Pub Date : 2020-01-01Epub Date: 2019-11-19DOI: 10.2196/17106
Donna L Coffman, Xizhen Cai, Runze Li, Noelle R Leonard
Background: Ambulatory assessment of electrodermal activity (EDA) is an emerging technique for capturing individuals' autonomic responses to real-life events. There is currently little guidance available for processing and analyzing such data in an ambulatory setting.
Objective: This study aimed to describe and implement several methods for preprocessing and constructing features for use in modeling ambulatory EDA data, particularly for measuring stress.
Methods: We used data from a study examining the effects of stressful tasks on EDA of adolescent mothers (AMs). A biosensor band recorded EDA 4 times per second and was worn during an approximately 2-hour assessment that included a 10-min mother-child videotaped interaction. The initial processing included filtering noise and motion artifacts.
Results: We constructed the features of the EDA data, including the number of peaks and their amplitude as well as EDA reactivity, quantified as the rate at which AMs returned to baseline EDA following an EDA peak. Although the pattern of EDA varied substantially across individuals, various features of EDA may be computed for all individuals enabling within- and between-individual analyses and comparisons.
Conclusions: The algorithms we developed can be used to construct features for dry-electrode ambulatory EDA, which can be used by other researchers to study stress and anxiety.
{"title":"Challenges and Opportunities in Collecting and Modeling Ambulatory Electrodermal Activity Data.","authors":"Donna L Coffman, Xizhen Cai, Runze Li, Noelle R Leonard","doi":"10.2196/17106","DOIUrl":"https://doi.org/10.2196/17106","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory assessment of electrodermal activity (EDA) is an emerging technique for capturing individuals' autonomic responses to real-life events. There is currently little guidance available for processing and analyzing such data in an ambulatory setting.</p><p><strong>Objective: </strong>This study aimed to describe and implement several methods for preprocessing and constructing features for use in modeling ambulatory EDA data, particularly for measuring stress.</p><p><strong>Methods: </strong>We used data from a study examining the effects of stressful tasks on EDA of adolescent mothers (AMs). A biosensor band recorded EDA 4 times per second and was worn during an approximately 2-hour assessment that included a 10-min mother-child videotaped interaction. The initial processing included filtering noise and motion artifacts.</p><p><strong>Results: </strong>We constructed the features of the EDA data, including the number of peaks and their amplitude as well as EDA reactivity, quantified as the rate at which AMs returned to baseline EDA following an EDA peak. Although the pattern of EDA varied substantially across individuals, various features of EDA may be computed for all individuals enabling within- and between-individual analyses and comparisons.</p><p><strong>Conclusions: </strong>The algorithms we developed can be used to construct features for dry-electrode ambulatory EDA, which can be used by other researchers to study stress and anxiety.</p>","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39712049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan C Espinoza, Kathryn M. Cooper, Nadine Afari, P. Shah, S. Batchu, Y. Bar-Cohen
Pediatric medical devices cover a broad array of indications and risk profiles, and have helped to reduce disease burden and improve quality of life for numerous children. However, many of the devices used in pediatrics are not intended for or tested on children. Several barriers have been identified that pose difficulties in bringing pediatric medical devices to the market. These include a small market and small sample size; unique design considerations; regulatory complexities; lack of infrastructure for research, development, and evaluation; and low return on investment. In 2007, the Food and Drug Administration (FDA) created the Pediatric Device Consortia (PDC) Grants Program under the administration of the Office of Orphan Products Development. In 2018, the FDA awarded over US $30 million to five new PDCs. The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) is one of these PDCs and is centered at the Children’s Hospital Los Angeles. In February 2019, CTIP convened its primary stakeholders to discuss its priorities and activities for the new grant cycle. In this paper, we have presented a report of the summit proceedings to raise awareness and advocate for patients and pediatric medical device innovators as well as to inform the activities and priorities of other organizations and agencies engaged in pediatric medical device development.
{"title":"Innovation in Pediatric Medical Devices: Proceedings From The West Coast Consortium for Technology & Innovation in Pediatrics 2019 Annual Stakeholder Summit","authors":"Juan C Espinoza, Kathryn M. Cooper, Nadine Afari, P. Shah, S. Batchu, Y. Bar-Cohen","doi":"10.2196/preprints.17467","DOIUrl":"https://doi.org/10.2196/preprints.17467","url":null,"abstract":"Pediatric medical devices cover a broad array of indications and risk profiles, and have helped to reduce disease burden and improve quality of life for numerous children. However, many of the devices used in pediatrics are not intended for or tested on children. Several barriers have been identified that pose difficulties in bringing pediatric medical devices to the market. These include a small market and small sample size; unique design considerations; regulatory complexities; lack of infrastructure for research, development, and evaluation; and low return on investment. In 2007, the Food and Drug Administration (FDA) created the Pediatric Device Consortia (PDC) Grants Program under the administration of the Office of Orphan Products Development. In 2018, the FDA awarded over US $30 million to five new PDCs. The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) is one of these PDCs and is centered at the Children’s Hospital Los Angeles. In February 2019, CTIP convened its primary stakeholders to discuss its priorities and activities for the new grant cycle. In this paper, we have presented a report of the summit proceedings to raise awareness and advocate for patients and pediatric medical device innovators as well as to inform the activities and priorities of other organizations and agencies engaged in pediatric medical device development.","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42968809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality. This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used. A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format. A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28). IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing.
