Detecting affective states in virtual rehabilitation

Virtual rehabilitation supports motor training following stroke by means of tailored virtual environments. To optimize therapy outcome, virtual rehabilitation systems automatically adapt to the different patients' changing needs. Adaptation decisions should ideally be guided by both the observable performance and the hidden mind state of the user. We hypothesize that some affective aspects can be inferred from observable metrics. Here we present preliminary results of a classification exercise to decide on 4 states; tiredness, tension, pain and satisfaction. Descriptors of 3D hand movement and finger pressure were collected from 2 post-stroke participants while they practice on a virtual rehabilitation platform. Linear Support Vector Machine models were learnt to unfold a predictive relation between observation and the affective states considered. Initial results are promising (ROC Area under the curve (mean±std): 0.713 ± 0.137). Confirmation of these opens the door to incorporate surrogates of mind state into the algorithm deciding on therapy adaptation

Unobtrusive inference of affective states in virtual rehabilitation from upper limb motions: a feasibility study

Virtual rehabilitation environments may afford greater patient personalization if they could harness the patient's affective state. Four states: anxiety, pain, engagement and tiredness (either physical or psychological), were hypothesized to be inferable from observable metrics of hand location and gripping strength -relevant for rehabilitation-. Contributions are; (a) multiresolution classifier built from Semi-Naïve Bayesian classifiers, and (b) establishing predictive relations for the considered states from the motor proxies capitalizing on the proposed classifier with recognition levels sufficient for exploitation. 3D hand locations and gripping strength streams were recorded from 5 post-stroke patients whilst undergoing motor rehabilitation therapy administered through virtual rehabilitation along 10 sessions over 4 weeks. Features from the streams characterized the motor dynamics, while spontaneous manifestations of the states were labelled from concomitant videos by experts for supervised classification. The new classifier was compared against baseline support vector machine (SVM) and random forest (RF) with all three exhibiting comparable performances. Inference of the aforementioned states departing from chosen motor surrogates appears feasible, expediting increased personalization of virtual motor neurorehabilitation therapies

Identification of the Dynamics of Biofouled Underwater Gliders

Marine growth has been observed to cause a drop in the horizontal and vertical velocities of underwater gliders, thus making them unresponsive and needing immediate recovery. Currently, no strategies exist to correctly identify the onset of marine growth for gliders and only limited datasets of biofouled hulls exist. Here, a field test has been run to investigate the impact of marine growth on the dynamics of underwater gliders. A Slocum glider was deployed first for eight days with drag stimulators to simulate severe biofouling; then the vehicle was redeployed with no additions to the hull for a further 20 days. The biofouling caused a speed reduction due to a significant increase in drag. Additionally, the lower speed causes the steady-state flight stage to last longer and thus a shortening of mission duration. As actual biofouling due to p. pollicipes happened during the deployment, it was possible to develop and test a system that successfully detects and identifies high levels of marine growth on the glider using steady-state flight data. The system will greatly help pilots re-plan missions to safely recover the vehicle if significant biofouling is detected

A Marine Growth Detection System for Underwater Gliders

Marine growth has been observed to cause a drop in the horizontal and vertical velocities of underwater gliders, thus making them unresponsive and needing immediate recovery. Currently, no strategies exist to correctly identify the onset of marine growth for gliders and only limited data sets of biofouled hulls exist. Here, a field test has been conducted to first investigate the impact of marine growth on the dynamics and power consumption of underwater gliders and then design an anomaly detection system for high levels of biofouling. A Slocum glider was deployed first for eight days with drag stimulators to imitate severe biofouling; then, the vehicle was redeployed with no additions to the hull for further 20 days. The mimicked biofouling caused a speed reduction due to a significant increase in drag. Additionally, the lower speed causes the steady-state flight stage to last longer and the rudder to become less responsive; hence, marine growth results in a shortening of deployment duration through an increase in power consumption. As actual biofouling due to p. pollicipes occurred during the second deployment, it is possible to develop and test a system that successfully detects and identifies high levels of marine growth on the glider, blending model- and data-based solutions using steady-state flight data. The system will greatly help pilots replan missions to safely recover the vehicle if significant biofouling is detected

Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries

PMCID: PMC3570554This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Physicians Infrequently Adhere to Hepatitis Vaccination Guidelines for Chronic Liver Disease

Background and Goals:Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.Methods:We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.Results:HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.Conclusions:Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines. © 2013 Thudi et al

Use of cardiovascular registries in regulatory pathways:perspectives from the EU-MDR Cardiovascular Collaboratory

On May 26, 2021, the European Medical Device Regulation (EU-MDR) entered into effect resulting in a major shift in the requirements for assessment of medical devices in Europe. The EU-MDR Cardiovascular Collaboratory (EU-MCVC) was founded to contribute to the development of faster, more efficient, and more effective pathways for innovation of cardiac medical devices. A registry is an organized system that collects uniform data and evaluates specified outcomes in a population defined by a disease, condition, or exposure. Most registries have been created to improve the quality of care and provide feedback to physicians, hospitals, and health providers. Clinical registries represent an ideal construct for scientific, clinical, and policy-making collaboration. We describe diverse experiences from 5 European countries and address the traditional quality components in clinical trials. Continued collaboration is expected among academics, clinical trialists, patient representatives, regulatory experts, research organizations, registry platforms, regulatory bodies, and industry partners. Data quality is a primary concern and registry leaders need to optimize data quality to become regulatory compliant. A collaborative approach among medical device stakeholders may improve quality of care, reduce costs, and provide faster access to innovative technologies, with the common objective of improving cardiovascular care and outcomes

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was €977.57 ± 1455.88 for the IG and €1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of −€250.51 ± 148.61 (95 % CI −541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective