Stretchable Electronics with Strain-Resistive Performance

Stretchable electronics have attracted tremendous attention amongst academic and industrial communities due to their prospective applications in personal healthcare, human-activity monitoring, artificial skins, wearable displays, human-machine interfaces, etc. Other than mechanical robustness, stable performances under complex strains in these devices that are not for strain sensing are equally important for practical applications. Here, a comprehensive summarization of recent advances in stretchable electronics with strain-resistive performance is presented. First, detailed overviews of intrinsically strain-resistive stretchable materials, including conductors, semiconductors, and insulators, are given. Then, systematic representations of advanced structures, including helical, serpentine, meshy, wrinkled, and kirigami-based structures, for strain-resistive performance are summarized. Next, stretchable arrays and circuits with strain-resistive performance, that integrate multiple functionalities and enable complex behaviors, are introduced. This review presents a detailed overview of recent progress in stretchable electronics with strain-resistive performances and provides a guideline for the future development of stretchable electronics.

System integration of magnetic medical microrobots: from design to control

Magnetic microrobots are ideal for medical applications owing to their deep tissue penetration, precise control, and flexible movement. After decades of development, various magnetic microrobots have been used to achieve medical functions such as targeted delivery, cell manipulation, and minimally invasive surgery. This review introduces the research status and latest progress in the design and control systems of magnetic medical microrobots from a system integration perspective and summarizes the advantages and limitations of the research to provide a reference for developers. Finally, the future development direction of magnetic medical microrobot design and control systems are discussed.

An integrated full-head OPM-MEG system based on 128 zero-field sensors

Compact optically-pumped magnetometers (OPMs) are now commercially available with noise floors reaching 10 fT/Hz^1/2. However, to be used effectively for magnetoencephalography (MEG), dense arrays of these sensors are required to operate as an integrated turn-key system. In this study, we present the HEDscan, a 128-sensor OPM MEG system by FieldLine Medical, and evaluate its sensor performance with regard to bandwidth, linearity, and crosstalk. We report results from cross-validation studies with conventional cryogenic MEG, the Magnes 3,600 WH Biomagnetometer by 4-D Neuroimaging. Our results show high signal amplitudes captured by the OPM-MEG system during a standard auditory paradigm, where short tones at 1000 Hz were presented to the left ear of six healthy adult volunteers. We validate these findings through an event-related beamformer analysis, which is in line with existing literature results.

[Research progress and maturity assessment of continuous manufacturing of traditional Chinese medicine]

The pharmaceutical manufacturing model is gradually changing from intermittent manufacturing to continuous manufacturing and intelligent manufacturing. This paper briefly reviewed the supervision and research progress in continuous pharmaceutical manufacturing in China and abroad and described the definition and advantages of continuous pharmaceutical manufacturing. The continuous manufacturing of traditional Chinese medicine(TCM) at the current stage was summarized in the following three terms: the enhancement of the continuity of intermittent manufacturing operations, the integration of continuous equipment to improve physical continuity between units, and the application of advanced process control strategies to improve process continuity. To achieve continuous manufacturing of TCM, the corresponding key technologies, such as material property characterization, process modeling and simulation, process analysis technology, and system integration, were analyzed from the process and equipment, respectively. It was proposed that the continuous manufacturing equipment system should have the characteristics of high speed, high response, and high reliability, "three high(H~3)" for short. Considering the characteristics and current situation of TCM manufacturing, based on the two dimensions of product quality control and production efficiency, a maturity assessment model for continuous manufacturing of TCM, consisting of operation continuity, equipment continuity, process continuity, and quality control continuity, was proposed to provide references for the application of continuous manufacturing technology for TCM. The implementation of continuous manufacturing or the application of key continuous manufacturing technologies in TCM can help to systematically integrate advanced pharmaceutical technology elements and promote the uniformity of TCM quality and the improvement of production efficiency.

Design and Performance Evaluation of Integrating the Waste Heat Recovery System (WHRS) for a Silicon Arc Furnace with Plasma Gasification for Medical Waste

A hybrid scheme integrating the current waste heat recovery system (WHRS) for a silicon arc furnace with plasma gasification for medical waste is proposed. Combustible syngas converted from medical waste is used to drive the gas turbine for power generation, and waste heat is recovered from the raw syngas and exhaust gas from the gas turbine for auxiliary heating of steam and feed water in the WHRS. Meanwhile, the plasma gasifier can also achieve a harmless disposal of the hazardous fine silica particles generated in polysilicon production. The performance of the proposed design is investigated by energy, exergy, and economic analysis. The results indicate that after the integration, medical waste gave rise to 4.17 MW net power at an efficiency of up to 33.99%. Meanwhile, 4320 t of the silica powder can be disposed conveniently by the plasma gasifier every year, as well as 23,040 t of medical waste. The proposed design of upgrading the current WHRS to the hybrid system requires an initial investment of 18,843.65 K$ and has a short dynamic payback period of 3.94 years. Therefore, the hybrid scheme is feasible and promising for commercial application.

