Priorities when designing a service-focused delivery model for mobility devices: a systematic review.

PURPOSE: Throughout the world, mobility devices are usually distributed using product-based business models, where a device is provided to a user, and serviced or replaced when the user returns to the clinic with an issue. Moving to a service-based business model can provide continuous and customised support for the user, and provide the clinicians and manufacturers with better data to base their decisions on. This study reviews papers on assistive technology service-based business models and considerations in designing such a model to optimise economic and social value. It then applies the findings to the mobility device space. METHOD: A systematic literature search was undertaken in PubMed, Web of Science, and OVID databases to analyse studies that discuss service delivery models used to provide assistive products. Inductive thematic analysis determined the themes, facilitators and barriers associated with providing a service. Findings were applied to mobility device service provision. RESULTS AND CONCLUSION: Themes from the 29 relevant papers were grouped into four categories: Access (affordability/availability/education), Utility (customisability/usability/adaptability), Integrity (quality/sustainability/impact), and Compliance (policy/privacy/security). The most common themes were customisability, affordability, availability, and education. There is a need for service-based delivery models to replace conventional product-based models, and many considerations to optimise their design. No publications discussed the design and implementation of a service-based model for mobility device provision that uses modern sensors, software and other digital technologies to optimise the service. Service-based models that use modern digital technologies are new for the mobility device field, but much can be learnt from other fields.

Service-based business models that make use of modern digital technologies are likely to improve ongoing individual rehabilitation, but they are new for the mobility device field and currently lack research and evidence-based practice.The systematic review found that modern digital technologies like sensors, apps, and AI might be useful for providing ongoing support and more personalised rehabilitation for users of assistive products.To provide ongoing support for end-users, a successful design of service-based business model for assistive products should be accessible, both physically and financially, as well as easy to customise and adapt over time.

Drag-reducing riblets with fouling-release properties: development and testing.

The manufacture and preliminary testing of a drag-reducing riblet texture with fouling-control properties is presented. The commercial fouling-release product Intersleek® 1100SR was modified to manufacture riblet-textured coatings with an embossing technology. Hydrodynamic drag measurements in a Taylor-Couette set-up showed that the modified Intersleek® riblets reduced drag by up to 6% compared to a smooth surface. Barnacle settlement assays demonstrated that the riblets did not substantially reduce the ability of Intersleek® 1100SR to prevent fouling by cyprids of Balanus amphitrite. Diatom adhesion tests revealed significantly higher diatom attachment on the riblet surface compared to smooth Intersleek® 1100SR. However, after exposure to flow, the final cell density was similar to the smooth surface. Statically immersed panels in natural seawater showed an increase of biofilm cover due to the riblets. However, the release of semi-natural biofilms grown in a multi-species biofilm culturing reactor was largely unaffected by the presence of a riblet texture.

Relationships between in vivo dynamic knee joint loading, static alignment and tibial subchondral bone microarchitecture in end-stage knee osteoarthritis.

OBJECTIVE: To study, in end-stage knee osteoarthritis (OA) patients, relationships between indices of in vivo dynamic knee joint loads obtained pre-operatively using gait analysis, static knee alignment, and the subchondral trabecular bone (STB) microarchitecture of their excised tibial plateau quantified with 3D micro-CT. DESIGN: Twenty-five knee OA patients scheduled for total knee arthroplasty underwent pre-operative gait analysis. Mechanical axis deviation (MAD) was determined radiographically. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four subregions (anteromedial, posteromedial, anterolateral, posterolateral). Regional differences in STB microarchitecture and relationships between joint loading and microarchitecture were examined. RESULTS: STB microarchitecture differed among subregions (P < 0.001), anteromedially exhibiting highest bone volume fraction (BV/TV) and lowest structure model index (SMI). Anteromedial BV/TV and SMI correlated strongest with the peak external rotation moment (ERM; r = -0.74, r = 0.67, P < 0.01), despite ERM being the lowest (by factor of 10) of the moments considered, with majority of ERM measures below accuracy thresholds; medial-to-lateral BV/TV ratios correlated with ERM, MAD, knee adduction moment (KAM) and internal rotation moment (|r|-range: 0.54-0.74). When controlling for walking speed, KAM and MAD, the ERM explained additional 11-30% of the variations in anteromedial BV/TV and medial-to-lateral BV/TV ratio (R2 = 0.59, R2 = 0.69, P < 0.01). CONCLUSIONS: This preliminary study suggests significant associations between tibial plateau STB microarchitecture and knee joint loading indices in end-stage knee OA patients. Particularly, anteromedial BV/TV correlates strongest with ERM, whereas medial-to-lateral BV/TV ratio correlates strongest with indicators of medial-to-lateral joint loading (MAD, KAM) and rotational moments. However, associations with ERM should be interpreted with caution.

