Treadmill associated head injuries on the rise: an 18 year review of U.S. emergency room visits.

OBJECTIVE: The treadmill is the most commonly used aerobic exercise equipment with studies showing many gym-related injuries are attributed to treadmills. The purpose of this study is to examine the incidence of treadmill-associated head injuries within the US. METHODS: Retrospective data from 1997 to 2014 was collected via the National Electronic Injury Surveillance System, which provides annual es7timates of injuries associated with consumer products. Patients over 18 years who sustained treadmill-associated head injuries were included, and the estimated annual incidence was determined. RESULTS: An estimated 4929 patients presented to US emergency departments with a head injury while exercising on a treadmill between 1997 and 2014. A >1000% increase in the number of head injuries was observed over the study period (p-value <0.001). Patients over 50 had a 14 times greater risk of admission than younger patients (p-value <0.001). Injuries were greater in women than men. CONCLUSION: Our study demonstrates a significant increase treadmill-associated head injuries from 1997 to 2014. This phenomenon is most pronounced in older and female populations. The exact etiology of this large increase remains unclear. Education on the proper use of treadmills as well as further investigation into the cause of the increase are warranted.

Estimating the global prevalence of transthyretin familial amyloid polyneuropathy.

INTRODUCTION: This study sought to estimate the global prevalence of transthyretin familial amyloid polyneuropathy (ATTR-FAP). METHODS: Prevalence estimates and information supporting prevalence calculations was extracted from records yielded by reference-database searches (2005-2016), conference proceedings, and nonpeer reviewed sources. Prevalence was calculated as prevalence rate multiplied by general population size, then extrapolated to countries without prevalence estimates but with reported cases. RESULTS: Searches returned 3,006 records; 1,001 were fully assessed and 10 retained, yielding prevalence for 10 "core" countries, then extrapolated to 32 additional countries. ATTR-FAP prevalence in core countries, extrapolated countries, and globally was 3,762 (range 3639-3884), 6424 (range, 1,887-34,584), and 10,186 (range, 5,526-38,468) persons, respectively. DISCUSSION: The mid global prevalence estimate (10,186) approximates the maximum commonly accepted estimate (5,000-10,000). The upper limit (38,468) implies potentially higher prevalence. These estimates should be interpreted carefully because contributing evidence was heterogeneous and carried an overall moderate risk of bias. This highlights the requirement for increasing rare-disease epidemiological assessment and clinician awareness. Muscle Nerve 57: 829-837, 2018.

Primary Salvage Survey of the Interference of Radiowaves Emitted by Smartphones on Medical Equipment.

Use of mobile phones has become a standard reality of everyday living for many people worldwide, including medical professionals, as data sharing has drastically helped to improve quality of care. This increase in the use of mobile phones within hospitals and medical facilities has raised concern regarding the influence of radio waves on medical equipment. Although comprehensive studies have examined the effects of electromagnetic interference from 2G wireless communication and personal digital cellular systems on medical equipment, similar studies on more recent wireless technologies such as Long Term Evolution, wideband code division multiple access, and high-speed uplink access have yet to be published. Numerous tests targeting current wireless technologies were conducted between December 2012 and March 2013 in an anechoic chamber, shielded from external radio signals, with a dipole antenna to assess the effects of smartphone interference on several types of medical equipment. The interference produced by electromagnetic waves across five frequency bands from four telecommunication standards was assessed on 49 components from 22 pieces of medical equipment. Of the 22 pieces of medical equipment tested, 13 experienced interference at maximum transmission power. In contrast, at minimum transmission power, the maximum interference distance varied from 2 to 5 cm for different wireless devices. Four machines were affected at the minimum transmission power, and the maximum interference distance at the maximum transmission power was 38 cm. Results show that the interference from smartphones on medical equipment is very controllable.

An ex vivo comparison of working length determination by 3 electronic apex locators.

