IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 60, NO. 12, DECEMBER 2013

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Guest Editorial: Special Section on Point-of-Care Healthcare Technologies EALTHCARE is undergoing a global transformation that is driven by the confluence of socioeconomic factors and progress in science and technology. The need for decreasing healthcare costs in the established markets and the promise of large value-driven emerging markets have contributed to shifting the focus of medical technology development towards more affordable, easier-to-use solutions. Point-of-care (POC) technologies are at the leading edge of this transformation. In established markets, POC technologies are enabling the performance of more and more medical procedures in the physician’s office and in the home. Also, we are witnessing a shift in responsibilities from medical specialists to nurses and generalists due to the simplification of medical procedures achieved by means of POC technologies. In emerging markets, innovation has been marked by simpler, but equally effective, POC solutions for clinical sites serving a large population. The greatest impact of this healthcare technology transformation has been on global health. Large-scale, inexpensive POC technologies are increasingly available to address diseases that affect the most resourceconstrained regions in the world. Substantial work, not only in academic laboratories around the world, but also in the laboratories of leading medical technology companies, is ongoing to develop POC technologies for global health applications. The papers of this special section devoted to recent advances in POC healthcare technologies cover a broad range of research topics that capture the ongoing transformation of the healthcare system described above. This diversity of research topics was apparent at the IEEE-EMBS Special Topic Conference on POC Healthcare Technologies in Bangalore, India, earlier this year. Experts who gathered at the Bangalore conference suggested that the primary objectives of the ongoing research in POC technologies are to: 1) reduce the cost and complexity of medical procedures; 2) decrease the need for highly skilled medical personnel in managing routine clinical problems; 3) enable the performance of fast medical screening techniques; and 4) facilitate the performance of periodic medical tests in order to monitor patient status and achieve early diagnosis of medical problems. Indeed, the call for papers for this special section reflected the broad range of research topics mentioned above. In response to the call for papers, we received more than one-hundred high-quality submissions from researchers around the world covering the wide range of topics mentioned above. The diversity of research topics covered by these papers, while making difficult the task of editing the section, also made for a very interesting reading. We hope that you, the readers, will

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Digital Object Identifier 10.1109/TBME.2013.2286711

enjoy this collection of papers as much as we did. The special section includes papers that focus on novel “product concepts” (such as the low-cost insole described by Howell et al.); innovations in technologies that enable POC testing or therapy (such as the electromagnetic-based sensor proposed by Mason et al. to detect the bacterium Pseudomonas aeruginosa); and new algorithms and methods that enable improved diagnoses and therapy (such as the algorithm proposed by Pires et al. to detect signs of diabetic retinopathy). A few of the papers in this special section are focused on product concepts aimed at enabling handheld diagnostics, shifting traditional laboratory-based blood/fluid tests to the home setting for lower cost, and higher frequency testing. Guo et al. present the development of a new system to perform an electrokinetic analysis of cell translocation in a portable Coulter counter to detect and enumerate tumor cells. The promising results presented in this paper may pave the way toward the development of micro-Coulter counter for POC prognosis. Reddington et al. present the use of a novel single-particle interferometric reflectance imaging sensor, combined with automated data acquisition and analysis and a relatively simple software interface for POC viral testing. Integration of a microfluidic cartridge in the system would allow the performance of a reliable POC viral test in the primary care setting, thus reducing the time to diagnosis and follow-up treatment. In an effort to provide gait monitoring and analysis capability at the point of care, Howell et al. propose a wearable and wireless insole-based gait analysis system, which provides kinetic measures of gait by using low-cost force-sensing resistors. Describing the design and fabrication of the insole and its evaluation in six control subjects and four hemiplegic stroke subjects, the authors present a compelling argument in support of the viability of such POC system for gait measurement. A number of papers in this special section relate to technologies that enable POC testing or therapy. Many of these papers delve into issues related to monitoring and ubiquitous reporting of physiological “electrical” signals. An electromagnetic-based sensor to detect the concentration of the Pseudomonas aeruginosa bacterium is the focus of the paper by Mason et al. The proposed sensor is based on electromagnetic transduction and is capable of estimating the concentration of Pseudomonas aeruginosa bacteria via changing resonant frequency of the device and peak quality factor. The paper by Das and Maji summarizes the preliminary results of their work toward the development of a flexible sensor built on a polydimethylsilozane polymer substrate to monitor blood flow. The sensor could be wrapped around catheters and provide information concerning plaque formation.

