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Journal Description

JMIR Biomedical Engineering (JBME) is a new sister journal of JMIR (the leading open-access journal in health informatics), focusing on the application of engineering principles, technologies, and medical devices to medicine and biology. 


As an open access journal, we are read by clinicians and patients alike and have (as are all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).


During a limited period of time, there are no fees to publish in this journal. Articles are carefully copyedited and XML-tagged, ready for submission in PubMed Central.


Be a founding author of this new journal and submit your paper today!

 

Recent Articles:

  • Source: Freepik; Copyright: prostooleh; URL: https://www.freepik.com/free-photo/artificial-jaw-dentist-s-office_4063997.htm; License: Licensed by JMIR.

    The Effects of Titanium Implant Surface Topography on Osseointegration: Literature Review

    Abstract:

    Background: A variety of claims are made regarding the effects of surface topography on implant osseointegration. The development of implant surfaces topography has been empirical, requiring numerous in vitro and in vivo tests. Most of these tests were not standardized, using different surfaces, cell populations, or animal models. The exact role of surface chemistry and topography on the early events of the osseointegration of dental implants remains poorly understood. Objective: The aim of this study was to consider the major claims made concerning the effects of titanium implant surface topography on osseointegration. The osseointegration rate of titanium dental implants is related to their composition and surface roughness. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants were reviewed. Important findings of consensus were highlighted, and existing controversies were revealed. Methods: This paper considered many of the research publications listed in Medical Literature Analysis and Retrieval System Online and presented in biomedical research publications and textbooks. Surface treatments, such as titanium plasma spraying, grit blasting, acid etching, alkaline etching, anodization, polymer demixing, sol-gel conversion, and their corresponding surface morphologies and properties were described. Results: Many in vitro evaluations are not predictive of or correlated with in vivo outcomes. In some culture models, increased surface topography positively affects proosteogenic cellular activities. Many studies reveal increase in bone-to-implant contact (BIC), with increased surface topography modifications on implant surfaces. Conclusions: Increased implant surface topography improves the BIC and the mechanical properties of the enhanced interface.

  • The Oculus Touch controllers. Source: Image created by the Authors; Copyright: Leia C Shum; URL: https://biomedeng.jmir.org/2019/1/e12291; License: Creative Commons Attribution (CC-BY).

    Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study

    Abstract:

    Background: As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications. Objective: This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space. Methods: Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units. Results: It was found that the maximum position accuracy error of the system was 3.5 ± 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 ± 9.9% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system. Conclusions: The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy.

  • The MIT-Wrist Robot. Source: Image created by the Authors; Copyright: Stan Durand; URL: https://biomedeng.jmir.org/2019/1/e11670; License: Creative Commons Attribution (CC-BY).

    The Impact of Aging and Hand Dominance on the Passive Wrist Stiffness of Squash Players: Pilot Study

    Abstract:

    Background: Passive joint stiffness can influence the risk of injury and the ability to participate in sports and activities of daily living. However, little is known about how passive joint stiffness changes over time with intensive repetitive exercise, particularly when performing unilateral activities using the dominant upper limb. Objective: This study aimed to investigate the difference in passive wrist quasi-stiffness between the dominant and nondominant upper limb of competitive squash players, compare these results with a previous study on young unskilled subjects, and explore the impact of aging on wrist stiffness. Methods: A total of 7 healthy, right-side dominant male competitive squash players were recruited and examined using the Massachusetts Institute of Technology Wrist-Robot. Subjects were aged between 24 and 72 years (mean 43.7, SD 16.57) and had a mean of 20.6 years of squash playing experience (range 10-53 years, SD 13.85). Torque and displacement data were processed and applied to 2 different estimation methods, the fitting ellipse and the multiple regression method, to obtain wrist stiffness magnitude and orientation. Results: Young squash players (mean 30.75, SD 8.06 years) demonstrated a stiffer dominant wrist, with an average ratio of 1.51, compared with an average ratio of 1.18 in young unskilled subjects. The older squash players (mean 64.67, SD 6.35 years) revealed an average ratio of 0.86 (ie, the nondominant wrist was stiffer than the dominant wrist). There was a statistically significant difference between the magnitude of passive quasi-stiffness between the dominant and nondominant wrist of the young and older squash player groups (P=.004). Conclusions: Findings from this pilot study are novel and contribute to our understanding of the likely long-term effect of highly intensive, unilateral sports on wrist quasi-stiffness and the aging process: adults who participate in repetitive sporting exercise may experience greater joint quasi-stiffness when they are younger than 45 years and more flexibility when they are older than 60 years.

