An investigation of the potential of rapid prototyping technology for image‐guided surgery

Science.gov (United States)

Rajon, Didier A.; Bova, Frank J.; Bhasin, R. Rick; Friedman, William A.

2006-01-01

Image‐guided surgery can be broken down into two broad categories: frame‐based guidance and frameless guidance. In order to reduce both the invasive nature of stereotactic guidance and the cost in equipment and time, we have developed a new guidance technique based on rapid prototyping (RP) technology. This new system first builds a computer model of the patient anatomy and then fabricates a physical reference frame that provides a precise and unique fit to the patient anatomy. This frame incorporates a means of guiding the surgeon along a preplanned surgical trajectory. This process involves (1) obtaining a high‐resolution CT or MR scan, (2) building a computer model of the region of interest, (3) developing a surgical plan and physical guide, (4) designing a frame with a unique fit to the patient's anatomy with a physical linkage to the surgical guide, and (5) fabricating the frame using an RP unit. Software was developed to support these processes. To test the accuracy of this process, we first scanned and reproduced a plastic phantom fabricated to validate the system's ability to build an accurate virtual model. A target on the phantom was then identified, a surgical approach planned, a surgical guide designed, and the accuracy and precision of guiding a probe to that target were determined. Steps 1 through 5 were also evaluated using a head phantom. The results show that the RP technology can replicate an object from CT scans with submillimeter resolution. The fabricated reference frames, when positioned on the surface of the phantom and used to guide a surgical probe, can position the probe tip with an accuracy of 1.7 mm at the probe tip. These results demonstrate that the RP technology can be used for the fabrication of customized positioning frames for use in image‐guided surgery. PACS number: 87.57.Gg PMID:17533357

Causes of customer dropouts in fitness and wellness centres: A ...

African Journals Online (AJOL)

The aim of this study was to identify which factors have an influence on customer dropouts in fitness and wellness centres in Spain based on the opinion of the agents involved in their management (managers, employees and customers). For that purpose, an interview was designed for each of the key agents to analyse ...

Development of customized positioning guides using computer-aided design and manufacturing technology for orthognathic surgery.

Science.gov (United States)

Lin, Hsiu-Hsia; Chang, Hsin-Wen; Lo, Lun-Jou

2015-12-01

The purpose of this study was to devise a method for producing customized positioning guides for translating virtual plans to actual orthognathic surgery, and evaluation of the feasibility and validity of the devised method. Patients requiring two-jaw orthognathic surgery were enrolled and consented before operation. Two types of positioning guides were designed and fabricated using computer-aided design and manufacturing technology: One of the guides was used for the LeFort I osteotomy, and the other guide was used for positioning the maxillomandibular complex. The guides were fixed to the medial side of maxilla. For validation, the simulation images and postoperative cone beam computed tomography images were superimposed using surface registration to quantify the difference between the images. The data were presented in root-mean-square difference (RMSD) values. Both sets of guides were experienced to provide ideal fit and maximal contact to the maxillary surface to facilitate their accurate management in clinical applications. The validation results indicated that RMSD values between the images ranged from 0.18 to 0.33 mm in the maxilla and from 0.99 to 1.56 mm in the mandible. The patients were followed up for 6 months or more, and all of them were satisfied with the results. The proposed customized positioning guides are practical and reliable for translation of virtual plans to actual surgery. Furthermore, these guides improved the efficiency and outcome of surgery. This approach is uncomplicated in design, cost-effective in fabrication, and particularly convenient to use.

Smart Metering Guide. Energy Saving and the Customer. Edition 2010

Energy Technology Data Exchange (ETDEWEB)

Kester, J.C.P. (ed.) [Energy research Centre of the Netherlands ECN, Petten (Netherlands); Gonzalez Burgos, M.J. (ed.) [Endesa Ingenieria, Madrid (Spain); Parsons, J. (ed.) [British Electrotechnical and Allied Manufacturers Association BEAMA, London (United Kingdom)

2010-11-15

Smart metering can provide the foundations for a radically different approach to energy reduction schemes. However, the implementation of smart metering is a complex undertaking and its success depends on getting many factors right, from technology choice to how the information is presented to final customers. Making the expected reduction in energy consumption depends on achieving a positive reaction from final customers. Maintaining and increasing these savings will need the engagement of Energy Retailers, energy agencies and others. This Guide has been produced to bring together the lessons learnt from smart metering systems and trials, targeted on the promotion of End Use Energy Efficiency. The aim is to assist those groups who are considering implementing smart metering for this purpose and to maximise the benefits arising from those implementations. . The main target audience for the Guide are utilities, ESCO's and service providers across Europe. In most countries these are the parties investing in the smart metering systems and providing the smart metering services. In addition to these, governments, regulators, consumer bodies and energy agencies, as well as suppliers and system integrators, will also find valuable information in the Guide. As the subtitle of the Guide indicates, the focus of this Guide is on the application of smart metering for delivering energy saving. Making the expected reduction in energy consumption depends on achieving a positive reaction from final customers. In general, the successful provision of smart metering services is highly dependent on the right involvement of the energy final customer. This guide is not a ready-to-go manual for the installation of a specific type of smart metering system. Rather, the authors have tried to give the reader an insight into some of the complexities of the whole implementation process of smart metering systems. Also the guide is impartial regarding different technologies unless there is

[Surgery guided by customized devices: reconstruction with a free fibula flap].

Science.gov (United States)

Schouman, T; Bertolus, C; Chaine, C; Ceccaldi, J; Goudot, P

2014-02-01

The reconstruction of jaws with a free fibula flap can be anticipated virtually. The simulation can be transferred to the operating theater using customized devices obtained from computer-assisted design and manufacturing in a complete digital workflow. Several alternatives are available, from cutting guides to customized titanium osteosynthesis plates, to obtain the best accuracy and reproducibility of reconstruction. Moreover, these new processes allow integrating prosthetic planning concomitantly with reconstruction. We present the virtual three-dimensional planning method for jaw reconstruction with a free fibula flap and the various alternatives of surgery guided by customized devices provided by this planning. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Accuracy of Implants Placed with Surgical Guides: Thermoplastic Versus 3D Printed.

Science.gov (United States)

Bell, Caitlyn K; Sahl, Erik F; Kim, Yoon Jeong; Rice, Dwight D

This study was conducted to evaluate the accuracy of implants placed using two different guided implant surgery materials: thermoplastic versus three-dimensionally (3D) printed. A cone beam computed tomography (CBCT) scan previously obtained and selected for single-tooth implant replacement was converted into a Digital Imaging and Communications in Medicine (DICOM) file. All models were planned and exported for printing using BlueSkyBio Plan Software with the DICOM files. A total of 20 3D-printed mandibular quadrant jaws replicating the CBCT were printed by Right Choice Milling, as was the control model to accept the control implant. Previously, 10 thermoplastic and 10 3D-printed surgical guides had been made by the same lab technician at Right Choice Milling. One Nobel Biocare implant with a trilobe connection was placed per guide and replica jaw model pair. Implants were placed using the thermoplastic and 3D-printed surgical guides, representing the two test groups, following the Nobel Biocare guided surgical protocol. A total of 21 CBCT scans were then taken, one for the control implant and one for each test implant. The CBCT volume was converted to a DICOM file and transferred to Invivo5 software version 5.4 (Anatomage). The DICOM file of each test implant was superimposed over the DICOM file of the control. The deviation of the head of the implant, the deviation of the apex of the implant, and the angle of deviation were evaluated from measurements on the superimposition of the control and test implants. Mann-Whitney U test was used to test the null hypotheses at α = .05 and a confidence interval of 95%. Descriptive statistics were used for the average ± standard deviation. The implants placed with the thermoplastic surgical guides showed an average of 3.40 degrees of angular deviation compared to 2.36 degrees for implants placed with the 3D-printed surgical guides (P = .143). The implants placed with the thermoplastic surgical guides showed an average of 1

Treatment of tophaceous pseudogout with custom-fitted temporomandibular joint: a two-staged approach

Directory of Open Access Journals (Sweden)

Robert Pellecchia, DDS

2015-12-01

Full Text Available Tophaceous pseudogout, a variant of calcium pyrophosphate dihydrate deposition, is a relatively rare juxta-articular disease. It is a metabolic condition, in which patients develop pseudo-tumoral calcifications associated with peri-articular structures secondary to calcium pyrophosphate deposition into joints with fibrocartilage rather than hyaline cartilage. These lesions are reported in the knee, wrist, pubis, shoulder, and temporomandibular joint (TMJ and induce a histocytic foreign body giant cell reaction. We report a case of tophaceous pseudogout affecting the left TMJ with destruction of the condyle and glenoid and middle cranial fossa that was reconstructed with a TMJ Concepts (Ventura, CA custom-fitted prosthesis in a 2-staged surgical approach using a silicone spacer. The surgical management using a patient-specific TMJ is a viable option when the fossa or condylar component has been compromised due to breakdown of bone secondary to a pathologic process. Our case describes and identifies the lesion and its rare occurrence in the region of the temporomandibular region. The successful management of tophaceous pseudogout of the TMJ must include a thorough patient workup including the involvement of other joints as well as the modification of bone of the glenoid fossa and condylar relationship of the TMJ.

Reliability of implant surgical guides based on soft-tissue models.

Science.gov (United States)

Maney, Pooja; Simmons, David E; Palaiologou, Archontia; Kee, Edwin

2012-12-01

The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides.

Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement.

Science.gov (United States)

Hananouchi, Takehito; Saito, Masanobu; Koyama, Tsuyoshi; Sugano, Nobuhiko; Yoshikawa, Hideki

2010-04-01

Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10 degrees from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques. Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Development and Assessment of a 3D-Printed Scaffold with rhBMP-2 for an Implant Surgical Guide Stent and Bone Graft Material: A Pilot Animal Study

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Ji Cheol Bae

2017-12-01

Full Text Available In this study, a new concept of a 3D-printed scaffold was introduced for the accurate placement of an implant and the application of a recombinant human bone morphogenetic protein-2 (rhBMP-2-loaded bone graft. This preliminary study was conducted using two adult beagles to evaluate the 3D-printed polycaprolactone (PCL/β-tricalcium phosphate (β-TCP/bone decellularized extracellular matrix (bdECM scaffold conjugated with rhBMP-2 for the simultaneous use as an implant surgical guide stent and bone graft material that promotes new bone growth. Teeth were extracted from the mandible of the beagle model and scanned by computed tomography (CT to fabricate a customized scaffold that would fit the bone defect. After positioning the implant guide scaffold, the implant was placed and rhBMP-2 was injected into the scaffold of the experimental group. The two beagles were sacrificed after three months. The specimen block was obtained and scanned by micro-CT. Histological analysis showed that the control and experimental groups had similar new bone volume (NBV, % but the experimental group with BMP exhibited a significantly higher bone-to-implant contact ratio (BIC, %. Within the limitations of this preliminary study, a 3D-printed scaffold conjugated with rhBMP-2 can be used simultaneously as an implant surgical guide and a bone graft in a large bone defect site. Further large-scale studies will be needed to confirm these results.

Development and Assessment of a 3D-Printed Scaffold with rhBMP-2 for an Implant Surgical Guide Stent and Bone Graft Material: A Pilot Animal Study

Science.gov (United States)

Bae, Ji Cheol; Lee, Jin-Ju; Shim, Jin-Hyung; Park, Keun-Ho; Lee, Jeong-Seok; Bae, Eun-Bin; Choi, Jae-Won; Huh, Jung-Bo

2017-01-01

In this study, a new concept of a 3D-printed scaffold was introduced for the accurate placement of an implant and the application of a recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded bone graft. This preliminary study was conducted using two adult beagles to evaluate the 3D-printed polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP)/bone decellularized extracellular matrix (bdECM) scaffold conjugated with rhBMP-2 for the simultaneous use as an implant surgical guide stent and bone graft material that promotes new bone growth. Teeth were extracted from the mandible of the beagle model and scanned by computed tomography (CT) to fabricate a customized scaffold that would fit the bone defect. After positioning the implant guide scaffold, the implant was placed and rhBMP-2 was injected into the scaffold of the experimental group. The two beagles were sacrificed after three months. The specimen block was obtained and scanned by micro-CT. Histological analysis showed that the control and experimental groups had similar new bone volume (NBV, %) but the experimental group with BMP exhibited a significantly higher bone-to-implant contact ratio (BIC, %). Within the limitations of this preliminary study, a 3D-printed scaffold conjugated with rhBMP-2 can be used simultaneously as an implant surgical guide and a bone graft in a large bone defect site. Further large-scale studies will be needed to confirm these results. PMID:29258172

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

Science.gov (United States)

Foran, Paula

2016-01-01

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone. Copyright © 2015 Elsevier Ltd. All rights reserved.

Processing system of jaws tomograms for pathology identification and surgical guide modeling

Energy Technology Data Exchange (ETDEWEB)

Putrik, M. B., E-mail: pmb-88@mail.ru; Ivanov, V. Yu. [Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg (Russian Federation); Lavrentyeva, Yu. E. [Private dental clinic «Uraldent», Yekaterinburg (Russian Federation)

2015-11-17

The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient’s examination always includes up to 600 images (or tomograms), that’s why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation.

Processing system of jaws tomograms for pathology identification and surgical guide modeling

International Nuclear Information System (INIS)

Putrik, M. B.; Ivanov, V. Yu.; Lavrentyeva, Yu. E.

2015-01-01

The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient’s examination always includes up to 600 images (or tomograms), that’s why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation

Autotransplantation of Premolars With a 3-Dimensional Printed Titanium Replica of the Donor Tooth Functioning as a Surgical Guide: Proof of Concept.

Science.gov (United States)

Verweij, Jop P; Moin, David Anssari; Mensink, Gertjan; Nijkamp, Peter; Wismeijer, Daniel; van Merkesteyn, J P Richard

2016-06-01

Autotransplantation of premolars is a good treatment option for young patients who have missing teeth. This study evaluated the use of a preoperatively 3-dimensional (3D)-printed replica of the donor tooth that functions as a surgical guide during autotransplantation. Five consecutive procedures were prospectively observed. Transplantations of maxillary premolars with optimal root development were included in this study. A 3D-printed replica of the donor tooth was used to prepare a precisely fitting new alveolus at the recipient site before extracting the donor tooth. Procedure time, extra-alveolar time, and number of attempts needed to achieve a good fit of the donor tooth in the new alveolus were recorded. For each transplantation procedure, the surgical time was shorter than 30 minutes. An immediate good fit of the donor tooth in the new alveolus was achieved with an extra-alveolar time shorter than 1 minute for all transplantations. These results show that the extra-alveolar time is very short when the surgical guide is used; therefore, the chance of iatrogenic damage to the donor tooth is minimized. The use of a replica of the donor tooth makes the autotransplantation procedure easier for the surgeon and facilitates optimal placement of the transplant. Copyright © 2016 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A custom-made guide-wire positioning device for Hip Surface Replacement Arthroplasty: description and first results

Directory of Open Access Journals (Sweden)

Clijmans Tim

2010-07-01

Full Text Available Abstract Background Hip surface replacement arthroplasty (SRA can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly relies on the optimal size and position of the femoral component. This can be defined before surgery with pre-operative templating. Reproducing the optimal, templated femoral implant position during surgery relies on guide wire positioning devices in combination with visual inspection and experience of the surgeon. Another method of transferring the templated position into surgery is by navigation or Computer Assisted Surgery (CAS. Though CAS is documented to increase accurate placement particularly in case of normal hip anatomy, it requires bulky equipment that is not readily available in each centre. Methods A custom made neck jig device is presented as well as the results of a pilot study. The device is produced based on data pre-operatively acquired with CT-scan. The position of the guide wire is chosen as the anatomical axis of the femoral neck. Adjustments to the design of the jig are made based on the orthopedic surgeon's recommendations for the drill direction. The SRA jig is designed as a slightly more-than-hemispherical cage to fit the anterior part of the femoral head. The cage is connected to an anterior neck support. Four knifes are attached on the central arch of the cage. A drill guide cylinder is attached to the cage, thus allowing guide wire positioning as pre-operatively planned. Custom made devices were tested in 5 patients scheduled for total hip arthroplasty. The orthopedic surgeons reported the practical aspects of the use of the neck-jig device. The retrieved femoral heads were analyzed to assess the achieved drill place in mm deviation from the predefined location and orientation compared to the predefined orientation. Results The orthopedic surgeons rated the passive stability, full contact with neck portion of the jig and knife

Factors Affecting Customer Loyalty of Fitness Centers: An Empirical Study

Directory of Open Access Journals (Sweden)

Livia Vania Suwono

2016-04-01

Full Text Available Awareness of healthy lifestyle in society is increasing day by day. Therefore, the fitness centers more motivated to focus on these business opportunities. Hence, it is important for companies to understand how to satisfy consumers to obtain consumer loyalty. Main variables were applied to predict customer loyalties areswitching cost, customer value, physical environment, and customer satisfaction. Data was collected through questionnaires distribution to students at private university in Tangerang. Data then was analyzed to by applying multipleregressionswith SPSS software. The results showed that there are three hypotheses are supported. The hypothesis is the relationship between switching cost and customer value, the relationship between customer value and customer satisfaction, and the relationship between customer satisfaction and customer loyalty. There is a hypothesis that is not supported, namely the relationship between the physical environment and customer satisfaction. This study also provides a discussion and offers direction for further research.Kesadaran akan hidup sehat dalam masyarakat semakin meningkat. Oleh karenaitu, perusahaan-perusahaan pusat kebugaran termotivasi untuk focus pada peluang bisnis ini. Dengan demikian, pemahaman akan kepuasan konsumen yang dapat menjadikan konsumen semakin loyal adalah penting bagi perusahaan. Penelitian ini focus pada variable biaya perpindahan, nilai yang diterima konsumen, lingkungan fisik, dan kepuasan konsumen dalam memprediksi loyalitas konsumen. Data dikumpulkan melalui penyebaran kuesioner pada mahasiswa di sebuah universitas swasta. Data kemudian dianalisis dengan menggunakan regresi berganda. Hasil penelitian menunjukkan bahwa terdapat tiga hipotesis yang didukung. Hipotesis tersebut adalah hubungan antara biaya perpindahan dan nilai yang diterima konsumen, hubungan antara nilai yang diterima konsumen dan kepuasan konsumen, dan hubungan antara kepuasan konsumen dan loyalitas konsumen

Pilot Study for OCT Guided Design and Fit of a Prosthetic Device for Treatment of Corneal Disease

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Hong-Gam T. Le

2012-01-01

Full Text Available Purpose. To assess optical coherence tomography (OCT for guiding design and fit of a prosthetic device for corneal disease. Methods. A prototype time domain OCT scanner was used to image the anterior segment of patients fitted with large diameter (18.5–20 mm prosthetic devices for corneal disease. OCT images were processed and analyzed to characterize corneal diameter, corneal sagittal height, scleral sagittal height, scleral toricity, and alignment of device. Within-subject variance of OCT-measured parameters was evaluated. OCT-measured parameters were compared with device parameters for each eye fitted. OCT image correspondence with ocular alignment and clinical fit was assessed. Results. Six eyes in 5 patients were studied. OCT measurement of corneal diameter (coefficient of variation, %, cornea sagittal height (%, and scleral sagittal height (% is highly repeatable within each subject. OCT image-derived measurements reveal strong correlation between corneal sagittal height and device corneal height ( and modest correlation between scleral and on-eye device toricity (. Qualitative assessment of a fitted device on OCT montages reveals correspondence with slit lamp images and clinical assessment of fit. Conclusions. OCT imaging of the anterior segment is suitable for custom design and fit of large diameter (18.5–20 mm prosthetic devices used in the treatment of corneal disease.

A Simple and Automatic Method for Locating Surgical Guide Hole

Science.gov (United States)

Li, Xun; Chen, Ming; Tang, Kai

2017-12-01

Restoration-driven surgical guides are widely used in implant surgery. This study aims to provide a simple and valid method of automatically locating surgical guide hole, which can reduce operator's experiences and improve the design efficiency and quality of surgical guide. Few literatures can be found on this topic and the paper proposed a novel and simple method to solve this problem. In this paper, a local coordinate system for each objective tooth is geometrically constructed in CAD system. This coordinate system well represents dental anatomical features and the center axis of the objective tooth (coincide with the corresponding guide hole axis) can be quickly evaluated in this coordinate system, finishing the location of the guide hole. The proposed method has been verified by comparing two types of benchmarks: manual operation by one skilled doctor with over 15-year experiences (used in most hospitals) and automatic way using one popular commercial package Simplant (used in few hospitals).Both the benchmarks and the proposed method are analyzed in their stress distribution when chewing and biting. The stress distribution is visually shown and plotted as a graph. The results show that the proposed method has much better stress distribution than the manual operation and slightly better than Simplant, which will significantly reduce the risk of cervical margin collapse and extend the wear life of the restoration.

Social Media Marketing Strategies for Customer Retention in Fitness Industry

OpenAIRE

Ilina, Aleksandra

2015-01-01

The purpose of the study was to investigate the most effective ways of social media marketing that can be applied for customers’ loyalty management in fitness industry, as well as particular features, benefits, and methods of these strategies. The main idea is to create appropriate guidelines for the case companies to build social bonds with customer that will positively impact on maintaining communication and retention. The data for this study were collected from several sources, such as ...

Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide

Directory of Open Access Journals (Sweden)

Zhen-Xuan Shao

2017-07-01

Full Text Available Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments of L1–L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05. Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.

Medical Visualization and Simulation for Customizable Surgical Guides

NARCIS (Netherlands)

Kroes, T.

2015-01-01

This thesis revolves around the development of medical visualization tools for the planning of CSG-based surgery. To this end, we performed an extensive computerassisted surgery (CAS) literature study, developed a novel optimization technique for customizable surgical guides (CSG), and introduce

How to write a surgical clinical research protocol: literature review and practical guide.

Science.gov (United States)

Rosenthal, Rachel; Schäfer, Juliane; Briel, Matthias; Bucher, Heiner C; Oertli, Daniel; Dell-Kuster, Salome

2014-02-01

The study protocol is the core document of every clinical research project. Clinical research in studies involving surgical interventions presents some specific challenges, which need to be accounted for and described in the study protocol. The aim of this review is to provide a practical guide for developing a clinical study protocol for surgical interventions with a focus on methodologic issues. On the basis of an in-depth literature search of methodologic literature and on some cardinal published surgical trials and observational studies, the authors provides a 10-step guide for developing a clinical study protocol in surgery. This practical guide outlines key methodologic issues important when planning an ethically and scientifically sound research project involving surgical interventions, with the ultimate goal of providing high-level evidence relevant for health care decision making in surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Accurate pre-surgical determination for self-drilling miniscrew implant placement using surgical guides and cone-beam computed tomography.

Science.gov (United States)

Miyazawa, Ken; Kawaguchi, Misuzu; Tabuchi, Masako; Goto, Shigemi

2010-12-01

Miniscrew implants have proven to be effective in providing absolute orthodontic anchorage. However, as self-drilling miniscrew implants have become more popular, a problem has emerged, i.e. root contact, which can lead to perforation and other root injuries. To avoid possible root damage, a surgical guide was fabricated and cone-beam computed tomography (CBCT) was used to incorporate guide tubes drilled in accordance with the planned direction of the implants. Eighteen patients (5 males and 13 females; mean age 23.8 years; minimum 10.7, maximum 45.5) were included in the study. Forty-four self-drilling miniscrew implants (diameter 1.6, and length 8 mm) were placed in interradicular bone using a surgical guide procedure, the majority in the maxillary molar area. To determine the success rates, statistical analysis was undertaken using Fisher's exact probability test. CBCT images of post-surgical self-drilling miniscrew implant placement showed no root contact (0/44). However, based on CBCT evaluation, it was necessary to change the location or angle of 52.3 per cent (23/44) of the guide tubes prior to surgery in order to obtain optimal placement. If orthodontic force could be applied to the screw until completion of orthodontic treatment, screw anchorage was recorded as successful. The total success rate of all miniscrews was 90.9 per cent (40/44). Orthodontic self-drilling miniscrew implants must be inserted carefully, particularly in the case of blind placement, since even guide tubes made on casts frequently require repositioning to avoid the roots of the teeth. The use of surgical guides, fabricated using CBCT images, appears to be a promising technique for placement of orthodontic self-drilling miniscrew implants adjacent to the dental roots and maxillary sinuses.

Split-mouth comparison of the accuracy of computer-generated and conventional surgical guides.

Science.gov (United States)

Farley, Nathaniel E; Kennedy, Kelly; McGlumphy, Edwin A; Clelland, Nancy L

2013-01-01

Recent clinical studies have shown that implant placement is highly predictable with computer-generated surgical guides; however, the reliability of these guides has not been compared to that of conventional guides clinically. This study aimed to compare the accuracy of reproducing planned implant positions with computer-generated and conventional surgical guides using a split-mouth design. Ten patients received two implants each in symmetric locations. All implants were planned virtually using a software program and information from cone beam computed tomographic scans taken with scan appliances in place. Patients were randomly selected for computer-aided design/computer-assisted manufacture (CAD/CAM)-guided implant placement on their right or left side. Conventional guides were used on the contralateral side. Patients underwent operative cone beam computed tomography postoperatively. Planned and actual implant positions were compared using three-dimensional analyses capable of measuring volume overlap as well as differences in angles and coronal and apical positions. Results were compared using a mixed-model repeated-measures analysis of variance and were further analyzed using a Bartlett test for unequal variance (α = .05). Implants placed with CAD/CAM guides were closer to the planned positions in all eight categories examined. However, statistically significant differences were shown only for coronal horizontal distances. It was also shown that CAD/CAM guides had less variability than conventional guides, which was statistically significant for apical distance. Implants placed using CAD/CAM surgical guides provided greater accuracy in a lateral direction than conventional guides. In addition, CAD/CAM guides were more consistent in their deviation from the planned locations than conventional guides.

Midmarket Solar Policies in the United States: A Guide for Midsized Solar Customers

Energy Technology Data Exchange (ETDEWEB)

Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Liu, Chang [National Renewable Energy Lab. (NREL), Golden, CO (United States); O' Shaughnessy, Eric [National Renewable Energy Lab. (NREL), Golden, CO (United States); Mathur, Shivani [National Renewable Energy Lab. (NREL), Golden, CO (United States); Holm, Alison [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, John [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2016-09-01

The midscale market for solar photovoltaics (PV) has not experienced the same high growth rate as residential- or utility-scale market segments in the past five years when solar PV deployment increased rapidly. Midscale solar can be defined as behind-the-meter solar PV between 50 kilowatts and 2 megawatts adopted by multi-housing residential, commercial, industrial, non-profit, and other entities. A number of challenges face the midscale segment, including difficulties in contracting, mismatch between tenant lease and PV financing terms, high transaction costs relative to project sizes, and inefficiencies in matching prospective projects with capital. The changing policy landscape across U.S. states provides both opportunities and challenges to midmarket solar. Some states, such as California, are expanding system capacity limits for policies such as net metering, thus enabling a wider range of customers to benefit from excess generation. A number of states and utilities are making changes to rate design to introduce new or higher user fees for solar customers or reduced tariffs for net metering, which decrease the value of solar generation. An understanding of these policies relative to project feasibility and economics is important for prospective customers to make informed decisions to adopt solar PV. This guide complements existing solar policy resources to help potential customers navigate through the policy landscape in order to make informed decisions for their solar investment. The first part of this guide introduces the key solar policies necessary for policy-based decision-making, which involves using knowledge of a solar policy to improve project economics and efficiency. Policies that could result in policy-based decisions include interconnection standards, net metering, user fees, incentives, and third-party ownership policies. The goal of this section is to equip prospective customers and project developers with the tools necessary to understand and

Building Customer Churn Prediction Models in Fitness Industry with Machine Learning Methods

OpenAIRE

Shan, Min

2017-01-01

With the rapid growth of digital systems, churn management has become a major focus within customer relationship management in many industries. Ample research has been conducted for churn prediction in different industries with various machine learning methods. This thesis aims to combine feature selection and supervised machine learning methods for defining models of churn prediction and apply them on fitness industry. Forward selection is chosen as feature selection methods. Support Vector ...

Customized surgical template fabrication under biomechanical consideration by integrating CBCT image, CAD system and finite element analysis.

Science.gov (United States)

Yu, Jian-Hong; Wang, Yu-Tzu; Lin, Chun-Li

2018-01-30

This study developed a customized surgical template under mechanical consideration for molar intrusion. Two finite element (FE) models were analyzed for the primary stability under 100 gf traction forces with one mini-screw inserted at the buccal side in horizontal and another in palatal side with two optional positions at 60° (P60) or 15° (P15) angles with inclination toward the molar occlusal surface. The surgical template was generated using rapid prototyping (RP) printing for the clinical application based on improved primarily stability model. The surrounding bone strains for models P15 and P60 were far lower than the bone remodeling critical value. Model P60 presented much lower micro-motion in the screw/bone interface and the screw head displacement than those values in model P15. Using FE analysis for biomechanical evaluation and combining with CT image, image superimposed method and CAD technique can fabricate accuracy/security customized surgical template for mini-screws with better primary stability.

Guide 61: how the EUB responds to utility customer service complaints

International Nuclear Information System (INIS)

1999-07-01

The guide answers common questions about regulated provincial utilities, how to make a formal complaint to the Electric Utilities Board (EUB) of Alberta about utility service, and how the Board handles customer concerns. The role of the EUB in regulating utilities has changed slightly with natural gas deregulation, with most consumers having the option to purchase natural gas from their supplier of choice. As the transition to electric deregulation is occuring, the EUB continues to set customer rates until the transition is complete. When a utility-related-complaint cannot be resolved, the EUB may schedule a hearing to thoroughly review the issue. The hearing and decision aspects are summarized

[Custom-fit kinematic alignment in total knee arthroplasty using PSI. The story of ShapeMatch technology].

Science.gov (United States)

Calliess, T; Ettinger, M; Stukenborg-Colsmann, C; Windhagen, H

2016-04-01

The story of ShapeMatch® custom-fit cutting guides for primary total knee arthroplasty (TKA) is special compared to other available techniques. First, it was the first such patient-specific instrument (PSI) on the market. Second, the underlying philosophy of kinematic alignment is unique compared to other competitors. Finally, it is the only PSI technique that has been withdrawn from the market. The objective of this paper is to summarize the history of the ShapeMatch® technology and to review the current literature regarding clinical evidence for kinematically aligned TKA. In the recent literature, faster rehabilitation, better knee function and higher patient satisfaction are described for kinematically aligned TKA compared to conventional alignment. However, there is also evidence for inaccuracies by using the PSI technology as a possible cause of treatment failures. Due to those problems, this technology was recalled from the market. As an alternative method to achieve kinematic alignment in TKA, manual as well as computer-assisted techniques are currently under development and are discussed here.

CUSTOMER RELATIONSHIP MANAGEMENT (CRM) IN PHYSICAL FITNESS CLUBS

OpenAIRE

Mahmoud Goodarzi

2011-01-01

Although customer relationship management has been identified as an important businessapproach in enterprise institutes; there is no universally accepted definition of CRM. Swiftdefined it as an enterprise approach to understanding and influencing customer behavior throughmeaningful communications in order to improve customer knowledge recovery; customeracquisition; customer retention; customer loyalty; and finally customer profitability (2).Thompson (2002) knows CRM as a business strategy to...

Virtually fabricated guide for placement of the C-tube miniplate.

Science.gov (United States)

Paek, Janghyun; Jeong, Do-Min; Kim, Yong; Kim, Seong-Hun; Chung, Kyu-Rhim; Nelson, Gerald

2014-05-01

This paper introduces a virtually planned and stereolithographically fabricated guiding system that will allow the clinician to plan carefully for the best location of the device and to achieve an accurate position without complications. The scanned data from preoperative dental casts were edited to obtain preoperative 3-dimensional (3D) virtual models of the dentition. After the 3D virtual models were repositioned, the 3D virtual surgical guide was fabricated. A surgical guide was created onscreen, and then these virtual guides were materialized into real ones using the stereolithographic technique. Whereas the previously described guide required laboratory work to be performed by the orthodontist, our technique is more convenient because the laboratory work is done remotely by computer-aided design/computer-aided manufacturing technology. Because the miniplate is firmly held in place as the patient holds his or her mandibular teeth against the occlusal pad of the surgical guide, there is no risk that the miniscrews can slide on the bone surface during placement. The software program (2.5-dimensional software) in this study combines 2-dimensional cephalograms with 3D virtual dental models. This software is an effective and efficient alternative to 3D software when 3D computed tomography data are not available. To confidently and safely place a miniplate with screw fixation, a simple customized guide for an orthodontic miniplate was introduced. The use of a custom-made, rigid guide when placing miniplates will minimize complications such as vertical mislocation or slippage of the miniplate during placement. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.

Science.gov (United States)

Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

2014-09-01

In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure. Copyright 2014, SLACK Incorporated.

Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

Science.gov (United States)

Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P

2017-06-01

Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX ® , Meshlab ® , Netfabb ® and Blender ® . Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Reliability of a CAD/CAM Surgical Guide for Implant Placement: An In Vitro Comparison of Surgeons' Experience Levels and Implant Sites.

Science.gov (United States)

Park, Su-Jung; Leesungbok, Richard; Cui, Taixing; Lee, Suk Won; Ahn, Su-Jin

This in vitro study evaluated the reliability of a surgical guide with regard to different levels of operator surgical experience and implant site. A stereolithographic surgical guide for epoxy resin mandibles with three edentulous molar sites was produced using a computer-aided design/computer-assisted manufacture (CAD/CAM) system. Two surgeons with and two surgeons without implant surgery experience placed implants in a model either using or not using the CAD/CAM surgical guide. Four groups were created: inexperienced surgeon without the guide (group 1); experienced surgeon without the guide (group 2); inexperienced surgeon with the guide (group 3); and experienced surgeon with the guide (group 4). Planned implants and placed implants were superimposed using digital software, and deviation parameters were calculated. There were no significant differences in any of the deviation parameters between the groups when using the surgical guide. With respect to the implant sites, there were no significant differences among the groups in any parameter. Use of the CAD/CAM surgical guide reduced discrepancies among operators performing implant surgery regardless of their level of experience. Whether or not the guide was used, differences in the anterior-posterior implant site in the molar area did not affect the accuracy of implant placement.

A Cost-Effective, In-House, Positioning and Cutting Guide System for Orthognathic Surgery.

Science.gov (United States)

McAllister, Peter; Watson, Melanie; Burke, Ezra

2018-03-01

Technological advances in 3D printing can dramatically improve orthognathic surgical planning workflow. Custom positioning and cutting guides enable intraoperative reproduction of pre-planned osteotomy cuts and can result in greater surgical accuracy and patient safety. This short paper describes the use of freeware (some with open-source) combined with in-house 3D printing facilities to produce reliable, affordable osteotomy cutting guides. Open-source software (3D Slicer) is used to visualise and segment three-dimensional planning models from imported conventional computed tomography (CT) scans. Freeware (Autodesk Meshmixer ©) allows digital manipulation of maxillary and mandibular components to plan precise osteotomy cuts. Bespoke cutting guides allow exact intraoperative positioning. These are printed in polylactic acid (PLA) using a fused-filament fabrication 3D printer. Fixation of the osteotomised segments is achieved using plating templates and four pre-adapted plates with planned screw holes over the thickest bone. We print maxilla/ mandible models with desired movements incorporated to use as a plating template. A 3D printer capable of reproducing a complete skull can be procured for £1000, with material costs in the region of £10 per case. Our production of models and guides typically takes less than 24 hours of total print time. The entire production process is frequently less than three days. Externally sourced models and guides cost significantly more, frequently encountering costs totalling £1500-£2000 for models and guides for a bimaxillary osteotomy. Three-dimensional guided surgical planning utilising custom cutting guides enables the surgeon to determine optimal orientation of osteotomy cuts and better predict the skeletal maxilla/mandible relationship following surgery. The learning curve to develop proficiency using planning software and printer settings is offset by increased surgical predictability and reduced theatre time, making this

Reliability of computer designed surgical guides in six implant rehabilitations with two years follow-up.

Science.gov (United States)

Giordano, Mauro; Ausiello, Pietro; Martorelli, Massimo; Sorrentino, Roberto

2012-09-01

To evaluate the reliability and accuracy of computer-designed surgical guides in osseointegrated oral implant rehabilitation. Six implant rehabilitations, with a total of 17 implants, were completed with computer-designed surgical guides, performed with the master model developed by muco-compressive and muco-static impressions. In the first case, the surgical guide had exclusively mucosal support, in the second case exclusively dental support. For all six cases computer-aided surgical planning was performed by virtual analyses with 3D models obtained by dental scan DICOM data. The accuracy and stability of implant osseointegration over two years post surgery was then evaluated with clinical and radiographic examinations. Radiographic examination, performed with digital acquisitions (RVG - Radio Video graph) and parallel techniques, allowed two-dimensional feedback with a margin of linear error of 10%. Implant osseointegration was recorded for all the examined rehabilitations. During the clinical and radiographic post-surgical assessments, over the following two years, the peri-implant bone level was found to be stable and without appearance of any complications. The margin of error recorded between pre-operative positions assigned by virtual analysis and the post-surgical digital radiographic observations was as low as 0.2mm. Computer-guided implant surgery can be very effective in oral rehabilitations, providing an opportunity for the surgeon: (a) to avoid the necessity of muco-periosteal detachments and then (b) to perform minimally invasive interventions, whenever appropriate, with a flapless approach. Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Neuronavigator-guided cerebral biopsy.

Science.gov (United States)

Koivukangas, J; Louhisalmi, Y; Alakuijala, J; Oikarinen, J

1993-01-01

Neuronavigators are new dynamic interactive instruments that use on-line computers to orient imaging data to the surgical field and guide the neurosurgeon to his target. We have been working since 1987 on a neuronavigator that serves not only as a precise pointer, but also as a dynamic arm that can be used to hold instruments, such as biopsy guides. The neuronavigator arm consists of six joints with optical encoders and is attached to the Mayfield headholder. The arm is connected to a workstation running customized 3D image graphics software. Special instruments and surgical technique have been developed. Here, we report on early clinical experience with ten biopsy procedures: 4 low-grade and 3 high-grade astrocytomas, one craniopharyngioma and one chronic intracerebral haematoma and intracerebral cyst, both of the latter with surrounding tumour suspect tissue. In all glioma cases serial biopsies were taken from optimal sites under ultrasound imaging control. Eight cases showed representative tumour tissue, while in two cases neoplasia was ruled out. The neuronavigator proved to be versatile, allowing comprehensive imaging data to be adapted to the surgical field.

Surgical positioning of orthodontic mini-implants with guides fabricated on models replicated with cone-beam computed tomography.

Science.gov (United States)

Kim, Seong-Hun; Choi, Yong-Suk; Hwang, Eui-Hwan; Chung, Kyu-Rhim; Kook, Yoon-Ah; Nelson, Gerald

2007-04-01

This article illustrates a new surgical guide system that uses cone-beam computed tomography (CBCT) images to replicate dental models; surgical guides for the proper positioning of orthodontic mini-implants were fabricated on the replicas, and the guides were used for precise placement. The indications, efficacy, and possible complications of this method are discussed. Patients who were planning to have orthodontic mini-implant treatment were recruited for this study. A CBCT system (PSR 9000N, Asahi Roentgen, Kyoto, Japan) was used to acquire virtual slices of the posterior maxilla that were 0.1 to 0.15 mm thick. Color 3-dimensional rapid prototyping was used to differentiate teeth, alveolus, and maxillary sinus wall. A surgical guide for the mini-implant was fabricated on the replica model. Proper positioning for mini-implants on the posterior maxilla was determined by viewing the CBCT images. The surgical guide was placed on the clinical site, and it allowed precise pilot drilling and accurate placement of the mini-implant. CBCT imaging allows remarkably lower radiation doses and thinner acquisition slices compared with medical computed tomography. Virtually reproduced replica models enable precise planning for mini-implant positions in anatomically complex sites.

Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing

OpenAIRE

Wang, Yu-Tzu; Yu, Jian-Hong; Lo, Lun-Jou; Hsu, Pin-Hsin; Lin, CHun-Li

2017-01-01

This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical ...

Compact instrument for fluorescence image-guided surgery

Science.gov (United States)

Wang, Xinghua; Bhaumik, Srabani; Li, Qing; Staudinger, V. Paul; Yazdanfar, Siavash

2010-03-01

Fluorescence image-guided surgery (FIGS) is an emerging technique in oncology, neurology, and cardiology. To adapt intraoperative imaging for various surgical applications, increasingly flexible and compact FIGS instruments are necessary. We present a compact, portable FIGS system and demonstrate its use in cardiovascular mapping in a preclinical model of myocardial ischemia. Our system uses fiber optic delivery of laser diode excitation, custom optics with high collection efficiency, and compact consumer-grade cameras as a low-cost and compact alternative to open surgical FIGS systems. Dramatic size and weight reduction increases flexibility and access, and allows for handheld use or unobtrusive positioning over the surgical field.

Bio-imaging and visualization for patient-customized simulations

CERN Document Server

Luo, Xiongbiao; Li, Shuo

2014-01-01

This book contains the full papers presented at the MICCAI 2013 workshop Bio-Imaging and Visualization for Patient-Customized Simulations (MWBIVPCS 2013). MWBIVPCS 2013 brought together researchers representing several fields, such as Biomechanics, Engineering, Medicine, Mathematics, Physics and Statistic. The contributions included in this book present and discuss new trends in those fields, using several methods and techniques, including the finite element method, similarity metrics, optimization processes, graphs, hidden Markov models, sensor calibration, fuzzy logic, data mining, cellular automation, active shape models, template matching and level sets. These serve as tools to address more efficiently different and timely applications involving signal and image acquisition, image processing and analysis, image segmentation, image registration and fusion, computer simulation, image based modelling, simulation and surgical planning, image guided robot assisted surgical and image based diagnosis.  This boo...

New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

Energy Technology Data Exchange (ETDEWEB)

Hashizume, M.; Yasunaga, T.; Konishi, K. [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Tanoue, K.; Ieiri, S. [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Kishi, K. [Hitachi Ltd, Mechanical Engineering Research Laboratory, Hitachinaka-Shi, Ibaraki (Japan); Nakamoto, H. [Hitachi Medical Corporation, Application Development Office, Kashiwa-Shi, Chiba (Japan); Ikeda, D. [Mizuho Ikakogyo Co. Ltd, Tokyo (Japan); Sakuma, I. [The University of Tokyo, Graduate School of Engineering, Bunkyo-Ku, Tokyo (Japan); Fujie, M. [Waseda University, Graduate School of Science and Engineering, Shinjuku-Ku, Tokyo (Japan); Dohi, T. [The University of Tokyo, Graduate School of Information Science and Technology, Bunkyo-Ku, Tokyo (Japan)

2008-04-15

To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

International Nuclear Information System (INIS)

Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.

