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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: Knowledge of the pressure distribution around human thorax in blast help to understand the injury mechanisms and their assessment. To investigate the transmission mechanism of the pressure on human thorax in blast, a three dimension surface model of human thorax was constructed in this work. To increase the precious of this model, tetrahedron element division method was applied to transfer the rough 3D surface model to hexahedral elements model. Using this model, the high pressure duration was computationally solved using numerical simulation of the hexahedral elements. Simulation results showed that the apex of lungs was subjected to the largest stress…in a blast. In order to verify this result, an animal experiment was performed on a dog. The animal experimental results was shown to have a same variation tendency with the calculation results based on our numerical model of human thorax, which made this model reliable for the blast injury research.
Keywords: Finite element model, human thorax, blast injury, numerical simulation
Abstract: Dental stem cells isolated for human dental pulp are an excellent source for regenerative medicine and dentistry. Simulation of clinical scenario is one of the crucial challenges for evaluation of the efficacy of DPSCs in various regenerative therapies. In this study we evaluated the viability of DPSCs after treatment with artificial bacterial lipopolysaccharides (LPS) as the main component responsible for inducing inflammatory response in majority of the inflammatory conditions in clinical scenario. Although a number of studies have previously treated stem cells with LPS from bacteria, however the accuracy level of the outcome was not established. Here we have analyzed…the outcome using adaptive neuro-fuzzy inferences system (ANFIS) to predict the viability of human DPSCs after treatment with bacterial LPS.
Abstract: BACKGROUND: Each year, on average 1.26 million students face physical injuries at German schools and universities. Implementation of systematic prevention programs against school-associated injuries in adolescents is poor. Part of the reason might be a lack of data on nature and frequency of common school-associated injuries. OBJECTIVE: The aim of this study was to obtain qualitative and quantitative data that might help to develop prevention or protection strategies against sport-associated injuries at school. METHODS: A retrospective analysis was conducted on all patients between the ages of 10 and 16 years admitted from January 1 st…, 2009 to December 31 st , 2013 to the emergency room of an academic teaching hospital for school-associated injuries (n = 901). For injuries associated with school sports, time of injury, type of sports and injured body region were analyzed. RESULTS: A significant part of school-associated injuries occurred in school sports (55.7%). The frequency of school sport-associated injuries per school day did not differ between months or seasons of the school year. Most injuries occurred between the ages of thirteen to fifteen. Ball sports were associated with 41% of all sport-associated injuries, particularly with soccer (22%). Distal extremities like hands (38.4%) and feet/ankle (30.3%) were predominantly injured, but only 5% of cases needed surgery. CONCLUSIONS: Most school-associated injuries occur in school sport, particularly with ball sports. Mostly, distal extremities were injured. Implementation of systematic prevention strategies for a reduction in finger injuries should be subject of future research.
Keywords: School-associated injury, sport-associated injury, physical education, adolescence, school sport
Abstract: OBJECTIVE: This study aims to compare the curative effect of different treatment methods of hypertensive putamen hemorrhage, in order to determine an ideal method of treatment; and to explore the curative effect of the application of soft channel technology-minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage. METHODS: Patients with hypertensive cerebral hemorrhage, who were treated in our hospital from January 2015 to January 2016, were included into this study. Patients were divided into three groups: minimally invasive drainage group, internal medical treatment group and craniotomy group. In the minimally…invasive drainage group, puncture aspiration and drainage were performed according to different hematoma conditions detected in brain CT, the frontal approach was selected for putamen and intracerebral hemorrhage, and drainage was reserved until the hematoma disappeared in CT detection. Drug therapy was dominated in the internal medical treatment group, while surgery under general anesthesia was performed to remove the hematoma in the craniotomy group. RESULTS: Post-treatment neurological function defect scores in minimally invasive drainage group and internal medical group were 16.14 ± 11.27 and 31.43 ± 10.42, respectively; and the difference was remarkably significant (P < 0.01). Post-treatment neurological function defect scores in the minimally invasive drainage group and craniotomy group were 16.14 ± 11.27 and 24.20 ± 12.23, respectively; and the difference was statistically significant (P < 0.05). There was a remarkable significant difference in ADL1-2 level during followed-up in survival patients between the minimally invasive drainage group and internal medical treatment group (P < 0.01), and there was a significant difference in followed-up mortality between these two groups (P < 0.01). CONCLUSION: Clinical observation and following-up results revealed that minimally invasive drainage treatment was superior to internal medical treatment and craniotomy.
