Morten Balle Hansen

Biopotentials as command and feedback signals in functional electrical stimulation systems.

Today Functional Electrical Stimulation (FES) is available as a clinical tool in muscle activation used for picking up objects, for standing and walking, for controlling bladder emptying, and for breathing. Despite substantial progress in development and new knowledge, many challenges remain to be resolved to provide a more efficient functionality of FES systems. The most important task of these challenges is to improve control of the activated muscles through open loop or feedback systems. Command and feedback signals can be extracted from biopotentials recorded from muscles (Electromyogram, EMG), nerves (Electroneurogram, ENG), and the brain (Electroencephalogram (EEG) or individual cells). This paper reviews work in which EMG, ENG, and EEG signals in humans have been used as command and feedback signals in systems using electrical stimulation of motor nerves to restore movements after an injury to the Central Nervous System (CNS). It is concluded that the technology is ready to push for more substantial clinical FES investigations in applying muscle and nerve signals. Brain-computer interface systems hold great prospects, but require further development of faster and clinically more acceptable technologies.

Theory-Based Stakeholder Evaluation

This article introduces a new approach to program theory evaluation called theory-based stakeholder evaluation or the TSE model for short. Most theory-based approaches are program theory driven and some are stakeholder oriented as well. Practically, all of the latter fuse the program perceptions of the various stakeholder groups into one unitary program theory. The TSE model keeps the program theories of the diverse stakeholder groups apart from each other and from the program theory embedded in the institutionalized intervention itself. This represents, the authors argue, an important clarification and extension of the standard theory-based evaluation. The TSE model is elaborated to enhance theory-based evaluation of interventions characterized by conflicts and competing program theories. The authors argue that especially in evaluations of complex and complicated multilevel and multisite interventions, the presence of competing theories is likely and the TSE model may prove useful.

Evaluating robustness of gait event detection based on machine learning and natural sensors

A real-time system for deriving timing control for functional electrical stimulation for foot-drop correction, using peripheral nerve activity as a sensor input, was tested for reliability to investigate the potential for clinical use. The system, which was previously reported on, was tested on a hemiplegic subject instrumented with a recording cuff electrode on the Sural nerve, and a stimulation cuff electrode on the Peroneal cuff. Implanted devices enabled recording and stimulation through telelinks. An input domain was derived from the recorded electroneurogram and fed to a detection algorithm based on an adaptive logic network for controlling the stimulation timing. The reliability was tested by letting the subject wear different foot wear and walk on different surfaces than when the training data was recorded. The detection system was also evaluated several months after training. The detection system proved able to successfully detect when walking with different footwear on varying surfaces up to 374 days after training, and thereby showed great potential for being clinically useful.

Real Time Foot Drop Correction using Machine Learning and Natural Sensors

The objective of this study was to investigate and test a real time system implemented for Functional Electrical Stimulation (FES) assisted foot drop correction, deriving control timing from signals recorded from a peripheral sensory nerve.

Marketization and Economic Performance

Abstract The public management reforms of the past three decades have been characterized by organizational innovations usually associated with New Public Management (NPM) and reinventing government. In particular, neoliberal ideas of strengthening market mechanisms in the public sector have been prominent. In the empirical literature focusing on the consequences of marketization, most studies have examined technical services such as refuse collection while very few have focused on the social sector. In this article, an example of the general trend towards marketization conducted within the social sector is analysed. A reform enforcing compulsory competitive tendering in homecare for elderly people in Denmark is analysed and its relation to measures of economic performance is explored. Two competing models of marketization are contrasted in the analysis: a problem solving model inspired by public choice ideology, in which marketization processes are seen as driven by work-related concerns for efficiency and performance, and a macro phenomenological institutional model, in which innovation processes are seen as driven by factors related to hegemonic ideologies, legitimacy concerns and coercive enforcement. Very little impact on economic performance is found, which lends support to an institutional interpretation of the findings.

Feasibility of Using Peroneal Nerve Recordings for Deriving Stimulation Timing in a Foot Drop Correction System

The objective of this research was to demonstrate the potential of using peroneal nerve activity to derive timing control for stimulation in foot drop correction and to attempt recording and stimulation through the same electrode. Two subjects were implanted with cuff electrodes on the peroneal nerve. An input domain was derived from the recorded electroneurogram (ENG) and fed to a detection algorithm based on an Adaptive Logic Network (ALN) for predicting stimulation timing. A switching circuit was furthermore built for switching between stimulator and recorder for combined use of the cuff electrode.

Results of Automated Retinal Image Analysis for Detection of Diabetic Retinopathy from the Nakuru Study, Kenya.

