Implementation fidelity of the Systems for Person-Centered Elder Care (SPEC): a process evaluation study

Background The Systems for Person-Centered Elder Care (SPEC), a complex intervention, was conducted to examine its effectiveness as a technology-enhanced, multidisciplinary, and integrated care model for frail older persons among ten nursing homes (NHs) in South Korea where formal long-term care has recently been introduced. The purpose of this study was to evaluate the implementation fidelity of the SPEC intervention and to identify moderating factors that influence the implementation fidelity. Methods This study was a process evaluation based on an evidence-based framework for implementation fidelity using a mixed-methods design. Quantitative data from consultant logbooks, NH documentations, an information and communications technology (ICT) system, and a standardized questionnaire were collected from April 2015 to December 2016 and analyzed by calculating the descriptive statistics. Semi-structured focus group interviews were held with multidisciplinary teams from the participating NHs. Qualitative data from a semi-structured questionnaire and the focus group interviews were analyzed using content analysis. Results The SPEC program demonstrated good implementation fidelity, and adherence to the SPEC program was strong in all aspects, such as content, coverage, frequency, and duration. Of the participating on-site coordinators, 60% reported that the SPEC model positively impacted needs assessment and the reporting system for resident care. The important facilitating factors were tailored facilitating strategies, assurance of the quality of delivery, and recruitment strategies. Conclusion The effectiveness of the SPEC program was driven by good implementation fidelity. The key factors of good implementation fidelity were tailored delivery of evidence-based interventions over process evaluation work, facilitating strategies, and ICT support. Larger implementation studies with a more user-friendly ICT system are recommended. Trial registration ISRCTN registry, ISRCTN11972147 . Registered on 16 March 2015This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea [HI13C2250]; a 2016 AXA Award funded by AXA Research Fund [900-2017006 to HK]; and the National Research Foundation of Korea funded by the Korean Government [NO.4199990514025]. The funding sources had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the manuscript for publication

Fabrication and Characterization of Magnetic Microrobots for Three-Dimensional Cell Culture and Targeted Transportation

Magnetically manipulated microrobots are demonstrated for targeted cell transportation. Full three‐dimensional (3D) porous structures are fabricated with an SU‐8 photoresist using a 3D laser lithography system. Nickel and titanium are deposited as a magnetic material and biocompatible material, respectively. The fabricated microrobots are controlled in the fluid by external magnetic fields. Human embryonic kidney 239 (HEK 239) cells are cultivated in the microrobot to show the possibility for targeted cell transportation

The Design and Optimization of a Compressive-Type Vector Sensor Utilizing a PMN-28PT Piezoelectric Single-Crystal

Underwater sensors that detect the distance and direction of acoustic sources are critical for surveillance monitoring and target detection in the water. Here, we propose an axial vector sensor that utilizes a small (~1 cm3) compressive-type piezoelectric accelerometer using piezoelectric single crystals. Initially, finite element analysis (FEA) was used to optimize the structure that comprised piezoelectric Pb(Mb1/3Nb2/3)O3-28%PbTiO3 single crystals on a tungsten seismic mass. The receiving voltage sensitivity (RVS) was enhanced through geometric optimization of the thickness and sensing area of the piezoelectric material and the seismic mass. The estimated maximum RVS of the optimized vector sensor was −212 dB. FEA simulations and practical measurements were used to verify the directivity of the vector sensor design, which exhibited a dipole pattern. The dipole beam pattern was used to obtain cardioid patterns using the simulated and measured results for comparison. The results clearly showed the feasibility of using the proposed piezoelectric single-crystal accelerometer for a compressive-type vector sensor. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.1

Magnetic microrobot control using an adaptive fuzzy sliding-mode method

The magnetic medical microrobots are influenced by diverse factors such as the medium, the geometry of the microrobot, and the imaging procedure. It is worth noting that the size limitations make it difficult or even impossible to obtain reliable physical properties of the system. In this research, to achieve a precise microrobot control using minimum knowledge about the system, an Adaptive Fuzzy Sliding-Mode Control (AFSMC) scheme is designed for the motion control problem of the magnetically actuated microrobots in presence of input saturation constraint. The AFSMC input consists of a fuzzy system designed to approximate an unknown nonlinear dynamical system and a robust term considered for mismatch compensation. According to the designed adaptation laws, the asymptotic stability is proved based on the Lyapunov theorem and Barbalat's lemma. In order to evaluate the effectiveness of the proposed method, a comparative simulation study is conducted

Strain sensitive flexible magnetoelectric ceramic nanocomposites

Advanced flexible electronics and soft robotics require the development and implementation of flexible functional materials. Magnetoelectric (ME) oxide materials can convert magnetic input into electric output and vice versa, making them excellent candidates for advanced sensing, actuating, data storage, and communication. However, their application has been limited to rigid devices due to their brittle nature. Here, we report flexible ME oxide composite (BaTiO3/CoFe2O4) thin film nanostructures that can be transferred onto a stretchable substrate such as polydimethylsiloxane (PDMS). In contrast to rigid bulk counterparts, these ceramic nanostructures display a flexible behavior and exhibit reversibly tunable ME coupling via mechanical stretching. We believe our study can open up new avenues for integrating ceramic ME composites into flexible electronics and soft robotic devices

