How Academic Medical Centers Can Navigate the Pandemic and Its Aftermath: Solutions for 3 Major Issues

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.

Weaving Enzymes with Polymeric Shells for Biomedical Applications

Enzyme therapeutics have received increasing attention due to their high biological specificity, outstanding catalytic efficiency, and impressive therapeutic outcomes. Protecting and delivering enzymes into target cells while retaining enzyme catalytic efficiency is a big challenge. Wrapping of enzymes with rational designed polymer shells, rather than trapping them into large nanoparticles such as liposomes, have been widely explored because they can protect the folded state of the enzyme and make post-functionalization easier. In this review, the methods for wrapping up enzymes with protective polymer shells are mainly focused on. It is aimed to provide a toolbox for the rational design of polymeric enzymes by introducing methods for the preparation of polymeric enzymes including physical adsorption and chemical conjugation with specific examples of these conjugates/hybrid applications. Finally, a conclusion is drawn and key points are emphasized.

A legal overview of the use of messaging platforms in healthcare

Medical interventions are becoming more complex day by day. Moreover, compared with the past, more healthcare professionals take part in the same intervention in the field of medicine. The use of technology in medical interventions has also increased. This change in the health sector brings together several legal discussions. In this study, the legal consequences that arise from the treatment processes carried out by the residents and resident educators (registerers / attending physicians), the exchange of information between them, and the usage of some messaging platforms, especially WhatsApp, in this process will be analyzed.

Implementation of Mobile Health Technologies in Clinical Trials of Movement Disorders: Underutilized Potential

Mobile health technologies (mHealth) are patient-worn or portable devices aimed at increasing the granularity and relevance of clinical measurements. The implementation of mHealth has the potential to decrease sample size, duration, and cost of clinical trials. We performed a review of the ClinicalTrials.gov database using a standardized approach to identify adoption in and usefulness of mHealth in movement disorders interventional clinical trials. Trial phase, geographical area, availability of data captured, constructs of interest, and outcome priority were collected. Eligible trials underwent quality appraisal using an ad hoc 5-point checklist to assess mHealth feasibility, acceptability, correlation with patient-centered outcome measures, and clinical meaningfulness. A total of 29% (n = 54/184) registered trials were using mHealth, mainly in Parkinson's disease and essential tremor (59.3% and 27.8%). In most cases, mHealth were used in phase 2 trials (83.3%) as secondary outcome measures (59.3%). Only five phase 3 trials, representing 9.3% of the total, used mHealth (1 as primary outcome measure, 3 as secondary, and 1 as tertiary). Only 3.7% (n = 2/54) of all trials used mHealth for measuring both motor and non-motor symptoms, and 23.1% (n = 12/52) used mHealth for unsupervised, ecologic outcomes. Our findings suggest that mHealth remain underutilized and largely relegated to phase 2 trials for secondary or tertiary outcome measures. Efforts toward greater alignment of mHealth with patient-centered outcomes and development of a universal, common-language platform to synchronize data from one or more devices will assist future efforts toward the integration of mHealth into clinical trials.

Triboelectric nanogenerators based on graphene oxide coated nanocomposite fibers for biomedical applications

A high demand for green and eco-friendly triboelectric nanogenerators (TENGs) has multiplied the importance of their degradability for biomedical applications. However, the charge generation of current eco-friendly TENGs is generally limited. In this research, a flexible TENG based on a silk fibroin (SF) fibrous layer and a polycaprolactone (PCL)/graphene oxide (GO) fibrous layer was developed. Moreover, the PCL/GO layer was surface modified using various concentrations of GO (0, 1.5, 3, 6, and 9 wt%). We demonstrated that surface modification using GO nanosheets significantly improved the output of the TENG. Notably, the optimized GO modified layer resulted in a voltage of 100 V, a current of 3.15 mA [Formula: see text], and a power density of 72 mW[Formula: see text]. Moreover, a thin PCL layer applied as an encapsulation layer did not significantly modulate the performance of the TENG. Furthermore, during 28 d of soaking in a phosphate buffer solution, the proposed TENG was able to successfully generate electricity. The TENG was also proposed to be used for the electrical stimulation of PC12 cells. The results confirmed that this self-powered electrical stimulator could promote the attachment and proliferation of PC12 cells. Therefore, we have shown the potential for an eco-friendly and cost-effective TENG based on GO modified PCl/GO and silk fibrous layers to be used as a power source for biomedical applications.

