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Introduction Few data are available on actual follow-up costs of remote monitoring (RM) of implantable defibrillators (ICD). Our study aimed at assessing current direct costs of 1-year ICD follow-up based on RM compared with conventional quarterly in-hospital follow-ups. Methods and results Patients ( N  = 233) with indications for ICD were consecutively recruited and randomized at implant to be followed up for 1 year with standard quarterly in-hospital visits or by RM with one in-hospital visit at 12 months, unless additional in-hospital visits were required due to specific patient conditions or RM alarms. Costs were calculated distinguishing between provider and patient costs, excluding RM device and service cost. The frequency of scheduled in-hospital visits was lower in the RM group than in the control arm. Follow-up required 47 min per patient/year in the RM arm versus 86 min in the control arm ( p  = 0.03) for involved physicians, generating cost estimates for the provider of USD 45 and USD 83 per patient/year, respectively. Costs for nurses were comparable. Overall, the costs associated with RM and standard follow-up were USD 103 ± 27 and 154 ± 21 per patient/year, respectively ( p  = 0.01). RM was cost-saving for the patients: USD 97 ± 121 per patient/year in the RM group versus 287 ± 160 per patient/year ( p  = 0.0001). Conclusion The time spent by the hospital staff was significantly reduced in the RM group. If the costs for the device and service are not charged to patients or the provider, patients could save about USD 190 per patient/year while the hospital could save USD 51 per patient/year.

The process of implementing a damage identification strategy for aerospace, civil and mechanical engineering infrastructure is referred to as structural health monitoring (SHM). Here, damage is defined as changes to the material and/or geometric properties of these systems, including changes to the boundary conditions and system connectivity, which adversely affect the system's performance. A wide variety of highly effective local non-destructive evaluation tools are available for such monitoring. However, the majority of SHM research conducted over the last 30 years has attempted to identify damage in structures on a more global basis. The past 10 years have seen a rapid increase in the amount of research related to SHM as quantified by the significant escalation in papers published on this subject. The increased interest in SHM and its associated potential for significant life-safety and economic benefits has motivated the need for this theme issue. This introduction begins with a brief history of SHM technology development. Recent research has begun to recognize that the SHM problem is fundamentally one of the statistical pattern recognition (SPR) and a paradigm to address such a problem is described in detail herein as it forms the basis for organization of this theme issue. In the process of providing the historical overview and summarizing the SPR paradigm, the subsequent articles in this theme issue are cited in an effort to show how they fit into this overview of SHM. In conclusion, technical challenges that must be addressed if SHM is to gain wider application are discussed in a general manner.

Carbon nanotube thin-film transistors 1 are expected to enable the fabrication of high-performance 2 , flexible 3 and transparent 4 devices using relatively simple techniques. However, as-grown nanotube networks usually contain both metallic and semiconducting nanotubes, which leads to a trade-off between charge-carrier mobility (which increases with greater metallic tube content) and on/off ratio (which decreases) 5 . Many approaches to separating metallic nanotubes from semiconducting nanotubes have been investigated 6 , 7 , 8 , 9 , 10 , 11 , but most lead to contamination and shortening of the nanotubes, thus reducing performance. Here, we report the fabrication of high-performance thin-film transistors and integrated circuits on flexible and transparent substrates using floating-catalyst chemical vapour deposition followed by a simple gas-phase filtration and transfer process. The resulting nanotube network has a well-controlled density and a unique morphology, consisting of long (~10 µm) nanotubes connected by low-resistance Y-shaped junctions. The transistors simultaneously demonstrate a mobility of 35 cm 2  V –1  s –1 and an on/off ratio of 6 × 10 6 . We also demonstrate flexible integrated circuits, including a 21-stage ring oscillator and master–slave delay flip-flops that are capable of sequential logic. Our fabrication procedure should prove to be scalable, for example, by using high-throughput printing techniques. Carbon nanotube transistors with high mobilities and high on/off ratios are demonstrated, along with flexible nanotube-based integrated circuits that are capable of sequential logic.

A major goal of therapeutic footwear in patients with pain or those at risk for skin injury is to relieve focal loading under prominent metatarsal heads. One frequent approach is to place plugs of compliant material into the midsole of the shoe. This study investigated 36 plug designs, a combination of three materials, six geometries, and two placements using a two-dimensional (2D) finite element model. Realistic loading conditions were obtained from plantar pressures (PP) recorded during walking in five subjects who wore control midsoles manufactured using Microcell Puff. Measured peak pressures underneath the second metatarsal head were similar to the results of the control model. PP obtained from simulations with the plugs built into a firm midsole were compared to the simulation results of the control midsole. Large plugs (e.g. 40 mm width), made out of Microcell Puff Lite or Plastazote Medium, placed at peak pressure sites, resulted in highest reductions in peak pressures (18–28%). Smaller plugs benefited from tapering when placed at high pressure areas. Case studies were completed on a healthy male subject and a diabetic female patient to address the efficacy of a plug design favored by our simulations (pressure based placement, 40×20 mm, Plastazote Medium). Successful reductions of second metatarsal head pressures were observed with a mediolateral load redistribution that was not represented by our model. 2D computer simulations allowed systematic investigation of plug properties without the need for high volume experimentation on human subjects and established basic guidelines for plug selection. In particular, plugs that are placed based on plantar pressure measurements were proven to be more effective when compared to those positioned according to the projection of the bony landmark on the foot-shoe plantar contact area.