Integration of neuromorphic AI in event-driven distributed digitized systems: Concepts and research directions

Increasing complexity and data-generation rates in cyber-physical systems and the industrial Internet of things are calling for a corresponding increase in AI capabilities at the resource-constrained edges of the Internet. Meanwhile, the resource requirements of digital computing and deep learning are growing exponentially, in an unsustainable manner. One possible way to bridge this gap is the adoption of resource-efficient brain-inspired "neuromorphic" processing and sensing devices, which use event-driven, asynchronous, dynamic neurosynaptic elements with colocated memory for distributed processing and machine learning. However, since neuromorphic systems are fundamentally different from conventional von Neumann computers and clock-driven sensor systems, several challenges are posed to large-scale adoption and integration of neuromorphic devices into the existing distributed digital-computational infrastructure. Here, we describe the current landscape of neuromorphic computing, focusing on characteristics that pose integration challenges. Based on this analysis, we propose a microservice-based conceptual framework for neuromorphic systems integration, consisting of a neuromorphic-system proxy, which would provide virtualization and communication capabilities required in distributed systems of systems, in combination with a declarative programming approach offering engineering-process abstraction. We also present concepts that could serve as a basis for the realization of this framework, and identify directions for further research required to enable large-scale system integration of neuromorphic devices.

An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD

Black and Latinx Americans are disproportionately at greater risk for having Alzheimer's disease and related dementias (ADRD) than White Americans. Such differences in risk for ADRD are arguably explained through health disparities, social inequities, and historical policies. Structural racism and discrimination (SRD), defined as "macro-level conditions that limit opportunities, resources, and well-being of less privileged groups," have been linked with common comorbidities of ADRD, including hypertension, obesity, diabetes, depression. Given the historical impact of SRD-including discriminatory housing policies resulting in racial residential segregation that has been shown to limit access to education, employment, and healthcare-Black and Latinx populations with ADRD are directly or indirectly negatively affected by SRD in terms of access, quality and cost for healthcare. Emerging studies have brought to light the value of structural-level hospital and public health collaboration on care coordination for improving healthcare quality and access, and thus could serve as a macro-level mechanism for addressing disparities for minoritized racial and ethnic populations with ADRD. This paper presents a conceptual framework delineating how care coordination can successfully be achieved through health information technology (HIT) systems and ultimately address SRD. To address health inequities, it is therefore critical that policy initiatives invest in HIT capacities and infrastructures to promote care coordination, identify patient needs and preferences, and promote engagement of patients with ADRD and their caregivers.

Review: System transformation to enhance transitional age youth mental health - a scoping review

BACKGROUND

Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries.

METHODS

The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies.

RESULTS

A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted.

CONCLUSIONS

There remains a need for innovative, evidence-based approaches to improve TAY mental health care.

A System for Autonomous Seaweed Farm Inspection with an Underwater Robot

This paper outlines challenges and opportunities in operating underwater robots (so-called AUVs) on a seaweed farm. The need is driven by an emerging aquaculture industry on the Swedish west coast where large-scale seaweed farms are being developed. In this paper, the operational challenges are described and key technologies in using autonomous systems as a core part of the operation are developed and demonstrated. The paper presents a system and methods for operating an AUV in the seaweed farm, including initial localization of the farm based on a prior estimate and dead-reckoning navigation, and the subsequent scanning of the entire farm. Critical data from sidescan sonars for algorithm development are collected from real environments at a test site in the ocean, and the results are demonstrated in a simulated seaweed farm setup.

An Aggregated Data Integration Approach to the Web and Cloud Platforms through a Modular REST-Based OPC UA Middleware

The Internet of Things (IoT) empowers the development of heterogeneous systems for various application domains using embedded devices and diverse data transmission protocols. Collaborative integration of these systems in the industrial domain leads to incompatibility and interoperability at different automation levels, requiring unified coordination to exchange information efficiently. The hardware specifications of these devices are resource-constrained, limiting their performance in resource allocation, data management, and remote process supervision. Hence, unlocking network capabilities with other domains such as cloud and web services is required. This study proposed a platform-independent middleware module incorporating the Open Platform Communication Unified Architecture (OPC UA) and Representational State Transfer (REST) paradigms. The object-oriented structure of this middleware allows information contextualization to address interoperability issues and offers aggregated data integration with other domains. RESTful web and cloud platforms were implemented to collect this middleware data, provide remote application support, and enable aggregated resource allocation in a database server. Several performance assessments were conducted on the developed system deployed in Raspberry Pi and Intel NUC PC, which showed acceptable platform resource utilization regarding CPU, bandwidth, and power consumption, with low service, update, and response time requirements. This integrated approach demonstrates an excellent cost-effective prospect for interoperable Machine-to-Machine (M2M) communication, enables remote process supervision, and offers aggregated bulk data management with wider domains.