2008-01-01

To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

Bone Reduction to Facilitate Immediate Implant Placement and Loading Using CAD/CAM Surgical Guides for Patients With Terminal Dentition.

Science.gov (United States)

Alzoubi, Fawaz; Massoomi, Nima; Nattestad, Anders

2016-10-01

The aim of this study is to present a method, using 3 computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, to accurately obtain the desired bone reduction followed by immediate implant placements and loading for patients diagnosed with terminal dentition. Patients who had bone reduction, implants placed, and immediate loading using Anatomage Invivo 5 CAD/CAM surgical guides between the period 2013 and 2015 were evaluated retrospectively. Patients diagnosed with terminal dentition and treated using the "3-guide technique" were identified. Pre- and postsurgical images were superimposed to evaluate deviations of the bone reduction and deviations at the crest, apex, and angle of implants placed. Twenty-six implants placed in 5 patients were included in this study. The overall deviation means measured for bone reduction was 1.98 mm. The overall deviation means measured for implant placement at the crest, apex, and angle were 1.43 mm, 1.90 mm, and 4.14°, respectively. The CAD/CAM surgical guide fabrication is an emerging tool that may facilitate the surgical process and aid in safe and predictable execution of bone reduction and immediate implant placement. Using 3 CAD/CAM surgical guides, a method is presented to obtain the desired bone reduction followed by immediate implant placement and loading for patients diagnosed with terminal dentition. This method may improve guide stability for patients with terminal dentition undergoing complete implant-supported treatment by taking advantage of the teeth to be extracted.

Patterns to Enable Mass-Customized Business Process Monitoring

NARCIS (Netherlands)

Jochem Vonk; dr Marco Comuzzi; dr. Samuil Angelov

2012-01-01

Mass-customization challenges the one-size-fits-all assumption of mass production, allowing customers to specify the options that best fit their requirements when choosing a product or a service. In business process management, to achieve mass-customization, providers offer to their customers the

Patterns to enable mass-customized business process monitoring

NARCIS (Netherlands)

Comuzzi, M.; Angelov, S.A.; Vonk, J.; Ralyté, J,; Franch, X.; Brinkkemper, S.; Wrycza, S.

2012-01-01

Mass-customization challenges the one-size-fits-all assumption of mass production, allowing customers to specify the options that best fit their requirements when choosing a product or a service. In business process management, to achieve mass-customization, providers offer to their customers the

Variation-Aware Design of Custom Integrated Circuits A Hands-on Field Guide A Hands-on Field Guide

CERN Document Server

McConaghy, Trent; Dyck, Jeffrey; Gupta, Amit

2013-01-01

This book targets custom IC designers who are encountering variation issues in their designs, especially for modern process nodes at 45nm and below, such as statistical process variations, environmental variations, and layout effects.  The authors have created a field guide to show how to handle variation proactively, and to understand the benefits of doing so. Readers facing variation challenges in their memory, standard cell, analog/RF, and custom digital designs will find easy-to-read, pragmatic solutions.   Reviews the most important concepts in variation-aware design, including types of variables and variation, useful variation-aware design terminology, and an overview and comparison of high-level design flows. Describes and compares a suite of approaches and flows for PVT corner-driven design and verification. Presents Fast PVT, a novel, confidence-driven global optimization technique for PVT corner extraction and verification that is both rapid and reliable. Presents a visually-oriented overview of ...

16 CFR 240.4 - Definition of customer.

Science.gov (United States)

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Definition of customer. 240.4 Section 240.4 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR ADVERTISING ALLOWANCES AND OTHER MERCHANDISING PAYMENTS AND SERVICES § 240.4 Definition of customer. A customer is any...

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery.

Science.gov (United States)

Bencharit, Sompop; Staffen, Adam; Yeung, Matthew; Whitley, Daniel; Laskin, Daniel M; Deeb, George R

2018-02-21

Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P = .01), box plots, and 95% confidence intervals for the mean. Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n = 20) were 0.17 ± 0.78 mm, 0.44 ± 0.78 mm, 0.23 ± 1.08 mm, -0.22 ± 1.44 mm, and -0.32° ± 2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n = 11) were 0.33 ± 1.38 mm, -0.03 ± 1.59 mm, 0.62 ± 1.15 mm, -0.27 ± 1.61 mm, and 0.59° ± 6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P = .006 and P guided implant surgery is more accurate than

Tensor-guided fitting of subduction slab depths

Science.gov (United States)

Bazargani, Farhad; Hayes, Gavin P.

2013-01-01

Geophysical measurements are often acquired at scattered locations in space. Therefore, interpolating or fitting the sparsely sampled data as a uniform function of space (a procedure commonly known as gridding) is a ubiquitous problem in geophysics. Most gridding methods require a model of spatial correlation for data. This spatial correlation model can often be inferred from some sort of secondary information, which may also be sparsely sampled in space. In this paper, we present a new method to model the geometry of a subducting slab in which we use a data‐fitting approach to address the problem. Earthquakes and active‐source seismic surveys provide estimates of depths of subducting slabs but only at scattered locations. In addition to estimates of depths from earthquake locations, focal mechanisms of subduction zone earthquakes also provide estimates of the strikes of the subducting slab on which they occur. We use these spatially sparse strike samples and the Earth’s curved surface geometry to infer a model for spatial correlation that guides a blended neighbor interpolation of slab depths. We then modify the interpolation method to account for the uncertainties associated with the depth estimates.

Customer Retention & Customer Relationship Marketing: Strategi Pemasaran Yang Potensial

OpenAIRE

Aprilia, Ariesya

2004-01-01

The traditional marketing approach advocates the marketing mix principles and the quest for market share dominance through mass marketing techniques and a focus on new customer acquisition. This approach has guided managers for decades in planning in implementing their marketing strategies. But nowadays, traditional approach has been changed by customer retention. Customer retention, in the traditional marketing approach, is however seen as the 'end' rather than the means to delivering long-t...

Computer-designed surgical guide template compared with free-hand operation for mesiodens extraction in premaxilla using “trapdoor” method

Science.gov (United States)

Hu, Ying Kai; Xie, Qian Yang; Yang, Chi; Xu, Guang Zhou

2017-01-01

Abstract The aim of this study was to introduce a novel method of mesiodens extraction using a vascularized pedicled bone flap by piezosurgery and to compare the differences between a computer-aided design surgical guide template and free-hand operation. A total of 8 patients with mesiodens, 4 with a surgical guide (group I), and 4 without it (group II) were included in the study. The surgical design was to construct a trapdoor pedicle on the superior mucoperiosteal attachment with application of piezosurgery. The bone lid was repositioned after mesiodens extraction. Group I patients underwent surgeries based on the preoperative planning with surgical guide templates, while group II patients underwent free-hand operation. The outcome variables were success rate, intraoperative time, anterior nasal spine (ANS) position, changes of nasolabial angle (NLA), and major complications. Data from the 2 groups were compared by SPSS 17.0, using Wilcoxon test. The operative time was significantly shorter in group I patients. All the mesiodentes were extracted successfully and no obvious differences of preoperative and postoperative ANS position and NLA value were found in both groups. The patients were all recovered uneventfully. Surgical guide templates can enhance clinical accuracy and reduce operative time by facilitating accurate osteotomies. PMID:28658139

A Novel Laser Refractive Surgical Treatment for Presbyopia: Optics-Based Customization for Improved Clinical Outcome.

Science.gov (United States)

Pajic, Bojan; Pajic-Eggspuehler, Brigitte; Mueller, Joerg; Cvejic, Zeljka; Studer, Harald

2017-06-13

Laser Assisted in Situ Keratomileusis (LASIK) is a proven treatment method for corneal refractive surgery. Surgically induced higher order optical aberrations were a major reason why the method was only rarely used to treat presbyopia, an age-related near-vision loss. In this study, a novel customization algorithm for designing multifocal ablation patterns, thereby minimizing induced optical aberrations, was used to treat 36 presbyopic subjects. Results showed that most candidates went from poor visual acuity to uncorrected 20/20 vision or better for near (78%), intermediate (92%), and for distance (86%) vision, six months after surgery. All subjects were at 20/25 or better for distance and intermediate vision, and a majority (94%) were also better for near vision. Even though further studies are necessary, our results suggest that the employed methodology is a safe, reliable, and predictable refractive surgical treatment for presbyopia.

Workers Experience Guides Karaoke in Updating Status in Facebook as Interpersonal Relations and Personal Communication with Customers

OpenAIRE

Amelia Sari, Kiki; Suprihartini, M.Si, Dra. Taufik

2016-01-01

The presence of information technology is rapid and practical nature can allow for changes in behavior or lifestyle. One of them is the development of information technology with the birth of social networks, namely Facebook. Karaoke guide also actively uses Facebook to update your status and communicate with customers. By using qualitative methods, this study aims to describe the "Experience of Guides Karaoke Workers when Updating status on Facebook as Interpersonal and Personality Communica...

Reconstruction of a Severely Atrophied Alveolar Ridge by Computer-Aided Gingival Simulation and 3D-Printed Surgical Guide: A Case Report.

Science.gov (United States)

Song, In-Seok; Lee, Mi-Ran; Ryu, Jae-Jun; Lee, Ui-Lyong

Dental implants positioned in severely atrophied anterior maxillae require esthetic or functional compromises. This case report describes the rehabilitation of a severely atrophied alveolar ridge with a three-dimensional (3D) computer-aided design/computer-aided manufacture (CAD/CAM) surgical guide. A 50-year-old woman had a severely atrophied anterior maxilla with unfavorably positioned dental implants. Functional and esthetic prosthodontic restoration was difficult to achieve. An anterior segmental osteotomy was planned to reposition the dental implants. A 3D surgical guide was designed for precise relocation of the segment. The surgical guide firmly grasped the impression copings of the dental implants, minimizing surgical errors. Three-dimensional gingival simulation was used preoperatively to estimate the appropriate position of the gingiva. Rigid fixation to the surrounding bone allowed immobilization of the implant-bone segment. Satisfactory esthetic and functional outcomes were attained 6 months after surgery. Finally, a severely atrophied alveolar ridge with unfavorably positioned dental implants was recovered with minimal esthetic and functional deterioration using gingival simulation and a 3D CAD/CAM surgical guide.

High pressure thimble/guide tube seal fitting with built-in low pressure seal especially suitable for facilitated and more efficient nuclear reactor refueling service

International Nuclear Information System (INIS)

Bhatt, P.N.; Blaushield, R.M.

1991-01-01

This patent describes a HP/LP seal arrangement for an elongated guide tube and an elongated thimble disposed therein. The guide tube and thimble extending outwardly from the core of a nuclear reactor to a seal table where the guide tube is welded to the seal table to provide a high pressure seal relative thereto. It comprises: a tubular seal fitting disposed in alignment with the guide tube with the thimble extending therethrough on the low pressure side of the seal table; first high pressure sealing means coupling one end of the fitting to an end of the guide tube to prevent leakage from within the guide tube; inwardly facing thread means disposed adjacent the other and outer end of the seal fitting; a nut having an opening through which the thimble extends and further having outwardly facing threading in mating engagement with the fitting thread means; the fitting having a seal seat spaced longitudinally inwardly from the thread means and facing the fitting outer end and further disposed annularly about the inner surface of the fitting; deformable ring seal means; second releasable high pressure sealing means coupling the thimble to the outer end portion of the guide tube

[How to make your own custom cutting guides for both mandibular and fibular stair step osteotomies?

Science.gov (United States)

Rem, K; Bosc, R; De Kermadec, H; Hersant, B; Meningaud, J-P

2017-12-01

Using tailored cutting guides for osteocutaneous free fibula flap in complex mandibular reconstruction after cancer resection surgery constitutes a substantial improvement. Autonomously conceiving and manufacturing the cutting guides within a plastic surgery department with computer-aided design (CAD) and three-dimensional (3D) printing allows planning more complex osteotomies, such as stair-step osteotomies, in order to achieve more stable internal fixations. For the past three years, we have been producing by ourselves patient-tailored cutting guides using CAD and 3D printing. Osteotomies were virtually planned, making the cutting lines more complex in order to optimize the internal fixation stability. We also printed reconstructed mandible templates and shaped the reconstruction plates on them. We recorded data including manufacturing techniques and surgical outcomes. Eleven consecutive patients were operated on for an oral cavity cancer. For each patient, we planned the fibular and mandibular stair-step osteotomies and we produced tailored cutting guides. In all patients, we achieved to get immediately stable internal fixations and in 10 patients, a complete bone consolidation after 6 months. Autonomously manufacturing surgical cutting guides for mandibular reconstruction by free fibula flap is a significant improvement, regarding ergonomics and precision. Planning stair-step osteotomies to perform complementary internal fixation increases contact surface and congruence between the bone segments, thus improving the reconstructed mandible stability. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Windows 7 Tweaks A Comprehensive Guide on Customizing, Increasing Performance, and Securing Microsoft Windows 7

CERN Document Server

Sinchak, Steve

2009-01-01

The definitive guide to unlocking the hidden potential of the Windows 7 OS. Written by bestselling author and the creator of tweaks.com Steve Sinchak, this unique guide provides you with the ultimate collection of hidden gems that will enable you to get the most out of Windows 7. Packed with more than 400 pages of insider tips, the book delves beneath the surface to reveal little-known ways to tweak, modify, and customize Windows 7 so you can get every ounce of performance from your operating system. Regardless of your experience with tweaking your system, you'll find fascinating and fun tips

CAD/CAM technologies in the surgical and prosthetic treatment of the edentulous patient with biomymetic individualized approach.

Science.gov (United States)

Pozzi, A; Gargari, M; Barlattani, A

2008-04-01

The advent of modern endosseous implant design and improved surface technology has allowed the development of new restorative techniques that decrease patient's total treatment time. Utilizing the latest scanning, CAD/CAM and manufacturing technolgies we are able to manufacture individualized dental restoration with high accuracy and a perfect precision of fit. This report describes the rehabilitation of a completely edentulous patient utilizing a CT-based implant planning with computer-assisted surgical design, simultaneous CAD/CAM fabrication of a surgical template, a flapless surgical placement of the implants, and a prefabricated fixed complete denture for an immediately loaded restoration according to Nobel Biocare's Teeth-in-an-Hour™ (Nobel Biocare Goteborg, Sweden) protocol. This systematic approach to full mouth rehabilitation reduces the time necessary for an edentulous patient to go from severely atrophic alveolar support to implant retained prosthetic restoration. These aspects of minimally invasive and simplified surgery, along with reducing the treatment time and postsurgical discomfort, are beneficial to the patient, and allowing for rehabilitation with the same level of success as in flap surgery. The Teeth-in-an-Hour protocol is a unique solution made possible by the Procera System. With the aid of the CT scans and a virtual planning software, a custom fabricated precision drill guide and a pre-manufactured prosthesis can be made before surgery. The execution of implant placement is performed with a flapless procedure that results in minimal surgical intervention. This results in a short and non-traumatic surgery with a minimum of postoperative complications, allowing the patient to leave the chair with a fixed prosthesis. Utilizing the latest scanning, CAD/CAM and manufacturing technologies the dental team is able to develop individualized zirconia full arch framework with high accuracy and precision of fit.

Fitting PAC spectra with stochastic models: PolyPacFit

Energy Technology Data Exchange (ETDEWEB)

Zacate, M. O., E-mail: zacatem1@nku.edu [Northern Kentucky University, Department of Physics and Geology (United States); Evenson, W. E. [Utah Valley University, College of Science and Health (United States); Newhouse, R.; Collins, G. S. [Washington State University, Department of Physics and Astronomy (United States)

2010-04-15

PolyPacFit is an advanced fitting program for time-differential perturbed angular correlation (PAC) spectroscopy. It incorporates stochastic models and provides robust options for customization of fits. Notable features of the program include platform independence and support for (1) fits to stochastic models of hyperfine interactions, (2) user-defined constraints among model parameters, (3) fits to multiple spectra simultaneously, and (4) any spin nuclear probe.

Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients

Directory of Open Access Journals (Sweden)

Mohammad A. Abusedera

2015-09-01

Conclusions: Bedside IVUS-guided filter placement in medical-surgical critically ill patient in intensive care unit is a feasible, safe and reliable technique for IVC interruption. IVUS may be the most appropriate tool to guide filter insertion in obese patient.

Design and implementation of a PC-based image-guided surgical system.

Science.gov (United States)

Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.

Accuracy Assessment of Immediate and Delayed Implant Placements Using CAD/CAM Surgical Guides.

Science.gov (United States)

Alzoubi, Fawaz; Massoomi, Nima; Nattestad, Anders

2016-10-01

The aim of this study is to assess the accuracy of immediately placed implants using Anatomage Invivo5 computer-assisted design/computer-assisted manufacturing (CAD/CAM) surgical guides and compare the accuracy to delayed implant placement protocol. Patients who had implants placed using Anatomage Invivo5 CAD/CAM surgical guides during the period of 2012-2015 were evaluated retrospectively. Patients who received immediate implant placements and/or delayed implant placements replacing 1-2 teeth were included in this study. Pre- and postsurgical images were superimposed to evaluate deviations at the crest, apex, and angle. A total of 40 implants placed in 29 patients were included in this study. The overall mean deviations measured at the crest, apex, and angle were 0.86 mm, 1.25 mm, and 3.79°, respectively. The means for the immediate group deviations were: crest = 0.85 mm, apex = 1.10, and angle = 3.49°. The means for the delayed group deviations were: crest = 0.88 mm, apex = 1.59, and angle = 4.29°. No statistically significant difference was found at the crest and angle; however, there was a statistically significant difference between the immediate and delayed group at the apex, with the immediate group presenting more accurate placements at the apical point than the delayed group. CAD/CAM surgical guides can be reliable tools to accurately place implants immediately and/or in a delayed fashion. No statistically significant differences were found between the delayed and the immediate group at the crest and angle, however apical position was more accurate in the immediate group.

Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

Science.gov (United States)

Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

2014-05-23

The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of

Analisis Brand Equity dan Customer Loyality Celebrity Fitness Cabang Mall Puri Indah Jakarta Barat

Directory of Open Access Journals (Sweden)

Robertus Tang Herman

2010-05-01

Full Text Available This study aims to determine the condition of the elements of brand equity Celebrity Fitness, namely knowing the brand awareness, brand association is formed, to know how the perception of performance and the interests of the brand, how consumers' brand loyalty, and what attributes of service quality a priority for improved performance to can meet consumers' desire to achieve satisfaction. The method used is descriptive method with the sampling technique using probability sampling (simple random sampling, with regional research area in West Jakarta. The results of this study indicate that the overall brand equity of the company is good enough to position the brand awareness top of mind, the brand associations that are formed from Celebrity Fitness is where fitness is comfortable and fun and has a diverse and interesting program, another association was formed team aggressive promotion. Performance level of perceived quality is also good enough. To Brand loyalty are in poor condition because of the high percentage of switchers. Overall customer satisfaction levels are good enough just need a little improvement in the performance of staff. The implication of this research is PT Exertainment should improve the performance of some quality attributes are prioritized so that the loyalty of the members has also increased.

Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates.

Science.gov (United States)

Nickenig, Hans-Joachim; Eitner, Stephan

2007-01-01

We assessed the reliability of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates. A total of 102 patients (250 implants, 55.4% mandibular; mean patient age, 40.4 years) who had undergone implant treatment therapy in an armed forces dental clinic (Cologne, Germany) between July 1, 2005 and December 1, 2005. They were treated with a system that allows transfer of virtual planning to surgical guide templates. Only in eight cases the surgical guides were not used because a delayed implant placement was necessary. In four posterior mandibular cases, handling was limited because of reduced interocclusal distance, requiring 50% shortening of the drill guides. The predictability of implant size was high: only one implant was changed to a smaller diameter (because of insufficient bone). In all cases, critical anatomical structures were protected and no complications were detected in postoperative panoramic radiographs. In 58.1% (147) of the 250 implants, a flapless surgery plan was realized. Implant placement after virtual planning of implant positions using cone beam CT data and surgical templates can be reliable for preoperative assessment of implant size, position, and anatomical complications. It is also indicative of cases amenable to flapless surgery.

Surgical neuro navigator guided by preoperative magnetic resonance images, based on a magnetic position sensor

International Nuclear Information System (INIS)

Perini, Ana Paula; Siqueira, Rogerio Bulha; Carneiro, Antonio Adilton Oliveira; Oliveira, Lucas Ferrari de; Machado, Helio Rubens

2009-01-01

Image guided neurosurgery enables the neurosurgeon to navigate inside the patient's brain using pre-operative images as a guide and a tracking system, during a surgery. Following a calibration procedure, three-dimensional position and orientation of surgical instruments may be transmitted to computer. The spatial information is used to access a region of interest, in the pre-operative images, displaying them to the neurosurgeon during the surgical procedure. However, when a craniotomy is involved and the lesion is removed, movements of brain tissue can be a significant source of error in these conventional navigation systems. The architecture implemented in this work intends the development of a system to surgical planning and orientation guided by ultrasound image. For surgical orientation, the software developed allows the extraction of slices from the volume of the magnetic resonance images (MRI) with orientation supplied by a magnetic position sensor (Polhemus R ). The slices extracted with this software are important because they show the cerebral area that the neurosurgeon is observing during the surgery, and besides they can be correlated with the intra-operative ultrasound images to detect and to correct the deformation of brain tissue during the surgery. Also, a tool for per-operative navigation was developed, providing three orthogonal planes through the image volume. In the methodology used for the software implementation, the Python tm programming language and the Visualization Toolkit (VTK) graphics library were used. The program to extract slices of the MRI volume allowed the application of transformations in the volume, using coordinates supplied by the position sensor. (author)

Microdose fluorescence imaging of ABY-029 on an operating microscope adapted by custom illumination and imaging modules

OpenAIRE

Elliott, Jonathan T.; Dsouza, Alisha V.; Marra, Kayla; Pogue, Brian W.; Roberts, David W.; Paulsen, Keith D.

2016-01-01

Fluorescence guided surgery has the potential to positively impact surgical oncology; current operating microscopes and stand-alone imaging systems are too insensitive or too cumbersome to maximally take advantage of new tumor-specific agents developed through the microdose pathway. To this end, a custom-built illumination and imaging module enabling picomolar-sensitive near-infrared fluorescence imaging on a commercial operating microscope is described. The limits of detection and system spe...

USE OF PLASTIC MATERIAL AND TRIPLE SCAN IN THE PREPARATION OF SURGICAL GUIDES FOR THE DENTAL IMPLANT TREATMENT-CASE REPORT

Directory of Open Access Journals (Sweden)

Rosen Borisov

2016-09-01

Full Text Available The use of surgical guides in implant treatment increases the accuracy of the dental implant positioning compared with manual methods. Regardless of how they are made, deviations of implants from their intended position are established in all kinds of surgical guides. This article considers the use of plastic material and new scanning technique for the production of CAD/CAM surgical guides that aim to overcome the deficiencies of the currently applied technologies in the production of surgical guides. Materials and methods: The study shows the techniques used to overcome degraded by metal artifacts CBCT images in implant treatment of patients with partial edentulism, and located medially to the defect metal-ceramic crowns. When planning implant treatment, a triple scan method has been implied. At the beginning, CBCT scan of the patient with a silicone impression material is made in the zone of interest. Secondly, CBCT scan only of the silicon impression is made, and thirdly - intraoral scanning of the patient with an intraoral scanner. Virtual analogues have been created of images from the three scans and have been repositioned one over another; as thereby an intraoral image have been accurately positioned over the CBCT image of the patient. Virtual planning of the implant positioning has been performed, and a model of surgical guide has been made for their placement. The guide has been printed with an SLA 3D printer technology of photopolymer with dualistic characteristics-rigid in the working part and plastic in the fixing part. Through it, implants have been placed to the treatment planning. Postoperative CBCT has been done on the patient to measure the implant deviation to their position in the treatment planning. Results: Axes angular deviation of the planned and placed implants has not been established. Average linear displacement of 240 μ (+/- 40 μ has been found. Conclusions: Using the triple scan method is possible to overcome the

The application of 3D printed surgical guides in resection and reconstruction of malignant bone tumor.

Science.gov (United States)

Wang, Fengping; Zhu, Jun; Peng, Xuejun; Su, Jing

2017-10-01

The clinical value of 3D printed surgical guides in resection and reconstruction of malignant bone tumor around the knee joint were studied. For this purpose, a sample of 66 patients from October 2013 to October 2015 were randomly selected and further divided into control group and observation group, each group consisted of 33 cases. The control group was treated by conventional tumor resection whereas, in the observation group, the tumor was resected with 3D printed surgical guide. However, reconstruction of tumor-type hinge prosthesis was performed in both groups and then the clinical effect was compared. Results show that there was no significant difference in the operation time between the two groups (p>0.05). However, the blood loss, resection length and complication rate were found significantly lower in the observation group than in the control group (p0.05) between two groups were statistically the same (p>0.05), whereas the Musculoskeletal Tumor Society (MSTS) score of the knee joint in the observation group was significantly better than that of the control group (p3D printed surgical guides can significantly improve the postoperative joint function after resection and reconstruction of malignant bone tumor around the knee joint and can reduce the incidence of complications.

A simple weighted scoring system to guide surgical decision-making in patients with parapneumonic pleural effusion.

Science.gov (United States)

Chang, Che-Chia; Chen, Tzu-Ping; Yeh, Chi-Hsiao; Huang, Pin-Fu; Wang, Yao-Chang; Yin, Shun-Ying

2016-11-01

The selection of ideal candidates for surgical intervention among patients with parapneumonic pleural effusion remains challenging. In this retrospective study, we sought to identify the main predictors of surgical treatment and devise a simple scoring system to guide surgical decision-making. Between 2005 and 2014, we identified 276 patients with parapneumonic pleural effusion. Patients in the training set (n=201) were divided into two groups according to their treatment modality (non-surgery vs. surgery). Using multivariable logistic regression analysis, we devised a scoring system to guide surgical decision-making. The score was subsequently validated in an independent set of 75 patients. A white blood cell count >13,500/µL, pleuritic pain, loculations, and split pleura sign were identified as independent predictors of surgical treatment. A weighted score based on these factors was devised, as follows: white blood cell count >13,500/µL (one point), pleuritic pain (one point), loculations (two points), and split pleura sign (three points). A score >4 was associated with a surgical approach with a sensitivity of 93.4%, a specificity of 82.4%, and an area under curve (AUC) of 0.879 (95% confidence interval: 0.828-0.930). In the validation set, a sensitivity of 94.3% and a specificity of 79.6% were found (AUC=0.869). The proposed scoring system reliably identifies patients with parapneumonic pleural effusion who are candidates for surgery. Pending independent external validation, our score may inform the appropriate use of surgical interventions in this clinical setting.

Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides.

Science.gov (United States)

Fürnstahl, Philipp; Vlachopoulos, Lazaros; Schweizer, Andreas; Fucentese, Sandro F; Koch, Peter P

2015-08-01

The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.

Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.

Science.gov (United States)

Ersoy, Ahmet Ersan; Turkyilmaz, Ilser; Ozan, Oguz; McGlumphy, Edwin A

2008-08-01

Dental implant placement requires precise planning with regard to anatomic limitations and restorative goals. The aim of this study was to evaluate the match between the positions and axes of the planned and placed implants using stereolithographic (SLA) surgical guides. Ninety-four implants were placed using SLA surgical guides generated from computed tomography (CT) between 2005 and 2006. Radiographic templates were used for all subjects during CT imaging. After obtaining three-dimensional CT images, each implant was virtually placed on the CT images. SLA surgical guides, fabricated using an SLA machine with a laser beam to polymerize the liquid photo-polymerized resin, were used during implant placement. A new CT scan was taken for each subject following implant placement. Special software was used to fuse the images of the planned and placed implants, and the locations and axes were compared. Compared to the planned implants, the placed implants showed angular deviation of 4.9 degrees+/-2.36 degrees, whereas the mean linear deviation was 1.22+/-0.85 mm at the implant neck and 1.51+/-1 mm at the implant apex. Compared to the implant planning, the angular deviation and linear deviation at the neck and apex of the placed maxillary implants were 5.31 degrees+/-0.36 degrees, 1.04+/-0.56 mm, and 1.57+/-0.97 mm, respectively, whereas corresponding figures for placed mandibular implants were 4.44 degrees+/-0.31 degrees, 1.42+/-1.05 mm, and 1.44+/-1.03 mm, respectively. SLA surgical guides using CT data may be reliable in implant placement and make flapless implant placement possible.

Effects of customization on application decisions and applicant pool characteristics in a web-based recruitment context.

Science.gov (United States)

Dineen, Brian R; Noe, Raymond A

2009-01-01

The authors examined 2 forms of customization in a Web-based recruitment context. Hypotheses were tested in a controlled study in which participants viewed multiple Web-based job postings that each included information about multiple fit categories. Results indicated that customization of information regarding person-organization (PO), needs-supplies, and demands-abilities (DA) fit (fit information customization) and customization of the order in which these fit categories were presented (configural customization) had differential effects on outcomes. Specifically, (a) applicant pool PO and DA fit were greater when fit information customization was provided, (b) applicant pool fit in high- versus low-relevance fit categories was better differentiated when configural customization was provided, and (c) overall application rates were lower when either or both forms of customization were provided. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Creating effective social marketing: let your customer be your guide.

Science.gov (United States)

Brookes, R

2000-02-01

Social marketing uses commercial marketing techniques to change behaviors that benefit individuals or society in general. Unlike conventional marketing, which seeks to sell products or services, social marketing aims to promote voluntary behavior change. Some examples of behaviors that have changed due to social marketing are: using seat belts, wearing bike helmets, child immunizations, and smoking cessation. Although good social marketing campaigns use the same techniques as that of commercial marketers, by letting the customer be the guide for all major decisions, it is not primarily advertising and is not about top-down planning and decisions. Instead, it is about having a consumer orientation, which means understanding the target audience very well. An effective social marketer must be committed to ongoing communication with the audience in order to create programs, products, or practice that enable them to make the changes desired.

Custom Hardware Processor to Compute a Figure of Merit for the Fit of X-Ray Diffraction

International Nuclear Information System (INIS)

Gomez-Pulido, P.J.A.; Vega-Rodriguez, M.A.; Sanchez-Perez, J.M.; Sanchez-Bajo, F.; Santos, S.P.D.

2008-01-01

A custom processor based on re configurable hardware technology is proposed in order to compute the figure of merit used to measure the quality of the fit of X-ray diffraction peaks. As the experimental X-ray profiles can present many peaks severely overlapped, it is necessary to select the best model among a large set of reasonably good solutions. Determining the best solution is computationally intensive, because this is a hard combinatorial optimization problem. The proposed processors, working in parallel, increase the performance relative to a software implementation.

Combined use of rapid-prototyping model and surgical guide in correction of mandibular asymmetry malformation patients with normal occlusal relationship.

Science.gov (United States)

Xu, Haisong; Zhang, Ce; Shim, Yoong Hoon; Li, Hongliang; Cao, Dejun

2015-03-01

The aim of this study is to discuss the application of rapid-prototyping model and surgical guide in the treatment of mandibular asymmetry malformation with normal occlusal relationship. Twenty-four mandibular asymmetry malformation patients with relatively normal occlusal relationship were included in this study. Surgical 3-dimensional rapid-prototyping mandibular models were made for all patients from the computed tomography (CT) DICOM data. The presurgical plan was designed on the model, and the surgical guiders for the osteotomy lines were manufactured. Genioplasty and/or mandibular osteotomy based on the presurgical plan were performed on these patients with the combined use of the rapid-prototyping model and surgical guides. All patients underwent postoperative CT scan and had at least 3-month follow-up. All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, all patients' mandibular asymmetry malformation was significantly improved, and the operation time was distinctly shortened relative to the conventional method. Rapid-prototyping model and surgical guide are viable auxiliary devices for the treatment of mandibular asymmetry malformation with relatively normal occlusal relationship. Combined use of them can make precise preoperative design, improve effects of operation, and shorten operating time.

Surgical vs ultrasound-guided drainage of deep neck space abscesses: a randomized controlled trial: surgical vs ultrasound drainage.

Science.gov (United States)

Biron, Vincent L; Kurien, George; Dziegielewski, Peter; Barber, Brittany; Seikaly, Hadi

2013-02-26

Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies and can result in significant morbidity with potential mortality. Traditionally, surgical incision and drainage (I&D) with antibiotics has been the mainstay of treatment. Some reports have suggested that ultrasound-guided drainage (USD) is a less invasive and effective alternative in select cases. To compare I&D vs USD of well-defined DNAs, using a randomized controlled clinical trial design. The primary outcome measure was effectiveness (length of hospital stay (LOHS) and safety), and the secondary outcome measure was overall cost to the healthcare system. Patients presenting to the University of Alberta Emergency Department with a well-defined deep neck space abscess were recruited in the study. Patients were randomized to surgical or US-guided drainage, placed on intravenous antibiotics and admitted with airway precautions. Following drainage with either intervention, abscess collections were cultured and drains were left in place until discharge. Seventeen patients were recruited in the study. We found a significant difference in mean LOHS between patients who underwent USD (3.1 days) vs I&D (5.2 days). We identified significant cost savings associated with USD with a 41% cost reduction in comparison to I&D. USD drainage of deep neck space abscesses in a certain patient population is effective, safe, and results in a significant cost savings to the healthcare system.

Customized Knee Prosthesis in Treatment of Giant Cell Tumors of the Proximal Tibia: Application of 3-Dimensional Printing Technology in Surgical Design.

Science.gov (United States)

Luo, Wenbin; Huang, Lanfeng; Liu, He; Qu, Wenrui; Zhao, Xin; Wang, Chenyu; Li, Chen; Yu, Tao; Han, Qing; Wang, Jincheng; Qin, Yanguo

2017-04-07

BACKGROUND We explored the application of 3-dimensional (3D) printing technology in treating giant cell tumors (GCT) of the proximal tibia. A tibia block was designed and produced through 3D printing technology. We expected that this 3D-printed block would fill the bone defect after en-bloc resection. Importantly, the block, combined with a standard knee joint prosthesis, provided attachments for collateral ligaments of the knee, which can maintain knee stability. MATERIAL AND METHODS A computed tomography (CT) scan was taken of both knee joints in 4 patients with GCT of the proximal tibia. We developed a novel technique - the real-size 3D-printed proximal tibia model - to design preoperative treatment plans. Hence, with the application of 3D printing technology, a customized proximal tibia block could be designed for each patient individually, which fixed the bone defect, combined with standard knee prosthesis. RESULTS In all 4 cases, the 3D-printed block fitted the bone defect precisely. The motion range of the affected knee was 90 degrees on average, and the soft tissue balance and stability of the knee were good. After an average 7-month follow-up, the MSTS score was 19 on average. No sign of prosthesis fracture, loosening, or other relevant complications were detected. CONCLUSIONS This technique can be used to treat GCT of the proximal tibia when it is hard to achieve soft tissue balance after tumor resection. 3D printing technology simplified the design and manufacturing progress of custom-made orthopedic medical instruments. This new surgical technique could be much more widely applied because of 3D printing technology.

Ultrasound-guided versus surgical transversus abdominis plane block in obese patients following cesarean section: a prospective randomised study

Directory of Open Access Journals (Sweden)

Aykut Urfalıoğlu

Full Text Available Abstract Background and objectives Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia. Methods Seventy-five pregnant women with pre- and post-pregnancy body mass index > 30 were randomized and allocated into two groups: Ultrasound-guided transversus abdominis plane block (UT group; n = 38 and surgical TAP block (ST group; n = 37. Visual analogue scale scores at post-operative 0, 2, 6, 12 and 24 hours (h, time to first analgesic requirement, total analgesic consumption amount in 24 h, post-operative side effects, complications and patient satisfaction were recorded. Results and conclusions Age, American Society of Anesthesiologist score, operative duration, body mass index, mean time to first analgesic requirement and total analgesic consumption in 24 h were similar between groups, while significant differences in pre- and post-pregnancy body mass index were observed between groups. Block procedure durations were 7 and 10 minutes in ST and UT groups, respectively. No significant differences in visual analogue scale scores were observed between the groups at all times; itching and nausea was observed in one (UT group and four (UT and ST groups patients, respectively. Surgical transversus abdominis plane block was safe in obese pregnant patients and provided similar post-operative analgesia to ultrasound-guided transversus abdominis plane block.

16 CFR 240.12 - Checking customer's use of payments.

Science.gov (United States)

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Checking customer's use of payments. 240.12 Section 240.12 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR ADVERTISING ALLOWANCES AND OTHER MERCHANDISING PAYMENTS AND SERVICES § 240.12 Checking customer's use of...

16 CFR 240.13 - Customer's and third party liability.

Science.gov (United States)

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Customer's and third party liability. 240.13 Section 240.13 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR ADVERTISING ALLOWANCES AND OTHER MERCHANDISING PAYMENTS AND SERVICES § 240.13 Customer's and third party...

Aesthetic properties and message customization: navigating the dark side of web recruitment.

Science.gov (United States)

Dineen, Brian R; Ling, Juan; Ash, Steven R; DelVecchio, Devon

2007-03-01

The authors examined recruitment message viewing time, information recall, and attraction in a Web-based context. In particular, they extended theory related to the cognitive processing of recruitment messages and found that the provision of customized information about likely fit related to increased viewing time and recall when good aesthetics were also present. A 3-way interaction among moderate-to low-fitting individuals further indicated that objective fit was most strongly related to attraction when messages included both good aesthetics and customized information. In particular, given this combination, the poorest fitting individuals exhibited lower attraction levels, whereas more moderately fitting individuals exhibited invariant attraction levels across combinations of aesthetics and customized information. The results suggest that, given good aesthetics, customized information exerts effects mostly by causing poorly fitting individuals to be less attracted, which further suggests a means of averting the "dark side" of Web recruitment that occurs when organizations receive too many applications from poorly fitting applicants. (c) 2007 APA, all rights reserved.

Tourism guide cloud service quality: What actually delights customers?

Science.gov (United States)

Lin, Shu-Ping; Yang, Chen-Lung; Pi, Han-Chung; Ho, Thao-Minh

2016-01-01

The emergence of advanced IT and cloud services has beneficially supported the information-intensive tourism industry, simultaneously caused extreme competitions in attracting customers through building efficient service platforms. On response, numerous nations have implemented cloud platforms to provide value-added sightseeing information and personal intelligent service experiences. Despite these efforts, customers' actual perspectives have yet been sufficiently understood. To bridge the gap, this study attempts to investigate what aspects of tourism cloud services actually delight customers' satisfaction and loyalty. 336 valid survey questionnaire answers were analyzed using structural equation modeling method. The results prove positive impacts of function quality, enjoyment, multiple visual aids, and information quality on customers' satisfaction as well as of enjoyment and satisfaction on use loyalty. The findings hope to provide helpful references of customer use behaviors for enhancing cloud service quality in order to achieve better organizational competitiveness.

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: An analysis for Austria

Energy Technology Data Exchange (ETDEWEB)

Gruber, R., E-mail: renate.gruber@meduniwien.ac.a [Medical University of Vienna, Department of Radiology, Division of Molecular and Gender Imaging, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Walter, E. [Institute of Pharmacoeconomic Research, Wolfengasse 4/7, A-1010 Vienna (Austria); Helbich, T.H. [Medical University of Vienna, Department of Radiology, Division of Molecular and Gender Imaging, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

2010-06-15

Purpose: To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. Materials and methods: In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Results: Overall cost savings for US-guided LCBB over OSB were Euro 977 ( Euro 2,337/ Euro 3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were Euro 1,542 ( Euro 2,600/ Euro 4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. Conclusion: From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be Euro 18.5 million.

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: An analysis for Austria

International Nuclear Information System (INIS)

Gruber, R.; Walter, E.; Helbich, T.H.

2010-01-01

Purpose: To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. Materials and methods: In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Results: Overall cost savings for US-guided LCBB over OSB were Euro 977 ( Euro 2,337/ Euro 3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were Euro 1,542 ( Euro 2,600/ Euro 4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. Conclusion: From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be Euro 18.5 million.

Effect of surgical drill guide and irrigans temperature on thermal bone changes during drilling implant sites - thermographic analysis on bovine ribs.

Science.gov (United States)

Marković, Aleksa; Lazić, Zoran; Mišić, Tijana; Šćepanović, Miodrag; Todorović, Aleksandar; Thakare, Kaustubh; Janjić, Bojan; Vlahović, Zoran; Glišić, Mirko

2016-08-01

During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 x 2 factorial design: drill guide (with or without) and saline (at 25°C or 5°C). Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p 0.05). Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p < 0.001). Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide.

Effect of surgical drill guide and irrigans temperature on thermal bone changes during drilling implant sites - thermographic analysis on bovine ribs

Directory of Open Access Journals (Sweden)

Marković Aleksa

2016-01-01

Full Text Available Background/Aim. During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. Methods. A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 x 2 factorial design: drill guide (with or without and saline (at 25°C or 5°C. Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. Results. The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p 0.05. Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p < 0.001. Conclusion. Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide.

Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics

International Nuclear Information System (INIS)

Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M.

2000-01-01

Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

Ultrasound-guided versus surgical transversus abdominis plane block in obese patients following caesarean section: a prospective randomised study

OpenAIRE

Urfalıoğlu, Aykut; Bakacak, Murat; Boran, Ömer Faruk; Yazar, Fatih Mehmet; Arslan, Mahmut; Öksüz, Hafize

2016-01-01

Abstract Background and objectives Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus ab...

Optimization of Fit for Mass Customized Apparel Ordering Using Fit Preference and Self Measurement

National Research Council Canada - National Science Library

Ahrens, Sean

2000-01-01

.... In order for firms in the apparel industry to successfully implement this promising new production program, ordering methodologies must be established that provide customized garments with acceptable...

[Contribution of computer-aided design for the conception of custom-made implants in Pectus Excavatum surgical treatment. Experience of the Nantes plastic surgery unit].

