A hierarchically patterned, bioinspired e-skin able to detect the direction of applied pressure for robotics.

Tactile sensing is required for the dexterous manipulation of objects in robotic applications. In particular, the ability to measure and distinguish in real time normal and shear forces is crucial for slip detection and interaction with fragile objects. Here, we report a biomimetic soft electronic skin (e-skin) that is composed of an array of capacitors and capable of measuring and discriminating in real time both normal and tangential forces. It is enabled by a three-dimensional structure that mimics the interlocked dermis-epidermis interface in human skin. Moreover, pyramid microstructures arranged along nature-inspired phyllotaxis spirals resulted in an e-skin with increased sensitivity, minimal hysteresis, excellent cycling stability, and response time in the millisecond range. The e-skin provided sensing feedback for controlling a robot arm in various tasks, illustrating its potential application in robotics with tactile feedback.

Haptic fMRI: Reliability and performance of electromagnetic haptic interfaces for motion and force neuroimaging experiments.

Haptic interfaces compatible with functional magnetic resonance imaging (Haptic fMRI) promise to enable rich motor neuroscience experiments that study how humans perform complex manipulation tasks. Here, we present a large-scale study (176 scans runs, 33 scan sessions) that characterizes the reliability and performance of one such electromagnetically actuated device, Haptic fMRI Interface 3 (HFI-3). We outline engineering advances that ensured HFI-3 did not interfere with fMRI measurements. Observed fMRI temporal noise levels with HFI-3 operating were at the fMRI baseline (0.8% noise to signal). We also present results from HFI-3 experiments demonstrating that high resolution fMRI can be used to study spatio-temporal patterns of fMRI blood oxygenation dependent (BOLD) activation. These experiments include motor planning, goal-directed reaching, and visually-guided force control. Observed fMRI responses are consistent with existing literature, which supports Haptic fMRI's effectiveness at studying the brain's motor regions.

Haptic fMRI: accurately estimating neural responses in motor, pre-motor, and somatosensory cortex during complex motor tasks.

Haptics combined with functional magnetic resonance imaging (Haptic fMRI) can non-invasively study how the human brain coordinates movement during complex manipulation tasks, yet avoiding associated fMRI artifacts remains a challenge. Here, we demonstrate confound-free neural activation measurements using Haptic fMRI for an unconstrained three degree-of-freedom motor task that involves planning, reaching, and visually guided trajectory tracking. Our haptic interface tracked subjects' hand motions, velocities, and accelerations (sample-rate, 350Hz), and provided continuous realtime visual feedback. During fMRI acquisition, we achieved uniform response latencies (reaching, 0.7-1.1s; tracking, 0.4-0.65s); minimized hand jitter (<;8mm); and ensured reliable motion trajectories (tracking, <;7mm root-mean-square error). In addition, our protocol decorrelated head motion from both hand speed (r=-0.03) and acceleration (r=-0.025), which reliably produced low head motion levels (<;0.4mm/s between scan volumes) and a low fMRI temporal noise-to-signal ratio (<;1%) across thirty-five scan runs. Our results address the primary outstanding Haptic fMRI confounds: motion induced low spatial-frequency magnetic field changes, which correlate neural activation across cortex; unreliable motions and response latencies, which reduce statistical power; and task-correlated head motion, which causes spurious fMRI activation. Haptic fMRI can thus reliably elicit and localize heterogeneous neural activation for different tasks in motor (movement), pre-motor (planning), and somatosensory (limb displacement) cortex, demonstrating that it is feasible to use the technique to study how the brain achieves three dimensional motor control.

Haptic fMRI: using classification to quantify task-correlated noise during goal-directed reaching motions.

