Technology and Health Care - Volume 22, issue 6

Authors: Zafar, Muhammad Sohail | Ahmed, Naseer

Article Type: Research Article

Abstract: Objectives: The anisotropic natures of dental tissues result in variable properties from one point to the other within the same tooth. The aim of this study was to analyze deciduous incisors enamel and dentin for elastic modulus and hardness. In addition, retained deciduous incisors were assessed to compare properties with exfoliated teeth. Methods: Deciduous mandibular incisors either exfoliated at physiological age or retained were included in this study. Samples were prepared by dissecting teeth in transverse sections and surfaces under investigation were prepared and polished for nanoindentation. Nanoindentation was performed at multiple sites using Hysitron [TI 725 Ubi] …testing instrument. Data analysis was performed using SPSS software (version 20) to calculate absolute hardness and elastic modulus. The statistical significance was calculated using the t-test. Results: The hardness of human deciduous incisor varies between 0.01–7 GPa. The highest value of hardness was observed for the incisal edge (5.09 ± 0.64 GPa) followed by mid-surface enamel and cervical enamel. The hardness of mantle dentin was (0.56 ± 0.19 GPa) and the inner dentin was (0.34 ± 0.12 GPa). Conclusions: The average hardness of primary teeth enamel is lower than permanent teeth enamel. The hardness of retained teeth enamel is greater than exfoliated teeth however lower than permanent teeth enamel of the equivalent region. Show more

Keywords: Nanoindentation, primary teeth, incisors, elastic modulus

DOI: 10.3233/THC-140852

Citation: Technology and Health Care, vol. 22, no. 6, pp. 785-793, 2014

Authors: Guédon, Annetje C.P. | Wauben, Linda S.G.L. | Overvelde, Marlies | Blok, Joleen H. | van der Elst, Maarten | Dankelman, Jenny | van den Dobbelsteen, John J.

Article Type: Research Article

Abstract: Background: Since the increase of the number of technological aids in the operating room (OR), equipment-related incidents have come to be a common kind of adverse events. This underlines the importance of adequate equipment management to improve the safety in the OR. Objective: A system was developed to monitor the safety status (periodic maintenance and registered malfunctions) of OR devices and to facilitate the notification of malfunctions. The objective was to assess whether the system is suitable for use in an busy OR setting and to analyse its effect on the notification of malfunctions. Methods: The …system checks automatically the safety status of OR devices through constant communication with the technical facility management system, informs the OR staff real-time and facilitates notification of malfunctions. The system was tested for a pilot period of six months in four ORs of a Dutch teaching hospital and 17 users were interviewed on the usability of the system. Results: The users provided positive feedback on the usability. For 86.6% of total time, the localisation of OR devices was accurate. 62 malfunctions of OR devices were reported, an increase of 12 notifications compared to the previous year. Conclusions: The safety status system was suitable for an OR complex, both from a usability and technical point of view, and an increase of reported malfunctions was observed. The system eases monitoring the safety status of equipment and is a promising tool to improve the safety related to OR devices. Show more

Keywords: Operating room, devices, RFID, safety, maintenance, checklists

DOI: 10.3233/THC-140854

Citation: Technology and Health Care, vol. 22, no. 6, pp. 795-803, 2014

Authors: Nakajima, Kanako | Anzai, Emi | Iwakami, Yumi | Ino, Shuichi | Yamashita, Kazuhiko | Ohta, Yuji

Article Type: Research Article

Abstract: Background: Hip fracture in the elderly is a serious problem, and solutions to prevent falls are needed. Objective: This study focused on elucidating data critical to fall prevention by evaluating ambulatory function, and we achieved this by developing a plantar pressure measurement device to determine gait function. Methods: Our device enables measurement of gait function in the unrestrained state by transmitting wireless data. In this study, we applied the device to field experiments involving 98 subjects (39 healthy individuals, 44 elderly non-fallers, and 15 elderly fallers). Gait features were determined by measuring the pressure values and …foot contact patterns used as gait function parameters in previous studies. Results: In particular, decreased peak pressure values were noted at heel strike and toe off during walking in elderly fallers compared with elderly non-fallers. In addition, compared with healthy subjects, elderly fallers also showed extension of the double support phase, and differences in individual gait pattern features were observed between the groups. Conclusions: Experiments confirmed that our device can be used to obtain the gait features of a diverse group of elderly individuals. Moreover, our device enables objective and quantitative evaluation of gait function and thus may be useful for evaluating gait function in the elderly. Show more