Science.gov (United States)

Tilliet Le Dentu, H; Lancien, U; Sellal, O; Duteille, F; Perrot, P

2018-02-01

Pectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method. We have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded. Between 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications. The management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Image-guided intracranial cannula placement for awake in vivo microdialysis in nonhuman primates

Science.gov (United States)

Chen, Antong; Bone, Ashleigh; Hines, Catherine D. G.; Dogdas, Belma; Montgomery, Tamara O.; Michener, Maria; Winkelmann, Christopher T.; Ghafurian, Soheil; Lubbers, Laura S.; Renger, John; Bagchi, Ansuman; Uslaner, Jason M.; Johnson, Colena; Zariwala, Hatim A.

2016-03-01

Intracranial microdialysis is used for sampling neurochemicals and large peptides along with their metabolites from the interstitial fluid (ISF) of the brain. The ability to perform this in nonhuman primates (NHP) e.g., rhesus could improve the prediction of pharmacokinetic (PK) and pharmacodynamics (PD) action of drugs in human. However, microdialysis in rhesus brains is not as routinely performed as in rodents. One challenge is that the precise intracranial probe placement in NHP brains is difficult due to the richness of the anatomical structure and the variability of the size and shape of brains across animals. Also, a repeatable and reproducible ISF sampling from the same animal is highly desirable when combined with cognitive behaviors or other longitudinal study end points. Toward that end, we have developed a semi-automatic flexible neurosurgical method employing MR and CT imaging to (a) derive coordinates for permanent guide cannula placement in mid-brain structures and (b) fabricate a customized recording chamber to implant above the skull for enclosing and safeguarding access to the cannula for repeated experiments. In order to place the intracranial guide cannula in each subject, the entry points in the skull and the depth in the brain were derived using co-registered images acquired from MR and CT scans. The anterior/posterior (A/P) and medial-lateral (M/L) rotation in the pose of the animal was corrected in the 3D image to appropriately represent the pose used in the stereotactic frame. An array of implanted fiducial markers was used to transform stereotactic coordinates to the images. The recording chamber was custom fabricated using computer-aided design (CAD), such that it would fit the contours of the individual skull with minimum error. The chamber also helped in guiding the cannula through the entry points down a trajectory into the depth of the brain. We have validated our method in four animals and our results indicate average placement error

Empirical research on Kano's model and customer satisfaction.

Science.gov (United States)

Lin, Feng-Han; Tsai, Sang-Bing; Lee, Yu-Cheng; Hsiao, Cheng-Fu; Zhou, Jie; Wang, Jiangtao; Shang, Zhiwen

2017-01-01

Products are now developed based on what customers desire, and thus attractive quality creation has become crucial. In studies on customer satisfaction, methods for analyzing quality attributes and enhancing customer satisfaction have been proposed to facilitate product development. Although substantial studies have performed to assess the impact of the attributes on customer satisfaction, little research has been conducted that quantitatively calculate the odds of customer satisfaction for the Kano classification, fitting a nonlinear relationship between attribute-level performance and customer satisfaction. In the present study, the odds of customer satisfaction were determined to identify the classification of quality attributes, and took customer psychology into account to suggest how decision-makers should prioritize the allocation of resources. A novel method for quantitatively assessing quality attributes was proposed to determine classification criteria and fit the nonlinear relationship between quality attributes and customer satisfaction. Subsequently, a case study was conducted on bicycle user satisfaction to verify the novel method. The concept of customer satisfaction odds was integrated with the value function from prospect theory to understand quality attributes. The results of this study can serve as a reference for product designers to create attractive quality attributes in their products and thus enhance customer satisfaction.

Sonographically guided percutaneous muscle biopsy in diagnosis of neuromuscular disease: a useful alternative to open surgical biopsy.

Science.gov (United States)

O'Sullivan, Paul J; Gorman, Grainne M; Hardiman, Orla M; Farrell, Michael J; Logan, P Mark

2006-01-01

The purpose of this study was to evaluate the feasibility of sonographically guided percutaneous muscle biopsy in the investigation of neuromuscular disorders. Sonographically guided percutaneous needle biopsy of skeletal muscle was performed with a 14-gauge core biopsy system in 40 patients over a 24-month period. Patients were referred from the Department of Neurology under investigation for neuromuscular disorders. Sonography was used to find suitable tissue and to avoid major vascular structures. A local anesthetic was applied below skin only. A 3- to 4-mm incision was made. Three 14-gauge samples were obtained from each patient. All samples were placed on saline-dampened gauze and sent for neuropathologic analysis. As a control, we retrospectively assessed results of the 40 most recent muscle samples acquired via open surgical biopsy. With the use of sonography, 32 (80%) of 40 patients had a histologic diagnosis made via percutaneous needle biopsy. This included 26 (93%) of 28 patients with acute muscular disease and 6 (50%) of 12 patients with chronic disease. In the surgical group (all acute disease), 38 (95%) of 40 patients had diagnostic tissue attained. Sonographically guided percutaneous 14-gauge core skeletal muscle biopsy is a useful procedure, facilitating diagnosis in acute muscular disease. It provides results comparable with those of open surgical biopsy in acute muscular disease. It may also be used in chronic muscular disease but repeated or open biopsy may be needed.

3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note.

Science.gov (United States)

Li, Jian; Lin, JiSheng; Yang, Yong; Xu, JunChuan; Fei, Qi

2018-06-01

Percutaneous vertebroplasty (PVP) is currently considered as an effective treatment for pain caused by acute osteoporotic vertebral compression fracture. Recently, puncture-related complications are increasingly reported. It's important to find a precise technique to reduce the puncture-related complications. We report a case and discussed the novel surgical technique with step-by-step operating procedures, to introduce the precise PVP assisted by a 3-dimensional printing guide template. Based on the preoperative CT scan and infrared scan data, a well-designed individual guide template could be established in a 3-dimensional reconstruction software and printed out by a 3-dimensional printer. In real operation, by matching the guide template to patient's back skin, cement needles' insertion orientation and depth were easily established. Only 14 times C-arm fluoroscopy with HDF mode (total exposure dose was 4.5 mSv) were required during the procedure. The operation took only 17 min. Cement distribution in the vertebral body was very good without any puncture-related complications. Pain was significantly relieved after surgery. In conclusion, the novel precise 3-dimensional printing guide template system may allow (1) comprehensive visualization of the fractured vertebral body and the individual surgical planning, (2) the perfect fitting between skin and guide template to ensure the puncture stability and accuracy, and (3) increased puncture precision and decreased puncture-related complications, surgical time and radiation exposure. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: an analysis for Austria.

Science.gov (United States)

Gruber, R; Walter, E; Helbich, T H

2010-06-01

To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Overall cost savings for US-guided LCBB over OSB were euro 977 (euro 2,337/euro 3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were euro 1,542 (euro 2,600/euro 4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be euro 18.5 million. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Percutaneous computed tomography-guided core needle biopsy of soft tissue tumors: results and correlation with surgical specimen analysis

Energy Technology Data Exchange (ETDEWEB)

Chojniak, Rubens; Grigio, Henrique Ramos; Bitencourt, Almir Galvao Vieira; Pinto, Paula Nicole Vieira; Tyng, Chiang J.; Cunha, Isabela Werneck da; Aguiar Junior, Samuel; Lopes, Ademar, E-mail: chojniak@uol.com.br [Hospital A.C. Camargo, Sao Paulo, SP (Brazil)

2012-09-15

Objective: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. Materials and Methods: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. Results: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). Conclusion: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning (author)

Team Foundation Server 2013 customization

CERN Document Server

Beeming, Gordon

2014-01-01

This book utilizes a tutorial based approach, focused on the practical customization of key features of the Team Foundation Server for collaborative enterprise software projects.This practical guide is intended for those who want to extend TFS. This book is for intermediate users who have an understanding of TFS, and basic coding skills will be required for the more complex customizations.

Custom-made prefabricated titanium miniplates in Le Fort I osteotomies: principles, procedure and clinical insights.

Science.gov (United States)

Philippe, B

2013-08-01

This paper describes a new type of miniplate system that is designed and custom made during virtual surgery planning based on an individual patient's osteotomy. These miniplates are prefabricated with commercially pure porous titanium using direct metal laser sintering. The principles that guide the conception and production of this new miniplate are presented. The surgical procedure from the stage of virtual surgery planning until the final Le Fort I osteotomy and bone fixation are described using a case example. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Empirical research on Kano’s model and customer satisfaction

Science.gov (United States)

Lin, Feng-Han; Tsai, Sang-Bing; Lee, Yu-Cheng; Hsiao, Cheng-Fu; Zhou, Jie; Wang, Jiangtao; Shang, Zhiwen

2017-01-01

Products are now developed based on what customers desire, and thus attractive quality creation has become crucial. In studies on customer satisfaction, methods for analyzing quality attributes and enhancing customer satisfaction have been proposed to facilitate product development. Although substantial studies have performed to assess the impact of the attributes on customer satisfaction, little research has been conducted that quantitatively calculate the odds of customer satisfaction for the Kano classification, fitting a nonlinear relationship between attribute-level performance and customer satisfaction. In the present study, the odds of customer satisfaction were determined to identify the classification of quality attributes, and took customer psychology into account to suggest how decision-makers should prioritize the allocation of resources. A novel method for quantitatively assessing quality attributes was proposed to determine classification criteria and fit the nonlinear relationship between quality attributes and customer satisfaction. Subsequently, a case study was conducted on bicycle user satisfaction to verify the novel method. The concept of customer satisfaction odds was integrated with the value function from prospect theory to understand quality attributes. The results of this study can serve as a reference for product designers to create attractive quality attributes in their products and thus enhance customer satisfaction. PMID:28873418

Where does the customer fit in a service operation?

Science.gov (United States)

Chase, R B

1978-01-01

While management skills can improve service systems, a manager is better off if he or she first has a clear understanding of the operating characteristics that set one service system apart from another. This author offers one view of services, which, if followed, results in a "rational approach to the rationalization" of services. His view, quite simply, is that the less direct contact the customer has with the service system, the greater the potential of the system to operate at peak efficiency. And, conversely, where the direct customer contact is high, the less the potential that exists to achieve high levels of efficiency. This distinction between high- and low-contact systems provides a basis for classifying service production systems that can enable the manager to develop a more effective service operation.

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

International Nuclear Information System (INIS)

Kim, Young Hwan; Kim, Yong Joo; Shin, Tae Beom

2011-01-01

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

2011-04-15

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Study of medical education in 3D surgical modeling by surgeons with free open-source software: Example of mandibular reconstruction with fibula free flap and creation of its surgical guides.

Science.gov (United States)

Ganry, L; Hersant, B; Bosc, R; Leyder, P; Quilichini, J; Meningaud, J P

2018-02-27

Benefits of 3D printing techniques, biomodeling and surgical guides are well known in surgery, especially when the same surgeon who performed the surgery participated in the virtual surgical planning. Our objective was to evaluate the transfer of know how of a neutral 3D surgical modeling free open-source software protocol to surgeons with different surgical specialities. A one-day training session was organised in 3D surgical modeling applied to one mandibular reconstruction case with fibula free flap and creation of its surgical guides. Surgeon satisfaction was analysed before and after the training. Of 22 surgeons, 59% assessed the training as excellent or very good and 68% considered changing their daily surgical routine and would try to apply our open-source software protocol in their department after a single training day. The mean capacity in using the software improved from 4.13 on 10 before to 6.59 on 10 after training for OsiriX ® software, from 1.14 before to 5.05 after training for Meshlab ® , from 0.45 before to 4.91 after training for Netfabb ® and from 1.05 before and 4.41 after training for Blender ® . According to surgeons, using the software Blender ® became harder as the day went on. Despite improvement in the capacity in using software for all participants, more than a single training day is needed for the transfer of know how on 3D modeling with open-source software. Although the know-how transfer, overall satisfaction, actual learning outcomes and relevance of this training were appropriated, a longer training including different topics will be needed to improve training quality. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Deriving DICOM surgical extensions from surgical workflows

Science.gov (United States)

Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

2007-03-01

The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

Transcending the Curricular Barrier between Fitness and Reading with FitLit

Science.gov (United States)

Opitz, Michael F.

2011-01-01

The author discusses how FitLit, children's literature that spotlights the multiple aspects of health and well-being, offers a vehicle for integrating reading and fitness into existing classroom routines such as guided reading, read-alouds, independent reading, and reading and writing workshop. Sample FitLit titles are provided as well as a…

Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report

Directory of Open Access Journals (Sweden)

Oliver Blume

2017-10-01

Full Text Available The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA block for its use in Guided Bone Regeneration (GBR procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.

Effect of iris registration on outcomes of LASIK for myopia with the VISX CustomVue platform

DEFF Research Database (Denmark)

Moshirfar, Majid; Chen, Michael C; Espandar, Ladan

2009-01-01

PURPOSE: To compare visual outcomes after LASIK using the VISX STAR S4 CustomVue, with and without Iris Registration technology. METHODS: In this retrospective study, LASIK was performed on 239 myopic eyes, with or without astigmatism, of 142 patients. Iris registration LASIK was performed on 121...... eyes and non-iris registration LASIK was performed on 118 eyes. Primary outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction. RESULTS: At 6 months, the mean values for UCVA (logMAR) were 0.00 +/- 0.09 in the iris registration...... magnitude of error of surgically induced astigmatism was -0.09 in the iris registration group and -0.04 in the non-iris registration group (P = .25). CONCLUSIONS: Wavefront-guided LASIK with the VISX STAR S4 CustomVue laser system, independent of iris registration status, is effective, safe, and predictable...

Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: A review of current literature

Science.gov (United States)

Martin, Aaron; Kistler, Charles Andrew; Wrobel, Piotr; Yang, Juliana F.; Siddiqui, Ali A.

2016-01-01

The management of pancreaticobiliary disease in patients with surgically altered anatomy is a growing problem for gastroenterologists today. Over the years, endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the treatment of pancreaticobiliary disease. Patient anatomy has become increasingly complex due to advances in surgical resection of pancreaticobiliary disease and EUS has emerged as the therapy of choice when endoscopic retrograde cholangiopancreatography failed cannulation or when the papilla is inaccessible such as in gastric obstruction or duodenal obstruction. The current article gives a comprehensive review of the current literature for EUS-guided intervention of the pancreaticobiliary tract in patients with altered surgical anatomy. PMID:27386471

Ultrasound guided aspiration of breast abscess as an alternative to surgical incision and drainage

International Nuclear Information System (INIS)

Naper, M.A.; Shaikh, M.S.; Dholia, K.R.

2017-01-01

To evaluate the outcome and assess the success rate of ultrasound guided aspiration of breast abscess as an alternative to surgical incision and drainage. Methodology: A prospective descriptive study was carried out at Department of Surgery, Chandka Medical College Hospital, Larkana, Pakistan, from January 2015 to December 2015. A total of 111 patients of breast abscess who underwent ultrasound guided aspiration without anesthesias with oral antibiotic cover were studied. Females with breast abscess within seven days, and the abscess size was <3cm were included in the study. Males, antibioma and inflammatory carcinoma were excluded from the study. Outcome of success or failure was observed within two weeks and recorded. Results: Out of 111 patients, 68.46% were lactating and 31.53% were non-lactating women, with ages ranging from 18 to 60 years (mean 36.5 years). The successful rate with complete resolution after ultrasound guided aspiration was observed in 94.5%. 80.82% responded after single aspiration, 12.38% after two times aspiration, and 6.66% after multiple aspirations, while 5.4% of patients required incision and drainage. Conclusion: Ultrasound guided aspiration of breast abscess is an effective treatment option with a diameter of <3cm, which can be recommended as a routine outpatient procedure. (author)

Table of tables of Hydro-Quebec customer needs: Support guide, June 1993

International Nuclear Information System (INIS)

Anon.

1994-01-01

Hydro-Quebec conducted surveys of its direct and indirect customers concerning their needs and expectations. Direct customers are those who have a business relationship with the utility and include residential, commercial, industrial, and institutional customers, large corporations, and neighboring utilities. Indirect customers are agencies whose regulatory authority applies to the utility. These agencies fall into the categories of nuclear energy, environment and land use development, products and services, and occupational health and safety. Using techniques including group discussions, interviews, and telephone surveys, direct customers were asked to define the features of the goods and services they expect from the utility. The importance of elements such as customer treatment, rates, energy conservation programs, payment terms, and behavior of utility personnel were evaluated and ranked. For indirect customers, their requirements were determined and the importance of each was evaluated by corporate experts. The impact of the utility's performance on meeting customer needs was then evaluated in five areas: sales and quality of service, supply of electricity, safety, price, and social responsibility. Results of the 1993 survey are presented, by customer category, and compared to results of the 1992 survey. 21 tabs

Surgical versus Non-surgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation

OpenAIRE

Kweon, Christopher Y.; Gagnier, Joel Joseph; Robbins, Christopher; Bedi, Asheesh; Carpenter, James E.; Miller, Bruce S.

2014-01-01

Objectives: Rotator cuff tears are a common shoulder disorder resulting in significant disability to patients and strain on the health care system. While both surgical and non-surgical management are accepted treatment options, little data exist to guide the surgeon in treatment allocation. Defining variables to guide treatment allocation may be important for patient education and counseling, as well as to deliver the most efficient care plan at the time of presentation. The objective of this...

AFMC Customer Satisfaction Study at the Air Logistics Centers

Science.gov (United States)

2008-03-01

research was guided by a previous Graduate Research Project (GRP) effort, which sought to determine how customer relationship management ( CRM ...and effectively. To accomplish this, AFMC is implementing Customer Relationship Management ( CRM ) as one of its initiatives. Problem Statement...for improvement. More than fifty-one percent of the participants were not aware that Customer Relationship Management ( CRM ) was a transformation

Design for Collaboration in Health Care: Experiences from Highly Specialized Surgical Care in Sweden

DEFF Research Database (Denmark)

Bødker, Susanne; Schroll, Jeremiah; Groth, Kristina

Medical Information Systems often need to be custom designed to fit the organization where they will be implemented. Participatory Design (PD) is a well known method for eliciting the user input that is necessary during this process. Recently it has been suggested that PD as it is often practiced...... will better meet these evolving needs. In this paper we present a case study of design as it is practiced at a gastro-surgical department at a University hospital in Sweden. The experiences of the department are used as a framework for discussing this issue and its implications for the CSCW/HCI community....

[Value of a novel categorization of congenital double-outlet right ventricle on guiding the choice of surgical approaches].

Science.gov (United States)

Pang, Kunjing; Meng, Hong; Wang, Hao; Hu, Shengshou; Hua, Zhongdong; Pan, Xiangbin; Li, Shoujun

2015-11-01

To explore the feasibility and value of a new categorization of double outlet right ventricular (DORV) on guiding the optimal choices of surgical approaches. Five hundred and twenty one DORV patients diagnosed by echocardiography, angiocardiography and CT at Fuwai Hospital from May 2003 to September 2014 were enrolled in this retrospective study. Congenital DORV was categorized according to three basic factors as follows: the positional relationships of great arteries (normal relation or abnormal relation), the relationships of the ventricular septal defect (VSD) to the great arteries (committed VSD or remote VSD), the presence or absence of pulmonary outflow tract obstruction (POTO). Eight types of DORV were established: type I (normal relation, committed VSD, without POTO), type II (normal relation, committed VSD, POTO), type III (normal relation, remote VSD, without POTO), type IV (normal relation, remote VSD, POTO), type V (abnormal relation, committed VSD, without POTO), type VI (abnormal relation, committed VSD, POTO), type VII (abnormal relation, remote VSD, without POTO), type VIII (abnormal relation, remote VSD, POTO). Feasibility of this classification and the value of this classification on guiding the choice of surgical approaches were analyzed. Among the five hundred and twenty one patients, there were 90 patients (17.3%) with type I DORV, 94 patients (18.0%) with type II, 33 patients (6.3%) with type III, 34 patients (6.5%) with type IV, 64 patients (12.3%) with type V, 61 patients (11.7%) with type VI, 33 patients (6.3%) with type VII, 112 patients (21.5%) with type VIII. Thus, all patients could be typed by this classification method. The echocardiography diagnosis was consistent with the intra-operative and or cardiac catheterization/CT findings. Excluding the contraindications of bi-ventricular repair, different surgical approaches were performed in every subtype of DORV according the classification, which indicated that this novel categorization

In situ repair of a failed compression fitting

Science.gov (United States)

Wolbert, Ronald R.; Jandrasits, Walter G.

1986-01-01

A method and apparatus for the in situ repair of a failed compression fitg is provided. Initially, a portion of a guide tube is inserted coaxially in the bore of the compression fitting and locked therein. A close fit dethreading device is then coaxially mounted on the guide tube to cut the threads from the fitting. Thereafter, the dethreading device and guide tube are removed and a new fitting is inserted onto the dethreaded fitting with the body of the new fitting overlaying the dethreaded portion. Finally, the main body of the new fitting is welded to the main body of the old fitting whereby a new threaded portion of the replacement fitting is precisely coaxial with the old threaded portion. If needed, a bushing is located on the dethreaded portion which is sized to fit snugly between the dethreaded portion and the new fitting. Preferably, the dethreading device includes a cutting tool which is moved incrementally in a radial direction whereby the threads are cut from the threaded portion of the failed fitting in increments.

Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique.

Science.gov (United States)

Sharma, Namrata; Urkude, Jayanand; Chaniyara, Manthan; Titiyal, Jeewan S

2017-10-01

We describe the surgical technique of microscope-integrated intraoperative optical coherence tomography (OCT)-guided small-incision lenticule extraction. The technique enables manual tracking of surgical instruments and identification of the desired dissection plane. It also helps discern the relation between the dissector and the intrastromal lenticule. The dissection plane becomes hyperreflective on dissection, ensuring complete separation of the intrastromal lenticule from the overlying and underlying stroma. Inadvertent posterior plane entry, cap-lenticule adhesion, incomplete separation of the lenticule, creation of a false plane, and lenticule remnants may be recognized intraoperatively so corrective steps can be taken immediately. In cases with a hazy overlying cap, microscope-integrated intraoperative OCT enables localization and extraction of the lenticule. The technique is helpful for inexperienced surgeons, especially in cases with low amplitudes of refractive errors, ie, thin lenticules. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Additively manufactured custom load-bearing implantable devices: grounds for caution

Directory of Open Access Journals (Sweden)

Elisabetta M Zanetti

2017-08-01

Full Text Available Background Additive manufacturing technologies are being enthusiastically adopted by the orthopaedic community since they are providing new perspectives and new possibilities. First applications were finalised for educational purposes, pre-operative planning, and design of surgical guides; recent applications also encompass the production of implantable devices where 3D printing can bring substantial benefits such as customization, optimization, and manufacturing of very complex geometries. The conceptual smoothness of the whole process may lead to the idea that any medical practitioner can use a 3D printer and her/his imagination to design and produce novel products for personal or commercial use. Aims Outlining how the whole process presents more than one critical aspects, still demanding further research in order to allow a safe application of this technology for fully-custom design, in particular confining attention to orthopaedic/orthodontic prostheses defined as components responding mainly to a structural function. Methods Current knowledge of mechanical properties of additively manufactured components has been examined along with reasons why the behaviour of these components might differ from traditionally manufactured components. The structural information still missing for mechanical design is outlined. Results Mechanical properties of additively manufactured components are not completely known, and especially fatigue limit needs to be examined further. Conclusion At the present stage, with reference to load-bearing implants subjected to many loading cycles, the indication of custom-made additively manufactured medical devices should be restricted to the cases with no viable alternative.

Double Guided Surgery in All-on-4® Concept: When Ostectomy Is Needed

Directory of Open Access Journals (Sweden)

Gabriele Tonellini

2018-01-01

Full Text Available Background. The rehabilitation of edentulous jaws with guided and flapless surgery applied to the All-on-4 concepts is a predictable treatment with a high implant and prosthetic survival rates, but there are several contraindications for this technique like when bone reduction is needed due to a high smile line in the maxilla or when there is an irregular or thin bone crest. Purpose. To report a technique with double guided surgery for bone reduction and implant placement with the All-on-4 concept. Materials and Methods. 7 patients were included in the study. Guided implant planning was performed using CBCT, and the virtual templates were created with three dedicated software. Custom surgical templates were made for the ostectomy and for implants positioning. Results. 28 implants were placed using a double bone-supported surgical guide. The mean angular errors between the preoperative-planned implant and the postoperative-placed implant were 2.155° ± 2.03°; the mean distance errors between the planned and the placed implants were 0.763 mm ± 0.55 mm on the shoulder implant and 0.570 mm ± 0.40 mm on the apex implant. Conclusions. The results of our study indicate that this treatment is predictable with an excellent survival rate allowing excellent results even when bone reduction is mandatory.

Bottom nozzle to guide tube connection

International Nuclear Information System (INIS)

Bryan, W.J.

1991-01-01

This patent describes a nuclear fuel assembly which includes an upper end fitting and a lower end fitting spaced therefrom and connected thereto by elongated guide tubes of one alloy having an open upper end and a closed lower end with spaced fuel element retaining grids mounted on the guide tubes therebetween, the closed lower ends of the guide tubes including a threaded central passageway and the attachment of the guide tubes to the lower end fitting of another alloy. It comprises: an externally threaded bolt with a first end threadably received in the threaded central passageway of the lower end of the guide tube and a head at the other end of the side of the lower end fitting opposite the guide tube; an interruption in the external threads of the bolt which forms a groove which communicates the interior of the guide tube with the side of the lower end fitting opposite the guide tube and enhances its frictional engagement with the threaded central passageway, thereby to hold and attach the guide tube and lower end fitting firmly together, even through a series of temperature cycles

Canadian Optically-guided approach for Oral Lesions Surgical (COOLS) trial: study protocol for a randomized controlled trial

International Nuclear Information System (INIS)

Poh, Catherine F; Durham, J Scott; Brasher, Penelope M; Anderson, Donald W; Berean, Kenneth W; MacAulay, Calum E; Lee, J Jack; Rosin, Miriam P

2011-01-01

Oral cancer is a major health problem worldwide. The 5-year survival rate ranges from 30-60%, and has remained unchanged in the past few decades. This is mainly due to late diagnosis and high recurrence of the disease. Of the patients who receive treatment, up to one third suffer from a recurrence or a second primary tumor. It is apparent that one major cause of disease recurrence is clinically unrecognized field changes which extend beyond the visible tumor boundary. We have previously developed an approach using fluorescence visualization (FV) technology to improve the recognition of the field at risk surrounding a visible oral cancer that needs to be removed and preliminary results have shown a significant reduction in recurrence rates. This paper describes the study design of a randomized, multi-centre, double blind, controlled surgical trial, the COOLS trial. Nine institutions across Canada will recruit a total of 400 patients with oral severe dysplasia or carcinoma in situ (N = 160) and invasive squamous cell carcinoma (N = 240). Patients will be stratified by participating institution and histology grade and randomized equally into FV-guided surgery (experimental arm) or white light-guided surgery (control arm). The primary endpoint is a composite of recurrence at or 1 cm within the previous surgery site with 1) the same or higher grade histology compared to the initial diagnosis (i.e., the diagnosis used for randomization); or 2) further treatment due to the presence of severe dysplasia or higher degree of change at follow-up. This is the first randomized, multi-centre trial to validate the effectiveness of the FV-guided surgery. In this paper we described the strategies, novelty, and challenges of this unique trial involving a surgical approach guided by the FV technology. The success of the trial requires training, coordination, and quality assurance across multiple sites within Canada. The COOLS trial, an example of translational research, may result in

Reliability of Soft Tissue Model Based Implant Surgical Guides; A Methodological Mistake.

Science.gov (United States)

Sabour, Siamak; Dastjerdi, Elahe Vahid

2012-08-20

Abstract We were interested to read the paper by Maney P and colleagues published in the July 2012 issue of J Oral Implantol. The authors aimed to assess the reliability of soft tissue model based implant surgical guides reported that the accuracy was evaluated using software. 1 I found the manuscript title of Maney P, et al. incorrect and misleading. Moreover, they reported twenty-two sites (46.81%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). As the authors point out in their conclusion, Soft tissue models do not always provide sufficient accuracy for implant surgical guide fabrication.Reliability (precision) and validity (accuracy) are two different methodological issues in researches. Sensitivity, specificity, PPV, NPV, likelihood ratio positive (true positive/false negative) and likelihood ratio negative (false positive/ true negative) as well as odds ratio (true results\\false results - preferably more than 50) are among the tests to evaluate the validity (accuracy) of a single test compared to a gold standard.2-4 It is not clear that the reported twenty-two sites (46.81%) which were considered accurate related to which of the above mentioned estimates for validity analysis. Reliability (repeatability or reproducibility) is being assessed by different statistical tests such as Pearson r, least square and paired t.test which all of them are among common mistakes in reliability analysis 5. Briefly, for quantitative variable Intra Class Correlation Coefficient (ICC) and for qualitative variables weighted kappa should be used with caution because kappa has its own limitation too. Regarding reliability or agreement, it is good to know that for computing kappa value, just concordant cells are being considered, whereas discordant cells should also be taking into account in order to reach a correct estimation of agreement (Weighted kappa).2-4 As a take home message, for reliability and validity analysis, appropriate tests should be

Microdose fluorescence imaging of ABY-029 on an operating microscope adapted by custom illumination and imaging modules.

Science.gov (United States)

Elliott, Jonathan T; Dsouza, Alisha V; Marra, Kayla; Pogue, Brian W; Roberts, David W; Paulsen, Keith D

2016-09-01

Fluorescence guided surgery has the potential to positively impact surgical oncology; current operating microscopes and stand-alone imaging systems are too insensitive or too cumbersome to maximally take advantage of new tumor-specific agents developed through the microdose pathway. To this end, a custom-built illumination and imaging module enabling picomolar-sensitive near-infrared fluorescence imaging on a commercial operating microscope is described. The limits of detection and system specifications are characterized, and in vivo efficacy of the system in detecting ABY-029 is evaluated in a rat orthotopic glioma model following microdose injections, showing the suitability of the device for microdose phase 0 clinical trials.

Segmentation of Portuguese customers’ expectations from fitness programs

Directory of Open Access Journals (Sweden)

Ricardo Gouveia Rodrigues

2017-10-01

Full Text Available Expectations towards fitness exercises are the major factor in customer satisfaction in the service sector in question. The purpose of this study is to present a segmentation framework for fitness customers, based on their individual expectations. The survey was designed and validated to evaluate individual expectations towards exercises. The study included a randomly recruited sample of 723 subjects (53% males; 47% females; 42.1±19.7 years. Factor analysis and cluster analysis with Ward’s cluster method with squared Euclidean distance were used to analyse the data obtained. Four components were extracted (performance, enjoyment, beauty and health explaining 68.7% of the total variance and three distinct segments were found: Exercise Lovers (n=312, Disinterested (n=161 and Beauty Seekers (n=250. All the factors identified have a significant contribution to differentiate the clusters, the first and third clusters being most similar. The segmentation framework obtained based on customer expectations allows better understanding of customers’ profiles, thus helping the fitness industry develop services more suitable for each type of customers. A follow-up study was conducted 5 years later and the results concur with the initial study.

Image-guided robotic surgery.

Science.gov (United States)

Marescaux, Jacques; Solerc, Luc

2004-06-01

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.

The Customer's Path to Loyalty: A Partial Test of the Relationships of Prior Experience, Justice, and Customer Satisfaction

OpenAIRE

Severt, Denver E.

2002-01-01

The service sector is the fastest growing segment of the economy, responsible for 75% of the GNP, and still growing. Its success is important to the global economy. Nonetheless, throughout the 20-year evolution of services marketing literature, research that guides theory, methodology, and practice for service success has remained underrepresented. Published research regarding the effect of customers' justice perceptions on customer satisfaction is primarily experimental and focuses only on...

A virtual reality interface for pre-planning of surgical operations based on a customized model of the patient

Science.gov (United States)

Witkowski, Marcin; Lenar, Janusz; Sitnik, Robert; Verdonschot, Nico

2012-03-01

We present a human-computer interface that enables the operator to plan a surgical procedure on the musculoskeletal (MS) model of the patient's lower limbs, send the modified model to the bio-mechanical analysis module, and export the scenario parameters to the surgical navigation system. The interface provides the operator with tools for: importing customized MS model of the patient, cutting bones and manipulating/removal of bony fragments, repositioning muscle insertion points, muscle removal and placing implants. After planning the operator exports the modified MS model for bio-mechanical analysis of the functional outcome. If the simulation result is satisfactory the exported scenario data may be directly used during the actual surgery. The advantages of the developed interface are the possibility of installing it in various hardware configurations and coherent operation regardless of the devices used. The hardware configurations proposed to be used with the interface are: (a) a standard computer keyboard and mouse, and a 2-D display, (b) a touch screen as a single device for both input and output, or (c) a 3-D display and a haptic device for natural manipulation of 3-D objects. The interface may be utilized in two main fields. Experienced surgeons may use it to simulate their intervention plans and prepare input data for a surgical navigation system while student or novice surgeons can use it for simulating results of their hypothetical procedure. The interface has been developed in the TLEMsafe project (www.tlemsafe.eu) funded by the European Commission FP7 program.

Numerical optimization of alignment reproducibility for customizable surgical guides.

Science.gov (United States)

Kroes, Thomas; Valstar, Edward; Eisemann, Elmar

2015-10-01

Computer-assisted orthopedic surgery aims at minimizing invasiveness, postoperative pain, and morbidity with computer-assisted preoperative planning and intra-operative guidance techniques, of which camera-based navigation and patient-specific templates (PST) are the most common. PSTs are one-time templates that guide the surgeon initially in cutting slits or drilling holes. This method can be extended to reusable and customizable surgical guides (CSG), which can be adapted to the patients' bone. Determining the right set of CSG input parameters by hand is a challenging task, given the vast amount of input parameter combinations and the complex physical interaction between the PST/CSG and the bone. This paper introduces a novel algorithm to solve the problem of choosing the right set of input parameters. Our approach predicts how well a CSG instance is able to reproduce the planned alignment based on a physical simulation and uses a genetic optimization algorithm to determine optimal configurations. We validate our technique with a prototype of a pin-based CSG and nine rapid prototyped distal femora. The proposed optimization technique has been compared to manual optimization by experts, as well as participants with domain experience. Using the optimization technique, the alignment errors remained within practical boundaries of 1.2 mm translation and [Formula: see text] rotation error. In all cases, the proposed method outperformed manual optimization. Manually optimizing CSG parameters turns out to be a counterintuitive task. Even after training, subjects with and without anatomical background fail in choosing appropriate CSG configurations. Our optimization algorithm ensures that the CSG is configured correctly, and we could demonstrate that the intended alignment of the CSG is accurately reproduced on all tested bone geometries.

At Their Service. Making Life Happier for Customers and Staff. The Helping Hand Series.

Science.gov (United States)

Nash, Claire

This guide is intended to help persons employed in the hotel and catering industry to improve their customer relations skills. The following topics are discussed: the importance of customers and good customer relations in the hospitality industry; what customers want; what employees in hospitality occupations can give customers; and importance of…

AutoCAD platform customization VBA

CERN Document Server

Ambrosius, Lee

2015-01-01

Boost productivity and streamline your workflow with expert AutoCAD: VBA programming instruction AutoCAD Platform Customization: VBA is the definitive guide to personalizing AutoCAD and the various programs that run on the AutoCAD platform, including AutoCAD Architecture, Civil 3D, Plant 3D, and more. Written by an Autodesk insider with years of customization and programming experience, this book features detailed discussions backed by real-world examples and easy-to-follow tutorials that illustrate each step in the personalization process. Readers gain expert guidance toward managing layout

MRI-guided Wire Localization Surgical Biopsy in an Adolescent Patient with a Difficult to Diagnose Case of Lymphoma

International Nuclear Information System (INIS)

Thompson, Scott M.; Gorny, Krzysztof R.; Jondal, Danielle E.; Rech, Karen L.; Mardini, Samir; Woodrum, David A.

2017-01-01

A 17-year-old previously healthy female presented with a progressive soft tissue infiltrative process involving the neck and thorax. Extensive diagnostic evaluation including multiple imaging, laboratory, and biopsy studies was nondiagnostic. Due to an urgent need to establish a diagnosis and several previous nondiagnostic biopsies, she was referred to interventional radiology for MRI-guided wire localization immediately prior to open surgical biopsy. Under general anesthesia, wires were placed in the areas of increased T2 signal within the bilateral splenius capitis muscles using intermittent MRI-guidance followed by immediate surgical biopsy down to the wires. Pathology confirmed the diagnosis of diffuse large B-cell lymphoma.

MRI-guided Wire Localization Surgical Biopsy in an Adolescent Patient with a Difficult to Diagnose Case of Lymphoma

Energy Technology Data Exchange (ETDEWEB)

Thompson, Scott M., E-mail: Thompson.scott@mayo.edu; Gorny, Krzysztof R.; Jondal, Danielle E. [Mayo Clinic College of Medicine, Department of Radiology (United States); Rech, Karen L. [Mayo Clinic College of Medicine, Department of Laboratory Medicine and Pathology (United States); Mardini, Samir [Mayo Clinic College of Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery (United States); Woodrum, David A. [Mayo Clinic College of Medicine, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

2017-01-15

A 17-year-old previously healthy female presented with a progressive soft tissue infiltrative process involving the neck and thorax. Extensive diagnostic evaluation including multiple imaging, laboratory, and biopsy studies was nondiagnostic. Due to an urgent need to establish a diagnosis and several previous nondiagnostic biopsies, she was referred to interventional radiology for MRI-guided wire localization immediately prior to open surgical biopsy. Under general anesthesia, wires were placed in the areas of increased T2 signal within the bilateral splenius capitis muscles using intermittent MRI-guidance followed by immediate surgical biopsy down to the wires. Pathology confirmed the diagnosis of diffuse large B-cell lymphoma.

Factors affecting customer satisfaction of online travel agencies in India

OpenAIRE

Dutta, Sabyasachi; Kumar Chauhan, Ram; Chauhan, Kavita

2017-01-01

Purpose – The purpose of this paper is to identify the factors affecting customer satisfaction for online travel agencies in India. It will help guide existing online travel agencies and future entrants to have an in-depth understanding of customer satisfaction and customer loyalty in their domain. It will also help to improve their business operations and investment focus, which in turn will lead to greater customer satisfaction and loyalty. Design – This paper defines the concept of cust...

BIG DATA ANALYTICS USE IN CUSTOMER RELATIONSHIP MANAGEMENT: ANTECEDENTS AND PERFORMANCE IMPLICATIONS

OpenAIRE

Suoniemi, Samppa; Meyer-Waarden, Lars; Munzel, Andreas

2016-01-01

Customer information plays a key role in managing successful relationships with valuable customers. Big data analytics use (BD use), i.e., the extent to which customer information derived from big data analytics guides marketing decisions, helps firms better meet customer needs for competitive advantage. This study aims to (1) determine whether organizational BD use improves customer-centric and financial outcomes, and (2) identify the factors influencing BD use. Drawing primarily from market...

Radiation exposure to surgical staff during F-18-FDG-guided cancer surgery

International Nuclear Information System (INIS)

Andersen, P.A.; Hesse, B.; Chakera, A.H.; Schmidt, G.; Klausen, T.L.; Binderup, T.; Grossjohann, H.S.; Friis, E.; Hansen, C.P.; Kjaer, A.

2008-01-01

High-energy gamma probes have recently become commercially available, developed for 18 F-FDG probe-guided surgery. The radiation received by the staff in the operating room might limit the use of it, but has never been determined. We therefore wanted to measure the absorbed staff doses at operations where patients had received a preoperative injection of 18 F-FDG. Thirty-four patients with different cancers (breast cancer, melanoma, gastrointestinal cancers, respectively) were operated. At every operation the surgeon was monitored with a TLD tablet on his finger of the operating hand and a TLD tablet on the abdomen. The surgeon and anaesthesiologist were also monitored using electronic dosimeters placed in the trousers lining at 25 operations. The dose rate to the surgeon's abdominal wall varied between 7.5-13.2 μSv/h, depending on tumour location. The doses to the anaesthesiologists and the finger doses to the surgeon were much lower. About 350-400 MBq, i.e. ca. eight times higher activities than those used in the present study are supposed to be necessary for guiding surgery. It can be calculated from the body doses measured that a surgeon can perform between 150-260 h of surgery without exceeding permissible limits for professional workers. The radiation load to the operating staff will generally be so small that it does not present any limitation for FDG-guided surgery. However, it is recommended to monitor the surgical staff considering that the surgeon may be exposed to other radiation sources, and since the staff often includes women of child-bearing age. (orig.)

Spokojenost zákazníků se službami Pulse Fitness v Benešově

OpenAIRE

Holánek, Michal

2016-01-01

Title: Customer Satisfaction with the Services of Pulse Fitness in Benešov Objectives: The primary aim of this thesis is to ascertain customer satisfaction with the services of Pulse Fitness in Benešov as well as the main factors which reduce the level of customer satisfaction with said services. The results obtained will be employed as the bases for recommended measures, whose implementation in Pulse Fitness should contribute to an increase in the level of customer satisfaction. Moreover, a ...

Smart Grid: Smart Customer Policy Needs

Energy Technology Data Exchange (ETDEWEB)

NONE

2011-07-01

In September 2010, the International Energy Agency (IEA) held a workshop on the regulatory, market and consumer policies necessary to ensure that smart grids are deployed with adequate consideration of their risks and benefits to all stakeholders. This was one of several workshops that brought together energy providers, network operators, technology developers, regulators, customers and government policy makers to discuss smart grid technology and policy. The Smart Grid - Smart Customer Policies workshop allowed stakeholders to: gain a perspective on key issues and barriers facing early deployment of smart grids; hear expert opinion on regulatory, consumer and market challenges to smart grids; discuss smart grid-smart customer policy priorities; and build consensus on the technology and policy ingredients needed for customer-friendly smart grid deployments. Drawing on workshop discussions, the following paper lays out a logical framework to maximise the benefits and minimise the risks that smart grids pose for customers. The paper also describes key policy research questions that will guide future IEA research on this topic.