OBJECTIVE: To compare the accuracy of 3 different electronic apex locators (EALs) in establishing the working length in recently extracted teeth. STUDY DESIGN: Sixty teeth (100 canals) were soaked in an alginate model and electronically measured with 3 EALs (Dentaport ZX, Raypex 5, and Elements Diagnostic Unit and Apex Locator). The real working length was calculated as 1.0 mm short of the real length of the canal. The electronic measurements were taken following the manufacturers' orientations within +/-0.05 mm and +/-1.0 mm using a #15 K-file attached to the holder, after canal irrigation with 1% NaOCl. Data were analyzed with Friedman test and Wilcoxon signed rank test, at a significance level of 5%. RESULTS: Within +/-0.5 mm and +/-1.0 mm, the accuracy was 39% and 90% (Dentaport ZX), 31% and 82% (Raypex 5), and 37% and 73% (Elements Diagnostic Unit and Apex Locator), respectively, with statistically significant differences between Elements Diagnostic Unit and Apex Locator and the other EALs. CONCLUSION: None of the EALs yielded an accuracy of 100%. Within the limitations of the present study. Elements Diagnostic Unit and Apex Locator proved to be less reliable than Dentaport ZX and Raypex 5 in the determination of the real working length.

Ex vivo comparison of the accuracy of Root ZX II in detecting apical constriction using different meter's reading.

The purpose of this study was to compare the accuracy of Root ZX II to locate the apical constriction with the display meter set at "0.5" and "1'"reading. Seventy single-rooted teeth were soaked in an alginate model and randomly distributed in 2 groups (n = 35). Measurements were taken following canal irrigation with 1% NaOCl. The length was established using a #20 K-file attached to the holder when the display indicator reached the marks "0.5" (group I) or "1" (group II), after the meter read "Apex." Then, the file was fixed in position and the teeth removed from the alginate. The apical portion of the root was shaved until the tip of the file could be seen, the distance to the apical constriction verified by means of a stereomicroscope and the measurements compared. Statistical analysis was performed by using Student t test with the null hypothesis set as 5%. The mean positions of the file tip relative to the apical constriction were -0.23 +/- 0.39 mm and -0.42 +/- 0.45 for groups I and II, respectively, with no statistical difference (P > .05). The accuracy was 90.5% and 83.78% for the Root ZX II "0.5" and "1" readings, respectively. It was concluded that the meter reading "1" of Root ZX II reduced the risk of working length overestimation.

Impact of a pharmaceutical care program on liver transplant patients' compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.

INTRODUCTION: Compliance with immunosuppressive therapy plays a major role in the long-term success of organ transplantation. Thus, strategies to promote compliance in posttransplant care are of particular interest. At the pharmacy department of the University Hospital Mainz, a program for pharmaceutical care of organ transplant patients has been developed for the first time ever. The main objective of the presented study was to examine the influence of this program on liver transplant patients' compliance with immunosuppressive therapy. METHODS: To measure compliance, medication event monitoring systems were used. Dosing compliance (DC) was calculated for each patient and the mean DC was compared between the two groups. Further direct and indirect methods of measuring compliance served to confirm the electronic compliance data. RESULTS: Pharmaceutical care of liver transplant patients led to a significant increase in compliance with the immunosuppressive therapy. The mean DC of the intervention group was 90%+/-6% compared with 81%+/-12% in the control group (P=0.015). Only two patients (10%) in the intervention group and nine patients (43%) in the control group showed a DC less than 80% (P=0.032). Furthermore, patients in the intervention group were more likely to achieve target blood levels. CONCLUSION: Patients who received pharmaceutical care with traditional patient care showed significantly better compliance with their immunosuppressive medication than patients who received only traditional patient care. Pharmaceutical care proved to be an effective intervention that should be implemented in posttransplant care.

Spectroscopic characterization of a novel electronic brachytherapy system.

