Technology and Health Care - Volume 25, issue 3

Authors: Shim, Sung J. | Kumar, Arun | Jiao, Roger

Article Type: Research Article

Abstract: BACKGROUND: Some healthcare managers use computer simulation to assist with staffing. As staffing actions are usually slow to evolve and long term in nature, computer simulation can provide the opportunity to evaluate different alternatives at substantially lower costs with fewer risks. OBJECTIVE: Using computer simulation, this paper seeks to determine the optimal number and allocation of clerks involved in the patient registration process of a hospital. METHODS: This paper is based on a case study conducted in a hospital and uses historical data provided by the hospital in simulating the patient registration process. …RESULTS: The simulation results indicate that computer simulation can be an effective decision supporting tool in modeling the patient registration process and evaluating the effects of changes in the number and allocation of clerks in the process. CONCLUSIONS: Based upon a case study applying real-world data, the results of this paper would be beneficial to those who consider utilizing computer simulation for staffing decisions. Show more

Keywords: Staffing, simulation, hospital, patient registration

DOI: 10.3233/THC-161268

Citation: Technology and Health Care, vol. 25, no. 3, pp. 385-390, 2017

Authors: Tsirmpas, Charalampos | Kouris, Ioannis | Anastasiou, Athanasios | Giokas, Kostas | Iliopoulou, Dimitra | Koutsouris, Dimitris

Article Type: Research Article

Abstract: Internet of Things (IoT) is the logical further development of today's Internet, enabling a huge amount of devices to communicate, compute, sense and act. IoT sensors placed in Ambient Assisted Living (AAL) environments, enable the context awareness and allow the support of the elderly in their daily routines, ultimately allowing an independent and safe lifestyle. The vast amount of data that are generated and exchanged between the IoT nodes require innovative context modeling approaches that go beyond currently used models. Current paper presents and evaluates an open interoperable platform architecture in order to utilize the technical characteristics of IoT and …handle the large amount of generated data, as a solution to the technical requirements of AAL applications. Show more

Keywords: Internet of Things, ambient assisted living, telemonitoring, context aware

DOI: 10.3233/THC-161270

Citation: Technology and Health Care, vol. 25, no. 3, pp. 391-401, 2017

Authors: Roh, Hee-Tae | So, Wi-Young

Article Type: Research Article

Abstract: Cranial electrotherapy stimulation (CES) is reported to aid in relieving symptoms of depression and anxiety, though the mechanism underlying this effect remains unclear. Therefore, the present study aimed to evaluate changes in the hypothalamic-pituitary-adrenal (HPA) axis response and levels of neurotrophic factors, as well as changes in mood state, in patients undergoing CES therapy. Fifty healthy postmenopausal women were randomly assigned to either a Sham CES group (n = 25) or an Active CES group (n = 25). CES treatment was conducted in 20-minute sessions, three times per week for 8 weeks, using a micro current cranial electrotherapy stimulator. Blood …samples were collected prior to and following the 8-week treatment period for measurement of cortisol, adrenocorticotropic hormone (ACTH), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) levels. Changes in mood state were also examined at the time of blood collection using the Profile of Mood States (POMS). No significant differences in cortisol, ACTH, BDNF, or NGF were observed between the two participant groups (p > 0.05) following the treatment period. However, those in the Active CES group exhibited significantly decreased Tension-Anxiety and Depression-Dejection scores on the POMS relative to pre-treatment scores (p < 0.05). Furthermore, Depression-Dejection scores following treatment were significantly lower in the Active CES group than in the Sham CES group (p < 0.05). No significant differences were observed in any other POMS scores such as Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment (p > 0.05). These results suggest that 8 weeks of CES treatment does not induce changes in blood levels of neurotrophic factors or HPA-axis-related hormones, though such treatment may be effective in treating symptoms of anxiety and depression. Show more

Keywords: Cranial electrotherapy stimulation, depression, anxiety, mental health, neurotrophic factor

DOI: 10.3233/THC-161275

Citation: Technology and Health Care, vol. 25, no. 3, pp. 403-412, 2017

Authors: Zeinali-Rafsanjani, B. | Faghihi, R. | Mosleh-Shirazi, M.A. | Mosalaei, A. | Hadad, K.

