CMBES Proceedings

Lending a Hand

Marium Japanwala — Wed, 26 Jun 2024 00:00:00 -0700

Introduction: Colonoscopy is an important tool in the detection and prevention of colorectal cancer [1]. In the largest survey-based study for endoscopic related injuries (ERI) in gastroenterologists, 71% of respondents reported an ERI. More than half of the respondents (63.3%) reported pain in thumb followed by hands/fingers (59%) [2].

The endoscopist uses the left thumb to turn angular dials to steer the endoscope’s tip during the procedure. This thumb provides all the mechanical force to turn the colonoscopes tip and repeatedly exerts this force to negotiate colonic turns. The current design has not been altered much since its development [3].

Objective: The primary objective of this research is to make a more ergonomic design for the interaction interface of the colonoscope. The study will compare the ergonomic performance of endoscopists when using a directional pad compared to angular wheels for colonoscopic control.

Methods: The first phase of this study will be the development of a directional pad (D-pad) to replace the angular wheels of the colonoscope. The D-pad will translate the up-down, left-right wheel functions directly into its counterpart buttons.

The second phase of this study is a cross-sectional paired design analysis to compare endoscopists’ performance on the two interfaces. Participants will include six expert endoscopists and six trainees who will train on the new model until they reach their best cecal intubation time. The participants will then be asked to perform eight consecutive cecal intubations on a simulator. In between each intubation, grip strength will be measured using a hand grip dynamometer. The mental workload of the endoscopist using each technique will be identified using the self-reported NASA task Load Index. Non-parametric Wilcoxon analysis will be used to analyze the difference in scores between the devices.

Gold Nanoparticles Loaded with Cannabinoids for Targeted Cancer Therapy

Wed, 26 Jun 2024 00:00:00 -0700

In recent years, numerous scientific studies have highlighted the advantages of natural anti-cancer agents. Many research groups have found that cannabinoids can inhibit tumor progression by impeding the proliferation of cancer cells, promoting apoptosis, and inducing cell cycle arrest, among other effects. However, the bioavailability of cannabinoids is very low due to their hydrophobic nature, gastric instability, and rapid metabolism. To improve its bioavailability, nanotechnological innovations can serve as crucial tools for developing new therapeutic strategies. In this respect we have designed a green protocol to simultaneously synthesize and load spherical GNPs with cannabidiol (CBD) by using a cocktail of two reducing agents viz. trisodium citrate and l-tyrosine. l-tyrosine, a hydrophobic α‑amino acid, binds strongly to the surface of GNPs through its amine group, thus creating hydrophobic pockets on the surface layer that serve as attachment site for cannabinoids via non-covalent interactions. The cannabinoid loaded colloidal gold solution was bright red in color and displayed a sharp plasmon band at around ~530 nm. We conducted cell viability tests on different cancer cell lines using the colorimetric MTT assay. In all cases, cannabinoid loaded onto GNPs were significantly more effective in killing cancer cells than their simple aqueous solution. Cells were seeded in a 96-well cell culture plate at a density of 10⁴ cells/well and treated with increasing concentrations of cannabinoids (i.e., free and attached cannabinoids on GNPs). As an example, for SK-BR-3 (a human breast cell line), IC₅₀ of free CBD was approximately 13 µM, whereas that of CBD loaded on GNPs was approximately 9 µM. Subsequently, 3D in vitro cell culture experiments were conducted on MDA-MB-231 spheroids, where cannabinoids loaded on GNPs outperformed the pure compounds. These results suggest that GNPs served as efficient nanocarriers for delivering cannabinoids into cancerous cells, highlighting the potential of cannabinoid-loaded GNPs as future of cancer therapy.

The Adhesion behaviour of Schwann cells on PVA-based hydrogel substrates

Larissa Marlene yakam djomatchoua — Wed, 26 Jun 2024 00:00:00 -0700

INTRODUCTION

Up to a billion people worldwide are affected by
neurological injuries and disorders, which
constitute a major public health problem. [1]
Injuries to peripheral nerves are common and
have a major impact on quality of life. [2] The
peripheral nervous system, as the main vector of
communication between the brain and the rest of
the body, relies on a set of essential glial cells,
including Schwann cells. These cells play a
fundamental role in nerve regeneration and the
formation of the myelin sheath, which are crucial
for the rapid transmission of nerve impulses.
Schwann cells supply neurons with key
extracellular matrix factors, such as laminin and
collagen IV, as well as nerve growth factors,
which stimulate neurite growth and the function of
peripheral neurons. They are also involved in
nerve repair after injury. [3]
Context

However, one of the major challenges in neural
tissue engineering lies in the regulation of neurite
growth to develop functional and organized tissue
structures. This requires the design of
biomaterials that provide essential mechanical
and biochemical cues to promote cell adhesion,
survival, and growth.
Objective

This study aims to analyze the adhesion
behaviour of Schwann cells on PVA-based
hydrogel materials.

Methodology

Firstly, we will examine two hydrogel copolymer
technologies: PVA-MA co-polymerized with
methacrylate gelatin (Gel- MA) and methacrylate
gelatin (Gel-MA) to determine which of these
hydrogels offers better cell adhesion. Secondly,
we will assess the suitability of the best
performing hydrogel substrate for neurite growth
by creating 3D microchannels. Finally, we will
evaluate the results and propose future
suggestions.

Choice of material

It was hypothesized that a support with
mechanical properties similar to those of neural
tissue would provide Schwann cells with
conditions conducive to their development, which
would in turn promote the survival and
development of neurons. PVA-MA copolymerized
with methacrylate gelatin (Gel-MA) or
methacrylate Poly-I-Lysine (PLL-MA) is chosen
because it has mechanical properties similar to
those of nervous tissues, has more
physiologically relevant morphologies and has
increased expression of extracellular matrix
proteins. [4]

Conclusion

In sum, our study lays the foundations for a
promising investigation of the interactions
between Schwann cells and PVA-based
hydrogels in the context of nerve regeneration.
The materials selected for their mechanical
properties and characteristics similar to nerve
tissues offer exciting prospects for future
research. We are confident that this
multidisciplinary approach will contribute to the
advancement of our understanding of nerve
regeneration and open up new perspectives for

the treatment of peripheral nerve injuries, even
though we are still in the early stage of scientific
adventure. This study demonstrates the
importance of tissue engineering research in
improving the quality of life of people suffering
from these disorders.
Key words: Peripheral nerve damage, Schwann
cells, Biomaterials, hydrogels, Nerve
regeneration, Extracellular matrices, Neurites, 3D
microchannel.

Effect of co-contraction and muscle strength on muscle-tendon dynamics

Wed, 26 Jun 2024 00:00:00 -0700

I. INTRODUCTION

Muscular co-contraction may be necessary for maintaining stability on uneven surfaces. However, co-contraction analyses are limited due to a sole reliance on electromyography (EMG) measurements, infrequent analysis on uneven terrain, and a focus on muscles stabilizing the hip, knee, and ankle joints—overlooking the 33 joints of the foot and ankle [1]. One such joint is the subtalar joint, crucial for stability in the medial and lateral directions. Recent evidence indicates that co-contraction may influence muscle-tendon dynamics [2]. Yet, the impact of co-contraction on muscle-tendon dynamics, particularly in stabilizing the subtalar joint under mediolateral perturbations, remains unclear. In addition, studies indicate that co-contraction may be essential for populations with reduced muscle strength [3]. However, no study investigates how co-contraction impacts muscle-tendon dynamics while humans with reduced muscle strength walk on mediolaterally unstable surfaces.

The first aim studies how muscles crossing the subtalar joint contribute to foot stabilization and how co-contraction strategies affect muscle-tendon dynamics in young healthy adults. The second aim mirrors the first but employs modelling walking behavior in a reduced strength scenario.

II. METHODS

20 young participants walked on a force-instrumented treadmill at a slow, preferred, and fast walking speed wearing five different 3D printed footwear conditions promoting or limiting foot pronation (Fig. 1). 30 reflective markers were placed over body landmarks and tracked using a 12 – camera motion capture. EMG activity of the tibialis anterior (TA), peroneus longus, and peroneus tertius (PT) was measured using surface electrodes. The TA and PB were imaged with two B-mode ultrasound probes.

Co-contraction was assessed for the TA/PL and TA/PT muscle pairs through two metrics: 1) the ratio of total antagonist to agonist muscle activity and 2) the ratio of total antagonist to agonist muscle moments. For the reduced strength model muscle-driven simulations will be created where maximal isometric forces will be reduced by 30% [4].

Fig. 1 3D – printed footwear conditions.

III. RESULTS AND EXPECTED RESULTS

Using metric 1, no significant differences (p < 0.05) were found in co-contraction of the TA/PL and TA/PL muscle pairs across all footwear conditions. Using metric 2, we anticipate increased co-contraction on uneven surfaces and at higher walking speeds. Co-contraction is expected to cause muscle-tendon units to operate more optimally, either by operating at their optimal length or isometrically.

For the reduced strength model, it is expected that co-contraction will increase on uneven surfaces with both metrics and relative to younger adults. Co-contraction will also not increase with increased walking speeds, relative to the slowest walking speed. Compared to younger adults, co-contraction may cause muscles to not function at their optimal length and/or isometrically.

ACKNOWLEDGEMENTS

NSERC awarded to M.J. Asmussen funded this study.

REFERENCES

Banks C. L et al. (2017) Electromyography exposes heterogeneity in muscle co-contraction following stroke. Front Neurol 8:699
Dick T. J et al. (2021) Series elasticity facilitates safe plantar plexor muscle-tendon shock absorption during perturbed human hopping Proc Royal Soc B 288:1947
Ebisu S et al. (2022) Decrease in force control among older adults under unpredictable conditions. Exp Gerontol 158:111649
Webber S. C et al. (2009) Modelling age-related neuromuscular changes in humans. Appl Physiol Nutr Metab 34:732-744

Examining the Effect of Supraphysiological Insulin in an In Vitro Insulin Infusion Cannula Host Response Model

Grace Riddell, Lindsay Fitzpatrick, Katrina Gee — Wed, 26 Jun 2024 00:00:00 -0700

Continuous subcutaneous insulin infusion (CSII), better known as "pump therapy" is a widely used and relatively effective insulin replacement strategy for individuals living with type 1 diabetes. However, the insulin infusion set (IIS) portion of the pump represents the most signifigant limitation of these devices, with a current wear time of just 2-3 days. Prolonged use of an IIS places individuals at risk for serious adverse events associated with poor glycemic management, including unexplained hyperglycemia and diabetic ketoacidosis. This limitation is often attributed to a local inflammatory host response, which is largely carried out by macrophages that interact with the cannula surface and its adsorbed protein layer. Additional emerging research has demonstrated that the insulin molecule itself can cause significant changes to local tissue which in turn may contribute to impaired IIS performance observed with extended wear time. Here, we present a novel in vitro model used to examine the effect of supraphysiological concentrations of insulin on the inflammatory responses of macrophages to mimic host responses to the IIS. Present data suggests that supraphysiological cocentrations of insulin, like those present at the infusion site, tend to exacerbate the pro-inflammatory macrophage response to IIS cannulas.

Examining the Integration of Digital Technology for Ankle-Foot Orthosis Registration and Quantitative Shape Comparison

Connor Matton, Ali Hussaini, Harry Sivasambu, Jan Andrysek — Wed, 26 Jun 2024 00:00:00 -0700

Ankle-foot deformities can affect an individual’s gait and cause increased pain and discomfort during the activities of daily living. This can significantly affect quality of life and lead to further complications and health-related risks. Custom-made ankle-foot orthotics (AFOs) are widely used in patient care and rehabilitation to improve and restore ankle-foot positioning, support, mobility, and stability. The traditional approach in designing custom-made AFOs relies heavily on the experience and craftsmanship of the orthotist during shape capture, design, and fabrication [1].

Digital workflows in orthotics, including design and fabrication of AFOs, are advancing patient care and rehabilitation by improving the quality and consistency of assistive devices [2]. These workflows include a series of steps that automate tasks and processes within an organization. Recent breakthroughs in digital technology have the potential of transforming the design processes of orthoses by replacing traditional methods. Digital workflows typically involve using an optical scanner to capture the foot shape, and computer-aided design and computer-aided manufacturing (CAD/CAM) systems to optimize the shape and fabricate the AFO. The use of digital technology requires less physical labor, allows models to be easily stored, modified, and replaced, and increases design flexibility. However, it remains a challenge to translate the subjective skills of orthotists into the digital realm [3]. Creating a visual representation of the areas of shape change during manual fabrication helps quantify the design process. This is often referred to as digital mapping. Registration is the process of digitally overlaying or superimposing two shapes with respect to each other. This is necessary to compare, or digitally map, different types of AFO workflows and designs. Current registration methods require the use of anatomical landmarks or reflective markers as reference points for aligning two shapes [4]. This process is inefficient and tedious. Therefore, this study serves to investigate and validate a suitable registration method that will streamline the process of aligning digital AFO models for shape comparison. This proposed digital algorithm will be used to align and compare AFO models acquired using both traditional and digital shape capture methods.

The constraints and limitations of current registration methods were identified by systematically testing the alignment digital models. An optimized registration algorithm using both iterative closest points (ICP) and principal component analysis (PCA) was developed and evaluated to align digital AFO models. Evaluations were conducted by aligning digital AFO models with known deformations to their original shapes. While ICP and PCA were ineffective on their own, results showed that these methods could be used together to obtain accurate registration for shapes misaligned in both translation and rotation.

In collaboration with the Department of Orthotics and Prosthetics (O&P) at the Holland Bloorview Kids Rehabilitation Hospital (HBKRH), participants prescribed a unilateral or bilateral AFO will be recruited. The participant will undergo traditional and digital shape capture in the same session. Scanning the ankle and foot directly will allow for alignment corrections to be applied digitally before quantitatively comparing the shapes. This work is essential in adopting full digital workflows for AFOs. It will also help improve digital technologies for orthotic and prosthetic practice.

