Technology and Health Care - Volume 24, issue 6

Authors: Thanaraj, Palani | Roshini, Mable | Balasubramanian, Parvathavarthini

Article Type: Research Article

Abstract: BACKGROUND: The fetal electrocardiogram (FECG) signals are essential to monitor the health condition of the baby. Fetal heart rate (FHR) is commonly used for diagnosing certain abnormalities in the formation of the heart. Usually, non-invasive abdominal electrocardiogram (AbECG) signals are obtained by placing surface electrodes in the abdomen region of the pregnant woman. AbECG signals are often not suitable for the direct analysis of fetal heart activity. Moreover, the strength and magnitude of the FECG signals are low compared to the maternal electrocardiogram (MECG) signals. The MECG signals are often superimposed with the FECG signals that make the monitoring …of FECG signals a difficult task. OBJECTIVE: Primary goal of the paper is to separate the fetal electrocardiogram (FECG) signals from the unwanted maternal electrocardiogram (MECG) signals. METHOD: A multivariate signal processing procedure is proposed here that combines the Multivariate Empirical Mode Decomposition (MEMD) and Independent Component Analysis (ICA). RESULTS: The proposed method is evaluated with clinical abdominal signals taken from three pregnant women (N= 3) recorded during the 38-41 weeks of the gestation period. The number of fetal R-wave detected (NEFQRS ), the number of unwanted maternal peaks (NMQRS ), the number of undetected fetal R-wave (NUFQRS ) and the FHR detection accuracy quantifies the performance of our method. Clinical investigation with three test subjects shows an overall detection accuracy of 92.8%. CONCLUSION: Comparative analysis with benchmark signal processing method such as ICA suggests the noteworthy performance of our method. Show more

Keywords: Multivariate empirical mode decomposition, independent component analysis, fetal ECG, maternal ECG, signal separation, fetal heart rate

DOI: 10.3233/THC-161224

Citation: Technology and Health Care, vol. 24, no. 6, pp. 783-794, 2016

Authors: Behbahani, Soroor | Dabanloo, Nader Jafarnia | Nasrabadi, Ali Motie | Dourado, Antonio

Article Type: Research Article

Abstract: BACKGROUND: Until now, different approaches have been published to resolve the problem of predicting epileptic seizures. The results are reminiscent of a substantial need for improvements in these methods to reach the stage of the clinical application. Our aim is to develop a reliable epileptic seizure prediction algorithm based on the Heart Rate Variability (HRV) analysis. METHODS: We analyzed the HRV of sixteen epileptic patients with a total of 170 seizures, to predict the occurrence of seizures based on the dynamic changes of Electrocardiogram (ECG) during the pre-ictal period. Time and frequency-domain features were computed forthe …consecutive time windows with a length of five minutes. An adaptive decision threshold method was used for raising alarms. Predictions were made when selected features exceeded the decision thresholds. RESULTS: For the seizure occurrence period (SOP) of 4:30 minutes, and intervention time (IT) of 110 Sec, the presented method showed an average sensitivity of 78.59%, and average false prediction rate of 0.21/Hr, which indicates that the system has superiority to the random predictor. CONCLUSION: The proposed approach shows a potential in the monitoring of epileptic patients and improving their life quality. The overall performance of the algorithm is a step forward for clinical implementation. Show more

Keywords: Epilepsy, HRV, prediction, threshold, circadian rhythm

DOI: 10.3233/THC-161225

Citation: Technology and Health Care, vol. 24, no. 6, pp. 795-810, 2016

Authors: Najafi, Ali | Ghanei, Mostafa | Jamalkandi, Sadegh Azimzadeh

Article Type: Research Article

Abstract: Airway Remodeling, a patho-physiologic process, is considered as a key feature of chronic airway diseases. In recent years, our understanding of the complex diseases has increased significantly by the use of combined approaches, including systems biology, which may contribute to the development of personalized and predictive medicine approaches. Integrative analysis, along with the cooperation of clinicians, computer scientists, research scientists, and bench scientists, has become an important part of the experimental design and therapeutic strategies in the era of omics. The airway remodeling process is the result of the dysregulation of several signaling pathways that modulate the airway regeneration; therefore, …high-throughput experiments and systems biology approach can help to understand this process better. The study reviews related literature and is consistent with the existing clinical evidence. Show more