A Decade of Lessons Learned from Integration Strategies in the Netherlands

Introduction

In the Netherlands multiple single, cross sector and cross governance level policy reforms were introduced to improve health and social care and decrease fragmentation. In addition to legislative and funding measures, the governmental strategy was to set up long-lasting improvement programs and supported by applied research.

Description

Five national improvement programs on chronic disease management, maternity care, youth care, care for older people and dementia care were analysed. The Laws of integration of Leutz were used as an analytical framework. The programs demonstrated a mixture of employing policy, quality and financial measures to stimulate coherence and integration.

Discussion

The Laws that Leutz formulated are to a large extent applicable in the Dutch context. However, the characteristics of the system of governance being corporatist in its structure and its culture imply that it is hard to distinguish single actors being in the lead. Integration is a more complex process and requires more dynamics, than the law 'keep it simple, stupid' suggests.

Conclusions

In the Dutch context integration implies a permanent pursuit of aligning mechanisms for integration. Sustainable integration requires long-standing efforts of all relevant stakeholders and cannot be achieved quickly. It may take a decade of consistently applying a mix of policy instruments.

A review of the UK and British Channel Islands practical tidal stream energy resource

This review provides a critical, multi-faceted assessment of the practical contribution tidal stream energy can make to the UK and British Channel Islands future energy mix. Evidence is presented that broadly supports the latest national-scale practical resource estimate, of 34 TWh/year, equivalent to 11% of the UK's current annual electricity demand. The size of the practical resource depends in part on the economic competitiveness of projects. In the UK, 124 MW of prospective tidal stream capacity is currently eligible to bid for subsidy support (MeyGen 1C, 80 MW; PTEC, 30 MW; and Morlais, 14 MW). It is estimated that the installation of this 124 MW would serve to drive down the levelized cost of energy (LCoE), through learning, from its current level of around 240   £ / MWh to below 150   £ / MWh , based on a mid-range technology learning rate of 17%. Doing so would make tidal stream cost competitive with technologies such as combined cycle gas turbines, biomass and anaerobic digestion. Installing this 124 MW by 2031 would put tidal stream on a trajectory to install the estimated 11.5 GW needed to generate 34 TWh/year by 2050. The cyclic, predictable nature of tidal stream power shows potential to provide additional, whole-system cost benefits. These include reductions in balancing expenditure that are not considered in conventional LCoE estimates. The practical resource is also dependent on environmental constraints. To date, no collisions between animals and turbines have been detected, and only small changes in habitat have been measured. The impacts of large arrays on stratification and predator-prey interaction are projected to be an order of magnitude less than those from climate change, highlighting opportunities for risk retirement. Ongoing field measurements will be important as arrays scale up, given the uncertainty in some environmental and ecological impact models. Based on the findings presented in this review, we recommend that an updated national-scale practical resource study is undertaken that implements high-fidelity, site-specific modelling, with improved model validation from the wide range of field measurements that are now available from the major sites. Quantifying the sensitivity of the practical resource to constraints will be important to establish opportunities for constraint retirement. Quantification of whole-system benefits is necessary to fully understand the value of tidal stream in the energy system.

A Review of Microrobot's System: Towards System Integration for Autonomous Actuation In Vivo

Microrobots have received great attention due to their great potential in the biomedical field, and there has been extraordinary progress on them in many respects, making it possible to use them in vivo clinically. However, the most important question is how to get microrobots to a given position accurately. Therefore, autonomous actuation technology based on medical imaging has become the solution receiving the most attention considering its low precision and efficiency of manual control. This paper investigates key components of microrobot’s autonomous actuation systems, including actuation systems, medical imaging systems, and control systems, hoping to help realize system integration of them. The hardware integration has two situations according to sharing the transmitting equipment or not, with the consideration of interference, efficiency, microrobot’s material and structure. Furthermore, system integration of hybrid actuation and multimodal imaging can improve the navigation effect of the microrobot. The software integration needs to consider the characteristics and deficiencies of the existing actuation algorithms, imaging algorithms, and the complex 3D working environment in vivo. Additionally, considering the moving distance in the human body, the autonomous actuation system combined with rapid delivery methods can deliver microrobots to specify position rapidly and precisely.

