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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 non-image-forming effects of luminous radiation on people with intellectual disabilities or dementia received attention from researchers. Such studies, however, have generally been conducted using disparate methodologies which precludes generalization and reproducibility. OBJECTIVE: The aim of this study was to determine the practical applicability of measurement devices for studies investigating non-image-forming effects of luminous radiation, specifically for people with intellectual disabilities or dementia. METHODS: In three experiments, ten cognitive impaired people and thirty-nine unaffected subjects participated by wearing one or more portable devices. Six devices were assessed in total. Measurement…data was accompanied with user experiences obtained from questionnaires, interviews and observations in order to assess the devices on practical and comfort issues. RESULTS: On average, the devices worn by the cognitive impaired subjects were not experienced as annoying or irritating. No significant differences are found between genders and for one of the portable devices significantly less annoyance was reported by the cognitive impaired participants compared to the unaffected group of participants. INNOVATIVE SOLUTION: The three phases of the research process in towards measuring personal luminous exposures are: selection of the most suitable portable device, application of the assessment method, and the application of the device in the (pilot) study. CONCLUSIONS: However, the findings of this study suggest that inaccuracies potentially caused by practical and comfort issues associated with the portable devices need to be considered.
Abstract: PURPOSE: To develop a mobile application (app) for oral cancer screening. METHODS: The app was developed using Android system version 4.4.2, with JAVA language. Information concerning sociodemographic data and risk factors for oral cancer development, e.g., tobacco and alcohol use, sun exposure and other contributing factors, such as unprotected oral sex, oral pain and denture use, were included. We surveyed a population at high risk for oral cancer development and then evaluated the sensitivity/specificity/accuracy and predictive values of clinical oral diagnosis between two blinded trained examiners, who used movies and data from the app, and…in loco oral examination as gold-standard. RESULTS: A total of 55 individuals at high risk for oral cancer development were surveyed. Of these, 31% presented homogeneous/heterogeneous white lesions with potential of malignancy. The clinical diagnoses performed by the two examiners using videos were found to have sensitivity of 82%-100% (average 91%), specificity of 81%-100% (average 90.5%), and accuracy of 87.27%-95.54% (average 90.90%), as compared with the gold-standard. The Kappa agreement value between the gold-standard and the examiner with the best agreement was 0.597. CONCLUSION: Mobile apps including videos and data collection interfaces could be an interesting alternative in oral cancer research development.
Keywords: Oral cancer, health informatics, health public policy
Abstract: BACKGROUND: Myocardial revascularization by coronary artery bypass grafting (CABG) is an effective measure for reducing symptoms and mortality in patients with unstable or severe coronary artery disease (CAD). Autonomic function can be estimated non-invasively using heart rate variability (HRV). HRV of patients undergoing CABG is investigated before and after CABG using a soft-decision wavelet based spectral analysis. OBJECTIVE: The main purpose of this work is to evaluate non-invasively HRV in patients undergoing CABG before operation; and to monitor the status of patients through HRV investigation on day 6 and day 30 after the CABG operation.…The study intends to contribute scientific value to understanding the effect of CABG on the cardiovascular autonomic function and surgical outcome. METHODS: The soft-decision wavelet-based technique is used in this work in order to measure the power spectral density of the three main bands (VLF, LF, and HF) of HRV in 24 patients undergoing CABG operation, before the operation (Group 1: G1), and 6 days after operation (Group 2: G2) and 30 days after operation (Group 3: G3). The data is obtained from Sultan Qaboos University hospital in Oman. RESULTS: The HF power increases in 22 out of 24 patients in G2 compared to G1. While the LF power decreases in 21 out of 24 patients in G2 compared to G1. Comparing G3 to G1 the LF power decreases in 20 patients. The sum of the VLF and LF power is reduced in G2 in all 24 subjects compared to G1, and in 19 subjects in G3 compared to G1. CONCLUSIONS: The power spectral density of the HF shows increase in patients recorded on day 6 after operation compared to patients before the operation. The LF shows a decrease in G2 compared to G1. The results of G3 after 30 days of operation still show an increase of the HF power and a decrease in the LF power in most of the patients compared to their values before operation.