A 3D-printed model of the subarachnoid space to study the role of meningothelial cells during optic nerve compartmentalization

Subashree Srinivasan — Wed, 26 Jun 2024 00:00:00 -0700

The cerebrospinal fluid (CSF)-filled subarachnoid space (SAS) between the arachnoid and pia mater is lined by meningothelial cells (MECs) and are in direct contact with flowing CSF. MECs are thought to contribute to maintaining CSF equilibrium by secreting proteins and eliminating neurotoxic waste via endocytosis. As CSF homeostasis is critical for neuronal function, MECs are deemed neuroprotective. Therefore to study MEC metabolism during optic nerve compartment syndrome, we developed a 3D-printed, perfusable SAS model compatible with confocal microscopy under (patho)physiological flow conditions.

Raman Microspectroscopy and Machine Learning: A Perspective for Tissue Remodelling Characterization

Natasha Kunchur, Dr. Louise-Hackett, Dr. Mostaço-Guidolin — Wed, 26 Jun 2024 00:00:00 -0700

Using novel technologies of the multimodal RM-SHG imaging system and machine learning (ML), we explore tissue remodelling. With ML, the imaged biochemical spatial maps of the tissues are characterized, and the main biomarkers associated with remodelling are identified.

Finite Element Modeling of an Uncoiled Cochlea Using Synchrotron Radiation-Phase Contrast Imaging

Nastaran Shakourifar, Seyed Alireza Rohani, Sumit Agrawal, Hanif Ladak — Wed, 26 Jun 2024 00:00:00 -0700

The cochlea is the spiral shaped end organ of hearing that contains the basilar membrane (BM) which separates cochlear scalae. Although the entire BM vibrates during stimulation, it has been shown that the perceived sound pitch is linked to the location of maximum deformation along the BM. Current computational models adjust the BM Young’s modulus to match the Greenwood function. The objective of this study is to investigate the effects of a realistic cochlear shape on the tuned BM Young’s modulus. A finite-element model of an uncoiled cochlea was constructed. The cochlear dimensions were derived from Synchrotron Radiation-Phase Contrast Imaging (SR-PCI) scans. Material properties, and boundary conditions were taken from the literature, and the BM Young’s modulus was calibrated so simulation results matched the Greenwood function over the auditory frequency spectrum. The simulated location of maximal BM displacement matched the Greenwood function after tuning the BM Young’s modulus. This value differs from the calibrated value found in the literature. This difference could arise because an unrealistic rectangular cross-sectional geometry was used in the literature. Therefore, obtaining accurate Young’s modulus needs a more realistic geometry.

Modeling fibroblast cells movement

Contesini, Zoya Versey, Elizabeth John, Leila Mostaço-Guidolin — Wed, 26 Jun 2024 00:00:00 -0700

Inspired by the success of Mathematical and Computational modeling in different fields, we study the movement of fibroblast cells and how they contribute to tissue fibrosis. With this approach, we can quantify the magnitude and scale of the mechanisms that drive these cell’s movement, and identify the conditions that lead to an increase of cell density. This approach allows us to optimize the costs and time of in-vitro experiments, while reproducing conditions which could be linked to fibrosis, and potentially elucidate possible paths to the development of novel treatments for fibrosis.

Evaluating the impact of biomaterials on modulating tumour-associated macrophages

Wed, 26 Jun 2024 00:00:00 -0700

In recent years, biomaterials have been widely used for developing tumour models to help us gain a better understanding of tumour microenvironment (TME). Macrophages, as immune cells, play a significant role in the TME and exhibit plasticity based on their environment. This work aimed to assess the fundamental impact of biomaterials on the functionality of macrophages.

Evolution of Clinical Engineering with the Growing Pressures on Healthcare and the Changing Landscape of Information, Communication and Automation Technology

Nima Esmailzadeh — Wed, 26 Jun 2024 00:00:00 -0700

A few decades ago in the Canadian hospital sector, Clinical Engineering (CE) and Information Technology (IT) were on disparate trajectories such that underlying connectivity technologies, management approaches and strategic planning were generally not aligned between these departments. Beginning in the early 2010s however, there has been a steady and now accelerating convergence and alignment between the two.

During the same time period, healthcare organizations have also been facing increasing pressures on both the labour and financial fronts. In particular, labour shortages, high prices for technology, equipment, supplies and services, as well as cost increases to treat sicker patients over longer stays have all been ballooning hospital expenses. From that perspective, while healthcare is one the most labour intensive industries in the economy, strategic digital health investments in this information-intensive industry can possibly improve productivity and reduce stress on the system as a whole.

Now, with the convergence of CE & IT, as medical technology continues to become integrated into systems and the line between medical, communication, and information systems continues to blur, there is an opportunity to expand CE activities within this digital health transformation with a special focus on information, communication and automation technology (ICAT). That is, considering the intersection of its roles and responsibilities between patient safety, financial stewardship and medical technology, clinical engineers are well positioned and have the appropriate set of skills and expertise to lead the various phases required to plan for/design/build/operationalize ICAT to: improve quality of care outcomes; improve patient and staff safety; improve patient experience and staff satisfaction; generate efficiencies (e.g., virtual Care, automation, clinical decision support, data analytics, mobility); enable effective communication between healthcare staff; allow for effective alarm management; improve data availability for research; enhance patient flow management capabilities. Hence, clinical engineers can become key contributors in reducing the two main pressures within our healthcare system through a well thought-out ICAT strategy. Sinai Health’s CE team has started expanding their activities to support digital health transformation through some recent work: remote patient monitoring; alarm management and secondary alarming; secure messaging and communication device planning.

Developing Future In-House Radiology Service Technologists

Emily Rose — Wed, 26 Jun 2024 00:00:00 -0700

Lower Mainland Biomedical Engineering (LMBME) Radiology Service group provides in-house service for medical imaging equipment across 28 acute hospital sites. The scarcity of qualified Radiology Service Technologists (RST) poses a risk to long-term sustainability of in-house radiology service. To bridge the gap between a Biomedical Engineering Technologist and a full-scope RST, a unique job description was created for a RST apprentice. The apprentice program has provided a viable path to fill future retirement vacancies and team expansions. This initiative can be shared with other service organizations looking to strategize around recruitment and retention of highly qualified RSTs and build a successful, sustainable in-house service for medical imaging systems.

In vitro screening of inflammatory responses to polypropylene-based surgical mesh used in the treatment of pelvic organ prolapse

Kaylee A Fennell, Katrina Gee, Laura A Wells — Wed, 26 Jun 2024 00:00:00 -0700

Polypropylene-based mesh used to treat pelvic organ prolapse and stress urinary incontinence was repurposed for gynecological surgery without clinical or pre-clinical testing leading to women facing adverse reactions. Foreign materials implanted in the body activate an immune response that can result in chronic inflammation often causing rejection of the material or pain. We present a novel in vitro method to screen inflammatory responses to surgical mesh where it was found that introducing mesh to polarized macrophages induced an increased expression of inflammatory proteins and genes.

Synergizing Spectrotemporal Dynamics and Filterbank Common Spatial Pattern for Decoding Imagined Speech from EEG

Fatemeh Bagheri, Behrad TaghiBeyglou — Wed, 26 Jun 2024 00:00:00 -0700

In this study, we investigated the feasibility of using spectrotemporal features, including 5th-order autoregressive model coefficients, the second norm of the 3rd-level discrete wavelet transform, and overall energy encompassed in the power spectral density, in conjunction with filterbank common spatial pattern (FBCSP) to classify three imagined words (rock, paper, and scissor) using electroencephalogram (EEG) signals. The dataset that is used in this research was released in the 3rd Iranian BCI competition (iBCIC2020) and was recorded from 15 right-handed healthy adults. Our results indicate that the average accuracy and Cohen's kappa on all participants is 44.37± 5.04% and 0.42 ± 0.07, respectively, which is superior in terms of kappa value compared to the previous literature (average accuracy of 51.2% and kappa of 0.36).

Impact of 12 weeks of robotic walking on contracture and spasticity in children with cerebral palsy

Kiran Isapure — Wed, 26 Jun 2024 00:00:00 -0700

Introduction

Cerebral palsy (CP) is the most common cause for physical disability in children and is a result of a lesion of the developing brain [1].

Most children with CP have muscle contracture and spasticity. Spasticity is defined as a velocity-dependent increase in tonic stretch reflexes to phasic stretch, in the absence of voluntary activity and contracture is defined as a pathological condition that causes stiffness, resistance to movement and reduced range of motion in joints [2]. Both contracture and spasticity contribute to resistance to movement.

Recently robotic devices have increasingly been utilized to provide the experience of walking [3]. In doing so, they provide repeated voluntary or passive knee extensions and thus may help reduce contracture and/or spasticity.

We aim to evaluate the impact of 12 weeks of robotic walking on muscle contracture and spasticity in children with CP.

Methods

Six participants (3 females, 3 males, age 5-24 years) with severe CP (Gross Motor Function Classification System IV-V), who were unable to walk independently, underwent 12 weeks of robotic walking. Passive ramp-and-hold knee extensions were performed at two speeds (10°/sec and 30°/sec) using a Biodex dynamometer before and after training.

Limb weight at each position was measured during 10°/sec stretches that had no muscle activity. The limb weight was subtracted from the torques recorded at 30 deg/s.

Torque at 30° knee flexion was measured. Muscle Stiffness was calculated as change in torque/degree from 60° to 30°knee flexion.

Figure 1: Change in Muscle stiffness and Torque at 30° knee flexion.

After 12 weeks of robotic walking, participants showed significant reduction in muscle stiffness(p=0.031). While a consistent reduction in torque at 30° knee flexion was observed, it did not reach statistical significance(p=0.0625).

Conclusion

Our results suggest that robotic walking may show reductions in spasticity and contracture in children with CP. Additional testing should be completed to make conclusions.

References

Rosenbaum, Peter et al. “A report: the definition and classification of cerebral palsy April 2006.” Developmental medicine and child neurology. Supplement vol. 109 (2007): 8-14.
Lance JW. The control of muscle tone, reflexes, and movement:Robert Wartenberg Lecture. Neurology 1980;30:1303–131.
Morone, Giovanni et al. “Clinical features of patients who might benefit more from walking robotic training.” Restorative neurology and neuroscience vol. 36,2 (2018): 293-299. doi:10.3233/RNN-170799

Optimizing Preventive Maintenance Strategy at The Ottawa Hospital through the Application of Alternative Equipment Maintenance

Maryam Sangargir, Joel Brose — Wed, 26 Jun 2024 00:00:00 -0700

With the goal of improving Preventive Maintenance (PM) practices, The Ottawa Hospital (TOH) has launched the Alternative Equipment Management (AEM) project. AEM introduces a systematic approach for scenarios where there is a need to deviate from manufacturer-recommended maintenance recommendations, aligning practices with the hospital's specific needs. This evaluation focuses on safety prioritization, the integration of World Health Organization (WHO) guidelines, and establishing a dedicated AEM committee.

Capillary Microfluidic Systems for Precise Microparticle Separation

Mohsen Hassani, Amir Sanati Nezhad — Wed, 26 Jun 2024 00:00:00 -0700

This study introduces an innovative capillary-based microfluidic system for precise microparticle separation. Fabricated with a Co₂ laser, the multi-layered microfluidic allows efficient particle manipulation within microchannels. Experimental validation demonstrates high-throughput processing within two minutes, showcasing its potential for rapid diagnostics in diverse applications.

Metabolic Reprogramming of Host Cells Induced by Cancer Cells: Implications for Premetastatic Niche Formation

Maryam Vatani, Ms. — Wed, 26 Jun 2024 00:00:00 -0700

The effect of cell-cell interactions in promoting metabolic alterations and transition of normal fibroblasts to CAFs were investigated using the MIMETAS OrganoPlate 3-lane 40 platform, revealing a significant decrease in Gln concentration, and increase in L-glutamic acid production by MRC5 cells following cancer cell-lung cell crosstalk. The observed metabolic shift suggests the potential transition of normal lung fibroblasts towards a CAF phenotype, indicating their contribution to creating a favorable environment for hosting cancer cells before their arrival.

A Smart Bili-wrapper: A Low-cost Phototherapy device for Low Resource Setting

Williams Baah — Wed, 26 Jun 2024 00:00:00 -0700

Phototherapy is a medical treatment in which natural or artificial light is used to improve the health condition of a patient (usually a neonate). It is used to treat newborn jaundice by lowering the bilirubin levels in a baby's blood through a process called photo-oxidation. Photo-oxidation adds oxygen to the bilirubin so it dissolves easily in water. More than 60% of all newborns suffer neonatal jaundice with the majority of these infants from developing countries without access to adequate phototherapy treatment. The neonatal mortality rate for Nigeria is 35.9 deaths per 1,000 live births. Six out of ten term babies and eight out of ten preterm babies are affected by neonatal jaundice according to the World Health Organization. This work sought to develop a smart low-cost potable device to administer phototherapy service to infants suffering from jaundice in low resource settings where access to standard healthcare services is a challenge. The design uses an embedded blue light source in a covering cloth for the neonate and incorporates a temperature regulating and alarm system to avoid excessive heat to the neonate. The test and evaluation results obtained confirm the technology is promising and viable to positively impact many lives, especially in sub-Saharan Africa where neonatal mortality is predominant.