Keywords: Airway remodeling, systems biology, clinical strategy

DOI: 10.3233/THC-161228

Citation: Technology and Health Care, vol. 24, no. 6, pp. 811-819, 2016

Authors: Zhang, Shuang | Pun, Sio Hang | Mak, Peng Un | Qin, Yu-Ping | Liu, Yi-He | Vai, Mang I.

Article Type: Research Article

Abstract: In this study, an experiment was designed to verify the low power consumption of galvanic coupling human-body communication. A silver electrode (silver content: 99%) is placed in a pig leg and a sine wave signal with the power of 0 dBm is input. Compared with radio frequency communication and antenna transmission communication, attenuation is reduced by approximately 10 to 15 dB, so channel characteristics are highly improved.

Keywords: Implantable, galvanic coupling human-body communication, attenuation, measurement

DOI: 10.3233/THC-161229

Citation: Technology and Health Care, vol. 24, no. 6, pp. 821-826, 2016

Authors: Fragidis, Leonidas L. | Chatzoglou, Prodromos D. | Aggelidis, Vassilios P.

Article Type: Research Article

Abstract: BACKGROUND: The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. OBJECTIVE: This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. METHODS: The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data …synchronization architecture for the proposed solution. RESULTS: The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. CONCLUSIONS: The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost. Show more

Keywords: Electronic health records, system integration, interoperability, semi-distributed architecture, middleware, ehealth

DOI: 10.3233/THC-161231

Citation: Technology and Health Care, vol. 24, no. 6, pp. 827-842, 2016

Authors: DesJardins, Ashley M. | Schiller, Martha | Eraqi, Enas | Samuels, Amanda Nicole | Galen, Sujay S.

Article Type: Research Article

Abstract: BACKGROUND: The wireless gait assessment tool (Wi-GAT) measures have been shown to have good to excellent concurrent validity with preferred walking speeds, however, the validity of the Wi-GAT measures at slow and fast walking speeds is unknown. OBJECTIVE: To establish validity of the Wi-GAT spatio-temporal gait measures at slow, fast, and preferred walking speeds. METHODS: Twenty two healthy adult volunteers, with a mean age of 25.7 (± 5.3) participated in this study. The spatio-temporal gait variables of each participant were concurrently recorded using the GAITrite and the Wi-GAT system, while the …participants performed 3 trials for each walking speed in a randomized order. Intraclass correlation analyses were performed to establish the agreement between the measures recorded by the GAITrite and Wi-GAT systems. RESULTS: Walking speed measured both by the Wi-GAT and the GAITrite systems showed excellent agreement for preferred (ICC = 0.979 p< 0.001), slow (ICC = 0.989 p< 0.001) and fast (ICC = 0.967 p< 0.001) walking speeds. Most gait parameters recorded at slow walking speed showed good (ICC > 0.70) to excellent (ICC > 0.85) agreement. CONCLUSIONS: Gait parameters recorded by the Wi-GAT system showed fair to excellent validity for preferred and slow walking speeds. Show more

Keywords: Gait analysis, gait speed, spatio-temporal gait parameters, wireless sensors

DOI: 10.3233/THC-161232

Citation: Technology and Health Care, vol. 24, no. 6, pp. 843-852, 2016

Authors: Ojoawo, Adesola O. | Olaogun, Matthew O.B. | Hassan, Mariam A.

