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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: Quantification of melanin pigment release in pigment dispersion syndrome as well as observations of melanin brightness changes can be valuable information in the management of this rare ocular disease. OBJECTIVES: Previous studies have focused on examining the iris pigment epithelium and aqueous humor. Therefore, the aim of this study was to examine the cornea. METHODS: A novel technique was developed for this purpose based on aperture photometry. Slit lamp digital video images of the cornea were recorded. A single frame from each video recording based on the quality was chosen for further…processing and analysis. Aperture photometry was performed with AstroImageJ open source software. Aperture selection was performed automatically. Melanin particles displaying a signal-to-noise ratio above 20 were analyzed. RESULTS: A total of 16 melanin particles from the right eye of the patient participating in the study were detected and a further 9 melanin particles from the left eye. The examined area of the cornea measured 348 × 348 pixels in the image. Brightness differed by as much as 8.98 × among particles in the right eye and 2.03 × in the left eye. CONCLUSIONS: It seems feasible for this new method to be potentially used in the monitoring of patients with pigment dispersion syndrome and pigmentary glaucoma as well as in other ocular diseases.
Abstract: BACKGROUND: In the past ten years, liver biopsies have been used as a method to accurately diagnose the stage of fibrosis. OBJECTIVE: This study aimed to evaluate whether body position and exercise affect the measurement of liver Young’s modulus of healthy volunteers by real-time shear wave elastography (RT-SWE). Methods: RT-SWE was used to measure liver Young’s modulus in the supine and left lateral positions of 70 healthy volunteers at rest and measure the liver Young’s modulus in the lying position before exercise, and at zero, five, and ten minutes of rest after exercise.…RESULTS: The liver Young’s modulus in the left lateral position was significantly higher than in the supine position (P < 0.05), and the measured value in the supine position was more stable than the left lateral position. The liver Young’s modulus measured at zero minutes after exercise was significantly higher than that measured before exercise (P < 0.05). The liver Young’s modulus measured at five minutes after exercise was significantly higher than that measured at zero minutes after exercise (P < 0.05) and was not statistically different from the measured value before exercise (P > 0.05). The liver Young’s modulus measured at ten minutes after exercise was significantly higher from that measured at zero minutes after exercise (P < 0.05) and was not statistically different from the measured value at five minutes after exercise (P > 0.05). CONCLUSION: Body position and exercise have a significant impact on the measurement of liver Young’s modulus. It is recommended that the examinees take a supine position during the measurement, and measurement should be conducted at least ten minutes after exercise.
Abstract: BACKGROUND: In order to alleviate muscle fatigue and improve ride comfort, many published studies aimed to improve the seat environment or optimize seating posture. However, the effect of lumbar support on the lumbar muscle of seated subjects under whole body vibration is still unclear. OBJECTIVE: This study aimed to investigate the effect of lumbar support magnitude of the seat on lumbar muscle fatigue relief under whole body vibration. METHODS: Twenty healthy volunteers without low back pain participated in the experiment. By measuring surface electromyographic signals of erector spinae muscles under vibration or non-vibration…for 30 minutes, the effect of different lumbar support conditions on muscle fatigue was analyzed. The magnitude of lumbar support d is assigned as d 1 = 0 mm, d 2 = 20 mm and d 3 = 40 mm for no support, small support and large support, respectively. RESULTS: The results showed that lumbar muscle activation levels vary under different support conditions. For the small support case (d 2 = 20 mm), the muscle activation level under vibration and no-vibration was the minimum, 42.3% and 77.7% of that under no support (d 1 = 0 mm). For all support conditions, the muscle activation level under vibration is higher than that under no-vibration. CONCLUSIONS: The results indicate that the small support yields the minimum muscle contraction (low muscle contraction intensity) under vibration, which is more helpful for relieving lumbar muscle fatigue than no support or large support cases. Therefore, an appropriate lumbar support of seats is necessary for alleviating lumbar muscle fatigue.
