Navigating healthcare systems: Is there a solution to healthy ageing?

Across cultures and countries, people have different understandings of what health entails, so improving the health of the elderly would also mean improving different health factors. Universal health as a notion is an illusionary idea, because it is context-dependent. Countries face different issues with elderly populations, and so they have different objectives for their healthcare systems. Even when elderly populations have similar problems, the social, political and cultural differences between countries make the implementation of universal health measures impossible. Countries’ healthcare systems are already different due to the different circumstances, and so healthy ageing should be promoted in a more localised fashion. Healthcare systems are not efficient in addressing local issues when the different understandings of health are not respected. For a healthcare system to work to its full potential, measures have to be adapted to local needs, local values, and local priorities. Healthy ageing might be a universal problem, but it has no universal solution

Towards Bidirectional Lower Limb Prostheses: Restoring Proprioception Using EMG Based Vibrotactile Feedback

As a result, they do not effectively replace the lost limb. Electromyography (EMG) control has been widely implemented in upper limb prostheses but is still underdeveloped in lower limb prostheses. The aim of this thesis is to design, develop, and evaluate a novel vibrotactile feedback system in combination with an EMG-controlled powered knee or ankle prosthesis to restore proprioception. This thesis demonstrates that discrete localised vibrations enable proprioceptive sensing for the user through the described sensory feedback system. Three subjects with a major lower limb amputation performed level ground and inclined walking tests under various conditions. The experiments reported in the thesis compare the effects of EMG control with and without sensory feedback on temporal gait symmetry and psychosocial metrics, i.e. cognitive workload assessment, prosthesis embodiment, and confidence. The key results from this thesis are the following: temporal gait symmetry and psychosocial measures tended to improve within and between session, though the results varied widely between subjects. Interference in the rest EMG signal was found when the vibrotactors were activated. Further, subjects were able to distinguish between sensory feedback levels. EMG control initially reduced gait symmetry, but gait symmetry was later increased with sensory feedback. Higher symmetry scores were measured after sensory feedback was turned off, demonstrating learning retention. Similar trends were measured in psychosocial metrics, indicating that the sensory feedback system contributed to perceived improvements of the prosthesis. In summary, results show promising effects of using vibrotactile feedback in combination with EMG control in lower limb prostheses, despite the need to improve system robustness. Longer training with EMG and sensory feedback might improve quality of life of prosthesis users even more

Optimization of Incisions in Cutaneous Surgery including Mohs’ Micrographic Surgery

In chapter 1, a general introduction into the rationale of surgery and various techniques for cutaneous excisional biopsies and repairing the defects were described. In the studies described in chapter 2, the most economical patterns with regard to extra skin waste, scar length and vertex angle were investigated. A comparison of minimum waste area showed that the best patterns were the rhomboid and the mosque excision. The second comparison of the scar length showed that the length was almost independent of the pattern. The third comparison showed that the rhomboid and the S-shape patterns possessed the smallest vertex angles and thus minimized the formation of dog ear. Interestingly, the common surgical ellipse was observed not to have any advantage in any of the cut pattern categories. The currently held paradigm that the vertex angle of a surgical ellipse should be 30° or less for length-to-width ratios of lower than 4 was found to be mathematically incorrect. The circular excision pattern, i.e. a direct excision of a round lesion, was found superior to other patterns that were examined in that there was no skin waste and that the resulting scar length was the shortest. However, the circular excision had the highest vertex angle (180°), which resulted in large dog ear formation during closure