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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Objectives: Technologies designed to optimally maintain older people as they age in their desired places of residence are proliferating. An important step in designing and deploying such technologies is to determine the current use and familiarity with technology in general among older people. The goal of this study was to determine the extent that community-dwelling elderly at highest risk of losing independence, the oldest old, use common electronic devices found in residential urban or rural settings. Methods: We surveyed 306 nondemented elderly age 85 or over; 144 were part of a rural aging study, the Klamath Exceptional…Aging Project, and 181 were from an urban aging cohort in Portland. Results: The most frequently used devices were televisions, microwave ovens, and answering machines. Persons with mild cognitive impairment were less likely to use all devices than those with no impairment. Higher socioeconomic status and education were associated with use of more complicated devices. Urban respondents were more likely than rural ones to use most devices. Conclusion: Technology use by very old community-dwelling elderly is common. There are significant differences in use between rural and urban elderly.
Keywords: Technology use, geriatrics, mild cognitive impairment, rural, survey research
Abstract: Body weight supported (BWS) treadmill exercise could potentially improve the cardiopulmonary fitness of those with an incomplete spinal cord injury (SCI). Despite this, methods for estimating key cardiopulmonary performance parameters have not been investigated. We investigated whether new exercise test protocols for BWS treadmill exercise in incomplete SCI enable accurate determination of key cardiopulmonary performance parameters and examined how these parameters change with training. Two subjects with incomplete SCI carried out 20 weeks of BWS treadmill training (BWSTT). They performed an incremental exercise test (IET) and constant load step exercise test (SET) at baseline and 4-week intervals. After training, peak…work rate had increased from 1.41 to 9.37 W in subject A and from 6.22 to 43.99 W in subject B. Peak oxygen uptake changed in subject A from 8.23 to 10.19 ml.kg-1 .min-1 and from 13.84 to 13.91 ml.kg-1 .min-1 in subject B. Dynamic O2 cost decreased from 115 to 29.03 ml.min-1 .W-1 (subject A) and from 66.57 to 4.52 ml.min-1 .W-1 (subject B). Gas exchange thresholds could not be identified from the IETs. V̇O2 kinetics could be identified during only 2 of subject B's SETs. Accurate estimation of key cardiopulmonary performance parameters was limited. The new protocols have the potential to characterise cardiopulmonary status and monitor adaptations to training interventions, but require testing with a larger subject cohort.
Abstract: Rotational malalignment after intramedullary nailing of femoral fractures is common, and symptoms occur when malrotation reaches 15°. Intraoperative measurement of rotation remains difficult, and multiple techniques have been described to address this. Regardless of the method used, rotational toggling may occur between the interlocking screws and the screw holes. We hypothesized that a clinically significant amount of rotation may occur with standard statically locked intramedullary nails. Mid-shaft diaphyseal fractures were created in 24 cadaveric femurs. Specimens were divided into 4 groups, and were stabilized with a statically locked intramedullary nail, a dynamically locked intramedullary nail, a compression plate,…and a locking plate. Six additional femurs were kept intact as a control group. Specimens were mounted in a custom holding jig, which stabilized the constructs proximally and allowed free rotation distally. A computer navigation system was applied, and the femoral anteversion was measured. 4 N-m of internal and external torque was applied, and the change in version was measured. The statically locked nails rotated 14.2°, and the dynamically locked group rotated 15.7°. Both intramedullary nail groups showed significantly greater rotation than the plated groups. The compression plate specimens rotated 6.5° on average, and the locked plate group rotated 3.8°. Intramedullary femoral nailing with static or dynamic interlocking allows 15° of rotation of the femur around the nail under physiologic load. This may exacerbate intraoperative errors in determining and setting rotation. Angular stable plates or nails may minimize this problem.
Abstract: Older people are an important and growing sector of the population. This demographic change raises the profile of frailty and disability within the world's population. In such conditions, many old people need aides to perform daily activities. Most of the support is given by family members who are now a new target in the therapeutic approach. With advances in technology, robotics becomes increasingly important as a means of supporting older people at home. In order to ensure appropriate technology, 30 caregivers filled out a self-administered questionnaire including questions on needs to support their proxy and requirements concerning the robotic agent's…functions and modes of action. This paper points out the functions to be integrated into the robot in order to support caregivers in the care of their proxy. The results also show that caregivers have a positive attitude towards robotic agents.