Joint loading and proximal tibia subchondral trabecular bone microarchitecture differ with walking gait patterns in end-stage knee osteoarthritis.

OBJECTIVES: To (1) stratify patient subgroups according to their distinct walking gait patterns in end-stage knee osteoarthritis (OA); (2) compare measures of joint loading and proximal tibia subchondral trabecular bone (STB) microarchitecture among these gait subgroups. DESIGN: Twenty-five knee OA patients undergoing total knee arthroplasty (TKA) had pre-operative gait analysis. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four tibial condylar regions of interest. Peak knee moments were input to k-means cluster analysis, to identify subgroups with homogeneous gait patterns. Joint loading and STB microarchitecture parameters were compared among gait subgroups (Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests). RESULTS: Three gait subgroups were revealed: biphasics (n = 7), flexors (n = 9), counter-rotators (n = 9). Peak knee adduction moment (KAM) and KAM impulse were significantly higher (P < 0.05) in biphasics than in flexors and counter-rotators (KAM = -0.65, -0.40 and -0.21 Nm/kg, respectively), suggesting a higher medial-to-lateral tibiofemoral load ratio in biphasics. Interestingly, STB medial-to-lateral bone volume fraction (BV/TV) ratio was also significantly higher (more than double) in biphasics and flexors than in counter-rotators (2.24, 2.00 and 1.00, respectively), whereas in biphasics it was only 10% higher than in flexors and not significantly so. CONCLUSIONS: Within the confines of the limited sample size, data suggests that different mechanisms between the biphasic and flexor gait subroups may generate comparable loads upon the tibial plateau and corresponding bony responses, despite significantly lower KAM indices in flexors. Hence, in flexor gait OA patients, conservative treatments designed to reduce KAM, may not be appropriate. Understanding joint loading among walking gait patterns and relationships to bone microarchitecture may aid at identifying/improving management of persons at risk for developing knee OA.

Time-elapsed screw insertion with microCT imaging.

Time-elapsed analysis of bone is an innovative technique that uses sequential image data to analyze bone mechanics under a given loading regime. This paper presents the development of a novel device capable of performing step-wise screw insertion into excised bone specimens, within the microCT environment, whilst simultaneously recording insertion torque, compression under the screw head and rotation angle. The system is computer controlled and screw insertion is performed in incremental steps of insertion torque. A series of screw insertion tests to failure were performed (n=21) to establish a relationship between the torque at head contact and stripping torque (R(2)=0.89). The test-device was then used to perform step-wise screw insertion, stopping at intervals of 20%, 40%, 60% and 80% between screw head contact and screw stripping. Image data-sets were acquired at each of these time-points as well as at head contact and post-failure. Examination of the image data revealed the trabecular deformation as a result of increased insertion torque was restricted to within 1mm of the outer diameter of the screw thread. Minimal deformation occurred prior to the step between the 80% time-point and post-failure. The device presented has allowed, for the first time, visualization of the micro-mechanical response in the peri-implant bone with increased tightening torque. Further testing on more samples is expected to increase our understanding of the effects of increased tightening torque at the micro-structural level, and the failure mechanisms of trabeculae.

A virtual-reality subtotal tonsillectomy simulator.

OBJECTIVES: To develop a virtual-reality subtotal tonsillectomy simulation for surgical training. MATERIALS AND METHODS: Computer models of a male patient's head and throat, and the surgical instrument, were created. These models were combined with custom-built simulation software. Recently developed tissue simulation technology that exploits recent developments in programmable graphics processing units was used to model tonsillar tissue in a way that allows surgical interaction whilst providing accurate tactile feedback. Current real-time rendering techniques were used to provide realistic visuals. Iterative refinements were made to the simulation, and in particular the tissue simulation, in consultation with relevantly experienced surgeons. RESULTS: We have used newly developed tissue simulation technology to developed a novel virtual-reality subtotal tonsillectomy simulation for surgical training, the first of its kind. CONCLUSION: Early feedback suggests that this simulator can help surgeons to rapidly acquire subtotal tonsillectomy surgical skills in a risk-free and realistic virtual environment.

Vessel calibre and haemoglobin effects on pulse oximetry.