The Axxent developed by Xoft Inc. is a novel electronic brachytherapy system capable of generating x-rays up to 50 keV. These low energy photon-emitting sources merit attention not only because of their ability to vary the dosimetric properties of the radiation, but also because of the radiobiological effects of low energy x-rays. The objective of this study is to characterize the x-ray source and to model it using the Geant4 Monte Carlo code. Spectral and attenuation curve measurements are performed at various peak voltages and angles and the source is characterized in terms of spectrum and half-value layers (HVLs). Also, the effects of source variation and source aging are quantified. Bremsstrahlung splitting, phase-space scoring and particle-tagging features are implemented in the Geant4 code, which is bench-marked against BEAMnrc simulations. HVLs from spectral measurements, attenuation curve measurements and Geant4 simulations mostly agree within uncertainty. However, there are discrepancies between measurements and simulations for photons emitted on the source transverse plane (90 degrees).

Electronic detectors for electron microscopy.

Due to the increasing popularity of electron cryo-microscopy (cryoEM) in the structural analysis of large biological molecules and macro-molecular complexes and the need for simple, rapid and efficient readout, there is a persuasive need for improved detectors. Commercial detectors, based on phosphor/fibre optics-coupled CCDs, provide adequate performance for many applications, including electron diffraction. However, due to intrinsic light scattering within the phosphor, spatial resolution is limited. Careful measurements suggest that CCDs have superior performance at lower resolution while all agree that film is still superior at higher resolution. Consequently, new detectors are needed based on more direct detection, thus avoiding the intermediate light conversion step required for CCDs. Two types of direct detectors are discussed in this review. First, there are detectors based on hybrid technology employing a separate pixellated sensor and readout electronics connected with bump bonds-hybrid pixel detectors (HPDs). Second, there are detectors, which are monolithic in that sensor and readout are all in one plane (monolithic active pixel sensor, MAPS). Our discussion is centred on the main parameters of interest to cryoEM users, viz. detective quantum efficiency (DQE), resolution or modulation transfer function (MTF), robustness against radiation damage, speed of readout, signal-to-noise ratio (SNR) and the number of independent pixels available for a given detector.

Accuracy of electronic apex locator in length determination in the presence of different irrigants: An in vitro study.

Determining the root canal length accurately had been a challenge in endodontics. Introduction of apex locators have definitely served as an effective adjuvant to radiographs. This in vitro study had attempted to compare the effectiveness of electronic apex locator in the presence of various canal contents. Comparison of the length determined by apex locators with the radiographic length was also made. The results of the study had shown that the length of root canals can be accurately made irrespective of the canal contents.

An integrated CMOS bio-potential amplifier with a feed-forward DC cancellation topology.

This paper describes a novel technique to realize an integrated CMOS bio-potential amplifier with a feedforward DC cancellation topology. The amplifier is designed to provide substantial DC cancellation even while amplifying very low frequency signals. More than 80 dB offset rejection ratio is achieved without any external capacitors. The cancellation scheme is robust against process and temperature variations. The amplifier is fabricated through MOSIS AMI 1.5 microm technology (0.05 mm2 area). Measurement results show a gain of 43.5 dB in the pass band (<1 mHz-5 KHz), an input referred noise of 3.66 microVrms, and a current consumption of 22 microA.

A LabVIEW based experiment system for the efficient collection and analysis of cyclic voltametry and electrode charge capacity measurements.

Cyclic voltametry and recording of stimulation electrode voltage excursions are two critical methods of measurement for understanding the performance of implantable electrodes. Because implanted electrodes cannot easily be replaced, it is necessary to have an a-priori understanding of an electrode's implanted performance and capabilities. In-vitro exhaustive tests are often needed to quantify an electrodes performance. Using commonly available equipment, the human labor cost to conduct this work is immense. Presented is an automated experiment system that is highly configurable that can efficiently conduct a battery of repeatable CV and stimulation recording measurements. Results of preparing 96 electrodes prior to an animal implantation are also discussed.

The Electronic Report on Adolescent Pregnancy (ERAP).