Keywords: Elderly, plantar pressure, gait feature, wireless monitoring

DOI: 10.3233/THC-140856

Citation: Technology and Health Care, vol. 22, no. 6, pp. 805-815, 2014

Authors: Kuecuekbalaban, Pinar | Schmidt, Silke | Kraft, Kathleen | Hoffmann, Wolfgang | Muehlan, Holger

Article Type: Research Article

Abstract: Background: A commercial breakthrough of point-of-care testing (POCT) and self-tests for laypersons (direct-to-consumer applications, DTC) is anticipated based on the advancements in the development of lab-on-a-chip system (LOC) technology. Objective: The aim of this study was to investigate risks and benefits of LOC based diagnostic devices for healthcare and private self-testers. Methods: Interviews with 22 developers/researchers of LOC technology and 10 technology assessment experts were conducted about the (a) need for, (b) benefits, and (c) risks of LOCs for healthcare and as DTC applications. A qualitative content analysis was conducted. Results: Need for LOCs …were seen mainly for healthcare, but not as DTC applications for fatal diseases. While benefits were seen mainly for healthcare and partially for DTC applications (e.g. faster diagnostics, more favourable diagnostics, POCT), risks were emphasised especially for DTC applications and less frequently for healthcare (e.g. various technical challenges, misinterpretation of test results, quality/reliability requirements). Conclusions: Medical expertise is the key imperative for the application of LOC based portable diagnostic devices in healthcare and particularly for self-testing. LOCs have to be designed to be easily operated and interpreted by self-testers. For healthcare, LOCs are envisaged to be a promising emerging technology with various benefits. Show more

Keywords: Risk, lab-on-a-chip system and LOC, self-test, direct-to-consumer application, healthcare

DOI: 10.3233/THC-140857

Citation: Technology and Health Care, vol. 22, no. 6, pp. 817-833, 2014

Authors: Priyadharsini, S. Suja | Rajan, S. Edward

Article Type: Research Article

Abstract: Background: Electroencephalogram (EEG) is an important tool for clinical diagnosis of brain-related disorders and problems. However, it is corrupted by various biological artifacts, of which ECG is one among them that reduces the clinical importance of EEG especially for epileptic patients and patients with short neck. Objective: To remove the ECG artifact from the measured EEG signal using an evolutionary computing approach based on the concept of Hybrid Adaptive Neuro-Fuzzy Inference System, which helps the Neurologists in the diagnosis and follow-up of encephalopathy. Methods: The proposed hybrid learning methods are ANFIS-MA and ANFIS-GA, which uses Memetic …Algorithm (MA) and Genetic algorithm (GA) for tuning the antecedent and consequent part of the ANFIS structure individually. The performances of the proposed methods are compared with that of ANFIS and adaptive Recursive Least Squares (RLS) filtering algorithm. Results: The proposed methods are experimentally validated by applying it to the simulated data sets, subjected to non-linearity condition and real polysomonograph data sets. Performance metrics such as sensitivity, specificity and accuracy of the proposed method ANFIS-MA, in terms of correction rate are found to be 93.8%, 100% and 99% respectively, which is better than current state-of-the-art approaches. Conclusions: The evaluation process used and demonstrated effectiveness of the proposed method proves that ANFIS-MA is more effective in suppressing ECG artifacts from the corrupted EEG signals than ANFIS-GA, ANFIS and RLS algorithm. Show more

Keywords: Adaptive Neuro-Fuzzy Inference System, Hybrid-ANFIS, electroencephalogram, electrocardiogram, memetic algorithm, genetic algorithm

DOI: 10.3233/THC-140860

Citation: Technology and Health Care, vol. 22, no. 6, pp. 835-846, 2014

Authors: Zhang, Melvyn W.B. | Ho, Cyrus S.H. | Ho, Roger C.M.