Creation of a smart template library for digital transradial prosthetic socket design

Vishal Pendse, Calvin C Ngan, Jan Andrysek — Wed, 26 Jun 2024 00:00:00 -0700

The prosthetic socket is an important interface between a residual limb and prosthesis. Its fabrication traditionally relies on manual plaster casting, which is subjective and time-consuming. Digital socket design—utilizing 3D scanning, software-based rectification, and 3D printing—offers a more efficient approach; however, it has been difficult to translate the manual, hands-on skills of clinicians to software on a computer screen. This study addresses this gap by aiming to create a digital shape library of transradial residual limbs and their corresponding sockets, which can be used by prosthetists as an evidence-based reference system when designing a new client’s prosthesis. A matching algorithm will be developed to categorize limbs based on certain shape parameters; this algorithm can be used to match a new client’s residual limb with one from the developed library, whose corresponding socket shape can be used as a smart template, which acts as a validated basis for digital socket design. Preliminary results indicate that this matching algorithm can be based on i) normalizing the models according to their length; ii) slicing the model along the vertical axis to obtain 2D regions; and iii) comparing these 2D regions using certain parameters, including the Sørenson–Dice coefficient, circularity, and cross-sectional area. Sockets fabricated using this method will be validated both qualitatively (using the socket comfort score and QUEST questionnaire) and quantitatively (through shape comparisons with traditionally fabricated sockets). This initial library will be continuously updated with new shapes and data obtained through collaboration and continued patient care. The templatization of socket design can decrease the frequency of patient visits, improve patient outcomes through increased standardization, and significantly reduce clinicians’ workloads by simplifying software-based rectification. Furthermore, its incorporation into digital socket design workflows can increase accessibility to healthcare, particularly in remote or resource-deprived regions

The synthesis and biodegradability of silver nanoparticles doped ZIF-8 composites injectable hydrogel.

Weng Chi Iong, Rong-Fuh Louh — Wed, 26 Jun 2024 00:00:00 -0700

This study is aimed to investigate the incorporation of homemade ZIF-8 nanocarriers with PEG injectable hydrogel. ZIF-8 is currently approved to be a potential drug nanocarrier that is biocompatible for a number of biomedical applications. In this study, the ZIF-8 nanocarrier is doped with sliver nanoparticles (AgNPs) which result in a synergistic antibacterial effect. Both stability and degradation of ZIF-8 are closely related to the amount and release rate. The ZIF-8 based injectable hydrogel can be successfully synthesized at room temperature. By exposing specimens in water and in PBS solution media for designated time intervals (12~72 hrs), changes in size and morphology as well as elemental distribution were observed by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS).

Understanding Covert Speech: Experiences with and Usability of Covert Speech for AAC Systems

Sonja Bonar, T. Claire Davies, Beata Batorowicz, Shane Pinder — Wed, 26 Jun 2024 00:00:00 -0700

Augmentative and alternative communication (AAC) systems are communication options for individuals who cannot reliably communicate verbally. The use of AAC systems allows individuals to grow relationships and enhance participation in societal activities. The use of covert, or inner, speech has the potential to be an intuitive communication method when decoded with a brain computer interface (BCI) and used as an AAC method. However, the most prominent theories on the development of inner speech neglect populations with disabilities. The purpose of this study is to gain insight into covert speech experiences of individuals with motor and communication disabilities or who use augmentative and alternative communication devices as their main form of communication. Through surveying, we seek to understand whether individuals with motor and communication disabilities use covert speech when processing commands and if covert speech can be decoded from BCI interface signals and used for AAC systems.

Effects of sex and footwear stiffness on lower limb running biomechanics

Vivian Nguyen, Banin Al-Shimari, Marco Perizzolo, Michael Asmussen — Wed, 26 Jun 2024 00:00:00 -0700

I. INTRODUCTION

Footwear longitudinal bending stiffness has been shown to affect a variety of running biomechanics and performance variables [1]. Even though footwear stiffness affects running biomechanics, the majority of studies have focused primarily on male participants [2]. However, it is known there are many differences between sexes such as body mass, lower limb muscle strength and size, and tendon stiffness, which could all influence running performance and how individuals adapt to footwear with different stiffness [3]. With respect to tendon stiffness, differences in the ratio of collagen fiber types, sensitivity to cellular signals, and total water content of tendons cause variation in tendon composition between sexes [3]. These sex-specific differences in tendon properties might influence how individuals adapt to footwear stiffness differently.

The aim of this study was to determine the sex-specific effects of running in footwear with different longitudinal bending stiffness on lower limb biomechanics.

II. METHODS

_{20 participants (10 male and 10 female) ran on a force-instrumented treadmill at 3.5 m/s in three different shoe conditions (Fig. 1). The shoe conditions were a minimalist shoe that was flexible and had either 1) no, 2) 1mm carbon fiber plate, or 3) 1.5mm carbon fiber plate to vary the longitudinal bending stiffness of the shoe. 23 retroreflective markers were placed over body landmarks and tracked using a 12-camera motion capture system. Participants ran for 30 seconds at each condition to assess a number of biomechanical running variables of the person’s right leg.}

III. RESULTS AND EXPECTED RESULTS

Increased footwear longitudinal bending stiffness is anticipated to decrease negative joint work and increase positive joint work at the MTP joint for both sexes compared to the control shoe. It is expected that metatarsophalangeal (MTP) moments will be significantly higher for males than for female runners. Males are expected to have stiffer tendons than females which have the potential to resist deformation or store more elastic energy during the loading or deceleration phase. Therefore, male runners are expected to exhibit a greater decrease in negative work and increase in positive work at the MTP joint compared to female runners when running in stiffer shoes. Additionally, increased footwear longitudinal bending stiffness is anticipated to decrease positive joint work at the ankle, knee, and hip joint for both sexes compared to less stiff shoes. Male runners are expected to exhibit a greater decrease in positive joint work at the ankle, knee and hip joint compared to female runners when running in stiffer shoes.

The results of this study are expected to contribute to the overall understanding of why and how different sexes adapt their running biomechanics based on footwear stiffness. This information will help shoe manufacturers design footwear that is specific for males and females.

ACKNOWLEDGEMENTS

NSERC awarded to MJA funded this study.

REFERENCES

Nigg, B. M., Stefanyshyn, D. J., Denoth, J. (2000). Work and energy – mechanical considerations. Biomechanics and biology of human movement., 5- 18.
Morio, C., & Flores, N. (2017). Effect of shoe bending stiffness on lower limb kinetics of female recreational runners. Computer Methods in Biomechanics and Biomedical Engineering, 20, 139–140..
Kubo, K., Kanehisa, H., & Fukunaga, T. (2003). Gender differences in the viscoelastic properties of tendon structures. European Journal of Applied Physiology, 88(6), 520–526.

HALO CT Phantom: Successful Implementation for Continuous Dose Monitoring

Douglas McTaggart — Wed, 26 Jun 2024 00:00:00 -0700

The HALO CT phantom design addresses the problem of the inability of current CT phantoms to measure absorbed dose with a physical size that is light and easy to setup. This new phantom design will allow a continuous dose monitoring program to be implemented.

Developing an Avatar in Virtual Reality for Mental Health Treatment

Amir Bani Saeed, Zahra Moussavi, Bruce Hardy — Wed, 26 Jun 2024 00:00:00 -0700

This paper explores the development of a naturalistic avatar as a digital representation of a person in VR, with the potential for utilization in mental health treatment. The avatar is created based on an image, incorporating intricate facial expressions, synchronized lip movements, and lifelike body gestures. The immersive VR setup utilizes the Oculus Rift headset and Unity's game engine for seamless integration. In the future, our goal is to use the avatar to represent an Indigenous healer in a virtual farm designed based on Indigenous culture, investigating the opportunities it may have in addressing mental health issues among Indigenous youth.

Pseudo-CT Image Generation from Magnetic Resonance Imaging (MRI) Using Generative Adversarial Networks (GANs) for Radiation Therapy Planning

Nicola Billings, Ryan Appleby, Amin Komeili, Eranga Ukwatta — Wed, 26 Jun 2024 00:00:00 -0700

Introduction

Radiation therapy plans require CT imaging to generate electron density maps for dose prescription and MRI imaging to aid in tumor delineation. This dual imaging approach significantly increases the cost, time investment, and congestion within veterinary imaging departments. The objective of this study is to observe if GANs can develop accurate pseudo-CT images from MRI images for radiation therapy planning.

Methods

This study acquired radiation therapy head standard CT images and T2 TRAN + C 3D FSPGR head MRI images for 45 non-brachycephalic canines with brain tumors who received radiation therapy at the Ontario Veterinary College. Image preprocessing for this study involved down sampling the CT images, rigidly registering the MRI and CT images, and normalizing the pixel data between 0 and 1. A conditional GAN (CGAN) with a U-Net encoder and PatchGAN classifier for the discriminator was used to generate the pseudo-CT images. Quantitative performance metrics for this study include mean absolute error (MAE), peak signal to noise ratio (PSNR), normalized mutual information (NMI), and dice scores for the entire cranial cavity and bone. Qualitative assessment for the pseudo-CT images involved having veterinary radiologist rank the quality of the pseudo-CT images in comparison to the actual CT images on a scale of 1 (poor quality) to 5 (exceptional quality).

Results

The average MAE was 142.92 ± 6.29 HU, the PSNR was 43.03 ± 6.29 dB, and the NMI was 0.64. The dice similarity score for the entire cranial cavity (fat, white matter, grey matter, water, and bone) was 0.718, where as the dice similarity score for just bone was 0.361. All these metrics were calculated between the actual CT images and the pseudo-CT images. For qualitative results the average score given by the veterinary radiologists was a 2 (low quality).

Conclusion

This model can produce relatively accurate pseudo-CT images; however, other types of GANS should be explored as this model is unable to produce detailed enough pseudo-CT images to be used for clinical diagnoses as seen from the ranking provided by the veterinary radiologists. This model demonstrates that MRI-based radiation therapy planning may be possible in veterinary medicine with further exploration.

3D Printing for Biomedical Technologists

Larry Cortez — Wed, 26 Jun 2024 00:00:00 -0700

Fundamental to health technology management (HTM) is to promote equipment uptime so staff/patients have the tools they need to provide exemplary care. This is typically achieved this via two maintenance activities. First, we conduct unscheduled maintenance using a “find and fix” approach. Second, we conduct scheduled maintenance as part of “predict and prevent” approach. However, very few medical devices benefit from schedule maintenance.(1) Therefore, there is a need to augment our ability to “predict and prevent” medical device issues.

Human factors science indicates that to prevent issues, person-focused interventions (which attempt to change knowledge; e.g., in-service training) are less effective than system-focused changes (which attempt to eliminate the issue by changing the underlying design; e.g., forcing functions).(2) Yet, in HTM we often focus on the former as they are perceived as requiring less effort(2) and that only manufacturers can change medical device design.

In 2021, the Medical Engineering Department at the University Health Network, Toronto, purchased a 3D printer. The intent was to challenge this paradigm and augment equipment uptime by preventing medical device issues through improved design. Since then, the printer has been in continuous use.

This presentation aims to support those not yet 3D-printing to start to do so, and for those already 3D-printing, to further embed this technology within HTM. This presentation will highlight:

How to implement 3D printing in an HTM department to address safety issues (e.g., equipment, software, training)
3D prints we have created, from simple to advanced 3D object designs; samples and their impacts will be shown.
Challenges and tips to ensure successful 3D printing and designs
Next steps to advance 3D printing in HTM (e.g., open source designs)

In summary, 3-D printing can prevent medical device issues and promote equipment uptime, and thus should become a standard and essential tool in HTM departments.

A Neural Learning-Based Approach for EOG Artifact Removal from EEG

Fatemeh Bagheri, Behrad TaghiBeyglou — Mon, 01 Jul 2024 00:00:00 -0700

In this paper, we proposed a novel methodology that combines a long short-term memory (LSTM)-based neural network with independent component analysis (ICA) to address the challenge of removing electrooculogram (EOG) artifacts from contaminated electroencephalogram (EEG) signals. Our approach achieved two primary objectives: 1) to estimate the horizontal and vertical EOG signals from the contaminated EEG data, and 2) to utilize ICA to eliminate the estimated EOG signals from the EEG, thereby generating an artifact-free EEG signal. To evaluate the effectiveness of our proposed method, we conducted experiments on a publicly available dataset consisting of recordings from 27 participants. We utilized established metrics such as mean squared error, mean absolute error, and mean error to assess the quality of our artifact removal technique. Furthermore, we compared the performance of our approach with two state-of-the-art deep learning-based methods reported in the literature, illustrating the superior performance of our proposed methodology.

Semi-Automation Of The Ki-67 Proliferative Index Quantification Method In Breast Cancer

Wed, 26 Jun 2024 00:00:00 -0700

In this retrospective study, the primary aim was to assess Ki-67 expression levels in breast cancer slide samples and analyze agreement among values obtained by different counting methods, including semi-automated approaches. The Ki-67 proliferative index, a crucial marker for assessing cell proliferation and predicting prognosis in breast cancer, was evaluated through three distinct methods: visual counting, manual counting by two calibrated observers, and a semi-automated approach. All mean values of the Intra-Class Correlation Coefficient obtained were statistically significant (p < 0.01). The lowest coefficient occurred in the comparison between the semi-automated program count and visual counting (0.791), while the highest correlation was between the program count and manual counting (0.996). This study underscores the importance of standardization and reliable methods in Ki-67 evaluation for precise interpretations and consistency in breast cancer cases, where the Ki-67 index plays a critical role in predicting disease progression and guiding treatment decisions.

Enabling Secondary Alerting for Patient Monitoring

Becky Ng — Wed, 26 Jun 2024 00:00:00 -0700

Secondary alerting is the capability of a system to elevate a subset of standard alarms in a way that is useful clinicians. The purpose of leveraging a secondary alarming system is to create a distinction between highly relevant and actionable alarms, and less important alarms. In creating this distinction, we can address alarm fatigue, increasing patient safety and enhancing clinical workflow. While the use case for secondary alarming is well documented and often requested by clinical teams, these systems are rarely implemented in Canadian hospitals due to the challenge of technical implementation and management. At Mount Sinai Hospital, we have functioning secondary alerting systems in place for physiological monitoring in both our Intensive Care Unit, and Neonatal Intensive Care Unit. Furthermore, we are working towards implementing secondary alerting for vitals monitoring and smart bed alarms in our Medical/Surgical in patient floors. This presentation will lay out the steps taken to initiate the project, build the clinical decision making body, hire the correct vendors, design and build the technical system components, enable clinical training and orientation, and manage the system post-implementation. It will also highlight the importance of the Clinical Engineering team to facilitate the execution of this type of project.