Imaging of foreign bodies in the face and ultrasound guided surgical removal; Diagnostico por imagem de corpos estranhos da face e retirada cirurgica guiada por ultra-sonografia

Energy Technology Data Exchange (ETDEWEB)

Lima, Claudio Marcio Amaral de Oliveira; Gambin, Moises; Ribeiro, Erica Barreiros; Amarante Junior, Jose Luiz de Medeiros [Hospital Naval Marcilio Dias, Rio de Janeiro, RJ (Brazil)]. E-mail: cmaol@br.inter.net; cmaolima@hotmail.com; Monteiro, Alexandra Maria Vieira [Pontificia Univ. Catolica do Rio de Janeiro (PUC/Rio), RJ (Brazil). Curso de Pos-Graduacao em Radiologia

2006-10-15

The identification and surgical removal of foreign bodies is a complex procedure in medical practice, principally when the involved material is radiolucent. The technological advent of the ultrasonography equipment comes enlarging the field of application of this method more and more, in medical practice. The authors describe a case of an ultrasound guided surgical removal of glass fragments from the face of a patient. The foreign bodies were previously diagnosed by ultrasound and computed tomography. The guided technic showed secure, less invasive and efficient, allowing the retreat of all the fragments. (author)

Serving online customers lessons for libraries from the business world

CERN Document Server

Barclay, Donald A

2014-01-01

To compete in the digital age, libraries must provide outstanding customer service to their virtual users. Serving Online Customers: Lessons for Libraries from the Business World is a practical guide to help libraries adopt and adapt the best practices of e-business for their own online operations.

Marketing assets: Relating brand equity and customer equity

Directory of Open Access Journals (Sweden)

Jaime Romero

2016-03-01

Full Text Available Purpose: Brand equity and customer equity are inextricably linked. Some authors propose that marketing activities build these intangible assets simultaneously. In contrast, others suggest that brand equity is an antecedent of customer equity. In this research, we aim to shed light about the relationship between brand equity and customer equity, by empirically testing these two alternative explanations. Design/methodology/approach: We propose four research models that reflect these two alternatives explanations regarding the link between brand equity and customer equity. In order to estimate these models we employ Structural Equations Modelling. We measure model variables using data collected through a survey to marketing managers of services companies that operate in Spain. We compare these four research models in terms of explanatory power and goodness of fit. Findings: Our results indicate that the models that correspond to the simultaneity approach have a higher explanatory power and goodness of fit than the models that suggest that brand equity is an antecedent of customer equity, thus supporting that these intangible assets are built by marketing activities at the same time. Research limitations/implications: Our results recommend caution when interpreting previous research about the effects of brand (customer equity, as they might indeed correspond to customer (brand management. Similarly, future research focusing on customer and brand management need to take into account both managerial areas in their studies. Practical implications: From a practitioners’ point of view, our findings suggest adopting a brand-customer portfolio approach to enhance company profitability. Similarly, we derive implications for firm valuation processes, which incorporate brand equity and customer equity in their calculations. Originality/value: We empirically study the relationship between brand equity and customer equity, while previous research has analyzed

Implant-Supported PMMA Monolithic Full-Arch Rehabilitation with Surgical Computer-Planned Guide and Immediate Provisional: A Case Report with One Year Follow-Up

Directory of Open Access Journals (Sweden)

Vincenzo Luca Zizzari

2018-01-01

Full Text Available The aim of this case report is to describe the surgical and prosthetic procedures to achieve maxillary and mandibular implant-supported PMMA monolithic full-arch rehabilitation (PMFR with surgical computer-planned guide and immediate provisional. In such cases, the correct planning of dental implants’ position, length, and diameter and the prosthetic phases via computer-aided design are very important to achieve good aesthetic and functional long-lasting results.

Implant-Supported PMMA Monolithic Full-Arch Rehabilitation with Surgical Computer-Planned Guide and Immediate Provisional: A Case Report with One Year Follow-Up

OpenAIRE

Zizzari, Vincenzo Luca; Tacconelli, Gianmarco

2018-01-01

The aim of this case report is to describe the surgical and prosthetic procedures to achieve maxillary and mandibular implant-supported PMMA monolithic full-arch rehabilitation (PMFR) with surgical computer-planned guide and immediate provisional. In such cases, the correct planning of dental implants’ position, length, and diameter and the prosthetic phases via computer-aided design are very important to achieve good aesthetic and functional long-lasting results.

Customized a Ti6Al4V Bone Plate for Complex Pelvic Fracture by Selective Laser Melting

Directory of Open Access Journals (Sweden)

Di Wang

2017-01-01

Full Text Available In pelvic fracture operations, bone plate shaping is challenging and the operation time is long. To address this issue, a customized bone plate was designed and produced using selective laser melting (SLM technology. The key steps of this study included designing the customized bone plate, metal 3D printing, vacuum heat treatment, surface post-processing, operation rehearsal, and clinical application and evaluation. The joint surface of the bone plate was placed upwards with respect to the build platform to keep it away from the support and to improve the quality of the joint surface. Heat conduction was enhanced by adding a cone-type support beneath the bone plate to prevent low-quality fabrication due to poor heat conductivity of the Ti-6Al-4V powder. The residual stress was eliminated by exposing the SLM-fabricated titanium-alloy bone plate to a vacuum heat treatment. Results indicated that the bone plate has a hardness of HV1 360–HV1 390, an ultimate tensile strength of 1000–1100 MPa, yield strength of 900–950 MPa, and an elongation of 8%–10%. Pre-operative experiments and operation rehearsal were performed using the customized bone plate and the ABC-made pelvic model. Finally, the customized bone plate was clinically applied. The intraoperative C-arm and postoperative X-ray imaging results indicated that the customized bone plate matched well to the damaged pelvis. The customized bone plate fixed the broken bone and guides pelvis restoration while reducing operation time to about two hours. The customized bone plate eliminated the need for preoperative titanium plate pre-bending, thereby greatly reducing surgical wounds and operation time.

Customized a Ti6Al4V Bone Plate for Complex Pelvic Fracture by Selective Laser Melting.

Science.gov (United States)

Wang, Di; Wang, Yimeng; Wu, Shibiao; Lin, Hui; Yang, Yongqiang; Fan, Shicai; Gu, Cheng; Wang, Jianhua; Song, Changhui

2017-01-04

In pelvic fracture operations, bone plate shaping is challenging and the operation time is long. To address this issue, a customized bone plate was designed and produced using selective laser melting (SLM) technology. The key steps of this study included designing the customized bone plate, metal 3D printing, vacuum heat treatment, surface post-processing, operation rehearsal, and clinical application and evaluation. The joint surface of the bone plate was placed upwards with respect to the build platform to keep it away from the support and to improve the quality of the joint surface. Heat conduction was enhanced by adding a cone-type support beneath the bone plate to prevent low-quality fabrication due to poor heat conductivity of the Ti-6Al-4V powder. The residual stress was eliminated by exposing the SLM-fabricated titanium-alloy bone plate to a vacuum heat treatment. Results indicated that the bone plate has a hardness of HV1 360-HV1 390, an ultimate tensile strength of 1000-1100 MPa, yield strength of 900-950 MPa, and an elongation of 8%-10%. Pre-operative experiments and operation rehearsal were performed using the customized bone plate and the ABC-made pelvic model. Finally, the customized bone plate was clinically applied. The intraoperative C-arm and postoperative X-ray imaging results indicated that the customized bone plate matched well to the damaged pelvis. The customized bone plate fixed the broken bone and guides pelvis restoration while reducing operation time to about two hours. The customized bone plate eliminated the need for preoperative titanium plate pre-bending, thereby greatly reducing surgical wounds and operation time.

Customer Satisfaction with Training Programs.

Science.gov (United States)

Mulder, Martin

2001-01-01

A model for evaluating customer satisfaction with training programs was tested with training purchasers. The model confirmed two types of projects: training aimed at achieving learning results and at changing job performance. The model did not fit for training intended to support organizational change. (Contains 31 references.) (SK)

Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.

Science.gov (United States)

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2017-11-01

Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.

Desirable design of hose fittings

DEFF Research Database (Denmark)

Voigt, Kristian

1998-01-01

This paper describes the primary functionality of a hose fitting. There has been made a discussion about the different parts of the hose assembly - the nipple, the hose and the outer compression parts. The last subject covered is which criteria should be put up for determining what is a good hose...... fittings. There has been made an uncompleted list of 'Voice of Customer' to this respect. Observations and interviews in industry should expand this list....

Improving Customer Satisfaction in an R and D Environment

Science.gov (United States)

Alexander, Anita; Liou, Y. H. Andrew

1998-01-01

Satisfying customer needs is critical to the sustained competitive advantage of service suppliers. It is therefore important to understand the types of customer needs which, if fulfilled or exceeded, add value and contribute to overall customer satisfaction. This study identifies the needs of various research and development (R&D) customers who contract for engineering and design support services. The Quality Function Deployment (QFD) process was used to organize and translate each customer need into performance measures that, if implemented, can improve customer satisfaction. This study also provides specific performance measures that will more accurately guide the efforts of the engineering supplier. These organizations can either implement the QFD methodology presented herein or extract a few performance measures that are specific to the quality dimensions in need of improvement. Listening to 'what' customers talk about is a good first start.

Customization of the voice prosthesis to prevent leakage from the enlarged tracheoesophageal puncture: results of a prospective trial.

Science.gov (United States)

Lewin, Jan S; Hutcheson, Katherine A; Barringer, Denise A; Croegaert, Lindsay E; Lisec, Asher; Chambers, Mark S

2012-08-01

Customization of the tracheoesophageal (TE) voice prosthesis (VP) is often preferred over surgical closure to prevent aspiration around the VP in laryngectomized patients with an enlarged tracheoesophageal puncture (TEP), but it has not been thoroughly evaluated. Single-institution prospective trial. A prospective trial was conducted to evaluate the effectiveness of a customized VP with the addition of an enlarged tracheal and/or esophageal collar in patients with leakage around an enlarged TEP. Absence of leakage around the VP after placement defined immediate effectiveness. Long-term success was defined by the prevention of adverse events related to leakage during the study period. Events that defined failure included: permanent gastrostomy dependence, aspiration pneumonia, and/or surgical TEP closure. Twenty-one patients with enlarged TEP were enrolled (2003-2006). Insertion of a customized VP was unsuccessful in one patient; 145 customizations were performed in the remaining 20 patients (median, 3.5 customizations) during the trial period. Of the customizations, 77% (112/145) prevented leakage immediately after VP insertion. The most common adverse event was dislodgement of the prosthesis (11%) or the collar alone (7%) in 18% (26/145) of customized VP placements. Six patients who died of disease were not evaluable for long-term outcomes. Long-term success was achieved in 80% (12/15) of evaluable patients who avoided permanent gastrostomy, aspiration pneumonia, and surgical TEP closure. Prosthetic customization offers an effective method to prevent leakage around the VP in many patients with an enlarged TEP, thereby preserving TE voice while avoiding surgical closure in this high-risk population. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Customer-based collection development an overview

CERN Document Server

2014-01-01

This essential guide to customer-based/patron-driven collection development will allow librarians to navigate the rapid changes in what users expect of libraries. The traditional "top down" approach to collection development definitely has its drawbacks: even after spending a good deal of time, energy, and resources, librarians are sometimes frustrated to find that their library's collection is not being used as they anticipated. But there's another strategy that's gaining momentum. This book gathers together the best practitioners in the emerging field of customer-based collection development to find out what library users need and want and provide strategies to allow librarians to manage collections accordingly. Drawing on the experiences of professionals from a variety of academic and public libraries, Customer-based Collection Development: * Offers strategies for planning and implementing a customer-based collection program * Summarizes its potential impact on a library's budget * Discusses cataloguing im...

Analysis of 3D scanning data for optimal custom footwear manufacture

OpenAIRE

Ture Savadkoohi, Bita

2010-01-01

Very few standards exist for tting products to people. Footwear fit is a noteworthy example for consumer consideration when purchasing shoes. As a result, footwear manufacturing industry for achieving commercial success encountered the problem of developing right footwear which is fulfills consumer's requirement better than it's competeries. Mass customization starts with understanding individual customer's requirement and it finishes with fulllment process of satisfying the target custome...

Take control of customizing Leopard

CERN Document Server

Neuburg, Matt

2009-01-01

Come up to speed quickly on Leopard's new features! So, what's new in Leopard? What's all the fuss about? This book shows you, through a hands-on guided tour of the adjustments, tweaks, and customizations you can make in the System and the Finder. Apple boasts of 300 new features in Leopard, but to make the most of those features, turn to Matt Neuburg for a road map on how to customize Leopard so it's right for you. Matt shows you how to protect your data with Time Machine, including instructions for searching through previous files with Spotlight. You'll also learn how to peek at files with

Custom-made titanium devices as membranes for bone augmentation in implant treatment: Clinical application and the comparison with conventional titanium mesh.

Science.gov (United States)

Sumida, Tomoki; Otawa, Naruto; Kamata, Y U; Kamakura, Satoshi; Mtsushita, Tomiharu; Kitagaki, Hisashi; Mori, Shigeo; Sasaki, Kiyoyuki; Fujibayashi, Shunsuke; Takemoto, Mitsuru; Yamaguchi, Atsushi; Sohmura, Taiji; Nakamura, Takashi; Mori, Yoshihide

2015-12-01

Development of new custom-made devices to reconstruct alveolar bone for implantation, and comparison with conventional methods were the goals of this study. Using a computer-aided design technique, three-dimensional images were constructed. From these data, custom-made devices were produced by a selective laser melting method with pure titanium. Clinical trials also have been conducted with 26 participants who needed bone reconstruction before implantation; they were divided into 2 groups with 13 patients each. The first group uses custom-made devices; the other uses commercial titanium meshes that need to bend during operation. Some clinical aspects are evaluated after the trial. The custom-made devices can be produced closely by following the data precisely. Devices are fit for bone defect site. Moreover, the operation time of the custom-made group (75.4 ± 11.6 min) was significantly shorter than that of the conventional group (111.9 ± 17.8 min) (p < 0.01). Mucosal rupture occurs, without significant difference (p = 0.27), in a patient in the custom-made without severe infection (7.7%), and 3 in conventional (23.1%), respectively. The retaining screw is significantly fewer in the custom-made group than commercial mesh group (p < 0.01). These results indicate that our novel protocol could be simple and safe for providing powerful support for guided bone regeneration. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Autotransplantation of premolars with a 3-dimensional printed titanium replica of the donor tooth functioning as a surgical guide: proof of concept

NARCIS (Netherlands)

Verweij, J.P.; Moin, D.A.; Mensink, G.; Nijkamp, P.; Wismeijer, D.; van Merkesteyn, J.P.R.

2016-01-01

Purpose: Autotransplantation of premolars is a good treatment option for young patients who have missing teeth. This study evaluated the use of a preoperatively 3-dimensional (3D)-printed replica of the donor tooth that functions as a surgical guide during autotransplantation. Materials and Methods:

CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

Energy Technology Data Exchange (ETDEWEB)

Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

2015-09-15

To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

Cardiorespiratory fitness moderates the effect of an affect-guided physical activity prescription: a pilot randomized controlled trial.

Science.gov (United States)

Baldwin, Austin S; Kangas, Julie L; Denman, Deanna C; Smits, Jasper A J; Yamada, Tetsuhiro; Otto, Michael W

2016-11-01

Physical activity (PA) interventions have a clear role in promoting mental health. Current PA guidelines directed toward specific PA intensities may have negative effects on affective response to exercise, and affective response is an important determinant of PA adherence. In this randomized trial of 67 previously inactive adults, we compared the effects of a PA prescription emphasizing the maintenance of positive affect to one emphasizing a target heart rate, and tested the extent to which the effect of the affect-guided prescription on PA is moderated by cardiorespiratory fitness (CRF). We found the effect of an affect-guided prescription was significantly moderated by CRF. At one week, for participants with lower CRF (i.e. poor conditioning), the affect-guided prescription resulted in significantly greater change in PA minutes (M = 240.8) than the heart rate-guided prescription (M = 165.7), reflecting a moderate-sized effect (d = .55). For those with higher CRF (i.e. good conditioning), the means were in the opposite direction but not significantly different. At one month, the same pattern emerged but the interaction was not significant. We discuss the implications of these findings for the type of PA prescriptions offered to individuals in need.

Customization of stock eye prosthesis for a pediatric patient by a simplified technique.

Science.gov (United States)

Jurel, Sunit Kumar; Talwar, Naina; Chand, Pooran; Singh, Raghuwar D; Gupta, Durga Shanker

2012-05-01

The unfortunate loss or absence of an eye may be caused by congenital defect , irreparable trauma, tumor or blind eye. The role of the maxillofacial prosthodontist in fabricating an ocular prosthesis to restore facial symmetry and normal appearance for the anophthalmic patient becomes essential. A custom-made ocular prosthesis is an excellent alternative for the people who lose their eye especially in young age. It has acceptable fit, retention and esthetics but is technically difficult to fabricate. On the other hand the stock eye has compromised fit and poor esthetics. Our case report presents a simple technique of customization of stock eye prosthesis to provide accurate fit and acceptable esthetics. How to cite this article: Jurel SK, Talwar N, Chand P, Singh RD, Gupta DS. Customization of Stock Eye Prosthesis for a Pediatric Patient by a Simplified Technique. Int J Clin Pediatr Dent 2012;5(2):155-158.

A Cross-Validation Study of the Other Customers Perceptions Scale in the Context of Sport and Fitness Centres. [Un estudio de validación cruzada sobre la escala de percepción de otros consumidores en el contexto de centros deportivos y de fitness].

Directory of Open Access Journals (Sweden)

Nicholas D Theodorakis

2014-01-01

Full Text Available This study aimed to extent the use of the Other Customer Perception (OCP scale by testing its psychometric properties and its generalizability in the context of sport and fitness centres. 360 members of three fitness clubs in Greece participated in the study. They were randomly divided into two subsamples (a calibration and a validation sample. Using Confirmatory Factor Analysis and composite reliability estimates the construct validity of OCP was supported. A cross-validation approach using invariance testing procedures across the two samples further supported the validity and generalizability of OCP in sport and fitness settings. OCP was found to be a reliable and valid scale for assessing the role of other customers in the service experience. Resumen Esta investigación ha pretendido extender el uso de la escala de percepción de otros consumidores (OCP por medio de la evaluación de sus propiedades psicométricas y su generalización en el contexto de centros deportivos y de fitness. La muestra la compusieron 360 miembros de tres clubes de fitness en Grecia, los cuales fueron divididos en dos submuestras (calibración y validación, respectivamente. Tras la aplicación del análisis factorial confirmatorio y estimaciones de fiabilidad compuesta, los resultados indican la validez de constructo de la escala. Además, se ha realizado un análisis de invarianza para el estudio de validación cruzada, que ha apoyado la generalización de su validez en este contexto de estudio. Por tanto, esta escala es fiable y válida para evaluar el papel de los otros consumidores en la experiencia con el servicio.

Surgical treatment for mediastinal abscess induced by endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.

Science.gov (United States)

Yokoyama, Yujiro; Nakagomi, Takahiro; Shikata, Daichi; Higuchi, Rumi; Oyama, Toshio; Goto, Taichiro

2017-07-14

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful and less invasive procedure for the definitive diagnosis of mediastinal and hilar lymph nodes. However, infectious complications can occur after EBUS-TBNA, although they are extremely rare. A 66-year-old man with necrotic and swollen lower paratracheal lymph nodes underwent EBUS-TBNA. A mediastinal abscess developed 9 days post-procedure. Surgical drainage and debridement of the abscess were performed along with lymph node biopsy followed by daily washing of the thoracic cavity. Surgical treatment was effective, leading to remission of the abscess. Biopsy revealed that the tumor was squamous cell carcinoma with no radiologically detected cancer elsewhere in the body. Mediastinal lung cancer was thus confirmed. Subsequent chemoradiotherapy led to the remission of the tumor. Mediastinitis after EBUS-TBNA is rare but should be considered, particularly if the target lymph nodes are necrotic. Mediastinitis can lead to serious and rapid deterioration of the patient's condition, for which surgical intervention is the treatment of choice.

INFLUENCE OF SERVICE QUALITY AND FARE TOWARD CUSTOMER SATISFACTION AND ITS IMPACT ON CUSTOMER LOYALTY OF EXPRESS TAXI IN JAKARTA

Directory of Open Access Journals (Sweden)

Mohammad Rizan

2015-09-01

Full Text Available The purpose of this study was to: to examine empirically the effect of service quality to customer satisfaction on Express taxi, to examine empirically the effect of fare to customer satisfaction on Express taxi, to examine empirically the effect of customer satisfaction to customer loyalty on Express taxi, to examine empirically the effect of service quality to customer loyalty on Express taxi, and to examine empirically the effect of fare to customer loyalty on Express taxi. Data collection using survey methods. Sample of this study are 200 respondents who have using services of Express taxi more than two times in last three months. Data analysis using SPSS version 23 and SEM (Structural Equation Modeling LISREL version 8.7. Results of hypothesis testing showed: service quality have positive and significant effect on customer satisfaction, fare have positive and significant effect on customer satisfaction, customer satisfaction have positive and significant effect on customer loyalty, service quality have positive and not significant effect to on customer loyalty. fare have positive and significant effect to on customer loyalty. Rated fit model with value of RMSEA 0.043, value of RMR 0.043, value of CMIN/DF 1.88, value of NFI 0.96, value of NNFI 0.98, and value of CFI 0.98. The results of this research beneficial to transportation company, especially Express taxi in Jakarta, to create better strategy in improving customer loyalty.

The Study on the Preferences of Customer Personal Values with Chinese Culture Background in Services

Science.gov (United States)

Li, Yi; Zhao, Hong; Yang, Yue

Customer personal values are the important factors which affect customer behaviors, and they guide and decide the customer's attitudes and behaviors on the products or the services. The paper thinks there are only several important customer personal values to guide customer's decisions, and these values will have -strong cultural differences. This study focuses on discussing the preferences of customer personal values with Chinese culture background when customers consume service and analyzes on the customer preferences of customer personal values with the deep interview method. After interviewing 16 responders with the semi-structured questionnaires, the study finds out some interesting results: (1) Some customers have recognized the existent of customer personal values, even though customer perceived values still have the strong influences on customer behaviors. (2) As they pursue to high quality lives, customers enjoy the lives in easy and pleasure way and care about the safe of the family. Quick response, simple and professional services contribute to enhance the experiences of easy and pleasure lives. (3) Non-rational consumers need the respect from the staff and the companies seriously. In comparison, the rational customers care less about the respect. (4) The sociable requirements have become a common consuming psychology of the customers. More and more customers try to gain the friends by consuming some services. (5) The preferences of customer personal values have a close relationship with the Chinese culture, such as collective values, family conception and "face" culture. The results benefit for service companies improving service brands and service quality.

Guided Modern Endodontic Surgery: A Novel Approach for Guided Osteotomy and Root Resection.

Science.gov (United States)

Strbac, Georg D; Schnappauf, Albrecht; Giannis, Katharina; Moritz, Andreas; Ulm, Christian

2017-03-01

Continuous improvements in techniques, instruments, and materials have established modern endodontic microsurgery as a state-of-the-art treatment method. The purpose of this approach was to introduce a new surgical endodontic technique by using a three-dimensional printed template for guided osteotomy and root resection. A 38-year-old patient was diagnosed with periapical lesions of teeth #3 and #4 and extruded gutta-percha material. Three-dimensional radiographic and optical scan files were imported into surgical planning software designed for guided implant surgery. Within the adapted software program the periapical lesions and the extruded gutta-percha were visualized and marked. With the aid of virtually positioned surgical pins and piezoelectric instruments, the osteotomy size, the apical resection level, and the bevel angle were defined before treatment. Three-dimensional surgical templates for each tooth were designed within the software program for a guided treatment approach. This approach comprised the treatment of periapical lesions of teeth #3 and #4 with root-end fillings and the detection and complete removal of the extruded gutta-percha material without perforation of sinus membrane. There were no postoperative complications, and clinical and radiologic assessments verified complete healing of the teeth. The guided microsurgical endodontic treatment presented appears to be a viable technique that allows for predefined osteotomies and root resections. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Implementation of whole slide imaging in surgical pathology: A value added approach

Directory of Open Access Journals (Sweden)

Mike Isaacs

2011-01-01

Full Text Available Background: Whole slide imaging (WSI makes it possible to capture images of an entire histological slide. WSI has established roles in surgical pathology, including support of off-site frozen section interpretation, primary diagnosis, educational activities, and laboratory quality assurance (QA activities. Analyses of the cost of WSI have traditionally been based solely on direct costs and diagnostic accuracy; however, these types of analyses largely ignore workflow and cost issues that arise as a result of redundancy, the need for additional staffing, and customized software development when WSI is integrated into routine diagnostic surgical pathology. The pre-scan, scan, and post-scan costs; quality control and QA costs; and IT process costs can be significant, and consequently, pathology groups can find it difficult to perform a realistic cost-benefit analysis of adding WSI to their practice. Materials and Methods: In this paper, we report a "value added" approach developed to guide our decisions regarding integration of WSI into surgical pathology practice. The approach focuses on specific operational measures (cost, time, and enhanced patient care and practice settings (clinical, education, and research to identify routine activities in which the addition of WSI can provide improvements. Results: When applied to our academic pathology group practice, the value added approach resulted in expanded and improved operations, as demonstrated by outcome based measures. Conclusion: A value added can be used to perform a realistic cost-benefit analysis of integrating WSI into routine surgical pathology practice.

Fabricating customized hydrogel contact lens

Science.gov (United States)

Childs, Andre; Li, Hao; Lewittes, Daniella M.; Dong, Biqin; Liu, Wenzhong; Shu, Xiao; Sun, Cheng; Zhang, Hao F.

2016-10-01

Contact lenses are increasingly used in laboratories for in vivo animal retinal imaging and pre-clinical studies. The lens shapes often need modification to optimally fit corneas of individual test subjects. However, the choices from commercially available contact lenses are rather limited. Here, we report a flexible method to fabricate customized hydrogel contact lenses. We showed that the fabricated hydrogel is highly transparent, with refractive indices ranging from 1.42 to 1.45 in the spectra range from 400 nm to 800 nm. The Young’s modulus (1.47 MPa) and hydrophobicity (with a sessile drop contact angle of 40.5°) have also been characterized experimentally. Retinal imaging using optical coherence tomography in rats wearing our customized contact lenses has the quality comparable to the control case without the contact lens. Our method could significantly reduce the cost and the lead time for fabricating soft contact lenses with customized shapes, and benefit the laboratorial-used contact lenses in pre-clinical studies.

Evaluation of a patient specific femoral alignment guide for hip resurfacing.

Science.gov (United States)

Olsen, Michael; Naudie, Douglas D; Edwards, Max R; Sellan, Michael E; McCalden, Richard W; Schemitsch, Emil H

2014-03-01

A novel alternative to conventional instrumentation for femoral component insertion in hip resurfacing is a patient specific, computed tomography based femoral alignment guide. A benchside study using cadaveric femora was performed comparing a custom alignment guide to conventional instrumentation and computer navigation. A clinical series of twenty-five hip resurfacings utilizing a custom alignment guide was conducted by three surgeons experienced in hip resurfacing. Using cadaveric femora, the custom guide was comparable to conventional instrumentation with computer navigation proving superior to both. Clinical femoral component alignment accuracy was 3.7° and measured within ± 5° of plan in 20 of 24 cases. Patient specific femoral alignment guides provide a satisfactory level of accuracy and may be a better alternative to conventional instrumentation for initial femoral guidewire placement in hip resurfacing. Crown Copyright © 2014. All rights reserved.

HRM and Fit: Survival of the fittest!?

NARCIS (Netherlands)

C.T. Boon (Corine)

2008-01-01

textabstractWhat is the nature of ‘fit’ in strategic HRM? This is the question guiding this thesis. Although the idea of fit is theoretically convincing, empirical evidence to support the role of fit is limited. Previous studies on fit have mainly focused on the alignment between HRM and strategy

Optimization of Fit for Mass Customized Apparel Ordering Using Fit Preference and Self Measurement.

Science.gov (United States)

2000-01-01

in significance and definition for both consumers and manufacturers. Fit preference involves an individualized bias toward a particular look, size...Committee. Bishton, D. (1984). The sweatshop report. Birmingham: AFFOR. 268 269 Bjerve, S. & Doksum, K. (1993). Correlation curves: Measures of...anthropometry methods. New York: John Wiley & Sons. Rosenbaum, R. & Schilling D. (1997). In sweatshops , wages are the issue. The Corporate Examiner

Factors affecting pharmacy engagement and pharmacy customer devotion in community pharmacy: A structural equation modeling approach.

Science.gov (United States)

Nitadpakorn, Sujin; Farris, Karen B; Kittisopee, Tanattha

2017-01-01

The concept of customer engagement and devotion has been applied in various service businesses to keep the customers with business However, a limited number of studies were performed to examine the context of customer engagement and devotion in pharmacy business which focus on the impact of customer perceptions about pharmacists, perceived quality of pharmacy structure, medication price strategy on pharmacy engagement and pharmacy customer devotion in a pharmacy providing pharmaceutical care to the customers. This study aimed to assess a conceptual model depicting the relationships among customer perceptions about pharmacists, pharmacy quality structure, medication price, customer engagement, and customer devotion. And also aimed to assess and measure if there is a direct or indirect relationship between these factors. A quantitative study was conducted by using self-administered questionnaires. Two hundred and fifty three customers who regularly visited the pharmacy were randomly recruited from a purposively selected 30 community pharmacies in Bangkok. The survey was completed during February to April 2016. A structural equation model (SEM) was used to assess the direct and indirect relationships between constructs. A total of 253/300 questionnaires were returned for analysis, and the response rate was 84%. Only perceptions about pharmacist in customers receiving professional pharmacy services was statically significant regarding relationship with pharmacy engagement (beta=0.45). Concurrently, the model from empirical data fit with the hypothetical model (p-value = 0.06, adjusted chi-square (CMIN/DF)=1.16, Goodness of Fit Index (GFI)=0.93, Comparatively Fit Index (CFI)=0.99, and Root Mean Square Error Approximation (RMSEA)=0.03). The study confirmed the indirect positive influence of customer perceptions about pharmacist on pharmacy customer devotion in providing pharmacy services via pharmacy engagement It was customer perceptions about pharmacist that influenced

Factors affecting pharmacy engagement and pharmacy customer devotion in community pharmacy: A structural equation modeling approach

Directory of Open Access Journals (Sweden)

Nitadpakorn S

2017-09-01

Full Text Available Background: The concept of customer engagement and devotion has been applied in various service businesses to keep the customers with business However, a limited number of studies were performed to examine the context of customer engagement and devotion in pharmacy business which focus on the impact of customer perceptions about pharmacists, perceived quality of pharmacy structure, medication price strategy on pharmacy engagement and pharmacy customer devotion in a pharmacy providing pharmaceutical care to the customers. Objective: This study aimed to assess a conceptual model depicting the relationships among customer perceptions about pharmacists, pharmacy quality structure, medication price, customer engagement, and customer devotion. And also aimed to assess and measure if there is a direct or indirect relationship between these factors. Methods: A quantitative study was conducted by using self-administered questionnaires. Two hundred and fifty three customers who regularly visited the pharmacy were randomly recruited from a purposively selected 30 community pharmacies in Bangkok. The survey was completed during February to April 2016. A structural equation model (SEM was used to assess the direct and indirect relationships between constructs. Results: A total of 253/300 questionnaires were returned for analysis, and the response rate was 84%. Only perceptions about pharmacist in customers receiving professional pharmacy services was statically significant regarding relationship with pharmacy engagement (beta=0.45. Concurrently, the model from empirical data fit with the hypothetical model (p-value = 0.06, adjusted chi-square (CMIN/DF=1.16, Goodness of Fit Index (GFI=0.93, Comparatively Fit Index (CFI=0.99, and Root Mean Square Error Approximation (RMSEA=0.03. Conclusion: The study confirmed the indirect positive influence of customer perceptions about pharmacist on pharmacy customer devotion in providing pharmacy services via pharmacy

Six-month postoperative outcomes of intraoperative OCT-guided surgical cystotomy for refractory cystoid macular edema in diabetic eyes

Directory of Open Access Journals (Sweden)

Asahina Y

2017-11-01

Full Text Available Yuichi Asahina, Naoko Tachi, Yumi Asahina, Kayoko Yoshimura, Yoshiki Ueta, Yoshihiro Hashimoto Eye Center, Shinseikai Toyama Hospital, Imizu, Toyama, Japan Purpose: This study evaluated the outcomes of surgical cystotomy for recurrent diabetic cystoid macular edema (CME.Patients and methods: We analyzed 20 eyes with a clinical diagnosis of diabetic retinopathy and refractory CME. Release of vitreoretinal adhesion, epiretinal membrane (ERM and internal limiting membrane (ILM peeling and cystotomy guided by intraoperative optical coherence tomography (iOCT were performed in every patient. Pars plana vitrectomy was also performed in 17 patients, 11 of whom also underwent lensectomy and intraocular lens implantation. Central retinal thickness (CRT, central minimum macular thickness (CMMT, macular volume (MV and best-corrected visual acuity (BCVA were compared preoperatively and 1 and 6 months post surgery.Results: CRT, CMMT and MV significantly improved 1 and 6 months post surgery in each group (P<0.01. Significant improvements in BCVA were only observed 6 months post surgery (P<0.01. No intra- or postoperative complications were observed in all patients.Conclusion: CRT, CMMT, MV and BCVA significantly improved 6 months following surgical cystectomy. This implies that iOCT-guided cystotomy could be another treatment option for refractory CME in diabetic eyes. Keywords: diabetic retinopathy, cystoid macular edema, intraoperative OCT, cystotomy

New multimedia advances in surgical information.

Science.gov (United States)

Glenn, Ian C; Abdulhai, Sophia; Lamoshi, Abdulraouf; Ponsky, Todd A

2018-06-01

When discussing new trends in pediatric surgery, the tendency is to focus on novel surgical technology and techniques. However, it is equally important to examine how the practicing surgeon stays abreast in an ever-changing field. This article serves as a brief guide to the future of surgical education for the attending surgeon. Broadly, advances in surgical education consist of new methods of filtration and delivery of knowledge.

Computer-guided laser for neurosurgery.

Science.gov (United States)

Koivukangas, J; Louhisalmi, Y

1990-01-01

On the basis of over 40 neurosurgical laser operations, including CO2, Nd-YAG and simultaneous CO2/Nd-YAG laser procedures, a computer-guided system for spatial control of the laser beam has been developed. The pilot laser has several modes: it can direct the neurosurgeon along the central axis of the surgical microscope to stereotactically determined point-like targets or outline selected layers of underlying volume targets onto superficial surfaces such as scalp and cortex and onto the tissue at the appropriate depth. The active treatment laser can be guided by preoperative CT/MRI or intraoperative ultrasound image data for layer-by-layer resection of tumor. The laser system can be connected to the surgical field by rigid stereotactic means or by neuronavigator. In the present system, a special brain surgery adapter coordinates the imaging system and laser to the surgical field. Thus, the laser system can be used for image-guided surgical orientation, for demarcation of lesions and for actual layer-by-layer removal of tumor.

Customized shaping of vibration modes by acoustic metamaterial synthesis

Science.gov (United States)

Xu, Jiawen; Li, Shilong; Tang, J.

2018-04-01

Acoustic metamaterials have attractive potential in elastic wave guiding and attenuation over specific frequency ranges. The vast majority of related investigations are on transient waves. In this research we focus on stationary wave manipulation, i.e., shaping of vibration modes. Periodically arranged piezoelectric transducers shunted with inductive circuits are integrated to a beam structure to form a finite-length metamaterial beam. We demonstrate for the first time that, under a given operating frequency of interest, we can facilitate a metamaterial design such that this frequency becomes a natural frequency of the integrated system. Moreover, the vibration mode corresponding to this natural frequency can be customized and shaped to realize tailored/localized response distribution. This is fundamentally different from previous practices of utilizing geometry modification and/or feedback control to achieve mode tailoring. The metamaterial design is built upon the combinatorial effects of the bandgap feature and the effective resonant cavity feature, both attributed to the dynamic characteristics of the metamaterial beam. Analytical investigations based on unit-cell dynamics and modal analysis of the metamaterial beam are presented to reveal the underlying mechanism. Case illustrations are validated by finite element analyses. Owing to the online tunability of circuitry integrated, the proposed mode shaping technique can be online adjusted to fit specific requirements. The customized shaping of vibration modes by acoustic metamaterial synthesis has potential applications in vibration suppression, sensing enhancement and energy harvesting.

Delivering good service: personal resources, job satisfaction and nurses' 'customer' (patient) orientation.

Science.gov (United States)

Gountas, Sandra; Gountas, John; Soutar, Geoffrey; Mavondo, Felix

2014-07-01

To explore the complex relationships between nurses' personal resources, job satisfaction and 'customer' (patient) orientation. Previous research has shown that nursing is highly intensive, emotionally charged work, which affects nurses' job performance and their customer orientation as well as patient or 'customer' satisfaction. This study contributes to the literature by examining how nurses' personal resources relate to their personal satisfaction and customer orientation and the relationships between them. Specifically, this study explores the effects of two facets of emotional labour (deep acting and surface acting), empathic concern, self-efficacy and emotional exhaustion on personal job satisfaction and customer orientation. We also test the moderating effects of inauthenticity and emotional contagion. A quantitative survey. Data were collected through a self-completion questionnaire administered to a sample of 159 Australian nurses, in a public teaching hospital, in 2010. The data were analysed using Partial Least Square analysis. Partial Least Square analysis indicates that the final model is a good fit to the data (Goodness of Fit = 0.51). Deep acting and surface acting have different effects (positive and negative) on job satisfaction and 'customer' orientation, self-efficacy has a positive effect on both and emotional exhaustion has a positive effect on customer orientation and a negative effect on job satisfaction. The moderating effects of emotional contagion and empathic concern, in the final model, are discussed. Understanding the complex interactions between personal resources, job satisfaction and customer orientation helps to increase service providers' (nurses in this study) personal satisfaction and 'customer' orientation particularly in difficult contexts. © 2013 John Wiley & Sons Ltd.

Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization

Science.gov (United States)

Markgraf, Rainer; Deutschinoff, Gerd; Pientka, Ludger; Scholten, Theo; Lorenz, Cristoph

2001-01-01

Background: Mortality predictions calculated using scoring scales are often not accurate in populations other than those in which the scales were developed because of differences in case-mix. The present study investigates the effect of first-level customization, using a logistic regression technique, on discrimination and calibration of the Acute Physiology and Chronic Health Evaluation (APACHE) II and III scales. Method: Probabilities of hospital death for patients were estimated by applying APACHE II and III and comparing these with observed outcomes. Using the split sample technique, a customized model to predict outcome was developed by logistic regression. The overall goodness-of-fit of the original and the customized models was assessed. Results: Of 3383 consecutive intensive care unit (ICU) admissions over 3 years, 2795 patients could be analyzed, and were split randomly into development and validation samples. The discriminative powers of APACHE II and III were unchanged by customization (areas under the receiver operating characteristic [ROC] curve 0.82 and 0.85, respectively). Hosmer-Lemeshow goodness-of-fit tests showed good calibration for APACHE II, but insufficient calibration for APACHE III. Customization improved calibration for both models, with a good fit for APACHE III as well. However, fit was different for various subgroups. Conclusions: The overall goodness-of-fit of APACHE III mortality prediction was improved significantly by customization, but uniformity of fit in different subgroups was not achieved. Therefore, application of the customized model provides no advantage, because differences in case-mix still limit comparisons of quality of care. PMID:11178223

Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings

International Nuclear Information System (INIS)

Kim, Min Jung; Kim, Eun-Kyung; Lee, Ji Young; Youk, Ji Hyun; Oh, Ki Keun; Park, Byeong-Woo; Kim, Seung-Il; Kim, Haeryoung

2007-01-01

The purpose of this study was to determine the frequency of carcinoma at percutaneous directional vacuum-assisted removal (DVAR) in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy, and to determine the role of DVAR in breast lesions with imaging-histologic discordance. A US-guided 14-gauge automated core needle biopsy was performed on 837 consecutive lesions. Imaging-histologic discordance was prospectively considered in 33 of 634 benign biopsies. DVAR was recommended in those lesions. Among the 33 lesions, 26 lesions that underwent subsequent DVAR or surgical excision made up our study population. Medical records, imaging studies, and histologic findings were reviewed. Among the 26 lesions, 18 lesions underwent subsequent US-guided DVAR, with 8-gauge probes for 15 of the lesions, and 11-gauge for three of the lesions. Two lesions were diagnosed as having carcinoma (2/18, 11.1% of upgrade rate; 3.1-32.8% CI). The remaining eight lesions underwent subsequent surgical excision, and carcinoma was diagnosed in one case (12.5% of upgrade rate; 2.2-47.1% CI). A US-guided DVAR of the breast mass with imaging-histologic discordance during US-guided 14-gauge automated core needle biopsy is a valuable alternative to surgery as a means of obtaining a definitive histological diagnosis. (orig.)

Pengaruh Customer Service Quality, Customer Perceived Value, Customer Satisfaction, Customer Trust Dan Switching Barriers Terhadap Customer Retention.

OpenAIRE

Hardjanti, Adiati; Amalia, Dinna

2014-01-01

Penelitian ini bertujuan untuk mengetahui pengaruh customer service quality, customer perceived value, customer satisfaction, customer trust dan switching barriers terhadap customer retention. Rancangan penelitian yang digunakan dalam penelitian ini adalah pengujian hipotesis (testing hypotesis). Pengambilan sampel dalam penelitian ini menggunakan teknik purposive sampling dan keseluruhan hipotesis diuji dengan metode structural equation modeling yang menggunakan Amos 7.0. Data dalam peneliti...

Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

Directory of Open Access Journals (Sweden)

Vijaya Prasad Kamavaram Ellore

2012-01-01

Full Text Available Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article.

Incidence and Outcomes of Optical Zone Enlargement and Recentration After Previous Myopic LASIK by Topography-Guided Custom Ablation.

