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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: Capsule endoscopy, known as the camera pill, is a pain-free minimally invasive method of visualising the lining of the gastrointestinal tract and has now been in use for over ten years. It has become the gold standard in diagnostics for small bowel disorders but has been shown to be clinically less valid in use for screening of the colon and other parts of the digestive tract. There are five principal limitations of capsule endoscopy: lack of propulsion, inability to take a biopsy or deliver direct therapeutic intervention, imaging and localization. Significant advancements have been made regarding locomotion, localization and imaging…which are likely to be commercially available in the short term. Further refinement is needed with current innovations regarding additional diagnostic and therapeutic capabilities before being more widely adopted in clinical use.
Abstract: BACKGROUND: As obligate intracellular parasites, all viruses penetrate target cells to initiate replication and infection. OBJECTIVE: This study introduces two approaches for evaluating the contact loads applied to a cell during early penetration of non-enveloped icosahedral viruses. METHODS: The first approach is analytical modeling which is based on Hertz's theory for the contact of two elastic bodies; here we model the virus capsid as a triangle and the cell as an order-of-magnitude larger sphere. The second approach is finite element modeling, where we simulate three types of viruses: adeno-, papilloma- and polio- viruses,…each interacting with a cell section. RESULTS: We find that the peak contact pressures and forces generated at the initial virus-cell contact depend on the virus geometry - that is both size and shape. With respect to shape, we show that the icosahedral virus shape induces greater peak pressures compared to a spherical virus shape. With respect to size, it is shown that the larger the virus is the greater are the contact loads in the attacked cell. CONCLUSION: Utilization of our modeling can be substantially useful not only for basic science studies, but also in other, more applied fields, such as in the field of gene therapy, or in `phage' virus studies.
Abstract: INTRODUCTION: Alcohol use disorders has been known and recently highlighted by the World Health Organization as a major worldwide problem. Harmful usage of alcohol has been linked to increased morbidity and mortality arising from common alcohol related disorders, such as liver disease, hypertension and violent deaths. Looking at the current literature, there have been previous peer reviewed publications about how technology has helped alcohol users. Of significance, a previous content analysis showed that the vast majority of the applications catered for alcohol use disorder which are currently available on the stores are not only not supported by evidence-base, but…some of them seemed to be promoting drinking instead. Zhang et al. have described how they have attempted to overcome the limitations of current alcohol applications in their video feature recently published. OBJECTIVE: The objective of this article is to evaluate (a) the receptiveness of the general population toward an alcohol tracker application and to determine (b) user preferences with regards to the different features present in an alcohol tracker. METHODS: Android Java Developmental kit (ADK) was utilized to program the core functions of the applications. The entire developmental process took approximately 6 weeks to complete and the android version of the application was launched and offered for free download on the android play store since the 4th of February 2015. The utilization of the application was then monitored and recorded using Google analytics. User perspectives with regards to the individual features of the application were collated via an application feedback survey embedded within the application. RESULTS: Based on the analytics, a total of 339 users have had access to the application. A cumulative total of 2029 downloads of the application have been made to date. Most of the participants are male (66%) and are of the age group of 30-39 years old (34%). The vast majority of the participants (94%) do not have any prior treatment for alcohol. Interestingly, the vast majority of the users have indicated that they have a drink 4 or more times a week (61%) and tend to drink between 3 to 4 drinks on a typical day they are out drinking. the vast majority reported that they were slightly and moderately comfortable with managing their alcohol use problem (25%). After the usage of the application, 27% of the individuals were moderately comfortable with managing their alcohol use problems and 20% of individuals were extremely comfortable with managing their alcohol use problems. CONCLUSION: In conclusion, this is perhaps one of the first few studies to demonstrate the receptiveness of an alcohol tracker that has included other behavioral change methods within as well as a variant of the conventional methodology of tracking alcohol consumption. The current study shows the receptiveness of global users as well as how such an intervention could help them gain more control about managing their underlying alcohol issue.
Keywords: Alcohol Tracker, smartphone, application, user perspectives
Abstract: OBJECTIVE: This study was to investigate the effects of Mirror Therapy (MT) combined with Neuromuscular Electrical Stimulation (NMES) on muscle strength and tone, motor function, balance, and gait ability in stroke survivors with hemiplegia. METHODS: This study was a randomized controlled trial. Twenty-seven hemiplegic stroke survivors from a rehabilitation center participated in the study. The participants were randomly assigned to either an experimental or a control group. The experimental group (n = 14) underwent MT combined with NMES and conventional physical therapy, and the control group (n = 13) underwent conventional physical therapy alone. Muscle strength…and tone, balance, and gait ability were examined at baseline and after 4 weeks of intervention. A hand-held dynamometer was used to assess muscle strength, the Modified Ashworth Scale (MAS) was used to assess muscle tone, the Berg Balance Scale (BBS) and Timed Up and Go test (TUG) were used to ascertain balance, and the 6-m Walk Test (6mWT) was used to examine gait ability. RESULTS: After the intervention, compared to baseline values, there were significant improvements in muscle strength and MAS, BBS, TUG, and 6mWT values in the experimental group (P< 0.05). In addition, at post-intervention, there were significant differences between the two groups in muscle strength and BBS (P< 0.05). CONCLUSION: MT combined with NMES may effectively improve muscle strength and balance in hemiplegic stroke survivors. However, further studies are necessary to demonstrate brain reorganization after MT combined with NMES.
