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Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.

Falls are not an inevitable consequence of aging. The risk and rate of falls can be reduced. Recent improvements in smartphone technology enable implementation of a wide variety of services and applications, thus making the smartphone more of a digital companion than simply a communication tool. This paper presents the results obtained by the FARSEEING project where smartphones are one example of intervention in a population-based scenario. The applications developed take advantage of the smartphone-embedded inertial sensors and require that subjects wear the smartphone by means of a waist belt. The uFall Android application has been developed for monitoring the user's motor activities at home. The application does not require any direct interaction with the user and it is also capable of running a real-time fall-detection algorithm. uTUG is a stand-alone application for instrumenting the Timed Up and Go test, which is a test often included in fall risk assessment protocols. The application acts like a pocket-sized motion laboratory, since it is capable not only of recording the trial but also of processing the data and immediately displaying the results. uTUG is designed to be self-administrable at home.

The objective of this study was to investigate the effects of two sources of electromagnetic fields (EMFs) on the proteome of cerebellum, hippocampus, and frontal lobe in Balb/c mice following long-term whole body irradiation. Three equally divided groups of animals (6 animals/group) were used; the first group was exposed to a typical mobile phone, at a SAR level range of 0.17-0.37 W/kg for 3 h daily for 8 months, the second group was exposed to a wireless DECT base (Digital Enhanced Cordless Telecommunications/Telephone) at a SAR level range of 0.012-0.028 W/kg for 8 h/day also for 8 months and the third group comprised the sham-exposed animals. Comparative proteomics analysis revealed that long-term irradiation from both EMF sources altered significantly (p < 0.05) the expression of 143 proteins in total (as low as 0.003 fold downregulation up to 114 fold overexpression). Several neural function related proteins (i.e., Glial Fibrillary Acidic Protein (GFAP), Alpha-synuclein, Glia Maturation Factor beta (GMF), and apolipoprotein E (apoE)), heat shock proteins, and cytoskeletal proteins (i.e., Neurofilaments and tropomodulin) are included in this list as well as proteins of the brain metabolism (i.e., Aspartate aminotransferase, Glutamate dehydrogenase) to nearly all brain regions studied. Western blot analysis on selected proteins confirmed the proteomics data. The observed protein expression changes may be related to brain plasticity alterations, indicative of oxidative stress in the nervous system or involved in apoptosis and might potentially explain human health hazards reported so far, such as headaches, sleep disturbance, fatigue, memory deficits, and brain tumor long-term induction under similar exposure conditions.

Mobile phones are becoming increasingly important in our everyday lives. The rising number of mobile phones reflects a similar increase in the number of base stations. Because of this rapid evolution, the establishment and planning of new base stations has become mandatory. However, the rise in the number of base stations, in terms of human health, is potentially very harmful. It is important to analyze the radiation levels of base stations until we can confirm that they are definitely not harmful in the long term. Mapping of electromagnetic field (EMF) is also important from a medical point of view because it provides useful information, for example, on the detection of diseases caused by EMF. With the help of this information the distribution of diseases over different regions can be obtained. In this article, the electromagnetic radiation levels of base stations were measured at 80 different points in Erciyes University (ERU), Turkey and detailed information about the measurement tools and measurement method were given. It was observed that no area in ERU exceeded the national and international limits. It is also observed that the effects of base stations vary according to duration and degree of exposure. Therefore, if people are exposed to a very low-intensity electromagnetic field for a very long time, serious health problems can occur.

Aims: Residents of one street expressed concern about the number of incident cancers, following the installation of a nearby mobile phone base station. The investigation explored whether the base station could be responsible for the cancers., Methods: Data were collected from residents' medical records. GPs and oncologists provided further information., Results: Ward-level cancer incidence and mortality data were also obtained, over four three-year time periods. A total of 19 residents had developed cancer. The collection of cancers did not fulfil the criteria for a cancer cluster. Standardized mortality ratios (SMRs) for all malignant neoplasms (excluding non-melanoma skin cancers) in females (1.38 (95% CI, 1.08-1.74)) and all persons (1.27 (CI, 1.06-1.51)) were significantly higher than in the West Midlands during 2001-3. There were no significant differences for colorectal, female breast and prostate cancers, for any time period. Standardized incidence ratios (SIRs) for non-melanoma skin cancers in males and all persons was significantly lower than in the West Midlands during 1999-2001, and significantly lower in males, females and all persons during 2002-4., Conclusions: We cannot conclude that the base station was responsible for the cancers. It is unlikely that information around a single base station can either demonstrate or exclude causality.

