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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: Background: The development of Occupational Safety and Health Management System in textile industry will rejuvenate the workers and energize the economy as a whole. In India, especially in Tamil Nadu, approximately 1371 textile business is running with the help of 38,461 workers under Ginning, Spinning, Weaving, Garment and Dyeing sectors. Textile industry of contributes to the growth of Indian economy but it fails to foster education and health as key components of human development and help new democracies. Purpose: The present work attempts to measure and develop OSHMS which reduce the hazards and risk involved in textile industry.…Among all other industries textile industry is affected by enormous hazards and risk because of negligence by management and Government. It is evident that managements are not abiding by law when an accident has occurred. Managements are easily deceiving workers and least bothered about the Quality of Work Life (QWL). Methodology: A detailed analysis of factors promoting safety and health to the workers has been done by performing confirmatory factor analysis, evaluating Risk Priority Number and the framework of OHMS has been conceptualized using Structural Equation Model. The data have been collected using questionnaire and interview method. Result: The study finds occupation health for worker in Textile industry is affected not only by safety measure but also by technology and management. Conclusion: The work shows that difficulty in identifying the cause and effect of hazards, the influence of management in controlling and promoting OSHMS under various dimensions. One startling fact is existence of very low and insignificance correlation between health factors and outcome.
Keywords: Occupational Safety and Health Management System, textile industry, hazards, safety, health, management, technology
Abstract: Background: Stent placement is thought to obstruct the inflow of blood to an aneurysm. However, we introduced parent artery expansion and demonstrated that this may reduce the blood flow by the stent. In our previous study using idealized shapes, the results showed that flow reduction was greater than 22.2%, even if the expansion rate was only 6%. Furthermore, the parent artery expansion is predominantly caused by the effect of flow reduction as compared to that of flow reduction due to the obstruction of flow under stent placement. However, a realistic shape is complex and the blood flow also becomes complex…flow. It is not understood whether the results of flow in the idealized shape are reflective of flow from a realistic 3D model. Therefore, we examined the effect of parent artery expansion using a realistic model. Objective: The aim is to clarify the effects of parent artery expansion on inflow rate, wall shear stress, and oscillatory shear index. Methods: We used a patient-specific geometry of a human internal carotid artery with an aneurysm. The geometry of parent artery expansion due to oversized stent constructed based on the voronoi diagram. We performed calculations in the unsteady-state situations using constructed models. Results: The complexity of the flow in the aneurysm decreases in case of expanded parent artery. The inflow rate decreases by 33.6% immediately after parent artery expansion alone without a stent. The effect of the parent artery expansion on flow reduction is larger than that of the obstruction flow by stent placement. In addition, wall shear stress and oscillatory shear index on the aneurysm wall decrease by change in blood flow due to the parent artery expansion. Conclusion: The effects of the parent artery expansion in a realistic aneurysm model with different stent lengths were evaluated on the basis of a numerical simulation. Although the flow was complex, the parent artery expansion with stent reduces the inflow to the aneurysm and wall shear stress and oscillatory shear index on the aneurysm. Therefore, we suggest that changes in the blood flow because of the parent artery expansion may be identified and, sometimes, is more effective than the obstruction flow due to the stent placement.
Abstract: Background: Segmentation of brain tumor from Magnetic Resonance Imaging (MRI) becomes very complicated due to the structural complexities of human brain and the presence of intensity inhomogeneities. Objective: To propose a method that effectively segments brain tumor from MR images and to evaluate the performance of unsupervised optimal fuzzy clustering (UOFC) algorithm for segmentation of brain tumor from MR images. Methods: Segmentation is done by preprocessing the MR image to standardize intensity inhomogeneities followed by feature extraction, feature fusion and clustering. Results: Different validation measures are used to evaluate the performance of…the proposed method using different clustering algorithms. The proposed method using UOFC algorithm produces high sensitivity (96%) and low specificity (4%) compared to other clustering methods. Conclusions: Validation results clearly show that the proposed method with UOFC algorithm effectively segments brain tumor from MR images.