Keywords: Old people, caregivers, needs, burden, robot
Abstract: This study aims to explore older adults' privacy considerations for technology based monitoring applications in eldercare that use video systems. It specifically aims to introduce alternative vision based tools and identify whether distorting or “anonymizing” captured images affect older adults' privacy concerns and willingness to allow such an application to be installed in their residence. Ten residents of an independent retirement community were recruited to participate in a series of scenarios. Each scenario involved a daily activity such as sitting in the living room and having a visitor, or preparing a snack. These sessions were video-recorded using different image processing…and extraction approaches. Follow-up in-depth interviews with participants were conducted after a demonstration of the captured images. Findings indicate that shape extraction can alleviate privacy concerns associated with the use of cameras. Participants expressed no privacy concerns with silhouette images and emphasized the importance of anonymity in the video sequences. They furthermore expressed the desire to control system operation by being able to turn a vision-based system off and on, and also determine who has access to the collected information.
Abstract: Microdamage in bone contributes to fractures and acts as a stimulus for bone remodeling. Osteocytes are the most abundant cells in bone, and their death by microdamage has been suggested to be the major event leading in the initiation of osteoclastic bone resorption. Even though there is increasing evidence that osteocyte density, microcracks and targeted remodeling are related, there still exist several questions. For example, how osteoclasts are targeted to the specific site of microdamage for repair. It has been proposed that apoptotic osteocytes could secrete a specific signal to target osteoclasts. The other question is the nature of this…signal. To elucidate the role of microdamage-induced osteocyte cell death in the initiation of targeted remodelling, this paper discusses the potential use of an in vitro model, in which osteocytes can be three-dimensionally cultured and locally damaged. Furthermore, the method enables one to study the osteocyte-derived soluble interactions with bone marrow cells. It was demonstrated that damaged osteocytes locally affect osteoclast precursors by secreting osteoclastogenic factors, and thus can have a role in the initiation of resorption in bone remodelling. This strongly supports the idea that damage to osteocyte cellular network has the potential to stimulate osteoclastic proliferation and therefore the activation of Basic Multicellular Units (BMUs).
Keywords: Osteocyte, microdamage, apoptosis, osteoclasts, targeted remodelling, in vitro model
Abstract: Stochastic resonance is exhibited by many biological systems, where the response to a small stimulus is enhanced with the aid of noise. This intriguing possibility provides a novel paradigm for understanding previously reported osteogenic benefits of low amplitude dynamic loading. However, it is unknown whether bone cell mechanosensitivity is enhanced by noise as an alternative mechanism for an amplified response to small stresses. We studied whether noise of varying intensities enhanced the mechanosensitivity of MC3T3-E1 cells. Nitric oxide (NO) production was measured as the parameter for bone cell activation. Dynamic fluid shear stress stimulated bone cells provided an initial-stress kick…was implemented. Without the initial stress-kick bone cells did not release a significant amount of NO demonstrating an essential non-linearity to bone cell responses to stress and the possibility of stochastic resonance in bone cell mechanosensitivity. The rapid NO response of MC3T3-E1 cells to a small periodic fluid shear stress was increased with the addition of noise compared to the response to stress with only noise. This confirms the possibility of stochastic resonance enhancement of NO production by bone cells. Since NO regulate bone formation as well as resorption, our results suggest that noise enhances the activity of bone cells in driving the mechanical adaptation of bone.
Abstract: Bone is an elementary component in the human skeleton. It protects vital organs, regulates calcium levels and allows mobility. As a result of daily activities, bones are cyclically strained causing microdamage. This damage, in the form of numerous microcracks, can cause bones to fracture and therefore poses a threat to mechanical integrity. Bone is able to repair the microcracks through a process called remodelling which is tightly regulated by bone forming and resorbing cells. However, the manner by which microcracks are detected, and repair initiated, has not been elucidated until now. Here we show that microcrack accumulation causes damage to…the network of cellular processes, resulting in the release of RANKL which stimulates the differentiation of cells specialising in repair.