Science.gov (United States)

Reinstein, Dan Z; Archer, Timothy J; Carp, Glenn I; Stuart, Alastair J; Rowe, Elizabeth L; Nesbit, Andrew; Moore, Tara

2018-02-01

To report the incidence, visual and refractive outcomes, optical zone enlargement, and recentration using topography-guided CRS-Master TOSCA II software with the MEL 80 excimer laser (Carl Zeiss Meditec AG, Jena, Germany) after primary myopic laser refractive surgery. Retrospective analysis of 73 eyes (40 patients) with complaints of night vision disturbances due to either a decentration or small optical zone following a primary myopic laser refractive surgery procedure using the MEL 80 laser. Multiple ATLAS topography scans were imported into the CRS-Master software for topography-guided ablation planning. The topography-guided re-treatment procedure was performed as either a LASIK flap lift, a new LASIK flap, a side cut only, or photorefractive keratectomy. Axial curvature maps were analyzed using a fixed grid and set of concentric circles superimposed to measure the topographic optical zone diameter and centration. Follow-up was 12 months. The incidence of use in the population of myopic treatments during the study period was 0.79% (73 of 9,249). The optical zone diameter was increased by 11% from a mean of 5.65 to 6.32 mm, with a maximum change of 2 mm in one case. Topographic decentration was reduced by 64% from a mean of 0.58 to 0.21 mm. There was a 44% reduction in spherical aberration, 53% reduction in coma, and 39% reduction in total higher order aberrations. A subjective improvement in night vision symptoms was reported by 93%. Regarding efficacy, 82% of eyes reached 20/20 and 100% reached 20/32 (preoperative CDVA was 20/20 or better in 90%). Regarding safety, no eyes lost two lines of CDVA and 27% gained one line. Regarding predictability, 71% of re-treatments were within ±0.50 diopters. Topography-guided ablation was effective in enlarging the optical zone, recentering the optical zone, and reducing higher order aberrations. Topography-guided custom ablation appears to be an effective method for re-treatment procedures of symptomatic patients after

Customized Fabrication of Osteochondral Tissue for Articular Joint Surface Repair

Science.gov (United States)

2016-09-01

AWARD NUMBER: W81XWH-14-1-0217 TITLE: Customized Fabrication of Osteochondral Tissue for Articular Joint Surface Repair PRINCIPAL INVESTIGATOR...4. TITLE AND SUBTITLE Customized Fabrication of Osteochondral Tissue for Articular Joint Surface Repair 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH...applicability of these novel osteochondral tissues for articular cartilage repair in rabbit model, using medical imaging-guided PSL. Such an approach may

Fit-For-Purpose Land Administration

DEFF Research Database (Denmark)

Enemark, Stig; McLaren, Robin

2017-01-01

This paper looks at implementing Fit-For-Purpose land administration solutions at county level. This will require a country specific strategy drawing from the recent GLTN publication on “Fit-For-Purpose Land Administration – Guiding Principles for Country Implementation”. The Fit...... administration; 4) Designing the country specific FFP spatial / legal / institutional frameworks; 5) Capacity development; 6) Country specific instruction manuals; and 7) Economic benefits analysis. Finally, the paper presents some experiences and reflections from a case study on implementing the FFP approach...

USE OF BIG DATA ANALYTICS FOR CUSTOMER RELATIONSHIP MANAGEMENT: POINT OF PARITY OR SOURCE OF COMPETITIVE ADVANTAGE?

OpenAIRE

Suoniemi, Samppa; Meyer-Waarden, Lars; Munzel, Andreas; Zablah, Alex R.; Straub, Detmar W.

2017-01-01

Customer information plays a key role in managing successful relationships with valuable customers. Big data customer analytics use (CA use), i.e., the extent to which customer information derived from big data analytics guides marketing decisions, helps firms better meet customer needs for competitive advantage. This study addresses three research questions: 1. What are the key antecedents of big data customer analytics use? 2. How, and to what extent, does big data...

SVX Sequence Crate Custom J2/J3 Backplane

International Nuclear Information System (INIS)

Utes, M.

1997-01-01

The Custom J2/J3 Backplane is a full length (21 slot) user specified custom 3U backplane to be used in both the J2 and J3 positions. Slot spacing is identical to that used for VME (0.8-inch), and each backplane shall fit into a standard Eurocard VME style crate. The purpose of the Custom J2/J3 Backplane is to send and receive control and clock signals from the SVX chips via 3M pleated foil cables (Slots 2-21), and in slot 1, accept a cable connector and route its signal through to a signal distribution board.

Fit, Healthy, and Ready To Learn: A School Health Policy Guide. Part II: Policies To Promote Sun Safety and Prevent Skin Cancer.

Science.gov (United States)

Fraser, Katherine

This publication is a supplementary chapter to "Fit, Healthy, and Ready to Learn: A School Health Policy Guide; Part I: General School Health Policies, Physical Activity, Healthy Eating, and Tobacco-Use Prevention." It discusses various aspects of a complete school policy and plan to promote sun safety. The first section "Purpose…

Driver fitness medical guidelines.

Science.gov (United States)

2009-09-01

This guide provides guidance to assist licensing agencies in making decisions about an individuals fitness for driving. This is the first attempt to produce a consolidated document covering medical conditions included in the task agreement between...

Are loyal customers profitable? : customer satisfaction, customer loyalty and customer profitability at the individual level

OpenAIRE

Helgesen, Øyvind

2000-01-01

Customer satisfaction is supposed to be positively related to profitability. This conception may be called “the paradigm of customer satisfaction”. Nevertheless, only a few studies have examined this fundamental relationship. Thus, evidence for this “much talked about relationship” is questioned. In this working paper the focus is on the individual customer with respect to the relationships between customer satisfaction, customer loyalty and customer profitability at the customer level. The f...

Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

Science.gov (United States)

Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M.; Hata, Nobuhiko; Fischer, Gregory S.

2014-01-01

This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure. PMID:26412962

Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution

Directory of Open Access Journals (Sweden)

L. Ciocca

2013-01-01

Full Text Available Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs and CAD-CAM customized pure and porous hydroxyapatite (HA scaffolds to replace the temporomandibular joint (TMJ condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P<0.05. The bone ingrowth (BI relative values of split-mouth comparison (right versus left side showed a significant difference between condyles with and without MSCs (P<0.05. Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

Mesenchymal stem cells and platelet gel improve bone deposition within CAD-CAM custom-made ceramic HA scaffolds for condyle substitution.

Science.gov (United States)

Ciocca, L; Donati, D; Ragazzini, S; Dozza, B; Rossi, F; Fantini, M; Spadari, A; Romagnoli, N; Landi, E; Tampieri, A; Piattelli, A; Iezzi, G; Scotti, R

2013-01-01

This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P < 0.05). The bone ingrowth (BI) relative values of split-mouth comparison (right versus left side) showed a significant difference between condyles with and without MSCs (P < 0.05). Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

Advanced customization in architectural design and construction

CERN Document Server

Naboni, Roberto

2015-01-01

This book presents the state of the art in advanced customization within the sector of architectural design and construction, explaining important new technologies that are boosting design, product and process innovation and identifying the challenges to be confronted as we move toward a mass customization construction industry. Advanced machinery and software integration are discussed, as well as an overview of the manufacturing techniques offered through digital methods that are acquiring particular significance within the field of digital architecture. CNC machining, Robotic Fabrication, and Additive Manufacturing processes are all clearly explained, highlighting their ability to produce personalized architectural forms and unique construction components. Cutting-edge case studies in digitally fabricated architectural realizations are described and, looking towards the future, a new model of 100% customized architecture for design and construction is presented. The book is an excellent guide to the profoun...

Customizing CAD system and its application for engineering design

International Nuclear Information System (INIS)

Shin, Jeong Ho; Kwak, Byung Man

2003-01-01

The computer is an important tool to design an engineering system and CAD systems are widely used for various design practice. To meet the market requirements, the old mass production system is being changed into the mass customization system. As for CAD systems, it is increasingly required to extend, automate, and customize a wide range of functionality. This article describes the state-of-the-art of the principal technologies for customizing CAD systems. And we have implemented an application that enables the parametric design by directly inputting numerical values of parameters for a CAD model. Based on this application, we have developed another system that makes it possible sharing of part family data between SolidEdge and Pro/Engineer. Through customization of CAD systems, it is possible to improve the product quality using external knowledge-based systems or to integrate with external system such as CAE tools. This paper can be a guide for engineering designers who want to customize CAD systems

Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography

Directory of Open Access Journals (Sweden)

Gaurav P Jayaswal

2011-01-01

Full Text Available Ocular defects may cause several ocular and orbital disorders, which require surgical intervention. These defects are psychologically disturbing for the patients, and therefore, they require immediate management and rehabilitation by a team of specialist. Ocular prosthesis may be either readymade (stock or custom made. Fabrication of a custom ocular prosthesis allows for a range of variations during construction. The iris can also be custom made by ocular painting or by digital photography. The optimum cosmetic and functional results of a custom-made prosthesis enhance the patient′s rehabilitation to a normal life style. This paper elaborates the technique for fabrication of a custom-made ocular prosthesis for an atrophic eye socket utilizing digital photography.

Comparative incidences of decompression illness in repetitive, staged, mixed-gas decompression diving: is 'dive fitness' an influencing factor?

Science.gov (United States)

Sayer, Martin Dj; Akroyd, Jim; Williams, Guy D

2008-06-01

Wreck diving at Bikini Atoll consists of a relatively standard series of decompression dives with maximum depths in the region of 45-55 metres' sea water (msw). In a typical week of diving at Bikini, divers can perform up to 12 decompression dives to these depths over seven days; on five of those days, divers can perform two decompression dives per day. All the dives employ multi-level, staged decompression schedules using air and surface-supplied nitrox containing 80% oxygen. Bikini is serviced by a single diving operator and so a relatively precise record exists both of the actual number of dives undertaken and of the decompression illness incidents both for customer divers and the dive guides. The dive guides follow exactly the dive profiles and decompression schedules of the customers. Each dive guide will perform nearly 400 decompression dives a year, with maximum depths mostly around 50 msw, compared with an average of 10 (maximum of 12) undertaken typically by each customer diver in a week. The incidence of decompression illness for the customer population (presumed in the absence of medical records) is over ten times higher than that for the dive guides. The physiological reasons for such a marked difference are discussed in terms of customer demographics and dive-guide acclimatization to repetitive decompression stress. The rates of decompression illness for a range of diving populations are reviewed.

Surgical stent for dental implant using cone beam CT images

International Nuclear Information System (INIS)

Choi, Hyung Soo; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan

2010-01-01

The purpose of this study is to develop a surgical stent for dental implant procedure that can be easily applied and affordable by using cone beam computerized tomography (CBCT). Aluminum, Teflon-PFA (perfluoroalkoxy), and acetal (polyoxymethylene plastic) were selected as materials for the surgical stent. Among these three materials, the appropriate material was chosen using the CBCT images. The surgical stent, which could be easily placed into an oral cavity, was designed with chosen material. CBCT images of the new surgical stent on mandible were obtained using Alphard-3030 dental CT system (Asahi Roentgen Co., Ltd., Kyoto, Japan). The point of insertion was prescribed on the surgical stent with the multiplanar reconstruction software of OnDemand3D (CyberMed Inc., Seoul, Korea). Guide holes were made at the point of insertion on the surgical stent using newly designed guide jig. CBCT scans was taken for the second time to verify the accuracy of the newly designed surgical stent. Teflon-PFA showed radiologically excellent image characteristics for the surgical stent. High accuracy and reproducibility of implantation were confirmed with the surgical stent. The newly designed surgical stent can lead to the accurate implantation and achieve the clinically predictable result.

Intra-operative reliability of ShapeMatch cutting guide placement in total knee arthroplasty.

Science.gov (United States)

Clark, Gavin; Leong, Anthony; McEwen, Peter; Steele, Robert; Tran, Ton; Trivett, Adrian

2013-01-01

Custom cutting guides based on pre-operative imaging have been introduced for total knee arthroplasty (TKA). The aim of this prospective cohort study was to assess the reliability of repeated placement of custom cutting guides by multiple surgeons in a group of patients undergoing TKA. Custom cutting guides (ShapeMatch®, Stryker Orthopaedics) were designed from pre-operative MRI scans. The treating surgeon placed each guide on the femur and tibia of each patient three times without pinning the block. The three-dimensional position and orientation of the guide was measured for each repetition using a computer navigation system. The surgeon was blinded to the navigation system display. Data from 24 patients and 6 surgeons were analyzed. Intraclass correlation coefficients for all measurement parameters were in the range 0.889-0.997 (excellent), and all comparisons were statistically significant (p reliable.

The Navy SEAL Physical Fitness Guide

Science.gov (United States)

1997-08-01

Injuries Reported by a Sample of Male Runners Injury Frequency (%) Knee 23 Achilles Tendon/Calf 16 Metatarsal 11 Hip/Groin/Toenails/Blisters 9 Plantar ... Fascia /Heel 8 Ankle Sprain 7 Shin Splints 6 Nerve/Quadriceps/Hamstring/Back 2 Run Tall Run Relaxed Run Naturally70 Running for Fitness Chapter 5...Name of Injury Description of Injury Plantar Fasciitis Inflammation and tightness of thick fibrous band on sole of foot. Achilles Tendonitis

Surgical anatomy of the temporal bone: an atlas

International Nuclear Information System (INIS)

Chan, L.L.; Manolidis, S.; Taber, K.H.; Hayman, L.A.

2001-01-01

This atlas demonstrates the usefulness of reconstructed high-resolution CT for planning temporal bone surgery. The first part focuses on a sagittal plane, the second on a rotated longitudinal plane, and the third on a rotated transverse plane. We believe knowledge of temporal bone anatomy in these planes facilitates surgical planning by showing anatomic relationships and providing a customized map for each patient. This decreases the likelihood of surgical mishap and improves teaching. (orig.)

New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

Directory of Open Access Journals (Sweden)

Simonetta Franco

2014-01-01

Full Text Available Bisphosphonate-related osteonecrosis of the jaw (BRONJ is the most serious side effect in patients receiving bisphosphonates (BPs for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up.

Komparace marketingového mixu dvou dámských fitness klubů v Praze 6

OpenAIRE

Havrdová, Lenka

2014-01-01

Title: The Comparison of Marketing Mix of the Two Women's Fitness Clubs in Prague 6 Objective: The aim of this work is to compare the two ladies fitness clubs, located in Prague 6. It is Contours Brevnov and Expreska Repy. To compare and determine from obtained data which of the two fitness clubs is more interesting for potential customers and to propose arrangements which could increase the satisfaction of new coming customers. Methods: The research is performed by qualitative survey based o...

Instant Autodesk AutoCAD 2014 customization with .NET

CERN Document Server

Nelson, Tom

2013-01-01

Filled with practical, step-by-step instructions and clear explanations for the most important and useful tasks. An instruction-based guide with examples written in the C# programming language. VB.NET programmers can also take advantage of these examples by using one of the free conversion websites to convert the examples to VB.NET.Clear, step-by-step instructions and complete code examples illustrate the processes, making it easy to develop your own custom AutoCAD tools.This book is perfect if you are interested in customizing AutoCAD 2014 using the .NET API. You should have a basic familiari

Customer Loyalty and Customer Relationship Management

Science.gov (United States)

Zhang, Pengwei; Li, Min; Jiao, Xiaojing; Zhou, Ruijin

The contemporary company attaches great importance to marketing relationship and customer relations is the core of this relationship. Further, customer satisfaction and loyalty is the core of the customer relationship management. Sometimes, high customer satisfaction causes low profit because enterprises do not realize that strengthening the loyalty of the aimed customer is the key of customer relationship management.

Evaluating Mind Fitness Training and Its Potential Effects on Surgical Residents’ Well-Being: A Mixed Methods Pilot Study.

Science.gov (United States)

Lases, S S; Lombarts, M J M H; Slootweg, Irene A; Arah, Onyebuchi A; Pierik, E G J M; Heineman, Erik

2016-01-01

Residents’ well-being is essential for both the individual physician and the quality of patient care they deliver. Therefore, it is important to maintain or possibly enhance residents’ well-being. We investigated (i) the influence of mind fitness training (MFT) on quality of care-related well-being characteristics: work engagement, empathy, work satisfaction and stress perception and explored (ii) residents’ perceptions of MFT. A multicenter study was conducted in eight Dutch teaching hospitals, from September 2012 to February 2014, using mixed methods—that is, quantitative and qualitative approaches to data collection and analysis. Eighty-nine surgical residents were invited to participate in pre- and post-intervention questionnaire surveys. Twenty-two residents participated in MFT and were additionally invited to evaluate the training by post-intervention interviews including open questions. At baseline 22 (100%) residents in intervention group and 47 (70.2%) residents in control group, and postintervention 20 (90.9 %) residents in intervention group and 41 (66.1%) residents in control group completed the questionnaires. In intervention-group, residents’ specialty satisfaction increased by 0.23 point on 5-point Likert scale (95% CI 0.23–0.24, P < 0.001) while stress scores decreased by -0.94 point on 10-point scale (95% CI -1.77 to -0.12, P = 0.026). No substantial changes were observed in control group. Participation in MFT was positively associated with residents’ empathy (b = 7.22; 95% CI 4.33–10.11; P < 0.001) and specialty satisfaction scores (b = 0.42; 95% CI 0.18–0.65; P = 0.001). Residents positively evaluated MFT with median scores of 6.80 for training design and 7.21 for outcome (10-point scale). Residents perceived improvement in focusing skills and reported being more aware of their own state of mind and feeling calmer and more in control. Mind fitness training could improve residents’ empathy, specialty satisfaction, stress

Surgical Engineering in Cranio-Maxillofacial Surgery: A Literature Review

Directory of Open Access Journals (Sweden)

Raphael Olszewski

2012-01-01

Full Text Available A systematic review of the literature concerning surgical engineering in cranio-maxillofacial surgery was performed. APubMed search yielded 1721 papers published between 1999 and 2011. Based on the inclusion/exclusion criteria, 1428 articles were excluded after review of titles and abstracts. Atotal of 292 articles were finally selected covering the following topics: finite element analysis (n = 18, computer-assisted surgery (n = 111, rapid prototyping models (n = 41, preoperative training simulators (n = 4, surgical guides (n = 23, image-guided navigation (n = 58, augmented reality (n = 2, video tracking (n = 1, distraction osteogenesis (n = 19, robotics (n = 8, and minimal invasive surgery (n = 7. The results show that surgical engineering plays a pivotal role in the development and improvement of cranio-maxillofacial surgery. Some technologies, such as computer-assisted surgery, image-guided navigation, and three-dimensional rapid prototyping models, have reached maturity and allow for multiple clinical applications, while augmented reality, robotics, and endoscopy still need to be improved.

Clinical utility of a 377 gene custom next-generation sequencing ...

Indian Academy of Sciences (India)

JEN BEVILACQUA

2017-07-26

Jul 26, 2017 ... Clinical utility of a 377 gene custom next-generation sequencing epilepsy panel ... number of genes, making it a very attractive option for a condition as .... clinical value of various test offerings to guide decision making.

Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

Science.gov (United States)

Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

2013-01-01

This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

Three-dimensional body scanning system for apparel mass-customization

Science.gov (United States)

Xu, Bugao; Huang, Yaxiong; Yu, Weiping; Chen, Tong

2002-07-01

Mass customization is a new manufacturing trend in which mass-market products (e.g., apparel) are quickly modified one at a time based on customers' needs. It is an effective competing strategy for maximizing customers' satisfaction and minimizing inventory costs. An automatic body measurement system is essential for apparel mass customization. This paper introduces the development of a body scanning system, body size extraction methods, and body modeling algorithms. The scanning system utilizes the multiline triangulation technique to rapidly acquire surface data on a body, and provides accurate body measurements, many of which are not available with conventional methods. Cubic B-spline curves are used to connect and smooth body curves. From the scanned data, a body form can be constructed using linear Coons surfaces. The body form can be used as a digital model of the body for 3-D garment design and for virtual try-on of a designed garment. This scanning system and its application software enable apparel manufacturers to provide custom design services to consumers seeking personal-fit garments.

MO-DE-202-03: Image-Guided Surgery and Interventions in the Advanced Multimodality Image-Guided Operating (AMIGO) Suite

Energy Technology Data Exchange (ETDEWEB)

Kapur, T. [Brigham & Women’s Hospital (United States)

2016-06-15

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

MO-DE-202-03: Image-Guided Surgery and Interventions in the Advanced Multimodality Image-Guided Operating (AMIGO) Suite

International Nuclear Information System (INIS)

Kapur, T.

2016-01-01

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

Cardiorespiratory fitness and muscle strength in pancreatic cancer patients.

Science.gov (United States)

Clauss, Dorothea; Tjaden, Christine; Hackert, Thilo; Schneider, Lutz; Ulrich, Cornelia M; Wiskemann, Joachim; Steindorf, Karen

2017-09-01

Cancer patients frequently experience reduced physical fitness due to the disease itself as well as treatment-related side effects. However, studies on physical fitness in pancreatic cancer patients are missing. Therefore, we assessed cardiorespiratory fitness and muscle strength of pancreatic cancer patients. We included 65 pancreatic cancer patients, mostly after surgical resection. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing (CPET) and 6-min walk test (6MWT). Hand-held dynamometry was used to evaluate isometric muscle strength. Physical fitness values were compared to reference values of a healthy population. Associations between sociodemographic and clinical variables with patients' physical fitness were analyzed using multiple regression models. Cardiorespiratory fitness (VO 2 peak, 20.5 ± 6.9 ml/min/kg) was significantly lower (-24%) compared to healthy reference values. In the 6MWT pancreatic cancer patients nearly reached predicted values (555 vs. 562 m). Maximal voluntary isometric contraction (MVIC) of the upper (-4.3%) and lower extremities (-13.8%) were significantly lower compared to reference values. Overall differences were larger in men than those in women. Participating in regular exercise in the year before diagnosis was associated with greater VO 2 peak (p fitness with regard to both cardiorespiratory function and isometric muscle strength, already in the early treatment phase (median 95 days after surgical resection). Our findings underline the need to investigate exercise training in pancreatic cancer patients to counteract the loss of physical fitness.

[Surgical treatment with an artificial iris].

Science.gov (United States)

Mayer, C S; Hoffmann, A E

2015-10-01

Iris defects with their disturbed pupillary function, visual impairment and glare constitute a therapeutic challenge in surgical reconstruction. A new therapeutic option for distinctive defects consists in the implantation of a custom-made silicone iris. This new and challenging therapy provides the opportunity to achieve an individual, aesthetically appealing and good functional result for the patient.

Green electricity buyer's guide

International Nuclear Information System (INIS)

Kelly, B.; Klein, S.; Olivastri, B.

2002-06-01

The electricity produced in whole or in large part from renewable energy sources like wind, small hydro electricity and solar energy, is generally referred to as green electricity. The authors designed this buyer's guide to assist customers in their understanding of green electricity, as the customers can now choose their electricity supplier. The considerations and steps involved in the purchasse of green electricity are identified, and advice is provided on ways to maximize the benefits from the purchase of green electricity. In Alberta and Ontario, customers have access to a competitive electricity market. The emphasis when developing this guide was placed firmly on the large buyers, as they can have enormous positive influence on the new market for green electricity. The first chapter of the document provides general information on green electricity. In chapter two, the authors explore the opportunity for environmental leadership. Chapter three reviews the basics of green electricity, which provides the link to chapter four dealing with the creation of a policy. Purchasing green electricity is dealt with in Chapter five, and maximizing the benefits of green electricity are examined in Chapter Six. 24 refs., 3 tabs

CUSTOMS POLICY, CUSTOMS BUSINESS, CUSTOMS REGULATION: TO PROBLEM OF CONCEPTION CORRELATIONS

OpenAIRE

A. D. Molokovich; K. N. Shabeka

2010-01-01

Theoretical and methodological comprehension of customs regulation place and role in provision of trade and transport activity under conditions of world integration processes is considered in the paper.The essence of such economic categories as «customs policy», «customs regulation», «customs and tariff regulation», «customs business» is ascertained with the help of justified argumentation, clear conception approaches.

Customer Clustering Based on Customer Purchasing Sequence Data

OpenAIRE

Yen-Chung Liu; Yen-Liang Chen

2017-01-01

Customer clustering has become a priority for enterprises because of the importance of customer relationship management. Customer clustering can improve understanding of the composition and characteristics of customers, thereby enabling the creation of appropriate marketing strategies for each customer group. Previously, different customer clustering approaches have been proposed according to data type, namely customer profile data, customer value data, customer transaction data, and customer...

16 CFR 240.10 - Availability to all competing customers.

Science.gov (United States)

2010-01-01

... are furnished by the seller, or payments by the seller to customers for their advertising or promotion... GUIDES FOR ADVERTISING ALLOWANCES AND OTHER MERCHANDISING PAYMENTS AND SERVICES § 240.10 Availability to... advertising on radio, TV, or in newspapers of general circulation. Because the purchases of some of the...

Customer Satisfaction in Internal Customer Service : Case: Abloy Oy Internal Customer Service

OpenAIRE

Turunen, Susanna

2011-01-01

ABSTRACT Turunen, Susanna Marita 2011. Customer Satisfaction in Internal Customer Service. Case: Abloy Oy Internal Customer Service. Master’s thesis. Kemi-Tornio University of Applied Sciences. Business and Culture. Pages 73. Appendix 1. This thesis discusses and studies service quality and customer satisfaction in internal customer service. The main objective is to find out what the service quality level in the internal customer service at Abloy Oy is and whether there exists a diffe...

Localization techniques for guided surgical excision of non-palpable breast lesions.

Science.gov (United States)

Chan, Benjamin K Y; Wiseberg-Firtell, Jill A; Jois, Ramesh H S; Jensen, Katrin; Audisio, Riccardo A

2015-12-31

Breast cancer is the most common form of cancer and the second leading cause of death amongst women in Europe. Amongst five invasive cancers per 1000 women detected in screening, 2.7 were localization (WGL). With the clinical setting shifting towards earlier non-palpable breast lesions being detected through screening, we investigated whether the current standard in assisting surgical excision of these lesions, WGL, yields the best therapeutic outcome for women with breast cancer. To assess the therapeutic outcomes of any new form of guided surgical intervention for non-palpable breast lesions against wire-guided localization, the current gold standard. We searched the Cochrane Breast Cancer Group's (CBCG) Specialized Register, MEDLINE (via PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal from the earliest available date up to 30 March 2015. We also handsearched recent conference proceedings and sought information from experts in the field. Two review authors, BC and RJ, independently screened by title and abstract the studies we had identified through the search strategy; when this was inconclusive, they examined the full-text article for inclusion. We resolved any discrepancies regarding eligibility by discussion with a third review author, RA. Three review authors, BC, JW, and RJ, independently extracted data using a standardized data sheet. We performed all analyses using Review Manager (RevMan) or the R meta package, and in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We reported results via a graphical assessment using forest plots showing the study estimates. We considered and discussed additional subgroup and sensitivity analyses. We identified 11 randomized controlled trials (RCTs) that met the inclusion criteria of this Cochrane review and included eight trials in the meta-analyses. Six RCTs

The use of virtual surgical planning and navigation in the treatment of orbital trauma

Directory of Open Access Journals (Sweden)

Alan Scott Herford

2017-02-01

Full Text Available Virtual surgical planning (VSP has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

Nuclear reactor fuel assemblies and end fitting grid structures therefor

International Nuclear Information System (INIS)

Jabsen, F.S.

1978-01-01

An improved end fitting grid structure is described for nuclear fuel assemblies which overcomes the need for load-bearing control rod guide tubes and the expensive special fittings that these tubes required. (UK)

Impact of CrossFit-Related Spinal Injuries.

Science.gov (United States)

Hopkins, Benjamin S; Cloney, Michael B; Kesavabhotla, Kartik; Yamaguchi, Jonathon; Smith, Zachary A; Koski, Tyler R; Hsu, Wellington K; Dahdaleh, Nader S

2017-11-16

Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated. All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed. Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not. CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.

Surgical neuro navigator guided by preoperative magnetic resonance images, based on a magnetic position sensor;Neuronavegador cirurgico guiado por imagens de ressonancia magnetica pre-operatoria, baseado num transdutor de posicao magnetico

Energy Technology Data Exchange (ETDEWEB)

Perini, Ana Paula; Siqueira, Rogerio Bulha; Carneiro, Antonio Adilton Oliveira, E-mail: adilton@ffclrp.usp.b [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Filosofia, Ciencias e Letras. Dept. de Fisica e Matematica; Oliveira, Lucas Ferrari de [Universidade Federal de Pelotas (UFPel), RS (Brazil). Dept. de Informatica; Machado, Helio Rubens [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Dept. de Neurocirurgia

2009-08-15

Image guided neurosurgery enables the neurosurgeon to navigate inside the patient's brain using pre-operative images as a guide and a tracking system, during a surgery. Following a calibration procedure, three-dimensional position and orientation of surgical instruments may be transmitted to computer. The spatial information is used to access a region of interest, in the pre-operative images, displaying them to the neurosurgeon during the surgical procedure. However, when a craniotomy is involved and the lesion is removed, movements of brain tissue can be a significant source of error in these conventional navigation systems. The architecture implemented in this work intends the development of a system to surgical planning and orientation guided by ultrasound image. For surgical orientation, the software developed allows the extraction of slices from the volume of the magnetic resonance images (MRI) with orientation supplied by a magnetic position sensor (Polhemus{sup R}). The slices extracted with this software are important because they show the cerebral area that the neurosurgeon is observing during the surgery, and besides they can be correlated with the intra-operative ultrasound images to detect and to correct the deformation of brain tissue during the surgery. Also, a tool for per-operative navigation was developed, providing three orthogonal planes through the image volume. In the methodology used for the software implementation, the Python{sup tm} programming language and the Visualization Toolkit (VTK) graphics library were used. The program to extract slices of the MRI volume allowed the application of transformations in the volume, using coordinates supplied by the position sensor. (author)

Customization and design of directed self-assembly using hybrid prepatterns

Science.gov (United States)

Cheng, Joy; Doerk, Gregory S.; Rettner, Charles T.; Singh, Gurpreet; Tjio, Melia; Truong, Hoa; Arellano, Noel; Balakrishnan, Srinivasan; Brink, Markus; Tsai, Hsinyu; Liu, Chi-Chun; Guillorn, Michael; Sanders, Daniel P.

2015-03-01

Diminishing error tolerance renders the customization of patterns created through directed self-assembly (DSA) extremely challenging at tighter pitch. A self-aligned customization scheme can be achieved using a hybrid prepattern comprising both organic and inorganic regions that serves as a guiding prepattern to direct the self-assembly of the block copolymers as well as a cut mask pattern for the DSA arrays aligned to it. In this paper, chemoepitaxy-based self-aligned customization is demonstrated using two types of organic-inorganic prepatterns. CHEETAH prepattern for "CHemoepitaxy Etch Trim using a self-Aligned Hardmask" of preferential hydrogen silsesquioxane (HSQ, inorganic resist), non-preferential organic underlayer is fabricated using electron beam lithography. Customized trench or hole arrays can be achieved through co-transfer of DSA-formed arrays and CHEETAH prepattern. Herein, we also introduce a tone-reversed version called reverse-CHEETAH (or rCHEETAH) in which customized line segments can be achieved through co-transfer of DSA-formed arrays formed on a prepattern wherein the inorganic HSQ regions are nonpreferential and the organic regions are PMMA preferential. Examples of two-dimensional self-aligned customization including 25nm pitch fin structures and an 8-bar "IBM" illustrate the versatility of this customization scheme using rCHEETAH.

Nerve stimulator-guided sciatic-femoral nerve block in raptors undergoing surgical treatment of pododermatitis.

Science.gov (United States)

d'Ovidio, Dario; Noviello, Emilio; Adami, Chiara

2015-07-01

To describe the nerve stimulator-guided sciatic-femoral nerve block in raptors undergoing surgical treatment of pododermatitis. Prospective clinical trial. Five captive raptors (Falco peregrinus) aged 6.7 ± 1.3 years. Anaesthesia was induced and maintained with isoflurane in oxygen. The sciatic-femoral nerve block was performed with 2% lidocaine (0.05 mL kg(-1) per nerve) as the sole intra-operative analgesic treatment. Intraoperative physiological variables were recorded every 10 minutes from endotracheal intubation until the end of anaesthesia. Assessment of intraoperative nociception was based on changes in physiological variables above baseline values, while evaluation of postoperative pain relied on species-specific behavioural indicators. The sciatic-femoral nerve block was feasible in raptors and the motor responses following electrical stimulation of both nerves were consistent with those reported in mammalian species. During surgery no rescue analgesia was required. The anaesthesia plane was stable and cardiorespiratory variables did not increase significantly in response to surgical stimulation. Iatrogenic complications, namely nerve damage and local anaesthetic toxicity, did not occur. Recovery was smooth and uneventful. The duration (mean ± SD) of the analgesic effect provided by the nerve block was 130 ± 20 minutes. The sciatic-femoral nerve block as described in dogs and rabbits can be performed in raptors as well. Further clinical trials with a control groups are required to better investigate the analgesic efficacy and the safety of this technique in raptors. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Factors Affecting Surgical Decision-making—A Qualitative Study

Directory of Open Access Journals (Sweden)

Caroline Gunaratnam

2018-01-01

Full Text Available Background Guidelines and Class 1 evidence are strong factors that help guide surgeons’ decision-making, but dilemmas exist in selecting the best surgical option, usually without the benefit of guidelines or Class 1 evidence. A few studies have discussed the variability of surgical treatment options that are currently available, but no study has examined surgeons’ views on the influential factors that encourage them to choose one surgical treatment over another. This study examines the influential factors and the thought process that encourage surgeons to make these decisions in such circumstances. Methods Semi-structured face-to-face interviews were conducted with 32 senior consultant surgeons, surgical fellows, and senior surgical residents at the University of Toronto teaching hospitals. An e-mail was sent out for volunteers, and interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding. Results Broadly speaking there are five groups of factors affecting surgeons’ decision-making: medical condition, information, institutional, patient, and surgeon factors. When information factors such as guidelines and Class 1 evidence are lacking, the other four groups of factors—medical condition, institutional, patient, and surgeon factors (the last-mentioned likely being the most powerful—play a significant role in guiding surgical decision-making. Conclusions This study is the first qualitative study on surgeons’ perspectives on the influential factors that help them choose one surgical treatment option over another for their patients.

Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

Science.gov (United States)

Giansanti, Matteo

2016-01-01

Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

Impact of Customer Relationship Management on Customer Loyalty, Customer Retention and Customer Profitability for Hotelier Sector

Directory of Open Access Journals (Sweden)

Sandra-Dinora Orantes-Jiménez

2017-08-01

Full Text Available Since the entrance of strategies oriented to marketing relational in Hotelier Sector, the traditional way of travel agents and other representatives arranging hospitality services for hotel and travel reservations has changed. The strategies oriented to customer relationship management are a relatively new area of specialty loyalty marketing in the hotel and hotelier sector, with advancements being made constantly. The use of this type of strategy can allow hoteliers or companies to tailor special guest programs, services and promotions based on hotel guest preferences. The hotel can use the data collected in a program to identify the needs of particular customers across hotel chains to be able to use marketing that can be targeted at specific groups of people. It also gives hoteliers the opportunity to evaluate frequent guest programs, personalize their services and perform trend analysis. A program based in marketing relational is typically run by hotels and companies to collect guest information and transaction data for use and examining to allow hoteliers to see target groups that should be marketed too. Based on these transactions hotels are able to create and manage guest loyalty programs and reward schemes. This research approach is to appraise the impact of customer relationship management on customer profitability as mediated by customer loyalty and customer retention within the hotelier sector of Mexico, and specifically for those hoteliers classified like of three stars. A sample of 100 hotels three stars was interviewed as respondents in this study. The objective of the study was to find the impact relationship between effective customer relationship implementation, customer loyalty, and customer retention and customer profitability. The findings of the study add value to hotels three stars in Mexico, and provide some invaluable statistical results essential for hotel managers and owners to successfully enhance customer loyalty

Guide to Eating for Sports

Medline Plus

Full Text Available ... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español A Guide to Eating for Sports KidsHealth / For Teens / A Guide to Eating for ...

Pengaruh Customer Relationship Management (Crm) Terhadap Customer Satisfaction Dan Customer Loyalty Pada Pelanggan Matahari Department Store

OpenAIRE

Ham, Meyske

2016-01-01

This study was conducted to determine the effect Benefits of Customer Relationship Management and Customer satisfation to Customer Loyalty in Customers Matahari Department Store. Customer relationship management (CRM) is part of a marketing strategy to get satisfaction and increase customer loyalty. CRM and customer satisfaction can encourage customer loyalty where customers do not easily switch to other companies. The population is all customers Matahari Department Store, and the sample are ...

[Correction of congenital malformations by custom-made silicone implants: Contribution of computer-aided design. Experience of 611 cases].

Science.gov (United States)

Chavoin, J P; Chaput, B; Garrido, I; Moreno, B; Dahan, M; Grolleau, J L

2016-10-01

Modern techniques of computer-aided design and tridimensional prototyping for manufacturing silicone elastomer custom implants are growing. They have widely modified the surgical indications in our unit. By presenting their experience of 611 cases managed between 1993 and 2016, the authors describe the method of conception from CT-scans, the virtual image of the body and the manufacture of the custom-made implant perfectly adapted to the anatomy of each one. The operative techniques are described for the three main indications: the funnel chest or pectus excavatum (474 cases) according to a modified CHIN classification is corrected simply and very satisfactorily. This approach may render thoracic surgery techniques obsolete. Indeed, these operations remain risky and of doubtful functional utility; Poland syndrome (116 cases), where the use of a custom-made implant for compensation of muscle volume is frequently used, but can be improved by a transfer of adipose tissue or a classic breast implant; the leg atrophies (21 cases) receive custom elastomer implants introduced in a sub-fascial plane. The results are excellent for pectus excavatum but more difficult to optimize for the other two indications, requiring sometimes complementary techniques. Complications are rare and often benign, implants endure for life. Quality of life, psychological comfort and self-esteem have been improved with low morbidity and without having undergone a painful surgical experience. Reconstructive procedures of congenital malformations by custom-made silicone implants open a new field of activity for our surgical specialty with vast opportunities. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A Flexible Domain-Domain Hinge Promotes an Induced-fit Dominant Mechanism for the Loading of Guide-DNA into Argonaute Protein in Thermus thermophilus

KAUST Repository

Zhu, Lizhe

2016-02-24

Argonaute proteins (Ago) are core components of the RNA Induced Silencing Complex (RISC) that load and utilize small guide nucleic acids to silence mRNAs or cleave foreign DNAs. Despite the essential role of Ago in gene regulation and defense against virus, the molecular mechanism of guide-strand loading into Ago remains unclear. We explore such a mechanism in the bacterium Thermus thermophilus Ago (TtAgo), via a computational approach combining molecular dynamics, bias-exchange metadynamics, and protein-DNA docking. We show that apo TtAgo adopts multiple closed states that are unable to accommodate guide-DNA. Conformations able to accommodate the guide are beyond the reach of thermal fluctuations from the closed states. These results suggest an induced-fit dominant mechanism for guide-strand loading in TtAgo, drastically different from the two-step mechanism for human Ago 2 (hAgo2) identified in our previous study. Such a difference between TtAgo and hAgo2 is found to mainly originate from the distinct rigidity of their L1-PAZ hinge. Further comparison among known Ago structures from various species indicates that the L1-PAZ hinge may be flexible in general for prokaryotic Agos but rigid for eukaryotic Agos. © 2016 American Chemical Society.

A Flexible Domain-Domain Hinge Promotes an Induced-fit Dominant Mechanism for the Loading of Guide-DNA into Argonaute Protein in Thermus thermophilus.

Science.gov (United States)

Zhu, Lizhe; Jiang, Hanlun; Sheong, Fu Kit; Cui, Xuefeng; Gao, Xin; Wang, Yanli; Huang, Xuhui

2016-03-17

Argonaute proteins (Ago) are core components of the RNA Induced Silencing Complex (RISC) that load and utilize small guide nucleic acids to silence mRNAs or cleave foreign DNAs. Despite the essential role of Ago in gene regulation and defense against virus, the molecular mechanism of guide-strand loading into Ago remains unclear. We explore such a mechanism in the bacterium Thermus thermophilus Ago (TtAgo), via a computational approach combining molecular dynamics, bias-exchange metadynamics, and protein-DNA docking. We show that apo TtAgo adopts multiple closed states that are unable to accommodate guide-DNA. Conformations able to accommodate the guide are beyond the reach of thermal fluctuations from the closed states. These results suggest an induced-fit dominant mechanism for guide-strand loading in TtAgo, drastically different from the two-step mechanism for human Ago 2 (hAgo2) identified in our previous study. Such a difference between TtAgo and hAgo2 is found to mainly originate from the distinct rigidity of their L1-PAZ hinge. Further comparison among known Ago structures from various species indicates that the L1-PAZ hinge may be flexible in general for prokaryotic Ago's but rigid for eukaryotic Ago's.

CERTS customer adoption model

Energy Technology Data Exchange (ETDEWEB)

Rubio, F. Javier; Siddiqui, Afzal S.; Marnay, Chris; Hamachi,Kristina S.

2000-03-01

This effort represents a contribution to the wider distributed energy resources (DER) research of the Consortium for Electric Reliability Technology Solutions (CERTS, http://certs.lbl.gov) that is intended to attack and, hopefully, resolve the technical barriers to DER adoption, particularly those that are unlikely to be of high priority to individual equipment vendors. The longer term goal of the Berkeley Lab effort is to guide the wider technical research towards the key technical problems by forecasting some likely patterns of DER adoption. In sharp contrast to traditional electricity utility planning, this work takes a customer-centric approach and focuses on DER adoption decision making at, what we currently think of as, the customer level. This study reports on Berkeley Lab's second year effort (completed in Federal fiscal year 2000, FY00) of a project aimed to anticipate patterns of customer adoption of distributed energy resources (DER). Marnay, et al., 2000 describes the earlier FY99 Berkeley Lab work. The results presented herein are not intended to represent definitive economic analyses of possible DER projects by any means. The paucity of data available and the importance of excluded factors, such as environmental implications, are simply too important to make such an analysis possible at this time. Rather, the work presented represents a demonstration of the current model and an indicator of the potential to conduct more relevant studies in the future.

Anatomy of the Higgs fits: A first guide to statistical treatments of the theoretical uncertainties

Directory of Open Access Journals (Sweden)

Sylvain Fichet

2016-04-01

Full Text Available The studies of the Higgs boson couplings based on the recent and upcoming LHC data open up a new window on physics beyond the Standard Model. In this paper, we propose a statistical guide to the consistent treatment of the theoretical uncertainties entering the Higgs rate fits. Both the Bayesian and frequentist approaches are systematically analysed in a unified formalism. We present analytical expressions for the marginal likelihoods, useful to implement simultaneously the experimental and theoretical uncertainties. We review the various origins of the theoretical errors (QCD, EFT, PDF, production mode contamination…. All these individual uncertainties are thoroughly combined with the help of moment-based considerations. The theoretical correlations among Higgs detection channels appear to affect the location and size of the best-fit regions in the space of Higgs couplings. We discuss the recurrent question of the shape of the prior distributions for the individual theoretical errors and find that a nearly Gaussian prior arises from the error combinations. We also develop the bias approach, which is an alternative to marginalisation providing more conservative results. The statistical framework to apply the bias principle is introduced and two realisations of the bias are proposed. Finally, depending on the statistical treatment, the Standard Model prediction for the Higgs signal strengths is found to lie within either the 68% or 95% confidence level region obtained from the latest analyses of the 7 and 8 TeV LHC datasets.

