Cost-effectiveness of sensor-augmented pump therapy in two different patient populations with type 1 diabetes in Italy.

BACKGROUND AND AIMS: Sensor-augmented pump therapy (SAP) combines real time continuous glucose monitoring (CGM) with Continuous Subcutaneous Insulin Infusion (CSII) and provides additional benefits beyond those provided by CSII alone. SAP with automated insulin suspension provides early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels are predicted to fall below a predefined threshold. Aim of this study was to assess the cost-effectiveness of SAP with automated insulin suspension versus CSII alone in type 1 diabetes. METHODS AND RESULTS: Cost-effectiveness analysis was performed using the CORE Diabetes Model. The analysis was performed in two different cohorts: one with high baseline HbA1c and one at elevated risk for hypoglycemic events. Clinical input data were sourced from published data. The analysis was conducted from a societal perspective over a lifetime time horizon; costs and clinical outcomes were discounted at 3% per year. In patients with poor glycemic control, SAP with automated insulin suspension resulted in improved discounted quality-adjusted life expectancy (QALY) versus CSII (12.44 QALYs vs. 10.99 QALYs) but higher mean total lifetime costs (€324,991 vs. €259,852), resulting in an incremental cost effectiveness ratio (ICER) of €44,982 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €33,692 per QALY gained for SAP versus CSII. CONCLUSION: In Italy, the use of SAP with automated insulin suspension is associated with projected improvements in outcomes as compared to CSII. These benefits translate into an ICER usually considered as good value for money, particularly in patients at elevated risk of hypoglycemia.

Low-cost Volumetric Ultrasound by Augmentation of 2D Systems: Design and Prototype.

Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands of an experienced user, yet 2D ultrasound remains clinically underutilized and inherently incomplete, with output being very operator dependent. Volumetric ultrasound systems can more fully capture a three-dimensional (3D) region of interest, but current 3D systems require specialized transducers, are prohibitively expensive for many clinical departments, and do not register image orientation with respect to the patient; these systems are designed to provide improved workflow rather than operator independence. This work investigates whether it is possible to add volumetric 3D imaging capability to existing 2D ultrasound systems at minimal cost, providing a practical means of reducing operator dependence in ultrasound. In this paper, we present a low-cost method to make 2D ultrasound systems capable of quality volumetric image acquisition: we present the general system design and image acquisition method, including the use of a probe-mounted orientation sensor, a simple probe fixture prototype, and an offline volume reconstruction technique. We demonstrate initial results of the method, implemented using a Verasonics Vantage research scanner.

A validation study of a new instrument for low cost bite force measurement.

Quantitative assessment of force in masticatory muscles is not a routine clinical test, probably due to the lack of an "easy-to-use" device. Aim of this study is (1) to present a low cost bite force instrument located in a custom-made housing, designed to guarantee a comfortable and effective bite action, (2) to evaluate its mechanical characteristics, in order to implement it in clinical settings and in experimental setups. Linearity, repeatability and adaptation over time were assessed on a set of four different sensors in bare and housed condition. Application of the housing to the transducer may appreciably alter the transducer's response. Calibration of the housed transducer is thus necessary in order to correctly record real bite force. This solution may represent a low cost and reliable option for biting force measurement and objective assessment of individual force control in the scientific and clinical setting.

The Effect of Microphone Type on Acoustical Measures of Synthesized Vowels.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to compare microphones of different directionality, transducer type, and cost, with attention to their effects on acoustical measurements of period perturbation, amplitude perturbation, and noise using synthesized sustained vowel samples. STUDY DESIGN: This was a repeated measures design. METHOD: Synthesized sustained vowel stimuli (with known acoustic characteristics and systematic changes in jitter, shimmer, and noise-to-harmonics ratio) were recorded by a variety of dynamic and condenser microphones. Files were then analyzed for mean fundamental frequency (fo), fo standard deviation, absolute jitter, shimmer in dB, peak-to-peak amplitude variation, and noise-to-harmonics ratio. Acoustical measures following recording were compared with the synthesized, known acoustical measures before recording. RESULTS: Although informal analyses showed some differences among microphones, and analyses of variance showed that type of microphone is a significant predictor, t-tests revealed that none of the microphones generated different means compared with the generated acoustical measures. CONCLUSION: In this sample, microphone type, directionality, and cost did not have a significant effect on the validity of acoustic measures.

Evaluation of a hydrogen peroxide-based system for high-level disinfection of vaginal ultrasound probes.