Article Type: Research Article

Abstract: PURPOSE: Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. METHODS AND MATERIAL: The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. …In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. RESULT: These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. CONCLUSION: The results of the treatment study show that the optimized standard and mid sternum treatment for different chest wall thicknesses is with 50 cm FSD and zero (vertical) tube angle, while in large contour patients, it is with 100 cm FSD and zero tube angle. Finally, chest wall kilovoltage and electron therapies were compared, which revealed that electron therapy produces a better dose distribution than kilovoltage therapy. Show more

Keywords: Chest wall irradiation, orthovoltage therapy, Monte Carlo simulation, treatment planning

DOI: 10.3233/THC-161276

Citation: Technology and Health Care, vol. 25, no. 3, pp. 413-424, 2017

Authors: Evangelista, Lorraine S. | Ghasemzadeh, Hassan | Lee, Jung-Ah | Fallahzadeh, Ramin | Sarrafzadeh, Majid | Moser, Debra K.

Article Type: Research Article

Abstract: BACKGROUND: It is unclear whether subgroups of patients may benefit from remote monitoring systems (RMS) and what user characteristics and contextual factors determine effective use of RMS in patients with heart failure (HF). OBJECTIVE: The study was conducted to determine whether certain user characteristics (i.e. personal and clinical variables) predict use of RMS using advanced machine learning software algorithms in patients with HF. METHODS: This pilot study was a single-arm experimental study with a pre- (baseline) and post- (3 months) design; data from the baseline measures were used for the current data analyses. …Sixteen patients provided consent; only 7 patients (mean age 65.8 ± 6.1, range 58-83) accessed the RMS and transmitted daily data (e.g. weight, blood pressure) as instructed during the 12 week study duration. RESULTS: Baseline demographic and clinical characteristics of users and non-users were comparable for a majority of factors. However, users were more likely to have no HF specialty based care or an automatic internal cardioverter defibrillator. The precision accuracy of decision tree, multilayer perceptron (MLP) and k-Nearest Neighbor (k-NN) classifiers for predicting access to RMS was 87.5%, 90.3%, and 94.5% respectively. CONCLUSION: Our preliminary data show that a small set of baseline attributes is sufficient to predict subgroups of patients who had a higher likelihood of using RMS. While our findings shed light on potential end-users more likely to benefit from RMS-based interventions, additional research in a larger sample is warranted to explicate the impact of user characteristics on actual use of these technologies. Show more

Keywords: E-health, telecardiology, telehealth

DOI: 10.3233/THC-161279

Citation: Technology and Health Care, vol. 25, no. 3, pp. 425-433, 2017

Authors: Liu, Shuangyan | Teng, Jing | Qi, Xianghua | Wei, Shoushui | Liu, Chengyu

Article Type: Research Article

Abstract: BACKGROUND: The usefulness of heart rate variability (HRV) in the clinical research has been verified in numerous studies. However, it is controversy that using pulse rate variability (PRV) as a surrogate of HRV in different clinical applications. OBJECTIVE: We aimed to investigate whether PRV extracted from finger pulse photoplethysmography (Pleth) signal could substitute HRV from ECG signal during different sleep stages by analyzing the common time-domain, frequency-domain and non-linear indices. METHODS: Seventy-five sleep apnea patients were enrolled. For each patient, ECG and Pleth signals were simultaneously recorded for the whole night using …Alice Sleepware Polysomnographic System and the sleep stage signals were automatically calculated by this System. Time-domain, frequency-domain and non-linear indices of both HRV and PRV were calculated for each sleep stage. RESULTS: Mann-Whitney U-test showed that for both time-domain and frequency-domain indices, there were no statistical differences between HRV and PRV results during all four sleep stages. For non-linear indices, sample entropy reported statistical differences between HRV and PRV results for N1, N2 and REM sleeps (all P< 0.01) whereas fuzzy measure entropy only reported statistical differences for REM sleep (P< 0.05). SDNN, LF and LF/HF indices decreased for both HRV and PRV with the sleep deepening while HF and non-linear indices increased. In addition, there were strong and significant correlation between HRV and PRV indices during all four sleep stages (all P< 0.01). CONCLUSIONS: PRV measurement could present the similar results as HRV analysis for sleep apnea patients during different sleep stages. Show more

Keywords: Heart rate variability, pulse rate variability, sleep apnea, sleep stage

DOI: 10.3233/THC-161283

Citation: Technology and Health Care, vol. 25, no. 3, pp. 435-445, 2017

Authors: Xia, Yirong | Yang, Licai | Mao, Xueqin | Zheng, Dingchang | Liu, Chengyu