Abstract: An abdominal aorta aneurysm (AAA) is a disease that aortic vessel inflates abnormally. The aorta blows up continuously, which may lead to the rupture of the aorta. The mortality of rupturing the aorta is between 75 and 90% to properly treat this disease, we need to accurate measure about variation of AAA size. our team performed that AAA is reconstructed as three dimensional (3D) images by computer tomography (CT), and analyzed the elements of inflation through a geometric parameter measurement . Subjects (seven males) who undergo an AAA are enrolled for the analysis. The authors used CT images as a…primary source, and obtained secondary CT images 12 months later. By means of these data, the authors constructed 3D images of AAA and performed examinations using a geometric analysis that calculates geometric parameter such as the tortuosity, diameter, saccular and so on based on volume, area of the segmented region of the CT slices that is set up by the centroids and 8 points around it. The result of the severity biomechanical factor shows increased AAA tortuosity ratio (4.9%), AAA diameter expansion ratio [cm/year] (6.8%), AAA total diameter ratio (4.7%), AAA saccular ratio (2.4%) than 12-month before. Through these results, We can plan to endovascular repair surgery to undergoing AAA patients and possible diagnosis estimation of AAA.
Keywords: Abdominal aorta aneurysm, computed tomography, 3D reconstruction
Abstract: Background: Clinical monitoring of planar pressure is vital in several pathological conditions, such as diabetes, where excess pressure might have serious repercussions on health of the patient, even to the extent of amputation. Objective: The main objective of this paper is to experimentally evaluate the combined application of the Fibre Bragg Grating (FBG) and the lead zirconate titanate (PZT) piezoceramic sensors for plantar pressure monitoring during walk at low and high speeds. Methods: For fabrication of the pressure sensors, the FBGs are embedded within layers of carbon composite material and stacked in an arc…shape. From this embedding technique, average pressure sensitivity of 1.3 pm/kPa and resolution of nearly 0.8 kPa is obtained. These sensors are found to be suitable for measuring the static and the low-speed walk generated foot pressure. Simultaneously, PZT patches of size 10 × 10 × 0.3 mm were used as sensors, utilizing the d33 (thickness) coupling mode. A sensitivity of 7.06 mV/kPa and a pressure resolution of 0.14 kPa is obtained from these sensors, which are found to be suitable for foot pressure measurement during high speed walking and running. Both types of sensors are attached to the underside of the sole of commercially available shoes. In the experiments, a healthy male subject walks/runs over the treadmill wearing the fabricated shoes at various speeds and the peak pressure is measured using both the sensors. Commercially available low-cost hardware is used for interrogation of the two sensor types. Results: The test results clearly show the feasibility of the FBG and the PZT sensors for measurement of plantar pressure. The PZT sensors are more accurate for measurement of pressure during walking at high speeds. The FBG sensors, on the other hand, are found to be suitable for static and quasi-dynamic (slow walking) conditions. Typically, the measured pressure varied from 400 to 600 kPa below the forefoot and 100 to 1000 kPa below the heel as the walking speed varied from 1 kilometer per hour (kmph) to 7 kmph. Conclusions: When instrumented in combination, the two sensors can enable measurements ranging from static to high speed conditions Both the sensor types are rugged, small sized and can be easily embedded in commercial shoes and enable plantar pressure measurement in a cost-effective manner. This research is expected to have application in the treatment of patients suffering from diabetes and gonarthrosis.
Abstract: Background and objectives: Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. Methods: A retrospective analysis (2000–2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AISChest ⩾ 3) was performed. Patients with AISHead ⩾ 3 were excluded. Patients receiving…either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AISChest , Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. Results: Two hundred and eighty-three patients were included (KT+: n = 160; KT-: n = 123). AISChest , age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. Conclusions: Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AISChest , but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.
Abstract: Background: In the clinical evaluation of femoroacetabular impingement (FAI), there is a lack of quantitative, reliable and informative assessment methods for the overall functional capability of an individual. Objective: We compared clinical and radiological measurements of the hip joint with a new methodology based on the concept of 3-dimensional reachable workspace using Microsoft Kinect. Methods: We assessed the correlation between the alpha angle of Nötzli on full-length radiographs and the clinical internal rotation. We evaluated the accuracy of joint positions and angles of the hip between the Kinect system and clinical examination including range of…motion (ROM). Results: The results of our clinical trial with 24 study participants showed a significant difference between normal internal rotation (> 21°) and reduced internal rotation (⩽ 21°) in comparison to the radiological alpha angle of Nötzli (P = 0.026). The acquired reachable Kinect data demonstrated a moderate agreement between the Kinect and clinical examination (correlation coefficients between 0.230 and 0.375). Conclusions: The findings suggest that a higher grade alpha angle of Nötzli accompanies reduced clinical internal rotation. The Kinect system provides reliable results of hip ROM. However, further test series must be performed for the application of Kinect in the clinical evaluation of FAI.