Background: With advancements in mobile technology, cellular phone-based store-and-forward teledermatology may be applied to skin cancer screening., Objective: We sought to determine diagnostic and management concordance between in-person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones., Methods: A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California. These patients' clinical history and skin images were captured by a software-enabled mobile phone. Patients were assessed separately by an in-person dermatologist and a teledermatologist, who evaluated the mobile phone-transmitted history and images. Diagnostic and management concordance was determined between the in-person and teledermatology evaluations., Results: The primary categorical diagnostic concordance was 82% between the in-person dermatologist and the teledermatologist (95% confidence interval 0.73-0.89), with a Kappa coefficient of 0.62 indicating good agreement. The aggregated diagnostic concordance between the in-person dermatologist and the teledermatologist was 62% (95% confidence interval 0.51-0.71), with Kappa coefficient of 0.60 indicating good agreement. Management concordance between the in-person dermatologist and the teledermatologist was 81% (95% confidence interval 0.72-0.88), with a Kappa coefficient of 0.57, which indicates moderate agreement between the dermatologists. Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in-person dermatologist, after adjusting for other factors., Limitations: Dermatoscopic images were not captured via mobile phones, which might improve diagnostic accuracy., Conclusion: Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening., (Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Self-management is critical to achieving diabetes treatment goals. Mobile phones and Bluetooth® can supportself-management and lifestyle changes for chronic diseases such as diabetes. A mobile health (mHealth) research platform--the Few Touch Application (FTA)--is a tool designed to support the self-management of diabetes. The FTA consists of a mobile phone-based diabetes diary, which can be updated both manually from user input and automatically by wireless data transfer, and which provides personalized decision support for the achievement of personal health goals. Studies and applications (apps) based on FTAs have included: (1) automatic transfer of blood glucose (BG) data; (2) short message service (SMS)-based education for type 1diabetes (T1DM); (3) a diabetes diary for type 2 diabetes (T2DM); (4) integrating a patient diabetes diary with health care (HC) providers; (5) a diabetes diary for T1DM; (6) a food picture diary for T1DM; (7) physical activity monitoring for T2DM; (8) nutrition information for T2DM; (9) context sensitivity in mobile self-help tools; and (10) modeling of BG using mobile phones. We have analyzed the performance of these 10 FTA-based apps to identify lessons for designing the most effective mHealth apps. From each of the 10 apps of FTA, respectively, we conclude: (1) automatic BG data transfer is easy to use and provides reassurance; (2) SMS-based education facilitates parent-child communication in T1DM; (3) the T2DM mobile phone diary encourages reflection; (4) the mobile phone diary enhances discussion between patients and HC professionals; (5) the T1DM mobile phone diary is useful and motivational; (6) the T1DM mobile phone picture diary is useful in identifying treatment obstacles; (7) the step counter with automatic data transfer promotes motivation and increases physical activity in T2DM; (8) food information on a phone for T2DM should not be at a detailed level; (9) context sensitivity has good prospects and is possible to implement on today's phones; and (10) BG modeling on mobile phones is promising for motivated T1DM users. We expect that the following elements will be important in future FTA designs: (A) automatic data transfer when possible; (B) motivational and visual user interfaces; (C) apps with considerable health benefits in relation to the effort required; (D) dynamic usage, e.g., both personal and together with HC personnel, long-/short-term perspective; and (E) inclusion of context sensitivity in apps. We conclude that mHealth apps will empower patients to take a more active role in managing their own health., (© 2012 Diabetes Technology Society.)

Purpose: To evaluate stand-alone mobile personal health record (mPHR) applications for the three leading cellular phone platforms (iOS, BlackBerry, and Android), assessing each for content, function, security, and marketing characteristics., Methods: Nineteen stand-alone mPHR applications (8 for iOS, 5 for BlackBerry, and 6 for Android) were identified and evaluated. Main criteria used to include mPHRs were: operating standalone on a mobile platform; not requiring external connectivity; and covering a wide range of health topics. Selected mPHRs were analyzed considering product characteristics, data elements, and application features. We also reviewed additional features such as marketing tactics., Results: Within and between the different mobile platforms attributes for the mPHR were highly variable. None of the mPHRs contained all attributes included in our evaluation. The top four mPHRs contained 13 of the 14 features omitting only the in-case-of emergency feature. Surprisingly, seven mPHRs lacked basic security measures as important as password protection. The mPHRs were relatively inexpensive: ranging from no cost to $9.99. The mPHR application cost varied in some instances based on whether it supported single or multiple users. Ten mPHRs supported multiple user profiles. Notably, eight mPHRs used scare tactics as marketing strategy., Conclusion: mPHR is an emerging health care technology. The majority of existing mPHR apps is limited by at least one of the attributes considered for this study; however, as the mobile market continues to expand it is likely that more comprehensive mPHRs will be developed in the near future. New advancements in mobile technology can be utilized to enhance mPHRs by long-term patient empowerment features. Marketing strategies for mPHRs should target specific subpopulations and avoid scare tactics., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

We demonstrate a cellphone-based rapid-diagnostic-test (RDT) reader platform that can work with various lateral flow immuno-chromatographic assays and similar tests to sense the presence of a target analyte in a sample. This compact and cost-effective digital RDT reader, weighing only ~65 g, mechanically attaches to the existing camera unit of a cellphone, where various types of RDTs can be inserted to be imaged in reflection or transmission modes under light-emitting diode (LED)-based illumination. Captured raw images of these tests are then digitally processed (within less than 0.2 s per image) through a smart application running on the cellphone for validation of the RDT, as well as for automated reading of its diagnostic result. The same smart application then transmits the resulting data, together with the RDT images and other related information (e.g., demographic data), to a central server, which presents the diagnostic results on a world map through geo-tagging. This dynamic spatio-temporal map of various RDT results can then be viewed and shared using internet browsers or through the same cellphone application. We tested this platform using malaria, tuberculosis (TB) and HIV RDTs by installing it on both Android-based smartphones and an iPhone. Providing real-time spatio-temporal statistics for the prevalence of various infectious diseases, this smart RDT reader platform running on cellphones might assist healthcare professionals and policymakers to track emerging epidemics worldwide and help epidemic preparedness.