Article Type: Research Article

Abstract: Recent studies have indicated that physiological parameters change with different emotion states. This study aimed to quantify the changes of vascular function at different emotion and sub-emotion states. Twenty young subjects were studied with their finger photoplethysmographic (PPG) pulses recorded at three distinct emotion states: natural (1 minute), happiness and sadness (10 minutes for each). Within the period of happiness and sadness emotion states, two sub-emotion states (calmness and outburst) were identified with the synchronously recorded videos. Reflection index (RI) and stiffness index (SI), two widely used indices of vascular function, were derived from the PPG pulses to quantify their …differences between three emotion states, as well as between two sub-emotion states. The results showed that, when compared with the natural emotion, RI and SI decreased in both happiness and sadness emotions. The decreases in RI were significant for both happiness and sadness emotions (both P< 0.01), but the decreases in SI was only significant for sadness emotion (P< 0.01). Moreover, for comparing happiness and sadness emotions, there was significant difference in RI (P< 0.01), but not in SI (P= 0.9). In addition, significant larger RI values were observed with the outburst sub-emotion in comparison with the calmness one for both happiness and sadness emotions (both P< 0.01) whereas significant larger SI values were observed with the outburst sub-emotion only in sadness emotion (P< 0.05). Moreover, gender factor hardly influence the RI and SI results for all three emotion measurements. This pilot study confirmed that vascular function changes with diffenrt emotion states could be quantified by the simple PPG measurement. Show more

Keywords: Emotion recognition, PPG, vascular function, reflection index, stiffness index

DOI: 10.3233/THC-161284

Citation: Technology and Health Care, vol. 25, no. 3, pp. 447-456, 2017

Authors: Kobayashi, Yuske | Hauptmann, Ralf | Kratz, Harald | Ebert, Monika | Wagner, Susanne | Taupitz, Matthias

Article Type: Research Article

Abstract: BACKGROUND: Pharmacokinetic studies and histological detection of superparamagnetic iron oxide nanoparticles (SPIO) in biomedical research are limited due to a high iron background especially in pathological tissues. OBJECTIVE: The suitability of doping the iron oxide cores of SPIO with europium (Eu) was tested for improved histologic detection and for quantitative analysis without changing their properties as probes for magnetic resonance imaging (MRI). A special variant of SPIO, so called very small superparamagnetic iron oxide nanoparticles (VSOP), was used for this approach. METHODS: VSOP, stabilized by a citrate coating, were synthesized with and without …addition of Eu (Eu-VSOP and VSOP, respectively). MR signal enhancing effects of Eu-VSOP and VSOP were studied in vitro. Cellular uptake of Eu-VSOP and VSOP was examined in RAW264.7 cells. For Eu-VSOP, fluorescence microscopy and spectrophotometry were used. Eu fluorescence was enhanced by means of an antenna system. For VSOP, Prussian blue staining and photometry using the phenanthroline method were applied. Results for both VSOP variants were compared. RESULTS: Eu-VSOP and VSOP did not differ with respect to MR signal enhancing effects nor to uptake characteristics in the RAW264.7 cell experiments. Fluorescence microscopy detects Eu-VSOP with higher sensitivity compared to light microscopy using Prussian blue staining. In microscopy as well as in the analytical quantification using fluorescence, detection of Eu-VSOP is not contaminated by Fe background. CONCLUSIONS: Doping the VSOP with Eu allows for their improved detection by fluorescence microscopy and quantitative analysis without changing their cellular uptake characteristics or their MR signal enhancing effects and thus would allow for a multimodal approach for studying their pharmacokinetics and biodistribution in experimental research. Show more

Keywords: Iron oxide nanoparticles, molecular imaging, lanthanide luminescence, MRI, macrophage

