Haptic Hand Exoskeleton for Precision Grasp Simulation

This paper outlines the design and the development of a novel robotic hand exoskeleton (HE) conceived for haptic interaction in the context of virtual reality (VR) and teleoperation (TO) applications. The device allows exerting controlled forces on fingertips of the index and thumb of the operator. The new exoskeleton features several design solutions adopted with the aim of optimizing force accuracy and resolution. The use of remote centers of motion mechanisms allows achieving a compact and lightweight design. An improved stiffness of the transmission and reduced requirements for the electromechanical actuators are obtained thanks to a novel principle for integrating speed reduction into torque transmission systems. A custom designed force sensor and integrated electronics are employed to further improve performances. The electromechanical design of the device and the experimental characterization are presented

Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study

Aim: This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study. Methods and results: Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 ± 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering “no-imaging” as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from − 969€/cd for CMR-CTCA to − 1490€/cd for CTCA-PET, − 3092€/cd for CTCA-SPECT and − 3776€/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure. Conclusion: In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization

Anti- Japanese-Encephalitis-Viral Effects of Kaempferol and Daidzin and Their RNA-Binding Characteristics

Background: New therapeutic tools and molecular targets are needed for treatment of Japanese encephalitis virus (JEV) infections. JEV requires an a-1 translational frameshift to synthesize the NS1 ’ protein required for viral neuroinvasiveness. Several flavonoids have been shown to possess antiviral activity in vitro against a wide spectrum of viruses. To date, the antiviral activities of flavonol kaempferol (Kae) and isoflavonoid daidzin (Dai) against JEV have not been described. Methodology/Principal Findings: The 50 % cytotoxic concentration (CC50) and 50 % effective concentration (EC50) against JEV were investigated in BHK21 cells by MTS reduction. Activity against viral genomic RNA and proteins was measured by real-time RT-PCR and western blotting. The frameshift site RNA-binding characterization was also determined by electrospray ionization mass spectrometry, isothermal titration calorimetry and autodocking analysis. EC 50 values of Kae and Dai were 12.6 and 25.9 mM against JEV in cells pretreated before infection, whereas in cells infected before treatment, EC50 was 21.5 and 40.4 mM, respectively. Kae exhibited more potent activity against JEV and RNA binding in cells following internalization through direct inhibition of viral replication and protein expression, indicating that its antiviral activity was principally due to direct virucidal effects. The JEV frameshift site RNA (fsRNA) was selected as a target for assaying Kae and Dai. ITC of fsRNA revealed an apparent Kb value for Kae that was nine fold stronger than that for Dai. This binding was confirmed and localized to the RNA using ESI-MS and autodock analysis. Kae could form non-covalent complexes wit

Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population

AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR 640.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects

Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study

Aim: This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study.Methods and results: Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 ± 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering “no-imaging” as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from − 969€/cd for CMR-CTCA to − 1490€/cd for CTCA-PET, − 3,09 €/cd for CTCA-SPECT and − 3776€/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure.Conclusion: In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization.</p

The Physical Environment and its Effect on Health Outcomes – A Systematic Review

Objective: The study aims to identify and review the latest existing knowledge about evidence- based design (EBD) for healthcare architecture and determine the extent to which such findings pertain to the overarching goals proposed by the Institute of Medicine (IOM). Background: There is increasing knowledge regarding influences of healthcare physical environments on health and well-being outcomes. The demand for more evidence has steadily grown, and systematic literature reviews have gained increased importance in the healthcare design field. Research question: A systematic literature review was performed according to the guidelines proposed by The Swedish Agency for Health Technology Assessment and Social Services Assessment. Specific aims included evaluating the current status of research relating to evidence-based healthcare architecture and determining the extent to which such evidence corresponds to the key goals established by the IOM. Methods: A systematic literature review with a Boolean search strategy was performed using the following databases: CINAHL, Medline, SCOPUS, Cochrane library, and Web of Science. The time period covered was 2010-2018. The reference lists of articles obtained from keyword searches were then examined to identify additional relevant studies. The articles retrieved have been screened for eligibility for inclusion, and the final retained articles have been evaluated with descriptive statistics to identify which IOM quality categories are addressed, what type of healthcare settings, physical environment intervention and target groups are investigated, and what types of research design and methodology have been implemented. Furthermore, two researchers are independently assessing the quality of the material retained. This data is part of an ongoing project therefore, preliminary results are reported. Results: A total of 4546 articles were retrieved and screened for eligibility for inclusion, resulting in 688 retained articles published since 2010. Of these 92 has been analyzed until now with descriptive statistics and results suggest that the most frequently cited IOM goals are related to health (84%) and safety (46%), person-centred approach (29%) and effectiveness of care (28%). Moreover, research has been performed across acute care and overall hospital settings (22 and 21%). Conclusion: The systematic literature review indicates that the body of knowledge relating to EBD is clearly growing, and the main focus is on design interventions to improve the health and safety of patients across acute care units. Lack of evidence are instead found in regard to other IOM aspects such as, equality of care and patients’ participation.publishedVersio

Haptic Interfaces: Collocation and Coherence Issues

Multi-modality, collocation and immersive VE nowadays represents the break-trough barrier of human computer interaction. Typical VE systems synthesize the information to be presented to the user by means of different algorithms and present them using different interfaces. On the other hand the human perceptive system is strongly integrated and “fatigues” to interpret these stimuli as belonging to a unique information source. Collocation and coherence issues may be noticed in any kind of multimodal integration: “visual and audio”, “visual and vestibular”, “audio and haptic”, “visual and haptic”, ... The present chapter deals with two specific kinds of multimodal integration: “visual and haptic” and “haptic and haptic”. The coherence problem of synchronizing several haptic devices is analyzed and an optimized solution is proposed. The proposed solution has been tested on a dual point HI, behaving a wide workspace realized at PERCRO. More specifically the present chapter will present a novel algorithm to achieve the absolute coordination of multiple HI working in the same VE. The system performances have been assessed and compared to those of existing solutions. The achieved results have been exploited for the EU project GRAB. The GRAB project investigates to which extent a purely haptic environment can be employed from sightless users

A robot-assisted neuro-rehabilitation system for post-stroke patients motor skill evaluation with alex exoskeleton

Robotic Neuro Rehabilitation has been proved to be effective for motor recovery and less demanding for therapists. During a therapy, the aim of the task is to maximize the patientâ\u80\u99s effort with respect to his/her clinical status and motor abilities, improving at the same time his/her impaired movements. In this paper, we propose a framework for performance evaluation of post-stroke subjects able to provide assistance-as-needed based on their motor skills during a therapy session with an upper-limb robotic exoskeleton