Abstract: BACKGROUND: TNF-α regulates immune cells and acts as an endogenous pyrogen. Reverse transcription polymerase chain reaction (RT-PCR) is one of the most commonly used methods for gene expression analysis. Among the alternatives to PCR, loop-mediated isothermal amplification (LAMP) shows good potential in terms of specificity and sensitivity. OBJECTIVE: However, few studies have compared RT-PCR and LAMP for human gene expression analysis. Therefore, in the present study, we compared one-step RT-PCR, two-step RT-LAMP and one-step RT-LAMP for human gene expression analysis. METHODS: We compared three gene expression analysis methods using the…human TNF-α gene as a biomarker from peripheral blood cells. Total RNA from the three selected febrile patients were subjected to the three different methods of gene expression analysis. RESULTS: In the comparison of three gene expression analysis methods, the detection limit of both one-step RT-PCR and one-step RT-LAMP were the same, while that of two-step RT-LAMP was inferior. One-step RT-LAMP takes less time, and the experimental result is easy to determine. CONCLUSIONS: One-step RT-LAMP is a potentially useful and complementary tool that is fast and reasonably sensitive. In addition, one-step RT-LAMP could be useful in environments lacking specialized equipment or expertise.
Abstract: BACKGROUND AND OBJECTIVE: With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation , information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text…on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence. METHODS : This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n = 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation. RESULTS AND CONCLUSION: We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
Keywords: Virtual health agent, conversational agent, relational agent, e-mental health, e-health, psychoeducation, adherence, persuasion, mode of presentation, expressive writing
Abstract: BACKGROUND: This study aimed to investigate effects on the transmission channel caused by heterogeneous distribution in tissues and joint characteristics. METHOD: Human arm section scans were taken using CT technology, and zoned, following which, a circumference measurement experiment was performed to analyze the effect of inhomogeneous distribution of tissues. In order to analyze the arm joint’s effect on channel transmission, we proposed a piecewise modeling method in combination with connection conditions. CONCLUSIONS: It can be seen from the experiment that, in the quasi-static mode, the communication channel error caused by the inhomogeneous distribution…of tissues is small enough to be negligible. The error between calculated and experimental results is reduced by 3.93 dB in this experiment relative to models that did not include joint characteristics, and the average error is lowered by 0.73 dB. The variation curve fit to experimental data is also improved in this method. As such, it can be quantitatively determined that a channel model with joint characteristics is superior to models excluding joint characteristics.
Keywords: Inhomogeneous distribution, quasi-static, communication channel, joint
Abstract: BACKGROUND: The adrenal tumor will disturb the secreting function of adrenocortical cells, leading to many diseases. Different kinds of adrenal tumors require different therapeutic schedules. OBJECTIVE: In the practical diagnosis, it highly relies on the doctor’s experience to judge the tumor type by reading the hundreds of CT images. METHODS: This paper proposed an automatic computer aided analysis method for adrenal tumors detection and classification. It consisted of the automatic segmentation algorithms, the feature extraction and the classification algorithms. These algorithms were then integrated into a system and conducted on the graphic interface…by using MATLAB Graphic user interface (GUI). RESULTS: The accuracy of the automatic computer aided segmentation and classification reached 90% on 436 CT images. CONCLUSION: The experiments proved the stability and reliability of this automatic computer aided analytic system.