  • Orthopedic surgeons. Source: Image created by the Authors; Copyright: Àngels Salvador; URL: http://biomedeng.jmir.org/2019/1/e12148/; License: Creative Commons Attribution (CC-BY).

    Perspectives of Orthopedic Surgeons on the Clinical Use of Bioprinted Cartilage: Qualitative Study

    Abstract:

    Background: Over the past 60 years, no technique used for treating cartilage disorders has been completely successful. Bioprinting provides a highly anticipated, novel alternative solution to this problem. However, identifying barriers to this new technology is crucial in order to overcome them when bioprinting reaches the implementation stage. This kind of research has been declared essential because clinical efficacy and safety studies alone do not always lead to successful implementation. Objective: This qualitative study aimed to explore the stance of orthopedic surgeons on the use of bioprinted cartilage grafts for cartilaginous lesions. The study sought to summarize and classify the barriers and facilitators of this technique and to identify the key factors for successful implementation of bioprinted cartilage in routine clinical practice. Methods: A qualitative thematic analysis method was used to evaluate data obtained from semistructured interviews and from focus groups. Data were collected between June 2017 and February 2018. Interviews focused on the collection of expert opinions on bioprinted cartilage. Results: The perceived barriers to the adoption of this technology were (1) awareness of a lack of information on the status and possibilities of this technology, (2) uncertainty regarding compliance with current health care regulations and policies, and (3) demands for clinical evidence. The facilitators were (1) lack of surgical alternatives, (2) the perception that research is the basis of the current health system, and (3) the hope of offering a better quality of life to patients. Conclusions: The results of this study are preliminary in nature and cannot be generalized without a broader group of participants. However, the key factors identified provide a frame of reference to help understand the challenges of bioprinted cartilage and help facilitate the transition toward its clinical use. These findings will also provide information for use at multidisciplinary meetings in scientific societies; create bridges between researchers, orthopedic surgeons, and regulators; and open a debate on the funding of this technique and the business model that needs to be developed.

  • An Analytics Framework for Physician Adherence to Clinical Practice Guidelines: Knowledge-Based Approach

    Abstract:

    Background: One of the problems in evaluating clinical practice guidelines (CPGs) is the occurrence of knowledge gaps. These gaps may occur when evaluation logics and definitions in analytics pipelines are translated differently. Objective: The objective of this paper is to develop a systematic method that will fill in the cognitive and computational gaps of CPG knowledge components in analytics pipelines. Methods: We used locally developed CPGs that resulted in care process models (CPMs). We derived adherence definitions from the CPMs, transformed them into computationally executable queries, and deployed them into an enterprise knowledge base that specializes in managing clinical knowledge content. We developed a visual analytics framework, whose data pipelines are connected to queries in the knowledge base, to automate the extraction of data from clinical databases and calculation of evaluation metrics. Results: In this pilot study, we implemented 21 CPMs within the proposed framework, which is connected to an enterprise data warehouse (EDW) as a data source. We built a Web–based dashboard for monitoring and evaluating adherence to the CPMs. The dashboard ran for 18 months during which CPM adherence definitions were updated a number of times. Conclusions: The proposed framework was demonstrated to accommodate complicated knowledge management for CPM adherence evaluation in analytics pipelines using a knowledge base. At the same time, knowledge consistency and computational efficiency were maintained.

  • Manual record analysis. Source: Pixabay; Copyright: rawpixel; URL: https://pixabay.com/en/document-paper-office-composition-3271743/; License: Public Domain (CC0).

    Automatic Near Real-Time Outlier Detection and Correction in Cardiac Interbeat Interval Series for Heart Rate Variability Analysis: Singular Spectrum...

    Authors List:

    Abstract:

    Background: Heart rate variability (HRV) is derived from the series of R-R intervals extracted from an electrocardiographic (ECG) measurement. Ideally all components of the R-R series are the result of sinoatrial node depolarization. However, the actual R-R series are contaminated by outliers due to heart rhythm disturbances such as ectopic beats, which ought to be detected and corrected appropriately before HRV analysis. Objective: We have introduced a novel, lightweight, and near real-time method to detect and correct anomalies in the R-R series based on the singular spectrum analysis (SSA). This study aimed to assess the performance of the proposed method in terms of (1) detection performance (sensitivity, specificity, and accuracy); (2) root mean square error (RMSE) between the actual N-N series and the approximated outlier-cleaned R-R series; and (3) how it benchmarks against a competitor in terms of the relative RMSE. Methods: A lightweight SSA-based change-point detection procedure, improved through the use of a cumulative sum control chart with adaptive thresholds to reduce detection delays, monitored the series of R-R intervals in real time. Upon detection of an anomaly, the corrupted segment was substituted with the respective outlier-cleaned approximation obtained using recurrent SSA forecasting. Next, N-N intervals from a 5-minute ECG segment were extracted from each of the 18 records in the MIT-BIH Normal Sinus Rhythm Database. Then, for each such series, a number (randomly drawn integer between 1 and 6) of simulated ectopic beats were inserted at random positions within the series and results were averaged over 1000 Monte Carlo runs. Accordingly, 18,000 R-R records corresponding to 5-minute ECG segments were used to assess the detection performance whereas another 180,000 (10,000 for each record) were used to assess the error introduced in the correction step. Overall 198,000 R-R series were used in this study. Results: The proposed SSA-based algorithm reliably detected outliers in the R-R series and achieved an overall sensitivity of 96.6%, specificity of 98.4% and accuracy of 98.4%. Furthermore, it compared favorably in terms of discrepancies of the cleaned R-R series compared with the actual N-N series, outperforming an established correction method on average by almost 30%. Conclusions: The proposed algorithm, which leverages the power and versatility of the SSA to both automatically detect and correct artifacts in the R-R series, provides an effective and efficient complementary method and a potential alternative to the current manual-editing gold standard. Other important characteristics of the proposed method include the ability to operate in near real-time, the almost entirely model-free nature of the framework which does not require historical training data, and its overall low computational complexity.

  • Source: Flickr; Copyright: Katrin Gilger; URL: https://flic.kr/p/7xQ4eg; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Auralife Instant Blood Pressure App in Measuring Resting Heart Rate: Validation Study

    Abstract:

    Background: mHealth apps that measure heart rate using pulse photoplethysmography (PPG) are classified as class II (moderate-risk) Food and Drug Administration devices; therefore, these devices need clinical validation prior to public release. The Auralife Instant Blood Pressure app (AuraLife IBP app) is an mHealth app that measures blood pressure inaccurately based on a previous validation study. Its ability to measure heart rate has not been previously reported. Objective: The objective of our study was to assess the accuracy and precision of the AuraLife IBP app in measuring heart rate. Methods: We enrolled 85 adults from ambulatory clinics. Two measurements were obtained using the AuraLife IBP app, and 2 other measurements were achieved with a oscillometric device. The order of devices was randomized. Accuracy was assessed by calculating the relative and absolute mean differences between heart rate measurements obtained using each AuraLife IBP app and an average of both standard heart rate measurements. Precision was assessed by calculating the relative and absolute mean differences between individual measurements in the pair for each device. Results: The relative and absolute mean (SD) differences between the devices were 1.1 (3.5) and 2.8 (2.4) beats per minute (BPM), respectively. Meanwhile, the within-device relative and absolute mean differences, respectively, were <0.1 (2.2) and 1.7 (1.4) BPM for the standard device and −0.1 (3.2) and 2.2 (2.3) BPM for the AuraLife IBP app. Conclusions: The AuraLife IBP app had a high degree of accuracy and precision in the measurement of heart rate. This supports the use of PPG technology in smartphones for monitoring resting heart rate.

  • Articulating paper mark area. Source: The Authors; Copyright: The Authors; URL: http://biomedeng.jmir.org/2018/1/e11347; License: Licensed by JMIR.

    Relationship Between the Applied Occlusal Load and the Size of Markings Produced Due to Occlusal Contact Using Dental Articulating Paper and T-Scan:...

    Abstract:

    Background: The proposed experimental design was devised to determine whether a relationship exists between the occlusal load applied and the size of the markings produced from tooth contact when dental articulating paper and T-Scan are interposed alternatively. Objective: The objective of our study was to compare the relationship between contact markings on an articulating paper and T-Scan for an applied occlusal load. Methods: In this in vitro study, dentulous maxillary and mandibular dies were mounted on a metal jig and articulating paper and T-Scan sensor were placed alternatively between the casts. Loads simulating occlusal loads began at 25 N and incrementally continued up to 450 N. The resultant markings (180 marks resulting from articulating paper and 138 from T-Scan) were photographed, and the marks were analyzed using MOTIC image analysis and sketching software. Descriptive statistical analyses were performed using one-way analysis of variance, Student t test, and Pearson correlation coefficient method. Results: Statistical interpretation of the data indicated that with articulating paper, the mark area increased nonlinearly with increasing load and there was a false-positive result. The characteristics of the paper mark appearance did not describe the amount of occlusal load present on a given tooth. The contact marking obtained using T-Scan for an applied occlusal load indicated that the mark area increased with increase in the load and provided more predictable results of actual load content within the occlusal contact. Conclusions: The size of an articulating paper mark may not be a reliable predictor of the actual load content within the occlusal contact, whereas a T-Scan provides more predictable results of the actual load content within the occlusal contact.