Integrated Piezoelectric AlN Thin Film with SU-8/PDMS Supporting Layer for Flexible Sensor Array

This research focuses on the development of a flexible tactile sensor array consisting of aluminum nitride (AlN) based on micro-electro-mechanical system (MEMS) technology. A total of 2304 tactile sensors were integrated into a small area of 2.5 × 2.5 cm2. Five hundred nm thick AlN film with strong c-axis texture was sputtered on Cr/Au/Cr (50/50/5 nm) layers as the sacrificial layer coated on a Si wafer. To achieve device flexibility, polydimethylsiloxane (PDMS) polymer and SU-8 photoresist layer were used as the supporting layers after etching away a release layer. Twenty-five mM (3-mercaptopropyl) trimethoxysilane (MPTMS) improves the adhesion between metal and polymers due to formation of a self-assembled monolayer (SAM) on the surface of the top electrode. The flexible tactile sensor has 8 × 8 channels and each channel has 36 sensor elements with nine SU-8 bump blocks. The tactile sensor array was demonstrated to be flexible by bending 90 degrees. The tactile sensor array was demonstrated to show clear spatial resolution through detecting the distinct electrical response of each channel under local mechanical stimulus. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.1

Synthesize and Segment: Towards Improved Catheter Segmentation via Adversarial Augmentation

Automatic catheter and guidewire segmentation plays an important role in robot-assisted interventions that are guided by fluoroscopy. Existing learning based methods addressing the task of segmentation or tracking are often limited by the scarcity of annotated samples and difficulty in data collection. In the case of deep learning based methods, the demand for large amounts of labeled data further impedes successful application. We propose a synthesize and segment approach with plug in possibilities for segmentation to address this. We show that an adversarially learned image-to-image translation network can synthesize catheters in X-ray fluoroscopy enabling data augmentation in order to alleviate a low data regime. To make realistic synthesized images, we train the translation network via a perceptual loss coupled with similarity constraints. Then existing segmentation networks are used to learn accurate localization of catheters in a semi-supervised setting with the generated images. The empirical results on collected medical datasets show the value of our approach with significant improvements over existing translation baseline methods. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.1

Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial

Background Healthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities.  Methods/design HWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted. Discussion As a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities. Trial registration ISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760This work was based on the Project to Empower Communities to Reduce Health Disparities, supported by the Korea Disease Control and Prevention Agency and the Seoul Metropolitan Government; the project was executed in Jungnang-gu (district) in Seoul. The funding sources had no role in the study design; data collection and management; writing the manuscript; or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the ofcial views of the funding sources

Steering Algorithm for a Flexible Microrobot to Enhance Guidewire Control in a Coronary Angioplasty Application

Magnetically driven microrobots have been widely studied for various biomedical applications in the past decade. An important application of these biomedical microrobots is heart disease treatment. In intravascular treatments, a particular challenge is the submillimeter-sized guidewire steering; this requires a new microrobotic approach. In this study, a flexible microrobot was fabricated by the replica molding method, which consists of three parts: (1) a flexible polydimethylsiloxane (PDMS) body, (2) two permanent magnets, and (3) a micro-spring connector. A mathematical model was developed to describe the relationship between the magnetic field and the deformation. A system identification approach and an algorithm were proposed for steering. The microrobot was fabricated, and the models for steering were experimentally validated under a magnetic field intensity of 15 mT. Limitations to control were identified, and the microrobot was steered in an arbitrary path using the proposed model. Furthermore, the flexible microrobot was steered using the guidewire within a three-dimensional (3D) transparent phantom of the right coronary artery filled with water, to show the potential application in a realistic environment. The flexible microrobot presented here showed promising results for enhancing guidewire steering in percutaneous coronary intervention (PCI)

Development of a high-density piezoelectric micromachined ultrasonic transducer array based on patterned aluminum nitride thin film

This study presents the fabrication and characterization of a piezoelectric micromachined ultrasonic transducer (pMUT; radius: 40 μm) using a patterned aluminum nitride (AlN) thin film as the active piezoelectric material. A 20 x 20 array of pMUTs using a 1 μm thick AlN thin film was designed and fabricated on a 2 x 2 mm2 footprint for a high fill factor. Based on the electrical impedance and phase of the pMUT array, the electromechanical coefficient was ~1.7% at the average resonant frequency of 2.82 MHz in air. Dynamic displacement of the pMUT surface was characterized by scanning laser Doppler vibrometry. The pressure output while immersed in water was 19.79 kPa when calculated based on the peak displacement at the resonant frequency. The proposed AlN pMUT array has potential applications in biomedical sensing for healthcare, medical imaging, and biometrics. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.1