A detachable electronic device for use with a long white cane to assist with mobility.

Vision-impaired individuals often use a long white cane to assist them with gathering information about their surroundings. However, these aids are generally not used to detect obstacles above knee height. The purpose of this study is to determine whether a low-cost, custom-built electronic device clipped onto a traditional cane can provide adequate vibratory warning to the user of obstacles above knee height. Sixteen normally sighted blindfolded individuals participated in two mobility courses which they navigated using a normal white cane and a white cane with the electronic device attached. Of the 16 participants, 10 hit fewer obstacles, and 12 covered less ground with the cane when the electronic device was attached. Ten participants found navigating with the electronic device easier than just the white cane alone. However, the time taken on the mobility courses, the number of collisions with obstacles, and the area covered by participants using the electronic device were not significantly different (p > 0.05). A larger sample size is required to determine if the trends found have real significance. It is anticipated that additional information provided by this electronic device about the surroundings would allow users to move more confidently within their environment.

Flow rate accuracy of ambulatory elastomeric and electronic infusion pumps when exposed to height and back pressures experienced during home infusion therapy.

Background: Elastomeric infusion pumps are widely used in the delivery of parenteral medications in the home, but real-life conditions may not match calibration or standardised testing conditions. This study investigated the impact of changes in infusion pump height and/or back pressure on infusion pump function. Methods: Volume delivered after one day, infusion duration, average and peak flow rates and time spent within stated accuracy were determined for four elastomeric and one electronic pump using gravimetric technique. Experiments were repeated after altering the height of the pump relative to the output (±40cm, ±20cm) and/or adding a back pressure (10-30mmHg) to the output of an attached catheter. Results: Under ideal operating conditions, the flow rate deviated from that specified by the manufacturer and between 88.5% and 99% of the total infusion volume was delivered. Varying the height or applying back pressure led to further changes in average flow rates and the volume of infusion solution delivered by the elastomeric pumps, but had little effect on the electronic pump. Conclusions: Clinicians should consider potential impact on drug delivery, safety and therapeutic effect for home infusion patients given variations in infusion pump performance observed in this study.

Automated Bone Screw Tightening to Adaptive Levels of Stripping Torque.

OBJECTIVE: To use relationships between tightening parameters, related to bone quality, to develop an automated system that determines and controls the level of screw tightening. METHODS: An algorithm relating current at head contact (IHC) to current at construct failure (Imax) was developed. The algorithm was used to trigger cessation of screw insertion at a predefined tightening level, in real time, between head contact and maximum current. The ability of the device to stop at the predefined level was assessed. RESULTS: The mean (±SD) current at which screw insertion ceased was calculated to be [51.47 ± 9.75% × (Imax - IHC)] + IHC, with no premature bone failures. CONCLUSIONS: A smart screwdriver was developed that uses the current from the motor driving the screw to predict the current at which the screw will strip the bone threads. The device was implemented and was able to achieve motor shut-off and cease tightening at a predefined threshold, with no premature bone failures.

"Turn-of-the-Nut" Method Is Not Appropriate for Use in Cancellous Bone.

OBJECTIVE: The level to which bone screws are tightened is determined subjectively by the operating surgeon. It is likely that the tactile feedback that surgeons rely on is based on localized tissue yielding, which may predispose the screw-bone interface to failure. A limited number of studies have investigated the ratio between clinical tightening torque and stripping torque. The purpose of this study was to measure, for the first time, the ratio between yield torque (T yield) and stripping torque (T max) during screw insertion into the cancellous bone and to compare these torques with clinical levels of tightening reported in the literature. Additionally, a rotational limit was investigated as a potential end point for screw insertion in cancellous bone. METHODS: A 6.5-mm outer diameter commercial cancellous bone screw was inserted into human femoral head specimens (n = 89). Screws were inserted to failure, while recording insertion torque, compression under the screw head, and rotation angle. RESULTS: The median, interquartile ranges, and coefficient of variation were calculated for each of the following parameters: T yield, T max, T yield/T max, slope, T plateau, and rotation angle. The median ratio of T yield/T max and rotation angle was 85.45% and 96.5 degrees, respectively. The coefficient of variation was greatest for the rotation angle compared with the ratio of T yield/T max (0.37 vs. 0.12). CONCLUSIONS: The detection of yield may be a more precise method than the rotation angle in cancellous bone; however, bone-screw constructs that exhibit a T yield close to T max may be more susceptible to stripping during insertion. Future work can identify factors that influence the ratio of T yield/T max may help to reduce the incidence of screw stripping.

Airflow resistance and CO2 rebreathing properties of anti-asphyxia pillows designed for epilepsy.

PURPOSE: Seizure related unconscious face-down positioning could contribute to sudden unexpected death in epilepsy via asphyxia. Low airflow resistance lattice foam pillows have been advocated for this group. However, data to support this approach remain lacking, and low airflow resistance per se may not negate asphyxia risk from expired gas rebreathing. This study was designed to compare the airflow resistance and CO2 rebreathing properties of lattice vs conventional pillows. METHODS: Airflow resistance and inspired CO2 levels during replicate 10 min periods of simulated adult ventilation and CO2 rebreathing were compared between cotton, latex and two lattice pillows designed for use in epilepsy (one commercially available, one prototype). Kaplan-Meier and Cox regression analyses were used to examine the hazard of exceeding 10% inspired CO2 within 10-min of rebreathing. RESULTS: Inspiratory resistance was significantly lower in the commercially available and prototype lattice compared to cotton and latex pillows (mean±SD; 3.2±0.8, 2.6±0.4, 26.1±3.5, 4.6±0.4 cm H2O l(-1)s respectively at 0.2l s(-1)). During simulated rebreathing, inspired CO2 exceeded 10% within 2 min with cotton and latex pillows, compared to an upper asymptote around 8-9% at 10 min with lattice pillows. The hazard of exceeding 10% inspired CO2 was therefore markedly reduced with lattice compared to cotton and latex pillows (hazard ratio vs cotton pillow; commercial 0.04 [0.01-0.18], prototype 0.08 [0.02-0.26], latex 0.79 [0.33-1.87]). CONCLUSION: Conventional pillows can rapidly accumulate potentially life-threatening CO2 levels during simulated rebreathing. Lattice pillows appear to reduce asphyxia risk but accumulated CO2 may still reach levels threatening to health and survival.

Predicting cancellous bone failure during screw insertion.

Internal fixation of fractures often requires the tightening of bone screws to stabilise fragments. Inadequate application of torque can leave the fracture unstable, while over-tightening results in the stripping of the thread and loss of fixation. The optimal amount of screw torque is specific to each application and in practice is difficult to attain due to the wide variability in bone properties including bone density. The aim of the research presented in this paper is to investigate the relationships between motor torque and screw compression during powered screw insertion, and to evaluate whether the torque during insertion can be used to predict the ultimate failure torque of the bone. A custom test rig was designed and built for bone screw experiments. By inserting cancellous bone screws into synthetic, ovine and human bone specimens, it was established that variations related to bone density could be automatically detected through the effects of the bone on the rotational characteristics of the screw. The torque measured during screw insertion was found to be directly related to bone density and can be used, on its own, as a good predictor of ultimate failure torque of the bone.