Article Type: Research Article

Abstract: PURPOSE: The study compared the effects of isometric quadriceps exercise and proprioceptive exercise on pain, joint stiffness and physical difficulties of patients with knee osteoarthritis. SUBJECTS: Forty-five patients with history of knee osteoarthritis were randomly allocated into two groups; A with 23 subjects and B with 22 subjects. METHODS: All subjects received infrared radiation for 20 minutes and kneading massage with methyl salicylate ointment. Group A underwent proprioceptive exercises while Group B had isometric quadriceps exercise. Each exercise session lasted for 10 minutes according to standard protocol, twice in a …week for six weeks. Pre-treatment, 3rd week and 6th week pain intensity, joint stiffness and physical difficulties were assessed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical package for social sciences (SPSS) version 17 was used to analyse the data while descriptive and inferential statistics were used to summarise the result. RESULTS: Proprioceptive exercises reduced pain intensity significantly (F = 4.76; p = 0.00) at 6th week with effect size of 2.79, and physical difficulty (F = 3.69; p < 0.04) with effect size of 7.53 better than isometric exercises. There was a significant reduction in the pain intensity (F = 12.08; p < 0.001), and physical difficulties (F = 3.69, p = 0.04) in pre-treatment, 3rd week and 6th week in both Group A and B. CONCLUSION: Both exercises are effective but proprioceptive exercises may be more effective in the management of patients with knee osteoarthritis (KOA) than isometric exercises. Show more

Keywords: Knee osteoarthritis, proprioceptive exercises, isometric exercise, pain intensity, joint stiffness

DOI: 10.3233/THC-161234

Citation: Technology and Health Care, vol. 24, no. 6, pp. 853-863, 2016

Authors: Russell, Robert D. | Huo, Michael H. | Rodrigues, Danieli C. | Kosmopoulos, Victor

Article Type: Research Article

Abstract: BACKGROUND: Stable femoral fixation during uncemented total hip arthroplasty is critical to allow for subsequent osseointegration of the prosthesis. Varying stem designs provide surgeons with multiple options to gain femoral fixation. OBJECTIVE: The purpose of this study was to compare the initial fixation stability of cylindrical and tapered stem implants using two different underreaming techniques (press-fit conditions) for revision total hip arthroplasty (THA). METHODS: A finite element femur model was created from three-dimensional computed tomography images simulating a trabecular bone defect commonly observed in revision THA. Two 18-mm generic femoral hip implants were …modeled using the same geometry, differing only in that one had a cylindrical stem and the other had a 2 degree tapered stem. Surgery was simulated using a 0.05-mm and 0.01-mm press-fit and tested with a physiologically relevant loading protocol. RESULTS: Mean contact pressure was influenced more by the surgical technique than by the stem geometry. The 0.05-mm press-fit condition resulted in the highest contact pressures for both the cylindrical (27.35 MPa) and tapered (20.99 MPa) stems. Changing the press-fit to 0.01-mm greatly decreased the contact pressure by 79.8% and 78.5% for the cylindrical (5.53 MPa) and tapered (4.52 MPa) models, respectively. The cylindrical stem geometry consistently showed less relative micromotion at all the cross-sections sampled as compared to the tapered stem regardless of press-fit condition. CONCLUSIONS: This finite element analysis study demonstrates that tapered stem results in lower average contact pressure and greater micromotion at the implant-bone interface than a cylindrical stem geometry. More studies are needed to establish how these different stem geometries perform in such non-ideal conditions encountered in revision THA cases where less bone stock is available. Show more

Keywords: Finite element analysis, total hip replacement, mechanics, arthroplasty, orthopaedics

DOI: 10.3233/THC-161235

Citation: Technology and Health Care, vol. 24, no. 6, pp. 865-872, 2016

Authors: Frosini, Francesco | Miniati, Roberto | Grillone, Saverio | Dori, Fabrizio | Gentili, Guido Biffi | Belardinelli, Andrea