Abstract: BACKGROUND: Researchers are measuring Reachable Workspace Volume (RWV) to assess the effects of various interventions on impaired upper extremity function. These measurement protocols have not been validated. OBJECTIVE: Assess the validity and reliability of two RWV protocols. METHODS: Fifteen able-bodied subjects and eight stroke subjects participated. Two RWV protocols (POLES and PLANES) were completed and compared with hemi-spheric volume estimations using the average reach in the Modified Functional Reach Test (MFRT). RWV, based on the movement of a single hand marker, was calculated using a 3D motion analysis system (Vicon, Centennial,…CO, USA). Intraclass correlation coefficients (ICC) represented reliability, Pearson's linear correlation coefficient (r) between RWVs and MFRT represented validity, and p < 0.05 represented significant differences between the volumes. RESULTS: For the able-bodied subjects, the POLES protocol had excellent validity and excellent reliability, the PLANES protocol had good validity and excellent reliability, and both RWVs were significantly larger than estimated MFRT volume. In the stroke subjects, both protocols had good validity, excellent reliability, and RWVs which were significantly smaller than the estimated MFRT volume. CONCLUSIONS: Both measurement protocols provided valid and reliable measures of RWV. MFRT may underestimate RWV in able-bodied subjects, and overestimate RWV in stroke subjects.
Abstract: The Prolate Spheroidal Impulse Radiating Antenna (PSIRA) is used to radiate very fast pulses in a narrow beam with low dispersion and high field amplitude. The PSIRA is suitable to apply fast, intense pulses without direct contact, for skin cancer treatment. In this proposed work, SWB (Slanted Wire Biconical), EPH (Elliptical Profile Horn), TSVS (Tapered Slot Vivaldi Shape) and Tapered Arm Conical Plate (TACP) feed antenna configurations for Prolate Spheroidal Reflector (PSR) are explored to enhance spatial resolution on biological targets. The feed antenna is placed at the first focal point and the target is located at the second focal…point of the PSR. Next, the near field focusing lens is designed to enhance the amplitude and the resolution of the wave incident at the second focus. A 10 layer Log periodic lens system is placed before the target to reduce the spot size of the focused field on the target. The delivery of subnanosecond pulses using reflector in conjunction with and without Log periodic lens system on the biological target is compared for all feed antenna configurations. Tapered Arm Conical Plate (TACP) fed PSR with the 10 layer Log periodic lens system greatly reduces the spot size to 0.75 cm along lateral direction and 1.5 cm along axial direction. The enhancement in spatial resolution is very suitable to reduce the damage to healthy tissues during cancer treatment.
Keywords: Near field focusing lens, Prolate Spheroidal Impulse Radiating Antenna, subnanosecond electric pulse, ultra wide band antenna
Abstract: BACKGROUND: The use of smart home sensor systems is growing primarily due to the appeal of unobtrusively monitoring older adult health and wellness. However, integrating large-scale sensor systems within residential settings can be challenging when deployment takes place across multiple environments, requiring customization of applications, connection across various devices and effective visualization of complex longitudinal data. OBJECTIVE: The objective of the study was to demonstrate the implementation of a smart home system using an open, extensible platform in a real-world setting and develop an application to visualize data real time. METHODS: We deployed…the open source Lab of Things platform in a house of 11 residents as a demonstration of feasibility over the course of 3 months. The system consisted of Aeon Labs Z-wave Door/Window sensors and an Aeon Labs Multi-sensor that collected data on motion, temperature, luminosity, and humidity. We applied a Rapid Iterative Testing and Evaluation approach towards designing a visualization interface engaging gerontological experts. We then conducted a survey with 19 older adult and caregiver stakeholders to inform further design revisions. RESULTS: Our initial visualization mockups consisted of a bar chart representing activity level over time. Family members felt comfortable using the application. Older adults however, indicated it would be difficult to learn to use the application, and had trouble identifying utility. A key for older adults was ensuring that the data collected could be utilized by their family members, physicians, or caregivers. CONCLUSIONS: The approach described in this work is generalizable towards future smart home deployments and can be a valuable guide for researchers to scale a study across multiple homes and connected devices, and to create personalized interfaces for end users.