Exploring non-assembly 3D printing for novel compliant surgical devices

In minimally invasive surgery, maneuverability is usually limited and a large number of degrees of freedom (DOF) is highly demanded. However, increasing the DOF usually means increasing the complexity of the surgical instrument leading to long fabrication and assembly times. In this work, we propose the first fully 3D printed handheld, multi-steerable device. The proposed device is mechanically actuated, and possesses five serially controlled segments. We designed a new compliant segment providing high torsion and axial stiffness as well as a low bending stiffness by merging the functions of four helicoids and a continuum backbone. Compliant segments were combined to form the compliant shaft of the new device. In order to control this compliant shaft, a control handle was designed that mimics the shaft structure. A prototype called the HelicoFlex was built using only three 3D printed parts. HelicoFlex, with its 10 degrees of freedom, showed a fluid motion in performing single and multi-curved paths. The multi-steerable instrument was 3D printed without any support material in the compliant shaft itself. This work contributes to enlarge the body of knowledge regarding how additive manufacturing could be used in the production of multi-steerable surgical instruments for personalized medicine.

Metal-Organic Frameworks for Biomedical Applications

Metal-organic frameworks (MOFs) are an interesting and useful class of coordination polymers, constructed from metal ion/cluster nodes and functional organic ligands through coordination bonds, and have attracted extensive research interest during the past decades. Due to the unique features of diverse compositions, facile synthesis, easy surface functionalization, high surface areas, adjustable porosity, and tunable biocompatibility, MOFs have been widely used in hydrogen/methane storage, catalysis, biological imaging and sensing, drug delivery, desalination, gas separation, magnetic and electronic devices, nonlinear optics, water vapor capture, etc. Notably, with the rapid development of synthetic methods and surface functionalization strategies, smart MOF-based nanocomposites with advanced bio-related properties have been designed and fabricated to meet the growing demands of MOF materials for biomedical applications. This work outlines the synthesis and functionalization and the recent advances of MOFs in biomedical fields, including cargo (drugs, nucleic acids, proteins, and dyes) delivery for cancer therapy, bioimaging, antimicrobial, biosensing, and biocatalysis. The prospects and challenges in the field of MOF-based biomedical materials are also discussed.

Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: a multicenter computer-based laboratory study

BACKGROUND

Maintaining adequate situation awareness is crucial for patient safety. Previous studies found that the use of avatar-based monitoring (Visual Patient Technology) improved the perception of vital signs compared to conventional monitoring showing numerical and waveform data; and was further associated with a reduction of perceived workload. In this study, we aimed to evaluate the effectiveness of Visual Patient Technology on perceptive performance and perceived workload when monitoring multiple patients at the same time, such as in central station monitors in intensive care units or operating rooms.

METHODS

A prospective, within-subject, computer-based laboratory study was performed in two tertiary care hospitals in Switzerland in 2018. Thirty-eight physician and nurse anesthetists volunteered for the study. The participants were shown four different central monitor scenarios in sequence, where each scenario displayed two critical and four healthy patients simultaneously for 10 or 30 s. After each scenario, participants had to recall the vital signs of the critical patients. Perceived workload was assessed with the National Aeronautics and Space Administration Task-Load-Index (NASA TLX) questionnaire.

RESULTS

In the 10-s scenarios, the median number of remembered vital signs significantly improved from 7 to 11 using avatar-based versus conventional monitoring with a mean of differences of 4 vital signs, 95% confidence interval (CI) 2 to 6, p < 0.001. At the same time, the median NASA TLX scores were significantly lower for avatar-based monitoring (67 vs. 77) with a mean of differences of 6 points, 95% CI 0.5 to 11, p = 0.034. In the 30-s scenarios, vital sign perception and workload did not differ significantly.

CONCLUSIONS

In central monitor multiple patient monitoring, we found a significant improvement of vital sign perception and reduction of perceived workload using Visual Patient Technology, compared to conventional monitoring. The technology enabled improved assessment of patient status and may, thereby, help to increase situation awareness and enhance patient safety.

A Prototype Framework Design for Assisting the Detection of Atrial Fibrillation Using a Generic Low-Cost Biomedical Sensor

Cardiovascular diseases are the leading cause of death around the world. As a result, low-cost biomedical sensors have been gaining importance in business and research over the last few decades. Their main benefits include their small size, light weight, portability and low power consumption. Despite these advantages, they are not generally used for clinical monitoring mainly because of their low accuracy in data acquisition. In this emerging technological context, this paper contributes by discussing a methodology to help practitioners build a prototype framework based on a low-cost commercial sensor. The resulting application consists of four modules; namely, a digitalization module whose input is an electrocardiograph signal in portable document format (PDF) or joint photographic expert group format (JPEG), a module to further process and filter the digitalized signal, a selectable data calibration module and, finally, a module implementing a classification algorithm to distinguish between individuals with normal sinus rhythms and those with atrial fibrillation. This last module employs our recently published symbolic recurrence quantification analysis (SRQA) algorithm on a time series of RR intervals. Moreover, we show that the algorithm applies to any biomedical low-cost sensor, achieving good results without requiring.

Smart Textile-Integrated Microelectronic Systems for Wearable Applications

The programmable nature of smart textiles makes them an indispensable part of an emerging new technology field. Smart textile-integrated microelectronic systems (STIMES), which combine microelectronics and technology such as artificial intelligence and augmented or virtual reality, have been intensively explored. A vast range of research activities have been reported. Many promising applications in healthcare, the internet of things (IoT), smart city management, robotics, etc., have been demonstrated around the world. A timely overview and comprehensive review of progress of this field in the last five years are provided. Several main aspects are covered: functional materials, major fabrication processes of smart textile components, functional devices, system architectures and heterogeneous integration, wearable applications in human and nonhuman-related areas, and the safety and security of STIMES. The major types of textile-integrated nonconventional functional devices are discussed in detail: sensors, actuators, displays, antennas, energy harvesters and their hybrids, batteries and supercapacitors, circuit boards, and memory devices.

High-range noise immune supersensitive graphene-electrolyte capacitive strain sensor for biomedical applications

This paper presents development and performance assessment of an innovative and a highly potent graphene-electrolyte capacitive sensor (GECS) based on the supercapacitor model. Although graphene has been widely researched and adapted in supercapacitors as electrode material, this combination has not been applied in sensor technology. A low base capacitance, generally the impeding factor in capacitive sensors, is addressed by incorporating electric double layer capacitance in GECS, and a million-fold increase in base capacitance is achieved. The high base capacitance (∼22.0 μF) promises to solve many inherent issues pertaining to capacitive sensors. GECS is fabricated by using thermally reduced microwave exfoliated graphene oxide material to form interdigitated electrodes coated with solid-state electrolyte which forms the double layer capacitance. The capacitance response of GECS on subjecting to strain is examined and an enormous operating range (∼300 nF) is seen, which is the salient feature of this sensor. The GECS showed an impressive device sensitivity of 11.24 nF kPa-1 and good immunity towards noise i.e. lead capacitance and stray capacitance. Two regimes of operation are identified based on the procedure of device fabrication. The device can be applied to varied applications and one such biomedical application of breath pattern monitoring is demonstrated.

Are cost-effective technologies feasible to measure gait in older adults? A systematic review of evidence-based literature

BACKGROUND

Unrestricted by time and place, innovative technologies seem to provide cost-effective solutions for gait assessment in older adults.

OBJECTIVE

The objective of this study is to provide an overview of gait assessment for older adults by investigating critical gait characteristics of older adults, discussing advantages and disadvantages of the current gait assessment technologies, as well as device applicability.

METHODS

The Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed during the review. Inclusion criteria were: (1) Sample consisting of adults older than 60 years; (2) qualitative, quantitative, or mixed-method researches using one or more specific gait assessment technologies; and (3) publication in English between 2000 and 2018.

RESULTS

In total, twenty-one studies were included. Gait speed, stride length, frequency, acceleration root mean square, step-to-step consistency, autocorrelation, harmonic ratio were reported in the existing literatures to be associated with falls. The enrolled studies address the use of pedometer, wearable accelerometer-based devices, Kinect, Nintendo Wii Balance Board as cost-effective gait assessment technologies.

CONCLUSIONS

Gait parameters and assessment approaches for older adults are diverse. Cost-effective technologies such as a wearable accelerometer-based device, Kinect, and the Nintendo Wii Balance Board provide potential alternatives for gait assessment with acceptable validity and reliability compared with sophisticated devices. The popularity and development of cost-effective devices have made large-scale data collection for gait assessment possible in the daily environment. Further study could involve older adults and their family members/caregivers in use of these technologies to design elderly-friendly products.

Rise of cyborg microrobot: different story for different configuration

By integrating organic parts achieved through evolution and inorganic parts developed by human civilisation, the cyborg microrobot is rising by taking advantage of the high flexibility, outstanding energy efficiency, extremely exquisite structure in the natural components and the fine upgradability, nice controllability in the artefact parts. Compared to the purely synthetic microrobots, the cyborg microrobots, due to the exceptional biocompatibility and biodegradability, have already been utilised in in situ diagnosis, precise therapy and other biomedical applications. In this review, through a thorough summary of recent advances of cyborg microrobots, the authors categorise the cyborg microrobots into four major classes according to the configuration between biomaterials and artefact materials, i.e. microrobots integrated inside living cell, microrobots modified with biological debris, microrobots integrated with single cell and microrobots incorporated with multiple cells. Cyborg microrobots with the four types of configurations are introduced and summarised with the combination approaches, actuation mechanisms, applications and challenges one by one. Moreover, they conduct a comparison among the four different cyborg microrobots to guide the actuation force promotion, locomotion control refinement and future applications. Finally, conclusions and future outlook of the development and potential applications of the cyborg microrobots are discussed.