DOI: 10.3233/THC-161285

Citation: Technology and Health Care, vol. 25, no. 3, pp. 457-470, 2017

Authors: Ahmad, Rana Fayyaz | Malik, Aamir Saeed | Kamel, Nidal | Reza, Faruque | Amin, Hafeez Ullah | Hussain, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Classification of the visual information from the brain activity data is a challenging task. Many studies reported in the literature are based on the brain activity patterns using either fMRI or EEG/MEG only. EEG and fMRI considered as two complementary neuroimaging modalities in terms of their temporal and spatial resolution to map the brain activity. For getting a high spatial and temporal resolution of the brain at the same time, simultaneous EEG-fMRI seems to be fruitful. METHODS: In this article, we propose a new method based on simultaneous EEG-fMRI data and machine learning approach to …classify the visual brain activity patterns. We acquired EEG-fMRI data simultaneously on the ten healthy human participants by showing them visual stimuli. Data fusion approach is used to merge EEG and fMRI data. Machine learning classifier is used for the classification purposes. RESULTS: Results showed that superior classification performance has been achieved with simultaneous EEG-fMRI data as compared to the EEG and fMRI data standalone. This shows that multimodal approach improved the classification accuracy results as compared with other approaches reported in the literature. CONCLUSIONS: The proposed simultaneous EEG-fMRI approach for classifying the brain activity patterns can be helpful to predict or fully decode the brain activity patterns. Show more

Keywords: EEG, fMRI, simultaneous EEG-fMRI, data fusion, classification

DOI: 10.3233/THC-161286

Citation: Technology and Health Care, vol. 25, no. 3, pp. 471-485, 2017

Authors: Mugica, Francisco | Nebot, Àngela | Bagherpour, Solmaz | Baladón, Luisa | Serrano-Blanco, Antonio

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Major depressive disorder causes more human suffering than any other disease affecting humankind. It has a high prevalence and it is predicted that it will be among the three leading causes of disease burden by 2030. The prevalence of depression, all of its social and personal costs, and its recurrent characteristics, put heavy constraints on the ability of the public healthcare system to provide sufficient support for patients with depression. In this research, a model for continuous monitoring and tracking of depression in both short-term and long-term periods is presented. This model is based on a …new qualitative reasoning approach. METHOD: This paper describes the patient assessment unit of a major depression monitoring system that has three modules: a patient progress module, based on a qualitative reasoning model; an analysis module, based on expert knowledge and a rules-based system; and the communication module. These modules base their reasoning mainly on data of the patient's mood and life events that are obtained from the patient's responses to specific questionnaires (PHQ-9, M.I.N.I. and Brugha). The patient assessment unit provides synthetic and useful information for both patients and physicians, keeps them informed of the progress of patients, and alerts them in the case of necessity. RESULTS: A set of hypothetical patients has been defined based on clinically possible cases in order to perform a complete scenario evaluation. The results that have been verified by psychiatrists suggest the utility of the platform. CONCLUSION: The proposed major depression monitoring system takes advantage of current technologies and facilitates more frequent follow-up of the progress of patients during their home stay after being diagnosed with depression by a psychiatrist. Show more

Keywords: Major depressive disorder, remote monitoring system, rule-base system, qualitative reasoning

DOI: 10.3233/THC-161289

Citation: Technology and Health Care, vol. 25, no. 3, pp. 487-511, 2017

Authors: Tayebi, Mansour | Shooli, Fatemeh Shekoohi | Saeedi-Moghadam, Mahdi

Article Type: Research Article

Abstract: BACKGROUND: Over the past few years, because of high attenuation and lightweight, non-toxic, lead-free aprons (LFAs) have been replaced by lead aprons (LAs). Lots of studies declared that this fact was based on the interactions of diagnostic X-ray with material such as the photoelectric effect (PE) and Compton scattering. These studies have demonstrated that in these types of aprons, due to the presence of different K-edge absorption, PE has a wide absorption in various metals with divers K-edges. The measurement geometry in most of these studies was narrow beam geometry, i.e. a collimated source and a collimated detector with …a large source-detector distance. OBJECTIVE: The present study intended to evaluate the attenuation of radiology scattered radiations in LAs and LFAs in both narrow and broad beam geometries, which is a more realistic situation, in order to check whether or not the higher attenuation is valid. METHODS: In this study, a lead apron contains (Pb + EPV) and two non-lead compounds of (W + Sn + EPVC) with different weight percent (Wt%) were evaluated in the energy range of diagnostic radiology (100 kVp). The MCNPX code was applied to simulate broad - and narrow-beam measurement geometries. The evaluations have been performed in three situations: 1st ) the same density thickness of LA and LFAs 2nd ) same line thickness of LA and LFAs 3rd ) considering the thickness of LFAs which has the same attenuation with LAs i.e. lead equivalent thickness for LFAs in the narrow beam. Finally, the x-ray transmission ratio (I/I_0) of LAs and LFAs was compared in 100 kVp for three mentioned conditions. RESULTS: Our results indicated that LFAs had more radiation attenuation rather than LA in the 1st and 2nd conditions with both geometries. However, LFAs had lower attenuation in comparison to LAs in the 3rd condition with broad beam geometry. More importantly, the transmission ratio (I/I_0) of LFAs in the broad beam condition was more significant than LA. CONCLUSION: The scattered radiations produced by LFAs are more than LAs because of the production of characteristic radiations resulted from K-edge absorption in composited aprons. Consequently, the LFAs should be evaluated in both narrow and broad beam situation using the lead equivalent thickness of LFAs to make sure that the non-lead aprons do not increase the radiation dose of the user. Show more

