Violent Infant Surrogate Shaking: Continuous High-Magnitude Centripetal Force and Abrupt Shift in Tangential Acceleration May Explain High Risk of Subdural Hemorrhage.

Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. Typical intracranial injuries include subdural and retinal hemorrhages. Using a laboratory surrogate model we conducted experiments evaluating the head motion patterns that may occur in violent shaking. An anthropomorphic test device (ATD; Q0 dummy) matching an infant of 3.5 kg was assembled. The head interior was equipped with accelerometers enabling assessment of three-axial accelerations. Fifteen volunteers were asked to shake the surrogate vigorously holding a firm grip around the torso. We observed the volunteers performing manual shaking of the surrogate at a median duration of 15.5 sec (range 5-54 sec). Typical acceleration/deceleration patterns were produced after 2-3 shakes with a steady-state shaking motion at a pace of 4-6 cycles (back and forth) per second. Mean peak sagittal tangential accelerations at the vertex were 45.7g (range 14.2-105.1g). The acceleration component in the orthogonal direction, the radial acceleration, fluctuated around a negative mean of more than 4g showing that the surrogate head was continuously subjected to centripetal forces caused by rotations. This surrogate experiment showed that violent shaking may induce high peak tangential accelerations and concomitantly a continuous high-magnitude centripetal force. We hypothesize that the latter component may cause increased pressure in the subdural compartment in the cranial roof and may cause constant compression of the brain and possibly increased stretching or shearing of the bridging veins. This may contribute to the mechanism accountable for subdural hematoma in abusive head trauma.

Towards Human Motion Tracking Enhanced by Semi-Continuous Ultrasonic Time-of-Flight Measurements.

Human motion analysis is a valuable tool for assessing disease progression in persons with conditions such as multiple sclerosis or Parkinson's disease. Human motion tracking is also used extensively for sporting technique and performance analysis as well as for work life ergonomics evaluations. Wearable inertial sensors (e.g., accelerometers, gyroscopes and/or magnetometers) are frequently employed because they are easy to mount and can be used in real life, out-of-the-lab-settings, as opposed to video-based lab setups. These distributed sensors cannot, however, measure relative distances between sensors, and are also cumbersome when it comes to calibration and drift compensation. In this study, we tested an ultrasonic time-of-flight sensor for measuring relative limb-to-limb distance, and we developed a combined inertial sensor and ultrasonic time-of-flight wearable measurement system. The aim was to investigate if ultrasonic time-of-flight sensors can supplement inertial sensor-based motion tracking by providing relative distances between inertial sensor modules. We found that the ultrasonic time-of-flight measurements reflected expected walking motion patterns. The stride length estimates derived from ultrasonic time-of-flight measurements corresponded well with estimates from validated inertial sensors, indicating that the inclusion of ultrasonic time-of-flight measurements could be a feasible approach for improving inertial sensor-only systems. Our prototype was able to measure both inertial and time-of-flight measurements simultaneously and continuously, but more work is necessary to merge the complementary approaches to provide more accurate and more detailed human motion tracking.

Increased heart rate functions as a signal of acute distress in non-communicating persons with intellectual disability.

Intellectual disability (ID) affects approximately 1% of the population. Some patients with severe or profound ID are essentially non-communicating and therefore risk experiencing pain and distress without being able to notify their caregivers, which is a major health issue. This real-world proof of concept study aimed to see if heart rate (HR) monitoring could reveal whether non-communicating persons with ID experience acute pain or distress in their daily lives. We monitored HR in 14 non-communicating participants with ID in their daily environment to see if specific situations were associated with increased HR. We defined increased HR as being > 1 standard deviation above the daily mean and lasting > 5 s. In 11 out of 14 participants, increased HR indicated pain or distress in situations that were not previously suspected to be stressful, e.g. passive stretching of spastic limbs or being transported in patient lifts. Increased HR suggesting joy was detected in three participants (during car rides, movies). In some situations that were previously suspected to be stressful, absence of HR increase suggested absence of pain or distress. We conclude that HR monitoring may identify acute pain and distress in non-communicating persons with ID, allowing for improved health care for this patient group.

The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review.

BACKGROUND: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. OBJECTIVE: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. METHODS: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. RESULTS: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. CONCLUSIONS: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support.

Meeting End User Needs in Collaborative Medical Device Technology Development Research Projects: A Qualitative Case Study.