An Energy Efficient Multi-User Asynchronous Wireless Transmitter for Biomedical Signal Acquisition

The paper presents a novel transmitter architecture for short-range asynchronous wireless communication, applicable to simultaneous multi-user wireless acquisition of biological signals. The analog signal, provided from an analog biosensor, is transformed to time information using an Integral Pulse Frequency Modulator (IPFM) as a Time-Encoding Machine. The IPFM generates a time-encoded unipolar pulse train, maintaining the linear dependence of the output pulse distance on analog input voltage. The system enables continuous acquisition of the signals from multiple sensors in which each transmitter has unique feedback loop delay used for multi-user coding. IPFM pulses trigger the Impulse Radio Ultra-Wideband pulse generator directly, providing two ultra-wideband (UWB) pulses per each IPFM pulse. Due to the lack of internal clock signal and microprocessor-free multi-user coding, the circuitry satisfies the requirements of multi-user coding energy efficiency and size reduction, which are crucial demands in biomedical applications. The proposed Time-Encoded UWB (TE-UWB) transmitter is implemented in 0.18 [Formula: see text] CMOS technology. Measurement results of the IPFM transfer function for input voltage ranging from 0.15 to 1.5 V are presented, providing the dependence of the IPFM pulse time distance on analog input voltage and power consumption dependence on the input voltage level. For continuous monitoring operation, total power consumption of the transmitter circuitry for the maximum input voltage is 10.8 [Formula: see text], while for the lowest input voltage it increases to 40.48 [Formula: see text]. The circuit occupies 0.14 [Formula: see text].

The effect of smart homes on older adults with chronic conditions: A systematic review and meta-analysis

As populations continue to age, the prevalence of multiple chronic conditions in older adults grows. The purpose of this study was to evaluate the effect of smart homes on older patients with chronic conditions. A review and meta-analysis were conducted after searching both English and Chinese databases. Fifteen RCTs were included in the review, with six studies qualifying for the meta-analysis. The meta-analysis revealed no significant effects on measures of hospital admissions (RR =0.90, 95% CI (0.57, 6.34), P = 0.65) or emergency department admissions (RR =0.99, 95% CI (0.34, 2.91), P = 0.98). Likewise, no effects were observed for tele-monitoring on days spent in the hospital (MD =-0.90, 95% CI (-3.34, 1.55), P = 0.47) or quality of life. However, almost all participants were satisfied with the smart homes. The effect of tele-exercise on cognitive functioning was unclear. However, the smart homes did have an effect on physical functioning and depression in older adults with chronic conditions. Future studies should focus on the economic effectiveness, security, accessibility and practicality of smart homes on older adults with chronic conditions.

Mothers' Voices Related to Caregiving: The Transition of a Technology-Dependent Infant from the NICU to Home

PURPOSE

The transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge.

DESIGN

A qualitative, descriptive, longitudinal design was employed.

SAMPLE

Nineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU.

MAIN OUTCOME VARIABLE

Description of mothers' transition experience.

RESULTS

Three themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.

Wearable Potentiometric Sensors for Medical Applications

Wearable potentiometric sensors have received considerable attention owing to their great potential in a wide range of physiological and clinical applications, particularly involving ion detection in sweat. Despite the significant progress in the manner that potentiometric sensors are integrated in wearable devices, in terms of materials and fabrication approaches, there is yet plenty of room for improvement in the strategy adopted for the sample collection. Essentially, this involves a fluidic sampling cell for continuous sweat analysis during sport performance or sweat accumulation via iontophoresis induction for one-spot measurements in medical settings. Even though the majority of the reported papers from the last five years describe on-body tests of wearable potentiometric sensors while the individual is practicing a physical activity, the medical utilization of these devices has been demonstrated on very few occasions and only in the context of cystic fibrosis diagnosis. In this sense, it may be important to explore the implementation of wearable potentiometric sensors into the analysis of other biofluids, such as saliva, tears and urine, as herein discussed. While the fabrication and uses of wearable potentiometric sensors vary widely, there are many common issues related to the analytical characterization of such devices that must be consciously addressed, especially in terms of sensor calibration and the validation of on-body measurements. After the assessment of key wearable potentiometric sensors reported over the last five years, with particular attention paid to those for medical applications, the present review offers tentative guidance regarding the characterization of analytical performance as well as analytical and clinical validations, thereby aiming at generating debate in the scientific community to allow for the establishment of well-conceived protocols.

A Biomechatronic EPP upper-limb prosthesis controller and its performance comparison to other topologies

Historically, Classic Extended Physiological Proprioception (EPP) as an upper-limb prosthesis control topology has been outperforming functionally all other topologies of the past. A novel Biomechatronic EPP controller has been designed to overcome shortcomings of the classic EPP control topology, and has been hypothesized to be functionally equivalent to the classic EPP topology. Using the dSpace realtime hardware platform and other mechanical and electronic components, the following were developed in the lab: (a) A Biomechatronic EPP controller, (b) a classic EPP controller, (c) an "unconnected" controller and (d) an EMG controller. All four topologies were tested in the lab using the target experiments methodology. Initial results of one subject show that performance of (a) is superior or comparable to (b) and superior to (c) and (d).

