Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU)

Background The first reports of using color Doppler ultrasound for evaluation of the microvasculature were in the 1990s. Despite the early reports of its efficacy, color Doppler ultrasound did not achieve popularity nor general usage in part due to the cumbersome size, cost and poor resolution. This is the first study to demonstrate the potential utility of a new, highly portable, tablet-based color Doppler ultrasound (PT-CDU) system for imaging perforator flaps. Methods The deep inferior epigastric artery (DIEP), lateral arm (LA), anterolateral thigh (ALT), thoracodorsal artery (TDAP), and the medial sural artery (MSAP) perforator flaps were imaged within classic topographic landmarks to visualize and measure variables related to perforator flap anatomy. The Philips Lumify L12–4 linear array probe attached to the Samsung Galaxy Tab A tablet was the system used for all examinations. Results A total of 216 flaps were scanned in 50 healthy adult volunteers: 44 DIEP, 44 LA, 40 ALT, 48 TDAP, and 40 MSAP. Precise anatomic information regarding perforator size, number, and location was obtained. Overall, the percent of flaps having at least 1 perforator within the specified topographical landmarks was 89% for the DIEP, 84.1% for the LA, 72.5% for the ALT, 50% for the TDAP, and 30% for the MSAP (p = 2.272e-09). The percent of patients having an asymmetry (right versus left) in the number of perforators was 72.7% (ALT), 65% (DIEP), 59.1% (LA), 41.7% (TDAP), and 30% (MSAP) (p = 0.0351). Conclusions Portable, tablet-based color Doppler ultrasound offers high-resolution images of perforators and represents a facile technology that may be of interest to microsurgeons in the planning of perforator flaps. Variations in vascular anatomy were well-demonstrated. This surgeon-driven imaging technology may represent an excellent alternative to other imaging modalities.

Design and Implementation of Loan Management System using ISI Server, PhP and MySql

Credit institutions are critical organizations whose role in society and modern economy is very important for issuing loan to individuals, businesses and other organizations. Before such institutions came to the scene, there was no secure place for individuals and businesses to get credit, which caused a lot of chaos. The proposed loan management system brings various loan portfolios on one platform to assist the atomization of servicing and management of such credit institutions. Branches of credit institutions are connected with the loan management system. If client provides all required information and submit all required documents, the loan underwriter will verify and approve the loan from the system. The proposed system will automatically inform to the applicant with required information for proceeding. Loan underwriter can manage and monitor multiple loan portfolios from multiple locations through a single platform starting from prospecting to closure. The proposed system also simplifies the decision making processes. The architecture of loan management system using ISI Server, PhP and MySql is proposed in this work. The suggested architecture consists of four primary components: Clients, internet link, server, and branches of credit institutions. Clients can register, apply and trace their loan through online via desktop, laptop, and portable tablet or mobile. A dependable and safe server is taken into account to actualize the framework. In addition, reliability and security problems considered for designing the system are stated here. Some portion of the suggested architecture is currently being implemented and tested that is also outlined in this paper.

Identification of Hearing Loss in Individuals With Cognitive Impairment Using Portable Tablet Audiometer

Purpose The purpose of this study was to determine the feasibility of using a tablet-based portable audiometer to identify hearing loss in a cognitively impaired population. Method In this study, we used a retrospective chart review of an outpatient memory clinic. During a quality initiative, older adult ( M age = 74.6) patients ( n = 91) completed pure-tone hearing testing (0.5–4 kHz) via automated self-administration and technician-administered threshold testing (gold standard) on a tablet-based audiometer. Results Technician-administered auditory threshold testing was successfully conducted in all patients. A total of 54 of the 91 patients (59%) also had hearing thresholds reliably obtained with automated self-administration. In bivariate analyses, older age, lower Mini-Mental State Examination (MMSE) scores, lower education, male sex, and higher degree of hearing impairment were associated with higher odds of having an unreliable self-administered test defined as multiple recorded false positives at 2 or more test frequencies. In multivariable analysis, lower MMSE scores and poorer hearing were significantly associated with higher odds of having an unreliable self-administered test. Conclusion Technician-administered hearing threshold testing using a portable, tablet-based audiometer can be successfully administered to patients with cognitive impairment. Reliability of automated self-administration is limited in patients with lower MMSE scores.

Comparing three portable, tablet-based visuomotor tasks to laboratory versions: An assessment of test validity

The assessment of visuomotor function can provide important information about neurological status. Many tasks exist for testing visuomotor function in the laboratory, but the availability of portable, easy-to-use versions that allow reliable, accurate, and precise measurement of movement timing and accuracy has been limited. We developed a tablet application that uses three laboratory visuomotor tests: the double-step task, interception task, and stop-signal task. We asked the participants to perform both the lab and tablet versions of each task and compared their response patterns across equipment types to assess the validity of the tablet versions. On the double-step task, the participants adjusted to the displaced target adequately in both the lab and tablet versions. On the interception task, the participants intercepted nonaccelerating targets and performed worse on accelerating targets in both versions of the task. On the stop-signal task, the participants successfully inhibited their reaching movements on short stop-signal delays (50–150 ms) more frequently than on long stop-signal delays (200 ms) in both versions of the task. Our findings suggest that the tablet version of each task assesses visuomotor processing in the same way as their respective laboratory version, thus providing the research community with a new tool to assess visuomotor function.

Communicative interaction between a non-speaking child with cerebral palsy and her mother using an iPadTM

There is a rapidly increasing range of augmentative and alternative communication (AAC) systems available for children who cannot communicate orally. Finding the best system for any one user is a challenge for the professionals and carers involved. As yet the use of portable, tablet forms of communication aid has been little researched, despite the rapid growth in their popularity. This article seeks to establish how a tablet form of AAC is exploited in day-to-day domestic interactions between a parent and a child where the child has a severe physical disability and complex communication needs. The study utilises conversation analysis (CA) as the methodology and looks in detail at sequential components of the interaction and the salience of certain interactional moves to both adult and child participants. The mother chose when and where the iPad or other forms of AAC were utilised within the day. Extracts were selected from the available data to exemplify the types of typical exchange that occurred and some key features of the iPad enhanced interaction. The analysis describes how turns are designed incorporating the iPad and discusses what is added to the communication toolkit. Asymmetries in this mother–child interaction are observed and discussed. The child typically remains a respondent to initiations by the caregiver, who in this scenario necessarily remains in control of the iPad symbol display. However, the child uses eye-gaze strategies to indicate interests that lie both within and external to those on offer on the iPad. The article reflects on the child’s agency in initiating a possible novel topic in this way.