Computer Vision for Continuous Bedside Pharmacological Data Extraction: A Novel Application of Artificial Intelligence for Clinical Data Recording and Biomedical Research

Introduction: As real time data processing is integrated with medical care for traumatic brain injury (TBI) patients, there is a requirement for devices to have digital output. However, there are still many devices that fail to have the required hardware to export real time data into an acceptable digital format or in a continuously updating manner. This is particularly the case for many intravenous pumps and older technological systems. Such accurate and digital real time data integration within TBI care and other fields is critical as we move towards digitizing healthcare information and integrating clinical data streams to improve bedside care. We propose to address this gap in technology by building a system that employs Optical Character Recognition through computer vision, using real time images from a pump monitor to extract the desired real time information. Methods: Using freely available software and readily available technology, we built a script that extracts real time images from a medication pump and then processes them using Optical Character Recognition to create digital text from the image. This text was then transferred to an ICM + real-time monitoring software in parallel with other retrieved physiological data. Results: The prototype that was built works effectively for our device, with source code openly available to interested end-users. However, future work is required for a more universal application of such a system. Conclusion: Advances here can improve medical information collection in the clinical environment, eliminating human error with bedside charting, and aid in data integration for biomedical research where many complex data sets can be seamlessly integrated digitally. Our design demonstrates a simple adaptation of current technology to help with this integration.

Assessment of the availability and utility of the paramedic record in the emergency department

OBJECTIVE

Clinical handover between pre-hospital ambulance service and the ED is important for patient safety and quality care. This study assessed the availability and utility of the paramedic record to ED clinicians in their patient assessment.

METHODS

The document transfer in 110 handovers between ambulance service and a tertiary metropolitan hospital ED was observed. Timestamps were recorded when the electronic paramedic record was printed, when it was placed in the hospital's paper-based patient medical record, when ED patient assessment occurred and it was noted if there was a verbal handover from paramedic to ED clinician. ED clinicians were surveyed about the availability and usefulness of the paramedic record.

RESULTS

The paramedic record was printed prior to the patient being seen in only 49% of encounters and was available in the medical record at the time of initial clinical assessment in 32% of encounters. When available it was reviewed in over 90% of encounters. 87% of these reviews were reported as 'significantly' or 'somewhat useful'. The paramedic record could not be located at all in 21% of encounters. In 98% of encounters the treating ED clinician would have preferred the paramedic record to have been electronic. The ED system data was corrupt in 4% of encounters.

CONCLUSIONS

The information in the paramedic record was found to be useful to ED clinicians when it was available. Increasing the availability of the paramedic record for ED clinical assessment may be an opportunity to improve patient safety and flow.

Thermodynamic Evaluation and Sensitivity Analysis of a Novel Compressed Air Energy Storage System Incorporated with a Coal-Fired Power Plant

A novel compressed air energy storage (CAES) system has been developed, which is innovatively integrated with a coal-fired power plant based on its feedwater heating system. In the hybrid design, the compression heat of the CAES system is transferred to the feedwater of the coal power plant, and the compressed air before the expanders is heated by the feedwater taken from the coal power plant. Furthermore, the exhaust air of the expanders is employed to warm partial feedwater of the coal power plant. Via the suggested integration, the thermal energy storage equipment for a regular CAES system can be eliminated and the performance of the CAES system can be improved. Based on a 350 MW supercritical coal power plant, the proposed concept was thermodynamically evaluated, and the results indicate that the round-trip efficiency and exergy efficiency of the new CAES system can reach 64.08% and 70.01%, respectively. Besides, a sensitivity analysis was conducted to examine the effects of ambient temperature, air storage pressure, expander inlet temperature, and coal power load on the performance of the CAES system. The above work proves that the novel design is efficient under various conditions, providing important insights into the development of CAES technology.

Recent Advances in Flexible and Stretchable Sensing Systems: From the Perspective of System Integration

Biological signals generated during various biological processes are critically important for providing insight into the human physiological status. Recently, there have been many great efforts in developing flexible and stretchable sensing systems to provide biological signal monitoring platforms with intimate integration with biological surfaces. Here, this review summarizes the recent advances in flexible and stretchable sensing systems from the perspective of electronic system integration. A comprehensive general sensing system architecture is described, which consists of sensors, sensor interface circuits, memories, and digital processing units. The subsequent content focuses on the integration requirements and highlights some advanced progress for each component. Next, representative examples of flexible and stretchable sensing systems for electrophysiological, physical, and chemical information monitoring are introduced. This review concludes with an outlook on the remaining challenges and opportunities for future fully flexible or stretchable sensing systems.

A Route Toward Smart System Integration: From Fiber Design to Device Construction

Fiber is a symbol of human civilization, being ubiquitous but obscure in society over most of history. Fiber has been revived upon the advent of fiber-based electronic devices in the past two decades. This is due to its desirable lightweight, flexible, and conformable characteristics, which enable it to play a fundamental role in the electronic and information era. Numerous fiber-based electronic devices have sprung up in energy conversion, energy storage, sensing, actuation, etc. A possibility is thereby conceived that they can be integrated into smart systems compatible with the human body, consisting of biotic fiber-based organs and tissues, which possess similar but more advanced functions. However, the design of mono-/multifibers, the construction of fiber-based devices, and the integration of these smart systems represent great challenges in fundamental understanding and practical implementation. A systematic review of the current state of the art with respect to the design and fabrication of electronic fiber materials, construction of fiber-based devices, and integration of smart systems is presented. In addition, limitations of current fiber-based devices and perspectives are explored toward potential and promising smart integration.