Digital Diabetes Congress 2018

Digital health is capturing the attention of the healthcare community. This paradigm whereby healthcare meets the internet uses sensors that communicate wirelessly along with software residing on smartphones to deliver data, information, treatment recommendations, and in some cases control over an effector device. As artificial intelligence becomes more widely used, this approach to creating individualized treatment plans will increase the opportunities for patients, even if they are in remote settings, to communicate with and learn from healthcare professionals. Simple design is needed to promote use of these tools, especially for the purpose of increased adherence to treatment. Widespread adoption by the healthcare industry will require better outcomes data, which will most likely be in the form of safety and effectiveness results from robust randomized controlled trials, as well as evidence of privacy and security. Such data will be needed to convince investors to direct resources into and regulators to clear new digital health tools. Diabetes Technology Society and William Sansum Diabetes Center launched the Digital Diabetes Congress in 2017 because of great interest in determining the potential benefits, metrics of success, and appropriate components of mobile applications for diabetes. The second annual meeting in this series took place on May 22-23, 2018 in San Francisco. This report contains summaries of the meeting's 4 plenary lectures and 10 sessions. This meeting report presents a summary of how 55 panelists, speakers, and moderators, who are leaders in healthcare technology, see the current and future landscape of digital health tools applied to diabetes.

Physical activity and weight maintenance: the utility of wearable devices and mobile health technology in research and clinical settings

PURPOSE OF REVIEW

The integration of wearable devices and mobile health (mHealth) technology to facilitate behavior change has the potential to transform the efficacy of interventions and implementation programs for weight maintenance. The purpose of this review was to provide a comprehensive analysis of the overall utility of wearable devices for assessing and promoting weight maintenance in research and clinical settings.

RECENT FINDINGS

Recent intervention trials using wearable devices have been successful in increasing physical activity and decreasing or maintaining body weight, but complex study designs involving multiple behavioral strategies make it difficult to assess whether wearable devices can independently influence weight status. The daily feedback that wearable devices and mHealth technology provide may assist in motivating higher levels of physical activity achievement. However, the integration of wearable devices into the healthcare setting and implementation of mHealth programs still need to be tested.

SUMMARY

Recent studies add concrete implications for providers and researchers to better assess and promote physical activity in healthcare settings by identifying how wearable devices can be advantageous for physical activity and health promotion.

Substrate-Independent Micropatterning of Polymer Brushes Based on Photolytic Deactivation of Chemical Vapor Deposition Based Surface-Initiated Atom-Transfer Radical Polymerization Initiator Films

Precise microscale arrangement of biomolecules and cells is essential for tissue engineering, microarray development, diagnostic sensors, and fundamental research in the biosciences. Biofunctional polymer brushes have attracted broad interest in these applications. However, patterning approaches to creating microstructured biointerfaces based on polymer brushes often involve tedious, expensive, and complicated procedures that are specifically designed for model substrates. We report a substrate-independent, facile, and scalable technique with which to prepare micropatterned biofunctional brushes with the ability to generate binary chemical patterns. Employing chemical vapor deposition (CVD) polymerization, a functionalized polymer coating decorated with 2-bromoisobutyryl groups that act as atom-transfer radical polymerization (ATRP) initiators was prepared and subsequently modified using UV light. The exposure of 2-bromoisobutyryl groups to UV light with wavelengths between 187 and 254 nm resulted in selective debromination, effectively eliminating the initiation of ATRP. In addition, when coatings incorporating both 2-bromoisobutyryl and primary amine groups were irradiated with UV light, the amines retained their functionality after UV treatment and could be conjugated to activated esters, facilitating binary chemical patterns. In contrast, polymer brushes were selectively grown from areas protected from UV treatment, as confirmed by atomic force microscopy, time-of-flight secondary ion mass spectrometry, and imaging ellipsometry. Furthermore, spatial control over biomolecular adhesion was achieved in three ways: (1) patterned nonfouling brushes resulted in nonspecific protein adsorption to areas not covered with polymer brushes; (2) patterned brushes decorated with active binding sides gave rise to specific protein immobilization on areas presenting polymer brushes; (3) and primary amines were co-patterned along with clickable polymer brushes bearing pendant alkyne groups, leading to bifunctional reactivity. Because this novel technique is independent of the original substrate's physicochemical properties, it can be extended to technologically relevant substrates such as polystyrene, polydimethylsiloxane, polyvinyl chloride, and steel. With further work, the photolytic deactivation of CVD-based initiator coatings promises to advance the utility of patterned biofunctional polymer brushes across a spectrum of biomedical applications.

New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis

BACKGROUND AND AIMS

The need to increase the adenoma detection rate (ADR) for colorectal cancer screening has ushered in devices that mechanically or optically improve conventional colonoscopy. Recently, new technology devices (NTDs) have become available. We aimed to compare the ADR, polyp detection rate (PDR), and adenoma miss rate (AMR) between NTDs and conventional colonoscopy and between mechanical and optical NTDs.