Neuroimaging artifacts in haptic functional magnetic resonance imaging (Haptic fMRI) experiments have the potential to induce spurious fMRI activation where there is none, or to make neural activation measurements appear correlated across brain regions when they are actually not. Here, we demonstrate that performing three-dimensional goal-directed reaching motions while operating Haptic fMRI Interface (HFI) does not create confounding motion artifacts. To test for artifacts, we simultaneously scanned a subject's brain with a customized soft phantom placed a few centimeters away from the subject's left motor cortex. The phantom captured task-related motion and haptic noise, but did not contain associated neural activation measurements. We quantified the task-related information present in fMRI measurements taken from the brain and the phantom by using a linear max-margin classifier to predict whether raw time series data could differentiate between motion planning or reaching. fMRI measurements in the phantom were uninformative (2σ, 45-73%; chance=50%), while those in primary motor, visual, and somatosensory cortex accurately classified task-conditions (2σ, 90-96%). We also localized artifacts due to the haptic interface alone by scanning a stand-alone fBIRN phantom, while an operator performed haptic tasks outside the scanner's bore with the interface at the same location. The stand-alone phantom had lower temporal noise and had similar mean classification but a tighter distribution (bootstrap Gaussian fit) than the brain phantom. Our results suggest that any fMRI measurement artifacts for Haptic fMRI reaching experiments are dominated by actual neural responses.

Mapping stiffness perception in the brain with an fMRI-compatible particle-jamming haptic interface.

We demonstrate reliable neural responses to changes in haptic stiffness perception using a functional magnetic resonance imaging (fMRI) compatible particle-jamming haptic interface. Our haptic interface consists of a silicone tactile surface whose stiffness we can control by modulating air-pressure in a sub-surface pouch of coarsely ground particles. The particles jam together as the pressure decreases, which stiffens the surface. During fMRI acquisition, subjects performed a constant probing task, which involved continuous contact between the index fingertip and the interface and rhythmic increases and decreases in fingertip force (1.6 Hz) to probe stiffness. Without notifying subjects, we randomly switched the interface's stiffness (switch time, 300-500 ms) from soft (200 N/m) to hard (1400 N/m). Our experiment design's constant motor activity and cutaneous tactile sensation helped disassociate neural activation for both from stiffness perception, which helped localized it to a narrow region in somatosensory cortex near the supra-marginal gyrus. Testing different models of neural activation, we found that assuming indepedent stiffness-change responses at both soft-hard and hard-soft transitions provides the best explanation for observed fMRI measurements (three subjects; nine four-minute scan runs each). Furthermore, we found that neural activation related to stiffness-change and absolute stiffness can be localized to adjacent but disparate anatomical locations. We also show that classical finger-tapping experiments activate a swath of cortex and are not suitable for localizing stiffness perception. Our results demonstrate that decorrelating motor and sensory neural activation is essential for characterizing somatosensory cortex, and establish particle-jamming haptics as an attractive low-cost method for fMRI experiments.

Haptic fMRI: combining functional neuroimaging with haptics for studying the brain's motor control representation.

A challenging problem in motor control neuroimaging studies is the inability to perform complex human motor tasks given the Magnetic Resonance Imaging (MRI) scanner's disruptive magnetic fields and confined workspace. In this paper, we propose a novel experimental platform that combines Functional MRI (fMRI) neuroimaging, haptic virtual simulation environments, and an fMRI-compatible haptic device for real-time haptic interaction across the scanner workspace (above torso ∼ .65×.40×.20m(3)). We implement this Haptic fMRI platform with a novel haptic device, the Haptic fMRI Interface (HFI), and demonstrate its suitability for motor neuroimaging studies. HFI has three degrees-of-freedom (DOF), uses electromagnetic motors to enable high-fidelity haptic rendering (>350Hz), integrates radio frequency (RF) shields to prevent electromagnetic interference with fMRI (temporal SNR >100), and is kinematically designed to minimize currents induced by the MRI scanner's magnetic field during motor displacement (<2cm). HFI possesses uniform inertial and force transmission properties across the workspace, and has low friction (.05-.30N). HFI's RF noise levels, in addition, are within a 3 Tesla fMRI scanner's baseline noise variation (∼.85±.1%). Finally, HFI is haptically transparent and does not interfere with human motor tasks (tested for .4m reaches). By allowing fMRI experiments involving complex three-dimensional manipulation with haptic interaction, Haptic fMRI enables-for the first time-non-invasive neuroscience experiments involving interactive motor tasks, object manipulation, tactile perception, and visuo-motor integration.