Integrated Cognitive Architecture for Robot Learning of Action and Language

The manner in which humans learn, plan, and decide actions is a very compelling subject. Moreover, the mechanism behind high-level cognitive functions, such as action planning, language understanding, and logical thinking, has not yet been fully implemented in robotics. In this paper, we propose a framework for the simultaneously comprehension of concepts, actions, and language as a first step toward this goal. This can be achieved by integrating various cognitive modules and leveraging mainly multimodal categorization by using multilayered multimodal latent Dirichlet allocation (mMLDA). The integration of reinforcement learning and mMLDA enables actions based on understanding. Furthermore, the mMLDA, in conjunction with grammar learning and based on the Bayesian hidden Markov model (BHMM), allows the robot to verbalize its own actions and understand user utterances. We verify the potential of the proposed architecture through experiments using a real robot.

Integration, Sensing, and Control of a Modular Soft-Rigid Pneumatic Lower Limb Exoskeleton

This article presents the system integration, sensing, and control of a novel modular soft-rigid pneumatic exoskeleton for lower limb. The proposed exoskeleton consists of three soft hinges (to drive the hip, knee, and ankle joints) and four rigid links (aligned with the waist, thigh, crus, and foot). Each soft hinge is made of and actuated by a customized bidirectional curl pneumatic artificial muscle (CPAM), whereas the links are three-dimensional printed. Each of the rigid links combined with its lower soft hinge (if any) is made into an independent soft-rigid module, that is, the waist-hip, thigh-knee, crus-ankle, and foot modules. With each of the modules are multiple sensors integrated, including two pressure sensors for detecting the inflating pressures, and two flex sensors and an inertia measurement unit for estimating the bending angles of the soft hinges via data fusion. Through a data-fitted angle-torque-pressure relationship of the CPAM, the actuation torque is estimated. An external electropneumatic control system is also developed. The double closed-loop control system consisting of pressure servos and position/torque controllers is designed to control the bending angles and actuation torques of the exoskeleton hinges. Experiment shows good motion controllability of the proposed exoskeleton in the range of motion of a gait cycle.

A Real-Time Automated Patient Screening System for Clinical Trials Eligibility in an Emergency Department: Design and Evaluation

Background

One critical hurdle for clinical trial recruitment is the lack of an efficient method for identifying subjects who meet the eligibility criteria. Given the large volume of data documented in electronic health records (EHRs), it is labor-intensive for the staff to screen relevant information, particularly within the time frame needed. To facilitate subject identification, we developed a natural language processing (NLP) and machine learning–based system, Automated Clinical Trial Eligibility Screener (ACTES), which analyzes structured data and unstructured narratives automatically to determine patients’ suitability for clinical trial enrollment. In this study, we integrated the ACTES into clinical practice to support real-time patient screening.

Objective

This study aimed to evaluate ACTES’s impact on the institutional workflow, prospectively and comprehensively. We hypothesized that compared with the manual screening process, using EHR-based automated screening would improve efficiency of patient identification, streamline patient recruitment workflow, and increase enrollment in clinical trials.

Methods

The ACTES was fully integrated into the clinical research coordinators’ (CRC) workflow in the pediatric emergency department (ED) at Cincinnati Children’s Hospital Medical Center. The system continuously analyzed EHR information for current ED patients and recommended potential candidates for clinical trials. Relevant patient eligibility information was presented in real time on a dashboard available to CRCs to facilitate their recruitment. To assess the system’s effectiveness, we performed a multidimensional, prospective evaluation for a 12-month period, including a time-and-motion study, quantitative assessments of enrollment, and postevaluation usability surveys collected from the CRCs.

Results

Compared with manual screening, the use of ACTES reduced the patient screening time by 34% (P<.001). The saved time was redirected to other activities such as study-related administrative tasks (P=.03) and work-related conversations (P=.006) that streamlined teamwork among the CRCs. The quantitative assessments showed that automated screening improved the numbers of subjects screened, approached, and enrolled by 14.7%, 11.1%, and 11.1%, respectively, suggesting the potential of ACTES in streamlining recruitment workflow. Finally, the ACTES achieved a system usability scale of 80.0 in the postevaluation surveys, suggesting that it was a good computerized solution.

Conclusions

By leveraging NLP and machine learning technologies, the ACTES demonstrated good capacity for improving efficiency of patient identification. The quantitative assessments demonstrated the potential of ACTES in streamlining recruitment workflow and improving patient enrollment. The postevaluation surveys suggested that the system was a good computerized solution with satisfactory usability.