METHODS

MEDLINE and Embase databases were searched from inception through September 2017 for articles or abstracts reporting ADR, PDR, and AMR with NTDs. Randomized controlled trials and case-control studies with >10 subjects were included. Primary outcomes included ADR, PDR, and AMR odds ratio (OR) between conventional colonoscopy and NTDs. Secondary outcomes included cecal intubation rates, adverse events, cecal intubation time, and total colonoscopy time.

RESULTS

From 141 citations, 45 studies with 20,887 subjects were eligible for ≥1 analyses. Overall, the ORs for ADR (1.35; 95% confidence interval [CI] 1.24-1.47; P < .01) and PDR (1.51; 95% CI, 1.37-1.67; P < .01) were higher with NTDs. Higher ADR (OR, 1.52 vs 1.25; P = .035) and PDR (OR, 1.63 vs 1.10; P ≤ .01) were observed with mechanical NTDs. The overall AMR with NTDs was lower compared with conventional colonoscopy (OR, .19; 95% CI, .14-.26; P < .01). Mechanical NTDs had lower AMRs compared with optical NTDs (OR, .10 vs .33; P < .01). No differences in cecal intubation rates, cecal intubation time, or total colonoscopy time were found.

CONCLUSIONS

Newer endoscopic technologies are an effective option to improve ADR and PDR and decrease AMR, particularly with mechanical NTDs. No differences in operability and safety were found.

Digital technologies for the assessment of cognition: a clinical review

Dementia is the most widespread form of neurodegenerative disorder and is associated with an immense societal and personal cost. Prevalence of this disorder is projected to triple worldwide by 2050 leading to an urgent need to make advances in the efficiency of both its care and therapy research. Digital technologies are a rapidly advancing field that provide a previously unavailable opportunity to alleviate challenges faced by clinicians and researchers working in this area. This clinical review aimed to summarise currently available evidence on digital technologies that can be used to monitor cognition. We identified a range of pervasive digital systems, such as smartphones, smartwatches and smart homes, to assess and assist elderly demented, prodromal and preclinical populations. Generally, the studies reported good level of agreement between the digital measures and the constructs they aimed to measure. However, most of the systems are still only in the initial stages of development with limited data on acceptability in patients. Although it is clear that the use of digital technology to monitor and support the cognitive domains affected by dementia is a promising area of development, additional research validating the efficacy, utility and cost-effectiveness of these systems in patient populations is needed.

Participatory design of healthcare technology with children

Purpose There are many frameworks and methods for involving children in design research. Human-Computer Interaction provides rich methods for involving children when designing technologies. The paper aims to discuss these issues. Design/methodology/approach This paper examines various approaches to involving children in design, considering whether users view children as study objects or active participants. Findings The BRIDGE method is a sociocultural approach to product design that views children as active participants, enabling them to contribute to the design process as competent and resourceful partners. An example is provided, in which BRIDGE was successfully applied to developing upper limb prostheses with children. Originality/value Approaching design in this way can provide children with opportunities to develop social, academic and design skills and to develop autonomy.

Multifocal spectral-domain optical coherence tomography based on Bessel beam for extended imaging depth

To advance the practical application of optical coherence tomography (OCT) in the field of biomedical imaging, the imaging depth must be extended without sacrificing resolution while maintaining sufficient sensitivity. However, there is an inherent trade-off between lateral resolution and depth of field (DOF) in OCT. To address this shortcoming, this article proposes a multifocal Bessel beam spectral-domain optical coherence tomography (MBSDOCT) capable of increasing the DOF with unchanged lateral resolution and a high signal-to-noise ratio. The proposed technique is demonstrated by simulation and experiment. A three-focal MBSDOCT with an axicon lens theoretically achieved a DOF of ∼6  mm with a lateral resolution of ∼13  μm. In imaging experiments performed on the acinar cells of orange tissue, a measured DOF of ∼4  mm was demonstrated with a sensitivity penalty of ∼18.1  dB, relative to the Gaussian beam spectral-domain OCT, with a 9-mW light source.

Emerging 0D Transition-Metal Dichalcogenides for Sensors, Biomedicine, and Clean Energy

Following research on two-dimensional (2D) transition metal dichalcogenides (TMDs), zero-dimensional (0D) TMDs nanostructures have also garnered some attention due to their unique properties; exploitable for new applications. The 0D TMDs nanostructures stand distinct from their larger 2D TMDs cousins in terms of their general structure and properties. 0D TMDs possess higher bandgaps, ultra-small sizes, high surface-to-volume ratios with more active edge sites per unit mass. So far, reported 0D TMDs can be mainly classified as quantum dots, nanodots, nanoparticles, and small nanoflakes. All exhibited diverse applications in various fields due to their unique and excellent properties. Of significance, through exploiting inherent characteristics of 0D TMDs materials, enhanced catalytic, biomedical, and photoluminescence applications can be realized through this exciting sub-class of TMDs. Herein, we comprehensively review the properties and synthesis methods of 0D TMDs nanostructures and focus on their potential applications in sensor, biomedicine, and energy fields. This article aims to educate potential adopters of these excitingly new nanomaterials as well as to inspire and promote the development of more impactful applications. Especially in this rapidly evolving field, this review may be a good resource of critical insights and in-depth comparisons between the 0D and 2D TMDs.