Article Type: Research Article

Abstract: Background: The usage of Smartphones and smartphone applications in the recent decade has indeed become more prevalent. Previous research has highlighted the lack of critical appraisal of new applications. In addition, previous research has highlighted a method of using just the Internet Browser and a text editor to create an application, but this does not eliminate the challenges faced by clinicians. In addition, even though there has been a high rate of smartphone applications usage and acceptance, it is common knowledge that it would cost clinicians as well as their centers a lot to develop smartphone applications that could be …catered to their needs, and help them in their daily educational needs. Objcetive: The objectives of the current research are thus to highlight a cost-effective methodology of development of interactive education smartphone applications, and also to determine whether medical students are receptive towards having smartphone applications and their perspectives with regards to the contents within. Methodology: In this study, we will elaborate how the Mastering Psychiatry Online Portal and web-based mobile application were developed using HTML5 as the core programming language. The online portal and web-based application was launched in July 2012 and usage data were obtained. Subsequently, a native application was developed, as it was funded by an educational grant and students are recruited after their end of posting clinical examination to fill up a survey questionnaire relating to perspectives. Results: Our initial analytical results showed that since inception to date, for the online portal, there have been a total of 15,803 views, with a total of 2,109 copies of the online textbook being downloaded. As for the online videos, 5,895 viewers have watched the training videos from the start till the end. 722 users have accessed the mobile textbook application. A total of 185 students participated in the perspective survey, with the majority having positive perspectives about the implementation of a smartphone application in psychiatry. Conclusions: This is one of the few studies that describe how an educational application could be developed using a simple and cost effective methodology and this study has also demonstrated students' perspectives towards Smartphone in psychiatric education. Our methods might apply to future research involving the use of technology in education. Show more

Keywords: Education, technology, smartphone applications, under-graduate psychiatry education innovations, developmental models

DOI: 10.3233/THC-140861

Citation: Technology and Health Care, vol. 22, no. 6, pp. 847-855, 2014

Authors: Kumar, H. Prasanna | Srinivasan, S.

Article Type: Research Article

Abstract: Background: In recent times there has been a significant change in lifestyle in many parts of the world, with most people experiencing a more sedentary existence combined with an abundance of food. This has resulted in the modern epidemic of obesity and consequent hyperinsulinemia – situations which in women may precipitate expression of fertility problems; effective methods to evaluate the fertility status are required. Ultrasonographic imaging is an effective, easy to use, safe, and readily available noninvasive means to evaluate fertility potential. Objective: Manual recognition of the follicles in terms of area measurement and counting the number of …follicles is laborious; often fatigue may lead to error-prone conclusions. The paper attempts an automated classification of the ovaries based on the biomarking done by the physician. Also, biomarked data correlates with the hormones values such as androgen, testosterone and leutinizing hormone. Methods: Despeckled images are segmented by improved active contour with split-Bregman optimization. The features are extracted from images using geometric and intensity method. The significant features selected by particle swarm optimization and dimension reduction by principal component analysis and classification by probabilistic neural network. Results: Proposed probabilistic neural network achieves maximum efficiency of 97% compared to SVM 92% and RBF 88%. Conclusions: The results obtained show that using a very large number of features combined with a feature selection approach allows us to achieve high classification rates. Show more

Keywords: Polycystic ovary syndrome, particle swarm optimization, principal component analysis, support vector machine, probabilistic neural network

DOI: 10.3233/THC-140863

Citation: Technology and Health Care, vol. 22, no. 6, pp. 857-865, 2014

Authors: Arunachalam, K. | Jacob, Lijin V. | Kamalanand, K.