Abstract: Body circumference is a known health-related factor. This cross-sectional study aimed to investigate the associations of relative lower body circumferences with metabolic syndrome (MetS) and arterial stiffness (AS) in 684 men aged > 40 (mean, 54.6 ± 8.5) years. Participants were measured for waist, thigh, and calf circumferences; underwent blood tests and blood pressure measurements to detect MetS; and received brachial ankle pulse wave velocity measurements to measure AS. The waist-to-thigh, waist-to-calf, and thigh-to-calf circumferences were calculated and classified into quartiles. Age-adjusted multiple logistic regression models were used to assess the associations between the circumference ratios and AS vs.…non-AS and MetS vs. non-MetS (systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting plasma glucose). The mean body mass index was 24.9 ± 2.8 kg/m2 ; the mean waist, thigh, and calf circumferences were 87.4 ± 7.6, 53.8 ± 4.2, and 36.4 ± 2.7 cm, respectively. Compared to the lowest quartiles, participants in waist-to-thigh circumference quartiles 3 (odds ratio [OR] = 3.195, 95% confidence interval [CI] = 1.825-5.594, p < 0.001) and 4 (OR = 4.755, 95% CI = 2.715-8.325, p < 0.001), and participants in waist-to-calf circumference quartiles 2 (OR = 2.511, 95% CI = 1.397-4.511, p = 0.002), 3 (OR = 3.929, 95% CI = 2.076-7.435, p < 0.001), and 4 (OR = 5.298, 95% CI = 2.847-9.858, p < 0.001) had significantly greater risks of MetS; participants in waist-to-calf circumference quartile 4 (OR = 2.481, 95% CI = 1.477-4.167, p < 0.001) and participants in waist-to-calf circumference quartile 4 (OR = 1.763, 95% CI = 1.088-2.856, p = 0.021) had a significantly greater risk of AS, indicating that age-adjusted relative lower body circumferences associate with MetS and AS. Large thigh and calf circumferences may indicate reduced risks for cardiovascular disease.
Keywords: Arterial stiffness, body circumference, metabolic syndrome
Abstract: BACKGROUND: Speech synthesis models have been considered as viable tools for performance evaluation of cochlear stimulation algorithms, due to the difficulties of clinical tests. OBJECTIVE: The present study has developed a tool that can be used before any audio signal reconstruction algorithm, which shows more conformity with the electrophysiological parameters of the patient in evaluation of the cochlear implant stimulation algorithms. METHODS: In this method, excitable nerve fiber characteristics such as stimulation threshold and effective refractory period have been considered in the signal pre-reconstruction process. This algorithm subsumes the user's biological parameters (e.g.,…the manner of distribution of the remaining intact nerve fibers) as well as the stimulation signal parameters (e.g., stimulation rate, pulse width, amplitude of stimulation, the distance between stimulation electrode and fibers) in the signal pre-reconstruction. RESULTS: Effect of changes in these parameters can be observed by the number of excited fibers, which is directly related to the signal intensity and pitch frequency perceived by the user. The obtained results from simulations are in accordance with previous clinical findings. Also, the ability of the proposed tool can be seen by the correspondence between the results obtained from the proposed model and the amplitude growth functions of the cochlear implant users. CONCLUSIONS: This paper has introduced a tool for signal reconstruction from electrical stimulation so that a more comprehensive criterion for examination of the stimulating algorithms in cochlear implant can be achieved.
Abstract: The medical device industry has grown rapidly and incessantly over the past century. The sophistication and complexity of the designed instrumentation is nowadays rising and, with it, has also increased the need to develop some better, more effective and efficient maintenance processes, as part of the safety and performance requirements. This paper presents the results of performance tests conducted on 50 mechanical ventilators and 50 infant incubators used in various public healthcare institutions. Testing was conducted in accordance to safety and performance requirements stated in relevant international standards, directives and legal metrology policies. Testing of output parameters for mechanical ventilators…was performed in 4 measuring points while testing of output parameters for infant incubators was performed in 7 measuring points for each infant incubator. As performance criteria, relative error of output parameters for mechanical ventilators and absolute error of output parameters for infant incubators was calculated. The ranges of permissible error, for both groups of devices, are regulated by the Rules on Metrological and Technical Requirements published in the Official Gazette of Bosnia and Herzegovina No. 75/14, which are defined based on international recommendations, standards and guidelines. All ventilators and incubators were tested by etalons calibrated in an ISO 17025 accredited laboratory, which provides compliance to international standards for all measured parameters. The results show that 30% of the tested medical devices are not operating properly and should be serviced, recalibrated and/or removed from daily application.
Abstract: BACKGROUND: The goal of this work is to develop a digital version of a standard cognitive assessment, the Trail Making Test (TMT), and assess its utility. OBJECTIVE: This paper introduces a novel digital version of the TMT and introduces a machine learning based approach to assess its capabilities. METHODS: Using digital Trail Making Test (dTMT) data collected from (N = 54) older adult participants as feature sets, we use machine learning techniques to analyze the utility of the dTMT and evaluate the insights provided by the digital features. RESULTS: Predicted…TMT scores correlate well with clinical digital test scores (r = 0.98) and paper time to completion scores (r = 0.65). Predicted TICS exhibited a small correlation with clinically derived TICS scores (r = 0.12 Part A, r = 0.10 Part B). Predicted FAB scores exhibited a small correlation with clinically derived FAB scores (r = 0.13 Part A, r = 0.29 for Part B). Digitally derived features were also used to predict diagnosis (AUC of 0.65). CONCLUSION: Our findings indicate that the dTMT is capable of measuring the same aspects of cognition as the paper-based TMT. Furthermore, the dTMT's additional data may be able to help monitor other cognitive processes not captured by the paper-based TMT alone.