PURPOSE: To create a data management system that: (1) standardizes antecedent, program, and outcome variables relevant to the shared goals of adolescent-oriented maternity programs while allowing users to add variables pertaining to unique aspects of their work; (2) cues providers to physiologic and psychosocial characteristics that predispose teenagers to adverse pregnancy and parenting outcomes, (3) standardizes patient care by guiding providers through adolescent-oriented prenatal, postpartum, and well baby visits, and (4) establishes the infrastructure to collect data from a nationally representative sample of pregnant and parenting teens. METHOD: We adapted a powerful, state-of-the-art relational database framework (Microsoft Access 2000) to create an easy-to-use data management system-The Electronic Report on Adolescent Pregnancy (ERAP)-that requires minimal training to use on a personal computer. RESULTS: ERAP is designed to meet the administrative and analytic needs of adolescent-oriented maternity programs. It consists of six linked core data tables (teen, pregnancy, prenatal visits, child, interconception interval, and interconception interval visits), that allow users to analyze data from these multiple views while preserving the family structure. In addition, the database standardizes methods for collecting and storing the information and automatically computing the variables needed to monitor and evaluate an adolescent-oriented maternity program. Since by adding variables and appending supplementary tables, users can modify the core database to accommodate unique aspects of their programs and/or research, ERAP is also an ideal conduit for translating research findings into clinical practice. Similarly, because ERAP actually structures the care patients receive, the database provides the infrastructure needed to develop and implement best practice guidelines for treating teen-headed families. Finally, the confidentiality of all subject data is assured because ERAP is password-protected and automatically prepares files for batched external analyses by removing personal identifiers. CONCLUSIONS: ERAP provides the infrastructure needed to create a teen-pregnancy databank at the national level and an efficient patient monitoring system at the program level. By standardizing variable definitions and data collection techniques, serving as a repository for data collected at multiple sites, and tracking the multidisciplinary aspects of the care patients receive, ERAP has the potential to facilitate collaboration between adolescent-oriented maternity programs, increase the scientific rigor of teen pregnancy research, and improve the quality of care individual teen-headed families receive by prompting compliance with best practice guidelines.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

RATIONALE AND OBJECTIVES: A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. MATERIALS AND METHODS: A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. RESULTS: Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. CONCLUSION: A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.

Evaluation of electronic databases used to identify solid oral dosage forms.

The ability of electronic drug identification databases to identify solid oral dosage forms by their imprint codes was studied. The following seven commercially available electronic drug identification databases were selected to identify 500 solid oral dosage forms by their imprint codes: Clinical Pharmacology (Gold Standard Media, Tampa, FL), eFacts (Facts and Comparison, St. Louis, MO), Ident-A-Drug (Therapeutic Research, Stockton, CA), Identidex (Micromedex, Greenwood Village, CO), Clinical Reference Library (Lexi-Comp, Hudson, OH), Physicians' Desk Reference (PDR) Electronic Library (Medical Economics, Montvale, NJ), and RxList (RxList LLC, San Francisco, CA), Chi-square test was used to compare the percentages of medications identified by each of the seven electronic references. The ability of the databases to identify medication by specific characteristics, such as brand name versus generic, prescription versus nonprescription, commercially available for more than one year versus less than one year, colored versus white drug products, and controlled versus noncontrolled substances was evaluated. A logistic regression model was used to determine the probability of a drug product being identified by one of the electronic references based on these characteristics. All seven electronic databases combined identified 95.6% of the unknown medications by imprint code, color, shape, and scoring. Ident-A-Drug and Identidex identified the most drugs. The PDR Electronic Library and Facts and Comparisons Identified the least number of drugs. Solid oral dosage forms more likely to be identified were those that were on the market for more than a year, brand-name products, and prescription medications. Generic products on the market for less than a year and nonprescription products were particularly difficult to identify. A combination of electronic drug identification databases provides the best method of drug identification in an institutional setting.

[Validation of electronic automatic-measurement arterial blood pressure devices]. / Validation des appareils électroniques d'automesure de la pression artérielle.

Validation of automatic devices for self blood pressure measurement is a necessity, as the mercury columns are no longer available. The European consensus meeting organized by the Group for blood pressure measurement and evaluation (GEM), from French Society of Hypertension held last June 1999 has defined a new international protocol for clinical validation of these devices. The main parts of this protocol are the following: the blood pressure is measured at the same arm with two observers simultaneously and then with the automatic device sequentially seven times among 38 patients. The evaluation is interrupted after the 15th patient if the pre-analysis fails defined criteria. Technical supports are available: A CD-rom from French society of HTA for the training and certification of observers, a special kit for the evaluation (2 mercury column's and a double stethoscope) and a specific software for data analysis created by the GEM.