Article Type: Research Article

Abstract: Background: Analysis of liver tissue in normal and abnormal conditions is essential for disease research, medical device design and treatment planning. Currently cirrhosis and malignancies of liver are among the major causes of mortality, worldwide. Objective: The objective of this work is to design an efficient capacitive sensor using Finite Element Methods (FEM), for diagnosis of cirrhotic and malignant liver. Methods: In this work, 3D geometric FEM models (N = 120) of normal, cirrhotic and malignant liver were generated using Comsol 3.5a. A set of ‘E’ shaped metallic plates, each with a dimension of 1 × …1 × 1 mm were modeled and mounted on the developed liver models. Four different bio-compatible metals namely Gold, Silver, Palladium and Platinum were used for analysis. Further, the observed capacitance values were converted into voltage using a De Sauty's bridge circuit implemented using Proteus 8. Finally, the statistical significance of the results was analyzed using the ANOVA test. Results: Results demonstrate that the observed voltages show significant variations between different liver pathologies. The developed sensor characteristic was found to be linear and the sensitivity of the sensor was found to be high when platinum electrodes were used. The diagnostic ability of the developed sensors for the adopted biocompatible metals was found to be highly statistically significant (P < 0.001). Conclusions: The proposed sensor design is compact with small dimensions and can be placed in contact with the human liver using endoscopic techniques. Hence, the developed sensor may provide a minimally invasive technique for liver diagnosis. This study appears to be of high clinical relevance since modelling of normal and abnormal liver, as well as design of suitable sensors for identification of liver abnormalities is required for improving the present diagnostic techniques. Show more

Keywords: Liver, finite element method, malignancy, cirrhosis, biocompatible metals, capacitive sensor

DOI: 10.3233/THC-140868

Citation: Technology and Health Care, vol. 22, no. 6, pp. 867-875, 2014

Authors: Debus, Florian | Karaman, Yeliz | Ruchholtz, Steffen | Aigner, Rene | Wirries, Andre | Kühne, Christian Alexander

Article Type: Research Article

Abstract: Background: The distal radius keeps heading the list of commonly fractured bones. Although little is known about the frequency and localization of accompanying fractures as well as their influence on the total course of in-patient treatment. Objective: This study is supposed to show the influence of concomitant fractures. These fractures should be identified as risk factors for a prolonged stay to improve the in hospital treatment. Methods: We retrospectively reviewed 721 patients with distal radius fracture. Frequency and localization of concomitant fractures, AO-type, patient age as well as duration of in-hospital treatment were analyzed. …Results: Out of 721 patients 124 (17.2%) had one or more concomitant fractures (CF). The most common CF were proximal femur fractures, pelvic ring fractures and humerus fractures. Compared to patients without CF, these patients showed a significant increase in duration of post operative hospital stay (5.2 vs. 12.5 days, p = 0.0001). Conclusions: Patients presenting a concomitant fracture should be thoroughly cared for by their physicians and therapists. Especially an early and focused mobilization and a well-timed relocation for further medical treatment are important to reduce avoidable treatment days in the acute care hospital. Show more

Keywords: Distal radius fracture, concomitant fractures, hospital stay, geriatric fractures

DOI: 10.3233/THC-140840

Citation: Technology and Health Care, vol. 22, no. 6, pp. 877-884, 2014

Authors: Zhang, Yanjun | Zhang, Xiangmin | Yan, Chengwen | Liu, Wenhui | Yu, Enjia | Luo, Yuxi

Article Type: Research Article

Abstract: Background: Healthy sleep can be characterized by several stages: wake, light, SWS, and REM sleep. The clinical experts find that the breath of subjects is different in these sleep stages, but such observation is lacking data supporting, The statistical research about investigating breathing patterns during sleep process will be helpful for the sleep and breathing domain. Objective: The objective of the paper is to statistically analyze the respiratory characteristics during different sleep stages. Methods: Firstly, we calculated the mean value and standard deviation of respiratory rates of these stages, in which the respiratory rates were obtained …by the autocorrelation method. Then the detrended fluctuation analysis (DFA) algorithm was applied to analyze long-range correlation of respiratory rates of sleep stages. Results: The mean and standard deviation of respiratory rates are wake: 16.62 ± 2.43 cycles per minute (CPM), light: 15.15 ± 1.53 CPM, SWS: 15.06 ± 0.96 CPM and REM: 16.37 ± 2.03 CPM, respectively. The scaling exponent applied by detrended fluctuation analysis (DFA) algorithm reached about 0.7 for each stage. Conclusion: Results of the mean and standard deviation of respiratory rates show that different sleep stages lead to different autonomic regulations of breathing and exhibit different respiratory rates and fluctuations. And the DFA results demonstrate that respiratory rates are all long-range correlated in these stages although they lead to different fluctuation. Show more