Article Type: Research Article

Abstract: OBJECTIVES: The following study proposes and tests an integrated methodology involving Health Technology Assessment (HTA) and Failure Modes, Effects and Criticality Analysis (FMECA) for the assessment of specific aspects related to robotic surgery involving safety, process and technology. METHODS: The integrated methodology consists of the application of specific techniques coming from the HTA joined to the aid of the most typical models from reliability engineering such as FMEA/FMECA. The study has also included in-site data collection and interviews to medical personnel. RESULTS: The total number of robotic procedures included in the analysis was …44: 28 for urology and 16 for general surgery. The main outcomes refer to the comparative evaluation between robotic, laparoscopic and open surgery. Risk analysis and mitigation interventions come from FMECA application. CONCLUSIONS: The small sample size available for the study represents an important bias, especially for the clinical outcomes reliability. Despite this, the study seems to confirm the better trend for robotics' surgical times with comparison to the open technique as well as confirming the robotics' clinical benefits in urology. More complex situation is observed for general surgery, where robotics' clinical benefits directly measured are the lowest blood transfusion rate. Show more

Keywords: Robotic surgery, FMECA, HTA

DOI: 10.3233/THC-161236

Citation: Technology and Health Care, vol. 24, no. 6, pp. 873-887, 2016

Authors: Manimaran, S. | Jayakumar, S. | Lakshmi, K. Bhagya

Article Type: Research Article

Abstract: Education Management Information System (EMIS) is a widely acceptable and developing technology within the Information Technology field. The advancement in technology in this century is being collaborated with scientific invention or explorer and information strengthening or development. This paper presents the results and experiences gained from applying students oriented EMIS for monitoring and managing mental health. The Mental Health of students depends on the acquiring adequate knowledge on basic concepts within a time period or academic schedule. It's obviously significance to evaluate and appraise the stress stimulators as a challenge or threat. The theoretical framework for the …study was designed for analyzing the stress stimulators, academic performance and EMIS accessibility. The sample examined in this study was stratified random sample from 75 students specifically all engineering college in Dindigul District of Tamilnadu. The primary factor is the academic stress stimulators that form one module of EMIS for each of the key variable such as curriculum & instruction related stressors, placement related, teamwork related and assessment related. The Mental Health related stress stimulators namely curriculum & syllabus, placement related, assessment related and team work related have a significant influence on academic performance by students in various institution. The important factor leading to the EMIS application in monitoring stress stimulators is curriculum & syllabus related and assessment related. Show more

Keywords: EMIS, stress management, Mental Health, academic stress, stress stimulators

DOI: 10.3233/THC-161250

Citation: Technology and Health Care, vol. 24, no. 6, pp. 889-897, 2016

Authors: Kratz, Thomas | Simon, Christina | Fendrich, Volker | Schneider, Ralph | Wulf, Hinnerk | Kratz, Caroline | Efe, Turgay | Schüttler, Karl F. | Zoremba, Martin

Article Type: Research Article

Abstract: BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes. METHODS: All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were …included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors. RESULTS: Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group. CONCLUSIONS: Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery. Show more

Keywords: Goal directed therapy, major abdominal surgery, pancreatic surgery, pluse-contour-automated-analysis, fluid therapy

DOI: 10.3233/THC-161237

Citation: Technology and Health Care, vol. 24, no. 6, pp. 899-907, 2016

Authors: Zens, Martin | Goldschmidtboeing, Frank | Wagner, Ferdinand | Reising, Kilian | Südkamp, Norbert P. | Woias, Peter

Article Type: Research Article

Abstract: BACKGROUND: Several different surgical techniques are used in the treatment of olecranon fractures. Tension band wiring is one of the most preferred options by surgeons worldwide. The concept of this technique is to transform a tensile force into a compression force that adjoins two surfaces of a fractured bone. Currently, little is known about the resulting compression force within a fracture. OBJECTIVE: Sensor devices are needed that directly transduce the compression force into a measurement quality. This allows the comparison of different surgical techniques. Ideally the sensor devices ought to be placed in the gap between …the fractured segments. METHODS: The design, development and characterization of miniaturized pressure sensors fabricated entirely from polydimethylsiloxane (PDMS) for a placement within a fracture is presented. The pressure sensors presented in this work are tested, calibrated and used in an experimental in vitro study. RESULTS: The pressure sensors are highly sensitive with an accuracy of approximately 3 kPa. A flexible fabrication process for various possible applications is described. The first in vitro study shows that using a single-twist or double-twist technique in tension band wiring of the olecranon has no significant effect on the resulting compression forces. CONCLUSIONS: The in vitro study shows the feasibility of the proposed measurement technique and the results of a first exemplary study. Show more

Keywords: Polydimethylsiloxane (PDMS), pressure sensor, tension band wiring, compression force

DOI: 10.3233/THC-161243

Citation: Technology and Health Care, vol. 24, no. 6, pp. 909-917, 2016

Authors: Bredow, J. | Beyer, F. | Oppermann, J. | Kraus, B. | Meyer, C. | Stein, G. | Eysel, P. | Koy, T.

Article Type: Research Article

Abstract: BACKGROUND: Goal of this study is to present an easily reproducible and reliable measurement to evaluate accuracy of screw placement in cervical spine. METHODS: Accuracy of cervical screw position was assessed in 52 patients treated with 163 screws. Each patient receiving pedicle, transarticular C1/2, lateral mass, or laminar screws and postoperative CT scan was included. Placement position was categorized in 5 grades: Grade 1 is ideal with pedicle wall perforation < 1 mm, grade 2 < 2 mm, grade 3 < 3 mm, and grade 4 < 4 mm. Grade 5 > 4 mm and/or obstruction …of transverse foramen by more than half a screw diameter. Intraclass correlation coefficient (ICC) values were assessed for inter- and intraobserver reliability. RESULTS: The mode of individual evaluations was calculated to assign a single value to each screw. This yielded 89 grade 1 (54.6%), 48 grade 2 (29.4%), 14 grade 3 (8.6%), 3 grade 4 (1.8%), and 9 grade 5 (5.5%) screws. Intraobserver reliability ICC was 0.966 and 0.959 for measurements. Interobserver reliability ICC was 0.938. CONCLUSION: This study introduces a reliable classification of cervical spine instrumentation with various screw types. This should enable the use of a uniform and reproducible, and thus comparable classification for screw position in cervical spine. Show more

Keywords: Classification, screw placement accuracy, cervical spine, spondylodesis

DOI: 10.3233/THC-161246

Citation: Technology and Health Care, vol. 24, no. 6, pp. 919-925, 2016

Authors: Wimmer, M.D. | Ploeger, M.M. | Friedrich, M.J. | Bornemann, R. | Roessler, P.P. | Gravius, S. | Randau, T.M.

Article Type: Research Article

Abstract: BACKGROUND: When deciding upon the best treatment strategy in revision arthroplasty, it is absolutely crucial to use the best possible preoperative detection whether a periprosthetic joint infection (PJI) is present or not. New molecular markers investigated in serum samples and synovial fluid can help to improve the preoperative diagnosis. In 2001, a novel IL-6 lateral flow immunoassay testing device was introduced which has never been tested in synovial fluid so far. OBJECTIVE: For our study we investigated whether the test can be used safely, feasibly and time effectively with synovial fluid gathered from potentially infected THAs …or TKAs and whether the already published cutoff for IL-6 in synovial fluid predicting a PJI can be reproduced using the QuickLine IL-6 immunoassay. METHODS: After ethic approval and within the scope of a prospective controlled trial we investigated 26 patients (m = 9, 34.6%; f= 17, 65.4%) with n = 13 (50%) potentially infected total hip arthroplasties (THAs) and n = 13 (50%) suspected PJIs of total knee arthroplasties (TKAs). Sterile aspirated synovial fluid was examined for total leukocyte count and cell differentiation by a blood count analyzer in body fluid mode as well as for IL-6 (Immulite, Siemens Medical Solutions Diagnostics GmbH, Eschborn, Germany). Another part of the joint aspirate was tested using the QuickLine IL-6 Test by Milenia Biotec (Milenia Biotec, Gießen, Germany). RESULTS: The mean concentration of IL-6 as determined from our reference laboratory testing (Siemens Immulight) for aseptic cases was 1,219 pg/mL (SD 1,369 pg/mL, min 134 pg/mL-max 4,214 pg/mL). The mean IL-6 concentration measured via the IL-6 QuickLine for aseptic cases was 410 pg/mL (SD 371 pg/mL, min 100 pg/mL-max 1562 pg/mL). The test showed no false negative or false positive results in the cases tested. In six patients, PJI was considered proven. The QuickLine Test indicated IL 6 concentrations > 10,000 pg/mL in these cases without further quantification above this maximum detection threshold. Results from the QuickLine Test and the laboratory tests were matched and a non-linear best fit curve (log-log-curve) was applied. The subsequent Spearman correlation showed a correlation coefficient of r = 0.92 (95% CI 0.81-0.97) which corresponds to a two-tailed p-value of < 0.0001, respectively. As a primary finding we were able to show that the Milenia QuickLine IL-6 Test can be used safely, feasibly and time effectively with synovial fluid gathered intraoperatively from potentially infected THAs or TKAs. The test as provided worked well in 84.6% of the samples tested and failed only due to very viscous synovial fluid. As a secondary result we found that the previously published cut-off for IL-6 in synovial fluid predicting a PJI with a sensitivity of 46.88% and a specificity of 97.62% can be reproduced using the QuickLine IL-6 immunoassay. CONCLUSION: Taking the limitations of the low sample size as a given this relatively simple point of care (POC) assay showed promising results in our pilot trial and may help diagnosing PJI. It may help physicians and surgeons to choose the best and least invasive treatment strategy for patients presenting with painful arthroplasty. Show more

Keywords: Prosthetic joint infections, total hip arthroplasty, retrograde forceps, diagnosis

DOI: 10.3233/THC-161247

Citation: Technology and Health Care, vol. 24, no. 6, pp. 927-932, 2016

Authors: Kim, Seonho | So, Wi-Young

Article Type: Research Article

Abstract: The purpose of this study was to examine the secular trends in weight status and weight-related behaviors in adolescents in Korea from 2006 to 2013. Using a repeated cross-sectional design, we analyzed raw data from the 2006 and 2013 Korea Youth Risk Behavior Web-based Survey, which included 69,500 adolescents in 2006 and 70,354 adolescents in 2013. Subjects were 12- to 18-year-old boys and girls from the first grade of middle school through the third grade of high school. The data was collected by using an anonymous self-administered online survey. From 2006 to 2013, the prevalence of obesity increased by 0.7 …(percent point; %p) (p < 0.001) in boys and 1.0%p (p < 0.001) in girls. At the same time, the prevalence of obesity increased by 1.0%p (p < 0.001) in middle-school students and decreased by 0.7%p (p < 0.001) in high-school students. Healthy, unhealthy, and extreme weight-control behaviors decreased in all adolescents (all p < 0.001). Obesity and unhealthy weight control behaviors in Korean adolescents remain major public concerns, and programs to encourage healthy weight control behaviors are required. Show more

Keywords: Adolescents, obesity, weight control behaviors

DOI: 10.3233/THC-161252

Citation: Technology and Health Care, vol. 24, no. 6, pp. 933-941, 2016

Authors: Stephan, Karl. D. | McLean, Robert J.C. | DeLeon, Gian | Melnikov, Vadim

Article Type: Research Article

Abstract: OBJECTIVE: We investigate the effect of feed-gas humidity on the oxidative properties of an atmospheric-pressure plasma jet using nitrogen gas. BACKGROUND: Plasma jets operating at atmospheric pressure are finding uses in medical and biological settings for sterilization and other applications involving oxidative stress applied to organisms. Most jets use noble gases, but some researchers use less expensive nitrogen gas. The feed-gas water content (humidity) has been found to influence the performance of noble-gas plasma jets, but has not yet been systematically investigated for jets using nitrogen gas. METHOD: Low-humidity and high-humidity feed gases …were used in a nitrogen plasma jet, and the oxidation effect of the jet was measured quantitatively using a chemical dosimeter known as FBX (ferrous sulfate-benzoic acid-xylenol orange). RESULTS: The plasma jet using high humidity was found to have about ten times the oxidation effect of the low-humidity jet, as measured by comparison with the addition of measured amounts of hydrogen peroxide to the FBX dosimeter. CONCLUSIONS: Atmospheric-pressure plasma jets using nitrogen as a feed gas have a greater oxidizing effect with a high level of humidity added to the feed gas. Show more