BioMEMS-based coding for secure medical diagnostic devices

Trustworthy and usable point-of-care solutions require not only effective disease diagnostic procedures to ensure delivery of rapid and accurate outcomes, but also lightweight privacy-preserving capabilities. In this paper, we present a Biomedical Microelectromachanical System (BioMEMS)-based sensor for portable, inexpensive smartphone-based biomarker detection. The biosensor presented here provides the ability for signal encryption at the physical sensor level to ensure patient's diagnostic confidentiality. Our results show that this design allow us to protect the samples measurements while accurately distinguish different test samples.

Electrical Stimulation: A Panacea for Disease?: DARPA Investigates New Bioelectrical Interfaces for a Range of Disorders

It seems simple: send a small electrical current to a major nerve in the body and stimulate hormones and organs to react in the way you want. New efforts by research teams are doing just that, zapping peripheral nerves attached to major organs in the hopes of addressing problems as diverse as inflammatory bowel disease, chronic pain, and posttraumatic stress disorder. Thanks to the continued advance of smaller and more efficient electronics, researchers are finding new ways to develop implantable bioelectrical devices to treat a wide range of ailments.

Endogenous Technology Adoption and Medical Costs

Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare spending covered by basic health insurance whilst controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. These results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare spending, whilst increased availability of percutaneous transluminal coronary angioplasty facilities is associated with reductions in per capita spending. However, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies that did not control for the possible endogeneity of the availability of technologies. Copyright © 2016 John Wiley & Sons, Ltd.

An RF-based wearable sensor system for indoor tracking to facilitate efficient healthcare management

To understand the utilization of clinical resources and improve the efficiency of healthcare, it is often necessary to accurately locate patients and doctors in a healthcare facility. However, existing tracking methods, such as GPS, Wi-Fi and RFID, have technological drawbacks or impose significant costs, thus limiting their applications in many clinical environments, especially those with indoor enclosures. This paper proposes a low-cost and flexible tracking system that is well suited for operating in an indoor environment. Based on readily available RF transceivers and microcontrollers, our wearable sensor system can facilitate locating users (e.g., patients or doctors) or objects (e.g., medical devices) in a building. The strategic construction of the sensor system, along with a suitably designed tracking algorithm, together provide for reliability and dispatch in localization performance. For demonstration purposes, several simplified experiments, with different configurations of the system, are implemented in two testing rooms to assess the baseline performance. From the obtained results, our system exhibits immense promise in acquiring a user location and corresponding time-stamp, with high accuracy and rapid response. This capability is conducive to both short- and long-term data analytics, which are crucial for improving healthcare management.

Nano-fabricated memristive biosensors for biomedical applications with liquid and dried samples

Nanowire based platforms are widely reported for sensing applications and for their potential in the bio-detection field. In the present work, memristive nanowire devices are implemented for label-free sensing in liquid samples as well as in dried samples via leveraging the modification of the hysteresis in the devices electrical response as a consequence of the surface modification. First, pH sensing in liquid conditions is demonstrated. In addition, the memristive devices are bio-functionalized using antibodies for Prostate Specific Antigen (PSA) as case of study. In this way, the nanowires are converted to memristive biosensors paving the way for future molecular diagnostics applications in general, and for detection of prostate cancer disease in particular.

Monitoring practice and alarm technology in anaesthesiology

In this article we examine how one of the most pervasive technological implementations in the healthcare domain - the alarm system - is used in anaesthesiology as part of patient monitoring. The utility and appropriateness of alarms in healthcare domains have been widely addressed in the literature. However, we argue that we still know little about the practical use of alarm systems in actual healthcare practice. Studies rarely examine in detail the everyday monitoring practices during normal operations in the absence of, or before, problems become critical and alarming. They have mainly considered how medical professionals manage the interpretation of and response to alarms. Rather than examining how the anaesthesiologist identifies and responds to alarms and critical problems, in this article we focus on how the anaesthesiologist is actively and prospectively engaged in implementing a situated and emergent organization of patient monitoring, using a wide range of different technological and material resources.