Goals, Recommendations, and the How-To Strategies for Developing and Facilitating Patient Safety and System Integration Simulations

PURPOSE

The aim of this article is to outline overall goals, recommendations, and provide practical How-To strategies for developing and facilitating patient safety and system integration (PSSI) simulations for healthcare team members and organizations.

BACKGROUND

Simulation is increasingly being used as a quality improvement tool to better understand the tasks, environments, and processes that support the delivery of healthcare services. These PSSI simulations paired with system-focused debriefing can occur prior to implementing a new process or workflow to proactively identify system issues. They occur as part of a continuous cycle of quality improvement and have unique considerations for planning, implementation, and delivery of healthcare.

METHOD

The Delphi technique was used to develop the recommendations and How-To strategies to guide those interested in conducting a PSSI simulations. The Delphi technique is a structured communication technique and systematic process of gathering information from a group of identified experts through a series of questionnaires to gain consensus regarding judgments on complex processes, where precise information is not available in the literature. The Delphi technique permitted an iterative and multistaged approach to transform expert opinions into group consensus.

RESULTS

The goals, recommendations, and How-To strategies include a focus on project management, stakeholder engagement, sponsorship, scenario design, prebriefing and debriefing, and evaluation metrics. The intent is to proactively identify system issues and disseminate actionable findings.

CONCLUSIONS

This article highlights salient features to consider when using simulation as a strategy and tool for patient safety and quality improvement.

Electrical Interconnects Fabricated From Biodegradable Conductive Polymer Composites

This study presents the development and characterization of biodegradable electrical interconnects for transient implantable medical devices. The interconnects comprised micropatterned biodegradable conductive polymer composites, which were developed using iron (Fe) microparticles as the conductive filler and polycaprolactone (PCL) as the insulating matrix. The electrical properties of the composites were investigated under various degradation conditions. Electrical percolation was observed at 17% iron volume fraction, but higher volume fractions exhibited more stable electrical resistivity throughout the time course of physiological degradation. The electrical resistivity of 40%vf Fe-PCL composites increased tenfold in an emulated packaged environment under degradation. Biodegradable electrical interconnects based on 40%vf Fe-PCL composites were successfully micropatterned in daisy chain structures, illustrating the process compatibility of Fe-PCL composites for interconnect applications. The electrical resistance of the packaged daisy chain structures exhibited a reasonable increase under degradation. An electrical lifetime of over 5 days was also achieved. System integration with a commercial humidity sensor and analytical calculations supporting other application scenarios confirmed the feasibility of micropatterned Fe-PCL interconnects for use in implantable electrical systems.

Custom Scanning Hyperspectral Imaging System for Biomedical Applications: Modeling, Benchmarking, and Specifications

Prototyping hyperspectral imaging devices in current biomedical optics research requires taking into consideration various issues regarding optics, imaging, and instrumentation. In summary, an ideal imaging system should only be limited by exposure time, but there will be technological limitations (e.g., actuator delay and backlash, network delays, or embedded CPU speed) that should be considered, modeled, and optimized. This can be achieved by constructing a multiparametric model for the imaging system in question. The article describes a rotating-mirror scanning hyperspectral imaging device, its multiparametric model, as well as design and calibration protocols used to achieve its optimal performance. The main objective of the manuscript is to describe the device and review this imaging modality, while showcasing technical caveats, models and benchmarks, in an attempt to simplify and standardize specifications, as well as to incentivize prototyping similar future designs.

[System Integration of Infant Incubators' Quality Control Testing Based on MCU]

This study is aimed to design the testing system of multiple parameters of the incubators, and to make their quality control plans. Also it is required to establish a model of data collection and processing based on MCU, and to program the host computer software in order to analyze data. The result shows that the testing system is accurate and stable; also it is convenient to collect the data. This testing system is a good complement of the quality control of incubators. It has a high practical value in improving medical safety and reducing the occurrence of adverse events.

A Generic Control Architecture for Hybrid Micro-Machines

Hybrid micro-machining, which integrates several micro-manufacturing processes on one platform, has emerged as a solution to utilize the so-called “1 + 1 = 3” effect to tackle the manufacturing challenges for high value-added 3D micro-products. Hybrid micro-machines tend to integrate multiple functional modules from different vendors for the best value and performance. However, the lack of plug-and-play solutions leads to tremendous difficulty in system integration. This paper proposes a novel three-layer control architecture for the first time for the system integration of hybrid micro-machines. The interaction of hardware is encapsulated into software components, while the data flow among different components is standardized. The proposed control architecture enhances the flexibility of the computer numerical control (CNC) system to accommodate a broad range of functional modules. The component design also improves the scalability and maintainability of the whole system. The effectiveness of the proposed control architecture has been successfully verified through the integration of a six-axis hybrid micro-machine. Thus, it provides invaluable guidelines for the development of next-generation CNC systems for hybrid micro-machines.