  • Source: Pexels; Copyright: bruce mars; URL: https://www.pexels.com/photo/man-with-hand-on-temple-looking-at-laptop-842554/; License: Public Domain (CC0).

    Wireless Surface Electromyography and Skin Temperature Sensors for Biofeedback Treatment of Headache: Validation Study with Stationary Control Equipment

    Abstract:

    Background: The use of wearables and mobile phone apps in medicine is gaining attention. Biofeedback has the potential to exploit the recent advances in mobile health (mHealth) for the treatment of headaches. Objectives: The aim of this study was to assess the validity of selected wireless wearable health monitoring sensors (WHMS) for measuring surface electromyography (SEMG) and peripheral skin temperature in combination with a mobile phone app. This proof of concept will form the basis for developing innovative mHealth delivery of biofeedback treatment among young persons with primary headache. Methods: Sensors fulfilling the following predefined criteria were identified: wireless, small size, low weight, low cost, and simple to use. These sensors were connected to an app and used by 20 healthy volunteers. Validity was assessed through the agreement with simultaneous control measurements made with stationary neurophysiological equipment. The main variables were (1) trapezius muscle tension during different degrees of voluntary contraction and (2) voluntary increase in finger temperature. Data were statistically analyzed using Bland-Altman plots, intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC). Results: The app was programmed to receive data from the wireless sensors, process them, and feed them back to the user through a simple interface. Excellent agreement was found for the temperature sensor regarding increase in temperature (CCC .90; 95% CI 0.83-0.97). Excellent to fair agreement was found for the SEMG sensor. The ICC for the average of 3 repetitions during 4 different target levels ranged from .58 to .81. The wireless sensor showed consistency in muscle tension change during moderate muscle activity. Electrocardiography artifacts were avoided through right-sided use of the SEMG sensors. Participants evaluated the setup as usable and tolerable. Conclusions: This study confirmed the validity of wireless WHMS connected to a mobile phone for monitoring neurophysiological parameters of relevance for biofeedback therapy.

  • Example of the mock skin indurations produced using special effects makeup (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://biomedeng.jmir.org/2017/1/e3/; License: Creative Commons Attribution (CC-BY).

    Measurement of Skin Induration Size Using Smartphone Images and Photogrammetric Reconstruction: Pilot Study

    Abstract:

    Background: The tuberculin skin test (TST) is the most common method for detecting latent tuberculosis infection (LTBI). The test requires that a patient return to the health facility or be visited by a health care worker 48 to 72 hours after the intradermal placement of tuberculin so that the size of the resulting skin induration, if any, can be measured. Objective: This study aimed to propose and evaluate an image-based method for measuring induration size from images captured using a smartphone camera. Methods: We imaged simulated skin indurations, ranging from 4.0 to 19 mm, in 10 subjects using a handheld smartphone, and performed three-dimensional reconstruction of the induration sites using photogrammetry software. An experienced TST reader measured the size of each induration using the standard clinical method. The experienced reader and an inexperienced observer both measured the size of each induration using the software. The agreement between measurements generated by the standard clinical and image-based methods was assessed using the intraclass correlation coefficient (ICC). Inter- and intraobserver agreement for the image-based method was similarly evaluated. Results: Results showed excellent agreement between the standard and image-based measurements performed by the experienced reader with an ICC value of .965. Inter- and intraobserver agreements were also excellent, indicating that experience in reading TSTs is not required with our proposed method. Conclusions: We conclude that the proposed smartphone image-based method is a potential alternative to standard induration size measurement and would enable remote data collection for LTBI screening.

  • Source: Pixabay; Copyright: Gerd Altmann; URL: https://pixabay.com/en/hand-man-bitcoin-keep-present-2308932/; License: Public Domain (CC0).