OBJECTIVES: Because of the complex process and the risk of errors associated with the glutaraldehyde-based solutions previously used at our institution for disinfection, our department has implemented a new method for high-level disinfection of vaginal ultrasound probes: the hydrogen peroxide-based Trophon system (Nanosonics, Alexandria, New South Wales, Australia). The aim of this study was to compare the time difference, safety, and sonographers' satisfaction between the glutaraldehyde-based Cidex (CIVCO Medical Solutions, Kalona, IA) and the hydrogen peroxide-based Trophon disinfection systems. METHODS: The Institutional Review Board approved a 14-question survey administered to the 13 sonographers in our department. Survey questions addressed a variety of aspects of the disinfection processes with graded responses over a standardized 5-point scale. A process diagram was developed for each disinfection method with segmental timing analysis, and a cost analysis was performed. RESULTS: Nonvariegated analysis of the survey data with the Wilcoxon signed rank test showed a statistical difference in survey responses in favor of the hydrogen peroxide-based system over the glutaraldehyde-based system regarding efficiency (P = .0013), ease of use (P = .0013), ability to maintain work flow (P = .026), safety (P = .0026), fixing problems (P = .0158), time (P = .0011), and overall satisfaction (P = .0018). The glutaraldehyde-based system took 32 minutes versus 14 minutes for the hydrogen peroxide-based system; the hydrogen peroxide-based system saved on average 7.5 hours per week. The cost of the hydrogen peroxide-based system and weekly maintenance pays for itself if 1.5 more ultrasound examinations are performed each week. CONCLUSIONS: The hydrogen peroxide-based disinfection system was proven to be more efficient and viewed to be easier and safer to use than the glutaraldehyde-based system. The adoption of the hydrogen peroxide-based system led to higher satisfaction among sonographers.

Jaw bite force measurement device.

We describe a cost-effective device that uses an off-the-shelf force transducer to measure patient bite force as a diagnostic aid in determining dental implant size, number of implants, and prosthetic design for restoring partial edentulism. The main advantages of the device are its accuracy, simplicity, modularity, ease of manufacturing, and low cost.

Potentiometric strip cell based on carbon nanotubes as transducer layer: toward low-cost decentralized measurements.

In this study, we developed a potentiometric planar strip cell based on single-walled carbon nanotubes that aims to exploit the attributes of solid-contact ion-selective electrodes for decentralized measurements. That is, the ion-selective and reference electrodes have been simultaneously miniaturized onto a plastic planar substrate by screen-printing and drop-casting techniques, obtaining disposable strip cells with satisfactory performance characteristics (i.e., the sensitivity is 57.4 ± 1.3 mV/dec, the response time is ≤30 s within the linear range from log a(K+) = -5 to -2, and the limit of detection is -6.5), no need of maintenance during long dry storage, quick signal stabilization, and light insensitivity in short-term measurements. We also show how the new potentiometric strip cell makes it possible to perform decentralized and rapid determinations of ions in real samples, such as saliva or beverages.

A cost effective simulator for education of ultrasound image interpretation and probe manipulation.

Ultrasonography is the lowest cost no risk medical imaging technique. However, reading an ultrasonographic (US) image as well as performing a good US probe positioning remain difficult tasks. Education in this domain is today performed on patients, thus limiting it to the most common cases. In this paper, we present a cost effective simulator that allows US image practice and realistic probe manipulation from CT data. More precisely, we tackle the issue of providing a realistic interface for the probe manipulation with a basic haptic feedback.

Wearable sensors: opportunities and challenges for low-cost health care.

Wearable sensors enable long-term continuous physiological monitoring, which is important for the treatment and management of many chronic illnesses, neurological disorders, and mental health issues. Examples include: diabetes, autism spectrum disorder (ASD), depression, drug addition, and anxiety disorders. In this paper, we present a few mobile health technologies developed by our group and also discuss emerging opportunities as well as existing challenges. Technologies presented include wearable sensors for electrodermal activity (EDA) and mobile plethysmography as well as mobile phones and the supporting wireless network architecture.

New and low-cost auto-algometry for screening hypertension-associated hypoalgesia.

OBJECTIVE: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. DESIGN AND SETTING: Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale. PATIENTS AND INTERVENTIONS: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto-algometry examination. RESULTS: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4-6 range. CONCLUSION: The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.

Low-cost fiber Bragg grating vibroacoustic sensor for voice and heartbeat detection.

A fiber Bragg grating (FBG) vibroacoustic sensor exploiting an intensity-based interrogation principle is presented. The optical system is complemented by signal processing techniques that allow disturbances to be mitigated and improve the spectral estimation. The sensor is capable of performing frequency analysis of sounds up to 3 kHz, with top sensitivity in the 100-500 Hz frequency range, and of dynamically tracking pulsed phenomena that induce a strain to the FBG. The sensor has been applied to the detection of voice, showing a great intelligibility of the speech despite the low-quality environment, and to the monitoring of the heartbeat rate from the wrist.

Cost-effective diffuse reflectance spectroscopy device for quantifying tissue absorption and scattering in vivo.