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

This paper provides a detailed report of the "First Annual Spinal Navigation, Emerging Technologies and Systems Integration" meeting held December 3, 2016 at the Seattle Science Foundation.

Integration of Distributed Services and Hybrid Models Based on Process Choreography to Predict and Detect Type 2 Diabetes

Life expectancy is increasing and, so, the years that patients have to live with chronic diseases and co-morbidities. Type 2 diabetes is one of the most prevalent chronic diseases, specifically linked to being overweight and ages over sixty. Recent studies have demonstrated the effectiveness of new strategies to delay and even prevent the onset of type 2 diabetes by a combination of active and healthy lifestyle on cohorts of mid to high risk subjects. Prospective research has been driven on large groups of the population to build risk scores that aim to obtain a rule for the classification of patients according to the odds for developing the disease. Currently, there are more than two hundred models and risk scores for doing this, but a few have been properly evaluated in external groups and integrated into a clinical application for decision support. In this paper, we present a novel system architecture based on service choreography and hybrid modeling, which enables a distributed integration of clinical databases, statistical and mathematical engines and web interfaces to be deployed in a clinical setting. The system was assessed during an eight-week continuous period with eight endocrinologists of a hospital who evaluated up to 8080 patients with seven different type 2 diabetes risk models implemented in two mathematical engines. Throughput was assessed as a matter of technical key performance indicators, confirming the reliability and efficiency of the proposed architecture to integrate hybrid artificial intelligence tools into daily clinical routine to identify high risk subjects.

Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components

Background

Primary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer’s disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs.

Methods

We employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. Thirty-eight candidate QIs and 19 potential quality improvement mechanisms were presented to participants in two rounds of electronic Delphi surveys. Written comments were collected and descriptively analyzed.

Results

The response rate for the first and second rounds were 21.3% (n = 179) and 12.8% (n = 88), respectively. The majority of respondents were physicians. Fourteen QIs remained after the consensus process. Ten quality improvement mechanisms were selected with those characterized by specialist integration, such as case discussions and mentorships, being ranked highly. Written comments revealed three major themes related to potential barriers and facilitators to quality assurance: 1) perceived importance, 2) collaboration and role clarity, and 3) implementation process.

Conclusion

We successfully utilized a consultative process among primary and specialty providers to identify core QIs and quality improvement mechanisms for PCMCs. Identified quality improvement mechanisms highlight desire for multi-modal education. System integration and closer integration between PCMCs and specialists were emphasized as essential for the provision of high-quality dementia care in community settings.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach

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.

A Wearable Electrochemical Platform for Noninvasive Simultaneous Monitoring of Ca(2+) and pH

Homeostasis of ionized calcium in biofluids is critical for human biological functions and organ systems. Measurement of ionized calcium for clinical applications is not easily accessible due to its strict procedures and dependence on pH. pH balance in body fluids greatly affects metabolic reactions and biological transport systems. Here, we demonstrate a wearable electrochemical device for continuous monitoring of ionized calcium and pH of body fluids using a disposable and flexible array of Ca(2+) and pH sensors that interfaces with a flexible printed circuit board. This platform enables real-time quantitative analysis of these sensing elements in body fluids such as sweat, urine, and tears. Accuracy of Ca(2+) concentration and pH measured by the wearable sensors is validated through inductively coupled plasma-mass spectrometry technique and a commercial pH meter, respectively. Our results show that the wearable sensors have high repeatability and selectivity to the target ions. Real-time on-body assessment of sweat is also performed, and our results indicate that calcium concentration increases with decreasing pH. This platform can be used in noninvasive continuous analysis of ionized calcium and pH in body fluids for disease diagnosis such as primary hyperparathyroidism and kidney stones.

Towards a Multifunctional Electrochemical Sensing and Niosome Generation Lab-on-Chip Platform Based on a Plug-and-Play Concept

In this paper, we present a new modular lab on a chip design for multimodal neurotransmitter (NT) sensing and niosome generation based on a plug-and-play concept. This architecture is a first step toward an automated platform for an automated modulation of neurotransmitter concentration to understand and/or treat neurodegenerative diseases. A modular approach has been adopted in order to handle measurement or drug delivery or both measurement and drug delivery simultaneously. The system is composed of three fully independent modules: three-channel peristaltic micropumping system, a three-channel potentiostat and a multi-unit microfluidic system composed of pseudo-Y and cross-shape channels containing a miniature electrode array. The system was wirelessly controlled by a computer interface. The system is compact, with all the microfluidic and sensing components packaged in a 5 cm × 4 cm × 4 cm box. Applied to serotonin, a linear calibration curve down to 0.125 mM, with a limit of detection of 31 μM was collected at unfunctionalized electrodes. Added sensitivity and selectivity was achieved by incorporating functionalized electrodes for dopamine sensing. Electrode functionalization was achieved with gold nanoparticles and using DNA and o-phenylene diamine polymer. The as-configured platform is demonstrated as a central component toward an “intelligent” drug delivery system based on a feedback loop to monitor drug delivery.