The aim of this case study has been to investigate to what extent user centered design (UCD) methodologies have been applied, how the process and outcomes were perceived by project team members, and what were potential barriers towards meeting end user needs. The case studied was the European Union Framework 7 integrated project d-LIVER (2011-2015), which aimed at developing an integrated care system for chronic liver disease patient management. d-LIVER is an example of a public funded, international, multidisciplinary, collaborative research project where development starts from a low technology readiness level, but where research is motivated by societal needs for better health care solutions. Awareness of central end user needs are therefore crucial. 14 project participants were interviewed. To meet societal and end user needs represent a prominent motivation factor for participants. The project organization with only clinical partners interacting with end users was accepted as a fact of life and not as a project pain point. A summary of observations and recommendations for good practice is given.

Portable qEEG and HD-tCS Device for Point-of-Injury Traumatic Brain Injury Diagnostics.

Mild Traumatic Brain Injury (mTBI) can cause prolonged or permanent injuries if left undetected and ignored. It is therefore of great interest to lower the threshold for diagnosis of individuals with mTBI injury. We report on the development of a prototype of a portable quantified EEG (qEEG) system intended for in-the-field mTBI diagnostics. The 32-electrode system is fully battery driven, is interfaced with a control unit being part of a telemedicine care system. Electrode montage is a central problem effectively challenging measurements outside clinical environments. The system concept is unique in the sense that it will allow an automated montage process employing a flexible, disposable, one-size-fits-all electrode cap. All electrodes are individually configurable so that they can be used for both wet and dry qEEG electrodes. All electrodes can also be individually configured to allow Trans-Cranial Current Stimulation (tCS) sessions in DC, AC or other current supply modalities. The system has been functionality tested in end-to-end configurations where all control and measurement signals are forwarded between the head device on one side and the user interface and telemedicine system on the other. Tests confirm that the device can acquire and forward EEG data from 32 channels in parallel at target sensitivities up to 1 kHZ sampling frequencies. Additional device clinical evaluation is planned.

A Novel Method for Continuous, Noninvasive, Cuff-Less Measurement of Blood Pressure: Evaluation in Patients With Nonalcoholic Fatty Liver Disease.

OBJECTIVE: One promising approach for a continuous, noninvasive, cuff-less ambulatory blood pressure (BP) monitor is to measure the pulse wave velocity or the inversely proportional pulse transit time (PTT), based on electrical and optical physiological measurements in the chest area. A device termed IsenseU-BP+ has been developed for measuring continuous BP, as well as other physiological data. The objective of this paper is to present results from the first clinical evaluation with a wide range of patients. The study was set up to verify whether IsenseU-BP+ can be used to measure raw signals with sufficient quality to derive PTT.  Methods: The test protocol, run 23 times on 18 different patients with nonalcoholic fatty liver disease, includes both supine measurement at rest as well as measurements during indoor cycling. Changes in PTT were compared with the BP changes measured using validated reference sensors.  Results: IsenseU-BP+ measured signals with good quality during rest on 17 of 18 patients despite the high diversity in age, body shape, and body mass index. Evaluation during cycling was difficult due to a lack of good reference measurements. CONCLUSION: IsenseU-BP+ measures PTT with high quality during supine rest and exercise and could therefore be suitable for deriving noninvasive continuous BP, although evaluation during exercise was limited due to inaccurate reference BP measurements. SIGNIFICANCE: Continuous, noninvasive measurement of BP would be highly beneficial in a number of clinical settings. Systems currently considered as the gold standard for the investigation of hypertension carry considerable limitations, which could be overcome by the method proposed here.

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.

Printed organic conductive polymers thermocouples in textile and smart clothing applications.

This work reports on an experimental investigation of the potential of using selected commercially available organic conductive polymers as active ingredients in thermocouples printed on textiles. Poly(3, 4-ethylenedioxythiophene): poly(4 styrenesulfonate) (PEDOT:PSS) and polyaniline (PANI) were screen printed onto woven cotton textile. The influence of multiple thermocycles between 235 K (-38 °C) and 350 K (+77 °C) on resistivity and thermoelectric properties was examined. The Seebeck coefficients of PEDOT:PSS and PANI were found to be about +18 µV/K and +15 uV/K, respectively, when "metal-polymer" thermocouples were realized by combining the polymer with copper. When "polymer-polymer" thermocouples were formed by combining PEDOT:PSS and PANI, a thermoelectric voltage of about +10 µV/K was observed. A challenge recognized in the experiments is that the generated voltage exhibited drift and fluctuations.