A hybrid optical device that uses a multimode fiber coupled to a tunable light source for illumination and a 2.4-mm photodiode for detection in contact with the tissue surface is developed as a first step toward our goal of developing a cost-effective, miniature spectral imaging device to map tissue optical properties in vivo. This device coupled with an inverse Monte Carlo model of reflectance is demonstrated to accurately quantify tissue absorption and scattering in tissue-like turbid synthetic phantoms with a wide range of optical properties. The overall errors for quantifying the absorption and scattering coefficients are 6.0+/-5.6 and 6.1+/-4.7%, respectively. Compared with fiber-based detection, having the detector right at the tissue surface can significantly improve light collection efficiency, thus reducing the requirement for sophisticated detectors with high sensitivity, and this design can be easily expanded into a quantitative spectral imaging system for mapping tissue optical properties in vivo.

A low-cost instrumented spatial linkage accurately determines ASIS position during cycle ergometry.

The purpose of this study was to develop and evaluate an alternative method for determining the position of the anterior superior iliac spine (ASIS) during cycling. The approach used in this study employed an instrumented spatial linkage (ISL) system to determine the position of the ASIS in the parasagittal plane. A two-segment ISL constructed using aluminum segments, bearings, and digital encoders was tested statically against a calibration plate and dynamically against a video-based motion capture system. Four well-trained cyclists provided data at three pedaling rates. Statically, the ISL had a mean horizontal error of 0.03 +/- 0.21 mm and a mean vertical error of -0.13 +/- 0.59 mm. Compared with the video-based motion capture system, the agreement of the location of the ASIS had a mean error of 0.30 +/- 0.55 mm for the horizontal dimension and -0.27 +/- 0.60 mm for the vertical dimension. The ISL system is a cost-effective, accurate, and valid measure for two-dimensional kinematic data within a range of motion typical for cycling.

A simple and inexpensive system for monitoring jaw movements in ambulatory humans.

A simple and inexpensive method for recording vertical movements of the human mandible relative to the maxilla is presented. Measurements are made from accelerometers and a Hall-effect device temporarily glued to the upper and lower anterior teeth. The accelerometer signals are integrated once to give velocity and a second time to give position. Movements of the mandible relative to the maxilla are obtained by integrating the difference between the two accelerometer signals. The (relative) velocity and position records derived in this way are linear, but subject to drift when the jaw is stationary. Steady mandibular position is obtained from the Hall-effect system, but this signal must be corrected for its inherent non-linearity. This device can record rapid movements of the mandible even when the head is unrestrained, and interferes minimally with normal jaw movements.

A low-cost transmittance transducer for measurement of blood oxygen saturation in extracorporeal circuits.

Designs for a low-cost dual wavelength transducer based on light transmittance and a disposable cuvette for monitoring oxygen saturation (SO2) in extracorporeal arterial and venous blood are presented. The transducer utilizes red and infrared light-emitting diodes and a large photodiode; it is designed to attach to a flow-through cuvette modified from 3/8-in x3/8-in bypass-circuit connectors. A mock extracorporeal circulation system was assembled to evaluate operation of the transducer at a controlled blood SO2 and the relationship between light transmittance and hemodilution. SO2 was calculated based on multiple linear regression analyses. The results show a high correlation between the SO2 obtained with the equipment designed and values measured with commercial gasometric equipment in the range of 50% to 100% (r2 = 0.976, error <2%). The method presented allows continuous and real time measurement of whole blood SO2 with a low-cost transmittance transducer.

[Phantom studies of ultrasound equipment for quality improvement in breast diagnosis]. / Phantomuntersuchungen von Ultraschallgeräten zur Qualitätsverbesserung in der Mammadiagnostik.

AIM: According to the German guidelines for quality control of ultrasonic equipment, the following conditions are required for breast ultrasound: A transducer frequency between 5-7.5 MHz and a minimum field of view of 5 cm. Satisfactory images must be obtained in a depth between 0.5 and 4 cm with a wide tolerance of the focal zones. This allows the use of poor quality equipment which does not produce satisfactory image quality and it excludes a number of high frequency and high resolution transducers with a field of view below 5 cm. This study with a test phantom was performed to define image quality objectively. METHOD: Sixteen ultrasound instruments in different price categories were used to perform standardized examinations on a breast phantom model 550 (ATS Laboratories, Bridgeport, USA). Contrast and spatial resolution in different penetration depths were investigated on cyst phantoms from 1-4 mm diameter and wire targets with defined distances between 0.5-3 mm 4 investigations reported the images. RESULTS: A positive correlation was seen between price category and image quality. CONCLUSION: This study demonstrates that transducer frequency and image geometry do not allow sufficient quality control. An improvement of ultrasound diagnosis is only possible if equipment guidelines are based on standard examinations with test phantoms.