Keywords: Data display, remote sensing technology, aged
Abstract: BACKGROUND AND OBJECTIVE: Non-operative treatment is widely accepted for early stages of lumbar spinal stenosis. In general, a trial of conservative treatment is recommended prior to surgery. However, there is an ongoing debate regarding benefits from non-operative treatment and their duration. METHODS: Thirty-eight patients were included in this prospective study. All patients received repeated epidural injections and facet joint injections as well as physiotherapy during a one week hospitalization. Patient characteristics, VAS scores, COMI and ODI scores and SF-36 were assessed prior to and immediately after treatment as well as after six, twelve, and 26 weeks.…For six weeks after treatment, patients were asked to record a pain diary. RESULTS: Back and leg pain scores improved significantly on VAS up to three months follow-up. COMI score improved significantly over the entire follow-up. Regarding quality of life, mental sub-scores showed no improvement. Physical component summary scores improved for the first three months. CONCLUSIONS: Non-operative treatment offers pain relief and improves physical function for three months. COMI scores improve up to six months follow-up. Spine Tango registry offers standardized instruments for outcome evaluation of non-operative treatment.
Abstract: BACKGROUND: Short-stem implants are routinely used for total hip arthroplasty in younger patients that are more likely to have secondary osteoarthritis than older patients. OBJECTIVE: To investigate the applicability of short-stem hip implants for secondary osteoarthritis due to developmental dysplasia of the hip. METHODS: This study analyzed the clinical and radiological results of patients with developmental dysplasia of the hip (DDH, 58 hips) and compared them to those of patients with primary osteoarthritis (POA, 59 hips) treated with the metaphyseal total hip arthroplasty (Metha® ) short stem with metaphyseal fixation. RESULTS:…The mean clinical and radiological follow-up periods were 2.9 ± 1.1 years and 3.8 ± 1.9 years, respectively. The mean Harris Hip Score (HHS) significantly increased in both groups over this period (p< 0.0001). The caput-collum-diaphysis (CCD) angle was significantly lower in the POA group prior to surgery and significantly increased in the POA and and decreased in DDH groups, respectively. The preoperative femoral offset was lower in the DDH group and increased significantly after surgery. CONCLUSIONS: The Metha® short stem in patients with DDH allows good reconstruction of joint biomechanics with a good clinical outcome.
Keywords: Developmental dysplasia, short stem, total hip arthroplasty
Abstract: BACKGROUND: The standard treatment of a periprosthetic infection after TKA involves a two-stage reimplantation with the intermittent implantation of spacers. Different designs of spacers have been described; currently articulating spacers and fixed spacers are used. The aim of the present study is to compare the advantages/disadvantages of the different spacers. PATIENTS AND METHODS: In this retrospective study we analyzed 37 cases after revision surgery of infected TKA. All patients that received spacers as part of the two-stage reimplantation were included. Exclusion criteria were massive bone loss prior to revision, because the implantation of a mobile…spacer would not have been possible. RESULTS: The average ROM was 98.0 (± 14.9) degrees in the articulating spacer group (group 1) and 79.3 (± 22.5) in the group that received the fixed spacers (group 2) before revision surgery started. At a late follow up the average ROM for group 1 was 102.0 (± 8.4) and 79.0 (± 26) for group 2. CONCLUSION: The use of articulating spacers in the two-stage revision for infected total knee arthroplasty is a safe alternative to fixed spacers, that equally preserves ligament balancing and has equal infection eradication rates. A long term improvement of the range of motion following reimplantation of the new joint was, however, not observed.
Keywords: Total knee arthroplasty (TKA), infection, two-stage revision, spacer
Abstract: This paper presents the employment of LEGO Mindstorms NXT robotics as core component of low cost multidisciplinary platform for assisting elderly and visually impaired people. LEGO Mindstorms system offers a plug-and-play programmable robotics toolkit, incorporating construction guides, microcontrollers and sensors, all connected via a comprehensive programming language. It facilitates, without special training and at low cost, the use of such device for interpersonal communication and for handling multiple tasks required for elderly and visually impaired people in-need. The research project provides a model for larger-scale implementation, tackling the issues of creating additional functions in order to…assist people in-need. The new functions were built and programmed using MATLAB through a user friendly Graphical User Interface (GUI). Power consumption problem, besides the integration of WiFi connection has been resolved, incorporating GPS application on smart phones enhanced the guiding and tracking functions. We believe that developing and expanding the system to encompass a range of applications beyond the initial design schematics to ease conducting a limited number of pre-described protocols. However, the beneficiaries for the proposed research would be limited to elderly people who require assistance within their household as assistive-robot to facilitate a low-cost solution for a highly demanding health circumstance.
