
leaning on the arms of his relatives, and was assisted to the summit.
Human sacrifices had been forbidden, and Father Olmedo came to
watch over the observance of the order; but it appears that four
captives had been offered during the night, and despite the
remonstrances of the friar the attendant rites went on.[531] The
captains thought it prudent not to exceed a protest, and
congratulated themselves when the ceremony was ended and the
emperor safely back in their quarters.
A fortnight after the seizure of Montezuma, Quauhpopoca
arrived in the capital, accompanied by his son and fifteen of his staff.
He made his entry with the pomp befitting a powerful governor and a
relative of the sovereign, and hastened to the palace. As was
customary with subjects who were about to appear in the imperial
presence, the rich robes were covered with a coarse cloak, in token
of humiliation. His master received him with a stern countenance,
and signified his displeasure at the proceedings which under pretext
of his authority had caused loss of Spanish life. No attention was
paid to explanations, and he was surrendered with his followers to
the Spaniards, to be dealt with as they thought fit.[532] Cortés held a
trial: he was a shrewd inquisitor, and his sentence was sure to
accord with his own interests. “Are you a vassal of Montezuma?” he
asked of Quauhpopoca. “What else could I be?” was the reply. “Did
you attack Spaniards by his order?” The prisoner was in a most
serious dilemma. At first he refused to implicate the emperor, but
finding that his fate was sealed he confessed having acted under his
orders.[533] This could not avail him, however, for in obeying his
master he had injured the subjects and outraged the laws and
majesty of the Spanish king, who was sovereign of all, and this
demanded punishment.
The fact was that Spanish prestige, on which so much
depended, had suffered through the machinations of the governor,
and it was considered necessary to restore it. Therefore it was
decreed that Quauhpopoca, with his son and officers, should be
burned alive in the plaza, before the palace. Cortés availed himself
of the opportunity to seize all the arms in the arsenals,[534] and
therewith build a pyre worthy such noted offenders.
When all was ready Cortés presented himself before the
emperor, and announced with a severe tone that the evidence of the
condemned showed their acts to have been authorized by him, and
as a life called for a life, according to Spanish laws, he deserved
death. Cortés, however, loved him—for himself, his generosity, and
services he loved him too dearly to let justice have its course, and
would take on himself to appease its demands by a nominal
punishment.[535] He then turned on his heel, while one of the
soldiers clasped a pair of shackles round the prisoner’s ankles, and
the mighty emperor of the Aztecs was ironed. For a moment
Montezuma stood rooted to the floor. Then he groaned with anguish
at this the greatest indignity ever offered his sacred person. He
trembled with apprehension at what might yet follow. His courtiers
were no less afflicted, and with tears in their eyes they knelt to
lessen the weight at least of the shameful bonds, and with bandages
to relieve the imperial limbs.[536]
Meanwhile the troops formed an imposing cordon in front of the
palace to prevent a rescue of the condemned as they were led out
and tied to the stake. Writhing with pain, yet mute as became brave
warriors, with the ascending smoke from Aztec shields and darts
they rendered up their anguished souls. It was rare strategy thus
with the offenders to destroy the means of offence. Supposing that
the execution was by imperial sanction, the populace tacitly
assented, gazing on the horrid spectacle with pallid faces and bated
breath. Though accustomed to scenes like this in connection with
their religious festivals, it appeared terrible when perpetrated by
foreigners, to the dreary sound of muffled drums.[537]
All being over, Cortés reëntered the apartments of Montezuma
with his captains, and kneeling down he himself took off the fetters,
declaring that he felt deeply grieved at the infliction, for he loved him
as a brother. The monarch became almost hysteric with joy at this
deliverance, and with falling tears he expressed himself in abject
terms of gratitude, like the dog licking the hand which has chastised
it. Every fresh incident reveals some new trait in the character of this
unhappy man which calls for pity or contempt. “Yet further,”
continued Cortés, “to show my deep regard and confidence, you are
now at full liberty to return to your own house.” But Montezuma
understood well enough that these were but words, an empty offer;
indeed he had been informed by the well prompted page that,
although the general might wish to release him, the Spanish captains
would never permit it.[538] He accordingly expressed his thanks, and
said that he preferred to remain with him, giving as a reason that,
were he free, the importunities of his relatives and nobles to attack
the Spaniards might prevail over his friendship for them and their
king, and this would entail not only loss of life on both sides, but the
ruin of the city. Thereupon Cortés embraced him with every
appearance of deep devotion, and said, “Next to my king you shall
be king; vast as are your possessions, I will make you ruler of more
and greater provinces.”[539]
We can imagine the words by which the Spaniards might justify
to themselves the death of Quauhpopoca, but we cannot understand
the object in degrading the emperor in the eyes of his subjects—an
act which they had hitherto been so careful to avoid—unless it was
to lift themselves in their own esteem and that of the natives, far
above the highest American princes and powers, and to impress the
sacredness of their persons on the minds of the Indians. Further
than this, they seemed to think some punishment of the emperor
necessary, either because he had authorized the Nautla outrage, or
because he had countenanced it by neglecting to reprimand the
perpetrators. At all events, the effect was salutary, so much so that
Spaniards were to be seen wandering singly about the country
without fear of molestation.[540]
This effect, which extended also to adjoining independent
provinces, enabled Cortés to carry out the long-cherished project of
gathering information on the condition of the country, particularly its
political feeling and its mineral resources. Montezuma readily gave
the aid requested by providing maps and officials to guide the
exploring parties. The first investigations were directed to the upper
parts of Rio Zacatula and to Miztecapan, some eighty leagues south
of the capital, and to the northern branches of the Papaloapan,
whence most of the gold was said to come.[541] The Zacatula party
was headed by Pilot Gonzalo de Umbría, in compensation perhaps
for the loss of his feet at Villa Rica. He returned before the other
parties, within the forty days allowed for the trip, and brought about
three hundred pesos’ worth of gold dust, washed out in dishes from
three rivers, by order of the cacique. Two chiefs accompanied him,
bearing gold presents of nearly the same value as the dust, and
offering allegiance to the Spaniards in the name of their caciques.
[542] Small as was the treasure, it afforded a substantial proof of the
glowing report of Umbría. He had passed through three beautiful and
fertile provinces, filled with towns containing buildings equal to any in
Spain. He described a fortress finer in appearance and stronger than
the castle of Búrgos, and the people of Tamazulapan as most
superior in dress and intelligence.[543]
Another party, under one Pizarro,[544] proceeded south-