Anatomy of the Higgs fits: A first guide to statistical treatments of the theoretical uncertainties

Science.gov (United States)

Fichet, Sylvain; Moreau, Grégory

2016-04-01

The studies of the Higgs boson couplings based on the recent and upcoming LHC data open up a new window on physics beyond the Standard Model. In this paper, we propose a statistical guide to the consistent treatment of the theoretical uncertainties entering the Higgs rate fits. Both the Bayesian and frequentist approaches are systematically analysed in a unified formalism. We present analytical expressions for the marginal likelihoods, useful to implement simultaneously the experimental and theoretical uncertainties. We review the various origins of the theoretical errors (QCD, EFT, PDF, production mode contamination…). All these individual uncertainties are thoroughly combined with the help of moment-based considerations. The theoretical correlations among Higgs detection channels appear to affect the location and size of the best-fit regions in the space of Higgs couplings. We discuss the recurrent question of the shape of the prior distributions for the individual theoretical errors and find that a nearly Gaussian prior arises from the error combinations. We also develop the bias approach, which is an alternative to marginalisation providing more conservative results. The statistical framework to apply the bias principle is introduced and two realisations of the bias are proposed. Finally, depending on the statistical treatment, the Standard Model prediction for the Higgs signal strengths is found to lie within either the 68% or 95% confidence level region obtained from the latest analyses of the 7 and 8 TeV LHC datasets.

Shouldn’t customers control customized product development

NARCIS (Netherlands)

Smets, L.P.M.; Langerak, F.; Rijsdijk, S.A.

2013-01-01

Nowadays, customized product development (CPD) is increasingly prevalent in business-to-business settings, which has motivated manufacturers into development approaches wherein the customer plays an active role. When the customer is merely viewed as a passive receiver of the customized product, the

Understanding Customer Experience Throughout the Customer Journey

NARCIS (Netherlands)

Lemon, Katherine N.; Verhoef, Peter C.

2016-01-01

Understanding customer experience and the customer journey over time is critical for firms. Customers now interact with firms through myriad touch points in multiple channels and media, and customer experiences are more social in nature. These changes require firms to integrate multiple business

Customer-to-customer roles and impacts in service encounters

OpenAIRE

Lee, Linda

2016-01-01

This thesis investigates customer-to-customer roles and impacts in the context of service encounters. This topic is studied from two angles: customer interactions during group service encounters and customer perceptions post service encounters. The first angle is a focus on group service encounters that addresses the lack of research on customer-to-customer interactions that occur in customer-to-customer interaction-intensive contexts. These are contexts where the interactions between custome...

Membangun Customer Loyalty Nasabah Bank melalui Customer Satisfaction

OpenAIRE

Sumarto, Sumarto

2007-01-01

In the relation between bank and its customer, the bank should to capable to fulfill need and satisfy through services and create the value to the customer. So in the compete situation, to give customer satisfaction is main duty of bank in order that the customer loyal permanently. The customer satisfaction is primary cause for building customer loyalty. More and more loyal customer to the bank, that's indicate the service superiority of its bank. Base description above this research purpose...

Image-guided navigation system for placing dental implants.

Science.gov (United States)

Casap, Nardy; Wexler, Alon; Lustmann, Joshua

2004-10-01

Navigation-guided surgery has recently been introduced into various surgical disciplines, including oral and maxillofacial surgery. Since the advent of dental implants, dental computed tomography (CT) scans have been used as a diagnostic tool for preoperative planning, but not as part of the surgical phase. This article explains the principles of computer-assisted surgery and describes the use of a computer-guided navigation system in dental implantology. The system uses preoperative dental CT scans for planning and as an integral part of the surgical procedure. This system allows continuous intraoperative coordination of the implantation phase with the preoperative plan, optimizing the accuracy of implant surgery. Deviations from the planned location of the implants are minimal. Several cases are discussed.

The impact of customer-specific marketing expenses on customer retention and customer profitability

NARCIS (Netherlands)

van Triest, S.; Bun, M.J.G.; van Raaij, E.M.; Vernooij, M.J.A.

2009-01-01

We study the effects of customer-specific marketing expenses on customer retention and customer profitability in a business-to-business setting. Using data from a company providing hygiene services, we look at the impact of a hitherto unstudied type of expense targeted at individual customer

Enabling complex nanoscale pattern customization using directed self-assembly.

Science.gov (United States)

Doerk, Gregory S; Cheng, Joy Y; Singh, Gurpreet; Rettner, Charles T; Pitera, Jed W; Balakrishnan, Srinivasan; Arellano, Noel; Sanders, Daniel P

2014-12-16

Block copolymer directed self-assembly is an attractive method to fabricate highly uniform nanoscale features for various technological applications, but the dense periodicity of block copolymer features limits the complexity of the resulting patterns and their potential utility. Therefore, customizability of nanoscale patterns has been a long-standing goal for using directed self-assembly in device fabrication. Here we show that a hybrid organic/inorganic chemical pattern serves as a guiding pattern for self-assembly as well as a self-aligned mask for pattern customization through cotransfer of aligned block copolymer features and an inorganic prepattern. As informed by a phenomenological model, deliberate process engineering is implemented to maintain global alignment of block copolymer features over arbitrarily shaped, 'masking' features incorporated into the chemical patterns. These hybrid chemical patterns with embedded customization information enable deterministic, complex two-dimensional nanoscale pattern customization through directed self-assembly.

Custom VLSI circuits for high energy physics

International Nuclear Information System (INIS)

Parker, S.

1998-06-01

This article provides a brief guide to integrated circuits, including their design, fabrication, testing, radiation hardness, and packaging. It was requested by the Panel on Instrumentation, Innovation, and Development of the International Committee for Future Accelerators, as one of a series of articles on instrumentation for future experiments. Their original request emphasized a description of available custom circuits and a set of recommendations for future developments. That has been done, but while traps that stop charge in solid-state devices are well known, those that stop physicists trying to develop the devices are not. Several years spent dodging the former and developing the latter made clear the need for a beginner's guide through the maze, and that is the main purpose of this text

Custom VLSI circuits for high energy physics

Energy Technology Data Exchange (ETDEWEB)

Parker, S. [Univ. of Hawaii, Honolulu, HI (United States)

1998-06-01

This article provides a brief guide to integrated circuits, including their design, fabrication, testing, radiation hardness, and packaging. It was requested by the Panel on Instrumentation, Innovation, and Development of the International Committee for Future Accelerators, as one of a series of articles on instrumentation for future experiments. Their original request emphasized a description of available custom circuits and a set of recommendations for future developments. That has been done, but while traps that stop charge in solid-state devices are well known, those that stop physicists trying to develop the devices are not. Several years spent dodging the former and developing the latter made clear the need for a beginner`s guide through the maze, and that is the main purpose of this text.

The impact of celebrity endorsement on attracting customers in the ...

African Journals Online (AJOL)

To break through the cluttered market environment and grab customer attention is one of the essential issue business sectors are faced with today. Brand endorsement has become a driving force for most business operations. The purpose of this study is to determine whether celebrity endorsement in the health and fitness ...

The impact of customer-specific marketing expenses on customer retention and customer profitability

NARCIS (Netherlands)

van Triest, S.; van Raaij, E.M.; Bun, M.; Vernooij, M.

2007-01-01

We study the effects of customer-specific marketing expenses on customer retention and cus-tomer profitability in a business-to-business setting. Using data from a company providing hygiene services, we look at the impact of a type of expenses targeted at individual customer relationships: the

76 FR 63942 - Notice of Issuance of Final Determination Concerning a Surgical Mask With a Protective Eye Shield

Science.gov (United States)

2011-10-14

... Determination Concerning a Surgical Mask With a Protective Eye Shield AGENCY: U.S. Customs and Border Protection... country of origin of a Surgical Mask with a Protective Eye Shield. Based upon the facts presented, CBP has concluded in the final determination that Turkey is the country of origin of the Surgical Mask with a...

Spinal intramedullary ependymoma: surgical approaches and outcome.

Science.gov (United States)

Borges, Lawrence F

2018-02-01

Intramedullary ependymomas are uncommon tumors that can occur within the medullary substance of the spinal cord. Despite this difficult location, they are typically benign tumors that can most often be removed completely with an acceptable surgical risk. Therefore, the recommended management approach is usually surgical excision. This review will consider the historical context in which surgeons began treating these tumors and then review the more recent literature that guides their current management.

From curve fitting to machine learning an illustrative guide to scientific data analysis and computational intelligence

CERN Document Server

Zielesny, Achim

2016-01-01

This successful book provides in its second edition an interactive and illustrative guide from two-dimensional curve fitting to multidimensional clustering and machine learning with neural networks or support vector machines. Along the way topics like mathematical optimization or evolutionary algorithms are touched. All concepts and ideas are outlined in a clear cut manner with graphically depicted plausibility arguments and a little elementary mathematics. The major topics are extensively outlined with exploratory examples and applications. The primary goal is to be as illustrative as possible without hiding problems and pitfalls but to address them. The character of an illustrative cookbook is complemented with specific sections that address more fundamental questions like the relation between machine learning and human intelligence. All topics are completely demonstrated with the computing platform Mathematica and the Computational Intelligence Packages (CIP), a high-level function library developed with M...

Clinical Fit of Partial Removable Dental Prostheses Based on Alginate or Polyvinyl Siloxane Impressions.

Science.gov (United States)

Fokkinga, Wietske A; Witter, Dick J; Bronkhorst, Ewald M; Creugers, Nico H

The aim of this study was to analyze the clinical fit of metal-frame partial removable dental prostheses (PRDPs) based on custom trays used with alginate or polyvinyl siloxane impression material. Fifth-year students of the Nijmegen Dental School made 25 correct impressions for 23 PRDPs for 21 patients using alginate, and 31 correct impressions for 30 PRDPs for 28 patients using polyvinyl siloxane. Clinical fit of the framework as a whole and of each retainer separately were evaluated by calibrated supervisors during framework try-in before (first evaluation) and after (second evaluation) possible adjustments (score 0 = poor fit, up to score 3 = good fit). Framework fit and fit of the denture base were evaluated at delivery (third evaluation). Finally, postinsertion sessions were evaluated and total number of sessions needed, sore spots, adjustments to the denture base, and reported food-impaction were recorded. No significant differences in clinical fit (of the framework as a whole, for the retainers, or for the denture base) were found between the groups in the three evaluation sessions. Differences were not found for postinsertion sessions with one exception: in the alginate group, four subjects reported food impaction, versus none in the polyvinyl siloxane group. Clinical fit of metal-frame PRDPs based on impressions with custom trays combined with alginate or polyvinyl siloxane was similar.

Respiratory source control using a surgical mask: An in vitro study.

Science.gov (United States)

Patel, Rajeev B; Skaria, Shaji D; Mansour, Mohamed M; Smaldone, Gerald C

2016-07-01

Cough etiquette and respiratory hygiene are forms of source control encouraged to prevent the spread of respiratory infection. The use of surgical masks as a means of source control has not been quantified in terms of reducing exposure to others. We designed an in vitro model using various facepieces to assess their contribution to exposure reduction when worn at the infectious source (Source) relative to facepieces worn for primary (Receiver) protection, and the factors that contribute to each. In a chamber with various airflows, radiolabeled aerosols were exhaled via a ventilated soft-face manikin head using tidal breathing and cough (Source). Another manikin, containing a filter, quantified recipient exposure (Receiver). The natural fit surgical mask, fitted (SecureFit) surgical mask and an N95-class filtering facepiece respirator (commonly known as an "N95 respirator") with and without a Vaseline-seal were tested. With cough, source control (mask or respirator on Source) was statistically superior to mask or unsealed respirator protection on the Receiver (Receiver protection) in all environments. To equal source control during coughing, the N95 respirator must be Vaseline-sealed. During tidal breathing, source control was comparable or superior to mask or respirator protection on the Receiver. Source control via surgical masks may be an important adjunct defense against the spread of respiratory infections. The fit of the mask or respirator, in combination with the airflow patterns in a given setting, are significant contributors to source control efficacy. Future clinical trials should include a surgical mask source control arm to assess the contribution of source control in overall protection against airborne infection.

When to "Fire" Customers: Customer Cost-Based Pricing

OpenAIRE

Jiwoong Shin; K. Sudhir; Dae-Hee Yoon

2012-01-01

The widespread adoption of activity-based costing enables firms to allocate common service costs to each customer, allowing for precise measurement of both the cost to serve a particular customer and the customer's profitability. In this paper, we investigate how pricing strategies based on customer cost information affects a firm's customer acquisition and retention dynamics, and ultimately its profit, using a two-period monopoly model with high- and low-cost customer segments. Although past...

Joomla! 25 Beginner's Guide

CERN Document Server

Tiggeler, Eric

2012-01-01

Written with a fast-paced but friendly and engaging approach, this Packt Beginner's guide is designed to be placed alongside the computer as your guide and mentor. Step-by-step tutorials are bolstered by explanations of the reasoning behind what you are doing. You will quickly pick up the necessary skills, tips, and tricks for building a successful Joomla! website. This book is written for beginners to website design. By the end of the book you will have built a complete custom content managed website, and be ready to build any kind of website.

[Shall all lobular intraepithelial neoplasia diagnosed on image-guided biopsy require a surgical management?].

Science.gov (United States)

Fischer-Hunsinger, Maeva; Guinebretière, Jean-Marc; Lasry, Serge; Langer, Adriana; Berment, Hélène; Nekka, Ibtissem; Nodiot, Philippe; Cherel, Pascal

2016-05-01

Lobular intraepithelial neoplasia (LIN) diagnosed on image-guided biopsy may be associated with an undiagnosed cancer. This is called under-diagnosis. The consequence is that management of these lesions is often surgical. But many surgeries finally are unnecessary. The aim of our study was to define criteria to avoid unnecessary surgery. This is a single-center, retrospective after a database collected prospectively study. Fourteen thousand biopsies were analyzed, including 456 diagnosed NLI. Under-diagnosis rates were analyzed according to many criteria. The average duration of following was 45 months. For atypical lobular hyperplasia (ALH), we obtained 7.6% under-diagnosis and combining several criteria, we got a low risk of cancer (2%). For LCIS, this rate was 23% and any low-risk group could be identified. ALH with calcifications≤20 mm, without any atypical lesion associated, histologically focal and whose removal is representative may be safely observed. For other LIN, surgery remains indicated. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Guide to Eating for Sports

Medline Plus

Full Text Available ... para adolescentes Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español A Guide to Eating for Sports KidsHealth / For Teens / A Guide to ...

Guide to a Strategic Procurement Planning Approach on Regulated Commodity Markets

Science.gov (United States)

Seifert, Marcus; Wüst, Thorsten

The access of Virtual Organizations to raw materials normally requires external resources. In many cases, the market for raw materials is regulated and the VO principles of trust, customer orientation etc. are not applicable. In consequence, the VO needs to provide reliable solutions for the customer while being dependent on the access to the required raw materials. The objective of the proposed paper is to present a guide to a strategic procurement planning for the manufacturing industry on regulated commodity markets. This guide can be used to evaluate specific sourcing options. The main goal of this guide is to identify the negative effects of market regulation at an early stage and reduce them by developing strategic alternatives. The successful application of this guide is demonstrated by the practical example of the refractory industry and one of their commodities, refractory grade bauxite.

A robotic system for 18F-FMISO PET-guided intratumoral pO2 measurements.

Science.gov (United States)

Chang, Jenghwa; Wen, Bixiu; Kazanzides, Peter; Zanzonico, Pat; Finn, Ronald D; Fichtinger, Gabor; Ling, C Clifton

2009-11-01

An image-guided robotic system was used to measure the oxygen tension (pO2) in rodent tumor xenografts using interstitial probes guided by tumor hypoxia PET images. Rats with approximately 1 cm diameter tumors were anesthetized and immobilized in a custom-fabricated whole-body mold. Imaging was performed using a dedicated small-animal PET scanner (R4 or Focus 120 microPET) approximately 2 h after the injection of the hypoxia tracer 18F-fluoromisonidazole (18F-FMISO). The coordinate systems of the robot and PET were registered based on fiducial markers in the rodent bed visible on the PET images. Guided by the 3D microPET image set, measurements were performed at various locations in the tumor and compared to the corresponding 18F-FMISO image intensity at the respective measurement points. Experiments were performed on four tumor-bearing rats with 4 (86), 3 (80), 7 (162), and 8 (235) measurement tracks (points) for each experiment. The 18F-FMISO image intensities were inversely correlated with the measured pO2, with a Pearson coefficient ranging from -0.14 to -0.97 for the 22 measurement tracks. The cumulative scatterplots of pO2 versus image intensity yielded a hyperbolic relationship, with correlation coefficients of 0.52, 0.48, 0.64, and 0.73, respectively, for the four tumors. In conclusion, PET image-guided pO2 measurement is feasible with this robot system and, more generally, this system will permit point-by-point comparison of physiological probe measurements and image voxel values as a means of validating molecularly targeted radiotracers. Although the overall data fitting suggested that 18F-FMISO may be an effective hypoxia marker, the use of static 18F-FMISO PET postinjection scans to guide radiotherapy might be problematic due to the observed high variation in some individual data pairs from the fitted curve, indicating potential temporal fluctuation of oxygen tension in individual voxels or possible suboptimal imaging time postadministration of hypoxia

King customer forever: Customer satisfaction and beyond

Directory of Open Access Journals (Sweden)

Myuers James

2004-01-01

Full Text Available "King Customer!" So proclaimed the front cover of Business Week in a 1989 issue. At about the same time, "Rediscovering the Customer" was the title of a series of company vignettes in Fortune magazine. And a Wall Street Journal article asked, "For Customers, More Than Lip Service?" Combined, these three prestigious business publications reflected a new era in business firms perceptions of their customers and the role they should play in the formulation of company strategies and priorities. Had the "Era of the Customer" finally arrived in American business? .

The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity.

Science.gov (United States)

Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie

2011-12-01

The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

Computer-Assisted Technique for Surgical Tooth Extraction

Directory of Open Access Journals (Sweden)

Hosamuddin Hamza

2016-01-01

Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

Independent Factors Affecting Postoperative Complication Rates After Custom-Made Porous Hydroxyapatite Cranioplasty: A Single-Center Review of 109 Cases.

Science.gov (United States)

Still, Megan; Kane, Abdoulaye; Roux, Alexandre; Zanello, Marc; Dezamis, Edouard; Parraga, Eduardo; Sauvageon, Xavier; Meder, Jean-François; Pallud, Johan

2018-06-01

Cranioplasties are an important neurosurgical procedure not only for improved cosmesis but also for improved functional recovery after craniectomy with a large cranial defect. The aim of this study was to identify predictive factors of postcranioplasty complications using custom-made porous hydroxyapatite cranioplasty. Retrospective review was performed of all patients who underwent a reconstructive cranioplasty using custom-made hydroxyapatite at our institution between February 2008 and September 2017. Postoperative complications considered included bacterial infection, seizures, hydrocephalus requiring ventricular shunt placement, and cranioplasty-to-bone shift. Variables associated at P < 0.1 level in unadjusted analysis were entered into backward stepwise logistic regression models. Of 109 patients included, 15 (13.8%) experienced postoperative infection, with craniectomy performed at an outside institution (adjusted odds ratio [OR] 10.37 [95% confidence interval [CI], 2.03-75.27], P = 0.012) and a previous infection at the surgical site (adjusted OR 6.15 [95%CI, 1.90-19.92], P = 0.003) identified as independent predictors. Six patients (5.5%) experienced postoperative seizures, with stroke (ischemic and hemorrhagic) as a reason for craniectomy (adjusted OR 11.68 [95% CI, 2.56-24.13], P < 0.001) and the presence of seizures in the month before cranioplasty (adjusted OR 9.39 [95% CI, 2.04-127.67], P = 0.002) identified as independent predictors. Four patients (3.7%) experienced postcranioplasty hydrocephalus necessitating shunt placement, and 5 patients (4.6%) experienced cranioplasty-to-bone shift ≥5 mm, but no significant predictive factors were identified for either complication. This study identified possible predictive factors for postcranioplasty complications to help identify at-risk patients, guide prophylactic care, and improve morbidity of this important surgical procedure. Copyright © 2018 Elsevier Inc. All rights reserved.

How to strengthen customer loyalty, using customer segmentation?

Directory of Open Access Journals (Sweden)

MELNIC Elena Lidia

2017-01-01

Full Text Available Do you provide exceptional customer service?”, “Is the customer service in your company extraordinary?” “How to convert satis fied customers into loyal customers?” - are the most frequent questions of today’s managers and have driven the research on this article to getting the answer to a highly important marketing topic “How to strengthen customer loyalty using customer segmentation?”. Anyone who has bought a product or a service has probably suffered at least once from a company’s apparent indifference to what should be its first concern: the customer experiences. If this is the case, the company is in a wrong direction, since loyalty is the most powerful tool in today competitive market. To strengthen the bonds with these high-profit customers, innovative companies are deploying enterprise-wide strategies built on consumer segmentation.

Customized photorefractive keratectomy to correct high ametropia after penetrating keratoplasty: A pilot study

OpenAIRE

De Rosa, Giuseppe; Boccia, Rosa; Santamaria, Carmine; Fabbozzi, Lorenzo; De Rosa, Luigi; Lanza, Michele

2014-01-01

Purpose: To evaluate preliminarily the safety and efficacy of customized photorefractive keratectomy (PRK) to correct ametropia and irregular astigmatism after penetrating keratoplasty (PK). Methods: This pilot study included five eyes of five patients with a mean spherical equivalent of −5.1 ± 1.46 D (range from −2.75 to −6.50 D). In all cases, ametropia and irregular astigmatism was corrected with topography-guided customized PRK. Ocular examinations with topographic analysis were perfor...

Jewish laws, customs, and practice in labor, delivery, and postpartum care.

Science.gov (United States)

Noble, Anita; Rom, Miriam; Newsome-Wicks, Mona; Engelhardt, Kay; Woloski-Wruble, Anna

2009-07-01

Many communities throughout the world, especially in the United States and Israel, contain large populations of religiously observant Jews. The purpose of this article is to provide a comprehensive, descriptive guide to specific laws, customs, and practices of traditionally, religious observant Jews for the culturally sensitive management of labor, delivery, and postpartum. Discussion includes intimacy issues between husband and wife, dietary laws, Sabbath observance, as well as practices concerning prayer, communication trends, modesty issues, and labor and birth customs. Health care professionals can tailor their practice by integrating their knowledge of specific cultures into their management plan.

The Impact of Customer Relationship Management to Customer Loyalty Through Customer Satisfaction in Cabal Dining Manado

OpenAIRE

Pandowo, Merinda; Pangemanan, Sifrid S.; Wattilete, Randy

2013-01-01

Customer relationship management is the one influencing customer loyalty, but to get customer loyalty we should know how to make customer satisfaction. This research is purposed to analyze the impact of customer relationship management to customer loyalty through customer satisfaction in Cabal Dining Manado. This research used the Path analysis as the method of this research. Population in this research is mainly in this research is people in Manado. The sample of this research is 100 respond...

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

Science.gov (United States)

Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

2017-12-29

To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

Ultrasound-guided versus surgical transversus abdominis plane block in obese patients following cesarean section: a prospective randomised study

Directory of Open Access Journals (Sweden)

Aykut Urfalıoğlu

2017-09-01

Full Text Available Background and objectives: Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia. Methods: Seventy-five pregnant women with pre- and post-pregnancy body mass index > 30 were randomized and allocated into two groups: Ultrasound-guided transversus abdominis plane block (UT group; n = 38 and surgical TAP block (ST group; n = 37. Visual analogue scale scores at post-operative 0, 2, 6, 12 and 24 hours (h, time to first analgesic requirement, total analgesic consumption amount in 24 h, post-operative side effects, complications and patient satisfaction were recorded. Results and conclusions: Age, American Society of Anesthesiologist score, operative duration, body mass index, mean time to first analgesic requirement and total analgesic consumption in 24 h were similar between groups, while significant differences in pre- and post-pregnancy body mass index were observed between groups. Block procedure durations were 7 and 10 minutes in ST and UT groups, respectively. No significant differences in visual analogue scale scores were observed between the groups at all times; itching and nausea was observed in one (UT group and four (UT and ST groups patients, respectively. Surgical transversus abdominis plane block was safe in obese pregnant patients and provided similar post-operative analgesia to ultrasound-guided transversus abdominis plane block. Resumo: Justificativa e objetivos: O bloqueio do

Analysis of Customer Loyalty through Total Quality Service, Customer Relationship Management and Customer Satisfaction

Science.gov (United States)

Binsar Kristian P., Feliks Anggia; Panjaitan, Hotman

2014-01-01

This research talks about total quality service and customer relationship management effects toward customer satisfaction and its impact on customer loyalty. Fast food restaurant KFC, always strives to continue to make improvements in total quality service, so that customer satisfaction can be maintained, which in turn will have an impact on…

Implementing service quality based on ISO/IEC 20000 a management guide

CERN Document Server

Kunas, Michael

2012-01-01

Potential customers will look for suppliers with ISO/IEC 20000 certification, seeking the reassurance it provides. This book will guide you through implementation and certification. Your streamlined management processes will enable you to offer first-class customer service at competitive prices. The impact on your profit margins is clear!

Marginal Vertical Fit along the Implant-Abutment Interface: A Microscope Qualitative Analysis

Directory of Open Access Journals (Sweden)

Nicola Mobilio

2016-09-01

Full Text Available The aim of this study was to qualitatively evaluate the marginal vertical fit along two different implant-abutment interfaces: (1 a standard abutment on an implant and (2 a computer-aided-design/computer-aided-machine (CAD/CAM customized screw-retained crown on an implant. Four groups were compared: three customized screw-retained crowns with three different “tolerance” values (CAD-CAM 0, CAD-CAM +1, CAD-CAM −1 and a standard titanium abutment. Qualitative analysis was carried out using an optical microscope. Results showed a vertical gap significantly different from both CAD-CAM 0 and CAD-CAM −1, while no difference was found between standard abutment and CAD-CAM +1. The set tolerance in producing CAD/CAM screw-retained crowns plays a key role in the final fit.

Full 3-D OCT-based pseudophakic custom computer eye model

Science.gov (United States)

Sun, M.; Pérez-Merino, P.; Martinez-Enriquez, E.; Velasco-Ocana, M.; Marcos, S.

2016-01-01

We compared measured wave aberrations in pseudophakic eyes implanted with aspheric intraocular lenses (IOLs) with simulated aberrations from numerical ray tracing on customized computer eye models, built using quantitative 3-D OCT-based patient-specific ocular geometry. Experimental and simulated aberrations show high correlation (R = 0.93; poptical geometrical and surgically-related factors to image quality, and are an excellent tool for characterizing and improving cataract surgery. PMID:27231608

Standards and Customer Service: Employees Behavior towards Customers

Directory of Open Access Journals (Sweden)

Venelin Terziev

2017-09-01

Full Text Available Ensuring effective customer service requires targeted efforts in a number of areas, one of which is to develop service standards for each market segment. The development and implementation of standards requires the organization to accurately determine customer service types, the cost of providing alternative services, and measures for measuring and controlling the services provided. At the core of the developed and implemented standards is the development and establishment of the customer service policy, which should start with a consumer demand analysis. The definition of customer service level should allow for quantitative measurement because the vague and quantifiable policy does not provide opportunities for evaluation and control of the activities and expenses of customer service. When developing service standards, it is appropriate to apply an algorithm that focuses primarily on standards related to employee behavior towards customers. This paper explores the need and capability to develop customer service standards and provides an algorithm for developing standards for employee behavior toward customers.

21 CFR 886.4300 - Intraocular lens guide.

Science.gov (United States)

2010-04-01

...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4300 Intraocular lens guide. (a) Identification. An intraocular lens guide is a device intended to be inserted into the eye during surgery to direct... lenses, the device is exempt from the premarket notification procedures in subpart E of part 807 of this...

From Curve Fitting to Machine Learning

CERN Document Server

Zielesny, Achim

2011-01-01

The analysis of experimental data is at heart of science from its beginnings. But it was the advent of digital computers that allowed the execution of highly non-linear and increasingly complex data analysis procedures - methods that were completely unfeasible before. Non-linear curve fitting, clustering and machine learning belong to these modern techniques which are a further step towards computational intelligence. The goal of this book is to provide an interactive and illustrative guide to these topics. It concentrates on the road from two dimensional curve fitting to multidimensional clus

Preventing customer defection and stimulating return of the lost customers

Directory of Open Access Journals (Sweden)

Senić Radoslav

2013-01-01

Full Text Available Customers represent company's most valuable asset. Company can assure its survival, further growth and development by retaining existing, attracting new and returning lost customers. Retaining existing, loyal customers is the most profitable business activity, attracting new ones is the most expensive, while returning lost and frequently forgotten customers is a type of business activity that still generates modest interest among researchers and practitioners. So far, marketing strategies have been mainly directed towards the first two categories of customers. The objective of this paper is dedicated to customer defection and returning lost customers. Paper discusses customer relationship life-cycle and the significance of managing customer return within it, types of customer defections, the process of managing return, as well as, the reasons that led to customer defection.

Custom ceramic microchannel-cooled array for high-power fiber-coupled application

Science.gov (United States)

Junghans, Jeremy; Feeler, Ryan; Stephens, Ed

2018-03-01

A low-SWaP (Size, Weight and Power) diode array has been developed for a high-power fiber-coupled application. High efficiency ( 65%) diodes enable high optical powers while minimizing thermal losses. A large amount of waste heat is still generated and must be extracted. Custom ceramic microchannel-coolers (MCCs) are used to dissipate the waste heat. The custom ceramic MCC was designed to accommodate long cavity length diodes and micro-lenses. The coolers provide similar thermal performance as copper MCCs however they are not susceptible to erosion and can be cooled with standard filtered water. The custom ceramic micro-channel cooled array was designed to be a form/fit replacement for an existing copperbased solution. Each array consisted of three-vertically stacked MCCs with 4 mm CL, 976 nm diodes and beamshaping micro-optics. The erosion and corrosion resistance of ceramic array is intended to mitigate the risk of copperbased MCC corrosion failures. Elimination of the water delivery requirements (pH, resistivity and dissolved oxygen control) further reduces the system SWaP while maintaining reliability. The arrays were fabricated and fully characterized. This work discusses the advantages of the ceramic MCC technology and describes the design parameters that were tailored for the fiber-coupled application. Additional configuration options (form/fit, micro-lensing, alternate coolants, etc.) and on-going design improvements are also discussed.

The impact of customer-specific marketing expenses on customer retention and customer profitability

NARCIS (Netherlands)

S. van Triest (Sander); M.J.G. Bun (Maurice); E.M. van Raaij (Erik); M.J.A. Vernooij (Maarten)

2009-01-01

textabstractWe study the effects of customer-specific marketing expenses on customer retention and customer profitability in a business-to-business setting. Using data from a company providing hygiene services, we look at the impact of a hitherto unstudied type of expense targeted at individual

Augmented Reality Platforms for Virtual Fitting Rooms

OpenAIRE

Ioannis Pachoulakis; Kostas Kapetanakis

2012-01-01

Multi-sensor body scanners combined with new algorithms and social media technologies have started a revolutionary shift away from the classic desktop paradigm and into the direction of intuitive, “natural interaction” where people interface with the technological world through hand gestures, speech and body language. This article reviews recent examples of Virtual Fitting Rooms (VFRs) and supporting technologies which facilitate the shopping experience by letting customers to try...

Facial attractiveness, symmetry, and physical fitness in young women.

Science.gov (United States)

Hönekopp, Johannes; Bartholomé, Tobias; Jansen, Gregor

2004-06-01

This study explores the evolutionary-based hypothesis that facial attractiveness (a guiding force in mate selection) is a cue for physical fitness (presumably an important contributor to mate value in ancestral times). Since fluctuating asymmetry, a measure of developmental stability, is known to be a valid cue for fitness in several biological domains, we scrutinized facial asymmetry as a potential mediator between attractiveness and fitness. In our sample of young women, facial beauty indeed indicated physical fitness. The relationships that pertained to asymmetry were in the expected direction. However, a closer analysis revealed that facial asymmetry did not mediate the relationship between fitness and attractiveness. Unexpected problems regarding the measurement of facial asymmetry are discussed.

Training basic laparoscopic skills using a custom-made video game

OpenAIRE

Goris, Jetse; Jalink, Maarten B.; ten Cate Hoedemaker, Henk O.

2014-01-01

Video games are accepted and used for a wide variety of applications. In the medical world, research on the positive effects of playing games on basic laparoscopic skills is rapidly increasing. Although these benefits have been proven several times, no institution actually uses video games for surgical training. This Short Communication describes some of the theoretical backgrounds, development and underlying educational foundations of a specifically designed video game and custom-made hardwa...

Custom anatomic healing abutments

Directory of Open Access Journals (Sweden)

Vinayak S Gowda

2016-01-01

Full Text Available Dental implants with their increasing success rates and predictability of final outcome are fast becoming the treatment of choice for replacing missing teeth. Considering the success of immediate implant placement in reducing tissue loss and achieving good esthetic results, is making it a more popular treatment modality in implant dentistry. Understanding the management of gingival tissues in relation to implants to obtain maximum esthetics is of utmost importance. The use of provisional abutments and immediate temporization has a proven track record of their ability to produce optimal esthetics and to guide the tissue response during the healing phase. With careful patient selection and execution, customized healing abutments can provide an effective method to enhance the esthetic and emergence profile for anterior implant restorations.

A simple guide to iPhone 5

CERN Document Server

Lett, Mary

2012-01-01

From basics such as voice mail, text messaging, and GPS to the newest and coolest apps, this straightforward user's guide helps readers customize their iPhone 5 for optimum productivity and fun. The book discusses how to customize home and lock screens and ring tones, take pictures and video, and use the App Store, while explaining the nuances of functions that help maximize readers' business and personal time. The impressive capabilities of the iPhone 5 are laid bare in this engaging manual.

Additive and non-additive effects on fitness traits

African Journals Online (AJOL)

GScholtz

2014-11-09

Nov 9, 2014 ... Condition of use: The user may copy, distribute, transmit and adapt the work, but must ... Fitness is of paramount importance to efficient and profitable beef production. ..... Statistical analysis system User's Guide: Statistics.

Pengaruh Customer Perceived Value Terhadap Customer Satisfaction PT. Xyz

OpenAIRE

Sucahyo, Martinus Wilman

2017-01-01

Penelitian ini membahas tentang Customer Perceived Value terhadap Customer Satisfaction PT. XYZ. Dalam penelitian ini, Customer Perceived Value diukur melalui dimensi Core Product Value, Service Value dan Relationship Value. Masing-masing dimensi ini akan diuji pengaruhnya terhadap Customer Satisfaction, baik secara simultan maupun secara parsial, serta dimensi mana yang paling berpengaruh terhadap Customer Satisfaction. Sampel penelitian berjumlah 100 pelanggan PT. XYZ. Data penelitian diola...

Customer acquisition plan for a small-size entrepreneur

OpenAIRE

Puotiniemi, Tiia

2014-01-01

The aim of this thesis was to draw a customer acquisition plan and improve the marketing planning in the company. Therefore, the final result was the market research summary. Development of the marketing strategy planning was based on internal and external situation analyses. This thesis is concentrated on a small-size operator’s business and therefore the internet marketing was brought up with its profitable benefits and advantages. The thesis was written as an auxiliary guide to build u...

3D Surgical Simulation

Science.gov (United States)

Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

2009-01-01

This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

Three-dimensional surgical simulation.

Science.gov (United States)

Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

2010-09-01

In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Hemorrhoidectomy - making sense of the surgical options

Science.gov (United States)

Yeo, Danson; Tan, Kok-Yang

2014-01-01

While debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn’t a “one size fits all” option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology. PMID:25493010

Customization Issues

DEFF Research Database (Denmark)

Jørgensen, Kaj Asbjørn; Brunø, Thomas Ditlev; Taps, Stig B.

2014-01-01

Implementation of mass customization and product configuration in companies requires fundamental considerations about how products can fulfil the demand from customers. In order to support such decision-making, a multi-level model for customization is developed. This model identifies four different...... levels of customization, ranging from the structure level at the bottom, through the performance level and the experience level, to the learning level at the top. The model also has a dual view with customers/demand at one side and product/supplier at the other side. It is a rather general model, which...... can be applied to many types of products, and typically, product designers must decide how far up in levels the customization should aim. In this paper, the four-level customization model is applied to wheel chairs....

Customer complaints and recovery effectiveness : A customer base approach

NARCIS (Netherlands)

Knox, G.; van Oest, R.D.

2014-01-01

Although customer complaints are a well-studied aspect of business, no study has measured the impact of actual complaints and recoveries on subsequent customer purchasing. The authors develop a customer base model to investigate the effectiveness of recovery in preventing customer churn. They

CT-guided biopsies and drainage

International Nuclear Information System (INIS)

Scheppers, I.; Wollschlaeger, D.

2011-01-01

Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [de

PRIVILEGES AND IMMUNITIES IN SWITZERLAND - PRACTICAL GUIDE

CERN Multimedia

Relations with the Host States Service

2002-01-01

The Permanent Mission of Switzerland to the International Organisations in Geneva has just published a practical guide to the implementation of the system of privileges and immunities and other facilities on its Web site. The guide is currently available in French only but an English translation is in preparation. Comprising around ten chapters, each dealing with a different subject (insurance, real estate, customs, etc.), the guide is not exhaustive but will be regularly supplemented, expanded and updated. The Mission specifies that the information contained in the document is given only as guide and that it implies no legal commitment on the part of the Host State. Relations with the Host States Service Tel. 72848

What evidence is there for the use of workplace-based assessment in surgical training?

Science.gov (United States)

Shalhoub, Joseph; Vesey, Alex Thomas; Fitzgerald, James Edward Frankland

2014-01-01

Recent years have seen broad changes in postgraduate training with a move toward structured formative and summative evaluation of trainees' competencies using workplace-based assessment (WBA) tools. The fitness for purpose of these instruments in surgery has been much debated. The aim of this study is to explore the evidence underlying the introduction and ongoing use of WBAs in surgical training. A critical literature review was conducted to identify studies evaluating the use of WBAs in postgraduate surgical training. The search was conducted using the electronic databases PubMed for full-text articles in English. Additional critical evaluations of the curriculum relating to WBAs were included. The articles were synthesized in a narrative review. The implementation of WBA requirements in surgical training has occurred despite a relative dearth of direct evidence of their efficacy and benefit. Studies and critical reviews are being regularly undertaken to ensure that supporting evidence is accrued and the drive for improvement and refinement is maintained. It is emerging that WBAs are (contrary to their current nomenclature) formative tools for feedback and hence learning. They can facilitate the progression toward expert practice at the center of the zone of proximal development and the higher levels of Miller's pyramid, but fall short--owing to their focus on competence--of guiding surgical trainees to the higher levels of Maslow's hierarchy. Limited evidence has potentially undermined the introduction of WBAs in surgical training to date. There are misunderstandings regarding their use as either summative or formative educational tools. These shortcomings are an opportunity for further work in examining WBAs in their current or modified form. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

ADA Compliance and Accessibility of Fitness Facilities in Western Wisconsin.

Science.gov (United States)

Johnson, Marquell J; Stoelzle, Hannah Y; Finco, Kristi L; Foss, Sadie E; Carstens, Katie

2012-01-01

The study expands the research on fitness facility accessibility by determining how compliant fitness facilities in rural western Wisconsin were with Title III of the Americans with Disabilities Act (ADA). Comparisons were made with 4 other studies that were conducted in different geographical regions. The study also examined fitness professionals' disability knowledge and awareness. An ADA fitness facility compliance instrument and a fitness professional disability awareness survey were used. Direct observation and physical measurements were taken during on-site visits to 16 of 36 eligible fitness facilities in rural western Wisconsin. Ten fitness professionals from participating facilities completed an online survey. Frequencies were used to analyze the results. None of the participating facilities were in 100% compliance with ADA. Customer service desk (84%) and path of travel throughout the facility (72%) were the highest compliance areas. Telephone (6%) and locker rooms (32%) were the lowest compliance areas. No fitness professional was trained in wheelchair transfers and very few had received training in providing services to individuals with disabilities. Fitness facility accessibility remains a concern nationally. Continued efforts need to be made to raise the awareness of ADA compliance among fitness professionals across the United States, especially in rural areas where fitness facility availability is limited.

Introduction of a Surgical Navigator in the Perioperative Process Improves Patient Satisfaction

Directory of Open Access Journals (Sweden)

Brett G Marshall

2017-03-01

Full Text Available Background: Patients who had received surgical services at Bellin Hospital reported anxiety with the surgical flow. This study tested the hypothesis that the introduction of a surgical navigator, someone who guided the patient and their accompanying others throughout the surgical process, would improve patient satisfaction. Methods: Ambulatory surgical patients were randomized to control and study groups. The study group patients were assigned a surgical navigator. Prior to discharge from the hospital, patients were asked to complete a patient satisfaction survey. Results: The study group had significantly higher mean scores (P value ≤ 0.026, top box scores (P value ≤ 0.021, and positive comments. Conclusion: The addition of a surgical navigator to the perioperative process significantly enhanced patient satisfaction in ambulatory surgical patients.

Influence of Customer Focused Mission Statement on Customer Satisfaction

Directory of Open Access Journals (Sweden)

Chijioke Nwachukwu

2017-01-01

Full Text Available The purpose of this study is to examine the influence of customer‑focused mission statements on customer satisfaction in selected cell phone manufacturing companies in the United States. The study employed content analysis for the mission statement and data from America customer satisfaction index (ACSI. In analysing our data, Pearson correlation, and multiple regression techniques were used. The result showed that product and service, technology, philosophy, self‑concept, and public image mission statement components are strongly positively correlated with customer satisfaction. Customer, survival, growth and profitability and market mission statement components are insignificantly negatively correlated with customer satisfaction. The study, therefore, recommends that companies that want to remain competitive by enhancing customer satisfaction should formulate mission statements from a customer perspective so that they include product and service, technology, philosophy, self‑concept, and public image components. The main limitation of the study represents the sample size and structure. This study empirically investigated the correlation and association of nine mission statement components with customer satisfaction.