沉浸式虚拟现实（IVR）为医疗保健的应用提供了新的可能性。医疗保健专业人员现在可以让患者沉浸在环境中，以接触特定的场景或体验，唤起有针对性的情绪反应，激发或分散对现实中发生的体验的注意力。本综述旨在确定头戴式IVR在健康状况急性治疗中以患者为中心的应用，并确定所用系统的技术规范。2018年，通过检索医学和工程同行评审的文献数据库进行了系统综述。数据库包括PubMed、EMBASE、护理和相关健康文献累积索引、计算机协会、电气和电子工程师协会、Scopus和Web of Science。使用了与健康和IVR相关的搜索术语。为了纳入研究，必须调查IVR对特定健康状况的急性治疗的有效性。IVR被定义为一种头戴式平台，为参与者提供虚拟和听觉沉浸，并包括至少3度的定向跟踪。一旦确定，就从文章中提取数据，并以叙述性综述的形式汇总。共在19个国家进行了58项研究。研究报告了IVR在5个主要临床领域的应用：神经和发育（n=10）、通过分心减轻疼痛（n=20）、恐惧症暴露治疗（n=9）、心理应用（n=14）和其他（n=5）。研究主要是探索系统和一般用户接受度的可行性研究（n=29）和测试临床效果的疗效研究（n=28）。IVR在医疗保健领域有着广阔的前景，无论是在研究领域还是在商业领域。由于许多研究仍在探索IVR用于急性治疗健康状况的可行性，IVR有效性的证据仍在发展中。
{"title":"Immersive Virtual Reality in Health Care: Systematic Review of Technology and Disease States","authors":"Aaron J. Snoswell, C. Snoswell","doi":"10.2196/15025","DOIUrl":"https://doi.org/10.2196/15025","url":null,"abstract":"\u0000 \u0000 Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality.\u0000 \u0000 \u0000 \u0000 This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used.\u0000 \u0000 \u0000 \u0000 A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format.\u0000 \u0000 \u0000 \u0000 A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28).\u0000 \u0000 \u0000 \u0000 IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing.\u0000","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43617143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ioannis Vourganas, V. Stanković, L. Stanković, A. Kerr
Stroke is increasingly one of the main causes of impairment and disability. Contextual and empirical evidence demonstrate that, mainly due to service delivery constraints, but also due to a move toward personalized health care in the comfort of patients’ homes, more stroke survivors undergo rehabilitation at home with minimal or no supervision. Due to this trend toward telerehabilitation, systems for stroke patient self-rehabilitation have become increasingly popular, with many solutions recently proposed based on technological advances in sensing, machine learning, and visualization. However, by targeting generic patient profiles, these systems often do not provide adequate rehabilitation service, as they are not tailored to specific patients’ needs. Our objective was to review state-of-the-art home rehabilitation systems and discuss their effectiveness from a patient-centric perspective. We aimed to analyze engagement enhancement of self-rehabilitation systems, as well as motivation, to identify the challenges in technology uptake. We performed a systematic literature search with 307,550 results. Then, through a narrative review, we selected 96 sources of existing home rehabilitation systems and we conducted a critical analysis. Based on the critical analysis, we formulated new criteria to be used when designing future solutions, addressing the need for increased patient involvement and individualism. We categorized the criteria based on (1) motivation, (2) acceptance, and (3) technological aspects affecting the incorporation of the technology in practice. We categorized all reviewed systems based on whether they successfully met each of the proposed criteria. The criteria we identified were nonintrusive, nonwearable, motivation and engagement enhancing, individualized, supporting daily activities, cost-effective, simple, and transferable. We also examined the motivation method, suitability for elderly patients, and intended use as supplementary criteria. Through the detailed literature review and comparative analysis, we found no system reported in the literature that addressed all the set criteria. Most systems successfully addressed a subset of the criteria, but none successfully addressed all set goals of the ideal self-rehabilitation system for home use. We identified a gap in the state-of-the-art in telerehabilitation and propose a set of criteria for a novel patient-centric system to enhance patient engagement and motivation and deliver better self-rehabilitation commitment.