Keywords: Lead-free aprons, lead aprons, diagnostic radiology, MCNPX, narrow and broad beam

DOI: 10.3233/THC-161293

Citation: Technology and Health Care, vol. 25, no. 3, pp. 513-520, 2017

Authors: Cha, Hyun Gyu | Kim, Myoung Kwon

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients. SUBJECTS AND METHODS: Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period. RESULTS: Subjects …in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05). CONCLUSIONS: Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients. Show more

Keywords: Motor recovery, repetitive transcranial magnetic stimulation, stroke

DOI: 10.3233/THC-171294

Citation: Technology and Health Care, vol. 25, no. 3, pp. 521-529, 2017

Authors: Call, Trevor | Hillock, Ronald

Article Type: Research Article

Abstract: BACKGROUND: Unprofessional conduct is detrimental to the Orthopaedic Surgery profession. Currently, no formal guidelines exist to define online professionalism other than the protection of patient confidentiality. OBJECTIVE: This study will extract a random but statistically significant number of practicing Orthopaedic Surgeons and review their online postings. METHODS: We observed the Internet content posted by 1,021 Orthopaedic Surgeons that were randomly selected from the American Academy of Orthopaedic Surgeons 2013 member directory. Each surgeon's name was entered into the Google.com search engine and on Social Media sites including Facebook.com, Twitter.com, LinkedIn.com, and …YouTube.com. The content was evaluated and recorded where it was encountered. Unprofessional content was recorded and reviewed by a panel for appropriateness. RESULTS: Of the 1,021 Orthopaedic Surgeons sampled, 82% have professional websites, 4% have professional blogs, 21% have professional Facebook accounts, 14% have professional Twitter accounts, 26% have professional LinkedIn accounts, and 14% have professional YouTube accounts. Unprofessional content was identified in 3.5% of all surgeons sampled who have some form of content on the Internet. CONCLUSION: Every Orthopaedic Surgeon should be aware of the content posted on the Internet. Our recommendation is for surgeons to routinely evaluate content posted on publically available venues for professionalism. Show more

Keywords: Orthopaedic, professionalism, Internet, website, social media

DOI: 10.3233/THC-171296

Citation: Technology and Health Care, vol. 25, no. 3, pp. 531-539, 2017

Authors: Ciou, Shih-Hsiang | Hwang, Yuh-Shyan | Chen, Chih-Chen | Luh, Jer-Junn | Chen, Shih-Ching | Chen, Yu-Luen

Article Type: Research Article

Abstract: BACKGROUND: Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical stimulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. OBJECTIVE: A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that …is more convenient and interesting. METHODS: An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES stimulation for inadequate ankle efforts. RESULTS: After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. CONCLUSIONS: Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation. Show more

Keywords: Stroke, smartphone, drop foot, portable, rehabilitation, FES

DOI: 10.3233/THC-160730

Citation: Technology and Health Care, vol. 25, no. 3, pp. 541-555, 2017

Authors: Zahn, Robert K. | Grotjohann, Sarah | Pumberger, Matthias | Ramm, Heiko | Zachow, Stefan | Putzier, Michael | Perka, Carsten | Tohtz, Stephan

