Sound frequency affects the auditory motion-onset response in humans.

The current study examines the modulation of the motion-onset response based on the frequency-range of sound stimuli. Delayed motion-onset and stationary stimuli were presented in a free-field by sequentially activating loudspeakers on an azimuthal plane keeping the natural percept of externalized sound presentation. The sounds were presented in low- or high-frequency ranges and had different motion direction within each hemifield. Difference waves were calculated by contrasting the moving and stationary sounds to isolate the motion-onset responses. Analyses carried out at the peak amplitudes and latencies on the difference waves showed that the early part of the motion response (cN1) was modulated by the frequency range of the sounds with stronger amplitudes elicited by stimuli with high frequency range. Subsequent post hoc analysis of the normalized amplitude of the motion response confirmed the previous finding by excluding the possibility that the frequency range had an overall effect on the waveform, and showing that this effect was instead limited to the motion response. These results support the idea of a modular organization of the motion-onset response with the processing of primary sound motion characteristics being reflected in the early part of the response. Also, the article highlights the importance of specificity in auditory stimulus design.

The application of surgical procedure manager (SPM): first experience with FESS.

In our hypothesis, the newly developed program SPM (surgical procedure manager) will ensure successful standardization and efficiency of the FESS (functional endoscopic sinus surgery) and therefore make a decisive contribution in terms of economization and improvement of intraoperative quality. Between 27th March 2015 and 8th October 2015, data from 259 FESS procedures were collected using the SPM. The study took place at the surgical desk, an operating room in the ACQUA clinic in Leipzig, Germany. 233 FESS (90%) of the total FESS (n = 259, 100%) were conducted entirely with SPM. 26 SPM terminations (10%) of 259 FESS remain, which are classified as actual SPM terminations-when the surgeon intentionally stops the SPM. The maximum time slot decreased clearly from 1 h 39 min (period A) to 1 h 10 min (period B). A time reduction can also be seen with the minimum duration of 13.5 min compared to 11 min. The variability of the time slot also decreases since the standard deviation is reduced by 4.5 min. On the basis of available recordings it can be postulated that the application of SPM is suitable for standardization for FESS. Standardization by means of SPM and minimal development can be recognized over a period of time. The SPM makes it possible to transfer the general advantages of mechanization on a concrete FESS and do not influence the medical processes nor even restrict the medical freedom. The users are still entirely free in the implementation of the respective procedure.

A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences.

BACKGROUND: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients' quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. OBJECTIVE: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. METHODS: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). RESULTS: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform's functionality and usability. CONCLUSIONS: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth.

A handheld flexible manipulator system for frontal sinus surgery.

PURPOSE: Draf drainage is the standard treatment procedure for frontal sinus diseases. In this procedure, rigid angled endoscopes and rigid curved instruments are used. However, laterally located pathologies in the frontal sinus cannot be reached with rigid instrumentation. In order to assist surgeons with such complicated cases, we propose a novel handheld flexible manipulator system. METHODS: A cross section of 3 mm × 4.6 mm enables transnasal guiding of a flexible endoscope with 1.4 mm diameter and a standard flexible surgical instrument with up to 1.8 mm diameter into the frontal sinus with increased reachability. The developed system consists of an electrical discharge-machined flexure hinge-based nitinol manipulator arm and a purely mechanical handheld control unit. The corresponding control unit enables upward and left-right bending of the manipulator arm, translation, rolling, actuation and also quick exchange of the surgical instrument. In order to verify the fulfillment of performance requirements, tests regarding reachability and payload capacity were conducted. RESULTS: Reachability tests showed that the manipulator arm can be inserted into the frontal sinus and reach its lateral regions following a Draf IIa procedure. The system can exert forces of at least 2 N in the vertical direction and 1 N in the lateral direction which is sufficient for manipulation of frontal sinus pathologies. CONCLUSION: Considering the fact that the anatomical requirements of the frontal sinus are not addressed satisfactorily in the development of prospective flexible instruments, the proposed system shows great potential in terms of therapeutic use owing to its small cross section and dexterity.

Anatomical Characterization of Frontal Sinus and Development of Representative Models.

This paper presents the methods and the materials towards characterizing frontal sinus anatomy and developing representative anatomical models which reflect the variance of the anatomy with three different sizes: small, medium and large. Anatomical characterization was performed using computer tomography data of up to 50 anonymous patients. Dimensional and volumetric measurements were conducted using the .stl files generated by segmentation and 3-D reconstruction. Three representative data sets were chosen to be realized in the form of models with frontal sinuses of small, medium and large sizes. The models include bone, mucosa and skin structures, whereas bone structures were manufactured by selective laser sintering of polyamide and the soft tissues by casting of gelatin and silicone. To ensure realistic optical and mechanical properties of the mucosa, verification tests were performed and the results were integrated into the manufacturing process.

An Improved Instrument Table for Use in Functional Endoscopic Sinus Surgery.

BACKGROUND: The clinical motivation for the current study was that various instrument tables are located far away from the patient's head, and the only way for the surgeon to access an instrument is via a scrub nurse. Thus, the idea for this study was the development and evaluation of an improved and conveniently positioned instrument table. MATERIAL AND METHODS: An improved instrument table (IT) was designed, built, and tested. We assessed its use in 150 surgeries from 1 October 2013 to 30 June 2014 (group A), and another 150 surgeries without use of the IT from 1 February 2013 to 31 October 2014 as a control group (group B). RESULTS: With use of the improved IT during functional endoscopic sinus surgery (FESS), preparation-time was extended by 0.1 min and the SLOT-time was reduced by 19.6%. The number of different instruments (35.3%) used was reduced, as well as the number of manual interactions with instruments (7.8%) and the number of manual interactions with the scrub nurse (66.1%). In addition, the ergonomics with use of the IT improved by 40.0%. The only potential disadvantage was a reduction of working space and thereby a constraint of the scope. Compared to the benefits, this problem is minor. CONCLUSIONS: Conclusively, the improved IT is of value for everyday use in surgery and offers a great benefit for FESS, and may be useful in other kinds of surgery (e.g., duraplasty).