{"title":"Factors That Contribute to the Use of Stroke Self-Rehabilitation Technologies: A Review","authors":"Ioannis Vourganas, V. Stanković, L. Stanković, A. Kerr","doi":"10.2196/13732","DOIUrl":"https://doi.org/10.2196/13732","url":null,"abstract":"\u0000 \u0000 Stroke is increasingly one of the main causes of impairment and disability. Contextual and empirical evidence demonstrate that, mainly due to service delivery constraints, but also due to a move toward personalized health care in the comfort of patients’ homes, more stroke survivors undergo rehabilitation at home with minimal or no supervision. Due to this trend toward telerehabilitation, systems for stroke patient self-rehabilitation have become increasingly popular, with many solutions recently proposed based on technological advances in sensing, machine learning, and visualization. However, by targeting generic patient profiles, these systems often do not provide adequate rehabilitation service, as they are not tailored to specific patients’ needs.\u0000 \u0000 \u0000 \u0000 Our objective was to review state-of-the-art home rehabilitation systems and discuss their effectiveness from a patient-centric perspective. We aimed to analyze engagement enhancement of self-rehabilitation systems, as well as motivation, to identify the challenges in technology uptake.\u0000 \u0000 \u0000 \u0000 We performed a systematic literature search with 307,550 results. Then, through a narrative review, we selected 96 sources of existing home rehabilitation systems and we conducted a critical analysis. Based on the critical analysis, we formulated new criteria to be used when designing future solutions, addressing the need for increased patient involvement and individualism. We categorized the criteria based on (1) motivation, (2) acceptance, and (3) technological aspects affecting the incorporation of the technology in practice. We categorized all reviewed systems based on whether they successfully met each of the proposed criteria.\u0000 \u0000 \u0000 \u0000 The criteria we identified were nonintrusive, nonwearable, motivation and engagement enhancing, individualized, supporting daily activities, cost-effective, simple, and transferable. We also examined the motivation method, suitability for elderly patients, and intended use as supplementary criteria. Through the detailed literature review and comparative analysis, we found no system reported in the literature that addressed all the set criteria. Most systems successfully addressed a subset of the criteria, but none successfully addressed all set goals of the ideal self-rehabilitation system for home use.\u0000 \u0000 \u0000 \u0000 We identified a gap in the state-of-the-art in telerehabilitation and propose a set of criteria for a novel patient-centric system to enhance patient engagement and motivation and deliver better self-rehabilitation commitment.\u0000","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46140088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical device catheters that are used in minimally invasive interventional medical procedures all follow the same integrated design and use paradigm. The features and elements of any catheter device are combined in a single unitary construction. A modular approach to the design, construction, and use of these types of interventional catheters may provide significant advantages and benefits not available with an integrated design paradigm. This paper aimed to present the design of a modular catheter system and the findings from an initial veterinary use as a case study for the potential of modular catheter systems in general. A modular catheter system was designed using commercially available angioplasty balloon dilatation catheters as one module in the system and a custom designed scoring adapter as the other module. The scoring adapter incorporates wires to add scoring features to the angioplasty balloon catheter to improve the dilatation performance during a pulmonary valvuloplasty procedure. The scoring adapter also includes a novel attachment mechanism to couple the scoring adapter to any 0.035-inch guidewire–compatible angioplasty balloon catheter. The modular catheter system was successfully designed, manufactured, and used in an initial minimally invasive veterinary cardiovascular intervention to treat a case of canine subvalvular pulmonary stenosis. The scoring adapter and angioplasty balloon catheter were successfully combined tableside in the operating room at the time of the procedure and used to successfully dilate the subvalvular obstruction. The successful design and use of the presented modular catheter system demonstrates the feasibility and potential advantages of this type of paradigm to enable physicians to create interventional catheter devices at the time of a procedure guided by the procedural needs.