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IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 60, NO. 12, DECEMBER 2013

A novel technique that appears to be suitable to detect deep brain hemorrhage and infarction is presented in the paper by Bonmassar and Lev. The proposed dual energy pulse technique improves upon existing electrical impedance spectroscopy systems that are based on the use of a single pulse. Yin and Fan describe in their paper a new exoskeleton-based technology proposed to deliver robot-assisted rehabilitation in early post-stroke rehabilitation. The system integrates into the controller of the robotic apparatus the results of analyses performed on surface electromyographic (EMG) data and sensor outputs to facilitate therapeutic interactions between the robot and the patient. An important research area in the development of POC technology is the protection of confidential patient information via encryption techniques. The paper coauthored by Ibaida and Khalil is devoted to this topic. The authors propose a novel wavelet-based steganographic technique to securely transmit electrocardiographic (ECG) data without introducing any significant data distortion. The usability and interoperability of POC systems based on wireless sensor networks is the focus of the paper by JimenezFernandez et al. The authors propose a system implementation that includes a network node designed according to criteria that address usability and interoperability challenges. The system was tested showing good results in a pilot study on 22 subjects. Also devoted to the use of wireless sensors is the paper by Tseng and Wang. The paper proposes a new technique to deal with the problem of redirecting wireless traffic in order to optimize the use of resources and minimize time lags. A third group of papers is focused on algorithms and methodologies that enable POC testing or therapy. The manuscript by Das and Kundu is focused on a novel approach to the fusion of multi-sensor data. The authors rely upon a neuro-fuzzy system to generate images of high quality. Koley and Dey also propose the use of advanced algorithms for the generation of clinically-relevant information from sensor data. The authors focus on the detection of apnea and hypopnea events based on a portable sleep apnea monitoring device. A comparison with data collected using a polysomnographic system was performed for the purpose of assessing the reliability of the proposed technique in comparison with existing techniques utilized both experimentally as well as in the clinic. The paper by Phan et al. presents a web-based system that facilitates the selection of algorithms for the identification of cancer biomarkers. The “engine” of the web-based system relies upon a novel method to compute the biological relevance of feature selection algorithms that leverage externally validated knowledge (i.e., the NCI Cancer Gene Index). A methodology to synthesize 12-lead ECG data from three wireless sensors is proposed in the paper by Tomasic et al. The technique allows one to reconstruct reliable ECG data with diagnostic capability that appears to be sufficient to monitor individuals with chronic myocardial ischemia. The paper by Zhou et al. is focused on the detection of seizure events via the analysis of intracranial electroencephalographic (EEG) data. This is a problem of great relevance in long-term monitoring of individuals with epilepsy with potential

significant impact on the ability of clinical teams to accurately titrate medications in this patient population. Lang et al. contributed to this special section an interesting paper with focus on a novel registration method for transesophageal echo images suitable for surgical procedures such as transcatheter aortic valve implantation that are currently performed by relying upon single-plane fluoroscopy for interoperative navigation. The proposed technique has the potential for providing a low-cost alternative to currently utilized techniques. An algorithm for the analysis of retinal images is presented in the paper authored by Pires et al. The authors propose a novel approach for the detection of signs of diabetic retinopathy based on the output of lesion detectors. Dima et al. authored an interesting paper in which they propose a novel signal processing technique to detect the presence of myocardial scar tissue from standard ECG/vectorcardiogram (VCG) recordings. The technique has great potential as a POC technology approach to screen individuals with cardiovascular problems. This collection of papers reflects the breath of the contributions that currently mark the ongoing research in the field of POC technology. We enjoyed reading the papers of the esteemed colleagues who contributed their work to this special section. We trust that the readers will find the content of these papers to be exciting and thought-provoking. ATAM DHAWAN, Guest Editor Albert Dorman Honors College New Jersey Institute of Technology Newark, NJ 07102 USA [email protected] SOUMYADIPTA ACHARYA, Guest Editor Department of Biomedical Engineering Johns Hopkins University Baltimore, MD 21218 USA [email protected] PAOLO BONATO, Guest Editor Department of Physical Medicine and Rehabilitation Harvard Medical School Spaulding Rehabilitation Hospital Charlestown, MA 02129 USA [email protected] ANURAG MAIRAL, Guest Editor Global Program Leader Technology Solutions Global Program PATH, Seattle, WA 98121 USA [email protected] KENJI SUNAGAWA, Guest Editor Division of Cardiology and Heart Center Department of Cardiovascular Medicine Graduate School of Medical Sciences Kyushu University Higashiku 8128582, Japan [email protected]

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Special section on point-of-care healthcare technologies.

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