Keywords: Plasma, plasma jet, humidity, nitrogen plasma jet, sterilization

DOI: 10.3233/THC-161226

Citation: Technology and Health Care, vol. 24, no. 6, pp. 943-948, 2016

Authors: Afzal, Uzma | Mahmood, Tariq | Anwar, Masood | Shaikh, Zubair

Article Type: Research Article

Abstract: BACKGROUND: Configuration of complex Laboratory Developed Tests (LDTs) is a time-consuming and complicated task, potentially leading to inconsistent LDTs in which features constraints remain unresolved and important features could remain unselected. OBJECTIVE: Our objective is to address these issues by presenting an automated, health informatics solution which autonomously optimizes feature selection in complex LDTs through Particle Swarm Optimization (PSO). The optimization goal is to minimize inconsistencies and configuration time, and maximize the number of selected features. METHODS: We implemented our technology …in a local, secondary-care hospital in Pakistan which configures LDT for a local epidemic disease. First, a list of inconsistent LDT configurations is generated. This is used to initially estimate optimal PSO parameters, which are then used for optimization process. RESULTS: Results show that PSO is able to minimize 91% inconsistencies between 9 and 11 seconds. The number of selected critical features also increases by 100% in the optimized LDT configuration. CONCLUSIONS: We present a novel and the first application of computational optimization to solve LDT configuration issues. Show more

Keywords: Laboratory developed test, health informatics, inconsistencies, particle swarm optimization

DOI: 10.3233/THC-161227

Citation: Technology and Health Care, vol. 24, no. 6, pp. 949-956, 2016

Authors: von Engelhardt, Lars Victor | El Tabbakh, Mohammed Roshdy | Engers, Rainer | Lahner, Matthias | Jerosch, Jörg

Article Type: Case Report

Abstract: BACKGROUND: Osteoid osteoma is an osteoblastic benign bone tumor usually affecting young adolescents. Intra-articular lesions are not common; usually the diagnosis is delayed. A lot of studies report difficulties and complications in the management of osteoid osteoma of the hip joint using imaging guided techniques or open surgical procedures. Only few published cases have described that it can be treated precisely using hip arthroscopy. Additionally, the use of hip arthroscopy to apply the Chondrofiller® , an acellular collagen matrix for the management of articular cartilage defects of the hip joint, has not yet been described. CASE …PRESENTATION: This report presents an osteoid osteoma of the femoral neck. A 20-year-old female professional basketball player presented with pain in the left groin since more than 12 months. On magnetic resonance and computed tomography imaging, an osteoid osteoma was suggested. The lesion was successfully removed using arthroscopy. During surgery, a concomitant grade 4 cartilage lesion on the femoral head was detected. For the treatment of this severe defect we used the Chondrofiller® , which is a new acellular collagen implant for auto-regeneration of articular cartilage. This matrix was filled into the prepared and dried defect using CO2 arthroscopy. After the hardening of the matrix the surgery was finished. The patient was pain free shortly after the operation and returned to sports within 16 weeks. Return to high-performance sports 8 months after surgery was without of any sign of complaints. CONCLUSIONS: This article demonstrates that hip arthroscopy is a valuable tool for biopsy and excision of intra-articular osteoid osteoma affecting the hip joint, as well as for addressing other concomitant pathologies such as a severe synovitis or cartilage defects. CO2 arthroscopy provided good conditions for the drying and filling of the cartilage defect with the Chondrofiller® . Show more

Keywords: Hip arthroscopy, osteoid osteoma, cartilage defect, cartilage matrix, hip joint, CO2 arthroscopy