    Heart Rate Monitoring Apps: Information for Engineers and Researchers About the New European Medical Devices Regulation 2017/745

    Authors List:

    Abstract:

    Background: After years in the making, on April 5, 2017, the European Parliament and Council finally adopted Regulation (EU) 2017/745, the new Medical Devices Regulation (MDR), repealing the existing Medical Device Directive (MDD) 93/42/EEC. Though long anticipated, this shift in policy will have strong and lasting effects in the medical devices industry. Objective: This paper focuses specifically on the classification of software as a potential medical device under MDD and MDR and examines whether or not the regulatory framework for health apps has changed substantially and what, if any, impact is to expected. A particular emphasis will be on the issue of classification uncertainty raised by borderline cases such as heart rate monitoring and well-being apps. The paper primarily targets researchers and engineers unfamiliar with regulatory requirements for medical devices and aims to provide a concise, yet accurate, overview of the European regulatory framework. This is of particular relevance as with the exponential growth of fitness and health-related apps, the lines between toys, lifestyle products, and medical devices have increasingly blurred. Methods: The recently published European Medical Device Regulation is analyzed and compared to the preceding MDD. Results: The previous regulatory framework already provided for the possibility of apps to fall under the definition of medical devices, in which case classification rules for active medical devices applied. However, while applicability of the new regulatory framework still hinges on whether the intended purpose is medical or not, the threshold for classifying as a medical device has been considerably lowered due to a broader interpretation of what constitutes a medical purpose. Conclusions: The adoption of the new European regulation on medical devices entails the risk that manufacturers previously unaffected by the medical devices regulatory framework may now unwillingly and unwittingly find themselves in the arena of medical device manufacturing.

  • Wearable Devices and Smart Watches for Fitness and Hospital Health Tracking. Source: http://photopin.com/free-photos/wearable-medical-devices; Copyright: BrotherUK; URL: http://www.flickr.com/photos/146431122@N02/31501281284; License: Creative Commons Attribution (CC-BY).

    Motivations and Key Features for a Wearable Device for Continuous Monitoring of Breathing: A Web-Based Survey

    Abstract:

    Background: Analysis of patterns of breathing over time may provide novel information on respiratory function and dysfunction. Devices that continuously record and analyze breathing rates may provide new options for the management of respiratory diseases. However, there is a lack of information about design characteristics that would make such devices user-friendly and suitable for this purpose. Objective: Our aim was to determine key device attributes and user requirements for a wearable device to be used for long-term monitoring of breathing. Methods: An online survey was conducted between June and July 2016. Participants were predominantly recruited via the Woolcock Institute of Medical Research database of volunteers, as well as staff and students. Information regarding the survey, a consent form, and a link to a Web-based questionnaire were sent to participants via email. All participants received an identical survey; those with doctor-diagnosed asthma completed an extra questionnaire on asthma control (Asthma Control Test). Survey responses were examined as a group using descriptive statistics. Responses were compared between those with and without asthma using the chi-square test. Results: The survey was completed by 134 participants (males: 39%, median age group: 50-59 years, asthma: 57%). Of those who completed the Asthma Control Test, 61% (47/77) had suboptimal asthma control. Of the 134 participants, 61.9% (83/134) would be willing to wear a device to monitor their breathing, in contrast to 6.7% (9/134) who would not. The remaining 31.3% (42/134) stated that their willingness depended on specific factors. Participants with asthma most commonly cited their asthma as motivation for using a wearable; the most common motivation for use in those without asthma was curiosity. More than 90% of total participants would use the device during the day, night, or both day and night. Design preferences among all users included a wrist watch (nominated by 92.5% [124/134] for both day and night use, out of four body sites), the ability to synchronize breathing data with a mobile phone or tablet (81.3%, 109/134), overnight power charging (33.6%, 45/134), and a cost of ≤Aus $100 (53.7%, 72/134). Conclusions: We have explored the motivations and likelihood for adopting wearable technologies for the purpose of monitoring breathing and identified user preferences for key design features. We found participants were motivated to adopt a wearable breathing monitor irrespective of health status, though rationale for use differed between those with and without asthma. These findings will help inform the design of a user-acceptable wearable device that will facilitate its eventual uptake in both healthy and asthma populations.

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  • Cloud based ecosystem for behavioural and physical monitoring in free-living context: a technical evaluation study for reliability assessment

    Date Submitted: Jul 10, 2019

    Open Peer Review Period: Jul 15, 2019 - Sep 9, 2019

    Background: Smartphone usage is widely spreading in the society. Functions and sensors embedded in these devices may play an importnat role in healthcare monitoring and intervention planning. However,...