Abstract: Over the past decade, there have been massive advances in technology. These advances in technology have significantly transformed various aspects of healthcare. The advent of E-health and its influence on healthcare practice also implies that there is a paradigm shift in the way healthcare professionals work. Conventionally, healthcare professionals would have to refer to books and journals for updates in treatment algorithms, but with the advent of technology, they could access this information via the web or via various smartphone applications on the go. In the field of Psychiatry, one of the commonest mental health disorder to date, with significant…morbidity and mortality is that of Major depressive disorder. Routinely, clinicians and healthcare professionals are advised to refer to standard guidelines in guiding them with regards to their treatment options. Given the high prevalence of conditions like Major Depressive Disorder, it is thus of importance that whatever guidelines that clinicians and healthcare professionals refer to are constantly kept up to date, so that patients could benefit from latest evidence based therapy and treatment. A review of the current literature highlights that whilst there are a multitude of smartphone applications designed for mental health care, previous systematic review has highlighted a paucity of evidence based applications. More importantly, current literature with regards to provision of treatment information to healthcare professionals and patients are limited to web-based interventions. It is the aim of this technical note to highlight a methodology to which the authors have conceptualized in the implementation of an evidence based mental health guideline applications, known as the `Wiki Guidelines' smartphone application. The authors hope to illustrate the algorithms behind the development of the application, and how it could be easily updated by the guidelines working group.
Keywords: Smartphone, mobile phone, applications, psychiatry, treatment algorithms
Abstract: BACKGROUND: Among vital signs of acutely ill hospital patients, respiratory rate (RR) is a highly accurate predictor of health deterioration. OBJECTIVE: This study proposes a system that consists of a passive and non-invasive single-lead electrocardiogram (ECG) acquisition module and an ECG-derived respiratory (EDR) algorithm in the working prototype of a mobile application. METHOD: Before estimating RR that produces the EDR rate, ECG signals were evaluated based on the signal quality index (SQI). The SQI algorithm was validated quantitatively using the PhysioNet/Computing in Cardiology Challenge 2011 training data set. The RR extraction algorithm was…validated by adopting 40 MIT PhysioNet Multiparameter Intelligent Monitoring in Intensive Care II data set. RESULTS: The estimated RR showed a mean absolute error (MAE) of 1.4 compared with the ``gold standard'' RR. The proposed system was used to record 20 ECGs of healthy subjects and obtained the estimated RR with MAE of 0.7 bpm. CONCLUSION: Results indicate that the proposed hardware and algorithm could replace the manual counting method, uncomfortable nasal airflow sensor, chest band, and impedance pneumotachography often used in hospitals. The system also takes advantage of the prevalence of smartphone usage and increase the monitoring frequency of the current ECG of patients with critical illnesses.
Keywords: Respiratory rate, single-lead ECG, algorithm, e-health system, mobile applications
Abstract: Dominques et al. in their recent article described how low-cost sensors, such as Microsoft Kinect could be utilized for the measurement of various anthropometric measures. With the recent advances in sensors and sensor based technology, along with the rapid advancement in E-health, Microsoft Kinect has been increasingly recognized by researchers and bioengineers to be a low-cost sensor that could help in the collation of various measurements and various data. A recent systematic review done by Da Gama et al. (2015) have looked into the potential of Kinect in terms of motor rehabilitation. The systematic review highlighted the tremendous potential of…the sensors and has clearly stated that there is a need for further studies evaluating its potential for rehabilitation. Zhang et al. (2015) in their recent article have advocated several reasons as to why biosensors are pertinent for stroke rehabilitation. Of note, recent studies done by the World Health Organization have highlighted that stroke is a growing epidemic. Aside to the utilization of smartphone based sensors for stroke rehabilitation, as proposed by Zhang et al. (2015), researchers have also investigated the use of other low cost alternatives, such as Kinect, to facilitate the rehabilitation of stroke survivors. Whilst it may seemed like that has been quite extensive evaluation of the Kinect sensor for stroke rehabilitation, one core area that bio-engineers and researchers have not looked into is that of the psychiatric and mental health issues that might at times arise following a stroke. It is thus the aim of this letter to address how such a sensor could be tapped upon for psychiatric rehabilitation amongst stroke survivors. To this end, the authors have thus conceptualized a game that could help in the cognitive remediation for stroke survivors using low cost Kinect sensors.
Abstract: The amount of data that is being generated in health care is enormous, especially with the widespread availability of multimedia devices. However, the data keeping in developing countries is still unstructured. Lots of this Big Data is therefore vulnerable to loss. In the current report we highlight the problem and suggest the need for cost effective solution.