eastward, through Tochtepec and Malinaltepec, both of which
yielded them gold dust to the value of about three hundred pesos.
Descending along the northern fork of Papaloapan, they reached the
country of the Chinantecs, hostile to the Aztecs who had taken some
of the border towns. Their independence had not otherwise been
affected, owing to their mountain fastnesses, their warlike spirit, and
their formidable weapons, which were pikes about twenty feet in
length. They invited the Spaniards to enter, but would not allow the
Mexican escort to cross the boundary. The guides warned Pizarro
not to trust himself to what they termed a treacherous people, but
after a brief hesitation he advanced and received a hearty reception.
Aid was given to search for gold, of which seven hundred pesos’
worth was obtained from several rivers, most of it in rough grains.
[545]On his return he brought two chiefs, who bore presents of gold
from their chief cacique Cohuatlicamac, and tendered his allegiance
on condition that the Aztecs should not be allowed to enter the
country. Finding the inhabitants so friendly and the province rich in
resources, Pizarro left four of his small party behind to establish
cacao and maize plantations and to search for more gold.[546]
The project appears to have found favor with Cortés, who

besought Montezuma to form plantations for the king also in his
adjoining province of Malinaltepec. This was at once attended to,
and within two months four substantial houses and a vast reservoir
had been constructed, and a large tract of land brought under
cultivation, the improvements being valued at twenty thousand pesos
de oro.[547]
Another important object was to find a better harbor than Villa
Rica, and the emperor being consulted, he at once ordered a map to
be made, which showed very accurately not only the rivers and inlets
already known to the Spaniards, between Pánuco and Tabasco, but
the yet unknown Rio Goazacoalco, beyond the Mexican border. This
being said to have a large and deep entrance, Cortés availed himself
of Ordaz’ offer to examine it. Ten men, chiefly sailors and pilots, and
some guides, accompanied him, and authority was given to take
escorts from the frontier garrisons. He proceeded to
Chalchiuhcuecan or San Juan de Ulua, and thence followed the
coast examining the inlets.
On reaching the frontier complaints became numerous against
the native garrisons by reason of raids and outrages, and supported
by the chiefs who attended him he reprimanded the commanders,
threatening them with the fate of Quauhpopoca unless they
restrained the troops. They used to extend their raids into the
Goazacoalco province, but were at present somewhat guarded,
owing to a repulse wherein a number of comrades had perished.[548]
Ordaz’ proceedings served him well, for Tuchintlec, the cacique
of this province, sent a deputation of leading men to extend a
welcome, and furnished canoes and men to aid in sounding the river.
The bar was found to be at least two fathoms and a half deep at low
water, and above this, for twelve leagues, the soundings showed
fully five fathoms, with a prospect of an equal depth for some
distance, whereupon the pilots expressed the opinion that the
channel might be a strait leading to the southern sea.[549] Ordaz
received not only presents of gold and pretty women for himself, but
brought with him messengers bearing jewels, tiger-skins, feathers,
and precious stones for Cortés, together with an offer of allegiance
and tribute similar to those already tendered by the neighbors of
Tabasco. His report, which extolled the agricultural resources as well
as the port, induced the general to send with the returning
messengers another party to examine these features more
thoroughly and to test the disposition of the inhabitants. They again
sounded the river, selected a town site, and reported in favor of a
settlement. The cacique also expressed himself eager to receive
settlers, and offered to begin at once the construction of houses.
This decided Cortés to establish a colony on the river, and in April
Juan Velazquez and Rodrigo Rangel set out with one hundred and
fifty men to carry out the project. This, however, was not destined to
be so speedily accomplished.[550]
Meanwhile Villa Rica had been a source of no small anxiety to
Cortés. He had appointed Alonso de Grado to fill the vacant place of