Structural health monitoring (SHM) is a term increasingly used in the last decade to describe a range of systems implemented on full-scale civil infrastructures and whose purposes are to assist and inform operators about continued 'fitness for purpose' of structures under gradual or sudden changes to their state, to learn about either or both of the load and response mechanisms. Arguably, various forms of SHM have been employed in civil infrastructure for at least half a century, but it is only in the last decade or two that computer-based systems are being designed for the purpose of assisting owners/operators of ageing infrastructure with timely information for their continued safe and economic operation. This paper describes the motivations for and recent history of SHM applications to various forms of civil infrastructure and provides case studies on specific types of structure. It ends with a discussion of the present state-of-the-art and future developments in terms of instrumentation, data acquisition, communication systems and data mining and presentation procedures for diagnosis of infrastructural 'health'.

Differences between wear-scar features of simulator-tested and retrieved tibial total knee replacement (TKR) liners have been reported. This disagreement may result from differences between in vivo kinematic profiles and those defined by the International Organization for Standardization (ISO). The purpose of this study was to determine the knee kinematics of a TKR subject group during level walking and compare them with the motion profiles defined by the ISO standard for a displacement-controlled knee wear testing simulator. Twenty-nine patients with a posterior cruciate ligament-retaining TKR design were gait tested using the point cluster technique to obtain flexion–extension (FE) rotation, anterior–posterior (AP) translation and internal–external (IE) rotation knee motions during a complete cycle of level walking. Relative ranges of motion and timing of key points within the in vivo motion data were compared against the same ranges and same key points from the input profiles of the displacement-controlled wear testing standard ISO14243-3. The subjects exhibited a FE pattern similar to ISO, with an insignificant difference in range of FE rotation from midstance to terminal stance. However, the subjects had a significantly higher range of knee flexion from terminal stance into swing. The subjects also exhibited a phase delay for the entire gait cycle. For AP translation, the standard profile had statistically significant lower magnitudes than seen in vivo. Opposite pattern of AP motion was also apparent from midstance and swing. Similarly, ISO specified a smaller IE total range of rotation with a motion pattern in complete opposition to that seen in vivo. In conclusion, significant differences were found in both the magnitudes and pattern of in vivo motion compared with ISO.

Wireless monitoring has emerged in recent years as a promising technology that could greatly impact the field of structural monitoring and infrastructure asset management. This paper is a summary of research efforts that have resulted in the design of numerous wireless sensing unit prototypes explicitly intended for implementation in civil structures. Wireless sensing units integrate wireless communications and mobile computing with sensors to deliver a relatively inexpensive sensor platform. A key design feature of wireless sensing units is the collocation of computational power and sensors; the tight integration of computing with a wireless sensing unit provides sensors with the opportunity to self-interrogate measurement data. In particular, there is strong interest in using wireless sensing units to build structural health monitoring systems that interrogate structural data for signs of damage. After the hardware and the software designs of wireless sensing units are completed, the Alamosa Canyon Bridge in New Mexico is utilized to validate their accuracy and reliability. To improve the ability of low-cost wireless sensing units to detect the onset of structural damage, the wireless sensing unit paradigm is extended to include the capability to command actuators and active sensors.

Stated in its most basic form, the objective of structural health monitoring is to ascertain if damage is present or not based on measured dynamic or static characteristics of a system to be monitored. In reality, structures are subject to changing environmental and operational conditions that affect measured signals, and these ambient variations of the system can often mask subtle changes in the system's vibration signal caused by damage. Data normalization is a procedure to normalize datasets, so that signal changes caused by operational and environmental variations of the system can be separated from structural changes of interest, such as structural deterioration or degradation. This paper first reviews the effects of environmental and operational variations on real structures as reported in the literature. Then, this paper presents research progresses that have been made in the area of data normalization.

BackgroundIn patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial.StudyClinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS.ResultsA total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively.ConclusionsOther than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.

The errors of low-cost inertial sensors, especially Micro-Electro Mechanical Systems (MEMS) ones, are highly dependent on environmental conditions such as the temperature. Thus, there is a need for the development of accurate and reliable thermal compensation models to reduce the impact of such thermal drift of the sensors. Since the conventional thermal calibration methods are typically time-consuming and costly, an efficient thermal calibration method to investigate the thermal drift of a full set of gyroscope and accelerometer errors (i.e., biases, scale factor errors and non-orthogonalities) over the entire temperature range in a few hours is proposed. The proposed method uses the idea of the Ramp method, which removes the time-consuming process of stabilizing the sensor temperature, and addresses its inherent problems with several improvements. We change the temperature linearly for a complete cycle and take a balanced strategy by making comprehensive use of the sensor measurements during both heating and cooling processes. Besides, an efficient 8-step rotate-and-static scheme is designed to further improve the calibration accuracy and efficiency. Real calibration tests showed that the proposed method is suitable for low-grade IMUs and for both lab and factory calibration due to its efficiency and sufficient accuracy.