{"title":"Modular Catheter Systems in Minimally Invasive Interventional Medical Procedures: Case Study","authors":"B. Beach, B. Scansen","doi":"10.2196/14443","DOIUrl":"https://doi.org/10.2196/14443","url":null,"abstract":"\u0000 \u0000 Medical device catheters that are used in minimally invasive interventional medical procedures all follow the same integrated design and use paradigm. The features and elements of any catheter device are combined in a single unitary construction. A modular approach to the design, construction, and use of these types of interventional catheters may provide significant advantages and benefits not available with an integrated design paradigm.\u0000 \u0000 \u0000 \u0000 This paper aimed to present the design of a modular catheter system and the findings from an initial veterinary use as a case study for the potential of modular catheter systems in general.\u0000 \u0000 \u0000 \u0000 A modular catheter system was designed using commercially available angioplasty balloon dilatation catheters as one module in the system and a custom designed scoring adapter as the other module. The scoring adapter incorporates wires to add scoring features to the angioplasty balloon catheter to improve the dilatation performance during a pulmonary valvuloplasty procedure. The scoring adapter also includes a novel attachment mechanism to couple the scoring adapter to any 0.035-inch guidewire–compatible angioplasty balloon catheter.\u0000 \u0000 \u0000 \u0000 The modular catheter system was successfully designed, manufactured, and used in an initial minimally invasive veterinary cardiovascular intervention to treat a case of canine subvalvular pulmonary stenosis. The scoring adapter and angioplasty balloon catheter were successfully combined tableside in the operating room at the time of the procedure and used to successfully dilate the subvalvular obstruction.\u0000 \u0000 \u0000 \u0000 The successful design and use of the presented modular catheter system demonstrates the feasibility and potential advantages of this type of paradigm to enable physicians to create interventional catheter devices at the time of a procedure guided by the procedural needs.\u0000","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49511710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Kumar, S. Ks, Vyoma Venkatesh Grandhi, Vrinda Gupta
Background: A variety of claims are made regarding the effects of surface topography on implant osseointegration. The development of implant surfaces topography has been empirical, requiring numerous in vitro and in vivo tests. Most of these tests were not standardized, using different surfaces, cell populations, or animal models. The exact role of surface chemistry and topography on the early events of the osseointegration of dental implants remains poorly understood. Objective: The aim of this study was to consider the major claims made concerning the effects of titanium implant surface topography on osseointegration. The osseointegration rate of titanium dental implants is related to their composition and surface roughness. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants were reviewed. Important findings of consensus were highlighted, and existing controversies were revealed. Methods: This paper considered many of the research publications listed in Medical Literature Analysis and Retrieval System Online and presented in biomedical research publications and textbooks. Surface treatments, such as titanium plasma spraying, grit blasting, acid etching, alkaline etching, anodization, polymer demixing, sol-gel conversion, and their corresponding surface morphologies and properties were described. Results: Many in vitro evaluations are not predictive of or correlated with in vivo outcomes. In some culture models, increased surface topography positively affects proosteogenic cellular activities. Many studies reveal increase in bone-to-implant contact (BIC), with increased surface topography modifications on implant surfaces. Conclusions: Increased implant surface topography improves the BIC and the mechanical properties of the enhanced interface. (JMIR Biomed Eng 2019;4(1):e13237) doi: 10.2196/13237
背景：关于表面形貌对种植体骨整合的影响，有各种各样的说法。植入物表面形貌的发展是经验的，需要大量的体外和体内测试。这些测试大多没有标准化，使用了不同的表面、细胞群或动物模型。表面化学和形貌在牙种植体骨整合早期事件中的确切作用尚不清楚。目的：本研究的目的是考虑关于钛种植体表面形貌对骨整合影响的主要主张。钛种植体的骨整合率与其成分和表面粗糙度有关。综述了提高钛种植体表面粗糙度或应用骨传导涂层的不同方法。会议强调了协商一致的重要发现，并揭示了现有的争议。方法：本文参考了医学文献分析与检索系统在线收录的许多研究出版物以及生物医学研究出版物和教科书中的研究出版物。介绍了钛等离子体喷涂、喷砂、酸蚀、碱蚀、阳极氧化、聚合物分层、溶胶-凝胶转化等表面处理方法及其相应的表面形貌和性能。结果：许多体外评估不能预测体内结果或与体内结果相关。在一些培养模型中，表面形貌的增加对成骨细胞活性有积极影响。许多研究表明，随着植入物表面表面形貌修饰的增加，骨与植入物的接触（BIC）增加。结论：植入物表面形貌的增加改善了BIC和增强界面的机械性能。（JMIR Biomed Eng 2019；4（1）：e13237）doi:10.196/13237
{"title":"The Effects of Titanium Implant Surface Topography on Osseointegration: Literature Review","authors":"P. Kumar, S. Ks, Vyoma Venkatesh Grandhi, Vrinda Gupta","doi":"10.2196/13237","DOIUrl":"https://doi.org/10.2196/13237","url":null,"abstract":"Background: A variety of claims are made regarding the effects of surface topography on implant osseointegration. The development of implant surfaces topography has been empirical, requiring numerous in vitro and in vivo tests. Most of these tests were not standardized, using different surfaces, cell populations, or animal models. The exact role of surface chemistry and topography on the early events of the osseointegration of dental implants remains poorly understood. Objective: The aim of this study was to consider the major claims made concerning the effects of titanium implant surface topography on osseointegration. The osseointegration rate of titanium dental implants is related to their composition and surface roughness. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants were reviewed. Important findings of consensus were highlighted, and existing controversies were revealed. Methods: This paper considered many of the research publications listed in Medical Literature Analysis and Retrieval System Online and presented in biomedical research publications and textbooks. Surface treatments, such as titanium plasma spraying, grit blasting, acid etching, alkaline etching, anodization, polymer demixing, sol-gel conversion, and their corresponding surface morphologies and properties were described. Results: Many in vitro evaluations are not predictive of or correlated with in vivo outcomes. In some culture models, increased surface topography positively affects proosteogenic cellular activities. Many studies reveal increase in bone-to-implant contact (BIC), with increased surface topography modifications on implant surfaces. Conclusions: Increased implant surface topography improves the BIC and the mechanical properties of the enhanced interface. (JMIR Biomed Eng 2019;4(1):e13237) doi: 10.2196/13237","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47897539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Passive joint stiffness can influence the risk of injury and the ability to participate in sports and activities of daily living. However, little is known about how passive joint stiffness changes over time with intensive repetitive exercise, particularly when performing unilateral activities using the dominant upper limb. Objective: This study aimed to investigate the difference in passive wrist quasi-stiffness between the dominant and nondominant upper limb of competitive squash players, compare these results with a previous study on young unskilled subjects, and explore the impact of aging on wrist stiffness. Methods: A total of 7 healthy, right-side dominant male competitive squash players were recruited and examined using the Massachusetts Institute of Technology Wrist-Robot. Subjects were aged between 24 and 72 years (mean 43.7, SD 16.57) and had a mean of 20.6 years of squash playing experience (range 10-53 years, SD 13.85). Torque and displacement data were processed and applied to 2 different estimation methods, the fitting ellipse and the multiple regression method, to obtain wrist stiffness magnitude and orientation. Results: Young squash players (mean 30.75, SD 8.06 years) demonstrated a stiffer dominant wrist, with an average ratio of 1.51, compared with an average ratio of 1.18 in young unskilled subjects. The older squash players (mean 64.67, SD 6.35 years) revealed an average ratio of 0.86 (ie, the nondominant wrist was stiffer than the dominant wrist). There was a statistically significant difference between the magnitude of passive quasi-stiffness between the dominant and nondominant wrist of the young and older squash player groups (P=.004). Conclusions: Findings from this pilot study are novel and contribute to our understanding of the likely long-term effect of highly intensive, unilateral sports on wrist quasi-stiffness and the aging process: adults who participate in repetitive sporting exercise may experience greater joint quasi-stiffness when they are younger than 45 years and more flexibility when they are older than 60 years.
{"title":"The Impact of Aging and Hand Dominance on the Passive Wrist Stiffness of Squash Players: Pilot Study","authors":"Taya Hamilton, S. Durand, H. Krebs","doi":"10.2196/11670","DOIUrl":"https://doi.org/10.2196/11670","url":null,"abstract":"Background: Passive joint stiffness can influence the risk of injury and the ability to participate in sports and activities of daily living. However, little is known about how passive joint stiffness changes over time with intensive repetitive exercise, particularly when performing unilateral activities using the dominant upper limb. Objective: This study aimed to investigate the difference in passive wrist quasi-stiffness between the dominant and nondominant upper limb of competitive squash players, compare these results with a previous study on young unskilled subjects, and explore the impact of aging on wrist stiffness. Methods: A total of 7 healthy, right-side dominant male competitive squash players were recruited and examined using the Massachusetts Institute of Technology Wrist-Robot. Subjects were aged between 24 and 72 years (mean 43.7, SD 16.57) and had a mean of 20.6 years of squash playing experience (range 10-53 years, SD 13.85). Torque and displacement data were processed and applied to 2 different estimation methods, the fitting ellipse and the multiple regression method, to obtain wrist stiffness magnitude and orientation. Results: Young squash players (mean 30.75, SD 8.06 years) demonstrated a stiffer dominant wrist, with an average ratio of 1.51, compared with an average ratio of 1.18 in young unskilled subjects. The older squash players (mean 64.67, SD 6.35 years) revealed an average ratio of 0.86 (ie, the nondominant wrist was stiffer than the dominant wrist). There was a statistically significant difference between the magnitude of passive quasi-stiffness between the dominant and nondominant wrist of the young and older squash player groups (P=.004). Conclusions: Findings from this pilot study are novel and contribute to our understanding of the likely long-term effect of highly intensive, unilateral sports on wrist quasi-stiffness and the aging process: adults who participate in repetitive sporting exercise may experience greater joint quasi-stiffness when they are younger than 45 years and more flexibility when they are older than 60 years.","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47131450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Àngels Salvador Vergés, L. Fernández-Luque, Meltem Yıldırım, Bertran Salvador-Mata, Francesc García Cuyàs