Objective Digital retinal imaging is an established method of screening for diabetic retinopathy (DR). It has been established that currently about 1% of the world’s blind or visually impaired is due to DR. However, the increasing prevalence of diabetes mellitus and DR is creating an increased workload on those with expertise in grading retinal images. Safe and reliable automated analysis of retinal images may support screening services worldwide. This study aimed to compare the Iowa Detection Program (IDP) ability to detect diabetic eye diseases (DED) to human grading carried out at Moorfields Reading Centre on the population of Nakuru Study from Kenya. Participants Retinal images were taken from participants of the Nakuru Eye Disease Study in Kenya in 2007/08 (n = 4,381 participants [NW6 Topcon Digital Retinal Camera]). Methods First, human grading was performed for the presence or absence of DR, and for those with DR this was sub-divided in to referable or non-referable DR. The automated IDP software was deployed to identify those with DR and also to categorize the severity of DR. Main Outcome Measures The primary outcomes were sensitivity, specificity, and positive and negative predictive value of IDP versus the human grader as reference standard. Results Altogether 3,460 participants were included. 113 had DED, giving a prevalence of 3.3% (95% CI, 2.7–3.9%). Sensitivity of the IDP to detect DED as by the human grading was 91.0% (95% CI, 88.0–93.4%). The IDP ability to detect DED gave an AUC of 0.878 (95% CI 0.850–0.905). It showed a negative predictive value of 98%. The IDP missed no vision threatening retinopathy in any patients and none of the false negative cases met criteria for treatment. Conclusions In this epidemiological sample, the IDP’s grading was comparable to that of human graders’. It therefore might be feasible to consider inclusion into usual epidemiological grading.

New Public Management, Public Service Bargains and the challenges of interdepartmental coordination: a comparative analysis of top civil servants in state administration

In this article we are interested in how the coordinating role of top civil servants is related to the argument that country-level differences in the adoption of New Public Management significantly alter the Public Service Bargains of top civil servants and consequently their capacity to accomplish interdepartmental coordination. A managerial PSB limits top civil servants’ role in interdepartmental coordination, as their focus will be on achieving goals set for their specific departments, rather than for the central government as a collective. We test our argument with empirical insights from a comparative analysis of five countries: Belgium, Canada, Denmark, the Netherlands and the United Kingdom. We find that our argument is only partly valid and discuss the theoretical and empirical implications of the analysis. Points for practitioners Alongside the introduction of New Public Management, the relationships between ministers and their top civil servants in state administration have evolved. At the same time, societal issues are getting more complex and demand a holistic, cross-sector approach. The concept of a managerial Public Service Bargain is used to analyze changes in top civil servants’ role and the impact of reforms on the capacity of top civil servants to accomplish interdepartmental coordination. Practitioners can learn more about the close link between challenges for interdepartmental coordination and changes in the role and functioning of top civil servants.

Adaptive fuzzy logic restriction rules for error correction and safe stimulation patterns during functional electrical stimulation.

Adaptive restriction rules based on fuzzy logic have been developed to eliminate errors and to increase stimulation safety in the foot-drop correction application, specifically when using adaptive logic networks to provide a stimulation control signal based on neural activity recorded from peripheral sensory nerve branches. The fuzzy rules were designed to increase flexibility and offer easier customization, compared to earlier versions of restriction rules. The rules developed quantified the duration of swing and stance phases into states of accepting or rejecting new transitions, based on the cyclic nature of gait and statistics on the current gait patterns. The rules were easy to custom design for a specific application, using linguistic terms to model the actions of the rules. The rules were tested using pre-recorded gait data processed through a gait event detector and proved to reduce detection delay and the number of errors, compared to conventional rules.

The Public Service Bargains of Danish Permanent Secretaries

Danish permanent secretaries, top civil servants in the Danish state administration, are formally both administrative heads of their ministries as well as prime advisers to Danish ministers. In this article we analyse whether and how the public service bargain (PSB) (Hood and Lodge, 2006) of Danish permanent secretaries primarily reflects elements of a managerial role as prescribed in many of the New Public Management reforms or whether their role as policy adviser is as important as their role as manager, as is formally prescribed. The PSB is assessed in terms of the typology of Hood and Lodge, including the dimensions: reward, competency, loyalty and responsibility. The analysis demonstrates that although elements of a managerial bargain have entered the role of Danish permanent secretaries, it is not more salient than the advisory aspect of the PSB.Danish permanent secretaries, top civil servants in the Danish state administration, are formally both administrative heads of their ministries as well as prime advisers to Danish ministers. In this article we analyse whether and how the public service bargain (PSB) (Hood and Lodge, 2006) of Danish permanent secretaries primarily reflects elements of a managerial role as prescribed in many of the New Public Management reforms or whether their role as policy adviser is as important as their role as manager, as is formally prescribed. The PSB is assessed in terms of the typology of Hood and Lodge, including the dimensions: reward, competency, loyalty and responsibility. The analysis demonstrates that although elements of a managerial bargain have entered the role of Danish permanent secretaries, it is not more salient than the advisory aspect of the PSB.