Polarized light interaction with tissues

This tutorial-review introduces the fundamentals of polarized light interaction with biological tissues and presents some of the recent key polarization optical methods that have made possible the quantitative studies essential for biomedical diagnostics. Tissue structures and the corresponding models showing linear and circular birefringence, dichroism, and chirality are analyzed. As the basis for a quantitative description of the interaction of polarized light with tissues, the theory of polarization transfer in a random medium is used. This theory employs the modified transfer equation for Stokes parameters to predict the polarization properties of single- and multiple-scattered optical fields. The near-order of scatterers in tissues is accounted for to provide an adequate description of tissue polarization properties. Biomedical diagnostic techniques based on polarized light detection, including polarization imaging and spectroscopy, amplitude and intensity light scattering matrix measurements, and polarization-sensitive optical coherence tomography are described. Examples of biomedical applications of these techniques for early diagnostics of cataracts, detection of precancer, and prediction of skin disease are presented. The substantial reduction of light scattering multiplicity at tissue optical clearing that leads to a lesser influence of scattering on the measured intrinsic polarization properties of the tissue and allows for more precise quantification of these properties is demonstrated.

A New Paradigm of Technology-Enabled ‘Vital Signs’ for Early Detection of Health Change for Older Adults

Environmentally embedded (nonwearable) sensor technology is in continuous use in elder housing to monitor a new set of ‘vital signs' that continuously measure the functional status of older adults, detect potential changes in health or functional status, and alert healthcare providers for early recognition and treatment of those changes. Older adult participants' respiration, pulse, and restlessness are monitored as they sleep. Gait speed, stride length, and stride time are calculated daily, and automatically assess for increasing fall risk. Activity levels are summarized and graphically displayed for easy interpretation. Falls are detected when they occur and alerts are sent immediately to healthcare providers, so time to rescue may be reduced. Automated health alerts are sent to healthcare staff, based on continuously running algorithms applied to the sensor data, days and weeks before typical signs or symptoms are detected by the person, family members, or healthcare providers. Discovering these new functional status ‘vital signs', developing automated methods for interpreting them, and alerting others when changes occur have the potential to transform chronic illness management and facilitate aging in place through the end of life. Key findings of research in progress at the University of Missouri are discussed in this viewpoint article, as well as obstacles to widespread adoption.

Characteristics of canine platelet-rich plasma prepared with five commercially available systems

OBJECTIVE

To characterize platelet-rich plasma (PRP) products obtained from canine blood by use of a variety of commercially available devices.

SAMPLE

Blood samples from 15 dogs between 18 months and 9 years of age with no concurrent disease, except for osteoarthritis in some dogs.

PROCEDURES

PRP products were produced from blood obtained from each of the 15 dogs by use of each of 5 commercially available PRP-concentrating systems. Complete blood counts were performed on each whole blood sample and PRP product. The degree of platelet, leukocyte, and erythrocyte concentration or reduction for PRP, compared with results for the whole blood sample, was quantified for each dog and summarized for each concentrating system.

RESULTS

The various PRP-concentrating systems differed substantially in the amount of blood processed, method of PRP preparation, amount of PRP produced, and platelet, leukocyte, and erythrocyte concentrations or reductions for PRP relative to results for whole blood.

CONCLUSIONS AND CLINICAL RELEVANCE

The characteristics of PRP products differed considerably. Investigators evaluating the efficacy of PRPs need to specify the characteristics of the product they are assessing. Clinicians should be aware of the data (or lack of data) supporting use of a particular PRP for a specific medical condition.

The Body Metric: From Skin Conductance to Brain Waves to Heart Rate, the Measurement of Physiological Function is Playing a Growing Role in Everyday Consumer Technology

From skin conductance to brain waves to heart rate, the measurement of physiological function is playing a growing role in everyday consumer technology.

The role of micro-scale current sensing in biomedicine: A unifying view and design guidelines

The electrical activity of cells is regulated by ion fluxes and chemical signaling between them is sustained by redox-reactive molecules. Consequently, current sensing represents a straightforward way to interface electronics with biology and a common detection tool in several applications spanning from patch-clamp and nanopores to micro-scale impedance tracking. Reaching pA resolution at the ms timescale represents a challenge for the readout circuit and here all the criticalities involved in the optimal design of the sensing electrode are reviewed. Advantages vs. drawbacks and risks of the use of silicon as active vs. passive substrate respectively are illustrated by means of experimental examples.

ESUMS: a mobile system for continuous home monitoring of rehabilitation patients

The pressure on the healthcare services is building up for several reasons. The ageing population trend, the increase in life-style related disease prevalence, as well as the increased treatment capabilities with associated general expectation all add pressure. The use of ambient healthcare technologies can alleviate the situation by enabling time and cost-efficient monitoring and follow-up of patients discharged from hospital care. We report on an ambulatory system developed for monitoring of physical rehabilitation patients. The system consists of a wearable multisensor monitoring device; a mobile phone with client application aggregating the data collected; a service-oriented-architecture based server solution; and a PC application facilitating patient follow-up by their health professional carers. The system has been tested and verified for accuracy in controlled environment trials on healthy volunteers, and also been usability tested by 5 congestive heart failure patients and their nurses. This investigation indicated that patients were able to use the system, and that nurses got an improved basis for patient follow-up.