Purpose: Smartphones have gained widespread use in the healthcare field to fulfill a variety of tasks. We developed a small iPhone application to take advantage of the built-in position sensor to measure angles in a variety of spinal deformities. We present a reliability study of this tool in measuring kyphotic angles., Methods: Radiographs taken from 20 different patients' charts were presented to a panel of six operators at two different times. Radiographs were measured with the protractor and the iPhone application and statistical analysis was applied to measure intraclass correlation coefficients between both measurement methods, and to measure intra- and interobserver reliability, Results: The intraclass correlation coefficient calculated between methods (i.e. CobbMeter application on the iPhone versus standard method with the protractor) was 0.963 for all measures, indicating excellent correlation was obtained between the CobbMeter application and the standard method. The interobserver correlation coefficient was 0.965. The intraobserver ICC was 0.977, indicating excellent reproductibility of measurements at different times for all operators. The interobserver ICC between fellowship trained senior surgeons and general orthopaedic residents was 0.989. Consistently, the ICC for intraobserver and interobserver correlations was higher with the CobbMeter application than with the regular protractor method. This difference was not statistically significant., Conclusion: Measuring kyphotic angles with the iPhone application appears to be a valid procedure and is in no way inferior to the standard way of measuring the Cobb angle in kyphotic deformities.

Objective: In this study, the effects of radiation emitted from mobile phone (MP) on heart rate variability (HRV) which is accepted a non-invasive indicator of autonomic nervous system (ANS) were investigated with considering the deficiency of previous studies., Methods: A randomized controlled study has been designed and utilized with 30 young and healthy volunteers. During the experiment that had three periods, the electrocardiogram (ECG) and respiration signals were recorded and MP was attached to subjects' right ear with a bone. Ten subjects selected randomly were exposed to high -level radiation during the second period (Experimental Group 1). Ten of others were exposed during the third period with maximum level radiation (Experimental Group 2). Ten records were also made while MP was closed as a control. Short -term HRV parameters were obtained and repeated measures ANOVA and suitable post-hoc tests applied to the results., Results: According to the results of the repeated measures ANOVA; there were no significant main effects of groups. However, there were some significant differences in measuring time periods and groups*period interactions. The post-hoc tests showed that mean R to R interval and HF power are significantly changed by maximum radiation emitted from MP., Conclusion: Due to the radiation emitted from MPs at maximum power, some changes may occur in HRV parameters that are associated with increased parasympathetic activity. But, the level of these changes is similar to daily activities as excitement, and stand up.

Objective: This pilot study tested the feasibility and impact of using mobile media devices to present peer health messages to human immunodeficiency virus (HIV)-positive patients., Subjects and Methods: A convenience sample of 30 adult patients from an outpatient HIV clinic serving a mostly rural catchment area in central Virginia volunteered for the study. Participants viewed short videos of people discussing HIV health topics on an Apple (Cupertino, CA) iPod® touch® mobile device. Pre- and post-intervention surveys assessed attitudes related to engagement in care and disease disclosure., Results: Participants found delivery of health information by the mobile device acceptable in a clinic setting. They used the technology without difficulty. Participants reported satisfaction with and future interest in viewing such videos after using the mobile devices. The majority of participants used the device to access more videos than requested, and many reported the videos "hit home." There were no significant changes in participant perceptions about engagement in care or HIV disclosure after the intervention., Conclusions: This pilot study demonstrates the feasibility and acceptability of using mobile media technology to deliver peer health messages. Future research should explore how to best use mobile media to improve engagement in care and reduce perceptions of stigma.

Alumina substrate can be found in electronic components used in portable electronic devices. The material is radiation sensitive and can be applied in dosimetry using thermally or optically stimulated luminescence. Electronic portable devices such as mobile phones, USB flash discs, mp3 players, etc., which are worn close to the body, can represent  personal dosemeters for members of the general public in situations of large-scale radiation accidents or malevolent acts with radioactive materials. This study investigated dosimetric properties of alumina substrates and aspects of using mobile phones as personal dosemeters. The alumina substrates exhibited favourable dosimetry characteristics. However, anomalous fading had to be properly corrected in order to achieve sufficient precision in dose estimate. Trial dose reconstruction performed by means of two mobile phones proved that mobile phones can be used for reconstruction of personal doses.

