Talk to the Hand: U.S. Army Biophysical Testing.

BACKGROUND: Many people are unaware of the science underlying the biophysical properties of Soldier clothing and personal protective equipment, yet there is a well-refined biomedical methodology initiated by Army physiologists in World War II. This involves a methodical progression of systematic material testing technologies, computer modeling, and human testing that enables more efficient development and rapid evaluation of new concepts for Soldier health and performance. Sophisticated manikins that sweat and move are a central part of this testing continuum. This report briefly summarizes the evolution and use of one specialized form of the manikin technologies, the thermal hand model, and its use in research on Soldier hand-wear items that sustain dexterity and protect the hand in extreme environments. METHODS: Thermal manikin testing methodologies were developed to provide an efficient and consistent analytical tool for the rapid evaluation of new clothing concepts. These methods have been upgraded since the original World War II and Korean War eras to include articulation and sweating capabilities, as characterized and illustrated in this article. The earlier "retired" versions of thermal hand models have now been transferred to the National Museum of Health and Science. FINDINGS: The biophysical values from manikin testing are critical inputs to the U.S. Army Research Institute of Environmental Medicine mathematical models that provide predictions of soldier comfort, duration of exposure before loss of manual dexterity, and time to significant risk of freezing (skin temperature <-1°C) and nonfreezing cold injuries (skin temperature <5°C). The greater thickness of better insulated handwear reduces dexterity and also increases surface area which makes added insulation increasingly less effective in retaining heat. Measurements of both thermal resistance (insulation) and evaporative resistance (permeability) collectively characterize the biophysical properties and enable mathematical modeling of the human thermophysiological responses. This information can help guide the hand-wear development and selection process which often requires trade-offs between factors such as material, cost, and sizing. IMPACT: Soldier hands provide fine motor dexterity in tactical functions, ranging from pulling a trigger to pulling a parachute ripcord; thus, protecting hand function is critical to soldier readiness. Also, the importance of protection against nonbattle cold injuries was highlighted during World War II in northern Europe, in the Aleutian Islands, and later in Korea. The U.S. Army has been on the forefront of the biophysical analysis of clothing including gloves since environmental research was established at the Armored Medical Research Laboratory and Climatic Research Laboratory during World War II. U.S. Army Research Institute of Environmental Medicine does not make the equipment but works with their Natick Soldier Research, Development, and Engineering Center partners to make the equipment better.

New horizons in design for autonomous ageing.

The world is ageing rapidly. Between 2000 and 2050, the number of people aged ≥65 will double as a proportion of the global population, from 7% to 16%, respectively. By 2050, for the first time in human history, there will be more older people than children (aged 0­14 years) in the population. More distinctive is the tremendous increase in the oldest old aged ≥85. This challenges society to adapt, in order to maximise the health and functional capacity of older people as well as their social participation and security. Ageing is a multidimensional process of change in the physical, mental and social domain, leading to functional decline. Design thinking has embraced ageing as a topic where it can add to public health interventions. Applications of design and technology can contribute to 'autonomous ageing', for example, independent living and life style support, and can compensate for functional deficits associated with ageing. The focus is on supporting and reinforcing the reduced physical, mental, social and functional capacities of older people by applying groundbreaking, innovative design inclusive engineering methods, always starting with a human-centered integrated approach. Examples of design for geriatric giants include design for falls prevention, dementia care and integrated care. The establishment of collaborative networks between clinicians and designers, academia and industry is required to advance design for autonomous ageing.

[Path to the execution of explorative clinical researches in National Cerebral and Cardiovascular Center (NCVC)].

In the Ministry of Health, Labour and Welfare's (MHLW) "5-year plan for activating clinical trials", we have put in place the infrastructure including human resources for supporting not only commercial clinical trials but also those initiated by academic researchers, including clinical research coordinator (CRC) support and consultation for planning clinical trial with biostatistician. We also prepared a data management unit and trained data managers for academic clinical trials. In 2011, the National Cerebral and Cardiovascular Center (NCVC) was selected one of the sites of the MHLW project of structure improvement to execute early phase clinical trials. To clinically develop medical devices invented by the NCVC researchers involved in the project, animal experiments which meet the GLP standards must be finished before the first-in-human clinical trial. We are planning to create the units containing human resources for developing medical devices such as professionals in regulatory affairs, safety tests, and Good Laboratory Practice (GLP) systems. Creation of a smooth pathway from the preclinical to the clinical phases will be key to the efficient development of new medical devices.

Current trends in hardware and software for brain-computer interfaces (BCIs).