Keywords: Computerized cognitive assessment, design and validation, machine learning, mobile application, Trail Making Test
Abstract: It is thought that the critical brain dynamics in sleep is modulated during frequent periods of wakefulness. This paper utilizes the capacity of EEG based scaling analysis to quantify sleep fragmentation in patients with obstructive sleep apnea. The scale-free (fractal) behavior refers to a state where no characteristic scale dominates the dynamics of the underlying process which is evident as long range correlations in a time series. Here, Multiscaling (multifractal) spectrum is utilized to quantify the disturbed dynamic of an OSA brain with fragmented sleep. The whole night multichannel sleep EEG recordings of 18 subjects were employed to compute and…quantify variable power-law long-range correlations and singularity spectra. Based on this characteristic, a new marker for sleep fragmentation named ``scaling based sleep fragmentation'' was introduced. This measure takes into account the sleep run length and stage transition quality within a fuzzy inference system to improve decisions made on sleep fragmentation. The proposed index was implemented, validated with sleepiness parameters and compared to some common indexes including sleep fragmentation index, arousal index, sleep diversity index, and sleep efficiency index. Correlations were almost significant suggesting that the sleep characterizing measure, based on singularity spectra range, could properly detect fragmentations and quantify their rate. This method can be an alternative for quantifying the sleep fragmentation in clinical practice after being approved experimentally. Control of sleep fragmentation and, subsequently, suppression of excessive daytime sleepiness will be a promising outlook of this kind of researches.
Abstract: BACKGROUND: Intraocular Pressure (IOP) is defined as the pressure of aqueous in the eye. It has been reported that the normal range of IOP should be within the 10-20 mmHg with an average of 15.50 mmHg among the ophthalmologists. Keratoconus is an anti-inflammatory eye disorder that debilitated cornea unable to reserve the normal structure contrary to the IOP in the eye. Consequently, the cornea would bulge outward and invoke a conical shape following by distorted vision. In addition, it is known that any alterations in the structure and composition of the lens and cornea would exceed a change of…the eye ball as well as the mechanical and optical properties of the eye. OBJECTIVE: Understanding the precise alteration of the eye components' stresses and deformations due to different IOPs could help elucidate etiology and pathogenesis to develop treatments not only for keratoconus but also for other diseases of the eye. METHODS: In this study, at three different IOPs, including 10, 20, and 30 mmHg the stresses and deformations of the human eye components were quantified using a Three-Dimensional (3D) computational Fluid-Structure Interaction (FSI) model of the human eye. RESULTS: The results revealed the highest amount of von Mises stress in the bulged region of the cornea with 245 kPa at the IOP of 30 mmHg. The lens was also showed the von Mises stress of 19.38 kPa at the IOPs of 30 mmHg. In addition, by increasing the IOP from 10 to 30 mmHg, the radius of curvature in the cornea and lens was increased accordingly. In contrast, the sclera indicated its highest stress at the IOP of 10 mmHg due to over pressure phenomenon. The variation of IOP illustrated a little influence in the amount of stress as well as the resultant displacement of the optic nerve. CONCLUSION: These results can be used for understanding the amount of stresses and deformations in the human eye components due to different IOPs as well as for clarifying significant role of IOP on the radius of curvature of the cornea and the lens.
Keywords: Human eye, Intraocular Pressure, keratoconus, fluid-structure interaction, stresses and deformations
Abstract: Evaluating the biomechanical and performance factors of the knee joint during golf swing can provide objective and quantitative information about improving the performance and development of efficient physical training, as the legs are important for achieving an efficient swing and maximum speed of the club head in golf. In the present study, kinematic movements of the knee joint were identified during the downswing by using 3-dimensional motion analysis, and isokinetic strength was measured with driver and 5-iron clubs in 15 professional (PRO) golfers and 10 amateur (AMA) golfers. Results showed that PRO golfers had a narrower minimal angle between the…thigh and lower leg in the trail knee than the AMA golfers, regardless of the club used, and the angular velocity of the lead knee was faster during the downswing with a 5-iron club in the AMA golfers than in the PRO golfers. The PRO and AMA golfers had a wider minimal angle between the thigh and lower leg, smaller total range of movement, and slower angular velocity of the trail knee when swinging a 5-iron club than when swinging a driver club. These results are expected to provide useful information to prevent golf-related injuries that usually arise in the knee joint and help improve the golf performance of amateur golfers.
Keywords: Downswing, golf, knee joint, isokinetic strength, kinematic movement