Using data from ambient assisted living and smart homes in electronic health records

INTRODUCTION

This editorial is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records".

BACKGROUND

To increase efficiency in the health care of the future, data from innovative technology like it is used for ambient assisted living (AAL) or smart homes should be available for individual health decisions. Integrating and aggregating data from different medical devices and health records enables a comprehensive view on health data.

OBJECTIVES

The objective of this paper is to present examples of the state of the art in research on information management that leads to a sustainable use and long-term storage of health data provided by innovative assistive technologies in daily living.

RESULTS

Current research deals with the perceived usefulness of sensor data, the participatory design of visual displays for presenting monitoring data, and communication architectures for integrating sensor data from home health care environments with health care providers either via a regional health record bank or via a telemedical center.

CONCLUSIONS

Integrating data from AAL systems and smart homes with data from electronic patient or health records is still in an early stage. Several projects are in an advanced conceptual phase, some of them exploring feasibility with the help of prototypes. General comprehensive solutions are hardly available and should become a major issue of medical informatics research in the near future.

A versatile valving toolkit for automating fluidic operations in paper microfluidic devices

Failure to utilize valving and automation techniques has restricted the complexity of fluidic operations that can be performed in paper microfluidic devices. We developed a toolkit of paper microfluidic valves and methods for automatic valve actuation using movable paper strips and fluid-triggered expanding elements. To the best of our knowledge, this is the first functional demonstration of this valving strategy in paper microfluidics. After introduction of fluids on devices, valves can actuate automatically after a) a certain period of time, or b) the passage of a certain volume of fluid. Timing of valve actuation can be tuned with greater than 8.5% accuracy by changing lengths of timing wicks, and we present timed on-valves, off-valves, and diversion (channel-switching) valves. The actuators require ~30 μl fluid to actuate and the time required to switch from one state to another ranges from ~5 s for short to ~50 s for longer wicks. For volume-metered actuation, the size of a metering pad can be adjusted to tune actuation volume, and we present two methods - both methods can achieve greater than 9% accuracy. Finally, we demonstrate the use of these valves in a device that conducts a multi-step assay for the detection of the malaria protein PfHRP2. Although slightly more complex than devices that do not have moving parts, this valving and automation toolkit considerably expands the capabilities of paper microfluidic devices. Components of this toolkit can be used to conduct arbitrarily complex, multi-step fluidic operations on paper-based devices, as demonstrated in the malaria assay device.

On integration and adaptation in complex service systems

The services sector employs a large and growing proportion of workers in the industrialized nations, and it is increasingly dependent on information and communication technologies. While the interdependences, similarities and complementarities of manufacturing and services are significant, there are considerable differences between goods and services, including the shift in focus from mass production to mass customization (whereby a service is produced and delivered in response to a customer's stated or imputed needs). In general, services can be considered to be knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Like manufacturing systems, an efficient service system must be an integrated system of systems, leading to greater connectivity and interdependence. Integration must occur over the physical, temporal, organizational and functional dimensions, and must include methods concerned with the component, the management, and the system. Moreover, an effective service system must also be an adaptable system, leading to greater value and responsiveness. Adaptation must occur over the dimensions of monitoring, feedback, cybernetics and learning, and must include methods concerned with space, time, and system. In sum, service systems are indeed complex, especially due to the uncertainties associated with the human-centered aspects of such systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation. The paper concludes with several insights, including a plea to shift the current misplaced focus on developing a science or discipline for services to further developing a systems engineering approach to services, an approach based on the integration and adaptation of a host of sciences or disciplines (e.g., physics, mathematics, statistics, psychology, sociology, etc.). In fact, what is required is a services-related transdisciplinary - beyond a single disciplinary - ontology or taxonomy as a basis for disciplinary integration and adaptation.

Control method for preloading with priority information in an integrated radiology information system/picture archiving and communication system

More than 10 years has passed since the concept of picture archiving and communication systems (PACS) was first proposed. A great deal of effort has been expended to make PACS suitable for routine use in clinical settings, but only a few systems are currently used in this manner. A major reason is the lack of the assurance of throughput equivalent to that of a conventional system based on order sheets and analog films. In this report, two techniques to increase throughput have been introduced and studied. The first is the preloading of data elements from the various information systems and the PACS. The second is the use of the priority information to rank order the examinations placed on the list for interpretation. We have applied these techniques to an actual system and have measured the distribution of time for processing examinations. These two techniques appear to make PACS useful in routine practice because most of the urgent cases were interpreted within the target time of 40 minutes.