Background: Mobile phones improve the efficiency of clinical communication and are increasingly involved in all areas of healthcare delivery. Despite this, healthcare workers' mobile phones provide a known reservoir of pathogenic bacteria, with the potential to undermine infection control efforts aimed at the reducing bacterial cross-contamination in hospitals. This potential could be amplified further when employers require doctors to carry additional electronic devices for communication, without concurrently providing appropriate guidance on decontamination or use., Methods: Eighty-seven on-call doctors' mobile phones were sampled for bacterial growth prior to, and 12 h after, a cleaning intervention involving 70% isopropyl alcohol., Results: Seventy-eight percent of doctors were aware that mobile phones could carry pathogenic bacteria, but only 8% cleaned their phones regularly. The cleaning intervention reduced the number of phones that grew bacteria by 79% (55% [48 of 87] before versus 16% [14 of 87] after cleaning). Eight percent of the phones grew Staphyloccus aureus, and 44.8% of phones grew Gram-positive cocci. All S. aureus isolates were methicillin-sensitive. Bacterial contamination was not associated with gender, specialty, or seniority of the phone user (p>0.05)., Conclusions: Simple cleaning interventions can reduce the surface bioburden of hospital-provided doctors' mobile phones and therefore the potential for cross-contamination. This cleaning intervention is inexpensive, easily instituted, and effective. Healthcare workers should carry the minimum number of electronic devices on their person, maintain good hand hygiene, and clean their device appropriately in order to minimize the potential for cross-contamination in the work place.

The objective of this study was to examine the distribution of the output power of mobile phones and other terminals connected to a 3G network in Sweden. It is well known that 3G terminals can operate with very low output power, particularly for voice calls. Measurements of terminal output power were conducted in the Swedish TeliaSonera 3G network in November 2008 by recording network statistics. In the analysis, discrimination was made between rural, suburban, urban, and dedicated indoor networks. In addition, information about terminal output power was possible to collect separately for voice and data traffic. Information from six different Radio Network Controllers (RNCs) was collected during at least 1 week. In total, more than 800000 h of voice calls were collected and in addition to that a substantial amount of data traffic. The average terminal output power for 3G voice calls was below 1 mW for any environment including rural, urban, and dedicated indoor networks. This is <1% of the maximum available output power. For data applications the average output power was about 6-8 dB higher than for voice calls. For rural areas the output power was about 2 dB higher, on average, than in urban areas., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: Disease management following hospital discharge is difficult in most low-resourced areas, posing a major obstacle to health equity. Although mobile phones are a ubiquitous and promising technology to facilitate healthcare access, few studies have tested the acceptability and feasibility of patients themselves using the devices for assisting linkages to healthcare services. We hypothesized that patients would use mobile phones to help manage postdischarge problems, if given a communication protocol. We developed a mobile phone-based program and investigated its acceptability and feasibility as a method of delivering posthospitalization care., Subjects and Methods: A consecutive cohort of adult patients in a public hospital in Quito, Ecuador was enrolled over a 1-month period. A hospital-based nurse relayed patients' discharge instructions to a community-based nurse. Patients corresponded with this nurse via text messaging and phone calls according to a protocol to initiate and participate in follow-up., Results: Eighty-nine percent of eligible patients participated. Ninety-seven percent of participants completed at least one contact with the nurse; 81% initiated contact themselves. Nurses completed 262 contacts with 32 patients, clarifying discharge instructions, providing preventive education, and facilitating clinic appointments. By this method, 87% of patients were successfully linked to follow-up appointments., Conclusions: High levels of patient participation and successful delivery of follow-up services indicate the mobile phone program's acceptability and feasibility for facilitating posthospitalization follow-up. Patients actively used mobile phones to interact with nurses, enabling the provision of posthospitalization medical advice and facilitate community-based care via mobile phone.

In this article, the general public daily exposure to broadcast signals and Global System for Mobile Communications (GSM) or Universal Mobile Telecommunications System (UMTS) mobile telephone signals in indoor areas is investigated. Temporal variations and traffic distributions during a day at different indoor sites in urban and rural zones are presented. The goal is to analyze the real exposure compared to the maximum assessment imposed by radio protection standards and to characterize the ratio between daily and maximum theoretical values. Hence, a realistic maximum is proposed based on the statistical analysis performed using measurements. Broadcast signals remain constant over the day so they are best fitted with a Normal distribution while the mobile telephone signals depend on the traffic demand during the day so they fit a three-Gaussian distribution model. A general mask is also constructed for underlining the maximum equivalent active traffic for different periods in the day. Also, relations between the mean values over 24 h, the realistic maximal values (at 99%) and the maximal theoretical values are presented. The realistic maximum is also presented with a sliding time average of 6 min applied to the measurements in accordance with international standards. An extrapolation factor is given for the different systems to easily assess the maximum values starting from an instantaneous measurement. The extrapolation factor is also given for a broadband measurement to estimate the maximum potential exposure during the day., (Copyright © 2011 Wiley Periodicals, Inc.)

By 2012, point of care (POC) testing will constitute roughly one third of the $59 billion in vitro diagnostics market. The ability to carry out multiplexed genetic testing and wireless connectivity are emerging as key attributes of future POC devices. In this study, an inexpensive, user-friendly and compact device (termed Gene-Z) is presented for rapid quantitative detection of multiple genetic markers with high sensitivity and specificity. Using a disposable valve-less polymer microfluidic chip containing four arrays of 15 reaction wells each with dehydrated primers for isothermal amplification, the Gene-Z enables simultaneous analysis of four samples, each for multiple genetic markers in parallel, requiring only a single pipetting step per sample for dispensing. To drastically reduce the cost and size of the real-time detector necessary for quantification, loop-mediated isothermal amplification (LAMP) was performed with a high concentration of SYTO-81, a non-inhibiting fluorescent DNA binding dye. The Gene-Z is operated using an iPod Touch, which also receives data and carries out automated analysis and reporting via a WiFi interface. This study presents data pertaining to performance of the device including sensitivity and reproducibility using genomic DNA from Escherichia coli and Staphylococcus aureus. Overall, the Gene-Z represents a significant step toward truly inexpensive and compact tools for POC genetic testing.