Background: Over the past 60 years, no technique used for treating cartilage disorders has been completely successful. Bioprinting provides a highly anticipated, novel alternative solution to this problem. However, identifying barriers to this new technology is crucial in order to overcome them when bioprinting reaches the implementation stage. This kind of research has been declared essential because clinical efficacy and safety studies alone do not always lead to successful implementation. Objective: This qualitative study aimed to explore the stance of orthopedic surgeons on the use of bioprinted cartilage grafts for cartilaginous lesions. The study sought to summarize and classify the barriers and facilitators of this technique and to identify the key factors for successful implementation of bioprinted cartilage in routine clinical practice. Methods: A qualitative thematic analysis method was used to evaluate data obtained from semistructured interviews and from focus groups. Data were collected between June 2017 and February 2018. Interviews focused on the collection of expert opinions on bioprinted cartilage. Results: The perceived barriers to the adoption of this technology were (1) awareness of a lack of information on the status and possibilities of this technology, (2) uncertainty regarding compliance with current health care regulations and policies, and (3) demands for clinical evidence. The facilitators were (1) lack of surgical alternatives, (2) the perception that research is the basis of the current health system, and (3) the hope of offering a better quality of life to patients. Conclusions: The results of this study are preliminary in nature and cannot be generalized without a broader group of participants. However, the key factors identified provide a frame of reference to help understand the challenges of bioprinted cartilage and help facilitate the transition toward its clinical use. These findings will also provide information for use at multidisciplinary meetings in scientific societies; create bridges between researchers, orthopedic surgeons, and regulators; and open a debate on the funding of this technique and the business model that needs to be developed. (JMIR Biomed Eng 2019;4(1):e12148) doi: 10.2196/12148
{"title":"Perspectives of Orthopedic Surgeons on the Clinical Use of Bioprinted Cartilage: Qualitative Study","authors":"Àngels Salvador Vergés, L. Fernández-Luque, Meltem Yıldırım, Bertran Salvador-Mata, Francesc García Cuyàs","doi":"10.2196/12148","DOIUrl":"https://doi.org/10.2196/12148","url":null,"abstract":"Background: Over the past 60 years, no technique used for treating cartilage disorders has been completely successful. Bioprinting provides a highly anticipated, novel alternative solution to this problem. However, identifying barriers to this new technology is crucial in order to overcome them when bioprinting reaches the implementation stage. This kind of research has been declared essential because clinical efficacy and safety studies alone do not always lead to successful implementation. Objective: This qualitative study aimed to explore the stance of orthopedic surgeons on the use of bioprinted cartilage grafts for cartilaginous lesions. The study sought to summarize and classify the barriers and facilitators of this technique and to identify the key factors for successful implementation of bioprinted cartilage in routine clinical practice. Methods: A qualitative thematic analysis method was used to evaluate data obtained from semistructured interviews and from focus groups. Data were collected between June 2017 and February 2018. Interviews focused on the collection of expert opinions on bioprinted cartilage. Results: The perceived barriers to the adoption of this technology were (1) awareness of a lack of information on the status and possibilities of this technology, (2) uncertainty regarding compliance with current health care regulations and policies, and (3) demands for clinical evidence. The facilitators were (1) lack of surgical alternatives, (2) the perception that research is the basis of the current health system, and (3) the hope of offering a better quality of life to patients. Conclusions: The results of this study are preliminary in nature and cannot be generalized without a broader group of participants. However, the key factors identified provide a frame of reference to help understand the challenges of bioprinted cartilage and help facilitate the transition toward its clinical use. These findings will also provide information for use at multidisciplinary meetings in scientific societies; create bridges between researchers, orthopedic surgeons, and regulators; and open a debate on the funding of this technique and the business model that needs to be developed. (JMIR Biomed Eng 2019;4(1):e12148) doi: 10.2196/12148","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44268382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: One of the problems in evaluating clinical practice guidelines (CPGs) is the occurrence of knowledge gaps. These gaps may occur when evaluation logics and definitions in analytics pipelines are translated differently. Objective: The objective of this paper is to develop