Escalante, as commander of the fortress, and as his lieutenant in the
district. Grado was a man of agreeable presence and conversation,
and with some fame among his comrades as a writer and musician,
but more of a braggart than a soldier, with decided sympathies in
favor of Velazquez. Indeed, Bernal Diaz charges him with having
been the ringleader of the mutinous demonstration at Tlascala.
Cortés was well acquainted with the character of the man; but his
glib tongue had evidently overcome the prudence of the general, or
else he preferred a less bold spirit than Escalante’s at this post.
“Now, Señor Grado,” said he in handing him his commission, “here is
the fulfilment of your long felt desire of going to Villa Rica. Take care
of the fort, treat the Indians well, and do not undertake any
expeditions like that of Escalante, or you may meet his fate.” “In
saying this,” adds Bernal Diaz, “he gave us soldiers a wink, which we
readily enjoyed, knowing well enough that Grado would not venture
to do so, even under penalty of disgrace.” The office of alguacil
mayor, held by the former commander, was not included in the
present commission, but was given to Sandoval, and when Grado
remonstrated he was promised compensation in due time.
On reaching Villa Rica the evil nature of the man came to the
front. He assumed pompous demeanor, and expected the settlers to
serve him as a great lord, while the Totonacs were pressed for gold
and female slaves. The fort and the duties connected with it were
neglected, and the commander spent his time in gormandizing and
gambling, not to mention the secret efforts to undermine his
general’s influence and to gain adherents for Velazquez. This soon
reached the ears of Cortés, who felt not a little annoyed at having
trusted such a fellow. He recognized the necessity of intrusting this
district to one thoroughly devoted to himself, since a fleet from Cuba
might at any moment arrive and create mischief. Therefore he sent
Sandoval, who was brave and prudent, as well as loyal, and with him
Pedro de Ircio, a former equerry, of insinuating manners and
gossiping tongue, whom Sandoval elevated to a commanding
position.[551]
Grado was immediately sent up to Mexico under a native guard,
and when he arrived, with hands tied and a noose round his neck,
the soldiers derided him, while Cortés felt half inclined to hang the
fellow. After a few days’ exposure in the stocks he was released, and
soon his smooth persuasion paved once more a way to the favor of
his general, with whom he became so reconciled as to obtain the
office of contador not long afterward.
Among the instructions to Sandoval was one to send to Mexico
two shipwrights with ship-building implements, also chains, iron,
sails, rope, compass, and everything needful to fit out four vessels
which had been placed on the stocks shortly after the seizure of the
emperor.[552] The object was to afford a means for the ready
movement of troops and for escape in case of an uprising, when the
bridges would doubtless be raised. In asking Montezuma for aid to

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is briefly explained. Then, Section 1.5 presents Applications of Healthcare

1.2 Big Data in Healthcare

Optimizing ER Admissions Learning & Development

Improved Patients’ I Risk & Disease

Prevent Opioid Abuse Aument Cancer Treatments

Figure 1.1 Big data in healthcare.

Figure 1.2 Five vs of big data.

According to Thota et al. [1], electronic health sources such as sensor

1. Variety: Without a doubt, the variety of data represents

plain text file. Additionally, structured, unstructured, and

1.3 Areas of Big Data Analytics in Medicine

Genomics Signal Processing Image Processing

Figure 1.3 Areas of big data analytics in medicine.

to interaction between different cardiovascular parameters (i.e. such as

claimed that, the most important factor in making recommendations in

1. Developing scalable genome-scale data states

Project (P4) is making strides by acquiring tools to help with handling

1.3.2 Signal Processing

Currently, healthcare systems rely on a patchwork of disparate and con-

1.3.3 Image Processing

1.4 Healthcare as a Big Data Repository

Although digital systems have long been commonplace in healthcare,

1.5 Applications of Healthcare Big Data

1.5.1 Electronic Health Records (EHRs)

1.5.3 NoSQL Database

1. Those based on the keys (Key-value).