Background: Non-coverage of households without a landline telephone is a major concern of telephone survey researchers. Sampling mobile telephone users in national surveys is vital in order to gain access to the growing proportion of households that use mobile telephones extensively or exclusively. The complex logistics of conducting surveys with mobile telephones have been discussed in the literature. This paper outlines the actual challenges encountered during a recent national sexual health survey in Ireland, which utilized a mobile telephone sampling frame to recruit approximately half of the sample., Method: The 2010 Irish Contraception and Crisis Pregnancy Survey (ICCP-2010) is a nationally representative sample of adults aged 18-45 years living in Ireland (n = 3002; 1416 recruited by landline telephone and 1586 recruited by mobile telephone). The overall response rate for the survey was 69% (79% for the landline telephone strand; 61% for the mobile telephone strand). All interviews were conducted using computer-assisting telephone interviewing., Results: During the 18-week fieldwork period, five main challenges relating to the use of mobile telephones were encountered: (1) explaining to respondents how random digit dialling works in relation to mobile telephones; (2) establishing the respondent's eligibility; (3) calling the respondent with the Caller ID blocked or withheld; (4) calling the respondent when they are in any number of locations or situations; and (5) explaining to respondents the importance of refusal conversion calls for the response rate calculation. Details of how the survey protocols and procedures were monitored and adapted throughout the study to ensure a high response rate are outlined., Conclusion: It is undeniably more challenging to recruit respondents using mobile telephones as opposed to landline telephones. Respondents are generally not familiar with being contacted on their personal mobile telephone for the purposes of being recruited for a research study. The main challenge for survey methodologists and interviewers is to devise simple protocols to explain to respondents why they are being contacted on a mobile telephone. Recommendations for survey researchers interested in using this methodological approach in the future are discussed.

Two studies are reported; a pilot study to demonstrate feasibility followed by a larger validity study. Study 1's objective was to test the effect of two ecological momentary assessment (EMA) approaches that varied in intensity on the validity/accuracy of estimating energy intake (EI) with the Remote Food Photography Method (RFPM) over 6 days in free-living conditions. When using the RFPM, Smartphones are used to capture images of food selection and plate waste and to send the images to a server for food intake estimation. Consistent with EMA, prompts are sent to the Smartphones reminding participants to capture food images. During Study 1, EI estimated with the RFPM and the gold standard, doubly labeled water (DLW), were compared. Participants were assigned to receive Standard EMA Prompts (n = 24) or Customized Prompts (n = 16) (the latter received more reminders delivered at personalized meal times). The RFPM differed significantly from DLW at estimating EI when Standard (mean ± s.d. = -895 ± 770 kcal/day, P < 0.0001), but not Customized Prompts (-270 ± 748 kcal/day, P = 0.22) were used. Error (EI from the RFPM minus that from DLW) was significantly smaller with Customized vs. Standard Prompts. The objectives of Study 2 included testing the RFPM's ability to accurately estimate EI in free-living adults (N = 50) over 6 days, and energy and nutrient intake in laboratory-based meals. The RFPM did not differ significantly from DLW at estimating free-living EI (-152 ± 694 kcal/day, P = 0.16). During laboratory-based meals, estimating energy and macronutrient intake with the RFPM did not differ significantly compared to directly weighed intake.

Objective: In this study, the diagnostic accuracy of interpretations of electrocardiogram (ECG) images taken by a mobile phone and sent as multimedia message was investigated., Materials and Methods: The ECGs of 305 patients who were admitted to the emergency department with cardiac complaints were photographed with the camera of a Nokia (Espoo, Finland) N93 mobile phone. The images were sent via a multimedia messaging system to an identical mobile phone carried by a cardiologist and were interpreted on the screen of that mobile phone. Another cardiologist and an emergency physician interpreted ECG paper printouts separately. The findings of the core laboratory were used as the gold standard. The interpretation errors were scaled from 1 to 4 with respect to the significance of findings., Results: The total ratio of Grade 4 errors, which consisted of significant errors, did not show any significant difference (p=0.76) between the interpretations by the emergency medicine specialist and the cardiologist who interpreted the ECGs on the mobile phone; the cardiologist who interpreted the ECG paper printouts made significantly fewer mistakes than the other two specialists (p=0.025 and p=0.023, respectively). The separate assessment of the findings showed that in the diagnostic process of ST-segment elevation, depression, and supraventricular tachycardia, the consistency of the interpretations (κ=0.81, κ=0.81, and κ=1.0, respectively) made on the mobile phone screen was slightly better than that of the emergency medicine specialist (κ=0.73, κ=0.77, and κ=0.80, respectively) and was similar to that of the cardiologist (κ=0.91, κ=0.91, and κ=1.0, respectively) who interpreted ECG paper printouts., Conclusions: Our findings suggest that sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure.