The accuracy of the Vivacare true pressure-sensitive periodontal probe system in terms of probing force.

BACKGROUND: The Hunter TPS Vivacare periodontal probe was invented to perform consistent, accurate and reliable periodontal examinations "with controlled pressures". AIMS: The aims of the present investigation are 3: (1) what is the accuracy of the probing force when various probe heads are used in a correct operation position; (2) what is the effect of over- and under-reading of the operation position on the probing force; (3) what is the accuracy of the probing force when different probe handles are used. The Hunter TPS probe consists of a tip connected to a special spring mechanism, which controls the pressure extended to the probe tip. According to the manufacturer, the force indicator lines coincide at approximately 20 g force. METHOD: The test apparatus consisted of an electronic balance, and an electronic caliper. 12 TPS probes tips and 3 handles were selected to test whether there were differences in force between probes. Each probe tip was adapted to the same handle and tested 10 times. In a 2nd test, the TPS handles and over-, accurate-, and under-readings were analyzed as to how they affect the probing force. The 12 TPS probe tips were connected to each of the 3 handles and tested 10x for each of 3 handles and levels. RESULTS: The range in force between TPS probe tips was 8.4 g (p<0.001). For the handles as well as for each of the readings of the operating positions, the differences were small and non-significant. However, between over- and under-readings, there were statistical significant differences. CONCLUSION: The conclusion is that the variation in force between probe tips is high and always above the manufacturer's "approximately" 20 g. As long as the same handle and the same probe tip are used together, and the examiner is reading the markings correct, the TPS probe is adequate.

Study of erythrocyte sedimentation behavior by piezoelectric crystal impedance sensor.

Based on the impedance characteristic of erythrocytes at high frequency, the response of piezoelectric crystal impedance (PCI) sensor in the erythrocyte suspension was derived and verified experimentally. A method of using PCI sensor to investigate erythrocyte aggregation-sedimentation phenomenon was proposed. From the frequency response of the PCI sensor, the erythrocyte aggregation time and sedimentation rate could be obtained during erythrocyte aggregation and sedimentation. With the present method, the effects of the erythrocyte deformability, the osmotic pressure and the coexisting macromolecules on the erythrocyte sedimentation rate were studied. The results show that the PCI sensor possesses some advantages, such as good sensitivity, simplicity of use and no thermal effect for the impedance study of erythrocyte aggregation and sedimentation.

Development of a microcontroller-based automatic control system for the electrohydraulic total artificial heart.

An automatic physiological control system for the actively filled, alternately pumped ventricles of the volumetrically coupled, electrohydraulic total artificial heart (EHTAH) was developed for long-term use. The automatic control system must ensure that the device: 1) maintains a physiological response of cardiac output, 2) compensates for an nonphysiological condition, and 3) is stable, reliable, and operates at a high power efficiency. The developed automatic control system met these requirements both in vitro, in week-long continuous mock circulation tests, and in vivo, in acute open-chested animals (calves). Satisfactory results were also obtained in a series of chronic animal experiments, including 21 days of continuous operation of the fully automatic control mode, and 138 days of operation in a manual mode, in a 159-day calf implant.

A multifrequency serial EIT system.

A multifrequency (1 kHz-1 MHz) serial electrical impedance tomography (EIT) system has been developed. It is based on 16 active electrodes and can be extended up to 32. Each active electrode can be programmed for current driving and for measuring either the injected current or the voltage difference between adjacent electrodes, and includes calibration facilities. Real and imaginary parts of the impedance are obtained by applying a parametric identification method (extended Prony), but other techniques are easily adaptable. Image reconstruction is carried out using the Sheffield filtered back-projection algorithm. Characteristic frequency images are under development and should be of great interest to distinguish between normal and tumorous tissues.