A brain-computer interface (BCI) provides a non-muscular communication channel to people with and without disabilities. BCI devices consist of hardware and software. BCI hardware records signals from the brain, either invasively or non-invasively, using a series of device components. BCI software then translates these signals into device output commands and provides feedback. One may categorize different types of BCI applications into the following four categories: basic research, clinical/translational research, consumer products, and emerging applications. These four categories use BCI hardware and software, but have different sets of requirements. For example, while basic research needs to explore a wide range of system configurations, and thus requires a wide range of hardware and software capabilities, applications in the other three categories may be designed for relatively narrow purposes and thus may only need a very limited subset of capabilities. This paper summarizes technical aspects for each of these four categories of BCI applications. The results indicate that BCI technology is in transition from isolated demonstrations to systematic research and commercial development. This process requires several multidisciplinary efforts, including the development of better integrated and more robust BCI hardware and software, the definition of standardized interfaces, and the development of certification, dissemination and reimbursement procedures.

Recent advances in charge balancing for functional electrical stimulation.

Charge balancing is a major concern in functional electrical stimulation, since any excess charge accumulation over time leads to electrolysis with electrode dissolution and tissue destruction. Its major function is to ensure that the mean value of electrode voltage is kept within a safe level. However, it serves as a failure protection as well. This paper presents an overview on recent advances in this field, both passive and active (closed-loop) charge balancing techniques.

[Artificial sight: recent developments]. / Künstliches Sehen: Stand der Entwicklung.

The implantation of electronic retina stimulators appears to be a future possibility to restore vision, at least partially in patients with retinal degeneration. The idea of such visual prostheses is not new but due to the general technical progress it has become more likely that a functioning implant will be on the market soon. Visual prosthesis may be integrated in the visual system in various places. Thus there are subretinal and epiretinal implants, as well as implants that are connected directly to the optic nerve or the visual cortex. The epiretinal approach is the most promising at the moment, but the problem of appropriate modulation of the image information is unsolved so far. This will be necessary to provide a interpretable visual information to the brain. The present article summarises the concepts and includes some latest information from recent conferences.

Diseño de una nueva herramienta para la exploración auditiva / Designing a new tool for hearing exploration

Introducción. Muchos pacientes presbiacúsicos presentan dificultad para entender ciertas palabras, hecho que podría estar justificado porque determinados sonidos en español presentan una dificultad mayor de perceptibilidad, en concreto los de energía en altas frecuencias. Se propone utilizar una oración como herramienta para comprobar la hipótesis de partida. Material y método. Se analizaron todos los sonidos del español, midiendo el grado de energía acústica que presenta cada una de las frecuencias. Las conclusiones extraídas de la comparación de sus resultados permitieron el diseño de la herramienta que aquí se propone. Resultados. Se establece una gradación de dificultad perceptiva, por lo que se puede decir que las oclusivas aparecen como los sonidos menos perceptibles, seguido de las fricativas y, finalmente, todos los segmentos que presentan armonicidad y una estructura formántica definida. Como herramienta para la práctica clínica, se propone la frase española «Ana vio ese coche rojizo fino», frase que cumple una serie de particularidades que la hacen especialmente útil para tal fin. Esta oración permitirá comprobar si la comprensión se va deteriorando a medida que se avanza desde la primera a la última de sus secciones, y así poder suponer que la capacidad para detectar auditivamente la presencia de energía reforzada en las altas frecuencias es indispensable para la inteligibilidad. Conclusiones. Un resultado positivo podría tener como consecuencia el diseño de sistemas de amplificación que mejoren la inteligibilidad de la palabra. Además, el hecho de tener una herramienta exploratoria podría permitir la exploración neuroacústica, de utilidad en el estudio de la enfermedad auditiva

Introduction. Many presbycusic patients have difficulty in understanding certain words. This could be justified because certain sounds in Spanish are more difficult to perceive, particularly the sounds with energy in the high frequencies. We propose to use a sentence as a tool to check this theory. Materials and method. All the Spanish sounds were analyzed, measuring the degree of acoustic energy in all the frequencies. The conclusions drawn from the comparison of the results allowed the design of the tool that is proposed here. Results. We established a gradient of perception difficulty, occlusive consonants being the least perceptible, followed by fricative, and finally all those segments with harmony and a clear formant structure. The Spanish sentence «Ana vio ese coche rojizo fino» is proposed as the tool for this study. This sentence has some as it comprises certain peculiarities that makes it particularly useful for this purpose. It will allow us to check whether understanding deteriorates as we move from beginning to end, helping evaluate the importance of high frequencies for intelligibility. Conclusions. A positive result could help in the design of amplification systems to improve speech intelligibility. In addition, the exploratory tool could allow neuro-acoustic exploration, useful in the central auditory pathology studies

Dental magnetic attachment: toward third generation devices.

Toward realizing the performance of functional and versatile dental magnetic attachments in the third generation required for individual prosthesis, it is important to control retentive characteristics of the attachments. For this purpose, three new types of magnetic attachment, i.e., split-pole type with a slant magnetization, modified split-pole type, and cylinder type, have been developed and evaluated in terms of the restoring force as well as the retentive force. The new attachments are designed to have high corrosion resistance, combining magnetic and nonmagnetic stainless steels and microlaser welding similar to the usual cup-yoke and sandwich-yoke types. It has been found that the two split-pole types have stronger restoring force and the cylinder type has weaker restoring force in comparison with the usual magnetic attachments. The attachments can be used properly and selectively according to individual requirement on abutment state and denture retention. As a result, the newly developed attachments may provide flexible retention performance useful for more effective and extensive applications of a magnetic attachment.