Abstract: BACKGROUND: In nanomachine applications towards targeted drug delivery, drug molecules released by nanomachines propagate and chemically react with tumor cells in aqueous environment. If the nanomachines release drug molecules faster than the tumor cells react, it will result in loss and waste of drug molecules. It is a potential issue associated with the relationship among reaction rate, release rate and efficiency. OBJECTIVE: This paper aims to investigate the relationship among reaction rate, release rate and efficiency based on two drug reception models. We expect to pave a way for designing a control method of drug release.…METHODS: We adopted two analytical methods that one is drug reception process based on collision with tumors and another is based on Michaelis Menten enzymatic kinetics. To evaluate the analytical formulations, we used the well-known simulation framework N3Sim to establish simulations. RESULTS: The analytical results of the relationship among reaction rate, release rate and efficiency is obtained, which match well with the numerical simulation results in a 3-D environment. CONCLUSIONS: Based upon two drug reception models, the results of this paper would be beneficial for designing a control method of nanomahine-based drug release.
Keywords: Nanomachine, targeted drug delivery, molecular diffusion
Abstract: A needle-free vaccine/drug injector that works by virtue of the impulse of a moving shock wave is presented in this communication. The device can deliver controlled micro-volumes of liquid vaccines into skin and soft tissue targets in human with minimal invasion. The operation of the injector was investigated by delivering a dyed liquid into human skin samples and soft tissue models. The depth of penetration of the liquid was examined by histology of the targeted human skin samples. The delivery mechanics and the depth of penetration were analyzed theoretically with an elastic model for the skin and a viscoelastic model…for the soft tissue targets, and a good agreement with experiments was observed. The current liquid vaccine/drug delivery technique can reduce pain, trauma and contamination, and can offer a cost-effective, needle-free, health-care solution.
Abstract: BACKGROUND: New technology should be extensively tested before it is tried on patients. Unfortunately representative models are lacking. In theory, fresh frozen human cadavers are excellent models. OBJECTIVE: To identify strengths and weaknesses of fresh frozen human cadavers as research models for new technology prior to implementation in gynecological surgery. METHODS: During pre-clinical validation studies regarding the MobiSep uterine manipulator, test procedures were performed on fresh frozen cadavers. Both the experimental setup as the performance of the prototype were assessed. RESULTS: Five tests including six human cadavers were performed. Major…changes were made to the MobiSep prototype design. The cadavers of two tests closely resembled surgical experiences as found in live patients. The anatomy of 4 of the 6 cadavers was not fully representative due to atrophy of the internal genitalia caused by age and due to the presence of pathology such extensive tumorous tissue. CONCLUSION: The cadaver tests provided vital information regarding design and functionality, that failed to emerge during the in-vitro testing. However, experiments are subject to anatomical uncertainties or restrictions. Consequently, the suitability of a cadaver should be carefully assessed before it is used for testing new technology.
Keywords: Laparoscopy, hysterectomy, technology, medical devices, innovation
Abstract: BACKGROUND: Measuring portal venous pressure is necessary to examine, diagnose, and treat portal hypertension, but current methods are invasive. OBJECTIVE: This study aimed to determine whether a noninvasive peripheral blood measurement could be used to estimate portal venous pressure by investigating correlations between certain physical parameter measurements in the peripheral blood with those obtained in portal blood samples. METHODS: A total of 128 peripheral and portal blood samples from patients (n = 128) were analyzed for blood rheology and routine blood parameters. RESULTS: The mean…peripheral and portal whole blood viscosities under the shear rates of 200 s - 1 (BV 200 s - 1 ) were 2.97 ± 0.50 mPa.s and 3.06 ± 0.39 mPa.s. The mean peripheral and portal BV 30 s - 1 values were 3.96 ± 0.79 mPa.s and 4.16 ± 0.64 mPa.s. We observed strong correlations between peripheral and portal blood measurements of BV 200 s - 1 (r 2 = 0.9649), BV 30 s - 1 (r 2 = 0.9622), BV 5 s - 1 (r 2 = 0.9610), and BV 1 s - 1 (r 2 = 0.9623). CONCLUSIONS: Our results indicate that peripheral blood can be used to evaluate certain parameters in portal blood for use in biofluid mechanics studies, and to provide noninvasive measurement of portal venous pressure.