Despite its success as a clinical monitoring tool, pulse oximetry may be improved with respect to the need for empirical calibration and the reports of biases in readings associated with peripheral vasoconstriction and haemoglobin concentration. To effect this improvement, this work aims to improve the understanding of the photoplethysmography signal-as used by pulse oximeters-and investigates the effect of vessel calibre and haemoglobin concentration on pulse oximetry. The digital temperature and the transmission of a wide spectrum of light through the fingers of 57 people with known haemoglobin concentrations were measured and simulations of the transmission of that spectrum of light through finger models were performed. Ratios of pulsatile attenuations of light as used in pulse oximetry were dependent upon peripheral temperature and on blood haemoglobin concentration. In addition, both the simulation and in vivo results showed that the pulsatile attenuation of light through fingers was approximately proportional to the absorption coefficients of blood, only when the absorption coefficients were small. These findings were explained in terms of discrete blood vessels acting as barriers to light transmission through tissue. Due to the influence of discrete blood vessels on light transmission, pulse oximeter outputs tend to be dependent upon haemoglobin concentration and on the calibre of pulsing blood vessels-which are affected by vasoconstriction/vasodilation. The effects of discrete blood vessels may account for part of the difference between the Beer-Lambert pulse oximetry model and empirical calibration.

A literature review of different pressure ulcer models from 1942-2005 and the development of an ideal animal model.

The literature from 1942-2005 was reviewed in order to determine an inexpensive animal model which can closely mimic pressure ulcers seen in humans of varying ages, without the need for surgical procedures. Two animal models for producing pressure ulcers were found to be inexpensive: pigs to mimic pressure ulcers in young humans due to their fixed skin, and rats to mimic pressure ulcers in the elderly due to their loose skin. The methods which were found to be inexpensive, reproducible, non-invasive and easy to carry out without the need of a surgeon or specialist were the use of magnets for rat models and the use of a cast placed over a bony prominence for pig models.

A virtual reality throat examination simulation.

Computer based patient simulators can provide an alternative to inanimate clinical skills training. Here we present a virtual reality throat examination simulation capable of simulating a range of throat pathologies. The computer interface employs haptic feedback to allow students to interact naturally with the software.

A virtual reality 3D jigsaw for teaching anatomy.

Virtual Reality has some advantages over traditional teaching and learning media. Here we describe a VR Jigsaw which uses a novel interface to facilitate learning the anatomy of the skull. A small trial was performed which indicates that the software succeeds at engaging students and suggests that their comprehension of complex 3D structures was improved.

SimTools: a new paradigm in high fidelity simulation.

We demonstrate a prototype set of clinical devices that deliver simulated information to the clinician when used with standardized patients or simple manikins.

Virtual patient monitors for new user familiarization.

We demonstrate web-based ECG monitor simulators that enable students to gain and demonstrate competence with equipment specific to a particular workplace.

Customization of a generic 3D model of the distal femur using diagnostic radiographs.

A method for the customization of a generic 3D model of the distal femur is presented. The customization method involves two steps: acquisition of calibrated orthogonal planar radiographs; and linear scaling of the generic model based on the width of a subject's femoral condyles as measured on the planar radiographs. Planar radiographs of seven intact lower cadaver limbs were obtained. The customized generic models were validated by comparing their surface geometry with that of CT-reconstructed reference models. The overall mean error was 1.2 mm. The results demonstrate that uniform scaling as a first step in the customization process produced a base model of accuracy comparable to other models reported in the literature.

The comparison of different feed forward neural network architectures for ECG signal diagnosis.

The electrocardiograms (ECGs) record the electrical activity of the heart and are used to diagnose many heart disorders. This paper proposes a two-stage feed forward neural network for ECG signal classification. The research is aimed at the design of an intelligent ECG diagnosis tool that can recognise heart abnormalities while reducing the complexity, cost, and response time of the system. A number of neural network architectures are designed and compared for their ability to classify six different heart conditions. Two network architectures based on one stage and two stage feed forward neural networks are chosen for this investigation. The training and testing ECG signals are obtained from MIT-BIH database. The network inputs are comprised of 12 ECG features and 13 compressed components of each heart beat signal. The performance of the different modules as well as the efficiency of the whole system is presented. Among different architectures, a proposed multi-stage network named NET_BST possesses the highest recognition rate of around 93%. Therefore, this network proves to be a suitable candidate in ECG signal diagnosis systems.

Reducing power line interference in digitised electromyogram recordings by spectrum interpolation.