Article Type: Research Article

Abstract: BACKGROUND: Pelvic tilt influences acetabular orientation (AO). Anatomical AO can be measured in relation to the anterior pelvic plane (APP), functional AO can be calculated relative to table's plane. OBJECTIVE: To assess to what extent functional AO is determined by pelvic tilt and if APP and table plane give equal information for correct AO. METHODS: AO was evaluated by computed tomography (CT) scans of 138 patients. Pelvic tilt, anatomical and functional AO were measured, differences between the two reference planes were calculated. RESULTS: Anatomical and functional acetabular anteversion (AA) were …found to be different in 21% of individuals with an enhanced extent of pelvic tilt. Functional AA was increased compared to anatomical AA at high posterior pelvic tilt (p < 0.001). Enlarged anterior tilting of the pelvis reduced APP-related AA (p < 0.002). Anatomical AA positively correlated with pelvic tilt, particularly in females (p < 0.01, correlation coefficient = 0.698, R2 = 0.523). CONCLUSIONS: APP and table plane do not provide equal information about AO at enhanced pelvic tilt. Functional orientation of the acetabulum is dependent on pelvic tilt, which itself is influenced by anatomical AA and should therefore be analyzed for precise AO. Show more

Keywords: Acetabular orientation, pelvic tilt, functional anatomy, sagittal balance

DOI: 10.3233/THC-161281

Citation: Technology and Health Care, vol. 25, no. 3, pp. 557-565, 2017

Authors: Bornemann, Rahel | Roessler, Philip P. | Jansen, Tom R. | Rommelspacher, Yorck | Sander, Kirsten | Wirtz, Dieter C. | Pflugmacher, Robert | Frey, Sönke P.

Article Type: Research Article

Abstract: BACKGROUND: 30% of myeloma patients suffer from vertebral compression fractures (VCF). Consequently, augmentation often becomes inevitable to prevent further problems. This study evaluated the interaction of radiation therapy (RT) and radiofrequency kyphoplasty (RFK) in the treatment of myeloma associated VCF. METHODS: Eighty-six myeloma patients with VCF were treated with RFK followed by radiation therapy (RFK group) or vice versa (RT group). Visual analgoue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height and kyphosis angle were assessed preoperatively, 3-4 days, 3 and 6 months postoperatively. Adverse events like cement leakage or additional fractures were documented. …RESULTS: Both groups achieved comparable outcomes, but the course of VAS and kyphosis angle differed. Early postoperative kyphosis angles improved significantly in the RFK group, but significantly worsened afterwards. The RT group showed a trend towards significantly improvement postoperatively and minor worsening afterwards. VAS remained constant in the RT group and worsened in the RFK group after 6 months. More cement leakages and additional fractures were noted in the RT group. CONCLUSIONS: RFK is an effective method for treating VCF in myeloma patients independent of treatment order with regard to radiation therapy. However, RT should be conducted after RFK to minimize risks of cement extrusion and additional fractures. Show more

Keywords: Radiofrequency kyphoplasty, vertebral compression fracture, myeloma, radiotherapy

DOI: 10.3233/THC-161288

Citation: Technology and Health Care, vol. 25, no. 3, pp. 567-575, 2017

Authors: Das, Anupam | Saha, Arindita | Chakraborty, Abhirup | Biswas, Bhaskar

Article Type: Research Article

Abstract: This paper deals with the investigation of external joint movement with respect to leg kinematics. The overall leg kinematics were investigated by means of a rigid, three-segment, 3D leg model. A 3D kinematics and ground reaction forces was being restructured. The images were then authenticated with the help of a cadaveric investigation and analysis. This was eventually used for prediction of the overall leg kinematics. Thereafter FEM based simulations were undertaken, and muscle forces were investigated based on the data available. With the help of FEM predictions it was found and understood that the overall leg kinematics were having higher …loading factor with respect to the lateral. Show more