Abstract: BACKGROUND: Smartphone sensors are underutilised in rehabilitation. OBJECTIVE: To validate the step count algorithm used in the STARFISH smartphone application. METHODS: Twenty-two healthy adults (8 male, 14 female) walked on a treadmill for 5 minutes at 0.44, 0.67, 0.90 and 1.33 m⋅ s - 1 . Each wore an activPAL TM and four Samsung Galaxy S3 TM…smartphones, with the STARFISH application running, in: 1) a belt carrycase, 2) a trouser or skirt pocket), 3a) a handbag on shoulder for females or 3b) shirt pocket for males and 4) an upper arm strap. Step counts of the STARFISH application and the activPAL TM were compared at corresponding speeds and Bland-Altman statistics used to assess level of agreement (LOA). RESULTS: The LOA between the STARFISH application and activPAL TM varied across the four speeds and positions, but improved as speed increased. The LOA ranged from 105–177% at 0.44 m⋅ s - 1 ; 50–98% at 0.67 m⋅ s - 1 ; 19–67% at 0.9 m⋅ s - 1 and 8–53% at 1.33 m⋅ s - 1 . The best LOAs were at 1.33 m⋅ s - 1 in the shirt pocket (8%) and upper arm strap (12%) positions. CONCLUSIONS: Step counts measured by the STARFISH smartphone application are valid in most body positions especially at walking speeds of 0.9 m⋅ s - 1 and above.
Abstract: BACKGROUND: A major problem associated with distraction osteogenesis is the long time required for consolidation. OBJECTIVE: The goal of this study was to determine whether a percutaneous injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a Gelfoam carrier would enhance bone consolidation following distraction. METHODS: A unilateral tibial osteotomy combined with external stabilization was performed in 14 adult sheep. After a latency of four days, distraction was performed at 1.25 millimetres per day for 20 days. On days 23 and 30, the sheep received an injection of rhBMP-2/Gelfoam or buffer/Gelfoam. During the following…50 days, radiographs and in vivo torsional stiffness measurements were obtained weekly. The effect of rhBMP-2 treatment post-mortem was assessed using destructive biomechanical testing, quantitative CT and DXA analysis. RESULTS: The in vivo stiffness measurements of the sheep treated with rhBMP-2 were significantly higher than those of the carrier control group (p < 0.05). These in vivo data were verified by post-mortem biomechanical testing and quantitative CT analysis. The maximum torsional moment observed was 55% greater in the sheep treated with rhBMP-2. CONCLUSIONS: These data support the potential use of rhBMP-2 in an injectable carrier for enhancing consolidation, as it may ultimately lead to shorter treatment times for patients undergoing distraction procedures.
Keywords: BMP, bone consolidation, distraction osteogenesis, gelfoam, growth factor
Abstract: In psychiatry, mindfulness based intervention has been increasingly popular as a means of psychosocial intervention over the last decade. With the alvanche of technological advances, there has been a myriad of mindfulness based applications. Recent reviews have highlighted how these applications are lacking in functionalities and without demonstrated efficacy. Other reviews have emphasized that there is a need to take into consideration the design of an application, due to placebo effects. It is the aim of this technical note to illustrate how the 5-Minutes Mindfulness application, which is an application designed to provide mindfulness exercises to relieve distress and suffering…amongst palliative patients, have been conceptualized. The conceptualized application builds on previous evidence of the efficacy of 5-Minutes Mindfulness demonstrated by pilot and randomized trials. In terms of design, the currently conceptualized application has been designed such that placebo effects could be controlled for.