Implementation and Maintenance of a Smart Bed System

Becky Ng, Nima Esmailzadeh — Wed, 26 Jun 2024 00:00:00 -0700

In 2019, Sinai Health was in a precarious situation with the status of its hospital bed fleet. The bed frames ranged from 15-20 years of age, and the mattresses were a comprised of a dozen different models. The lack of standardization caused confusion to end users, and general difficulty with supplying patients with the correct bed and mattress for their needs. One interim approach to addresses these needs were to rent mattresses as needed, which contributed to significant equipment rental costs. Recognizing these challenges, and the high risk of mass bed frame failures, the Clinical Engineering team embarked on a fleet replacement of the beds. This project saw the replacement of 340 frames and mattresses. While this method of full fleet replacement creates a large capital cost upfront, it enables the standardization of equipment which optimizes staff workflows and knowledge retention, also therefore increasing patient safety. It also allowed Sinai Health to build out the infrastructure to create a full smart bed solution including bed locators, which communicate with a server to log bed availability and status. Another infrastructure piece which is enabled for use by standardizing the bed type is alerting. For use where there’s risk of patient falls, the new beds are equipment with built-in patient exit alarms. Tracking of this data in year 1 of the bed replacement showed a 50% reduction in patient falls, and a 42.5% reduction in equipment rental costs. The new bed fleet has now been in place for over two years, and there is still optimization and maintenance work to be done. One item being worked on is to have secondary alerts sent to nurse phones to alert them of the patient exit alarms. Secondly, we are working to optimize the use of the server data to ensure continued uptime of the bed fleet. Another initiative is to optimize the workflow around low air loss and other specialty mattresses.

In this paper or presentation, we will present the workflow followed to achieve the current state at Sinai Health, future steps to continue optimizing the system, as well as lessons learnt and suggestions to improve the process for others.

Canadian Biomedical Technologists:

Sonia Pinkney, Devika Jain, Ishtar Al-Tahir, Marie-Ange Janvier, Anikke Rioux — Wed, 26 Jun 2024 00:00:00 -0700

The benefits of workplace diversity, including gender diversity, are well documented and range from improved creativity/innovation, decision-making, team satisfaction and quality of work[1]. Achieving these outcomes requires more than simply pursuing diverse staff demographics; it must also include harnessing the diversity through systemic change[1]. However, examining staff demographics provides a good first step for reflection and learning. In the field of health technology management, research shows strong representation of women-identifying students and staff in biomedical engineering roles[2,4,5], suggesting that the perception of a collaborative, multidisciplinary, high human impact, and “helping” profession draw in women-identifying engineers[2,3,5]. In contrast, less focus has been paid to the gender diversity in biomedical technologist roles, with anecdotes that women-identifying technologists are underrepresented. While biomedical technologists are similar to engineers (i.e., collaborative, multidisciplinary, high human impact, “helping” profession), there may be distinct barriers in attracting and retaining women-identifying technologists. Identifying gender demographics in the biomedical technologist pipeline – from student applications to colleges to staff hiring and retention – will help confirm if there is a lack of gender diversity and if so, provide a foundation to explore opportunities for targeted interventions and improve and harness gender diversity.

Analysis on gender diversity within the biomedical technologist career pipeline is being investigated. At the technical college level, British Columbia Institute of Technology reports an intake average of women-identifying biomedical technologist students of 32%, and a graduating average of women-identifying students of 33% from 2008 to 2021. Ontario’s Centennial College has a similar intake average of women-identifying biomedical technologist students of 35% between 2018-2023.

A Canada-wide survey was conducted in 2023 to better understand the gender diversity in hospital health technology management departments. From 14 departments that responded, the number of women-identifying healthcare technology management professionals is 27% of the full professional makeup. Staff in the biomedical technologist role are 16% women-identifying.

Preliminary data is confirming that there is insufficient gender diversity in both our colleges and workforce, with a potential reduction of women-identifying technologists during job recruitment and retention. To help inform further discussions and targeted interventions, data continues to be gathered.

Strategies to load curcumin into poly(2-hydroxyethyl methacrylate)-based disks to increase controlled release time for intraocular lenses

Christopher A. Rayner, Laura A. Wells — Wed, 26 Jun 2024 00:00:00 -0700

I. Introduction

The Canadian Council of the Blind estimates that 3.7 million Canadians were living with cataracts in 2019 [1]. Treatment involves replacing the diseased lens with a prosthetic intraocular lens (IOL). After surgery, patients apply eye drops with anti-inflammatories and antibiotics but the drugs’ low retention times on the eye and poor diffusion through the eye limit their effectiveness. Furthermore, reactive oxygen species can promote epithelial to mesenchymal transition in lens epithelial cells contributing to posterior capsule opacification [2]. Curcumin inhibits these transitions at low concentrations of 10 μM [3], but easily degrades and is hydrophobic making ocular delivery challenging [4]. We hypothesized solvent-based loading strategies would allow high amounts of curcumin to be loaded into IOL materials to protect the curcumin and allow controlled release over months.

II. Materials and Methods

Hydrogel disks were made by polymerizing 71 mol% 2-hydroxyethyl methacrylate, 7 mol% methyl methacrylate, 21 mol% acrylamide, and 1 mol% ethylene glycol dimethacrylate through free radical polymerization (Irgacure-1173 and UV light). The disks were dried and loaded with curcumin using a variety of acetone:water ratios, concentrations, and incubation times, and then dried to remove solvents. After reswelling, each disk was incubated in 3 mL of phosphate buffered saline (PBS) and periodically, solutions were replaced with fresh PBS and the releasate measured spectrophotometrically. At the conclusion of the release studies, 2,2-diphenyl-1-picrylhydrazyl (DPPH•) assays were done on the remaining encapsulated curcumin (after its extraction) and compared to fresh solutions.

III. Results and Discussion

The resulting disks were similar to IOLs with a water content of ~45%, transmittance of 90% (375-700 nm), and refractive index of 1.42 ± 0.002. Incubation of disks with curcumin solutions of high acetone:water ratios enabled high loading of curcumin without damage to the disks. Curcumin appeared to slightly reduce disk swelling, and Figure 1 shows its extended release for over 60 days with potential for greater than 90 days (three months) of release based on assessments of the remaining curcumin content, longer than many ocular delivery systems loaded using soaking techniques which deliver over days or weeks [5]. Release rates of 0.0029 ± 0.0002 μmol/day (Loading Ratio 1) and 0.0027 ± 0.0003 μmol/day (Loading Ratio 2) were observed in the release studies from Fig. 1 after 25 days (p < 0.05). Precipitate found on the disks suggest dissolution was the mechanism of release, protecting the curcumin. The curcumin remaining in the hydrogel disks after 60 days was measured to have the same scavenging capability to fresh solutions of matched concentration (p > 0.05). Curcumin typically degrades quickly in solution (60% degradation in one hour with light exposure) [4] but the disks protected the curcumin over the lengthy release studies.

Fig. 1 Release of curcumin into PBS (pH 7.4, 37°C) (± 1 SD, n=3).

IV. Conclusion

Loading solutions with mixtures of acetone and water enabled the high loading of curcumin into the hydrogel disks. After 25 days, its release was independent of loading and continued past two months. Curcumin loaded into poly(2-hydroxyethyl methacrylate)-based disks maintain activity upon release over extended periods of time.

REFERENCES

CCB, “The cost of vision loss and blindness in Canada”, Deloitte Access Economics, Sydney, AUS, May 2021.
Kubo, et al., “Roles of TGF β and FGF Signals in the Lens: Tropomyosin Regulation for Posterior Capsule Opacity”, Int. J. Mol. Sci., vol. 19, no. 10, p. 3093, 2018.
Liu, et al., “Curcumin Inhibits Proliferation and Epithelial-Mesenchymal Transition in Lens Epithelial Cells through Multiple Pathways”, BioMed Res. Int., vol. 2020, no. 6061894, 2020.
Appendino, et al., “Shedding light on curcumin stability”, Fitoterapia, vol. 156, no. 105084, 2022.
Topete, et al., “Intraocular lenses as drug delivery devices”, Int. J. Pharm., vol. 602, no. 120613, 2021.

3D Printing Method for Upper-Limb Diagnostic Sockets: A Technical Note

Katrina Meng, Calvin C Ngan, Harry Sivasambu, Jan Andrysek — Wed, 26 Jun 2024 00:00:00 -0700

A diagnostic socket is commonly used by prosthetists to assess and optimize the fit and comfort of the device on the patient before fabricating the definitive socket. As such, it must be transparent, rigid, and thermoformable. However, a viable method for 3D printing a diagnostic socket meeting these criteria has yet to be established. Therefore, the objective of this study is to present a clinically viable approach to 3D print diagnostic sockets for upper-limb prosthetics.

In this study, a Fused Deposition Modelling (FDM) 3D printer was selected due to its accessibility, cost-effectiveness, and desired part properties. Commonly used thermoplastic filaments were evaluated. Printing parameters such as layer height, shell thickness, and number of perimeters were optimized to enhance transparency and rigidity. Post-processing techniques were explored to improve transparency.

Five diagnostic sockets were created using polyvinyl butyral (PVB) filament with specific printing parameters and underwent successful clinical assessments by prosthetists. Feedback from both prosthetists and patients confirmed that the 3D printed sockets met transparency, rigidity, and thermoformability criteria, making them a promising alternative to traditional sockets. This research underscores the potential of FDM 3D printing for affordable and accessible prosthetic socket fabrication, with implications for transforming traditional clinical practice to a digital process.

Preliminary characterization of rectification for three-quarter transradial prosthetic sockets

Wed, 26 Jun 2024 00:00:00 -0700

Achieving proper socket fit is crucial for the effective use of a prosthesis. However, digital socket design lacks standardization and presents a steep learning curve for prosthetists. While research has focused on digital socket design for the lower-limb population, there is a research gap in upper-limb socket design. This study aimed to characterize the design (rectification) process for the transradial socket, specifically the three-quarter design, towards the development of a more systematic, data-driven socket design approach. Fourteen (n=14) pairs of unrectified and rectified plaster models were compared. Six common rectification zones were identified through shape analysis, with zones of plaster addition being the most prominent in terms of volume and surface area. A novel 3D vector mapping technique was employed, which revealed that most of the shape changes occurred in the anterior–posterior and proximal–distal directions. Overall, the interquartile range of each rectification zone demonstrated reasonable consistency in terms of volume, surface deviation, and 3D vector representation. The initial findings from this study support the potential for quantitively modelling the transradial socket design process. This opens the door for developing tools for categorizing and predicting socket designs across diverse populations through the application of techniques such as machine learning.

Development and Assessment of a Wearable Biofeedback System to Elicit Gait Changes using Rhythmic Auditory Stimulation

Aliaa Gouda, Dr. Jan Andrysek — Wed, 26 Jun 2024 00:00:00 -0700

Temporal gait asymmetry (TGA) is commonly observed in individuals facing mobility challenges. Rhythmic auditory stimulation (RAS) can improve temporal gait parameters by promoting synchronization with external cues. While biofeedback for gait training, providing real-time feedback based on specific gait parameters measured, has been proven to successfully elicit changes in gait patterns, RAS-based biofeedback as a treatment for TGA has not been extensively explored. In this study, a wearable RAS-based biofeedback gait training system was developed to measure temporal gait symmetry in real-time and deliver RAS accordingly. Three different RAS-based biofeedback strategies were compared: open- and closed-loop RAS at constant and variable target levels. The objectives were to induce TGA in able-bodied individuals using RAS, characterize each strategy's impact on TGA, and assess the response and workload using NASA-TLX. Ten AB participants underwent gait training to induce TGA at different asymmetry levels. All three strategies enabled participants to achieve TGA compared to baseline. However, participants could not precisely match the target symmetry, suggesting the importance of setting RAS targets close to true symmetry in gait training for mobility-challenged populations. Notably, speed and cadence remained largely unchanged during RAS-based biofeedback gait training. Comparing all three strategies, participants' performance was similar. Future research should focus on long-term evaluations of RAS-based biofeedback gait training and explore these strategies with specific patient groups and gait disorders. These findings hold promise for developing personalized and effective gait training interventions to address TGA in patient populations with mobility limitations.

The Supraphysiological Insulin Levels Amplify Pro-Inflammatory Response and Induce Apoptosis in Macrophages: An In Vitro Cell-Material Interaction Model

Yuxi Zhang, Lindsay Fitzpatrick — Wed, 26 Jun 2024 00:00:00 -0700

INTRODUCTION

Continuous subcutaneous insulin infusion is a pivotal method of managing Type 1 diabetes, relying on the effectiveness of insulin infusion sets (IIS) to ensure the reliable delivery of insulin to a subcutaneous depot [1]. However, IIS face challenges marked by short wear time and high failure rates [2]. Emerging evidence idicates that the local inflammatory response to the IIS cannula may play a role in both the limited wear time and unreliable insulin adsorption [3-5]. However, a comprehensive understanding of the underlying mechanisms remains elusive. This study integrates a selected supraphysiological insulin concentration range with the “tissue damage” protein adsorption model. The primary objective is to investigate key parameters related to macrophage response, including nuclear factor-κB (NF-κB) and activating protein 1 (AP-1) activity, ROS accumulation, as well as assessments of cell density, viability, and apoptosis. The findings aim to advance our knowledge in the field and potentially inform strategies for enhancing the reliability of IIS in the management Type 1 diabetes.