Keywords: Lumbar support, muscle fatigue, support magnitude, surface electromyographic, vibration
Abstract: BACKGROUND: Acetowhite (AW) region is a critical physiological phenomenon of precancerous lesions of cervical cancer. An accurate segmentation of the AW region can provide a useful diagnostic tool for gynecologic oncologists in screening cervical cancers. Traditional approaches for the segmentation of AW regions relied heavily on manual or semi-automatic methods. OBJECTIVE: To automatically segment the AW regions from colposcope images. METHODS: First, the cervical region was extracted from the original colposcope images by k -means clustering algorithm. Second, a deep learning-based image semantic segmentation model named DeepLab V3+ was used to…segment the AW region from the cervical image. RESULTS: The results showed that, compared to the fuzzy clustering segmentation algorithm and the level set segmentation algorithm, the new method proposed in this study achieved a mean Jaccard Index (JI) accuracy of 63.6% (improved by 27.9% and 27.5% respectively), a mean specificity of 94.9% (improved by 55.8% and 32.3% respectively) and a mean accuracy of 91.2% (improved by 38.6% and 26.4% respectively). A mean sensitivity of 78.2% was achieved by the proposed method, which was 17.4% and 10.1% lower respectively. Compared to the image semantic segmentation models U-Net and PSPNet, the proposed method yielded a higher mean JI accuracy, mean sensitivity and mean accuracy. CONCLUSION: The improved segmentation performance suggested that the proposed method may serve as a useful complimentary tool in screening cervical cancer.
Keywords: Cervical cancer, visual inspection with acetic acid, medical image segmentation, deep learning
Abstract: OBJECTIVE: This study investigated the differences in trunk sway during stair climbing between people with normal spinal alignment and people with flat-back syndrome. METHODS: Twelve male volunteers with flat-back syndrome (global angle < 20 degrees) and 12 male volunteers with normal spinal alignment (global angle between 20 degrees and 30 degrees) were enrolled. An accelerator was attached to the third lumbar spine and the sway of each participant’s trunk was measured during stair climbing. RESULT: Participants with flat-back syndrome showed significant differences in vector, anteroposterior sway, and vertical sway of…the trunk during stair climbing (p < 0.05). However, mediolateral sway of the trunk and gait time did not significantly differ between groups (p > 0.05). CONCLUSION: Our findings can be used as baseline data for prevention of back pain. Furthermore, increased trunk sway can cause increased energy usage, leading to inefficient gait. Further research is needed to prevent this problem.
Abstract: BACKGROUND: Traditional healthcare is centred around providing in-hospital services using hospital owned medical instruments. The COVID-19 pandemic has shown that this approach lacks flexibility to insure follow-up and treatment of common medical problems. In an alternative setting adapted to this problem, participatory healthcare can be considered centred around data provided by patients owning and operating medical data collection equipment in their homes. OBJECTIVE: In order to trigger such a shift reliable and price attractive devices need to become available. Snoring, as a human sound production during sleep, can reflect sleeping behaviour and indicate sleep problems as…an element of the overall health condition of a person. METHODS: The use of off-the-shelf hardware from Internet of Things platforms and standard audio components allows the development of such devices. A prototype of a snoring sound detector with this purpose is developed. RESULTS: The device, controlled by the patient and with specific snoring recording and analysing functions is demonstrated as a model for future participatory healthcare. CONCLUSIONS: Design of monitoring devices following this model could allow market introduction of new equipment for participatory healthcare, bringing a care complementary to traditional healthcare to the reach of patients, and could result in benefits from enhanced patient participation.