Several studies have been using a GSM mobile phone in stand-by mode as the source for exposure, and they claimed that this caused effects on for instance sleep and testicular function. In stand-by mode the phone is only active in periodic location updates, and this occurs with a frequency set by the net operator. Typical updates occur with 2-5 h in between, and between these updates the phone is to be considered as a passive radio receiver with no microwave emission. Thus, the exposure in stand-by mode can be considered negligible.

Purpose: To evaluate the diagnostic capability of a smartphone handset compared with a standard office computer workstation for teleophthalmology fundus photo assessments of diabetic retinopathy., Methods: Eligible, consenting participants' fundus images were acquired using a non-mydriatic camera. These images along with other medical data were transmitted 20 miles away through the Internet (gold standard) and also through an iPhone(®) (Apple, Cupertino, CA) to two ophthalmologists, who independently compared the images., Results: The κ coefficient between the gold standard workstation display and iPhone images to detect retinopathy-related changes for both readers was more than 0.9. The image quality of the iPhone was scored high by the ophthalmologists., Conclusions: Ophthalmic images transmitted through both smartphone and Internet techniques match well with each other. Despite current limitations, smartphones could represent as a tool for fundus photo assessments of diabetic retinopathy. Further studies are needed to investigate the economic and clinical feasibility of smartphones in ophthalmology.

Objective: To identify the accuracy of a camera-enabled mobile phone in assessing patients with nasal bone injuries and to determine if treatment in the form of manipulation of the nasal bones and therefore outpatient attendance was necessary., Methods: Prospective study of patients with nasal injuries attending the weekly ear-nose-throat emergency clinic. The patient is assessed and examined, and a preset questionnaire is filled out. An anteroposterior photograph and an overhead photograph of the nose are taken. The pictures are then e-mailed to a senior member of the team who reviews the pictures and determines based on the images whether intervention in the form of manipulation of nasal bones was required. The results were then compared with the actual assessment and management in the clinic., Results: Of the 50 patients assessed, 94% showed a direct correlation between the perceived need for treatment based on the clinical images and the actual management in the outpatient clinic. The results also showed the test to be 88% specific and 100% sensitive., Conclusions: We conclude that the use of a mobile phone camera to assess nasal bone injuries could be a useful triage tool in correctly identifying patients who may require intervention in the form of nasal bone manipulation.

The potential usefulness of smartphones in the medical field is evolving everyday. This article describes various tools available on smartphones, largely focusing on the iPhone, for the examination of an ophthalmic patient, for patient and physician education, as well as reference tools for both ophthalmologists and vision researchers. Furthermore, the present article discusses how smartphones can be used for ophthalmic photography and image management, and foremost, the usefulness of the applications such as the Eye Handbook for the ophthalmologist and interested students, patients, physicians, and researchers, currently available in the iPhone.

A head exposure setup for efficient and precisely defined exposure of human subjects equipped with a near-infrared imaging (NIRI) sensor is presented. In a partially shielded anechoic chamber the subjects were exposed to Universal Mobile Telecommunications System (UMTS)-like electromagnetic fields (EMF) by using a patch antenna at a distance of 4 cm from the head. The non-contact design of the exposure setup enabled NIRI sensors to easily attach to the head. Moreover, different regions of the head were chosen for localised exposure and simultaneous NIRI investigation. The control software enabled the simple adaptation of the test parameters during exploratory testing as well as the performance of controlled, randomised, crossover and double-blind provocation studies. Four different signals with a carrier frequency of 1900 MHz were chosen for the exposure: a simple continuous wave signal and three different UMTS signals. Furthermore, three exposure doses were available: sham, low (spatial peak specific absorption rate (SAR) = 0.18 W/kg averaged over 10 g) and high (spatial peak SAR = 1.8 W/kg averaged over 10 g). The SAR assessment was performed by measurement and simulation. Direct comparison of measurement and numerical results showed good agreement in terms of spatial peak SAR and SAR distribution. The variability analysis of the spatial peak SAR over 10 g was assessed by numerical simulations. Maximal deviations of -22% and +32% from the nominal situation were observed. Compared to other exposure setups, the present setup allows for low exposure uncertainty, combined with high SAR efficiency, easy access for the NIRI sensor and minimal impairment of test subjects., (Copyright © 2011 Wiley Periodicals, Inc.)

With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home.

Fall prevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls-left and right lateral, forward trips, and backward slips-while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls.

Background: Periodic limb movements (PLMs) are repetitive, stereotypical and unconscious movements, typically of the legs, that occur in sleep and are associated with several sleep disorders. The gold standard for detecting PLMs is overnight electromyography which, although highly sensitive and specific, is time and labour consuming. The current generation of smart phones is equipped with tri-axial accelerometers that record movement., Aim: To develop a smart phone application that can detect PLMs remotely., Method: A leg movement sensing application (LMSA) was programmed in iOS 5x and incorporated into an iPhone 4S (Apple INC.). A healthy adult male subject underwent simultaneous EMG and LMSA measurements of voluntary stereotypical leg movements. The mean number of leg movements recorded by EMG and by the LMSA was compared., Results: A total of 403 leg movements were scored by EMG of which the LMSA recorded 392 (97%). There was no statistical difference in mean number of leg movements recorded between the two modalities (p = 0.3)., Conclusion: These preliminary results indicate that a smart phone application is able to accurately detect leg movements outside of the hospital environment and may be a useful tool for screening and follow up of patients with PLMs.