METHODS

3T3 fibroblast lysate were pre-adsorbed on tissue culture plates (TCPs) to model the damage-associated molecular patterns (DAMPs) released from tissue injury. A relevant supraphysiological insulin concentration range (0.1~10 U/ml) at the infusion site was chosen. Humulin-N (Eli Lilly), an insulin analog, was introduced to adherent RAW-Blue reporter macrophages on lysate-adsorbed surfaces to examine the impact on macrophage inflammatory response. NF-B/AP-1 dependent macrophage pro-inflammatory activity was assessed using the Quanti-Blue alkaline phosphatase activity assay (InvivoGen), normalized to cell density via QuantiFlour dsDNA assay (Promega). Intracellular ROS was measured with ROS-ID Total Detection Kit (Enzo Life Science) and normalized to adherent cell density. Statistical analysis employed a two-way ANOVA with Dunnett’s post hoc (n= 6-8). Real-time apoptotic cell measurement used the IncuCyte® Zoom imaging system (Essen BioScience) with multiplex staining of IncuCyte® Caspase-3/7 green dye. Data were collected via IncuCyte® Live-Cell Analysis System and plotted in GraphPad Prism software.

RESULTS AND CONCLUSION

Supraphysiological insulin concentration (0.5~10 U/ml) enhanced the NF-kB/AP-1 activity and enhanced ROS accumulation at insulin concentration of 5 U/ml in macrophages on lysate-adsorbed surfaces. Notably, insulin had no significant impact on NF-B/AP-1 nor ROS in the absence of the inflammatory stimulus. Moreover, supraphysiological insulin (5 U/ml) induced macrophages apoptosis both with and without lysate adsorption.

In summary, the study demonstrates that insulin concentration ( 10 U/ml) alone had no significant effect, but concentration ( 0.5 U/ml) enhanced the activity of pro-inflammatory transcription factors NF-kB and AP-1, and showed significant increased intracellular ROS and increased macrophage apoptosis at 5 U/ml when combined with an inflammatory stimulus. This study contributes to the emerging evidence that infused insulin contributes to an enhanced inflammatory response to IIS.

ACKNOWLEDGEMENTS

Funding for this work was provided from the Canadian Institute of Health Research Project Grant and the Queen’s University Special Research Fund.

REFERENCES

Heinemann, L., et al., J. Diabetes Sci. Technol, 2012.
Flores, M., et al., BMJ Open Diabetes Res. Care, 2020.
Hauzenberger, J. R. et al., Diabetes Technol. Ther.2017.
Eisler, G. et al., BMJ Open Diabetes Res. Care, 2019.
Regittnig, W. et al., Diabetes Obes. Metab. 2022.

Women in Science and Engineering: The importance of visibility

Dr. Monique Frize, P.Eng., O.C., Dr. Claire Deschênes, Marina Bokovay — Wed, 26 Jun 2024 00:00:00 -0700

The article discusses how to increase the visibility of women scientists and engineers and their contributions in these fields. One way to discover women is to find papers describing their work and their lives. The Canadian Institute for Women in Science and Engineering-L’Institut canadien pour les femmes en ingénierie et en sciences (CIWES-ICFIS) began to collaborate with the University of Ottawa Library to encourage women to donate their papers. The project began in 2014 and has now close to 500 links with such donations in archives across Canada. Historians, researchers, and writers can find women and include them in their books on science, engineering, and technology. Another important source of information on women’s participation in science and engineering is through their technical presentations at conferences. A conference series: International Conference of Women Engineers and Scientists (ICWES), was unique in several ways: It was attended mostly by women, and presentations could be on a technical topic or on gender issues; it was held in various countries around the world between 1964 and today. A book has just been published on this extraordinary adventure.

Time Domain Cluster Analysis of Human Activity Using Triaxial Accelerometer Data

Krunoslav Jurcic, Ratko Magjarevic — Wed, 26 Jun 2024 00:00:00 -0700

This paper presents a cluster analysis of raw tri-axial accelerometer data aquired from various human physical activities as well as simulated falls. Clustering was performed using K Means, Gaussian Mixed Model and Fuzzy C-Means clustering. In our analysis we focused on two problems: the first clustering problem was based on activity recognition and differentiation from simulated human falls, while the other problem focused on distinction between single jerk events (e.g. jumping, falling) and continuous activity signals (e.g. running, walking).

Wearable microfluidic biosensor for real-time cortisol monitoring

Wed, 26 Jun 2024 00:00:00 -0700

Abstract

The impact of stress on physical and mental health is significant. The increased levels of cortisol observed during stress are reflected in its release from sweat glands, providing an external sweat biomarker for monitoring stress states. However, current approaches to utilize wearable sensors for monitoring sweat cortisol encounter challenges related to effective sweat management and the real-time and high-sensitivity detection of cortisol. Addressing this gap, we introduce a flexible and scalable capillary microfluidic device integrated with sensors.

Predicting Hip Kinematics during Cycling Task with CNN

Reza Ahmadi, Parsaei Parsaei, Amin Komeili — Wed, 26 Jun 2024 00:00:00 -0700

To understand the biomechanics of cycling, it is essential to precisely measure and monitor joint kinematics and kinetics, which aids in optimizing performance and preventing injuries. The traditional method of analyzing hip joint kinematics in cycling using motion capture system is constrained by high costs, limited accessibility, and lack of real-time applicability in clinical and training environments. To address this gap, this study leveraged a Convolutional Neural Networks (CNNs) model to predict the hip joint kinematics during pedaling task on a stationary cycling ergometer. The present study involved 10 participants, comprising eight males and two females, devoid of musculoskeletal disorders, to ensure the purity and relevance of the data. Using the Vicon motion capture system, a comprehensive dataset of hip joint kinematics parameters were collected. The CNN model, designed with five hidden layers, was meticulously trained on this dataset.

Our results showed a notable accuracy in predicting hip joint kinematics parameters using CNN, with a Root Mean Square Error (RMSE) of 2.98±0.61° for hip flexion, 1.51±0.46° for hip adduction, and 1.73±0.49° for hip rotation. These values, within acceptable limits, demonstrate the model's robustness in hip measurements. This research tried to underscore the efficacy of deep learning in biomechanical applications, particularly for healthcare and sports applications.

This study contributes significantly to the biomechanical study of the hip joint, offering a potential integration of predictive models and real-time monitoring of hip joint kinematics during cycling exercise with stationary ergometers. This CNN-based technology has the potential to be employed in studies where a motion capture lab is not available.

SAM Zero-Shot detection of vertebral surfaces from freehand 3D ultrasound

Sen Li, Farida Cheriet, Catherine Laporte — Wed, 26 Jun 2024 00:00:00 -0700

Freehand 3D ultrasound imaging has emerged as a promising modality for spine imaging due to its non-invasive nature and cost-effectiveness. Accurate extraction of the 3D bone surface from freehand ultrasound image sequences is crucial for comprehensive interpretation of spinal structures, geometric spine deformity analysis, and for guiding ultrasound-assisted spine interventions. However, the vertical bone surface adjacent to the spinous process is usually invisible in ultrasound scans. In this preliminary study, a novel method for tissue-bone separation utilizing landmark-guided SAM is proposed to achieve accurate 3D bone surface reconstruction from low-quality ultrasound image sequences. The resulting bone surface, represented as a 3D mesh, effectively reproduces a smooth outline of the vertebra, encompassing the left lamina, spinous process, and right lamina. To evaluate the performance of the proposed method, we collected three freehand ultrasound sequences from three participants. The acoustic shadow masks beneath the extracted bone surface were evaluated against manually labeled masks, achieving a mean IoU above 0.92. Our evaluation on one human subject’s data reveals a mean surface distance of the extracted lumbar vertebral surfaces of 0.61±0.12 mm.

A Scoping Review of Current Methodologies of Measuring Cardiopulmonary Coupling and their Limitations in Sleep Apnea Detection

Wed, 26 Jun 2024 00:00:00 -0700

Cardiopulmonary coupling (CPC) analysis is a noninvasive technique increasingly used to evaluate the autonomic nervous system's control over heart and respiratory functions, particularly during sleep. This review delves into current methods
of CPC analysis, including the preprocessing of electrocardiogram (ECG) signals, extraction of meaningful measures, and features,
and the use of machine-learning classification for sleep-related diseases. The review also examines different patient cohorts in the
existing literature and the efficiency and accuracy of automated sleep apnea detection, highlighting the limitations and potential of these methodologies in clinical settings.

Predict Knee Kinematics During Stationary Cycling via Machine Learning Regression Models

Atousa Parsaei, Reza Ahmadi, Saied Jalal Aboodarda, Amin Komeili — Wed, 26 Jun 2024 00:00:00 -0700

To improve athletes' performance and prevent injuries, an understanding of the kinematics of lower limbs is becoming increasingly important in rehabilitating lower extremities with cycling ergometer, particularly the knees. Multiple methods are being used for capturing motion and simulating kinematics of motion. Motion capture system is a common method for motion studies, which includes placement of reflective markers on the lower limbs (at about 36 locations), as well as the use of cameras to track the trajectory of markers. However, these methods require complex and expensive equipment, are limited to the laboratory environment, might face some difficulties in finding some trajectories, and are typically expensive and time-consuming. The purpose of this study is to integrate Machine Learning methods with data from a motion capture system to develop a model that can predict where markers will be placed on the knee on the basis of an individual’s anthropometric information and the cycling device dimensions. There are several advantages to this method, including the possibility of expanding it to studies of other parts of the body, and saving time and costs in comparison to capture motion systems. Improving and optimizing the proposed method will pave the road for developing efficient and cost-effective methods for conducting kinematics analyses.

Assessing the Impact of Asthma on Cardiopulmonary Metrics in Patients with Obstructive Sleep Apnea

Wed, 26 Jun 2024 00:00:00 -0700

This study explores the relationship between obstructive sleep apnea (OSA) and asthma, focusing on the impact of asthma attacks on nocturnal cardiopulmonary metrics in individuals with moderate OSA. Polysomnography data from 38 subjects with and without asthma attacks were analyzed to extract pre- and post-sleep metrics related to heart rate, heart rate variability, oxygen saturation, and hypopnea events. A significant difference was found in the percentage of time spent in Stage 2 of non-rapid eye movement sleep between subjects with and without asthma. Additionally, significant differences were found in arterial oxygen saturation pre- and post-sleep in the non-asthma group. Future research should further explore temporal patterns and variations across sleep stages, apnea events, and hypopnea events to better understand the intricate relationship between asthma and OSA.

Innovative Strategy for Quality Control of Preparing Molecularly Imprinted Polymer Biosensor for Grail Fibrillary Acidic Protein Detection

Wed, 26 Jun 2024 00:00:00 -0700

The reproducibility of biosensors is an important parameter for mass-production of biosensors in different applications. In this paper, the novel strategy for screening the electrodes has been introduced to improve the reliability and performance of fabricated molecularly imprinted polymer biosensors that is the main challenge of the almost research in this field. In this strategy, we just use the non-interfering quality controls during the fabrication procedures. By using electro-fabrication approach for each step of preparation and analyzing their results, we could make the perfect decision about screening of electrodes. According to this strategy, we could prepare reproducible biosensors for detection of grail fibrillary acidic protein (GFAP). As the bare screen-printed electrodes suffer from a lack of reproducibility because of variable resistance, capacitance or electroactive area, the percent of preparing the repetitive and good performance GFAP biosensors to bare electrodes is about 36 % (13 of 36). The impedance electrochemical results showed the efficient performance of this novel approach for preparing high quality MIP biosensors.

Electro-fabrication of Molecular Imprinted Polymer Biosensor: Efficient Approach to Achieve Reliable and Reproducible Biosensors

Bahareh Babamiri — Wed, 26 Jun 2024 00:00:00 -0700

In this investigation, a reagent-less and ultrasensitive electrochemical biosensors by stabilizing electrodeposited Prussian blue nanoparticles (PB NPs) as the embedded redox probe was designed based on the concept of molecularly imprinted polymers (MIP) as artificial receptors for highly sensitive and specific detection of agmatine. The MIP biosensor was fabricated by the electrodeposition of PB, electropolymerization of pyrrole (Py) in the presence of agmatine as a template molecule, and electro-cleaning of template molecules, which each electrosynthesis step of the MIP biosensors has been monitored by electrochemical approach. The presence of Prussian blue in the structure of the MIP biosensor provides the possibility of monitoring all the fabrication steps of the biosensor through electrochemical methods which leads to screening the electrodes during electrosynthesis of MIP biosensors that can be used as an efficient quality control (QC) approach to achieve reproducible MIP biosensors.

Thermography-based Breast Abnormality Detection using Siamese Network

Ankita Dey, Prof. Sreeraman Rajan — Wed, 26 Jun 2024 00:00:00 -0700

Thermography is a potential imaging modality for early breast abnormality detection. Both breasts of a healthy individual have a similar temperature distribution. Thermal asymmetry between the left and the right breasts may indicate the presence of an abnormality. This work introduces a novel Siamese network for learning the similarity between the left and the right breast thermogram images to identify breast abnormalities. This work also proposes a novel algorithm to identify breast abnormalities using the similarity scores obtained from the introduced Siamese network. A comparison of the proposed breast abnormality detection methodology at different margin values is presented. The proposed methodology using the Siamese network achieves an accuracy of 81% with a standard error of 0.3% when the margin was set to 1. All evaluations are done using a publicly available dataset.