SERVICE QUALITY AND CUSTOMER SATISFACTION IN PUBLIC TRANSPORTS

Directory of Open Access Journals (Sweden)

Filipa Fonseca

2010-06-01

Full Text Available The objective of the paper is to identify the determinants of service quality as well as its impact on the satisfaction of public transport commuters. The paper explores the relationship between service quality and customer satisfaction in a public transport service taking into account both internal and external perspectives. In order to analyse this relationship, the concepts of service quality, consumer satisfaction and dissatisfaction are assessed. A model of analysis is developed aiming at explaining this relationship and guiding the empirical study. This is based on an exploratory case study of a metro company in Europe. The results of the study put in evidence two key findings. The first is related to the level of service quality in its main dimensions. We conclude that reliability, security, speed, comfort and punctuality are quality dimensions of greater importance for the public transport services. Secondly, the study explores satisfaction and their determinants. Despite literature stipulates the existence of a distinction between the constructs of quality and satisfaction, this study found that the transport company, non-customers and customers clearly do not make such a distinction.

Control rod guide tube assembly

International Nuclear Information System (INIS)

Jabsen, F.S.

1982-01-01

An improved fuel assembly is described as consisting of a sleeve that engages one end of a control rod guide tube essentially fixing the guide tube to one of the fuel assembly end structures. The end of the sleeve protrudes above the surface of the end fitting. The outer surface of the sleeve has a peripheral groove that engages the resilient sides of a cellular grid or lattice shaped lock. This lock fixes the sleeve in position between the various elements that comprise the end fitting, thereby eliminating a profusion of costly and potentially troublesome nuts, threaded studs and the like that are frequently employed in the fuel assemblies that are presently in use

The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

Science.gov (United States)

Bosi, Marcello; De Vito, Andrea; Gobbi, Riccardo; Poletti, Venerino; Vicini, Claudio

2017-03-01

The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

Fast MRI-guided vacuum-assisted breast biopsy: initial experience.

Science.gov (United States)

Liberman, Laura; Morris, Elizabeth A; Dershaw, D David; Thornton, Cynthia M; Van Zee, Kimberly J; Tan, Lee K

2003-11-01

The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. SUBJECTS AND METHODS. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Vacuum-assisted biopsy and surgical histology were correlated. Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4-6.4 cm). Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24-48 min). Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. One complication occurred: a hematoma that resolved with compression. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI.

MO-DE-202-01: Image-Guided Focused Ultrasound Surgery and Therapy

Energy Technology Data Exchange (ETDEWEB)

Farahani, K. [National Cancer Institute (United States)

2016-06-15

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

MO-DE-202-01: Image-Guided Focused Ultrasound Surgery and Therapy

International Nuclear Information System (INIS)

Farahani, K.

2016-01-01

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

Customer Loyalty Research : Can customer loyalty programs really build loyalty?

OpenAIRE

Romppanen, Maiju; Kellgren, Cecilia; Moradi, Ladan

2007-01-01

Background: During the last decades the efforts to foster customer relationships have become important due to increased competition in the consumer markets. One of the most popular strategies have been to introduce customer loyalty programs which are believed to enhance the customer loyalty. The popularity of the customer loyalty programs is based on the beliefs that loyal customers are lucrative and these programs would bond the customers to the company. More recently however, the discussion...

Improved guide tube bulge tool

International Nuclear Information System (INIS)

Vaill, R.E.; Phillips, W.D.

1979-01-01

A guide tube bulge tool for securing control rod guide tubes to a fuel assembly grid, includes a cylinder having several flexible tines each of which is equipped with a semispherical radially outwardly extending projection. A tapered ram fits into the cylinder so as to force the tines outwardly when the ram is pulled into the cylinder while supporting the other tines. (UK)

Relationships between Personal Traits, Emotional Intelligence, Internal Marketing, Service Management, and Customer Orientation in Korean Outpatient Department Nurses.

Science.gov (United States)

Kim, Bogyun; Lee, Jia

2016-03-01

Current increase and complexity of medical tests and surgical procedures at outpatient department (OPD) require OPD nurses to have customer orientation focusing on various customers' interests and needs. The purpose of this study was to identify the factors associated with customer orientation in nurses working at OPD of hospitals. The study used a descriptive correlational design with cross-sectional survey. The study settings were four general hospitals in Seoul and its metropolitan area. Data were collected from 138 OPD nurses from general hospitals. Study variables were personal traits, emotional intelligence, internal marketing, service management and customer orientation. Factors associated with customer orientation were identified as conscientiousness from personal traits (β = .37, p marketing from environmental characteristics (β = .21, p = .001). Hospital administrators should support OPD nurses to cultivate sincere and sociable personal traits and emotional intelligence, and to consider employees as internal customers to improve patient-oriented services and satisfaction. Copyright © 2015. Published by Elsevier B.V.

Temporary Shell Proof-of-Concept Technique: Digital-Assisted Workflow to Enable Customized Immediate Function in Two Visits in Partially Edentulous Patients

Science.gov (United States)

Pozzi, Alessandro; Arcuri, Lorenzo; Moy, Peter K

2018-03-01

The growing interest in minimally invasive implant placement and delivery of a prefabricated provisional prosthesis immediately, thus minimizing "time to teeth," has led to the development of numerous 3-dimensional (3D) planning software programs. Given the enhancements associated with fully digital workflows, such as better 3D soft-tissue visualization and virtual tooth rendering, computer-guided implant surgery and immediate function has become an effective and reliable procedure. This article describes how modern implant planning software programs provide a comprehensive digital platform that enables efficient interplay between the surgical and restorative aspects of implant treatment. These new technologies that streamline the overall digital workflow allow transformation of the digital wax-up into a personalized, CAD/CAM-milled provisional restoration. Thus, collaborative digital workflows provide a novel approach for time-efficient delivery of a customized, screw-retained provisional restoration on the day of implant surgery, resulting in improved predictability for immediate function in the partially edentate patient.

[Genetic isolates and inbreeding customs in three rural municipalities from Honduras].

Science.gov (United States)

Herrera-Paz, Edwin Francisco

2016-01-01

The isonymic method has been amply used to assess the approximate genetic structure of human communities. The objective of the study was to evaluate the magnitude of genetic isolation and inbreeding customs in 57 communities from three rural municipalities of Honduras using isonymy techniques. The list of 408 different surnames from 20712 voters registered in the national electoral organism, residing in the 57 Honduran communities, was used for this study. For each community, random (IR), non-random (IN), and total (IT) isonymy values were calculated in order to assess inbreeding coefficients FST, FIS and FIT. High consanguinity due to isolation and to endogamous customs was unveiled in many communities. Significant deviation from the exogamous behavior typical of many human populations was observed in the three studied municipalities, when compared to other Honduran populations. The studied communities present high consanguinity due to isolation, ethnic segregation and/or endogamous customs.

Customer Relationship Management Influence on Customer Value, Product Quality and Service Quality in Improving Customer Satisfaction and Its Implication on the Customer Loyalty

OpenAIRE

Harryani, Sri

2017-01-01

The purpose of this research is to determine the influence of Customer Relationship Management (CRM) on the Customer Value (CV), Product Quality (PQ) and Service Quality (SQ) in improving Customer Satisfaction (CS) that will have implications on the Customer Loyalty (CL). The research focuses on corporate banking, where customers serve as the research sample. The data in this research using the primary data and secondary data. Source primary data used questionnaire and source the secondary da...

A novel dental implant guided surgery based on integration of surgical template and augmented reality.

Science.gov (United States)

Lin, Yen-Kun; Yau, Hong-Tzong; Wang, I-Chung; Zheng, Cheng; Chung, Kwok-Hung

2015-06-01

Stereoscopic visualization concept combined with head-mounted displays may increase the accuracy of computer-aided implant surgery. The aim of this study was to develop an augmented reality-based dental implant placement system and evaluate the accuracy of the virtually planned versus the actual prepared implant site created in vitro. Four fully edentulous mandibular and four partially edentulous maxillary duplicated casts were used. Six implants were planned in the mandibular and four in the maxillary casts. A total of 40 osteotomy sites were prepared in the casts using stereolithographic template integrated with augmented reality-based surgical simulation. During the surgery, the dentist could be guided accurately through a head-mounted display by superimposing the virtual auxiliary line and the drill stop. The deviation between planned and prepared positions of the implants was measured via postoperative computer tomography generated scan images. Mean and standard deviation of the discrepancy between planned and prepared sites at the entry point, apex, angle, depth, and lateral locations were 0.50 ± 0.33 mm, 0.96 ± 0.36 mm, 2.70 ± 1.55°, 0.33 ± 0.27 mm, and 0.86 ± 0.34 mm, respectively, for the fully edentulous mandible, and 0.46 ± 0.20 mm, 1.23 ± 0.42 mm, 3.33 ± 1.42°, 0.48 ± 0.37 mm, and 1.1 ± 0.39 mm, respectively, for the partially edentulous maxilla. There was a statistically significant difference in the apical deviation between maxilla and mandible in this surgical simulation (p augmented reality technology. © 2013 Wiley Periodicals, Inc.

The influence of customer relationship management information on customer loyalty

OpenAIRE

Ignatovič, Eva

2009-01-01

The purpose of this master thesis is to approve that customer relationship management (CRM) has influenced on customer loyalty. In order to achieve this purpose the work was divided into four main tasks: review of the relevant literature; analyze the influence of customer relationship management on customer loyalty and approve its importance for companies, research of the concrete business-to-business (B2B) Company CRM process and its customer loyalty, and the development of the customer rela...

Guided Autotransplantation of Teeth: A Novel Method Using Virtually Planned 3-dimensional Templates.

Science.gov (United States)

Strbac, Georg D; Schnappauf, Albrecht; Giannis, Katharina; Bertl, Michael H; Moritz, Andreas; Ulm, Christian

2016-12-01

The aim of this study was to introduce an innovative method for autotransplantation of teeth using 3-dimensional (3D) surgical templates for guided osteotomy preparation and donor tooth placement. This report describes autotransplantation of immature premolars as treatment of an 11-year-old boy having suffered severe trauma with avulsion of permanent maxillary incisors. This approach uses modified methods from guided implant surgery by superimposition of Digital Imaging and Communications in Medicine files and 3D data sets of the jaws in order to predesign 3D printed templates with the aid of a fully digital workflow. The intervention in this complex case could successfully be accomplished by performing preplanned virtual transplantations with guided osteotomies to prevent bone loss and ensure accurate donor teeth placement in new recipient sites. Functional and esthetic restoration could be achieved by modifying methods used in guided implant surgery and prosthodontic rehabilitation. The 1-year follow-up showed vital natural teeth with physiological clinical and radiologic parameters. This innovative approach uses the latest diagnostic methods and techniques of guided implant surgery, enabling the planning and production of 3D printed surgical templates. These accurate virtually predesigned surgical templates could facilitate autotransplantation in the future by full implementation of recommended guidelines, ensuring an atraumatic surgical protocol. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Therapeutic efficacy of guided tissue regeneration and connective tissue autotransplants with periosteum in the management of gingival recession

Directory of Open Access Journals (Sweden)

Jovičić Bojan

2008-01-01

Full Text Available Background/Aim. Gingival recession progression in clinical practice as an ethiological factor of periodontal diseases, and symptoms of the disease have caused the development of various surgical procedures and techniques of the reconstruction of periodontal defects. The aim of this study was to verify efficacy of surgical procedures that include connective tissue autotransplants with periosteum and guided tissue regeneration for the treatment of gingival recession. Methods. The study included 20 teet with gingival recession, Müller class II and III. Ten teeth with gingival recession were treated with resorptive membrane and coronary guided surgical flap (GTR group. On the contralateral side 10 teeth with gingival recession were treated with connective tissue autotransplants with periosteum in combination with coronary guided surgical flap (TVT group. We measured the degree of epithelial attachment (DEA, width of subgingival curettage (WGC and vertical deepness of recession (VDR. For statistical significance we used Student's ttest. Results. The study revealed statistical significance in reducing VDR by both used treatments. Root deepness in GTR and TVT group was 63.5%, and 90%, respectively. With both surgical techniques we achieved coronary dislocation of the epithelial attachment, larger zone of gingival curettage, and better oral hygiene. Conclusion. Current surgical techniques are effective in the regeneration of deep periodontal spaces and the treatment of gingival recession. Significantly better results were achieved with the used coronary guided surgical flap than with guided tissue regeneration.

3D accuracy of implant positions in template-guided implant placement as a function of the remaining teeth and the surgical procedure: a retrospective study.

Science.gov (United States)

Schnutenhaus, Sigmar; Edelmann, Cornelia; Rudolph, Heike; Dreyhaupt, Jens; Luthardt, Ralph G

2018-01-22

The aim of this study was to investigate differences between the virtually planned and clinically achieved implant positions in completely template-guided implantations as a function of the type of edentulous space, the residual natural dentition, and the surgical implementation. Fifty-six patient cases with a total of 122 implants were evaluated retrospectively. The implantations were completely template-based. The data of the planned implant positions were overlaid with the actual clinical implant positions, followed by measurements of the 3D deviations in terms of coronal (x c ) and apical distance, height (x h ), and angulation (ang) and statistical analysis. The mean x c was 1.2 mm (SD 0.7 mm); the mean x a was 1.8 mm (SD 0.9 mm), the mean x h was 0.8 mm (SD 0.7 mm); and the mean ang was 4.8° (SD 3.1). The type of edentulous space and the jaw (maxilla/mandible) had no significant effect on the results in terms of implant positions. The presence of an adjacent natural tooth at the time of implantation had a significant influence on x h (p = 0.04) and ang (p = 0.05). No significant differences were found regarding the surgical approach for any of the parameters examined. The results of our study are in the same range as those of other studies. Template-guided implantation offers a high degree of accuracy even in the presence of different configurations of the residual dentition or different surgical approaches. A clinical benefit is therefore present, especially from a prosthetic point of view. The clinically achievable accuracy can be described as sufficient for further prosthetic treatment, given the intrinsic and methodological tolerances, making prosthetic rehabilitation safe and predictable.

OPTION OF USERS IN SURGICAL CONTRACEPTION FAMILY HEALTH UNIT

Directory of Open Access Journals (Sweden)

Vagner Ferreira do Nascimento

2013-09-01

Full Text Available The study is a descriptive and quantitative approach, which aimed to meet customers the option of surgical contraception by a Family Health Unit in the municipality of Barra do Herons - Mato Grosso. Data were collected on 22 forms of reference that would be forwarded to the sector and family planning counseling. Data were collected and grouped by age, marital status, gender, children and quantitative choice of surgical method of contraception. The period of data collection occurred from March to December 2011. The age group with the highest participation was from 18 to 25 years. Predominantly single, female, with two sons and opting for sterilization. The variety of options to be used as contraceptive methods should be widely publicized and encouraged by health professionals, leaving the surgical methods of reversible or irreversible disruption as a last choice.

3D Printed, Customized Cranial Implant for Surgical Planning

Science.gov (United States)

Bogu, Venkata Phanindra; Ravi Kumar, Yennam; Asit Kumar, Khanra

2018-06-01

The main objective of the present work is to model cranial implant and printed in FDM machine (printer model used: mojo). Actually this is peculiar case and the skull has been damaged in frontal, parietal and temporal regions and a small portion of frontal region damaged away from saggital plane, complexity is to fill this frontal region with proper curvature. The Patient CT-data (Number of slices was 381 and thickness of each slice is 0.488 mm) was processed in mimics14.1 software, mimics file was sent to 3-matic software and calculated thickness of skull at different sections where cranial implant is needed then corrected the edges of cranial implant to overcome CSF (cerebrospinal fluid) leakage and proper fitting. Finally the implant average thickness is decided as 2.5 mm and printed in FDM machine with ABS plastic.

A Study to Investigate the Effect of Customer Value on Customer Satisfaction, Brand Loyalty and Customer Relationship Management Performance

OpenAIRE

Berrin Onaran,; Zeki Atil Bulut,; Alparslan Ozmen

2013-01-01

Beyond satisfying needs, customer value is the key to establish and maintain long run relationships. Hence, providing excellent customer value as a driving force of customer relationships management performance plays a key role in gaining sustainable competitive advantage. The aim of this research is to investigate the relationships among dimensions of customer value, customer satisfaction, brand loyalty and customer relationship management performance. Data obtained from customers of thermal...

Assessing Customer Satisfaction at the NIST Research Library: Essential Tool for Future Planning

Science.gov (United States)

Liu, Rosa; Allmang, Nancy

2008-01-01

This article describes a campus-wide customer satisfaction survey undertaken by the National Institute of Standards and Technology (NIST) Research Library in 2007. The methodology, survey instrument, data analysis, results, and actions taken in response to the survey are described. The outcome and recommendations will guide the library both…

Nuclear reactor internals with control elements guides

International Nuclear Information System (INIS)

Baujat, J.; Chevereau, G.

1991-01-01

The internals have a lower plate, a superior plate, support columns and guide tubes for the control rods displacements. The lower section of the control rod guide tube have a base that fits into a bevelled seat in the lower plate. The guide tube is held into the seat by a spring, compressed between the base of the upper section of the tube and the lower plate

A flexible, interactive software tool for fitting the parameters of neuronal models.

Science.gov (United States)

Friedrich, Péter; Vella, Michael; Gulyás, Attila I; Freund, Tamás F; Káli, Szabolcs

2014-01-01

The construction of biologically relevant neuronal models as well as model-based analysis of experimental data often requires the simultaneous fitting of multiple model parameters, so that the behavior of the model in a certain paradigm matches (as closely as possible) the corresponding output of a real neuron according to some predefined criterion. Although the task of model optimization is often computationally hard, and the quality of the results depends heavily on technical issues such as the appropriate choice (and implementation) of cost functions and optimization algorithms, no existing program provides access to the best available methods while also guiding the user through the process effectively. Our software, called Optimizer, implements a modular and extensible framework for the optimization of neuronal models, and also features a graphical interface which makes it easy for even non-expert users to handle many commonly occurring scenarios. Meanwhile, educated users can extend the capabilities of the program and customize it according to their needs with relatively little effort. Optimizer has been developed in Python, takes advantage of open-source Python modules for nonlinear optimization, and interfaces directly with the NEURON simulator to run the models. Other simulators are supported through an external interface. We have tested the program on several different types of problems of varying complexity, using different model classes. As targets, we used simulated traces from the same or a more complex model class, as well as experimental data. We successfully used Optimizer to determine passive parameters and conductance densities in compartmental models, and to fit simple (adaptive exponential integrate-and-fire) neuronal models to complex biological data. Our detailed comparisons show that Optimizer can handle a wider range of problems, and delivers equally good or better performance than any other existing neuronal model fitting tool.

A flexible, interactive software tool for fitting the parameters of neuronal models

Directory of Open Access Journals (Sweden)

Péter eFriedrich

2014-07-01

Full Text Available The construction of biologically relevant neuronal models as well as model-based analysis of experimental data often requires the simultaneous fitting of multiple model parameters, so that the behavior of the model in a certain paradigm matches (as closely as possible the corresponding output of a real neuron according to some predefined criterion. Although the task of model optimization is often computationally hard, and the quality of the results depends heavily on technical issues such as the appropriate choice (and implementation of cost functions and optimization algorithms, no existing program provides access to the best available methods while also guiding the user through the process effectively. Our software, called Optimizer, implements a modular and extensible framework for the optimization of neuronal models, and also features a graphical interface which makes it easy for even non-expert users to handle many commonly occurring scenarios. Meanwhile, educated users can extend the capabilities of the program and customize it according to their needs with relatively little effort. Optimizer has been developed in Python, takes advantage of open-source Python modules for nonlinear optimization, and interfaces directly with the NEURON simulator to run the models. Other simulators are supported through an external interface. We have tested the program on several different types of problem of varying complexity, using different model classes. As targets, we used simulated traces from the same or a more complex model class, as well as experimental data. We successfully used Optimizer to determine passive parameters and conductance densities in compartmental models, and to fit simple (adaptive exponential integrate-and-fire neuronal models to complex biological data. Our detailed comparisons show that Optimizer can handle a wider range of problems, and delivers equally good or better performance than any other existing neuronal model fitting

Model Fit and Item Factor Analysis: Overfactoring, Underfactoring, and a Program to Guide Interpretation.

Science.gov (United States)

Clark, D Angus; Bowles, Ryan P

2018-04-23

In exploratory item factor analysis (IFA), researchers may use model fit statistics and commonly invoked fit thresholds to help determine the dimensionality of an assessment. However, these indices and thresholds may mislead as they were developed in a confirmatory framework for models with continuous, not categorical, indicators. The present study used Monte Carlo simulation methods to investigate the ability of popular model fit statistics (chi-square, root mean square error of approximation, the comparative fit index, and the Tucker-Lewis index) and their standard cutoff values to detect the optimal number of latent dimensions underlying sets of dichotomous items. Models were fit to data generated from three-factor population structures that varied in factor loading magnitude, factor intercorrelation magnitude, number of indicators, and whether cross loadings or minor factors were included. The effectiveness of the thresholds varied across fit statistics, and was conditional on many features of the underlying model. Together, results suggest that conventional fit thresholds offer questionable utility in the context of IFA.

A Custom Fit

Science.gov (United States)

Ramaswami, Rama

2010-01-01

In its broadest sense, open content refers to material published under a license that allows any user to edit, adapt, remix, and distribute it. It is distinct from free content, which is in the public domain and has no significant legal restrictions on its modification. In a much-publicized action in January 2008, Florida became the first state to…

Mass Customization Services

DEFF Research Database (Denmark)

Friedrich, Gerhard

Topics of the IMCM’08 & PETO’08 and this book are: Mass customization in service, mass customizing financial services, mass customization in supply networks, implementation issues in logistics, product life cycle and mass customization. The research field of mass customization is more than 15 years...

Collagen nerve guides for surgical repair of brachial plexus birth injury.

Science.gov (United States)

Ashley, William W; Weatherly, Trisha; Park, Tae Sung

2006-12-01

Standard brachial plexus repair techniques often involve autologous nerve graft placement and neurotization. However, when performed to treat severe injuries, this procedure can sometimes yield poor results. Moreover, harvesting the autologous graft is time-consuming and exposes the patient to additional surgical risks. To improve surgical outcomes and reduce surgical risks associated with autologous nerve graft retrieval and placement, the authors use collagen matrix tubes (Neurogen) instead of autologous nerve graft material. Between 1991 and 2005, the authors surgically treated 65 infants who had suffered brachial plexus injury at birth. During this time, seven patients were treated using collagen matrix tubes (Neurogen). This study is a retrospective analysis of the initial five patients who were treated using the tubes. Two patients underwent tube placement recently and were excluded from the analysis because of the inadequate follow-up period. Four of the five patients experienced a good recovery (motor scale composite [MSC] > 0.6), and three exhibited an excellent recovery (MSC > 0.75) at 2 years postoperatively. The MSC improved by an average of 69 and 78% at 1 and 2 years, respectively. The movement scores improved to greater than or equal to 50% range of motion in most patients, and the contractures were usually mild or moderate. Follow-up physical and occupational therapy evaluations confirm these patients' functional status. When last seen, four of five of these children could feed and dress themselves. Technically, the use of the collagen matrix tubes was straightforward and efficient, and there were no complications. The outcomes in this small series are encouraging.

Customer experience

OpenAIRE

Koperdáková, Zuzana

2016-01-01

Bachelor thesis deals with the theme of customer experience and terms related to this topic. The thesis consists of three parts. The first part explains the terms generally, as the experience or customer loyalty. The second part is dedicated to medotology used for Customer Experience Management. In the third part is described application of Customer Experience Management in practice, particularly in the context Touch Point Analyses in GE Money Bank.

Customer satisfaction and customer loyalty as predictors of future business potential

DEFF Research Database (Denmark)

Eskildsen, Jacob Kjær; Kristensen, Kai

2008-01-01

This paper analyses the relationship between customer satisfaction, customer loyalty and the future business potential of existing customers. The data for the analysis come from the Danish Customer Satisfaction Index 2006. Here a total of approximately 2000 private customers evaluated...

Customer Relationship Management

OpenAIRE

Abdillah, Leon

2018-01-01

Contents: 1) Introduction, 2) Basic Concept of CRM, 3) The Customer Service/Sales Profile, 4) Customer Relationship, 5) Planning and implementing CRM projects, 6) Developing, managing and using customer-related databases, 7) Managing and Sharing Customer Data, 8) Tools for Capturing Customer Information, 9) E-Commerce: Customer Relationships on the Internet, 10) Information Technology for CRM, 11) Sales-force automation, 12) Marketing automation, 13) Service automation, 14) Presentations, 15)...

Analisa Customer Value dan Customer Experience terhadap Customer Loyalty dengan Customer Satisfaction sebagai Variabel Intervening (Studi pada Waroeng Spesial Sambal Cabang Purwokerto)

OpenAIRE

Ariningsih, Kuswanti; Muji Rahayu, Tri Septin

2015-01-01

This research was based on the comptitive business condition in restaurant business that was getting more competitive, therefore the corporates had to make a new marketing strategy to stay and achieve he higher market. This research aimed to test the effect of customer value and customer experience toward customer loyalty with customer satisfaction as intervening variable. The data were gained by questionnaire method to the 110 respondent of waroeng spesial sambal cabang purwok...

La calidad percibida de servicio y su influencia en la fidelidad de usuarios mayores en centros de fitness públicos (Influence of perceived service quality on loyalty among elderly users of public fitness centres

Directory of Open Access Journals (Sweden)

Jerónimo García, Ainara Bernal

2013-08-01

Full Text Available Nowadays, there is an increasing number of elderly people attending sports centres leading to interest in the evaluation of perceived quality due to its impact on loyalty. Thus, the objectives of this study/survey were to determine perceived quality and customer loyalty among users older than 55 years old attending public fitness centres, to analyze whether there were significant differences between users, and to examine if perceived quality influenced customer loyalty. We used a sample of 610 users of public fitness centres (406 women and 204 men, performing exploratory factor analysis, reliability analysis, t-test and one-way ANOVA, and linear regression. The results show reliable and valid scales of service quality (employees, programs, and facilities and loyalty. Significant differences were found in the employees and facilities dimensions regarding gender, age, and educational background and in the programs dimension regarding gender, educational background, marital status, and duration of the practice session. A positive influence was found between quality and customer loyalty. These findings suggest the importance of good quality management.

Product Customization

DEFF Research Database (Denmark)

Hvam, Lars; Mortensen, Niels Henrik; Riis, Jesper

For the majority of industrial companies, customizing products and services is among the most critical means to deliver true customer value and achieve superior competitive advantage. The challenge is not to customize products and services in itself – but to do it in a profitable way...... from more than 40 product configuration projects in companies providing customer tailored products and services........ The implementation of a product configuration system is among the most powerful ways of achieving this in practice, offering a reduction of the lead time for products and quotations, faster and more qualified responses to customer inquiries, fewer transfers of responsibility and fewer specification mistakes...

When Does Salespeople’s Customer Orientation Lead to Customer Loyalty? : The Differential Effects of Relational and Functional Customer Orientation

OpenAIRE

Homburg, Christian; Müller, Michael; Klarmann, Martin

2010-01-01

Is a customer orientation universally effective for salespeople? Or does its effectiveness depend on the selling situation? While previous research has largely neglected this question, this study investigates contextual influences on the link between customer-oriented behaviors and customer loyalty. To do so, it takes a role theory perspective on salesperson customer orientation by distinguishing functional customer orientation and relational customer orientation. It then investigates which t...

Least Squares Data Fitting with Applications

DEFF Research Database (Denmark)

Hansen, Per Christian; Pereyra, Víctor; Scherer, Godela

As one of the classical statistical regression techniques, and often the first to be taught to new students, least squares fitting can be a very effective tool in data analysis. Given measured data, we establish a relationship between independent and dependent variables so that we can use the data....... In a number of applications, the accuracy and efficiency of the least squares fit is central, and Per Christian Hansen, Víctor Pereyra, and Godela Scherer survey modern computational methods and illustrate them in fields ranging from engineering and environmental sciences to geophysics. Anyone working...... with problems of linear and nonlinear least squares fitting will find this book invaluable as a hands-on guide, with accessible text and carefully explained problems. Included are • an overview of computational methods together with their properties and advantages • topics from statistical regression analysis...

Twitter classification model: the ABC of two million fitness tweets.

Science.gov (United States)

Vickey, Theodore A; Ginis, Kathleen Martin; Dabrowski, Maciej

2013-09-01

The purpose of this project was to design and test data collection and management tools that can be used to study the use of mobile fitness applications and social networking within the context of physical activity. This project was conducted over a 6-month period and involved collecting publically shared Twitter data from five mobile fitness apps (Nike+, RunKeeper, MyFitnessPal, Endomondo, and dailymile). During that time, over 2.8 million tweets were collected, processed, and categorized using an online tweet collection application and a customized JavaScript. Using the grounded theory, a classification model was developed to categorize and understand the types of information being shared by application users. Our data show that by tracking mobile fitness app hashtags, a wealth of information can be gathered to include but not limited to daily use patterns, exercise frequency, location-based workouts, and overall workout sentiment.

The relationship between customer satisfaction and the demographic profile of participants in the exercise programs of health and fitness clubs for municipal youth and sport organizations

Directory of Open Access Journals (Sweden)

ALEXANDRA TRIPOLITSIOTI

2007-01-01

Full Text Available The objective of this study is to analyze the satisfaction of participants in the offered programs of exercise of health and fitness clubs for municipal Youth and Sport organizations. A random sample of 320 participants was selected from 18 closed halls and responded to a questionnaire that was pre-checked for reliability, validity and objectivity (Chen, 2001. The questionnaire included questions related to demographics, participant satisfaction from the exercise programs and from the level of organisation these have, the quality of equipment the athletic halls have and the variety of services offered. Data was analysed statistically to determine the relationships and differences between the mean value of the different variables. Results show that the profile of the major customer segment is women from 26 to 35 years old with University education. Also, statistical analysis shows that there are significant differences between the average values in all 5 dimensions of participant satisfaction: the prices of exercise programs, program content, the quality of hall equipment, public relations and employee performance. Also, there are statistically significant differences between the demographic variables (age, sex, income and the 5 participant satisfaction dimensions. However, the dimensions that present statistically significant differences vary according to the demographic variable analysed. This shows that municipal sports centres should differentiate their offers according to the dimensions of satisfaction that are more important for each customer segment as these are formed based on age, income or sex.

Integrating sentiment analysis and term associations with geo-temporal visualizations on customer feedback streams

Science.gov (United States)

Hao, Ming; Rohrdantz, Christian; Janetzko, Halldór; Keim, Daniel; Dayal, Umeshwar; Haug, Lars-Erik; Hsu, Mei-Chun

2012-01-01

Twitter currently receives over 190 million tweets (small text-based Web posts) and manufacturing companies receive over 10 thousand web product surveys a day, in which people share their thoughts regarding a wide range of products and their features. A large number of tweets and customer surveys include opinions about products and services. However, with Twitter being a relatively new phenomenon, these tweets are underutilized as a source for determining customer sentiments. To explore high-volume customer feedback streams, we integrate three time series-based visual analysis techniques: (1) feature-based sentiment analysis that extracts, measures, and maps customer feedback; (2) a novel idea of term associations that identify attributes, verbs, and adjectives frequently occurring together; and (3) new pixel cell-based sentiment calendars, geo-temporal map visualizations and self-organizing maps to identify co-occurring and influential opinions. We have combined these techniques into a well-fitted solution for an effective analysis of large customer feedback streams such as for movie reviews (e.g., Kung-Fu Panda) or web surveys (buyers).

In vivo virtual intraoperative surgical photoacoustic microscopy

International Nuclear Information System (INIS)

Han, Seunghoon; Kim, Sehui; Kim, Jeehyun; Lee, Changho; Jeon, Mansik; Kim, Chulhong

2013-01-01

We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo

In vivo virtual intraoperative surgical photoacoustic microscopy

Energy Technology Data Exchange (ETDEWEB)

Han, Seunghoon, E-mail: hsh860504@gmail.com; Kim, Sehui, E-mail: sehui0916@nate.com; Kim, Jeehyun, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [School of Electrical Engineering and Computer Science, Kyungpook National University, Daegu 702-701 (Korea, Republic of); Lee, Changho, E-mail: ch31037@postech.edu; Jeon, Mansik, E-mail: msjeon@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Kim, Chulhong, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, New York 14221 (United States)

2013-11-11

We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

Treatment planning for permanent and temporary percutaneous implants with custom made templates

International Nuclear Information System (INIS)

Osian, A.D.; Anderson, L.L.; Linares, L.A.; Nori, D.; Hilaris, B.S.

1989-01-01

Nine patients who were presented at MSKCC with primary or recurrent pelvic or head and neck tumors and for whom surgery or further external radiation were excluded, were treated with percutaneous permanent or temporary implants, with individual pre-treatment planning and custom made templates. The tumor dose distributions achieved were as good as for implants performed at the time of surgical exploration. No serious complications have been encountered

To Customize or Not to Customize? Exploring Science Teacher Customization in an Online Lesson Portal

Science.gov (United States)

Littenberg-Tobias, Joshua; Beheshti, Elham; Staudt, Carolyn

2016-01-01

New technologies are increasingly giving science teachers the ability to access and customize science lessons. However, there is substantial debate in the literature about whether and under what conditions teacher customization benefit student learning. In this study, we examined teacher customization of inquiry-based science lessons from an…

Pengaruh Customer Experience Quality Terhadap Customer Satisfaction & Customer Loyalty Di Kafe Excelso Tunjungan Plaza Surabaya: Perspektif B2C

OpenAIRE

Senjaya, Vivie

2013-01-01

This study discusses about the quality of the customer experience, which is thought to affect customer satisfaction at Cafe Excelso Tunjungan Plaza Surabaya. In this study, the variable of the customer experience quality is measured through the dimensions of accessibility, competence, customer recognition, helpfulness, personalization, problem solving, promise fulfillment, and value for time. Each of these dimensions will be partially tested how it affects customer satisfaction and customer l...

Analisa Pengaruh Customer Experience Terhadap Customer Loyalty Dengan Customer Engagement Dan Customer Trust Sebagai Variabel Intervening Di the Body Shop

OpenAIRE

Felita, Christina Irene

2015-01-01

Perkembangan bisnis ritel saat ini berkembang sangat pesat. Sebagai Perusahaan ritel yang bergerak di bidang beauty & personal care, The Body Shop harus memiliki keunggulan bersaing agar dapat menang dalam persaingan yang ketat. Salah satu strategi untuk menciptakan keunggulan bersaing adalah dengan memberikan customer experience yang tepat dan memuaskan sehingga dapat memanjakan mereka sebagai customer dan membuat mereka menjadi customer yang loyal. Penelitian ini dilakukan untuk mengan...

Arbitrary beam control using passive lossless metasurfaces enabled by orthogonally polarized custom surface waves

Science.gov (United States)

Kwon, Do-Hoon; Tretyakov, Sergei A.

2018-01-01

For passive, lossless impenetrable metasurfaces, a design technique for arbitrary beam control of receiving, guiding, and launching is presented. Arbitrary control is enabled by a custom surface wave in an orthogonal polarization such that its addition to the incident (input) and the desired scattered (output) fields is supported by a reactive surface impedance everywhere on the reflecting surface. Such a custom surface wave (SW) takes the form of an evanescent wave propagating along the surface with a spatially varying envelope. A growing SW appears when an illuminating beam is received. The SW amplitude stays constant when power is guided along the surface. The amplitude diminishes as a propagating wave (PW) is launched from the surface as a leaky wave. The resulting reactive tensor impedance profile may be realized as an array of anisotropic metallic resonators printed on a grounded dielectric substrate. Illustrative design examples of a Gaussian beam translator-reflector, a probe-fed beam launcher, and a near-field focusing lens are provided.

Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap.

Science.gov (United States)

Ganry, L; Quilichini, J; Bandini, C M; Leyder, P; Hersant, B; Meningaud, J P

2017-08-01

Very few surgical teams currently use totally independent and free solutions to perform three-dimensional (3D) surgical modelling for osseous free flaps in reconstructive surgery. This study assessed the precision and technical reproducibility of a 3D surgical modelling protocol using free open-source software in mandibular reconstruction with fibula free flaps and surgical guides. Precision was assessed through comparisons of the 3D surgical guide to the sterilized 3D-printed guide, determining accuracy to the millimetre level. Reproducibility was assessed in three surgical cases by volumetric comparison to the millimetre level. For the 3D surgical modelling, a difference of less than 0.1mm was observed. Almost no deformations (free flap modelling was between 0.1mm and 0.4mm, and the average precision of the complete reconstructed mandible was less than 1mm. The open-source software protocol demonstrated high accuracy without complications. However, the precision of the surgical case depends on the surgeon's 3D surgical modelling. Therefore, surgeons need training on the use of this protocol before applying it to surgical cases; this constitutes a limitation. Further studies should address the transfer of expertise. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The National Map Customer Requirements: Findings from Interviews and Surveys

Science.gov (United States)

Sugarbaker, Larry; Coray, Kevin E.; Poore, Barbara

2009-01-01

The purpose of this study was to receive customer feedback and to understand data and information requirements for The National Map. This report provides results and findings from interviews and surveys and will guide policy and operations decisions about data and information requirements leading to the development of a 5-year strategic plan for the National Geospatial Program. These findings are based on feedback from approximately 2,200 customers between February and August 2008. The U.S. Geological Survey (USGS) conducted more than 160 interviews with 200 individuals. The American Society for Photogrammetry and Remote Sensing (ASPRS) and the International Map Trade Association (IMTA) surveyed their memberships and received feedback from over 400 members. The Environmental Systems Research Institute (ESRI) received feedback from over 1,600 of its U.S.-based software users through an online survey sent to customers attending the ESRI International User Conference in the summer of 2008. The results of these surveys were shared with the USGS and have been included in this report.

SVX Sequence Crate Custom J1 Backplane

International Nuclear Information System (INIS)

Utes, M.

1997-01-01

The Custom J1 Backplane is a full length (21 slot) user specified custom 3U backplane to be used in the J1 position. Slot spacing is identical to that used for VME (0.8-inch), and each backplane shall fit into a standard Eurocard VME style crate. The purpose of the Custom J1 Backplane is to: (1) Provide +5 volt power to slots 1 through 21; (2) Provide -5.2 volt power to slots 1 through 21; (3) Provide five bits of geographic addressing to slots 2 through 21. Slot 2 will have all five bits pulled low; slot 21 will have the value 10100. See Appendix A; (4) Route a differential 1553 signal from a triaxial bulkhead connector to slots 2 through 11. This differential signal is bussed as a daisy chain. A 75 ohm resistor to ground shall be located near the last destination slot for each of these two signals; (5) Route a second differential 1553 signal from a triaxial bulkhead connector to slots 12 through 21. This differential signal is bussed as a daisy chain. A 75 ohm resistor to ground shall be located near the last destination slot for each of these two signals; (6) Route two NRZ signals and two Clock signals from slot 1 to each of slots 2 through 21. These are individual signals, not bussed.

The total customer relationship in health care: broadening the bandwidth.

Science.gov (United States)

Berwick, D M

1997-05-01

The health care system is in the midst of a market revolution, driven by cost containment but also fully charged by the idea that competition among providers will lead to reforms that neither the government nor the professions have been able to achieve by themselves. An agenda of "reports to consumers" has been advanced as a bright new hope for improving the health care system. An alternative to this notion of consumerism is far broader--that is the concept of total relationship. In the hands of masters outside the health care domain, the total customer relationship embraces several elements that can be imported into health care and that offer more promise than "report cards," including the following: Customers as assistants in decreasing waste; Mass customization and stratification of need; Shaping demand; Immediate recovery; Delight as the objective; and Customer knowledge and innovation. A CREDO: The next phase of development of total customer relationship might well be guided by a credo including several tenets about the wisdom of those the health care system serves and the nature of its purpose: 1. In a helping profession, the ultimate judge of performance is the person helped. 2. Most people, including sick people, are reasonable most of the time. 3. Different people have different, legitimate needs. 4. Pain and fear produce anxiety in both the victim and the helper. 5. Meeting needs without waste is a strategic and moral imperative.

Customer retention through supplier-organization-customer relationship management

OpenAIRE

Žvirelienė, Renata; Bučiūnienė, Ilona; Škudienė, Vida; Sakalas, Algimantas

2009-01-01

The research objective was to assess the relationship marketing outputs' (internal relationship, relationship with customer, relationship with supplier) interrelationship and their relationship with customers' retention. The internal and external relationship dimensions of commitment, satisfaction, trust, communication, cooperation and empathy were used to measure supplier-organization-customer relationship strength. The survey was conducted in cargo vehicles trading industry companies in Lit...

Employee guide to respiratory protection

International Nuclear Information System (INIS)

Wright, E.M.

1982-01-01

This employee guide discusses use of respiratory protective equipment for particulates, gases, vapors, supplied air, and self-contained breathing apparatus. It also covers equipment selection medical factors, fitting criteria; care; and employee responsibilities

Immediate implant placement and provisionalization with simultaneous guided bone regeneration in the esthetic zone

Directory of Open Access Journals (Sweden)

Chih-Long Chen

2011-03-01

Full Text Available The procedure for immediate implant placement and provisionalization is time-saving, possibly with only one surgical intervention required, although allowing maximal preservation of peri-implant tissues. In this case, we extracted a fractured maxillary right central incisor of a 46-year-old woman with high esthetic expectations, and a transmucosal implant was immediately installed. Simultaneous guided bone regeneration was performed to correct the defects at the facial side of the socket and augment the alveolar ridge horizontally. Primary stability of the implant body and wound closure without tension were confirmed. Connection of a 15° angled abutment and fabrication of a provisional acrylic resin crown without occlusal contact were also completed in the same appointment. After intensive follow-up and soft-tissue molding for 6 months, the customized zirconia abutment and all-ceramic crown were definitively fabricated. During the 18-month follow-up period, the patient was satisfied with the esthetic and functional results.