    Background: Smartphone usage is widely spreading in the society. Functions and sensors embedded in these devices may play an importnat role in healthcare monitoring and intervention planning. However, the usage of smartphone as a relevant tool for intrapersonal continuous behavioral and physical monotoring is not yet fully supported by adequate studies addressing technical reliability and acceptance. Objective: The objective of this paper is to identify and discuss technical issues that may impact on the wide usage of smartphones as clinical monitoring tools. Main focus is on the quality of the acquired data and the transparency of the data acquisition process to the user daily life. Methods: QuantifyMyPerson (QMP) is a complete architecture for continuous acquisition of smartphone usage features and embedded sensors data. The platform consists of a mobile app running on the smartphone for data acquisition, a backend cloud server for data storing and processing and a web-based dashboard for users' management and data visualization. The data processing is aimed at the extraction of meaningful features for the description of the daily life accoridng ot the existing literature. These features include phone switching on and off, calls, apps usage, GPS and accelerometer data. 12 health subjects installed on their personal smartphones and run the mobile app for and overall period of 7 months. The acquired data were analysed to assess their quality in terms of impact on the daily life of the smartphone (i.e. battery consumption and anomalies in functioning) as well as data integrity. Data integrity was computed as the ratio of app running time and total smartphone working time. Relevance of the selected features in describing changes in daily life was assessed through the computation of a k-NN Global Anomaly Score aimed at detecting days that "differ" from the others with the aim of using the platform to trigger potential modification in daily lifestyle. Results: The effectiveness of smartphone-based continuous monitoring depends on the acceptability and interoperability of the system to increase users' retention and on integrity of the acquired data. Acceptability was confirmed by the full transparency of the app once installed and the absence of any anomaly in smartphone usage when the mobile app is running. The only negative issue pointed out in acceptability was the battery consumption. Even if the trend of battery drain with and without mobile app running was comparable, the users complain about this. Referring interoperability, the app was successfully installed and run on several brands and models of Android-based smartphones. It has to be pointed out that some smartphone manufacturers implement power saving policies that do not allow a continuous acquisition of data from embedded sensors so impacting on data integrity. Data integrity was 96% on smartphones without power saving policies and 84% overall. Conclusions: The results of the testing pointed out two main issues that may impact on spreading of continuous behavioural and physical monitoring in free living conditions. On one side there is the battery consumption. However the issue, mainly due to GPS triangulation is limited. It is expected that users motivated to have the app running on their smartphone because of health or wellness related aims may better accept the increasing in battery consumption. On the other side there are the power saving policies of some manufacturing impacting on the continuity of data acquisition. Also this aspect revealed to be not highly relevant in daily life. Because the embedded sensors are re-activated by any event happening on the smartphone, the missing data demonstrated to be related to periods of non usage of the phone in which the activity data would have been anyway null. The key need to have continuous monitoring running on any smartphone to assure no impact in daily habits widely justifies the partial data loss. According to the results of this feasibility test, wide spreading of continuous monitoring on the end user side seem to be fully feasible. Quality of data processing, depending on specific aims of the investigation, as well as usage of the data from the clinical operators is not part of this paper and require further investigation.

  • Immersive virtual reality in healthcare: A systematic review of technology and disease states

    Date Submitted: Jun 15, 2019

    Open Peer Review Period: Jun 18, 2019 - Aug 13, 2019

    Background: IVR presents interesting possibilities for application in the field of healthcare. Healthcare professionals can now immerse their patients in environments to achieve exposure to a specific...

    Background: IVR presents interesting possibilities for application in the field of healthcare. Healthcare professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, to evoke targeted emotional responses, to inspire or to distract from an experience occurring in reality. Objective: To identify the patient-focused applications for immersive virtual reality (IVR) for treatment of acute health conditions and determine the technical specifications of the systems used. Methods: A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. Databases include PubMed, EMBASE, CINAHL, ACM, IEEE, Scopus, and Web of Science. Search terms relating to health and immersive virtual reality were used. To be included studies had to investigate the effectiveness of immersive virtual reality for the treatment of an acute non-chronic specific health condition. Immersive virtual reality was defined as a platform that provides virtual and auditory immersion for the participant and includes a minimum of 3-degrees of position and/or orientation tracking. Once identified, data was extracted from articles and aggregated in a narrative review format. Results: The 58 studies were conducted in 19 countries. The studies reported IVR use for five main clinical areas; neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and other (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=29). Conclusions: Overall IVR has a promising future in healthcare, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for treatment of acute conditions evidence for the effectiveness of IVR is still developing. Clinical Trial: N/A

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