Keywords: Sleep stages, autocorrelation, detrended fluctuation analysis (DFA)

DOI: 10.3233/THC-140853

Citation: Technology and Health Care, vol. 22, no. 6, pp. 885-894, 2014

Authors: Bredow, Jan | Wenk, Birte | Westphal, Ralf | Wahl, Friedrich | Budde, Stefan | Eysel, Peer | Oppermann, Johannes

Article Type: Research Article

Abstract: Background: Revision joint replacements are challenging surgical tasks. Knowing the exact type of primary prosthesis is essential to avoid long preoperative organisation, long operation times, and especially loss of bone and soft-tissue during operation. In daily routine there is often no information about the primary prosthesis. Objective: We are developing methods for identifying implanted prostheses from x-ray images by means of matching template images generated from prosthesis CAD data. Methods: The application is separated into three major components: The “Template Image Generation” adds 3d models of endoprostheses to a database. The “X-ray Image Segmentation” extracts endoprostheses …from provided sets of x-ray images. The “Template Matching” finds the best matching prosthesis types in the data base. At the current stage, one prosthesis model (Corin, Knee ProthesisUniglide) was used for evaluating these algorithms. Results: Very accurate identifications with accuracies of about 90% for lateral and over 70% for frontal images could be achieved. Conclusions: The current results of this feasibility study are very promising. A reliable and fast prosthesis identification process seems realistic to support the surgeon when planning and performing revision arthroplasty. Further improvements of segmentation accuracies and extending the prosthesis data base are intended next steps towards this goal. Show more

Keywords: Revision arthroplasty, x-ray, image segmentation, template matching, prosthesis

DOI: 10.3233/THC-140858

Citation: Technology and Health Care, vol. 22, no. 6, pp. 895-900, 2014

Authors: Mommsen, Philipp | Doering, Matthias | Röhrs, Ehrenfried | Egidy, Claus | Gehrke, Thorsten | Krettek, Christian | Kendoff, Daniel

Article Type: Research Article

Abstract: Background: Low-molecular-weight heparins (LMWH), e.g. enoxaparin, represent the standard thromboprophylactic agents in Europe after total hip replacement. The oral direct thrombin inhibitor dabigatran etexilate provides comparable effectiveness and safety. The present study aimed to evaluate the influence of dabigatran etexilate on perioperative blood loss and wound secretion in total hip arthroplasty compared to enoxaparin. Methods: Patients receiving primary total hip replacement between January and June 2009 were included. The association between thromboembolism prophylaxis with dabigatran etexilate or enoxaparin and the perioperative blood loss was investigated. The effective blood loss (EBL) was calculated taking blood transfusions and the difference …between preoperative haemoglobin and haemoglobin on the day of discharge into account. Additional comparison of wound secretion depending on thromboprophylactic agents was performed in a separate, prospectively collected patients' population. Statistical analysis was performed with χ2 -Test, Student's t-test or Mann-Whitney U-test. Statistical significance was considered at p < 0.05. Results: 198 patients (111 women, 87 men) with primary total hip arthroplasty were enrolled. Patients' mean age was 63.0 ± 11.9 years. Thromboembolism prophylaxis was performed in 111 patients (56.1%) with dabigatran etexilate, 87 patients (43.9%) received enoxaparin. No significant differences concerning EBL and wound secretion were found between both study groups. In the dabigatran etexilate group the EBL was 1.66 ± 0.56 l compared to 1.77 ± 0.65 l in patients with enoxaparin. Conclusions: Dabigatran etexilate can safely be used for thromboembolism prophylaxis after primary total hip replacement without an increased risk for perioperative blood loss and prolonged wound secretion. Show more

Keywords: Hip arthroplasty, thromboembolism prophylaxis, blood loss, wound secretion, dabigatran etexilate, enoxaparin

DOI: 10.3233/THC-140859

Citation: Technology and Health Care, vol. 22, no. 6, pp. 901-908, 2014

Authors: Reising, K. | Konstantinidis, L. | Helwig, P. | Wagner, F.C.L. | Südkamp, N.P. | Strohm, P.C.