DOI: 10.3233/THC-161223

Citation: Technology and Health Care, vol. 24, no. 6, pp. 957-964, 2016

Authors: Leite, Fernando Ochoa | Cochat, Catarina | Salgado, Henrique | da Costa, Mariana Pinto | Queirós, Marta | Campos, Olga | Carvalho, Paulo

Article Type: Case Report

Abstract: INTRODUCTION: Doctor-patient communication is essential to the establishment of a therapeutic relationship and to the clinical improvement of the patient. Medical Interpreter Services (MIS) allow the doctors to communicate with patients that do not speak the same language of the clinical staff. However, MIS are not always available and when that happens it is of the upmost importance to find alternatives. OBJECTIVES AND METHODS: Presentation of a clinical case in which Google Translate^© (GT^©) was used as a translation tool to communicate with a patient. Discussion of the utility and validity of GT^© as a …translation tool in Medicine. A Pubmed search for articles concerning the use of technological innovations as translation tools was performed using the key words: GT^©, language barriers, foreign language, and communication barriers. RESULTS: In the reported clinical case, GT^© allowed the translation and the establishment of communication with a foreign patient. The Pubmed search found two articles concerning the use and validity of GT^© as a translation tool in Medicine. CONCLUSIONS: GT^© is the most readily available and free initial mode of communication between a doctor and a patient when language is a barrier. Nonetheless, GT^© should not be trusted for important medical communications unless all avenues to find a human translator have been exhausted, and the procedure is clinically urgent. Show more

Keywords: Medical translation, Google Translate^©, communication

DOI: 10.3233/THC-161241

Citation: Technology and Health Care, vol. 24, no. 6, pp. 965-968, 2016

Authors: Masoni, Marco | Guelfi, Maria Renza | Gensini, Gian Franco

Article Type: Short Communication

Abstract: Illegal activities prosecutable by law in the real life can be committed on the internet alike. In the healthcare domain, we refer mainly to selling of illegal and counterfeit drugs, exchange of pedo-pornographic material and marketing of stolen medical records. These illegal activities are made easier by recent developments of the Internet that medical community must be aware of: darknet and bitcoin. The first allows anonymous surfing and the last anonymous financial transactions. After discussing which healthcare areas are affected by these technological developments of the Internet and the deriving consequences, then the Authors express their opinion …on what actions can be taken to protect internet community. Show more

Keywords: Darknet, TOR, bitcoin, regulation, drugs trade, anonymity, pedo-pornography, medical records

DOI: 10.3233/THC-161244

Citation: Technology and Health Care, vol. 24, no. 6, pp. 969-972, 2016

Authors: Zhang, Melvyn W.B. | Ho, Roger C.M.

Article Type: Short Communication

Abstract: There have been massive advances in E-Health and M-Health technology, with recent interest in the utility of games for healthcare and the promotion of well-being and recovery as well as patient empowerment. There has been various review demonstrating the clinical effectiveness and efficacy of games for healthcare. It is the aim of this technical note to illustrate how appropriate gaming engines could be used by non-expert clinicians to program games that could run across various platforms, as well as games that could integrate well with existing mechanical sensors. This would address the limitations with regards to the evidence base of …games, as well as the limitations in the deployment of games to various participants. More importantly, games designed are also more likely to be cost-effective and lower in cost. The ability of integration with existing mechanical sensors would value-add existing games and enable recovery and remediation in various domains of health. This would further expand the potential of games as an adjunctive treatment for patients, or at least, to maintain the gains that they have made in their recovery process. Show more

Keywords: M-Health, smartphones, gaming, cross-platform, healthcare

DOI: 10.3233/THC-161249

Citation: Technology and Health Care, vol. 24, no. 6, pp. 973-976, 2016

Article Type: Other

Citation: Technology and Health Care, vol. 24, no. 6, pp. 977-1005, 2016

Article Type: Other

Citation: Technology and Health Care, vol. 24, no. 6, pp. 1007-1016, 2016