Keywords: Mindfulness, smartphone, palliative care
Abstract: People residing in rural and remote areas (worldwide) have substantially worse outcome in early detection and diagnosis of glaucoma than those living in metropolitan areas. This gap can be reduced by improved glaucoma diagnosis activities in primary care, but there is little empirical evidence regarding use of tonometry in rural settings, or the expertise associated with quality of eye care. This article describes a feasibility study of a novel through-eyelid tonometer based on the use of an instrumented form of indentation and applanation tonometry.
Abstract: BACKGROUND: Poor fine motor skills are common among chronic stroke patients. Conventional rehabilitation programs only emphasize intensive and repeated exercises that do not motivate patients to continue rehabilitation. Using a vibrotactile glove rehabilitation system with a human-computer interaction interface can therefore resolve this issue. OBJECTIVE: The objective of this study was to examine the potential benefits of this vibrotactile glove rehabilitation system for chronic stroke patients who have already reached the recovery plateau. METHODS: Two interesting computer games were designed to coordinate with the vibrotactile gloves in patient training. The training sessions lasted…for about 30 minutes twice a week for five consecutive weeks. We compared finger ROM, grip strength, pinch strength, NHPT, and MHQ results before and after the intervention and surveyed subject satisfaction afterwards. RESULTS: The subjects showed slight improvements in muscle strength and hand after five weeks. The patients reported progress, but the differences did not reach statistical significance. In the satisfaction questionnaire, the subjects gave positive ratings. CONCLUSIONS: This vibrotactile glove rehabilitation system has the potential to help chronic stroke patients who have reached their recovery plateau to make progress and is clinically quite effective in increasing their motivation.
Keywords: Motor recovery, hemiparesis, vibrotactivel glove
Abstract: Wireless body area network (WBAN) is a breakthrough technology in healthcare areas such as hospital and telemedicine. The human body has a complex mixture of different tissues. It is expected that the nature of propagation of electromagnetic signals is distinct in each of these tissues. This forms the base for the WBAN, which is different from other environments. In this paper, the knowledge of Ultra Wide Band (UWB) channel is explored in the WBAN (IEEE 802.15.6) system. The measurements of parameters in frequency range from 3.1–10.6 GHz are taken. The proposed system, transmits data up to 480 Mbps by using…LDPC coded APSK Modulated Differential Space-Time-Frequency Coded MB-OFDM to increase the throughput and power efficiency.
Keywords: Low Density Parity Check (LDPC), Amplitude Phase Shift Key (APSK), orthogonal frequency-division multiplexing (OFDM), ultra-wideband (UWB), differential space-time-frequency codes (DSTFC), wireless body area network (WBAN)
Abstract: OBJECTIVE: This study proposed a method of using a modified micro-bubble generator with its ejection nozzle connected to an ergonomically designed soft teeth-tray for plaque removal. The applicability of this method was verified and the influence on plaque removal efficacy of some parameters of this device was clarified. METHODS: The micro-bubble generator used in this study has 5 rotation speed settings, 5 nozzle sizes, and a soft teeth-tray ejection pore diameters. These were used as independent variables to investigate their effect on the ejected flow volume, velocity and micro-bubble dimension, and how they eventually affect the…plaque removal efficacy from a denture. RESULTS: When the micro-bubble generator coupled with large (4.8 mm) ejection pore teeth-tray and the largest (1.2 mm) nozzle diameter more than 98% of plaque can be removed; its applicability on cleaning denture can be verified. In general, the larger nozzle diameter and teeth-tray ejection pore diameter will remove more plaques; while the higher the flow velocity and the smaller the micro-bubble of the ejected stream, better cleaning efficacy can be achieved. CONCLUSION: The application of micro-bubble on plaque removal seems effective, although at this moment it is applied on denture cleaning. The finding of the influence of some critical design parameters of micro-bubble generator and variables of ejected stream can be referred to further design a new micro-bubble cleaner for effective plaque removal from the teeth in human oral cavity.
Keywords: Micro-bubble generator, the soft teeth-tray, dental plaque removal