[Liposuction]. / Liposuktion.

Through the appropriate use of tumescent anesthesia and the use of modern instruments and techniques, liposuction surgery has become a low-risk procedure which produces predictable and aesthetically pleasing results. New indications for liposuction surgery include lipedema and cellulite. Vibration-assisted liposuction has proven to be especially gentle to the tissues. The induced tissue contraction helps to create better results in correction procedures after less-than-satisfactory liposuction. Autologous fat transfer is also firmly established as an augmentation procedure. In liporecycling, the fat obtained during reduction liposuction is used elsewhere for augmentation. New approaches in fat transfer include the microdroplet technique, flatter injection approaches and three-dimensional tissue augmentation.

Historical perspectives on interventional electrophysiology.

The history of interventional electrophysiology is long and fascinating. In the beginning, there is not simply the anatomy and physiology of the heart, but also analysis of the pulse, which indicates the activity of the heart. The analysis of the (peripheral) pulse as a mechanical expression of heart activity goes back several millennia. In China, in 280 B.C., Wang Chu Ho wrote ten books about the pulse. The Greeks called the pulse "sphygmos", and the sphygmology thus deals with a theory of this natural occurrence. In Roman times, Galen interpreted the various types of pulse according to the widespread presumption of the time, that each organ in every disease has its own form of pulse. The basic tool for arrhythmia diagnosis became the electrocardiography introduced by Willem Einthoven who obtained the first human electrogram 1902 in Leiden, The Netherlands. The growing clinical importance of electrical cardiac stimulation has been recognized and renewed as Zoll (1911-1999) in 1952 reported a successful resuscitation in cardiac standstill by external stimulation. Meanwhile all over the world, millions of patients with cardiac arrhythmias have been treated with pacemakers in the last 45 years. The concept of a fully automatic implantable cardioverter-defibrillator system (ICD) for recognition and treatment of ventricular tachyarrhythmias was first suggested in 1970. The first implantation of the device in a human being was performed in February 1980. Further developments concern atrial and atrioventricular defibrillators, radiofrequency ablation, laser therapy and advanced antiarrhythmic surgery, new antiarrhythmic drugs and sophisticated devices for preventive pacing. The advances in the field of diagnostic and therapeutic application of pharmacologic and electrical tools as well as alternative methods will continue as rapidly as before in order to give us further significant aid in taking care of the patient.

Historical perspective milestones in the evolution of lumbar spinal postural health in seating.

The best knowledge on seated posture before the Enlightenment was not scientific, but influenced by sociocultural, economic, and manufacturing factors. Although the pursuit of knowledge related to spinal postural health was advanced with the advent of empirico-analytic research, academic opinion continued to be influenced by unsubstantiated information, often resulting in incorrect advice to the public. Only in the past decade has advice on "correct" seated posture, spanning the time from the Hippocratic texts to the present, been brought into question by evidence-based research. By exploring seating from 3100 B.C to the present, this article discusses key influences that have an impact on seating functional to spinal postural health. Emphasis is placed on the role of medical opinion.

[Digital radiography: from storage phosphor plates to direct detector systems]. / Digitale Radiographie: Von der Speicherfolie zum Direktdetektor.

All three currently commercially available systems for digital radiography of the chest such as the selenium drum, storage phosphor plates and the flat panel direct detector systems provide an excellent image quality that is at least equivalent or superior to that of conventional film. Reasons for that are the continuously improved detective or dose efficiency of the detector systems and an improved image processing. The new direct detector systems have the largest potential for dose reduction while storage phosphor and selenium radiographs are usually obtained with a dose comparable to that of a 400 speed system. Improved image processing algorithms allow for the production of digital images that are adapted to the conventional image characteristics within the lung regions combined with an increased transparency of the high absorption areas such as the retrocardial and retrodiaphragmatic regions.

Experimental and clinical standards, and evolution of lasers in neurosurgery.

From initial experiments of ruby, argon and CO2 lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters--wavelength, fluence and mode--and on the exposed tissues optical and thermal properties--water and haemoglobin content, thermal conductivity and specific heat. CO2 and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 microns and 1.32 microns Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopic tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage. The choice of a laser in a neurosurgical operating room implies an evaluation of the laser use (applications, frequency), of the available budget and costs--including purchase, maintenance and staff training--, and material that will be necessary: unit, peripherals, safety devices and measures, training programme. Future applications of lasers in neurosurgery will come from technological advances and refined experimental applications. The availability of new wavelength, tunable, small sized and "smart" laser units, will enlarge the thermal and non-thermal interactions between laser energy and neural tissue leading to new surgical applications. Tissue photo-ablation, photohynamic therapy using second generation of photosensitizers, updated thermotherapy protocols, are current trends for further use of lasers in neurosurgery.