Approximately one-third of adults in the United States are physically inactive. This is a significant public health concern as physical activity (PA) can influence the risk of cardiovascular disease, diabetes, and certain forms of cancer. To minimize these health risks, effective PA interventions must be developed and disseminated to the vast number of individuals who remain sedentary. Smartphone technology presents an exciting opportunity for delivering PA interventions remotely. Although a number of PA applications are currently available for smartphones, these "apps" are not based on established theories of health behavior change and most do not include evidence-based features (e.g., reinforcement and goal setting). Our aim was to collect formative data to develop a smartphone PA app that is empirically and theoretically-based and incorporates user preferences. We recruited 15 sedentary adults to test three currently available PA smartphone apps and provide qualitative and quantitative feedback. Findings indicate that users have a number of specific preferences with regard to PA app features, including that apps provide automatic tracking of PA (e.g., steps taken and calories burned), track progress toward PA goals, and integrate a music feature. Participants also preferred that PA apps be flexible enough to be used with several types of PA, and have well-documented features and user-friendly interfaces (e.g., a one-click main page). When queried by the researcher, most participants endorsed including goal-setting and problem-solving features. These findings provide a blue print for developing a smartphone PA app that incorporates evidence-based components and user preferences.

Objective: This study used a driving simulator to investigate the effect of using a Bluetooth hands-free cellular phone earpiece on the driving behavior of two age groups., Methods: Forty-eight participants (24 aged 20-26 and 24 aged 65-73) were examined to assess their performance on the following divided-attention tasks under 2 driving load conditions (high and low): (1) attempting to maintain the speed limit and (2) using a cellular phone while driving. The length of the call conversation (long vs. short) and the conversational content (complex vs. simple) were manipulated as within-subject independent variables. The driving behavior of the participants, their task reaction times and accuracy, and subjective ratings were collected as dependent variables., Results: The results indicate that under low driving loads, short talk times, and simple conversational content, the driving behavior of the participants showed low variance in the vehicle's mean speed. In contrast, complex conversation had a significantly negative impact on driving behavior. Notably, under a low driving load, motorists' driving behaviors, measured in lateral acceleration, caused significantly smaller variance in complex conversations compared to no call and simple conversations. The use of a hands-free cellular phone affected the performance (acceleration, lane deviation, reaction time, and accuracy) of older drivers significantly more than younger drivers. While performing divided attention tasks, the accuracy of the older drivers was 66.3 percent and that of the younger drivers was 96.3 percent. Although this study did not find a clear impact of cellular phone use on the driving behavior of younger drivers, their divided-attention task reaction times and accuracy were better under no-call than calling conditions., Conclusions: This study indicates that the use of hands-free cellular phones could significantly affect the safety of driving among the older and present risks, although lesser, for younger drivers.

Objective: To test the feasibility of using cell phone technology to provide video medical interpretation services at a distance., Materials and Methods: Alternative cell phone services were researched and videoconferencing technologies were tried out to identify video products and telecommunication services needed to meet video medical interpretation requirements. The video and telecommunication technologies were tried out in a pharmacy setting and compared with use of the telephone., Results: Outcomes were similar to findings in previous research involving video medical interpretation with higher bandwidth and video quality. Patients appreciated the interpretation service no matter how it is provided, while health providers and interpreters preferred video., Conclusion: It is possible to provide video medical interpretation services via cellular communication using lower bandwidth videoconferencing technology that provides sufficient quality, at least in pharmacy settings. However, a number of issues need to be addressed to ensure quality of service.

The popularization of mobile phones, combined with a technological evolution, means a large number of scrap and obsolete equipment are discarded every year, thereby causing economic losses and environmental pollution. In the present study, the printed wiring boards scrap of mobile phones were characterized in order to recycle some of the device components, using techniques of mechanical processing, hydrometallurgy and electrometallurgy. The use of the techniques of mechanical processing (milling, particle size classification, magnetic and electrostatic separation) was an efficient alternative to obtain a concentrated fraction (mainly iron in the magnetic fraction and copper in the conductive fraction) and another fraction containing polymers and ceramics. At the end of mechanical processing, a concentrated fraction of metals could be obtained with an average concentration of 60% copper. This concentrated fraction in metals was dissolved in aqua regia and sent to electrowinning to recover 92% of the dissolved copper. The obtained cathodes have a copper content above 95%, which demonstrates the technical feasibility of recovery of copper using the techniques of mechanical processing, hydrometallurgy and electrometallurgy., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: to study the sensitivity and specificity of fall detection using mobile phone technology., Design: an experimental investigation using motion signals detected by the mobile phone., Setting and Participants: the research was conducted in a laboratory setting, and 18 healthy adults (12 males and 6 females; age = 29 ± 8.7 years) were recruited., Measurement: each participant was requested to perform three trials of four different types of simulated falls (forwards, backwards, lateral left and lateral right) and eight other everyday activities (sit-to-stand, stand-to-sit, level walking, walking up- and downstairs, answering the phone, picking up an object and getting up from supine). Acceleration was measured using two devices, a mobile phone and an independent accelerometer attached to the waist of the participants., Results: Bland-Altman analysis shows a higher degree of agreement between the data recorded by the two devices. Using individual upper and lower detection thresholds, the specificity and sensitivity for mobile phone were 0.81 and 0.77, respectively, and for external accelerometer they were 0.82 and 0.96, respectively., Conclusion: fall detection using a mobile phone is a feasible and highly attractive technology for older adults, especially those living alone. It may be best achieved with an accelerometer attached to the waist, which transmits signals wirelessly to a phone.