a systematic method that will fill in the cognitive and computational gaps of CPG knowledge components in analytics pipelines. Methods: We used locally developed CPGs that resulted in care process models (CPMs). We derived adherence definitions from the CPMs, transformed them into computationally executable queries, and deployed them into an enterprise knowledge base that specializes in managing clinical knowledge content. We developed a visual analytics framework, whose data pipelines are connected to queries in the knowledge base, to automate the extraction of data from clinical databases and calculation of evaluation metrics. Results: In this pilot study, we implemented 21 CPMs within the proposed framework, which is connected to an enterprise data warehouse (EDW) as a data source. We built a Web–based dashboard for monitoring and evaluating adherence to the CPMs. The dashboard ran for 18 months during which CPM adherence definitions were updated a number of times. Conclusions: The proposed framework was demonstrated to accommodate complicated knowledge management for CPM adherence evaluation in analytics pipelines using a knowledge base. At the same time, knowledge consistency and computational efficiency were maintained. (JMIR Biomed Eng 2019;4(1):e11659) doi: 10.2196/11659
背景：评估临床实践指南（CPG）的问题之一是知识差距的出现。当分析管道中的评估逻辑和定义被不同地翻译时，可能会出现这些差距。目的：本文的目的是开发一种系统的方法，填补分析管道中CPG知识组件的认知和计算空白。方法：我们使用本地开发的CPG，产生护理过程模型（CPM）。我们从CPM中推导出依从性定义，将其转换为可计算执行的查询，并将其部署到专门管理临床知识内容的企业知识库中。我们开发了一个可视化分析框架，其数据管道连接到知识库中的查询，以自动从临床数据库中提取数据和计算评估指标。结果：在这项试点研究中，我们在所提出的框架内实现了21个CPM，该框架连接到作为数据源的企业数据仓库（EDW）。我们建立了一个基于Web的仪表板，用于监测和评估CPM的遵守情况。该仪表盘运行了18个月，在此期间CPM遵守定义被多次更新。结论：所提出的框架已被证明可以在使用知识库的分析管道中适应CPM依从性评估的复杂知识管理。同时，保持了知识的一致性和计算效率。（JMIR Biomed Eng 2019；4（1）：e11659）doi:10.196/1659
{"title":"An Analytics Framework for Physician Adherence to Clinical Practice Guidelines: Knowledge-Based Approach","authors":"Jaehoon Lee, N. Hulse","doi":"10.2196/11659","DOIUrl":"https://doi.org/10.2196/11659","url":null,"abstract":"Background: One of the problems in evaluating clinical practice guidelines (CPGs) is the occurrence of knowledge gaps. These gaps may occur when evaluation logics and definitions in analytics pipelines are translated differently. Objective: The objective of this paper is to develop a systematic method that will fill in the cognitive and computational gaps of CPG knowledge components in analytics pipelines. Methods: We used locally developed CPGs that resulted in care process models (CPMs). We derived adherence definitions from the CPMs, transformed them into computationally executable queries, and deployed them into an enterprise knowledge base that specializes in managing clinical knowledge content. We developed a visual analytics framework, whose data pipelines are connected to queries in the knowledge base, to automate the extraction of data from clinical databases and calculation of evaluation metrics. Results: In this pilot study, we implemented 21 CPMs within the proposed framework, which is connected to an enterprise data warehouse (EDW) as a data source. We built a Web–based dashboard for monitoring and evaluating adherence to the CPMs. The dashboard ran for 18 months during which CPM adherence definitions were updated a number of times. Conclusions: The proposed framework was demonstrated to accommodate complicated knowledge management for CPM adherence evaluation in analytics pipelines using a knowledge base. At the same time, knowledge consistency and computational efficiency were maintained. (JMIR Biomed Eng 2019;4(1):e11659) doi: 10.2196/11659","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45570348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Heart rate variability (HRV) is derived from the series of R-R intervals extracted from an electrocardiographic (ECG) measurement. Ideally all components of the R-R series are the result of sinoatrial node depolarization. However, the actual R-R series are contaminated by outliers due to heart rhythm disturbances such as ectopic beats, which ought to be detected and corrected appropriately before HRV analysis. Objective: We have introduced a novel, lightweight, and near real-time method to detect and correct anomalies in the R-R series based on the singular spectrum analysis (SSA). This study aimed to assess the performance of the proposed method in terms of (1) detection performance (sensitivity, specificity, and accuracy); (2) root mean square error (RMSE) between the actual N-N series and the approximated outlier-cleaned R-R series; and (3) how it benchmarks against a competitor in terms of the relative RMSE. Methods: A lightweight SSA-based change-point detection procedure, improved through the use of a cumulative sum control chart with adaptive thresholds to reduce detection delays, monitored the series of R-R intervals in real time. Upon detection of an anomaly, the corrupted segment was substituted with the respective outlier-cleaned approximation obtained using recurrent SSA forecasting. Next, N-N intervals from a 5-minute ECG segment were extracted from each of the 18 records in the MIT-BIH Normal Sinus Rhythm Database. Then, for each such series, a number (randomly drawn integer between 1 and 6) of simulated ectopic beats were inserted at random positions within the series and results were averaged over 1000 Monte Carlo runs. Accordingly, 18,000 R-R records corresponding to 5-minute ECG segments were used to assess the detection performance whereas another 180,000 (10,000 for each record) were used to assess the error introduced in the correction step. Overall 