Article Type: Research Article

Abstract: Background: Fracture of the distal humerus is a fairly rare injury and makes high demands on the treating surgeon. Prerequisites for a good outcome are anatomical reconstruction and osteosynthesis stable enough for exercises. A method permitting early restoration of function is especially important for patients with osteoporosis. The extensive surgical approach necessary for open reduction is associated with a high number of wound healing disorders and infections with a frequency of 11% being reported in the literature. Although open reduction and internal fixation in double-plating technique is unavoidable for complex intraarticular fractures, an alternative, minimally invasive and, consequently, tissue-preserving procedure …is desirable for simpler fractures. Objectve: To investigate this issue further an angular stable nail system developed for the distal radius was implanted as a stabilizer and the construct tested biomechanically as part of a feasibility study. Methods: Distal humerus fractures were stabilized by insertion of a distal radius nail, namely, the Targon DR (Aesculap, Tuttlingen) and a K-wire. To test the hypothesis six cadaveric bones fixed in formalin were tested biomechanically for displacement, implant failure, and stiffness. Displacement was determined by means of an ultrasound-based system. Results: An average displacement of 1.6 mm ± 0.7 was recorded at a maximum compression force of 100 N in extension and an average displacement of 1.4 mm ± 0.9 in flexion. Implant failure was not observed for any of the constructs. Conclusions: The study presented here permits the conclusion that a minimally invasive procedure is possible at the distal humerus and does ensure adequate stability. Although the nail was not specifically designed for the humerus, current findings form the basis for a promising approach that will be pursued further after modification of the nail design. Show more

Keywords: Distal humerus fracture, minimal invasive, nail osteosynthesis, angular stable

DOI: 10.3233/THC-140864

Citation: Technology and Health Care, vol. 22, no. 6, pp. 909-913, 2014

Authors: Yeh, Shih-Ching | Chen, Shuya | Wang, Pa-Chun | Su, Mu-Chun | Chang, Chia-Huang | Tsai, Po-Yi

Article Type: Research Article

Abstract: Background: Chronic imbalance is common in patients with vestibular dysfunction. Vestibular rehabilitation is effective in improving upright balance control. Vestibular rehabilitation exercises, such as Cawthorne-Cooksey exercises, include simple repetitive movements and have limited feedback and adaptive training protocols. Interactive systems based on virtual reality (VR) technology may improve vestibular rehabilitation. Objective: The objective of this study was to examine the effectiveness of an interactive 3-dimensional VR system for vestibular rehabilitation. Methods: In 49 subjects with vestibular dysfunction, VR rehabilitation exercises were performed in 6 sessions. Before and after rehabilitation, subjects were evaluated for performance of the …training exercises; the center of pressure was measured for 20 seconds and balance indices were determined. Results: Five training scores (total 6) showed a significant improvement. For balance indices in condition of non-stimulation, all of them (total 5) showed a trend of improvement, in which there was a significant improvement in mean mediolateral. For balance indices in condition of post-stimulation, there was a significant improvement in statokinesigram and maximum mediolateral. Conclusions: The VR rehabilitation exercises were effective in improving upright balance control in patients with vestibular dysfunction. Show more

Keywords: Balance, rehabilitation, virtual reality, vestibular

DOI: 10.3233/THC-140855

Citation: Technology and Health Care, vol. 22, no. 6, pp. 915-921, 2014

Article Type: Other

DOI: 10.3233/THC-2014-22615

Citation: Technology and Health Care, vol. 22, no. 6, pp. 923-934, 2014

Article Type: Other

DOI: 10.3233/THC-2014-22616

Citation: Technology and Health Care, vol. 22, no. 6, pp. 935-939, 2014