Keywords: Snoring, participatory healthcare, sleep analysis, internet of things, e-health
Abstract: BACKGROUND: In recent years the global landscape of pharmaceutical development has evolved drastically in order to adapt to innovative products such as immunotherapy, regenerative medicines and cell and gene therapy, all offering the hope to cure numerous untreated diseases. The global COVID-19 pandemic also led competent authorities in charge of approval of new medicines to implement adapted regulatory pathways allowing early access to innovative treatments and vaccines. New challenges are to be overcome, it is the short development time, or the small patient populations, or again drug product features requiring complete new production, testing and distribution strategies. OBJECTIVE:…This paper provides a short overview of the different adaptations required to allow the development of such innovative medicines. METHOD: Several drug development strategies for products under clinical development or recently approved were assessed. RESULTS: Fully integrated strategies encompassing research, non-clinical, clinical and product manufacturing development along with adapted regulatory pathways, anticipation of market access and supported by risk based are important. In such fast pace, the development of relevant manufacturing processes and test methods assessing quality, safety and efficacy of new drugs falls on the critical path and requires particular attention, anticipation and detailed planning as early as possible in order to ensure successful filing and approval. CONCLUSION: Insights within innovative products approved recently reveal the importance of defining a solid chemistry manufacturing and control strategy early on as part of clinical development. Interactions with agencies at key milestones of development are also essential to reduce risks, prioritize development to support safety and allow early access to patients.
Keywords: Chemistry Manufacturing and Control (CMC), regulations, innovative drugs, accelerated approval
Abstract: BACKGROUND: Originally, digital healthcare was created to support underserved and rural patients gain access to health services. Phones, devices, and computers need IP (Internet Protocol) addresses to connect to the Internet. OBJECTIVE: This paper aims to study the close relationship between the Internet and the transformation of healthcare services. METHODS: The current protocol in use is the Internet Protocol version 4 (IPv4), whose number of Internet addresses has been globally exhausted. The Internet Protocol version 6 (IPv6) with 47 octillion unique addresses for every person on the planet has become the only option…for sustainable growth and innovation. However, most of the worldwide industry is still in IPv4. In the era of Artificial Intelligence, Internet of Things, Fifth Generation of Cellular Technology (5G), and Blockchain, there will be a massive need of IP addresses. For 2025, experts predict over 1.5 billion new IPv6 users which will continue to grow exponentially. RESULTS: Nations need to tackle the increasing industry requirements for IPv6 and telehealth adoption to benefit from the full IPv6 connectivity which is the key strategic advantage for the healthcare industry. CONCLUSION: The strategic potential that telehealth brings to the healthcare industry is widely appreciated. However, what are the implications of its expansion around the world? How can we prioritize the poorest and most vulnerable in society without new technologies?
Abstract: BACKGROUND: EpidemiXs is an innovative ecosystem of digital tools centralizing official and validated information on COVID-19 for healthcare workers and the general public in a single hub. OBJECTIVE: The vision of EpidemiXs is to foster collaboration between researchers, institutions and individuals to promote “open data” in order to enrich the scientific community and further accelerate science in the fight against COVID-19. METHODS: Through its set of solutions, EpidemiXs Info, EpidemiXs TV and EpidemiXs Studies, this innovative ecosystem contributes to advancing collaborations, data collection and analysis, and helps find funders. RESULTS:…EpidemiXs was launched in March 2020 in Spain with 30 healthcare institutions and rapidly reached close to 1 million users and 2 million views. EpidemiXs gained international recognition when it was awarded the Barcelona Health Hub Awards (BHHAwards) 2020 of the category “Best Startup Initiative to help tackle COVID-19”. CONCLUSION: EpidemiXs has proven the efficiency of the rapid deployment of digital tools in times of COVID-19.
Keywords: COVID-19, infodemic, pandemic, digital health, technology, research, open data, healthcare
Abstract: BACKGROUND: Technologies for COVID-19 are in high demand, and supply chains from biotech and pharma industries face critical supply issues. OBJECTIVE: This paper discusses the case on mRNA technologies and quality assurance issues. METHODS: Interviews with managers of biotech companies were performed. These helped to prepare biotech panels at a roundtable on quality of medicine, organized by the Polish Academy of Sciences in Paris (PAN) in 2021. RESULTS: This paper analyzes the new mRNA technology and shows the importance of emerging new biotech firms, especially tool companies providing services in…quality assurance. It highlights research areas and types of survey instruments with academic collaborators, to better understand the economics of mRNA technology platforms. CONCLUSIONS: A future research agenda for collaboration with academic communities is proposed on cost-quality tradeoffs and clinical quality attributes for such genomic technologies.
Keywords: Biotech value chain, tool companies, mRNA technology, cost and quality, COVID-19, healthcare