By applying Axiomatic Design, a Smart Medical Cast was developed to provide patients, who are suffering from forearm fractures, with a personalized healing process. The device monitors the overall healing status and three complications, which are: Muscle Atrophy, Compartment Syndrome, and Deep Vein Thrombosis. In the conceptual phase, desk research has been performed to find biomarkers that correlate with the monitored processes. Per biomarker, a measuring principle has been designed and these combined formed the design of the smart medical cast. Following the design phase, two tests were performed on healthy individuals to measure the robustness in a real application. The first test focused on correctly measuring the biomarkers and further specifying the sensor specifications. For the second test, a new prototype was used to determine correlations between the measured data and the monitored process and the impact of application during the casting process. The test results show that the measuring system can measure the biomarkers within the expected range, except for bone density. No significant impact on the casting process was measured. The Smart Medical Cast has only been evaluated in situations without a fracture, the next step will be to test the measurables in an environment with a fracture
DOCUMENT
Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
DOCUMENT
Aims: Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. Methods: A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. Results: In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. Conclusions: This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
MULTIFILE
More and more aged people are joining the traffic, either using a passenger car or through a special low speed two-seater for in-city use. For elderly people, self-management in staying mobile is an essential part of their quality of life. However, with increased involvement of elderly in traffic, the risk of serious accidents increases, especially in cities. Fortunately, a rapid development of innovative technology is shown in vehicle design, with focus on advanced driver support, herewith referred to as ‘ambient intelligence’. This holds a promise to improve the safety situation, under the condition that adaption to the elderly driver’s need is accounted for. And that is not a straightforward issue, since ‘no size fits all’. With increasing age, we see an increased variety in driving skills with emphasis on cognitive, perceptual and physical limitations. In addition, people may suffer from diseases with a neurological background or other (cardiopulmonary disease, obesity or diabetes). The partners in this project have expressed the need to survey the feasibility of ‘ambient intelligence’ technology for low-speed vehicles also addressing E-Health functions to bring people safely home or involve medical help in case of health-critical situations. The MAX Mobiel make their vehicle available for that, and will help to guard the elder customer demand. The HAN Automotive Research team carries out the research, in cooperation with the HAN professorship on E-Health. Hence, both the automotive technology part of the HAN University of Applied Sciences as well as expertise from the Health oriented part of the HAN are included, being essential to successfully extend the relevant technologies to a fully integrated elderly driver support system, in the future. Noldus Information Technology is involved on the basis of their knowledge in human monitoring (drive lab) and data synchronization. The St. Maartenskliniek (Nijmegen) brings in their experience with people being restricted in physical or neurological sense.
The application of sensors in water technology is a crucial step to provide broader, more effi-cient and more circular systems. Among the different technologies used in this filed, ultra-sound based systems are widely used in water technology, basically to generate energy peaks for cell lyse and particle separation. In this work we propose the adaptation of a (cur-rently used for medical applications) ultra sound ecosystem to monitor the vertical profile of solid particles in UASB reactors. Such information is nowadays obtained via long duration (solids) analysis and can compromises the efficiency of such reactors, especially regarding the sludge stabilization and phase separation. The project is a small part of a big effort done by different countries, e.g. Brazil, UK and The Netherlands, to bring international technology and expertise to improve the quality of waste water systems in Brazil, by supporting tech-nology and knowledge sharing. If proven feasible, the concept can generate a big business market to the involved Dutch (SME) partners as well as favor the automation of WWTP in Brazil and around the world.
The goal of UPIN is to develop and evaluate a scalable distributed system that enables users to cryptographically verify and easily control the paths through which their data travels through an inter-domain network like the Internet, both in terms of router-to-router hops as well as in terms of router attributes (e.g., their location, operator, security level, and manufacturer). UPIN will thus provide the solution to a very relevant and current problem, namely that it is becoming increasingly opaque for users on the Internet who processes their data (e.g., in terms of service providers their data passes through as well as what jurisdictions apply) and that they have no control over how it is being routed. This is a risk for people’s privacy (e.g., a malicious network compromising a user’s data) as well as for their safety (e.g., an untrusted network disrupting a remote surgery). Motivating examples in which (sensitive) user data typically travels across the Internet without user awareness or control are: - Internet of Things for consumers: sensors such as sleep trackers and light switches that collect information about a user’s physical environment and send it across the Internet to remote services for analysis. - Medical records: health care providers requiring medical information (e.g., health records of patients or remote surgery telemetry) to travel between medical institutions according to specified agreements. - Intelligent transport systems: communication plays a crucial role in future autonomous transportation systems, for instance to avoid freight drones colliding or to ensure smooth passing of trucks through busy urban areas. The UPIN project is novel in three ways: 1. UPIN gives users the ability to control and verify the path that their data takes through the network all the way to the destination endpoint, both in terms of hops and attributes of routers traversed. UPIN accomplishes this by adding and improving remote attestation techniques for on-path routers to existing path verification mechanisms, and by adopting and further developing in-packet path selection directives for control. 2. We develop and simulate data and control plane protocols and router extensions to include the UPIN system in inter-domain networking systems such as IP (e.g., using BGP and segment routing) and emerging systems such as SCION and RINA. 3. We evaluate the scalability and performance of the UPIN system using a multi-site testbed of open programmable P4 routers, which is necessary because UPIN requires novel packet processing functions in the data plane. We validate the system using the earlier motivating examples as use cases. The impact we target is: - Increased trust from users (individuals and organizations) in network services because they are able to verify how their data travels through the network to the destination endpoint and because the UPIN APIs enable novel applications that use these network functions. - More empowered users because they are able to control how their data travels through inter-domain networks, which increases self-determination, both at the level of individual users as well as at the societal level.