Estudo comparativo entre duas plataformas para realização de Lasik personalizado para correção de miopia e astigmatismo: Alcon CustomCornea® versus Bausch & Lomb Zyoptix® Wavefront-Guided Lasik for low to moderate myopia: CustomCornea® versus Zyoptix®

Directory of Open Access Journals (Sweden)

Telma Pereira Barreiro

2009-08-01

Full Text Available OBJETIVO: Comparar os resultados obtidos após o Lasik personalizado utilizando duas plataformas diferentes. MÉTODOS: Estudo prospectivo, randomizado com 50 pacientes míopes submetidos a cirurgia refrativa em ambos os olhos. Foram selecionados para o estudo, pacientes com equivalente esférico semelhante entre os olhos. Todos foram submetidos a Lasik bilateral e simultâneo, sendo que um olho foi operado pela plataforma CustomCornea® e o outro pela Zyoptix®. Acuidade visual sem e com correção, refração dinâmica e estática, medida das aberrações oculares, teste de sensibilidade ao contraste foram realizados no período pré-operatório e pós-operatório de 1, 3 e 6 meses. RESULTADOS: No período pré-operatório a média do equivalente esférico era de -3,29 ± 1,56 D no grupo CustomCornea® e de -3,22 ± 1,50 D no Zyoptix® (p=0,267. No sexto mês de pós-operatório, a média do equivalente esférico no grupo CustomCornea® era de -0,077 ± 0,23 D e -0,282 ± 0,30 D no Zyoptix® (p 20/20 foi alcançada em 86% dos olhos no grupo CustomCornea® e 70% no grupo Zyoptix® (p=0,094. Nenhum paciente perdeu duas ou mais linhas da melhor acuidade visual corrigida. Cem por cento dos olhos CustomCornea® e 88% dos Zyoptix® ficaram entre ± 0,50 D da emetropia (p=0,014*. Melhora da sensibilidade ao contraste em todas as frequências espaciais testadas foi observada em ambos os grupos. A aberração esférica apresentou aumento em ambos os grupos, porém este foi estatisticamente maior na plataforma Zyoptix® (pPURPOSE: To compare the visual and clinical outcomes of Wavefront-guided laser in situ keratomileusis (Lasik with Alcon CustomCornea® and Zyoptix® systems. METHODS: A prospective, randomized, masked and bilateral study was conducted. Fifty patients with preoperative spherical equivalent ranging from -1.00 to -6.50 D were enrolled for customized ablation in both eyes. All of them were submitted to Lasik CustomCornea® treatment in one

Outsourcing customer support : The role of provider customer focus

NARCIS (Netherlands)

Wuyts, S.H.K.; Rindfleisch, A.; Citrin, A.

An increasing number of firms are outsourcing customer support to external service providers. This creates a triadic setting in which an outsourcing provider serves end customers on behalf of its clients. While outsourcing presents an opportunity to serve customers, service providers differ in their

Customer Engagement as a New Perspective in Customer Management

NARCIS (Netherlands)

Verhoef, Peter C.; Reinartz, Werner J.; Krafft, Manfred

Since 2000, customer management (CM) research has evolved and has had a significant impact on the marketing discipline. In an increasingly networked society where customers can interact easily with other customers and firms through social networks and other new media, the authors propose that

Fabrication of malleable three-dimensional-printed customized bolus using three-dimensional scanner.

Directory of Open Access Journals (Sweden)

Jae Won Park

Full Text Available A three-dimensional (3D-printed customized bolus (3D bolus can be used for radiotherapy application to irregular surfaces. However, bolus fabrication based on computed tomography (CT scans is complicated and also delivers unwanted irradiation. Consequently, we fabricated a bolus using a 3D scanner and evaluated its efficacy. The head of an Alderson Rando phantom was scanned with a 3D scanner. The 3D surface data were exported and reconstructed with Geomagic Design X software. A 3D bolus of 5-mm thickness designed to fit onto the nose was printed with the use of rubber-like printing material, and a radiotherapy plan was developed. We successfully fabricated the customized 3D bolus, and further, a CT simulation indicated an acceptable fit of the 3D bolus to the nose. There was no air gap between the bolus and the phantom surface. The percent depth dose (PDD curve of the phantom with the 3D bolus showed an enhanced surface dose when compared with that of the phantom without the bolus. The PDD of the 3D bolus was comparable with that of a commercial superflab bolus. The radiotherapy plan considering the 3D bolus showed improved target coverage when compared with that without the bolus. Thus, we successfully fabricated a customized 3D bolus for an irregular surface using a 3D scanner instead of a CT scanner.

Training basic laparoscopic skills using a custom-made video game.

Science.gov (United States)

Goris, Jetse; Jalink, Maarten B; Ten Cate Hoedemaker, Henk O

2014-09-01

Video games are accepted and used for a wide variety of applications. In the medical world, research on the positive effects of playing games on basic laparoscopic skills is rapidly increasing. Although these benefits have been proven several times, no institution actually uses video games for surgical training. This Short Communication describes some of the theoretical backgrounds, development and underlying educational foundations of a specifically designed video game and custom-made hardware that takes advantage of the positive effects of games on basic laparoscopic skills.

PRIVILEGES AND IMMUNITIES IN SWITZERLAND: PRACTICAL GUIDE

CERN Multimedia

2003-01-01

The Permanent Mission of Switzerland to the International Organisations in Geneva has informed CERN that the "Practical Manual of the regime of privileges and immunities and other facilities" is available on its Web site: - in English (http://www.dfae.admin.ch/geneva_miss/e/home/guide.html); - in French (http://www.dfae.admin.ch/geneva_miss/f/home/guide.html). Comprising around ten chapters, each dealing with a different subject (insurance, real estate, customs, etc.), the guide is not exhaustive but will be regularly supplemented, expanded and updated. The Mission specifies that the information contained in the document is given only as guide and that it implies no legal commitment on the part of the Host State. Relations with the Host States Service http://www.cern.ch/relations/ Tel. 72848

The Role of Customer Engagement in Enhancing Passenger Loyalty in IndonesianAirline Industry: Relationship Marketing Approach

Directory of Open Access Journals (Sweden)

Raditha Hapsari

2015-09-01

Full Text Available Scholars and practitioners agree that organisations cannot rely on transactional marketing since customers demand more personalized goods and services. Consequently, organisations need to build a relationships based on a mutual exchange with their customers to satisfy their needs and wants and customer relationship emerged to enhance long-term customer profitability. Customer perceived value have been widely accepted as important antecedents improving customer loyalty. However, only a few published studies have the integrated customer engagement construct with the other important marketing constructs to examine the interrelationship among them. This research aims to examine the interrelationships among perceived value, customer engagement and customer loyalty. Focus group discussions, and a survey of 250 Indonesian airline passengers in East Java Province, Indonesia, were conducted to satisfy the research objectives. In order to carry out a comprehensive investigation of the relationship between variables, a quantitative approach is used in this study. The methods used to analyse the data are Confirmatory Factor Analysis (CFA to test the model fit and Structural Equation Modelling (SEM to test the hypothesis. Sobel’s test is also used to test the mediating role of customer engagement. The findings of this study indicate while customer perceived value consistently influences loyalty, customer engagement is also proven to be an antecedent of loyalty. Furthermore, customer engagement is also proven to play a mediating role which strengthens the relationship between perceived value and loyalty. The results of the empirical analysis is supported by previous studies that suggest customer engagement is a new construct that has an important role to play in enhancing passenger loyalty.

Sampling a guide for internal auditors

CERN Document Server

Apostolou, Barbara

2004-01-01

While it is possible to examine 100 percent of an audit customer's data, the time and cost associated with such a study are often prohibitive. To obtain sufficient, reliable, and relevant information with a limited data set, sampling is an efficient and effective tool. It can help you evaluate the customer's assertions, as well as reach audit conclusions and provide reasonable assurance to your organization. This handbook will help you understand sampling. It also serves as a guide for auditors and students preparing for certification. Topics include: An overview of sampling. Statistical and nonstatistical sampling issues. Sampling selection methods and risks. The pros and cons of popular sampling plans.

Current Capabilities and Development Potential in Surgical Robotics

Directory of Open Access Journals (Sweden)

Mathias Hoeckelmann

2015-05-01

Full Text Available Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

Understanding customer experience.

Science.gov (United States)

Meyer, Christopher; Schwager, Andre

2007-02-01

Anyone who has signed up for cell phone service, attempted to claim a rebate, or navigated a call center has probably suffered from a company's apparent indifference to what should be its first concern: the customer experiences that culminate in either satisfaction or disappointment and defection. Customer experience is the subjective response customers have to direct or indirect contact with a company. It encompasses every aspect of an offering: customer care, advertising, packaging, features, ease of use, reliability. Customer experience is shaped by customers' expectations, which largely reflect previous experiences. Few CEOs would argue against the significance of customer experience or against measuring and analyzing it. But many don't appreciate how those activities differ from CRM or just how illuminating the data can be. For instance, the majority of the companies in a recent survey believed they have been providing "superior" experiences to customers, but most customers disagreed. The authors describe a customer experience management (CEM) process that involves three kinds of monitoring: past patterns (evaluating completed transactions), present patterns (tracking current relationships), and potential patterns (conducting inquiries in the hope of unveiling future opportunities). Data are collected at or about touch points through such methods as surveys, interviews, focus groups, and online forums. Companies need to involve every function in the effort, not just a single customer-facing group. The authors go on to illustrate how a cross-functional CEM system is created. With such a system, companies can discover which customers are prospects for growth and which require immediate intervention.

Investigating Customers' Experiences with Their Financial Services Customer Education Programs as It Impacts Customer Loyalty to the Financial Firm

Science.gov (United States)

Islam, Kaliym A.

2017-01-01

The problem addressed in this study was that customer education programs are intended to strengthen customer loyalty; however, research on the effects of customer education on customer loyalty remains insufficient. This phenomenological study investigated how the lived experiences of customers' participating in financial services' customer…

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review.

Science.gov (United States)

Mendes, Adriano Fernando; Neto, José da Mota; Heringer, Erica Maciel; de Simoni, Leandro Furtado; Pires, Diego Demolinari; Labronici, Pedro José

2018-01-01

CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome. We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment. Acute compartment syndrome in the arms after intense physical exercise is a rare occurrence that should be suspected by practitioners of physical activity experiencing intense, disproportionate and progressive pain. In the case presented, hyperbaric oxygen therapy was successfully used in the treatment of the disorder, with satisfactory progress, and without the need for a surgical fasciotomy as therapy. Copyright© Undersea and Hyperbaric Medical Society.

Customer Satisfaction and Customer Loyalty as Predictors of Future Business Potential

DEFF Research Database (Denmark)

Eskildsen, Jacob Kjær; Kristensen, Kai

2007-01-01

This paper analyzes the relationship between customer satisfaction, customer loyalty and the future business potential of existing customers. The data for the analysis comes from the Danish Customer Satisfaction Index 2006. Here a total of app. 2000 private customers evaluated their...

Do psychological variables affect early surgical recovery?

Directory of Open Access Journals (Sweden)

Michael N Mavros

Full Text Available BACKGROUND: Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. METHODS: We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. RESULTS: We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. CONCLUSION: Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.

Managing customer knowledge

OpenAIRE

2013-01-01

M. Phil. (Information Management) Customer relationship management has been exposed as a strategic failure, unveiling only customer dissatisfaction. A new method for managing customers is consequently required. The effect of the knowledge economy has brought about a change in global orientation, in the focus on customer wants and needs to increase satisfaction. There was then a shift in focus from information to knowledge. In such an economy, the customer knowledge management strategy, as ...

The use of data mining by private health insurance companies and customers' privacy.

Science.gov (United States)

Al-Saggaf, Yeslam

2015-07-01

This article examines privacy threats arising from the use of data mining by private Australian health insurance companies. Qualitative interviews were conducted with key experts, and Australian governmental and nongovernmental websites relevant to private health insurance were searched. Using Rationale, a critical thinking tool, the themes and considerations elicited through this empirical approach were developed into an argument about the use of data mining by private health insurance companies. The argument is followed by an ethical analysis guided by classical philosophical theories-utilitarianism, Mill's harm principle, Kant's deontological theory, and Helen Nissenbaum's contextual integrity framework. Both the argument and the ethical analysis find the use of data mining by private health insurance companies in Australia to be unethical. Although private health insurance companies in Australia cannot use data mining for risk rating to cherry-pick customers and cannot use customers' personal information for unintended purposes, this article nonetheless concludes that the secondary use of customers' personal information and the absence of customers' consent still suggest that the use of data mining by private health insurance companies is wrong.

Smart Automation, Customer Experience and Customer Engagement in Electric Vehicles

Directory of Open Access Journals (Sweden)

Asad Ullah

2018-04-01

Full Text Available A major challenge to cleaner and more sustainable transportation is the lack of adoptability of electric vehicles (EVs by customers. Therefore, most of the vehicles we see on the road use fossil fuel instead of sustainable green energy sources. One way to improve customer acceptance is to market EVs as a socially desirable product, rather than only environmentally friendly. The silver lining to promote is the potential of information and communications technology (ICT features in EVs, which can lead to a deeper connection between the EVs and their users. These engaging technologies can bring customers closer to the company, resulting in generating big data, which can lead to even deeper insights into customer preferences. Because the technology of vehicle connectivity and automation is just taking off, it is important to understand how these technologies in EVs can enhance customer experiences and result in sustainable customer engagement. Unfortunately, this important research area remains neglected. This research, therefore, is focused on building a conceptual framework for understanding the influence of electric vehicle (EV automation and connectivity on customer experience, and ultimately, customer engagement.

Custom total knee replacement in a dog with femoral condylar bone loss.

Science.gov (United States)

Liska, William D; Marcellin-Little, Denis J; Eskelinen, Esa V; Sidebotham, Christopher G; Harrysson, Ola L A; Hielm-Björkman, Anna K

2007-06-01

To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog. Clinical case report. A 3-year-old, 20 kg Karelian Bear Hound. Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted. Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60-165 degrees postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb. Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint. With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.

Ultrasound-controlled neuronavigator-guided brain surgery.

Science.gov (United States)

Koivukangas, J; Louhisalmi, Y; Alakuijala, J; Oikarinen, J

1993-07-01

The development of a unique neurosurgical navigator is described and a preliminary series of seven cases of intracerebral lesions approached with the assistance of this neuronavigation system under ultrasound control is presented. The clinical series included five low-grade astrocytomas, one chronic intracerebral hematoma, and one porencephalic cyst. Management procedures included biopsy in all cases, drainage of the hematoma, and endoscopy and fenestration for the cyst. The features of the neuronavigation system are interactive reconstructions of preoperative computerized tomography and magnetic resonance imaging data, corresponding intraoperative ultrasound images, versatility of the interchangeable end-effector instruments, graphic presentation of instruments on the reconstructed images, and voice control of the system. The principle of a common axis in the reconstructed images served to align the navigational pointer, biopsy guide, endoscope guide, ultrasound transducer, and surgical microscope to the brain anatomy. Intraoperative ultrasound imaging helped to verify the accuracy of the neuronavigator and check the results of the procedures. The arm of the neuronavigation system served as a holder for instruments, such as the biopsy guide, endoscope guide, and ultrasound transducer, in addition to functioning as a navigational pointer. Also, the surgical microscope was aligned with the neuronavigator for inspection and biopsy of the hematoma capsule to rule out tumor etiology. Voice control freed the neurosurgeon from manual exercises during start-up and calibration of the system.

Communication Systems Simulation Laboratory (CSSL): Simulation Planning Guide

Science.gov (United States)

Schlesinger, Adam

2012-01-01

The simulation process, milestones and inputs are unknowns to first-time users of the CSSL. The Simulation Planning Guide aids in establishing expectations for both NASA and non-NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware/software developers. It is intended to assist their engineering personnel in simulation planning and execution. Material covered includes a roadmap of the simulation process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, facility interfaces, and inputs necessary to define scope, cost, and schedule are included as an appendix to the guide.

A natural fit: home healthcare and biomedical engineering.

Science.gov (United States)

Damasco, Nestor; Abe, Chris

2010-01-01

The involvement of Biomed in management of home care equipment has become a natural fit for Rady Children's Hospital. Managing all aspects of home care equipment through an in-house biomedical engineering department is cost-effective, efficient, provides excellent customer service, and enhances the relationship with the clinical staff and patients. It develops a sense of security for patients and staff that home care equipment is tested and maintained in a stringent manner that promotes safety.

A comparative study on the customized design of mandibular reconstruction plates using finite element method

Directory of Open Access Journals (Sweden)

Abdulrahman Al-Ahmari

2015-07-01

Full Text Available Mandible defects and its deformities are serious complications and its precise reconstruction is one of the most challenging tasks in oral maxillofacial surgery. The commercially available standard mandible implants are manually bended before surgery to custom fit the patient’s jaw. A slight mismatch in the plate and bone alignment may result in the implant failure. However, with the integration of computer-aided design, rapid prototyping, and advanced imaging systems (computed tomography or magnetic resonance imaging, it is possible to produce a customized mandible implant that can precisely fit the patient’s jaw. The aim of this article is to compare a new design of customized mandible implant (sinewave plate and compare it with the commonly used straight implant design. The finite element–simulated results reveal that the commonly used straight reconstruction plates are more prone to loosening of the screws due to its higher strain concentration on the screw hole when compared to newly designed sinewave reconstruction plate. Moreover, the straight plate is more sensitive to the chewing load variations and develops almost 20% increase in the stresses when compared to sinewave plate. The study reveals that the sinewave reconstruction plate can significantly enhance the stability and safety of the mandible implant.

The customs issues of the European Union and Serbia: The customs base

Directory of Open Access Journals (Sweden)

Vranješ Mile

2012-01-01

Full Text Available Regulation (EC No 450/2008 of the European Parliament and of the Council of 23 April 2008 laying down the Community Customs Code (Modernized Customs Code, Council Regulation (EEC No 2913/92 of 12 October 1992 establishing the Community Customs Code, The Customs Law of Serbia of 26 March 2010 in a very detailed and extensive way regulate customs base. These legal documents envisage the methods of determination of customs value: the primary ones, which are based on the transaction value, but also the secondary ones, which are based on other methods for determination of customs value of goods. The customs services of the EU Member States have on their disposal six methods for determination of customs value of goods. Those methods in the mentioned acts of the EU and Serbia are transposed from the Article VII of the General Agreement on Tariffs and Trade 1994 and Agreement on Implementation of Article VII of the General Agreement on Tariffs and Trade 1994. The fact that mentioned acts of the EU and Serbia request that the customs value of goods must be clearly and precisely determined, that means to be determined in the same way, is understandable because the customs base is one of the most significant elements of customs. There are many reasons for that: in a certain way, the customs base is in relation with all other elements of customs structure; from the procedure in which the customs base is determined, that means from its universality depends the amount of income which will the EU and Serbia, on that ground, collect to finance public expenditure predicted in the budget; and most of the customs on the imported goods in the EU is determined ad valorem.

EFEK CUSTOMER CUSTOMER INTERACTION TERHADAP SATISFACTION DAN WORD OF MOUTH PADA HOTEL MANDARIN ORIENTAL

Directory of Open Access Journals (Sweden)

Putri Hijir

2016-08-01

Full Text Available The background of this research was the effect of Customer to Customer Interaction affect satisfaction, word of mouth, in mandarin oriental hotel. The objective of this research is to examine the impact of Customer satisfaction, Service Atmosphere, Personal Interaction, Customer Customer Interaction, Word of Mouth. The design of this research applies primary data obtained by distributing questionnaires to 200 customer who are using Mandarin Oriental Hotel. Data analysis method used in this research is Structural Equation Model (SEM. The result of this research there is positive impact Personal Interaction Quality toward customer Satisfaction, there is positive impact Service Atmosphere toward Customer Satisfaction, there is positive impact Service atmosphere toward Customer Customer Interaction, there is positive impact Customer Customer Interaction toward Customer Satisfaction, there is positive impact Customer Customer Interaction toward Word of Mouth, there is positive impact Customer Satisfaction toward Word of Mouth.

Benefitting from virtual customer environments: An empirical study of customer engagement

NARCIS (Netherlands)

Verhagen, T.; Swen, E; Feldberg, J.F.M.; Merikivi, J.

2015-01-01

Customer engagement has been labeled as a prerequisite for the success of virtual customer environments. A key challenge for organizations serving their customers via these environments is how to stimulate customer engagement. This study is among the first to shed light on this issue by examining

Optimization in multi-implant placement for immediate loading in edentulous arches using a modified surgical template and prototyping: a case report.

Science.gov (United States)

Jayme, Sérgio J; Muglia, Valdir A; de Oliveira, Rafael R; Novaes, Arthur B Júnior

2008-01-01

Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance throughout the treatment period. Placement of dental implants requires precise planning that accounts for anatomic limitations and restorative goals. Diagnosis can be made with the assistance of computerized tomographic scanning, but transfer of planning to the surgical field is limited. Recently, novel CAD/CAM techniques such as stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. The aim of this case report was to show a modified surgical template used throughout implant placement as an alternative to a conventional surgical guide.

Surgical training in your hands: organising a skills course.

Science.gov (United States)

Burnand, Henry; Mutimer, Jon

2012-12-01

The advent of simulated surgical skills courses has brought dynamic changes to the traditional approach to acquiring practical skills in surgery. Teaching is a core part of the surgical profession, and any trainee can be involved in the organisation of skills training courses. This paper outlines the importance of organising surgical skills courses for trainees, and provides a practical guide on how to do so within busy clinical environments. The paper examines how to plan a course, how to design the programme, and provides tips on faculty staff requirements, venue, finance and participants, with additional suggestions for assessment and evaluation. We recommend the organisation of skills courses to any trainee. By following key ground rules, the surgical trainee can enable the acquisition of advanced learning opportunities and the ability to demonstrate valuable organisational skills. © Blackwell Publishing Ltd 2012.

Customer relationship management

OpenAIRE

Gudeliūnas, Mindaugas

2016-01-01

My name is Mindaugas Gudeliūnas. My bachelors thesis topic is "Customer Relationship Management". The main goal of my work was to investigate customers relationship management and to create modern system, which is fast, easy to use and made for small business. Customer relationship management is really beneficial for a lot of companies. It can make your relationships with a customer more reliable and loyal, it can automate a lot of processes, which are related to customer management, human re...

Structural and mechanical characterization of custom design cranial implant created using additive manufacturing

OpenAIRE

Khaja Moiduddin; Saied Darwish; Abdulrahman Al-Ahmari; Sherif ElWatidy; Ashfaq Mohammad; Wadea Ameen

2017-01-01

Background: Reconstruction of customized cranial implants with a mesh structure using computer-assisted design and additive manufacturing improves the implant design, surgical planning, defect evaluation, implant-tissue interaction and surgeon's accuracy. The objective of this study is to design, develop and fabricate cranial implant with mechanical properties closer to that of bone and drastically decreases the implant failure and to improve the esthetic outcome in cranial surgery with preci...

Review of emerging surgical robotic technology.

Science.gov (United States)

Peters, Brian S; Armijo, Priscila R; Krause, Crystal; Choudhury, Songita A; Oleynikov, Dmitry

2018-04-01

The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

The Loyalty of older people in fitness centers: Managing customers for physical activity programs

Directory of Open Access Journals (Sweden)

Jerónimo García Fernández

2010-01-01

Full Text Available The fitness centers are now places where partners perform «controlled» physical activity, which improves their physical and mental state, and where they socialize with other partners of all ages. These centers have been typically managed by people without training in this subject and with the only interest of obtaining partners without taking into account the long-term impact. This problem, together with management problems of the center and personal problems of the members, have meant that there are high desertion rates in this type of indoor facilities, with the consequent increase in expenditure on marketing and a non-sustainable profitability. We propose a program of physical activity that could improve the rate of loyalty, being the central point of management of sports centers today, the satisfaction and loyalty to the fitness centers.

The Customer Service Experience.

Science.gov (United States)

Bell, Chip R.

2001-01-01

Discusses ways to embed customer service learning and customer loyalty including making customers think, examining every aspect of customers' service encounters with staff, providing follow-up, making learning fun, and involving customers in your business. (JOW)

Customer Segmentation by Factors Influencing Brand Loyalty and Customer Involvement

OpenAIRE

Tereza Vebrová; Kateřina Venclová; Stanislav Rojík

2016-01-01

Brand loyalty and customer involvement are two important concepts that help explain and understand a significant part of consumer shopping behavior. The aim of the present work is to identify factors influencing brand loyalty and customer involvement. A further aim is to consider subsequent segmentation of customers with respect to different degrees of brand loyalty and customer involvement. The research was focused on the field of Czech telecommunication services – mobile operators. Primary ...

Evaluation of the fit of preformed nickel titanium arch wires on normal occlusion dental arches

Directory of Open Access Journals (Sweden)

Rakhn G. Al-Barakati

2016-01-01

Conclusions: Using an archwire form with the best fit to the dental arch should produce minimal changes in the dental arch form when NiTi wires are used and require less customization when stainless-steel wires are used.

A review of the customer lifetime value as a customer profitability measure in the context of customer relationship management

Directory of Open Access Journals (Sweden)

Raphael Damm

2011-11-01

Full Text Available Purpose: A number of customer metrics allow estimating customer profitability with methods such as the Customer Lifetime Value (CLV. However, investments in customer relationships carry the potential risk to destroy value and reduce profitability when based on incorrect estimates of customer profitability. Therefore, estimating future customer value correctly is essential to allocate marketing expenditures in the most effective way. In this article recent literature about the CLV is reviewed in order to assess its ability as a customer profitability measure. Besides the financial perspective of the CLV, non-financial perspectives such as customer advocacy, (customer or open innovation and learning have been identified to have an impact on customer profitability. How to properly estimate a customer’s value taking all relevant value creating factors, financial as well as non-financial, into account is the underlying research question.Design/methodology/approach: This research is based on the review of a number of theoretical and empirical articles published between 1990 and 2010. The aggregation of measures, key-drivers and risks of each key-perspective of the customer relationship contributes to the development of a more systematic understanding of the value creation process and provides answers to the research question. Indirect effects of the CLV as a source of value have received increasing attention in previous research but are not sufficiently accounted for by mainstream methods for valuing customers (Ryals, 2008. Therefore, the attempt to structure available knowledge on indirect effects of the CLV in its contextual setting is made.Findings: This research is concluded providing evidence that one-dimensional calculations of the CLV deliver an incomplete picture of the customer relationship and estimate customer profitability incorrectly. This supports the idea of a multidimensional CLV approach that accounts for interrelated key

Ontological knowledge engine and health screening data enabled ubiquitous personalized physical fitness (UFIT).

Science.gov (United States)

Su, Chuan-Jun; Chiang, Chang-Yu; Chih, Meng-Chun

2014-03-07

Good physical fitness generally makes the body less prone to common diseases. A personalized exercise plan that promotes a balanced approach to fitness helps promotes fitness, while inappropriate forms of exercise can have adverse consequences for health. This paper aims to develop an ontology-driven knowledge-based system for generating custom-designed exercise plans based on a user's profile and health status, incorporating international standard Health Level Seven International (HL7) data on physical fitness and health screening. The generated plan exposing Representational State Transfer (REST) style web services which can be accessed from any Internet-enabled device and deployed in cloud computing environments. To ensure the practicality of the generated exercise plans, encapsulated knowledge used as a basis for inference in the system is acquired from domain experts. The proposed Ubiquitous Exercise Plan Generation for Personalized Physical Fitness (UFIT) will not only improve health-related fitness through generating personalized exercise plans, but also aid users in avoiding inappropriate work outs.

Development and Assessment of a 3D-Printed Scaffold with rhBMP-2 for an Implant Surgical Guide Stent and Bone Graft Material: A Pilot Animal Study

OpenAIRE

Bae, Ji Cheol; Lee, Jin-Ju; Shim, Jin-Hyung; Park, Keun-Ho; Lee, Jeong-Seok; Bae, Eun-Bin; Choi, Jae-Won; Huh, Jung-Bo

2017-01-01

In this study, a new concept of a 3D-printed scaffold was introduced for the accurate placement of an implant and the application of a recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded bone graft. This preliminary study was conducted using two adult beagles to evaluate the 3D-printed polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP)/bone decellularized extracellular matrix (bdECM) scaffold conjugated with rhBMP-2 for the simultaneous use as an implant surgical guide stent an...

Putting "Service" into Library Staff Training: A Library Manager's Training Guide. LAMA Occasional Papers Series. A Patron-Centered Guide.

Science.gov (United States)

Bessler, Joanne M.

This guide is built on librarianship training literature and customer service research from a variety of professions. It tells library managers how to identify and describe service ideals, to translate these ideals into realistic goals, and to lead new and experienced staff in fulfilling these service ideals. They are encouraged to focus the…

Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care.

Science.gov (United States)

Vaughn, Lisa M; DeJonckheere, Melissa; Pratap, Jayant Nick

2016-06-09

Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery. © The Author(s) 2016.

Macintosh Troubleshooting Pocket Guide for Mac OS

CERN Document Server

Lerner, David; Corporation, Tekserve

2009-01-01

The Macintosh Troubleshooting Pocket Guide covers the most common user hardware and software trouble. It's not just a book for Mac OS X (although it includes tips for OS X and Jaguar), it's for anyone who owns a Mac of any type-- there are software tips going back as far as OS 6. This slim guide distills the answers to the urgent questions that Tekserve's employee's answer every week into a handy guide that fits in your back pocket or alongside your keyboard.

Customer Segmentation by Factors Influencing Brand Loyalty and Customer Involvement

Directory of Open Access Journals (Sweden)

Tereza Vebrová

2016-01-01

Full Text Available Brand loyalty and customer involvement are two important concepts that help explain and understand a significant part of consumer shopping behavior. The aim of the present work is to identify factors influencing brand loyalty and customer involvement. A further aim is to consider subsequent segmentation of customers with respect to different degrees of brand loyalty and customer involvement. The research was focused on the field of Czech telecommunication services – mobile operators. Primary data were acquired through the method of questionnaire survey. In total, the questionnaire was completed by 340 respondents, of which 319 respondents owned their mobile phones for private purposes only. For more accurate interpretation of the identified factors the Exploratory Factor Analysis method was used. Four factors of brand loyalty were extracted, which account for 75 % of the variability of the original parameters: (1 Cognitive affective loyalty, (2 Trustworthiness, (3 Attitudinal loyalty and (4 Commitment and three factors of customer involvement were found to account for 71 % variability of the original parameters: (1 Social involvement, (2 Centrality, (3 Importance. High loyalty customers mostly have only one SIM card and 73 % of them use a tariff. In a further group of highly involved customers own from 80 % only one SIM card. This study forms part of a research programme investigating the influence of customer involvement on brand loyalty.

SALOME. User's guide

International Nuclear Information System (INIS)

Zastrow, K.D.

1994-01-01

A user's guide for a least squares fit analysis program is presented, which has been developed for VUV and visible plasma spectroscopy on the Extrap-T1 experiment. The program can be used for line and multiplet identification, multiplet intensity and line width measurements. Atomic data are used extensively to aid the interpretation of the spectra. 7 figs

MO-DE-202-02: Advances in Image Registration and Reconstruction for Image-Guided Neurosurgery

Energy Technology Data Exchange (ETDEWEB)

Siewerdsen, J. [Johns Hopkins University (United States)

2016-06-15

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

MO-DE-202-02: Advances in Image Registration and Reconstruction for Image-Guided Neurosurgery

International Nuclear Information System (INIS)

Siewerdsen, J.

2016-01-01

At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

Guide to Using Sierra

Energy Technology Data Exchange (ETDEWEB)

Shaw, Ryan Phillip [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Agelastos, Anthony Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Miller, Joel D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-03-01

Sierra is an engineering mechanics simulation code suite supporting the Nation's Nuclear Weapons mission as well as other customers. It has explicit ties to Sandia National Labs' workfow, including geometry and meshing, design and optimization, and visualization. Dis- tinguishing strengths include "application aware" development, scalability, SQA and V&V, multiple scales, and multi-physics coupling. This document is intended to help new and existing users of Sierra as a user manual and troubleshooting guide.

Guide to Using Sierra

Energy Technology Data Exchange (ETDEWEB)

Shaw, Ryan Phillip; Agelastos, Anthony Michael; Miller, Joel D.

2017-04-01

Sierra is an engineering mechanics simulation code suite supporting the Nation's Nuclear Weapons mission as well as other customers. It has explicit ties to Sandia National Labs' workfow, including geometry and meshing, design and optimization, and visualization. Dis- tinguishing strengths include "application aware" development, scalability, SQA and V&V, multiple scales, and multi-physics coupling. This document is intended to help new and existing users of Sierra as a user manual and troubleshooting guide.

Talking about Customer Service.

Science.gov (United States)

Talley, Mary; Axelroth, Joan

2001-01-01

Discusses customer service in information centers and how to define it. Topics include the effects of competition, that give customers more choices; defining customers, and defining services; communications; physical environment; change, in customers and in technology; measuring customer service; and evaluating policies and procedures. (LRW)

Identification with the retail organization and customer-perceived employee similarity: effects on customer spending.

Science.gov (United States)

Netemeyer, Richard G; Heilman, Carrie M; Maxham, James G

2012-09-01

Two constructs important to academicians and managers are the degree to which employees and customers identify with an organization, employee organizational identification (employee OI) and customer-company identification (customer identification), respectively. This research examines the effects of these identification constructs and the related construct of customer perceived similarity to employees on customer spending. Via a 1-year multilevel study of 12,047 customers and 1,464 store employees (sales associates) covering 212 stores of a specialty apparel retailer, our study contributes to the literature in 2 critical ways. First, we expand the theoretical network of employee OI and customer identification by examining the related construct of a customer's perceived similarity to store employees. We examine the incremental (not fully mediated) main and interaction effects of customer-perceived similarity to employees and employee OI on customer spending. Second, we examine the effect of customer identification on customer spending relative to the effect of customer satisfaction on customer spending. Thus, our study also contributes by demonstrating a potential complementary route to achieve customer spending (customer identification), a route that may be more readily affected by management than the efforts required for a sustained increase in customer satisfaction. Implications for academics and managers are offered.

Customer satisfaction and competencies

DEFF Research Database (Denmark)

Gritti, Paola; Foss, Nicolai Juul

We empirically address how customer satisfaction and loyalty in the banking industry may affect profitability. This helps to identify the strategy and competencies necessary to benefit from customer relationships which are important sources for improved performance in the banking. We do......, loyalty is a mediator between financial and not-financial customer value and two sources of customer satisfaction, namely relationships with the front office and the branch, on the one hand, and the products offered, on the other....... this by analyzing data collected on 2,105 customers of 118 branches of one of the biggest banks of an Italian banking group. We find that customer satisfaction impacts loyalty, which in turn has a direct effect on financial and non-financial customer value/total customer value/complex customer value. Moreover...

Customer Relationship Malevolence: A Reflection on Accounting, Marketing and Customer Valuation

Directory of Open Access Journals (Sweden)

Kenneth Weir

2014-10-01

Full Text Available Ideas centring on knowing and understanding the customer have been core concerns of business since the 1960s. As a result, several attempts to understand the customer have been devised, leading to the generation of data collection systems and calculative technologies that try to provide numerical understanding of the customer, which now lies at the heart of contemporary customer management schemes. However, these technologies can produce several social consequences. This paper discusses valuation metrics used in customer management systems and outlines the negative issues that can result from widespread usage.

Corrosion protection of reusable surgical instruments.

Science.gov (United States)

Shah, Sadiq; Bernardo, Mildred

2002-01-01

To understand the corrosion properties of surgical scissors, 416 stainless steel disks and custom electrodes were used as simulated surfaces under various conditions. These simulated surfaces were exposed to tap water and 400-ppm synthetic hard water as Ca2CO3 under different conditions. The samples were evaluated by various techniques for corrosion potential and the impact of environmental conditions on the integrity of the passive film. The electrodes were used to monitor the corrosion behavior by potentiodynamic polarization technique in water both in the presence and absence of a cleaning product. The surface topography of the 416 stainless steel disks was characterized by visual observations and scanning electron microscopy (SEM), and the surface chemistry of the passive film on the surface of the scissors was characterized by x-ray photoelectron spectroscopy (XPS). The results suggest that surgical instruments made from 416 stainless steel are not susceptible to uniform corrosion; however, they do undergo localized corrosion. The use of suitable cleaning products can offer protection against localized corrosion during the cleaning step. More importantly, the use of potentiodynamic polarization techniques allowed for a quick and convenient approach to evaluate the corrosion properties of surgical instruments under a variety of simulated-use environmental conditions.

[Non-surgical management after blunt traumatic liver injuries: A review article].

Science.gov (United States)

Noyola-Villalobos, Héctor Faustino; Loera-Torres, Marco Antonio; Jiménez-Chavarría, Enrique; Núñez-Cantú, Olliver; García-Núñez, Luis Manuel; Arcaute-Velázquez, Fernando Federico

2016-01-01

Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. Copyright © 2016 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Customer Equity von KMUs

NARCIS (Netherlands)

Biemel, Friedhelm W.; Henseler, Jörg; Meyer, Jorn-Axel

2003-01-01

Customer relationships are most important assets of many SMEs. Customer Equity is the sum of the values of all customer relationships. Customer Equity will not be found in any balance sheet, nevertheless it has strategic importance. Even if companies do not want to publish their Customer Equity for

PENGARUH SYSTEMIC FAIRNESS DARI LAYANAN INTERNET BANKING TERHADAP CUSTOMER SATISFACTION DENGAN CUSTOMER TRUST DAN CUSTOMER PERCEIVED VALUE SEBAGAI VARIABEL INTERVENING

OpenAIRE

Reza Putra Pratama

2014-01-01

The background of this research is to investigate and analyze the effect of systematic fairness from internet banking services to customer satisfaction with customer trust and customer perceived value as intervening variable. The objective of this research findings in internet banking, fairness that includes distributive fairness, procedural fairness and informational fairness is positively related to customer satisfaction. Trust is identified as the key mediator of fairness to customer sa...

Accurately fitting advanced training. Flexible simulator training by modular training course concepts

International Nuclear Information System (INIS)

Sickora, Katrin; Cremer, Hans-Peter

2010-01-01

Every employee of a power plant contributes with his individual expertise to the success of the enterprise. Certainly personal skills of employees differ from each other as well as power plants are different. With respect to effective simulator training this means that no two simulator training courses can be identical. To exactly meet the requirements of our customers KWS has developed modules for simulation training courses. Each module represents either a technical subject or addresses a topic in the field of soft skills. An accurately fitting combination of several of these modules to the needs of our customers allows for most efficient simulator training courses. (orig.)

Quantifying and Reducing Curve-Fitting Uncertainty in Isc

Energy Technology Data Exchange (ETDEWEB)

Campanelli, Mark; Duck, Benjamin; Emery, Keith

2015-06-14

Current-voltage (I-V) curve measurements of photovoltaic (PV) devices are used to determine performance parameters and to establish traceable calibration chains. Measurement standards specify localized curve fitting methods, e.g., straight-line interpolation/extrapolation of the I-V curve points near short-circuit current, Isc. By considering such fits as statistical linear regressions, uncertainties in the performance parameters are readily quantified. However, the legitimacy of such a computed uncertainty requires that the model be a valid (local) representation of the I-V curve and that the noise be sufficiently well characterized. Using more data points often has the advantage of lowering the uncertainty. However, more data points can make the uncertainty in the fit arbitrarily small, and this fit uncertainty misses the dominant residual uncertainty due to so-called model discrepancy. Using objective Bayesian linear regression for straight-line fits for Isc, we investigate an evidence-based method to automatically choose data windows of I-V points with reduced model discrepancy. We also investigate noise effects. Uncertainties, aligned with the Guide to the Expression of Uncertainty in Measurement (GUM), are quantified throughout.

Improving Internal Customer Service

Science.gov (United States)

1990-09-01

34Companies are recognizing that treating customers and associates like people has a very high value" (21:20). 2 Customer service has become more that... customer service is also a strategy with the focus towards people , not product (24:1). Customers are demanding quality service for several reasons...34 (39:45). External Customers . External customers are an organization’s ultimate consumers . They purchase the end product or service an organization

Extracting Fitness Relationships and Oncogenic Patterns among Driver Genes in Cancer.

Science.gov (United States)

Zhang, Xindong; Gao, Lin; Jia, Songwei

2017-12-25

Driver mutation provides fitness advantage to cancer cells, the accumulation of which increases the fitness of cancer cells and accelerates cancer progression. This work seeks to extract patterns accumulated by driver genes ("fitness relationships") in tumorigenesis. We introduce a network-based method for extracting the fitness relationships of driver genes by modeling the network properties of the "fitness" of cancer cells. Colon adenocarcinoma (COAD) and skin cutaneous malignant melanoma (SKCM) are employed as case studies. Consistent results derived from different background networks suggest the reliability of the identified fitness relationships. Additionally co-occurrence analysis and pathway analysis reveal the functional significance of the fitness relationships with signaling transduction. In addition, a subset of driver genes called the "fitness core" is recognized for each case. Further analyses indicate the functional importance of the fitness core in carcinogenesis, and provide potential therapeutic opportunities in medicinal intervention. Fitness relationships characterize the functional continuity among driver genes in carcinogenesis, and suggest new insights in understanding the oncogenic mechanisms of cancers, as well as providing guiding information for medicinal intervention.

Customized computer models of eyes with intraocular lenses.

Science.gov (United States)

Rosales, P; Marcos, S

2007-03-05

We compared experimental wave aberrations in pseudophakic eyes with aspheric intraocular lenses (IOLs) to simulate aberrations from numerical ray tracing on customized computer eye models using corneal topography, angle lambda, ocular biometry, IOL geometry, and IOL tilt and decentration measured on the same eyes. We found high correlations between real and simulated aberrations even for the eye with only the cornea, and these increased on average when the IOL geometry and position were included. Relevant individual aberrations were well predicted by the complete eye model. Corneal spherical aberration and horizontal coma were compensated by the IOL, and in 58.3% of the cases IOL tilt and decentration contributed to compensation of horizontal coma. We conclude that customized computer eye models are a good representation of real eyes with IOLs and allow understanding of the relative contribution of optical, geometrical and surgically-related factors to image quality. Corneal spherical aberration is reduced by aspheric IOLs, although other corneal high order aberrations are still a major contributor to total aberrations in pseudophakic eyes. Tilt and decentration of the IOLs represent a relatively minor contribution of the overall optical quality of the eye.

Customer Order Decoupling Point Selection Model in Mass Customization Based on MAS