A Smart Recommender System to Stratify Heart Attack Risk

Almat Bolatbekov — Wed, 26 Jun 2024 00:00:00 -0700

Heart diseases are a major cause of mortality and morbidity. Faster detection of life-threatening emergency events and an earlier start of the therapy would save many lives and reduce successive disabilities. We developed an automated smart recommender system (Explainable Artificial Intelligence) for heart attack prediction and risk stratification. This study is focused on an improved recommender approach to identify key risk factors impacting risk stratification for a particular patient. To help patients and clinicians better understand specific risk factors associated with heart attack and the degree of association, we used CatBoost classifier to build the model and SHAP to interpret its results. The risk factors that can be measured using smart monitoring wearable devices are called dynamic, while other risk factors obtained from users directly are static. The system collects both factor types to predict a heart attack risk. We created a Django-based online application that uses patient data to update medical information about an individual’s heart attack risk. Moreover, the individual can quickly locate nearby doctors and hospitals from the application. The smart recommender system achieved high accuracy in predicting a patient risk level with an average AUC of 0.85. Utilizing the SHAP inter pretation technique, we provided insights into the reasoning behind the predictions, including group-based and patient-specific explanations. Additionally, we employed a smart monitoring wearable device, such as a Smartwatch to automatically gather dynamic risk factors from the patient. The recommender system is cost-effective, easy to use, and portable since the main component of the system is commonly available on smartwatches, smartphones, and the Django framework. Early detection can improve patient management and lower heart attack risk while timely therapy aids in avoiding subsequent disabilities.

Upper Airway Resistance Measurement with Esophageal Catheter and Oscillometry

Wed, 26 Jun 2024 00:00:00 -0700

Esophageal catheters equipped with multiple sensors are typically inserted nasally to reach the esophagus, to measure a range of pressure. These measurements can detect variations in pressure caused by obstructions at different points in the respiratory tract. Pressure sensors along the catheter are positioned differently based on the different anatomical structures of the respiratory tract among individuals. Our research is thus focused on investigating the association between pharyngeal airway resistance obtained from different pressure sensors with the gold standard measurement. We calculated the pressure difference of two sensors relative to atmosphere pressure and estimated pharyngeal airway resistance at the corresponding locations using multiple linear regression models on pressure, airflow, and volume. The gold standard measurement to assess pharyngeal airway resistance was Oscillometry. Participants were grouped by sex, height, and age, and the association of resistance between the two approaches was examined using the Bland-Altman plot and Pearson correlation. In our study, 19 adult participants were included. Our data suggested that those who are either male, taller, or older adults have a longer pharyngeal length compared to female, short, or middle-aged adults. Therefore, to assess pharyngeal airway resistance using a catheter for these groups, we should opt for more proximal pressure sensors, as the distal sensor is placed deeper into the esophagus. This can have significant implications for research studies analyzing data from esophageal catheters.

HOX Gene Signatures Predict Survival Outcomes of Glioblastoma Patients

Yasin Mamatjan — Wed, 26 Jun 2024 00:00:00 -0700

Diffuse gliomas represent over 80\% of malignant brain tumors ranging from low-grade to aggressive high-grade lesions. Molecular characterization of gliomas has led to the development of a more accurate World Health Organization (WHO) classification system comprising specific glioma subtypes. The adult-type diffuse glioma was classified into three categories: astrocytomas (IDH-mutated), oligodendrogliomas (IDH-mutated and 1p/19q-deleted), and glioblastomas (IDH-wildtype (IDH-wt)) in 2021. The HOX (homologous box) gene is known as the leading gene of cell differentiation and vertebrate growth. HOX genes display important roles by regulating several hallmarks of cancer. HOX genes are virtually absent in healthy adult brains when they are detected in malignant brain tumors, namely gliomas. There is a need for new molecular biomarkers that can accurately predict patient outcomes. Our goal is to characterize glioblastoma and identify the HOX gene signatures of the outcome to understand which HOX-gene biomarkers predict bad survival in glioblastoma, IDH-wt. We used 237 and 310 IDH-wt glioblastoma gene expression (RNAseq) from The Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA) respectively. To identify prognostic HOX genes, supervised analysis and COX analysis on grade 3 vs 2 and grade 4 vs 3 were performed separately, and the common significant HOX genes between supervised analysis and COX analysis. The selected 8-HOX genes (\textit{HOXA2, HOXA3, HOXC11, HOXC6, HOXC9, HOXD11, HOXD12, HOXD4}) were used for gene expression and survival analysis. Notably, 8-HOX gene signatures in the TCGA dataset split the glioblastoma cohort into two prognostic groups that strongly predict the survival probability of glioblastoma patients ($p<0.01$). Furthermore, the identified 8 HOX-gene signatures associated with patient survival were validated by using an independent CGGA dataset ($p<0.01$). Thus, glioblastoma can further be stratified into clinically relevant categories based on HOX gene expression which shows the importance of HOX genes in the outcome of IDHwt gliomas to identify relevant molecular subtypes for practical tumor classification.

An experimental investigation on the effect of airflow on the sound generated in a simplified tube with a constriction representing trachea for obstructive sleep apnea diagnosis during wakefulness

Walid Ashraf, Zahra Moussavi — Wed, 26 Jun 2024 00:00:00 -0700

Obstructive sleep apnea (OSA) diagnosis using tracheal breathing sounds analysis during wakefulness has already shown a great potential with an accuracy of 84.5% compared to gold-standard polysomnography (PSG). The inclusion of geometrical parameters to acoustic diagnosis of OSA during wakefulness may not only increase the accuracy but also give an insight into OSA pathology. In this study, we aimed to develop an upper airway model for flow-sound relationship in the presence of a constriction (e.g. increased airway stiffness and/or collapsibility). The geometrical change selected for this study is a circular constriction representing tracheal narrowing. An experimental measurement was conducted on a 3D printed model of a tube with a constriction while recording the airflow-generated sound at three locations. Several constriction sizes were tested at different airflow rates. The results show a higher frequency shift for the resonating frequencies for the smaller constrictions. In addition, Larger slopes of the logarithmic relationship between airflow and the generated sounds’ power were observed for the larger constrictions. These findings are encouraging for future studies to evaluate the mathematical relationship between the tracheal breathing sounds at the presence of different constriction sizes for a realistic upper airway geometry.

Evaluating Slips on Icy Surfaces: A Data Collection Protocol

Davood Dadkhah, Hamed Ghomashchi, Tilak Dutta — Wed, 26 Jun 2024 00:00:00 -0700

This study presents a protocol for collecting a diverse dataset encompassing motion, video, audio, kinematic, and environmental metrics related to walking on icy surfaces. Aimed at enhancing the understanding of the biomechanics involved in navigating such challenging conditions, the study recruited 27 participants for data collection in the state-of-the-art WinterLab at the Toronto Rehabilitation Institute. The protocol captures a wide array of data points including detailed body measurements, gait patterns, and slip occurrences that were recorded using an array of devices like Android phones, GoPro cameras, wireless microphones, and a Vicon motion capture system. Preliminary analysis of the dataset, involving over 2700 steps from one participant, demonstrates valuable insights into slip frequencies. This research not only advances the biomechanical understanding of walking on icy surfaces but also has practical implications in the design of preventative measures such as slip-resistant footwear and public safety strategies. This dataset will facilitate the development of predictive models for slip risk assessment, contributing to both academic research and better safety in winter conditions.

Deep Learning for The Chronic Obstructive Pulmonary Disease Assessment using Lung CT

Halimah Alsurayhi, Abbas Samani — Wed, 26 Jun 2024 00:00:00 -0700

COPD is a prevalent and progressive lung disease. It is identified as airflow limitation due to airway and/or air sacs inflammation. To limit disease progression and prevent future exacerbation, GOLD has recently proposed a staging system to devise proper treatment plan. Predictors used in this staging system assessed using a comprehensive or simple questionnaire about the disease history. In contrast to such qualitative assessment approach, lung CT images can be used for quantitative assessment of the disease severity. In this project, we developed a classification tool for COPD assessment using lung CT images processed through a deep learning model. For this purpose, we developed two CNN models to identify the severity of the two predictors of symptoms and exacerbation. The two models are utilized to design a novel classification tool based on the GOLD2023 staging system. Results obtained from this model indicate reasonable accuracy despite requiring a single 3D CT scan.

Combining Morphological and Textural Features to Characterize Mitochondrial Structure

Amulya Kaianathbhatta, Malak Al Daraawi, Edana Cassol, Leila Mostaco-Guidolin — Wed, 26 Jun 2024 00:00:00 -0700

Understanding cellular microenvironments and cellular responses is crucial when evaluating treatments and/or pathological conditions. Changes in sub-cellular structures can be assessed by imaging and used to evaluate cellular responses to external factors. One of the key sub-cellular structures that can be assessed by imaging and used as cues to correlate cellular responses with external factors. One of the key sub-cellular structures which can provide us with information about cellular metabolic states are mitochondria. They are the cell ‘powerhouses’ responsible for energy production and produce bioactive molecules that regulate other cellular functions. Thus, investigating changes in mitochondria organization/structure and their localization within the cell can provide important insights into cell-microenvironment interactions. The mitochondrial structure changes dynamically and the main formed structures can be classified as network-like arrangements, puncti, or rods. In this study, super-resolution confocal microscopy was used to assess mitochondrial structure and a combination of image-based morphological and textural features are used to extractive objective information about the main mitochondrial structure’s shapes such as fiber orientation, length, concentration based on pixel intensities, degree of structural organization and other related features. Our preliminary results show that morphological feature-based metrics were not successful in differentiating the mitochondrial arrangements. However, textural features provided the potential to allow the quantification of differences between puncta and fiber-network structures. Rods-like structures are still under investigation. By combining morphological and textural features we aim to create an image-based score which will account for all three main mitochondrial structures commonly present in cells and then allow us to perform a systematic image-based differentiation of cellular metabolic states.

The Role of Oxygen in ECM remodeling

Nadia Abzan, Zoya Versey, William Willmore, Leila Mostaco-Guidolin — Wed, 26 Jun 2024 00:00:00 -0700

The extracellular matrix (ECM) regulates several cellular functions via different signals. The structure and composition of the ECM change in various diseases. The mechanisms of ECM alternations and the role of oxygen in ECM remodeling is poorly understood. We are establishing in vitro models that simulate the ECM microenvironment to investigate the effect of oxygen in ECM remodeling.

Sound Level Within Transport Incubator During Use of Ambulance Siren

Wed, 26 Jun 2024 00:00:00 -0700

During medical transport, neonates may be exposed to high levels of sound and vibration. A ground ambulance test had been performed in collaboration with the Children’s Hospital of Eastern Ontario and the Ottawa Paramedic Service to quantify sound and vibration at the transport incubator location. Ambulance sirens were not utilized during this test, although in emergency transport they are activated for short periods when required. An interest in quantifying the sound levels due to the ambulance siren was expressed. This paper presents the findings from a stationary siren test, which has been completed to assess the sound level within the ambulance cabin, inside the transport incubator, and at the driver location. The vehicle’s two siren tones were run over 30 second durations, and the A-weighted sound pressure levels at the three locations were evaluated, as well as the frequency response in the form of power spectral density. The sound levels within the incubator averaged 65 dBA and 67 dBA during the two tones, both exceeding the recommended level of 60 dBA. The findings support a recommended practice of limiting siren use when transporting neonatal patients.

Integrating Biomechanics and Probability: A Novel Framework for Helmet Impact Evaluation in Sports Injury

Reza Deabae, Walter Herzog, Amin Komeili — Wed, 26 Jun 2024 00:00:00 -0700

This study introduces a framework for the evaluation of helmet protective performance in sports-related head injuries, including Traumatic Brain Injury (TBI) and concussion. The significance of this framework lies in its capacity to assess the performance of helmets in various impact conditions through simulations or experimental tests utilizing a range of evaluation metrics. Unlike existing testing protocols, this model is not confined to a set of pre-determined scenarios and metrics, and it incorporates the probability of each impact situation. An OR tree structure is employed to systematically represent a spectrum of impact configurations, such as impact locations, angles, and velocities, with an assigned probability value for each node. This facilitates a comprehensive analysis of potential impacts, generating a probabilistic evaluation for each configuration. The framework can employ multiple metrics, such as Head Injury Criteria (HIC), peak acceleration, and brain strain, to determine the helmet's overall protective efficacy, considering the likelihood of each impact scenario. Furthermore, this framework is designed to serve as an objective function for the optimization of helmet design. The present study also includes a case study to illustrate the practical application of the proposed method.

Label Aware Denoising Pretraining

Dean Ninalga — Wed, 26 Jun 2024 00:00:00 -0700

Most large-scale pre-trained image models are not designed with segmentation or medical imaging in mind. Hence, practitioners often use specialized augmentation techniques such as CarveMix and denoising pretraining objectives to initialize and train their models. However, these methodologies may misappropriate model resources for learning task-irrelevant information as they do not incorporate label information. We propose Label Aware Denoising Pretraining (LADP), a deep learning model pretraining technique for hypoxic-ischemic encephalopathy lesion segmentation, which causes severe motor and cognitive disability and high mortality in neonates. LADP uses the region-of-interest extraction method from CarveMix to impart increasing levels of noise to regions surrounding lesion contours. In this way, models efficiently learn better representations for a few key areas most relevant to the downstream task.

Synthesis of Bacteriostatic Materials from Quaternary Ammonium Salts

Kazi Naziba Tahsin — Wed, 26 Jun 2024 00:00:00 -0700

Dental implants are commonly used to address tooth loss. Since the implant's surface is exposed to the oral cavity, it becomes susceptible to colonization by microorganisms. Recent in vivo research demonstrated that bacterial colonization begins as early as 30 minutes after implant placement. The most common bacteria associated with dental implant infections include Staphylococcus aureus. Engineering the implant surface to provide antimicrobial activity is one line of defence that has been taken up in recent years. An antimicrobial coating was prepared by quaternising the copolymer of vinylbenzyl chloride (VBC) and [3-(Methacryloyloxy)propyl]trimethoxysilane (MPS). The copolymer MPS-VBC was synthesized by free radical polymerization. The obtained copolymer was then quaternized to form Quaternized Salts (QAS) which were characterized by Fourier Transform Infrared (FTIR). The baceriostatic property of these compounds was investigated in gram positive, S. Aureus, by serial dilution method. This work explores the development and application of a novel quaternary ammonium, attached to economical and clinically relevant material surfaces.

Postoperative Opioid-Induced Respiratory Depression: Who Are at the Greatest Risk?