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Eastern Saudi Arabia cohort of the A1chieve study.

BACKGROUND: The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. MATERIALS AND METHODS: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Eastern Saudi Arabia. RESULTS: A total of 1040 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 489), insulin detemir (n = 360), insulin aspart (n = 37), basal insulin plus insulin aspart (n = 96) and other insulin combinations (n = 57). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 10.0%) and insulin user (mean HbA1c: 9.2%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA1c (insulin naïve: -2.7%, insulin users: -1.7%). No major hypoglycaemic episodes were observed at 24 weeks. SADR was reported in 0.6% of insulin users. CONCLUSION: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Reconstruction and EMG-informed control, simulation and analysis of human movement for athletics: performance improvement and injury prevention.

In this paper we present methods to track and characterize human dynamic skills using motion capture and electromographic sensing. These methods are based on task-space control to obtain the joint kinematics and extract the key physiological parameters and on computed muscle control to solve the muscle force distribution problem. We also present a dynamic control and analysis framework that integrates these metrics for the purpose of reconstructing and analyzing sports motions in real-time.

Cancer prevention and control in the Eastern Mediterranean region: the need for a public health approach.

Cancer is increasingly recognized as a major health concern in the Eastern Mediterranean (EM) region. The emergence of cancer and other non-communicable diseases (NCDs) in most EM region countries is related to increases in life expectancy, an increasing proportion of elderly people, and the successful control of most childhood communicable diseases, along with rapid strides in socioeconomic development. In the next 15 years, cancer incidence in the EM is expected to increase by 100% to 180%, according to World Health Organization (WHO) projection modelling, the largest increase foreseen among developing countries. Even though 30% of cancers can be prevented and controlled using available knowledge, death rates will increase by 17% by 2015 because of the challenges and barriers to implementing national strategic action plans. Other problems facing countries in the region are the lack of national cancer surveillance and little harmonization in monitoring and surveillance methodologies. Data on cancer mortality in the 21 countries is limited or lacking, with only 7 countries having national population-based registries. There is no linking of cancer mortality data to NCD prevention and control. A model of integrated care for NCD prevention programs in general and cancer in particular is lacking, and finally, there is inadequate national capacity-building and a lack of program sustainability. The WHO Regional Committee for the EM has adopted a resolution recognizing the considerable magnitude of cancer as a major cause of morbidity, human suffering, and mortality in the region. In the last 15 years, the WHO Cancer Control Programme has fostered the development of national cancer control programs as a primary intervention strategy for a comprehensive and cost-effective approach at the country level.

The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries.

OBJECTIVE: To assess the availability and affordability of medicines used to treat cardiovascular disease, diabetes, chronic respiratory disease and glaucoma and to provide palliative cancer care in six low- and middle-income countries. METHODS: A survey of the availability and price of 32 medicines was conducted in a representative sample of public and private medicine outlets in four geographically defined areas in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. We analysed the percentage of these medicines available, the median price versus the international reference price (expressed as the median price ratio) and affordability in terms of the number of days wages it would cost the lowest-paid government worker to purchase one month of treatment. FINDINGS: In all countries

Palliative care initiative for the Eastern Mediterranean Region: a proposal.

The Eastern Mediterranean Region (EMR), with 22 countries and about half a billion people, has scarce palliative care services that are far from meeting the needs of the region. The authors of this paper believe that the resources and international influence of the World Health Organization could be combined with the excellent palliative care expertise of King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia to establish a collaborative initiative for promotion of palliative care services in the region. This proposal is based on the major components of professional training, development of regional guidelines, integration of palliative care into health plans and polices, and ensuring availability of essential medications. Investment in developing palliative care in the EMR would be expected to relieve the suffering of hundreds of thousands of patients and families in this part of the world.