Keywords: Strain gauge, medical instrumentation, pressure sensor, resonance

DOI: 10.3233/THC-161290

Citation: Technology and Health Care, vol. 25, no. 3, pp. 577-589, 2017

Authors: Sadeghi, Morteza | Ghasemi, Gholam Ali | Karimi, Mohammad Taghi

Article Type: Research Article

Abstract: BACKGROUND: Subjects with Spinal Cord Injury (SCI) should use various assistive devices to stand and walk. Unfortunately they suffer from slow walking speed, high energy consumption, and too much force applied on upper limb while walking. The aim of this study was to determine the gap between the gait performance of SCI and normal subjects to conclude how the performance of SCI can be improved. METHOD : Three groups of SCI walked with orthosis, SCI walked without orthosis, and normal subjects were recruited in this study. The normal subjects also walked with the same orthoses as SCI …subjects. Some parameters such as ranges of motion of hip, knee and spatiotemporal gait parameters were evaluated by use of Qualysis motion analysis system. The difference between the gait parameters of three groups were evaluated by use of two sample t test. RESULTS : The mean values of hip joint range of motion of normal subjects while walking with and without orthosis were 48.3 ± 2.5 and 18.5 ± 8.8 degrees, respectively (p-value = 0.00). There was a significant difference between walking speed of normal subjects with and without orthosis. The walking speed of SCI subject with and without orthosis differed significantly. CONCLUSION : Although use of orthosis enable SCI subjects to stand and walk, but has some restrictions. As use of orthosis decreased the abilities of normal subjects it can be concluded that more attention should be done on design of orthosis and style of walking. Show more

Keywords: Spinal cord injury, kinematic, gait, style of walking, orthosis

DOI: 10.3233/THC-171295

Citation: Technology and Health Care, vol. 25, no. 3, pp. 591-597, 2017

Authors: Yao, Daiwei | Lahner, Matthias | Jakubowitz, Eike | Thomann, Anna | Ettinger, Sarah | Noll, Yvonne | Stukenborg-Colsman, Christina | Daniilidis, Kiriakos

Article Type: Research Article

Abstract: BACKGROUND: An active ankle dorsiflexion is essential for a proper gait pattern. If there is a failure of the foot lifting, considerable impairments occur. The therapeutic effect of an implantable peroneus nerve stimulator (iPNS) for the ankle dorsiflexion is already approved by recent studies. However, possible affection for knee and hip motion after implantation of an iPNS is not well described. OBJECTIVE: The objective of this retrospective study was to examine with a patient cohort whether the use of iPNS induces a lower-extremity flexion withdrawal response in the form of an increased knee and hip flexion …during swing phase. METHODS: Eighteen subjects (12 m/6 w) treated with an iPNS (ActiGait® , Otto Bock, Duderstadt, Germany) were examined in knee and hip motion by gait analysis with motion capture system (Vicon Motion System Ltd® , Oxford, UK) and Plug-in-Gait model after a mean follow up from 12.5 months. The data were evaluated and compared in activated and deactivated iPNS. RESULTS: Only little changes could be documented, as a slight average improvement in peak knee flexion during stand phase from 1.0° to 2.5° and peak hip flexion in stance from 3.1° to 2.1° In contrast, peak knee flexion during swing appeared similar (25.3° to 25.7°) same as peak hip flexion during swing. In comparison with the healthy extremity, a more symmetric course of the knee flexion during stand phase could be shown. CONCLUSIONS: No statistical significant improvements or changes in hip and knee joint could be shown in this study. Only a more symmetric knee flexion during stand phase and a less hip flexion during stand phase might be hints for a positive affection of iPNS for knee and hip joint. It seems that the positive effect of iPNS is only based on the improvement in ankle dorsiflexion according to the recent literature. Show more

Keywords: Stroke, implantable peroneus nerve stimulator, gait pattern, knee and hip motion

DOI: 10.3233/THC-171297

Citation: Technology and Health Care, vol. 25, no. 3, pp. 599-606, 2017

Authors: Fahmi, Fahmi | Nasution, Tigor H. | Anggreiny, Anggreiny

Article Type: Research Article

Abstract: The use of medical imaging in diagnosing brain disease is growing. The challenges are related to the big size of data and complexity of the image processing. High standard of hardware and software are demanded, which can only be provided in big hospitals. Our purpose was to provide a smart cloud system to help diagnosing brain diseases for hospital with limited infrastructure. The expertise of neurologists was first implanted in cloud server to conduct an automatic diagnosis in real time using image processing technique developed based on ITK library and web service. Users upload images through website and the result, …in this case the size of tumor was sent back immediately. A specific image compression technique was developed for this purpose. The smart cloud system was able to measure the area and location of tumors, with average size of 19.91 ± 2.38 cm2 and an average response time 7.0 ± 0.3 s. The capability of the server decreased when multiple clients accessed the system simultaneously: 14 ± 0 s (5 parallel clients) and 27 ± 0.2 s (10 parallel clients). The cloud system was successfully developed to process and analyze medical images for diagnosing brain diseases in this case for tumor. Show more

Keywords: Cloud system, ITK, web services, medical image, brain diseases

DOI: 10.3233/THC-171298

Citation: Technology and Health Care, vol. 25, no. 3, pp. 607-610, 2017