Wed, 26 Jun 2024 00:00:00 -0700

Opioid-induced respiratory depression (OIRD) is a life-threatening complication in postoperative patients receiving opioids for pain management. Identifying patients at higher risk for OIRD is crucial to preventing adverse events associated with opioids. This narrative review aims to evaluate the risk factors associated with postoperative OIRD. The review synthesizes evidence from 22 studies, involving over 1.8 million postoperative patients, to understand the complexities of OIRD. It highlights significant variability in the incidence of OIRD, ranging from 0.1% to 46%. This variation is attributed to differences in monitoring techniques, definitions of respiratory depression, methods of opioid administration, and patient-specific factors. Certain characteristics, comorbidities, and surgical and anesthetic factors are associated with a higher incidence of OIRD. Key intrinsic patient
factors influencing OIRD include age, sex, BMI, opioid naïveté, and comorbidities such as obstructive sleep apnea, pulmonary, and cardiac diseases.

Fine-tuning an Automatic Speech Recognition Model for a Canadian Indigenous Counselling Program

Emmanuel Olaniyanu — Wed, 26 Jun 2024 00:00:00 -0700

Automatic Speech Recognition (ASR) systems are programs designed to transcribe or identify spoken language. Most modern ASRs are created using End to End Neural Networks and are largely dependent on the quantity and quality of available speech training data. The lack of accented speech data can lead to poor ASR performance with niche accents and voice types. The ASR model presented in this paper is designed to work within an interactive VR counselling software for Canadian Indigenous youth, with an elder. This paper outlines the use of fine-tuning and other data processing techniques to minimize the Word Error Rate of our ASR model. These techniques provide valuable insight into data selection and processing.

Influence of Body Posture and Electrode Placement on the Measurement of Electrocardiogram Using Textile Electrodes

Wed, 26 Jun 2024 00:00:00 -0700

Abstract— Wearable technology has become popular in recent years due to its convenient ability to be integrated into our everyday lives. These tools can collect a wide range of data and help us to observe and manage various aspects of our health more closely. Smart clothing is a wearable that can track physiological signals, such as electrocardiogram (ECG) conveniently, remotely, and continuously. The quality of the captured ECG signal depends on various factors such as body posture and electrode placement. This study's main objective is to investigate these factors' influence on the ECG signal quality.

Three healthy adults participated in the study. ECG signal was captured with both gold standard gel electrodes and dry textile electrodes simultaneously. The heart rate (HR) values from both gel and textile electrodes were calculated in different body postures and with different electrode placements. Statistical analysis was done to see how accurately the textile captured ECG in comparison with the gold standard in different body postures and with different electrode placements. Furthermore, the absolute error between gel and textile measurements was calculated in different body postures and electrode placements to see which combinations give more accurate HR compared to the gold standard.

The early results indicate that electrode placement and body posture interact to affect HR measurement accuracy. Future work to gather more data is being done to achieve additional statistical power to draw definitive conclusions regarding the influence of electrode placement and body posture on ECG accuracy.

Keywords— Smart Textiles, ECG Monitoring, Heart Rate, Electrode Placement, Body Posture

Detecting Apneas and Hypopneas During Sleep by Measuring Heart Rate Changes and Assessing Out-of-Sample Performance

Wed, 26 Jun 2024 00:00:00 -0700

Sleep Apnea is a breathing condition characterized by episodes of reduced airflow during sleep, with the airway partially (hypopnea) or fully (apnea) obstructed. Conventional methods of diagnosis include overnight sleep studies, which are resource and time intensive. Previous studies have shown that heart rate and heart rate variability are associated with sleep apnea severity. However, the performance of these features in detecting respiratory events (apnea or hypopnea), and particularly in unknown datasets, was not examined. We trained a set of conventional machine learning models to label segments of electrocardiography data based on whether they contained apneas or hypopneas. Tuning hyperparameters using leave-one-subject-out cross-validation, logistic regression was found to have strong performance across area under the receiver-operating curve, accuracy, specificity, sensitivity and F1 score metrics, with scores of 0.736±0.102, 72.3±15.8%, 92.0±4.8%, 27.7±16.9%, and 31.7±17.4%, respectively. The application of this model to another dataset, the apnea-ECG dataset, showed an average accuracy of 60.7%. We have also assessed whether there were age- or sex-based differences in model performance. This study thus provides a workflow for comparing machine learning models for apnea detection and highlights how models may not perform as strongly on other datasets.

Fractional Fourier Time-Frequency Representation for Heart Sound Classification

Ebrahim A. Nehary, Sreeraman Rajan — Wed, 26 Jun 2024 00:00:00 -0700

Early detection of heart sounds can significantly
reduce mortality rates by allowing physicians to intervene on
time. However, manual heart sound analysis is subjective and
it relies heavily on the skills and experience of the physi-
cian. Fortunately, deep learning has emerged as a promising
method for heart sound classification. Time-frequency repre-
sentations (TFR) such as spectrograms and continuous wavelet
transforms (CWT), and Mel-Frequency ceptral coefficients have
been widely accepted input representations for heart sound rep-
resentation. This study proposes a combination of fractional
Fourier time-frequency representation (FrFT_TFR) and a deep
learning model for heart sound classification and uses a public
dataset to demonstrate the efficacy of the proposed representa-
tion.Classification using deep learning model with FrFT_TFR as
input outperforms that obtained with spectrograms and CWT
as inputs by approximately 4% and by 13% over Mel-frequency
cepstral coefficients (MFCC) as inputs. The results underscore
the effectiveness of using FrFT_TFR for heart sound classifica-
tion for initial heart sound diagnosis.

Development and initial evaluation of novel tourniquet apparatus for improved safety through optimization of tourniquet inflation time

Matthew Yee, Dr., Tom Lai, Julie Egan — Wed, 26 Jun 2024 00:00:00 -0700

Current clinical practice for reducing tourniquet inflation time by applying a cuff and only inflating it when necessary, can introduce a hazard of venous congestion if the cuff is applied tightly. Venous congestion is associated with risks such as limb swelling, excess blood loss, thrombosis, and hemorrhagic infiltration of nerves. Clinical feedback and results of a conducted survey indicate that venous congestion due to improper cuff application is common, and likely related to variations in training or experience of the applicator, cuff design, and the inaccurate and subjective methods for assessing proper cuff snugness. Therefore, a novel self-loosening tourniquet cuff was developed to reduce the risk of venous congestion by ensuring proper and consistent application snugness, facilitating the optimization of tourniquet time by enabling a cuff to be applied safely and remain uninflated until necessary. After development, a pilot clinical study was conducted to evaluate the cuff’s efficacy in reducing venous congestion caused by tight application when compared to a standard cuff and a no-cuff control. A published air plethysmography method was adapted to characterize changes in limb volume indicative of venous congestion in ten healthy subjects (5 male, 5 female; 36.4 ± 10.7 years). The no-cuff control showed no increase in plethysmography pressure above the baseline. The greatest pressures above the baseline were reduced by 20.98 ± 3.55mmHg (83.7%), when comparing the standard cuff (25.07 ± 3.41mmHg) to the self-loosening cuff (4.09 ± 1.00mmHg). Regardless of the cuff application tightness, the novel cuff significantly reduced the change in pressure (4.09mmHg) indicative of venous congestion, while achieving a consistent snugness (±1.00mmHg). These results indicate that the self-loosening tourniquet cuff can reduce the risk of venous congestion and improve cuff application consistency, enabling the optimization of tourniquet time by enabling a cuff to be applied and safely remain uninflated until needed.

The Development of a Head and Neck Support Device for Children with Cerebral Palsy.

Hannah Cooke — Wed, 26 Jun 2024 00:00:00 -0700

INTRODUCTION

Children with cerebral palsy (CP) that are classified as levels 4 and 5 on the Gross Motor Function Classification System (GMFCS), struggle with posture and sitting upright [1]. The proposed research will develop a head and neck support device for children with CP. A user-centered design approach has been taken through partnerships made with children with CP, in the Kingston community. A quality function deployment (QDF) was performed to identify the engineering specifications. A series of tests were performed to gain information about the participant, which is vital for the development of the device. The first testing objective was to gain information surrounding the motion of the head as it moves from the upright position through cervical/lateral flexion. The second testing objective was to gain information about the force of the head as it tilts from the initial upright position through cervical flexion/lateral flexion. The device will be designed using an AutoCAD software and manufactured using a combination of computer numerical control and three-dimensional printing. Once manufactured the device will be evaluated based on parameters such as: children’s improved ability to communicate, increased comfort and compatibility with assistive devices.

2. METHODS

A. Co-design Process

By conducting a QFD, clear design requirements can be established between the client and the primary researcher. Design requirements were categorized by aesthetics, usability, performance and structural properties. These design requirements were then translated into technical engineering specifications. Throughout the entire project, the client and their family will be very involved. They have reviewed and ranked multiple design options and have undergone a series of tests. Their feedback will be crucial to create an optimal design.

B. Testing

Before designing, it is important to gather information on the client. Thus, two testing scenarios were created to collect data on head/neck force and motion. To gain information about the motion of the head/neck as it moves from the upright position through cervical/lateral flexion, inertial measurement units were used. Two sensors were placed on the forehead and neck, and the data was recorded and plotted. A second testing scenario was created to determine the force exerted by the client when they moved from the upright position through cervical/lateral flexion. A strap force sensor, which included a strain gauge, was placed on the client’s forehead and the data was recorded and plotted in a spreadsheet. The tests will be repeated once the device is developed, to evaluate improvement in these areas.

C. Designing

The design process has included reviewing literature, hosting a parallel design session and independently designing. To ensure the device addresses the issues that the client experiences with other assistive devices, it is important to understand the field of head and neck support devices. From the QFD, a presentation was created and shared with members of the Building Devices and Assistive Technology Laboratory. This provided them with adequate information to create design ideas during a parallel design session. A large portion of designing has been conducted by the primary researcher.

3. CONCLUSIONS

Co-design will be prioritized throughout the duration of this project, to optimize the device. This device will allow children with CP to sit more comfortably and communicate more easily, which will inherently lead to a higher quality of life.

REFERENCES

-Y. Park, “Stability of the Gross Motor Function Classification system in children with cerebral palsy for two years,” BMC Neurology, vol. 20, no. 1, 202

Improving BME Support by Remotely Locating Third Party Systems in Catheterization and Electrophysiology Labs

Sarah Deschamps, Stephanie Liddle, Josh Henne, Mohammed Mohd — Wed, 26 Jun 2024 00:00:00 -0700

The University of Ottawa Heart Institute Biomedical Engineering team has found many benefits to relocating third-party medical devices and equipment from the control and procedure rooms of both catheterization and electrophysiology labs and moving them to a remote equipment room. This paper covers how the team achieved success in setting up a fully functional equipment room and what considerations to take when deciding to implement this type of workflow.

Essential elements of a modern Clinical Engineering Internship

Andrew AM Ibey, Marie-Ange — Wed, 26 Jun 2024 00:00:00 -0700

Abstract— The Ottawa Carleton Institute of Biomedical Engineering has offered a clinical engineering graduate degree program since 2013. To date, this program has graduated 9 students, and has 3 pending graduations. The internship program follows a robust rubric and tutorials that covers the scope of the American College of Clinical Engineering Body of Knowledge preparing students for the current demands of the profession. 2024 will include 3 Ottawa internships and 1 new internship Toronto, growing the program to 4. We hope this rubric to be adopted by other international programs wishing to establish a similar foundation for a modern Clinical Engineering Internship.

Sex-Stratified Analysis of Airway Collapsibility Among Individuals Undergoing Chronic Opioid Therapy

Atousa Assadi, Muammar Kabir, Frances Chung, Clodagh Ryan, Azadeh Yadollahi — Wed, 26 Jun 2024 00:00:00 -0700

Opioids, known for suppressing respiration and reducing upper airway dilator muscle activity, contribute to increased risk of airway collapsibility and obstructive sleep apnea (OSA). This study addresses the existing gap in understanding the sex-specific impact of opioids therapy on airway dynamics during sleep, investigating differences in airway collapsibility among sexes. To address this goal, sleep studies of 44 participants on chronic opioids therapy who had OSA were analyzed. Airway collapsibility was estimated based on the ratio of obstructive apneas and hypopneas. Our results showed that while the severity of OSA was significantly higher in men than women during total sleep time and non-rapid eye movement sleep stage, the airway collapsibility was not statistically different. Moreover, we observed that there is an interaction effect between body mass index and sex as well as opioids dosage in modeling the airway collapsibility.

Predictive Capital Equipment Replacement Planning through Equipment Life Cycle Management

Umalkhair Ahmed — Wed, 26 Jun 2024 00:00:00 -0700

Every year Canadian hospitals spend millions on the procurement of capital equipment. Often the capital planning and procurement of equipment is a reactive and not proactive process. As a result, critical information required during the procurement process and accurate prioritization of equipment replacement is missed. This paper will highlight factors to consider when replacing medical equipment, and challenges with implementation of a predictive replacement life cycle management program. Additionally, this paper will review the steps involved in the creation of a predictive Medical Equipment Life Cycle Management program at The Hospital for Sick Children (SickKids). SickKids took a methodical approach when designing the program which included reviewing a medical equipment database, literature review, third party consultation (ECRI), and meetings with end users.

Reducing Risk to Patient Safety with Custom Modification to Manufacturer’s Design

Kamallesh Canjimavadivel — Wed, 26 Jun 2024 00:00:00 -0700

This paper explores the experimental process of improving the design of an adapter to reduce patient safety risk. The built-in tether that secures the adapter to the multi-function cable for a defibrillator did not meet the clinical needs. As a consequence the adapter gets discarded and leaves the defibrillator in a state not ready to be used in an emergency situation. Three solutions were considered to minimize the risk. The final solution is a combination of two solutions which involves a set screw being added to the lock tab which prevents the tab from being pressed. This, in-turn, limits the ability to remove the adapter. A label was also added to add a visual that would prevent the removal of the adapter. The proposed solution was met with positive feedback from the clinical staff and was implemented across two units, ICU and ER. Since the implementation there have not been any complaints of missing adapters. This process opens up the opportunity to improve the design of other accessories as needed.