198,000 R-R series were used in this study. Results: The proposed SSA-based algorithm reliably detected outliers in the R-R series and achieved an overall sensitivity of 96.6%, specificity of 98.4% and accuracy of 98.4%. Furthermore, it compared favorably in terms of discrepancies of the cleaned R-R series compared with the actual N-N series, outperforming an established correction method on average by almost 30%. Conclusions: The proposed algorithm, which leverages the power and versatility of the SSA to both automatically detect and correct artifacts in the R-R series, provides an effective and efficient complementary method and a potential alternative to the current manual-editing gold standard. Other important characteristics of the proposed method include the ability to operate in near real-time, the almost entirely model-free nature of the framework which does not require historical training data, and its overall low computational complexity. (JMIR Biomed Eng 2019;4(1):e10740) doi: 10.2196/10740 JMIR Biomed Eng 2019 | vol. 4 | iss. 1 | e10740 | p. 1 https://biome
背景:心率变异性(HRV)是从心电图(ECG)测量中提取的一系列R-R间隔中得出的。理想情况下，R-R系列的所有组成部分都是窦房结去极化的结果。然而，实际的R-R系列由于异位搏动等心律紊乱而受到异常值的污染，应在HRV分析之前检测并适当纠正。目的:我们介绍了一种基于奇异谱分析(SSA)的新颖、轻量级、接近实时的方法来检测和纠正R-R序列中的异常。本研究旨在从以下几个方面评估该方法的性能:(1)检测性能(灵敏度、特异性和准确性);(2)实际N-N序列与近似的剔除离群值的R-R序列之间的均方根误差(RMSE);(3)在相对均方根误差方面，它如何与竞争对手进行基准测试。方法:一个轻量级的基于ssa的变化点检测程序，通过使用具有自适应阈值的累积和控制图来改进以减少检测延迟，实时监测R-R区间的序列。一旦检测到异常，损坏的部分被替换为使用循环SSA预测获得的相应的异常值清洗近似。接下来，从MIT-BIH正常窦性心律数据库中的18条记录中提取5分钟心电图段的N-N个间隔。然后，对于每个这样的序列，在序列中的随机位置插入一个数字(随机抽取1到6之间的整数)模拟异位心跳，并在1000次蒙特卡罗运行中对结果进行平均。因此，使用与5分钟心电段相对应的18,000条R-R记录来评估检测性能，而使用另外180,000条(每条记录10,000条)来评估校正步骤中引入的误差。本研究共使用了198,000个R-R系列。结果:基于ssa的算法可靠地检测出R-R序列中的异常值，总体灵敏度为96.6%，特异性为98.4%，准确率为98.4%。此外，在清洗后的R-R序列与实际的N-N序列的差异方面，该方法比现有的校正方法平均高出近30%。结论:该算法利用SSA的功能和多功能性自动检测和纠正R-R系列中的伪影，提供了一种有效和高效的补充方法，并可能替代当前的手动编辑金标准。该方法的其他重要特征包括接近实时的操作能力、框架几乎完全无模型的特性(不需要历史训练数据)以及总体上较低的计算复杂度。[j] . JMIR Biomed Eng 2019;4(1):e10740) doi: 10.2196/107401 | e10740 | p. 1 https://biomedeng.jmir.org/2019/1/e10740/(页码不用于引用目的)Lang JMIR BIOMEDICAL ENGINEERING
{"title":"Automatic Near Real-Time Outlier Detection and Correction in Cardiac Interbeat Interval Series for Heart Rate Variability Analysis: Singular Spectrum Analysis-Based Approach","authors":"M. Lang","doi":"10.2196/10740","DOIUrl":"https://doi.org/10.2196/10740","url":null,"abstract":"Background: Heart rate variability (HRV) is derived from the series of R-R intervals extracted from an electrocardiographic (ECG) measurement. Ideally all components of the R-R series are the result of sinoatrial node depolarization. However, the actual R-R series are contaminated by outliers due to heart rhythm disturbances such as ectopic beats, which ought to be detected and corrected appropriately before HRV analysis. Objective: We have introduced a novel, lightweight, and near real-time method to detect and correct anomalies in the R-R series based on the singular spectrum analysis (SSA). This study aimed to assess the performance of the proposed method in terms of (1) detection performance (sensitivity, specificity, and accuracy); (2) root mean square error (RMSE) between the actual N-N series and the approximated outlier-cleaned R-R series; and (3) how it benchmarks against a competitor in terms of the relative RMSE. Methods: A lightweight SSA-based change-point detection procedure, improved through the use of a cumulative sum control chart with adaptive thresholds to reduce detection delays, monitored the series of R-R intervals in real time. Upon detection of an anomaly, the corrupted segment was substituted with the respective outlier-cleaned approximation obtained using recurrent SSA forecasting. Next, N-N intervals from a 5-minute ECG segment were extracted from each of the 18 records in the MIT-BIH Normal Sinus Rhythm Database. Then, for each such series, a number (randomly drawn integer between 1 and 6) of simulated ectopic beats were inserted at random positions within the series and results were averaged over 1000 Monte Carlo runs. Accordingly, 18,000 R-R records corresponding to 5-minute ECG segments were used to assess the detection performance whereas another 180,000 (10,000 for each record) were used to assess the error introduced in the correction step. Overall 198,000 R-R series were used in this study. Results: The proposed SSA-based algorithm reliably detected outliers in the R-R series and achieved an overall sensitivity of 96.6%, specificity of 98.4% and accuracy of 98.4%. Furthermore, it compared favorably in terms of discrepancies of the cleaned R-R series compared with the actual N-N series, outperforming an established correction method on average by almost 30%. Conclusions: The proposed algorithm, which leverages the power and versatility of the SSA to both automatically detect and correct artifacts in the R-R series, provides an effective and efficient complementary method and a potential alternative to the current manual-editing gold standard. Other important characteristics of the proposed method include the ability to operate in near real-time, the almost entirely model-free nature of the framework which does not require historical training data, and its overall low computational complexity. (JMIR Biomed Eng 2019;4(1):e10740) doi: 10.2196/10740 JMIR Biomed Eng 2019 | vol. 4 | iss. 1 | e10740 | p. 1 https://biome","PeriodicalId":87288,"journal":{"name":"JMIR biomedical engineering","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42007044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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