Background: Loss to follow-up of trial participants represents a threat to research validity. To date, interventions designed to increase participants' awareness of benefits to society of completing follow-up, and the impact of a telephone call from a senior female clinician and researcher requesting follow-up have not been evaluated robustly., Purpose: Trial 1 aimed to evaluate the effect on trial follow-up of written information regarding the benefits of participation to society. Trial 2 aimed to evaluate the effect on trial follow-up of a telephone call from a senior female clinician and researcher., Methods: Two single-blind randomized controlled trials were nested within a larger trial, Txt2stop. In Trial 1, participants were allocated using minimization to receive a refrigerator magnet and a text message emphasizing the benefits to society of completing follow-up, or to a control group receiving a simple reminder regarding follow-up. In Trial 2, participants were randomly allocated to receive a telephone call from a senior female clinician and researcher, or to a control group receiving standard Txt2stop follow-up procedures., Results: Trial 1: 33.5% (327 of 976) of the intervention group and 33.8% (329 of 974) of the control group returned the questionnaire within 26 weeks of randomization, risk ratio (RR) 0.99; 95% confidence interval (CI) 0.88-1.12. In all, 83.3% (813 of 976) of the intervention group and 82.2% (801 of/974) of the control group sent back the questionnaire within 30 weeks of randomization, RR 1.01; 95% CI 0.97, 1.05. Trial 2: 31% (20 of 65) of the intervention group and 32% (20 of 62) of the control group completed trial follow-up, RR 0.93; 95%CI 0.44, 1.98., Conclusions: In presence of other methods to increase follow-up neither experimental method (refrigerator magnet and text message emphasizing participation's benefits to society nor a telephone call from study's principal investigator) increased participant follow-up in the Txt2stop trial.

Background: In the development of the requirements for telecoil-compatible magnetic signal sources for wireless and cordless telephones to be specified in the American National Standards Institute (ANSI) C63.19 and ANSI/Telecommunications Industry Association-1083 compatibility standards, it became evident that additional data concerning in-the-field telecoil use and subjective preferences were needed., Purpose: Primarily, the magnetic signal levels and, secondarily, the field orientations required for effective and comfortable telecoil use with wireless and cordless handsets needed further characterization. (A companion article addresses user signal-to-noise needs and preferences.), Research Design: Test subjects used their own hearing aids, which were addressed with both a controlled acoustic speech source and a controlled magnetic speech source. Each subject's hearing aid was first measured to find the telecoil's magnetic field orientation for maximum response, and an appropriate large magnetic head-worn coil was selected to apply the magnetic signal. Subjects could control the strength of the magnetic signal, first to match the loudness of a reference acoustic signal and then to find their Most Comfortable Level (MCL). The subjective judgments were compared against objective in-ear probe tube level measurements., Study Sample: The 57 test subjects covered an age range of 22 to 79 yr, with a self-reported hearing loss duration of 12 to 72 yr. All had telecoils that they used for at least some telecommunications needs. The self-reported degree of hearing loss ranged from moderate to profound. A total of 69 hearing aids were surveyed for their telecoil orientation., Data Collection and Analysis: A guided intake questionnaire yielded general background information for each subject. A custom-built test jig enabled hearing aid telecoil orientation within the aid to be determined. By comparing this observation with the in-use hearing aid position, the in-use orientation for each telecoil was determined. A custom-built test control box fed by prepared speech recordings from computer files enabled the tester to switch between acoustic and magnetic speech signals and to read and record the subject's selected magnetic level settings., Results: The overwhelming majority of behind-the-ear aids tested exhibited in-use telecoil orientations that were substantially vertical. An insufficient number of participants used in-the-ear aids to be able to draw general conclusions concerning the telecoil orientations of this style aid. The subjects showed a generally consistent preference for telecoil speech levels that subjectively matched the level that they heard from 65 dB SPL acoustic speech. The magnetic level needed to achieve their MCL, however, varied over a 30 dB range., Conclusions: Producing the necessary magnetic field strengths from a wireless or cordless telephone's handset in an in-use vertical orientation is vital for compatibility with the vast majority of behind-the-ear aids. Due to the very wide range of preferred magnetic signal levels shown, only indirect conclusions can be drawn concerning required signal levels. The strong preference for a 65 dB SPL equivalent level can be combined with established standards addressing hearing aid performance to derive reasonable source level requirements. Greater consistency between in-the-field hearing aid telecoil and microphone sensitivity adjustments could yield improved results for some users., (American Academy of Audiology.)