Keywords: Kinect system, femoroacetabular impingement (FAI), alpha angle of Nötzli, range of motion (ROM), goniometer
Abstract: Background: A smaller humerus in some patients makes the use of a large fragment fixation plate difficult. Dual small fragment plate constructs have been suggested as an alternative. Objective: This study compares the biomechanical performance of three single and one dual plate construct for mid-diaphyseal humeral fracture fixation. Methods: Five humeral shaft finite element models (1 intact and 4 fixation) were loaded in torsion, compression, posterior-anterior (PA) bending, and lateral-medial (LM) bending. A comminuted fracture was simulated by a 1-cm gap. Fracture fixation was modelled by: (A) 4.5-mm 9-hole large fragment plate (wide), (B) 4.5-mm 9-hole…large fragment plate (narrow), (C) 3.5-mm 9-hole small fragment plate, and (D) one 3.5-mm 9-hole small fragment plate and one 3.5-mm 7-hole small fragment plate. Results: Model A showed the best outcomes in torsion and PA bending, whereas Model D outperformed the others in compression and LM bending. Stress concentrations were located near and around the unused screw holes for each of the single plate models and at the neck of the screws just below the plates for all the models studied. Other than in PA bending, Model D showed the best overall screw-to-screw load sharing characteristics. Conclusion: The results support using a dual small fragment locking plate construct as an alternative in cases where crutch weight-bearing (compression) tolerance may be important and where anatomy limits the size of the humerus bone segment available for large fragment plate fixation.
Keywords: Finite element analysis, internal fracture fixation, mechanical stress, bone plates, humerus
Abstract: Background: Femoroacetabular impingement (FAI) is accompanied by increased hip alpha angles, in particular in athletes with high impact sports. Objective: The aim of our study was to investigate the dynamic function of the foot during walking in male soccer players with increased versus normal alpha angles. Methods: Plantar pressures of 20 injury-free male soccer players were recorded during barefoot walking at 1.6 m/s. Ten subjects had bilaterally increased (>55°) (IA) and ten subjects normal (<50°) hip alpha angles (NA). Both standing and kicking leg were analyzed. Results: Compared to NA, IA showed…lower force-time-integrals (−23%; p < 0.01), pressure-time-integrals (−29%; p < 0.001) and relative loads (p < 0.05) under the heel. In IA contact area of the hallux is about 13% (p < 0.05) reduced. In IA relative loads are increased under the lateral midfoot (p < 0.05) and the second toe (p < 0.05). Higher loading of the lateral midfoot is also reflected in the increased force-time integral (+33%; p < 0.001). No differences between legs and no interactions, indicating a specifity in kicking or standing leg, are found. Conclusions: Compared to NA, soccer players with IA show a forward shifting of the center of pressure which indicates a compensatory mechanism of the foot during walking.
Abstract: The global burden of diseases is predicted to increase considerably in the coming decades (GBD project, WHO, 2010 ) – WHO-World Bank study, 1991 ); for example, the World Alzheimer Report and the UN Declaration on Non-Communicable Diseases estimate that the burden associated with dementia will increase 2-fold by 2030 and 3-4-fold by 2050. Therefore, urgent needs must be met in order to help policy-makers deal with the increasing societal costs of diseases. Recent technologies can facilitate the detection and prevention of mild cases of cognitive impairments, or integrative genomic medicine can target more individualized genetic traits and…pedigrees; however, scientists do not necessarily agree: results from a recent population-based study using population imaging  differed from results obtained using integrative genomics approaches , and controversy exists between molecular biologists [5,6] and geneticists [7,8] with respect to asthma genetics. These differences have led to different predictive disease models and can influence the assessment of aging and environmental modifiers. This paper highlights implications for the governance of health systems using current debates on the evolution of these major fields of science. In addition, this paper discusses the potential translation of these models for use in clinical practice, particularly with telemedicine and telecare dominated by new IT technologies and challenges of science in transition.
Keywords: Scientific controversies, health system reforms, mobile healthcare technologies
Abstract: To date, the actual rate of successful translation has been extremely low although those few successes have been notable and provide for continued and expanding enthusiasm and support. This paper examines whether the fundamental premise may be flawed. Could the success rate be improved to further enhance quality of life and cost optimization for patients by changing the paradigm to “bedside to bench to bedside”, and focusing the research on addressing unmet clinical needs? It examines all aspects of the healthcare ecosystem to understand issues that arise with real world patients and in real world clinical practice and how addressing…these should be the focus of translational research.
Keywords: Translational medicine, unmet clinical needs, breast cancer, rare disease