Interference from power lines (50 or 60 Hz) is the largest source of extraneous noise in many bio-electric signals and is within the bandwidth of many such signals. In this study, two different methods were compared for their efficacy in removing 50 Hz noise added to surface electromyogram (EMG) signals free of power line interference. The first was a simple second-order recursive digital notch filter. The second was an approach called spectrum interpolation, in which it is assumed that the magnitude of the original 50 Hz component of the EMG signal can be approximated by interpolation of the amplitude spectrum of the signal. When the spectrum was based on records containing an integer number of cycles of 50 Hz interference, and the frequency resolution was finer than 1 Hz, spectrum interpolation performed similarly to, or significantly better than, the notch filter (p < 0.01). It was also possible to make spectrum interpolation more robust than the notch filter. The Pearson squared correlation coefficient r2 between clean signals and signals processed using the notch filter was reduced from 0.98 to 0.65 when the interference frequency was increased by 0.5 Hz, but r2 for spectrum interpolation at 0.2 Hz resolution was only reduced from 0.99 to 0.85 if spectral values between approximately 49.5 and 50.5 Hz were modified by interpolation.

Learning to apply effective cricoid pressure using a part task trainer.

An anatomically-correct model of a larynx inside a head and neck model was constructed so that the location, direction and amount of force applied to the neck could be measured. Fifty trained staff from three general hospitals were then asked to apply cricoid pressure on the model. None was able to state the force that should be applied (30 N), and only five (10%) actually applied cricoid pressure effectively. After training using the model, 45 (90%) applied cricoid pressure correctly (p < 0.001). This study demonstrates that improved training in cricoid pressure is needed and supports earlier researchers who suggested that this can be achieved using simulators.

When are we better than them and they worse than us? A closer look at social discrimination in positive and negative domains.

This article argues that in-group favoritism occurs on positive and negative dimensions only when the dimensions of comparison provide an appropriate and meaningful basis for self-other definition, that is, when traits comparatively and normatively fit in-group-out-group categorizations. Three studies are reported in which groups were evaluated on positive or negative traits that varied in their degree of normative fit to in-group and out-group identity. In line with predictions, fit rather than stimulus valence was the crucial determinant of (a) in-group favoritism and (b) absolute level of differentiation between groups. Implications of the findings for explanations of positive-negative asymmetry and broader understandings of intergroup discrimination are discussed.

Tendon organ sensitivity to steady-state isotonic contraction of in-series motor units in feline peroneus tertius muscle.

1. Measurements have been made of the sensitivity of tendon organs to steady-state, isotonic contractions of single and groups of in-series motor units in the peroneus tertius muscle of the cat hindlimb. 2. Linear relationships were found between the Ib afferent discharge and the contractile tension generated by tetanic stimulation of single motor units. These relationships held for the fast, fatiguable (FF) units and for all but the lowest tensions generated by the slow (S) and some fast, fatigue resistant (FR) units. The sensitivity of the organs was independent of the contractile properties of the units. 3. Groups of three motor units were stimulated isotonically at low rates (around 30 Hz), but asynchronously to produce a smooth tension profile. Again, linear relationships pertained between the discharge rate and the tension, and the sensitivity was the same for different motor unit types. 4. Under isotonic conditions, therefore, the tendon organs showed linear responses to the tension with similar sensitivities, indicating that tendon organs may have the capacity to signal faithfully steady-state contractile tensions.

Spectral pattern of neonatal cerebral blood flow velocity: comparison with spectra from blood pressure and heart rate.

The cerebral blood flow velocity (CBFV) frequency spectra were studied in 106 premature and term newborns (gestational age range. 24-42 wk) and compared with the heart rate (HR) and mean arterial blood pressure (BP) spectra over the 0.005-0.5 Hz range. CBFV, BP, and HR were shown to have similar but not identical spectral patterns. Adjustment of a l/f model to these spectra produced highly significant fittings, but the residuals were not independent. This condition was met only by the CBFV and BP spectra over a limited frequency range (0.005-0.06 Hz). These results provide a characterization of the CBFV spectra for a much larger population of newborns than hitherto available, indicating that under certain conditions CBFV and BP might show the properties of chaotic systems. In infants without major complications, gestational age (GA) did not have a significant influence on the CBFV spectrum, whereas the spectral power to 0.5 Hz of both BP and HR was found to increase with GA. The spectral power increased over the first 24 h of postnatal life for all three variables: only CBFV showed a significant spectral change in the low frequency (LF, 0.02-0.08 Hz) range. A matched group comparison, adjusted for GA and postnatal age, indicated a reduction in CBFV LF power for term infants with birth asphyxia when compared with normal infants, which was not reproduced in the HR spectra.

Advances in capillary electrochromatography.

Capillary electrochromatography (CEC) is a hybrid between capillary electrophoresis and high performance liquid chromatography (HPLC) that has gained popularity in recent years. CEC uses an electrically driven flow to transport the solutes through the chromatographic column. Separation can be achieved by differential partition between two phases, differential electromigration, or a combination of these two. Herein, the main features of CEC are presented, including basic principles and a literature overview on different practical approaches used.