Remote Biomedical Services Support Program

SeyedehAida Razavi — Wed, 26 Jun 2024 00:00:00 -0700

The Biomedical Engineering team at the University of Ottawa Heart Institute (UOHI) encountered challenges in seeking support from medical equipment vendors' service experts during the COVID-19 pandemic, primarily due to travel restrictions. Given that most vendors and their support teams are not based in Ottawa, the necessity for travel to address equipment issues at UOHI became a cumbersome, time-consuming, costly, and often impractical task, especially during pandemic conditions. The absence of the option for Remote Service Support resulted in decreased equipment uptime, limited collaboration between the Biomedical Engineering team and vendors, and escalated costs.

This paper outlines the creation of a novel Remote Service Support program for the Biomedical Engineering department at UOHI. The program aims to streamline and expedite the process of obtaining assistance from vendors by establishing a remote connection between Biomedical Engineering Technologists (BMETs) and the medical equipment's service experts through live, real-time calls. This innovative approach enables BMETs to conduct hands-free maintenance, while the remote expert can provide assistance and share documents or screenshots simultaneously. The implemented use cases in this project demonstrate the program's alignment with existing processes in the Biomedical Engineering department, presenting a pioneering strategy in the realm of Biomedical Services.

Applications of 3D Printing in Healthcare - Challenges and Considerations in Biomedical Engineering

Nicholas Jenne — Wed, 26 Jun 2024 00:00:00 -0700

3D printing, a form of additive manufacturing, has demonstrated potential to revolutionize various aspects of
biomedical engineering, from medical device prototyping, producing replacement parts to extend product life cycle, patient
specific implants, and anatomical models for surgical planning. Biomedical and clinical engineering departments can benefit
from 3D printing technologies to better support medical devices with shorter turnarounds due to quicker repairs. This paper will
aim to address the challenges and considerations to be made for biomedical engineering teams in hospitals looking to
incorporate 3D printing technology into shops across the region in British Columbia (BC). This paper focuses on
biocompatibility, device modification, intellectual property, and infection prevention and control (IPAC). The paper also
explores different clinical 3D printing activities in the province at cancer centers, research institutes, and biomedical
engineering shops, exploring their current processes and similarities. Data was collected through research, stakeholder
interviews, and on site printing activities at Surrey Memorial Hospital. Different methods of 3D printing are explored and
assessed for their suitability for this use case. Different biocompatible 3D printing materials on the market are looked at, as well
as common filaments used in fused deposition modeling (FDM) printing and their properties and potential for the clinical
space. Computer aided design (CAD), slicing, and segmentation software are also discussed and the role they can play in the
workflow. This data was used to develop a workflow tool to assist biomedical technologists in printing custom parts ‘in-house’
through 3D printing, this tool includes IPAC considerations as well as material and printer recommendations for specific 3D
printed part cases.

A Machine Learning Based Algorithm to Determine Unloaded Geometry of the Breast Using MRI Image Data

Xi Feng, Abbas Samani — Wed, 26 Jun 2024 00:00:00 -0700

Biomechanical modelling has many medical applications in computer assisted diagnosis and intervention related to the breast. Examples include accurate breast cancer diagnosis, biopsies and surgeries, and breast post-surgery reconstruction. This approach also has industrial applications such as bra design. Breast mechanical models can be developed using Finite Element Method (FEM). Fundamental to reliable such breast models is the breast reference geometry under no loading. Most breast models use the breast Magnetic Resonance Image (MRI) to develop patient-specific FE models. However, the breast MRI scan is acquired under a prone body position which is associated with large breast tissue deformation resulting from gravity loading. As such, the breast MRI scans can only provide an approximate breast reference geometry, hence compromising the model’s expected accuracy. Such compromised accuracy can impact the accuracy of vital medical procedures such as breast biopsies that require needle targeting within few millimeters. In this study, an inverse algorithm is developed which aims at accurate determination of the breast reference geometry. In the proposed framework we generated two breast shape spaces, one filled with points representing a breast undeformed shape while the other containing points representing corresponding breasts deformed due to gravity loading under prone body position obtained using each breast’s FE model. To obtain a compact representation of the two spaces before fitting a function between them, principal component analysis was applied to each shape point set. A neural network was trained to find a mapping relationship between the two spaces. For validating the accuracy of reconstructed stress-free breast geometry, we applied gravityloading to assumed unloaded breast geometry using accurate FE simulation and used it as input geometry. To validate output stress-free breast shape, Intersection of Union (IoU) score and Hausdorff distance to compare it to the input breast geometry. Results indicated that the proposed inversion algorithm is accurate in capturing the breast’s stress-free configuration as well as in predicting its mechanical behavior.

BRIDGING BORDERS: TRAINING & EDUCATING CLINICAL ENGINEERING WORKFORCE - A CANADIAN & AMERICAN PERSPECTIVE

Arif Subhan, Anthony Chan — Wed, 26 Jun 2024 00:00:00 -0700

This presentation will explore the nuances and commonalities in training and educating clinical engineering professionals in both Canada and the United States. By comparing the two approaches, this presentation will seek to identify the best practices, challenges, and opportunities to enhance the effectiveness of clinical engineering education on both sides of the border.

By assessing the educational approaches of both Canada and the United States, this presentation will provide valuable insights for optimizing the training and education of clinical engineering professionals.

It will explore the future trends and emerging technologies in healthcare and their impact on clinical engineering education. It will review anticipated changes in future workforce demands and skills.

Assessing and bridging the educational perspectives from both countries will be a positive contribution to a comprehensive understanding of the field of clinical engineering. It will foster collaboration and enhancement in the critical profession of clinical engineering that plays a critical role in enhancing the quality and safe delivery of healthcare.

Improving Bed Repair Turn Around Time through Parts Management

Emily Rudderham, Joshua Henne, Sarah Deschamps, Stephanie Liddle — Wed, 26 Jun 2024 00:00:00 -0700

Hospital beds requiring service spend an average of 20 days in the biomedical engineering department at the University of Ottawa Heart Institute (UOHI) due to delays in receiving parts and limited part storage. Analysis of the work orders was completed to determine what parts should be stored onsite to improve the turnaround time. During analysis it was found that more discrete data should be captured in the Computerized Maintenance Management System (CMMS) work orders to provide better insight into part usage and delivery time. This paper provides recommendations for improvements to CMMSs to ensure sufficient information for predictive analysis of parts usage can be collected. These include discrete ‘received dates’ for purchase order line items, standardizing quantity data for multiunit item orders, and providing user prompts to record parts. Measures which can be implemented in the interim to reduce the turnaround time of hospital beds are also discussed. These measures include completing storage space organization as well as holding work order reviews and stand-up meetings to provide updates on large equipment repairs.

Benefits of Biomedical Engineering Internships Conducted in Biomedical Engineering Departments in Hospitals

Sarah Grenier — Wed, 26 Jun 2024 00:00:00 -0700

Biomedical engineering internships for undergraduate students are difficult to find as there are not many that exist. The University of Ottawa Heart Institute together with the Leacross Foundation has offered internship opportunities to female students in Biomedical Engineering programs since 2010. This paper discusses the benefits on hiring biomedical engineering interns for the Biomedical Engineering department as well as the intern’s development.

Statistical Analysis of Distribution-based Spectral Features of Low-Sampled Snoring Vibrations in Predicting Treatment Outcomes in Obstructive Sleep Apnea

Behrad TaghiBeyglou, Tasnia Kamal, Fernanda Almeida, Azadeh Yadollahi — Wed, 26 Jun 2024 00:00:00 -0700

This study delves into the statistical significance of spectral characteristics of snoring vibrations in the prediction of the efficacy of oral appliance devices in the treatment of obstructive sleep apnea. By analyzing data from 20 participants who underwent at-home sleep apnea testing both before and after a 5-month utilization of mandibular advancement devices, we established that specific distribution-based descriptive spectral features can predict the efficacy of oral appliances. Our analysis revealed that among 20 highly correlated features from an initial set of 192 features, only two features are significantly different between the group of responders and non-responders. Using these two features and a linear regression model, a predictive accuracy of 75%, coupled with a sensitivity of 67% and specificity of 82% was achieved. Our findings are also aligned with previous clinical outcomes on the snoring sounds, which share a lot of similarities with the snoring vibration signals.

Challenges supporting Clinical Engineering Initiatives in Low- and Middle-Income Countries (LMIC)

Martin Poulin, Marie-Ange Janvier — Wed, 26 Jun 2024 00:00:00 -0700

Two case studies are discussed regarding the support of clinical engineering initiatives in Ghana. One is the support of clinical engineering best practices at hospitals sites in northern Ghana including the introduction of Computerized Maintenance Management Systems (CMMS) capabilities. The second is the support of the donation of hemodialysis units to Komfo Anokye Teaching Hospital Hospital in Kumasi, central Ghana. Challenges to overcome with these initiatives include the time and effort to convince senior leadership and clinical engineers regarding the benefits of clinical engineering best practices, identifying and fostering local champions for the initiatives, and recognizing that ongoing support is needed to keep these initiatives moving forward to sustainment. Supports include ongoing training webinars, mini-conferences and discussion forums. Support for implementation and transport of donated technology is also critical to ensure the success of the donation. All support must be provided in a culturally sensitive manner and an understanding of the infrastructure limitations with a focus that the local clinical engineering champions must be the driving force of the initiatives.

Critical Reflection: Post-Implementation Challenges and Effective Strategies in Large-Scale Medical Equipment Deployments

maryam Samiee — Wed, 26 Jun 2024 00:00:00 -0700

This text outlines the challenges faced in implementing a standardized medical equipment system within a regional healthcare service model, particularly focusing on the consequences of inadequate pre-implementation evaluations. The document discusses a specific case in 2022, where physiological patient monitors in multiple hospital locations experienced frequent signal dropouts, posing potential harm. In response, a strategic ad-hoc committee, featuring Clinical Engineering, vendor(s), Value Analysis, and Users, was established to address the issues. The proposed presentation outlines the committee's composition, goals, and responsibilities, delving into reported issues, the investigation process, and the subsequent findings. The multifaceted problems identified include issues with installation, ergonomics, cleaning practices, staff training, and equipment design. The presentation concludes with lessons learned, highlighting gaps and improvements for healthcare technology management practices and vendor collaboration, emphasizing the need for robust evaluation processes and collaborative frameworks.

Optimizing Biomedical Engineering Test Equipment Inspection Frequencies

Sara MacGillivray, Nicole Hamilton , Martin Poulin — Wed, 26 Jun 2024 00:00:00 -0700

This report presents an analysis conducted by the Island Health Biomedical Engineering Department, focusing on the optimization of inspection frequencies for biomedical engineering test equipment. The study, spanning eight months, included 164 assets across ten subcategories, utilizing data extracted from the TMS Computerized Maintenance Management System and inspection certificates.

The standard annual inspection frequency was examined and specific inspection intervals, ranging from one to four years, are recommended for each subcategory based on observed trends. Data challenges, especially in acquiring inspection certificates emphasize the critical need for enhanced collaboration with vendors to ensure accurate and comprehensive data records.

Recommendations include addressing data gaps for complete evaluations and suggesting pilot studies for subcategories with limited data. The report concludes with a detailed set of recommendations for each subcategory, providing a technical framework for updating inspection frequencies within Island Health and other Health Authorities in BC. Continuous updates are emphasized to align with evolving requirements and adhere to clinical engineering best practices.

Best and Final Offer (BAFO) Procurement of Clinical Medical Equipment

Andia Toomari — Wed, 26 Jun 2024 00:00:00 -0700

Public funded Ontario hospitals are required to be in compliance with the Broader Public Sector (BPS) procurement directive. As part of this directive, a total procurement value of goods, non-consulting services and construction above a threshold value of $121,200 (effective January 1, 2024) will require an open competitive process. This process often referred to as Request for Proposal (RFP) may have an additional step, called best and final offer (BAFO) incorporated. In the BAFO process, shortlisted vendors would go through an additional stage with new rated criteria and submission of best and final offer for pricing. An RFP process may span several months depending on the complexity of the product or services being procured. The addition of the BAFO step extends these timelines. This is in addition to the increased effort and resources required to draft and evaluate additional rated criteria and to evaluate the BAFO results. In this paper we aim to provide an overview of the steps involved in RFP and BAFO processes. We will also compare and analyze the results of two RFP and BAFO initiatives undertaken by The Hospital for Sick Children (SickKids) and review the benefits and challenges given the impact on project schedule, cost, and resources. We will also provide recommendations on important aspects to consider before initiating BAFO RFPs.

An Update on the Development of Cybersecurity Practices for Biomedical Engineering Departments

Adeel Alam, Kamran Samanian, Qwynn Ferreira — Wed, 26 Jun 2024 00:00:00 -0700

Through the medical device framework, Sinai Health Biomedical Engineering team provides an update on the work they have done the previous year and provide an example of how this work has proactively reconciled a vulnerability in our medical device environment.

Development of a Methodology for Imaging Equipment Replacement Prioritization

Rebecca Austman, Sarah Kelso, Chris Bzovey, Harry Ingleby — Wed, 26 Jun 2024 00:00:00 -0700

Imaging equipment provides a vital service to healthcare organizations across Canada. Due to limited capital budgets, complex factors must be considered by healthcare leadership as to how devices should be prioritized for replace-ment. A methodology was developed for prioritization of these high value devices to optimize budget allocation and ensure de-vices with the highest risk of impacting patients and the healthcare system are replaced first, based on both quantitative data from an equipment database and qualitative data points obtained from operational leaders. This methodology has re-sulted in an improvement of the prioritization process, and in-creased confidence in decisions which have the potential to greatly impact both patient care and capital budgets.